The Refractive Legacy of Prematurity: A Systematic Review and Meta-Analysis of Refractive Errors and Ocular Biometry in Infants With and Without Retinopathy of Prematurity
5
Issued Date
2026-07-01
Resource Type
eISSN
22288082
Scopus ID
2-s2.0-105044454213
Journal Title
Siriraj Medical Journal
Volume
78
Issue
7
Start Page
508
End Page
518
Rights Holder(s)
SCOPUS
Bibliographic Citation
Siriraj Medical Journal Vol.78 No.7 (2026) , 508-518
Suggested Citation
Booranapong N., Jaruniphakul P., Khampang R., Surachatkumtonekul T. The Refractive Legacy of Prematurity: A Systematic Review and Meta-Analysis of Refractive Errors and Ocular Biometry in Infants With and Without Retinopathy of Prematurity. Siriraj Medical Journal Vol.78 No.7 (2026) , 508-518. 518. doi:10.33192/smj.v78i7.282004 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/118045
Title
The Refractive Legacy of Prematurity: A Systematic Review and Meta-Analysis of Refractive Errors and Ocular Biometry in Infants With and Without Retinopathy of Prematurity
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Abstract
Objective: To compare the prevalence of refractive errors in children born prematurely with and without retinopathy of prematurity (ROP) and to identify potential factors contributing to heterogeneity. Materials and Methods: Relevant literature was systematically searched in PubMed, EMBASE, and CINAHL for studies available through January 2025. Studies were eligible if they used cross-sectional, cohort, or case-control designs and reported refractive outcomes among preterm children stratified by ROP status. Effect estimates were synthesized using random-effects models and expressed as pooled odds ratios and mean differences. Between-study variability was evaluated using Cochran's Q statistic and the I² metric. Additional analyses included subgroup comparisons, meta-regression, and assessment of potential publication bias. Results: Twelve studies were included. ROP was significantly associated with myopia (OR, 1.76; 95% CI, 1.17–2.64; p = 0.01) and astigmatism (OR, 1.90; 95% CI, 1.49–2.43; p < 0.001), but not hyperopia (OR, 0.97; 95% CI, 0.64–1.47; p = 0.89). Strong associations were observed in upper-middle–income countries. Age significantly modified the ROP–myopia association (p = 0.002). Biometric analysis showed greater vitreous thickness in ROP children (mean difference, 0.16 mm; p = 0.04), while axial length, lens thickness, and anterior chamber depth were not significantly different (all p > 0.4). No publication bias was detected. Conclusions: ROP is associated with increased risks of myopia and astigmatism, with effects influenced by age and socioeconomic context. Vitreous thickness was the only biometric parameter significantly affected, suggesting a potential mechanism underlying refractive sequelae, although this requires further validation.