Very preterm infants face up to a 50 percent higher risk of developmental challenges affecting movement, learning, language, and behavior. Today, many of those challenges are not fully recognized until later in infancy or early childhood. Doctors have lacked reliable tools to identify which infants are most vulnerable during the early neonatal period, when timely intervention could have the greatest impact.
In a new study published June 4 in JAMA Ophthalmology, researchers from Duke University School of Medicine found that specific features in the developing retina, the light-sensitive tissue at the back of the eye, are closely linked to cognitive, motor, and behavioral outcomes at age 2. The findings suggest that the eye could serve as an early biomarker for brain development in vulnerable infants.
A simple, noninvasive eye scan, performed at bedside in very premature infants, may offer an early window into how their brains will develop, potentially helping doctors identify children at risk for developmental challenges years before symptoms emerge.
“Because the retina is part of the central nervous system, it gives us a unique, noninvasive way to study the developing brain,” said corresponding author Cynthia Toth, MD, Joseph A.C. Wadsworth Distinguished Professor of Ophthalmology. “Using a quick, safe eye scan, we may be able to identify infants at higher risk for developmental delays much earlier.”
This study demonstrates that optical coherence tomography (OCT), a fast, information-rich imaging technology to capture detailed images of the infants’ retinas, may provide valuable information about future neurodevelopment.
The ability to predict developmental outcomes as early as a few weeks after birth could help clinicians develop more effective care plans, connect families with resources sooner, and potentially improve long-term outcomes.
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C. Michael Cotten, MD, MHS, professor of pediatrics and study co-author, emphasized the clinical potential: “For families and care teams, having earlier insight into a baby’s developmental trajectory could be transformative. Tools like this may help us better tailor follow-up care and connect children and their families with supportive therapies at the time they can have the greatest impact.”
Duke researchers followed a group of very preterm infants through age 2. The infants underwent investigative non-contact OCT imaging. The handheld device uses safe infrared light to capture detailed images of the retina during routine retinopathy of prematurity eye exams. The team focused on the retinal nerve fiber layer (RNFL), which contains fibers that connect the eye to the brain. At age 2, children completed standardized developmental testing to assess motor, cognitive, and behavioral outcomes. Infants with a thicker RNFL at approximately 36 weeks had better motor and cognitive outcomes at age 2.
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“This research moves us closer to identifying which children may need extra support much earlier in life,” said lead author Kathryn E. Gustafson, PhD, professor in psychiatry and behavioral sciences. “Earlier detection means earlier intervention—and that can make a lifelong difference.”
The results highlight an exciting and growing field of research exploring the connection between the eye and the brain.
“Our goal is to give every child the best possible start,” said Toth. “If we can use a quick eye scan to better understand brain development, that’s a powerful step forward.”
This research is part of the ongoing NIH-funded “BabySTEPS” study, which started at Duke in 2016, and aims to help improve preterm infant health and vision. Using objective bedside OCT imaging and analysis, the study seeks to identify early signs of retinal disease (retinopathy of prematurity, or ROP) as well as indicators of visual and neurological development. The goal is to accelerate early intervention and inform improvements in the care of vulnerable infants.
Authors:
Kathryn E. Gustafson, PhD; Neeru Sarin, MBBS; Jocelyn He, MS, Gui-Shuang Ying, PhD; Vincent Tai, MS; Katrina P. Winter, BS; C. Michael Cotten, MD, MHS; Cynthia A. Toth, MD; for the BabySTEPS Group.