Neonatal Optical Coherence Tomography Angiography to Assess the Effects of Postnatal Exposures on Retinal Development and Predict Neurodevelopmental Outcomes

PROJECT SUMMARY/ABSTRACT Worldwide, more than 1 in 10 babies are born premature. Prematurity is not only the leading cause of death in children under 5 years of age, but also has serious long-term consequences for those preterm infants who survive. As such, there is a growing population of infants at risk for retinopathy of prematurity (ROP), visual impairment and neurodevelopmental impairment. Understanding how the eye is altered due to preterm birth, while accounting for postnatal factors such as oxygen use and anti-vascular endothelial growth factor (anti- VEGF) treatment, is key to determining those infants at highest risk for visual and neurodevelopmental impairment. Historically, this vulnerable population has been difficult to study, as invasive testing is both difficult to perform as well as potentially harmful. Our study will utilize non-invasive eye imaging, using ocular coherence tomography and angiography (OCT/OCTA), in preterm and term infants requiring intensive care. These images will be analyzed using established measures, to identify how eye development differs in newborn infants exposed to various systemic and local treatments such as oxygen and anti-VEGF intravitreal injections. Moreover, we will identify retinal biomarkers from OCT/OCTA imaging that predict a number of key visual and development outcomes, including treatment-requiring ROP shortly after birth and visual and neurodevelopmental impairment at 2-3 years of age. Results from these studies will broaden and deepen our understanding of retinal blood vessel development in preterm infants, the eye’s response to oxygen and anti-VEGF. In addition, developing non- invasive retinal biomarkers as predictors for visual and neurodevelopmental impairment will augment identification of at-risk infants early in the postnatal period will help to initiate individualized therapies during a period of critical neurodevelopment which will optimize their long-term outcomes.