Myopia of Prematurity

Myopia of prematurity is nearsightedness that starts very early in babies born too soon. In myopia, distant objects look blurry because the eye focuses light in front of the retina, not on it. In premature babies, myopia often shows up in the first years of life and can be stronger than typical childhood myopia. It is linked to how the infant eye grows after early birth and to eye conditions common in prematurity, especially retinopathy of prematurity (ROP) and its treatments. Studies show that these children often have steeper corneas, thicker lenses, and shallower front chambers of the eye, and sometimes shorter eye length than expected—this unique mix leads to strong focusing power and early myopia. PubMedPMC

Myopia of Prematurity is short-sightedness that develops in babies born too early, especially those who had retinopathy of prematurity (ROP) or needed treatment for it. Unlike typical school-age myopia (which is mostly due to a longer eyeball), MOP often comes from front-of-the-eye changes (steeper cornea, thicker lens, shallow anterior chamber) after premature birth and/or ROP care. These changes make the eye focus light in front of the retina, so far objects look blurry. PMCScienceDirectPubMed

Why the eye becomes myopic in prematurity (in simple terms):

• A full-term baby’s eyes usually “self-tune” toward normal focus during the first years (a process called emmetropization).

• In premature babies, that tuning process can be interrupted. The front parts of the eye (cornea, lens, chamber in front of the lens) can develop in unusual proportions (for example, steeper cornea and thicker lens), making the eye too powerful, so it focuses images in front of the retina. This is different from “regular” school-age myopia, which is often due to the eye growing too long. PubMedPMC

• Babies with more severe ROP are more likely to develop stronger myopia.

• Laser treatment for ROP, which saves vision by stopping abnormal vessel growth, is associated with higher rates and degrees of myopia later on.

• Anti-VEGF injections (another ROP treatment) tend to lead to less myopia on average than laser, although results vary across studies. PMC

• Timing: It often appears earlier (infancy or toddler years), not just in school age.

• Eye shape: It is usually driven by front-of-the-eye power (steep cornea, thick lens, shallow chamber) more than a long eye. In contrast, common school myopia is mostly due to longer eye length. PubMed

• Companions: It frequently comes with astigmatism, anisometropia (unequal glasses power between eyes), strabismus (eye misalignment), and amblyopia (lazy eye), so careful follow-up is important. Nature

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Types

1) By severity (glasses strength):

• Low myopia: up to −3.00 D

• Moderate myopia: −3.00 to −6.00 D

• High myopia: worse than −6.00 D (these children need closer monitoring for amblyopia, strabismus, and safety). (General severity bands; clinical practices may vary.)

2) By association with ROP:

• MOP without ROP (prematurity alone).

• MOP with mild ROP (no treatment).

• MOP after ROP treatment

  • Laser-treated (more myopia on average).

  • Anti-VEGF–treated (usually less myopia than laser). PMC

3) By the main optical driver:

• Anterior-segment–predominant MOP (steep cornea, thick lens, shallow chamber).

• Axial-length–predominant (less common in the early years of prematurity-related myopia). PubMed

4) By course over time:

• Early-onset, early plateau: strong myopia appears early and then stabilizes somewhat.

• Early-onset, progressive: myopia starts early and continues to worsen—needs tight follow-up.

5) By laterality:

• Bilateral (both eyes; most common).

• Unilateral (one eye; often tied to asymmetry in ROP severity, scarring, or treatment).

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Causes and Risk Factors

1. Prematurity itself – Early birth interrupts normal eye growth and “self-tuning.” PMC

2. Lower gestational age – The earlier the birth, the higher the risk. PMC

3. Lower birth weight – Very low birth weight is strongly linked to refractive problems. PMC

4. Presence of ROP – ROP changes the retina and can alter eye growth signals. Nature

5. Greater ROP severity – More severe stages correlate with more myopia on average. Nature

6. Laser treatment for ROP – Life-saving but associated with higher myopia later. PMC

7. Number/intensity of laser spots – Heavier laser burden relates to more myopia in some studies. PMC

8. Anti-VEGF treatment – On average, less myopia than laser, but still possible. PMC

9. Steeper corneal curvature – A steeper “front window” bends light too much. PubMed

10. Thicker or more powerful lens – A stronger lens focuses light too soon. PubMed

11. Shallower anterior chamber – The lens sits closer to the cornea, boosting focusing power. PubMed

12. Shorter axial length in infancy – In MOP, strong front-of-eye power can outweigh short eye length. PubMed

13. Astigmatism – Common in former preemies and adds to overall blur. PMC

14. Interrupted emmetropization – The normal “move toward zero power” doesn’t complete. PMC

15. NICU factors and oxygen fluctuations – Systemic stresses can influence retinal/ocular growth signals. (Mechanism: retina helps guide eye growth.) Nature

16. Poor postnatal growth/low IGF-1 milieu (inferred) – Growth signaling can affect ocular development; evidence is evolving. (Inference from retinal/neuro-development literature.) Nature

17. Anisometropia (unequal focus) after asymmetric ROP – One eye more affected than the other. Nature

18. Retinal scarring/structural changes after ROP – Can disturb normal growth cues. Nature

19. Family history of refractive error – Genetics can set the background risk; prematurity adds extra risk. (General pediatric myopia risk.) AAPOS

20. Coexisting ocular conditions (e.g., corneal or lens problems) – Any condition that increases front-of-eye power can tip toward myopia in a premature eye.

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Symptoms

(Infants cannot describe blur; we rely on behavior and later-childhood complaints.)

1. Squinting to see far objects (distance is blurry). AAPOSMayo Clinic

2. Sitting very close to screens or books to see details. Mayo Clinic

3. Holding toys or books very near the face. UCLA Health

4. Blinking often when trying to see distant things. Mayo Clinic

5. Eye rubbing after visual tasks. Mayo Clinic

6. Poor interest in distant faces or objects (distance remains blurry). Mayo Clinic

7. Short attention to distance-based activities (board work, sports needing distance vision). Optometrists.org

8. Getting very close to picture books to look at details. AAPOS

9. Frequent head tilt or peeking (trying to find the clearest angle).

10. Bumping into things or misjudging distance (especially in low light).

11. Sitting at the front of the class “by preference.” Optometrists.org

12. Complaints of headaches or eye strain in older toddlers/children. Posa-pa

13. Visible eye misalignment (strabismus) in some children with prematurity/ROP history. PMCJAMA Network

14. Reduced depth perception (trouble catching a ball), especially if one eye is much blurrier (anisometropia/amblyopia). PMC

15. Nystagmus (involuntary eye shaking) in a small subset with high myopia or retinal changes.

(Many of these signs are general “childhood myopia” clues; in former preemies, we watch more closely because of added risks of strabismus and amblyopia.) Nature

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Diagnostic Tests

A) Physical exam & observation

1. General pediatric exam (growth, neurodevelopment): Checks overall health; growth signals affect eye development.

2. External eye exam: Looks at lids, cornea clarity, and eye movements.

3. Red reflex test: A quick light reflection check to screen for media clarity and large refractive issues.

4. Fixation and following behavior (infant visual behavior): Does the baby lock onto and track faces/toys? Abnormal responses prompt full testing.

5. Pupil reactions and anterior segment look with handheld light/slit lamp: Screens for shallow chamber, lens clarity, or inflammation.

B) Manual/clinical vision tests

1. Cycloplegic retinoscopy (gold standard in infants): Eye drops relax the focusing muscle, then the clinician measures the true glasses number with a streak light. This is the core test to diagnose MOP accurately.
2. Handheld cycloplegic autorefraction (e.g., Retinomax): A quick device estimate of the prescription; useful adjunct to retinoscopy.
3. Preferential looking visual acuity (Teller Acuity Cards): Grating cards let us measure acuity in preverbal infants by watching where they look—solid evidence supports this method. AAO JournalPMC
4. Cardiff Acuity Test (pictures for toddlers): Picture-based preferential looking for 1–3-year-olds; reliable for early acuity measurement. PubMed
5. Contrast sensitivity tests (age-appropriate): Sometimes used later to gauge visual function beyond acuity in children with a prematurity history. Nature
6. Cover–uncover and alternate cover tests: Detect strabismus (eye misalignment) which is more common after prematurity/ROP. PMC
7. Stereopsis (depth) tests (when age-ready): Check binocular function; reduced stereo may signal amblyopia or misalignment.

C) Lab & pathological tests

1. ROP/treatment documentation review (chart, oxygen/ventilation history): Clarifies risk context and guides follow-up intensity. PMC
2. Genetic testing if myopia is extreme or syndromic features are present: Rarely, very high infantile myopia can be part of a genetic condition—testing is considered case-by-case (specialist-directed).
3. Systemic screening guided by pediatrics (e.g., metabolic or inflammatory workups) only if atypical findings suggest broader disease (not routine for uncomplicated MOP).

D) Electrodiagnostic tests 

1. Visual evoked potentials (VEP): Measures how quickly and strongly the brain responds to visual signals; helpful if vision seems poorer than expected from the eye exam in former preemies. Nature
2. Electroretinography (ERG): Measures retina function; can help if retinal dysfunction is suspected alongside refractive issues. PMC

E) Imaging and measurements 

1. Axial length (A-scan ultrasound or optical biometry): Measures eye length; in MOP, early myopia often relates more to front-of-eye power, but tracking axial length over time helps with risk and progression. PMC
2. Keratometry / corneal topography: Quantifies corneal curvature and astigmatism (often steeper in former preemies). PMC
3. Anterior segment OCT (including handheld systems): Noninvasive imaging of the front of the eye; shows anterior chamber depth, angle, lens position, and supports decisions when the chamber looks shallow. PMCNature
4. Posterior segment OCT (when feasible): Views macula/fovea structure; prematurity can leave subtle macular changes that influence vision. Nature
5. Wide-field retinal imaging (e.g., RetCam/ultra-widefield): Documents the retina in babies and tracks ROP or scars; helpful context when interpreting refractive outcomes. PMC
6. Indirect ophthalmoscopy (dilated fundus exam): Pediatric ophthalmologist checks retina directly and monitors for ROP changes and sequelae (standard of care in preemies). Nature

Non-pharmacological treatments

Below are practical, therapy/management steps without medicines. For each: What it is → Purpose → How it helps (mechanism).

1. Timely ROP screening & follow-up.
   Purpose: Catch disease early; plan treatment; track refractive error as the child grows.
   Mechanism: Early detection reduces vision-threatening complications; scheduled refractions pick up MOP sooner. (Follow professional screening schedules.) AAPOS

2. Accurate cycloplegic refraction (with safe infant protocols).
   Purpose: Get the true refractive error for proper glasses.
   Mechanism: Temporarily relaxes focusing to avoid “over-minus” or “missed hyperopia.” (See infant dilation safety/practice literature.) PMC

3. Appropriate spectacle correction (full-time wear).
   Purpose: Clear vision, prevent amblyopia, support development.
   Mechanism: Corrects optical blur; reduces amblyopia risk. Evidence-based pediatric prescribing guidance supports early correction in significant errors. PMCWebEye

4. Contact lenses for high myopia/anisometropia.
   Purpose: Better optics when glasses are very thick or uneven between eyes.
   Mechanism: Contact lenses can minimize image-size differences and improve visual quality in high refractive errors. (Standard pediatric practice.)

5. Patching therapy (amblyopia).
   Purpose: Strengthen the weaker eye if amblyopia is present.
   Mechanism: Temporarily covers the stronger eye to drive visual development in the weaker eye. (Guideline-based care.)

6. Early vision stimulation & parent coaching.
   Purpose: Encourage looking, tracking, and reaching.
   Mechanism: Repeated high-contrast, age-appropriate visual tasks improve visual attention and cortical development.

7. Low-vision rehabilitation (when needed).
   Purpose: Maximize functional vision if retinal damage limits acuity.
   Mechanism: Optical aids, positioning, lighting, and training.

8. Strabismus management (including prisms/occlusion; surgery if needed later).
   Purpose: Align eyes, improve binocular vision.
   Mechanism: Optical/prism correction may reduce misalignment; surgery is for cases not corrected optically.

9. Axial length & keratometry monitoring.
   Purpose: Track eye growth and corneal curvature over time.
   Mechanism: Distinguishes MOP’s anterior-segment component from axial elongation and guides optical choices. PubMed

10. Outdoor-time habit (as child grows).
    Purpose: Reduce risk of new myopia onset/progression in later childhood.
    Mechanism: Bright outdoor light is protective for onset; less certain for progression. (Useful once child is ambulatory.) JAMA NetworkPMC

11. Limit excessive near-work/screen time (age-appropriate).
    Purpose: Support healthy visual habits as child grows.
    Mechanism: High screen time associates with higher myopia risk; balanced routines help. JAMA Network

12. Breast milk / optimal NICU nutrition.
    Purpose: Provide DHA/AA and antioxidants that support retinal and neural development.
    Mechanism: Nutrient sufficiency supports normal vascular and neural maturation. JAMA NetworkBMJ Nutrition

13. Oxygen-saturation management in the NICU (team protocol).
    Purpose: Reduce severe ROP and support survival.
    Mechanism: Target ranges (commonly around 90–94/95%) balance ROP risk and mortality; precise targets per unit policy. New England Journal of MedicinePMC

14. Judicious RBC transfusion (avoid unnecessary transfusions).
    Purpose: Lower ROP risk signals linked to multiple/early transfusions.
    Mechanism: Adult RBCs reduce fetal hemoglobin and may worsen retinal oxygen stress; minimize non-essential transfusions. PMC

15. Cycled NICU lighting & sleep hygiene (unit practice).
    Purpose: Support circadian maturation; avoid continuous bright light.
    Mechanism: More physiologic light cycles support retinal and brain development (evolving evidence).

16. Regular developmental screening (vision+neurodevelopment).
    Purpose: Coordinate therapies (OT/PT/SLT) early if delays appear.
    Mechanism: Vision ties closely to motor/language milestones; early support improves outcomes.

17. Protective eyewear for fragile retinas/high myopia.
    Purpose: Prevent trauma to already vulnerable eyes.
    Mechanism: Polycarbonate lenses reduce injury risk.

18. Optical myopia-control options in later childhood (case-by-case): DIMS/“myopia-control” spectacles.
    Purpose: Slow progression once the child is older and cooperative.
    Mechanism: Peripheral defocus design slows elongation in school-age children (not infant MOP-specific). PMC

19. Orthokeratology (older, carefully selected children only).
    Purpose: Nighttime contact lenses reshape the cornea to slow progression (not for infants/ROP eyes; specialist decision).
    Mechanism: Peripheral myopic defocus.

20. Parental education & scheduled follow-ups.
    Purpose: Ensure adherence to glasses/patching and appointments.
    Mechanism: Consistency is the biggest driver of outcomes in early years.

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Drug treatments

⚠️ Safety first: Doses in newborns are specialist-calculated. The numbers below reflect common trial doses to give context, not prescriptions. An ophthalmologist/neonatologist decides the exact regimen.

1. Bevacizumab (anti-VEGF; intravitreal)
   Dose used in BEAT-ROP: 0.625 mg/0.025 mL once; retreatment if recurrence.
   Purpose: Treat severe posterior ROP to prevent detachment.
   How: Neutralizes VEGF to stop abnormal vessels and allow normal vascularization.
   Side effects: Ocular (infection, hemorrhage); systemic VEGF suppression concerns (monitor neurodevelopment). ScienceDirect

2. Ranibizumab (anti-VEGF; intravitreal)
   RAINBOW dose: 0.2 mg; lower systemic exposure vs bevacizumab; labeled in some regions for ROP.
   Purpose/How/SEs: As above; shorter systemic half-life. Nature

3. Aflibercept (anti-VEGF; intravitreal)
   FIREFLEYE/BUTTERFLEYE dose: 0.4 mg; recently shown effective; comparative trials ongoing.
   Purpose/How/SEs: As above; binds VEGF-A/-B & PlGF. PubMed

Refractive outcome context: Across large datasets, anti-VEGF tends to yield lower myopia than laser in the long term (but individualized care rules). PMC+1

4. Cyclopentolate (0.5–1% drops, with phenylephrine 2.5% as needed)
   Use: Short-term for cycloplegic refraction/ROP exam.
   Purpose: Accurate refraction; safe, effective dilation in neonates with proper monitoring.
   SEs: Tachycardia, flushing—rare with careful dosing. PMC

5. Tropicamide (0.5–1% drops)
   Use: Alternative/adjunct for dilation.
   Purpose/How: Short-acting mydriasis for exams/refraction.
   SEs: Stinging; rarely systemic effects. PMC

6. Phenylephrine (2.5% drops)
   Use: Pupillary dilation (avoid 10% in infants).
   SEs: Potential tachycardia, BP changes—neonatal dosing is conservative with monitoring. PMC

7. Atropine 1% (amblyopia penalization in toddlers/children, not neonates)
   Dose used in trials: Weekend or daily dosing regimens per PEDIG studies.
   Purpose: Blurs the stronger eye to treat amblyopia.
   SEs: Light sensitivity, near blur; rare systemic anticholinergic effects. Drugs.com

8. Low-dose atropine (0.01–0.05%) for myopia control in older children
   Use: Not for infants with MOP. Consider later childhood if progression occurs.
   Evidence: LAMP/ATOM trials show 0.05% most effective among low doses; used nightly.
   SEs: Mild photophobia/near blur; generally well tolerated. PMC+1

9. Caffeine citrate (systemic NICU therapy)
   Use: Treats apnea of prematurity; observationally linked to lower severe ROP in some cohorts.
   Mechanism: Adenosine receptor antagonist, improves respiratory drive; may stabilize oxygenation.
   Note: It’s not an eye drug but part of holistic NICU care. PubMed

10. IOP-lowering drops (e.g., timolol/dorzolamide) when secondary glaucoma occurs
    Use: Case-by-case specialty care in eyes with angle anomalies after ROP.
    Mechanism: Reduce intraocular pressure; protect optic nerve. (Specialist-directed.)

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Dietary, molecular & supportive supplements

⚠️ These are medical nutrition decisions for neonatology/ophthalmology teams. Doses below are typical study regimens or common ranges—not stand-alone instructions.

1. Arachidonic acid + DHA (AA:DHA)
   Typical trial dosing: 100 mg/kg/day AA + 50 mg/kg/day DHA enterally in extremely preterm infants.
   Function/Mechanism: Replaces in-utero supply; supports normal retinal/brain vascular development; lowered severe ROP in an RCT. PubMed

2. DHA (as part of breast milk/fortifier/formula)
   Function: Photoreceptor membrane integrity; anti-inflammatory.
   Mechanism: Omega-3 signals promote healthier angiogenesis. BMJ Nutrition

3. Lutein ± Zeaxanthin
   Dosing in trials: Enteral lutein (e.g., 0.14–0.28 mg/kg/day) has been studied.
   Function: Macular carotenoids; antioxidant light-filtering.
   Evidence: Mixed but biologically plausible. Stem Cell Reference

4. Vitamin A
   Use: Standard neonatal supplementation supports epithelial/immune health; exploratory signals for ROP/ERG improvement.
   Mechanism: Supports photoreceptor function. PubMed

5. Zinc
   Typical enteral range: Often ~1–3 mg/kg/day (per unit protocol).
   Function: Cofactor in growth/retinal enzymes; trials show growth benefits and possible mortality reduction. Cochrane LibraryAAP Publications

6. Choline
   Function: Neurodevelopment and membrane phospholipids; often low in preterm diets; combined choline+DHA trials exist.
   Estimated adequate intake (research): up to ~76 mg/kg/day suggested in analyses; dosing individualized by NICU. SpringerLinkPMC

7. Taurine
   Function: Retinal neuroprotection; abundant in human milk; deficiency linked to retinal injury in models.
   Evidence: Preclinical and nutritional studies support a role; neonatal practice varies. PMCSpringerLink

8. Vitamin E (caution)
   Function: Antioxidant; historical ROP studies mixed with safety concerns (sepsis/NEC).
   Approach: Use only per NICU protocol; balance risks/benefits.

9. Protein/energy-adequate feeds (fortified human milk)
   Function: Supports overall growth; better brain maturation correlates with adequate calories/lipids. BMJ Nutrition

10. Iron (careful balance)
    Function: Prevent anemia; avoid excessive transfusions.
    Note: Iron strategy is individualized to reduce transfusion needs yet avoid oxidative stress; team-directed. PMC

11. Lactoferrin (investigational/adjunct)
    Function: Iron binding; antimicrobial; studied for NEC/sepsis; eye-specific effects uncertain.

12. Probiotics (per NICU policy)
    Function: Reduce NEC and systemic inflammation; indirect benefits to retinal health are plausible but unproven.

13. Vitamin D
    Function: Bone/immune support; standard neonatal practice; retina-specific effects not established.

14. Antioxidant-rich maternal diet (for breastfeeding parent)
    Function: Supports milk micronutrient profile (carotenoids/omega-3s).

15. Electrolyte & micronutrient balance via fortified feeds
    Function: Overall neural/retinal development support.

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“Regenerative”, “hard immunity”, and stem-cell–type drugs

Important reality check: There are no approved stem-cell or “regenerative” drugs for ROP/MOP. Research explores growth-factor replacement (IGF-1/IGFBP-3) and mesenchymal-stem-cell approaches, but clinical trials haven’t shown clear ROP prevention, and these are not standard of care. Below are research directions only (not recommendations).

1. rhIGF-1/rhIGFBP-3 infusion (investigational)
   Goal: Restore fetal-like IGF-1 levels to support normal retinal vascularization.
   Evidence: Phase II data did not reduce ROP; some signals for BPD reduction; dosing via continuous IV in trials. PMCScienceDirect

2. Mesenchymal stem cells (MSCs) / extracellular vesicles (preclinical/early feasibility in other retinopathies)
   Goal: Pro-repair, anti-inflammatory, anti-angiogenic effects.
   Status: Animal models and non-ROP human work suggest potential; not approved for ROP/MOP. PMCBioMed Central

3. Endothelial progenitor cell–based strategies (preclinical)
   Goal: Promote normal re-vascularization of avascular retina.
   Status: Experimental only. Annals of Eye Science

4. Umbilical cord blood strategies
   Goal: Modify transfusion-related risks and provide fetal-type hemoglobin; ROP effect under study.
   Status: A randomized trial is underway; no proven benefit yet. Frontiers

5. Neurotrophic factor delivery (e.g., PEDF-loaded EVs; preclinical)
   Goal: Anti-angiogenic/neuroprotective.
   Status: Lab models only. BioMed Central

6. Gene- or cell-based retina rescue approaches
   Goal: Protect photoreceptors/retinal neurons.
   Status: Conceptual for ROP/MOP; clinical use exists for other diseases but not for MOP. MDPI

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Surgeries & procedures

1. Laser photocoagulation (standard treatment for treatment-requiring ROP).
   Procedure: Laser ablation of avascular peripheral retina.
   Why: Reduces VEGF drive; prevents traction and detachment. (ETROP established earlier treatment improves outcomes.) PubMed

2. Cryotherapy (historical; rarely used where laser is available).
   Procedure: Freezing probe ablation of peripheral retina.
   Why: Effective but more inflammation/edema than laser; largely replaced. (CRYO-ROP trial.) PubMed

3. Intravitreal anti-VEGF injection
   Procedure: Tiny dose of anti-VEGF into vitreous cavity.
   Why: Preferred by some for Zone I/AP-ROP; easier in tiny babies; less average myopia than laser in many series. PubMedPMC

4. Lens-sparing vitrectomy (stage 4 ROP)
   Procedure: Remove vitreous scaffolding to relieve traction and reattach retina.
   Why: Salvage for partial detachment.

5. Scleral buckling (selected tractional detachments)
   Procedure: Silicone band around eye to counter retinal traction.
   Why: Option in stage 4/5; case-selected, specialized centers.

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Prevention

1. Prevent preterm birth when possible (maternal health, antenatal steroids).

2. NICU oxygen targets within team-approved ranges (commonly 90–94/95%, not low 85–89%). New England Journal of MedicinePMC

3. Avoid big swings in oxygen/CO₂ and temperature; gentle, consistent respiratory care.

4. Evidence-based caffeine therapy for apnea (part of organized NICU care). PubMed

5. Prefer breast milk; optimize AA/DHA via fortification when needed. PubMed

6. Judicious transfusion practices; prevent anemia where possible (minimize iatrogenic blood loss). PMC

7. Cycled NICU lighting & protected sleep (unit policy).

8. Routine early eye exams for all preterms at guideline timings. AAPOS

9. Parent education on glasses/patching adherence and follow-ups.

10. As child grows: encourage daily outdoor time and balanced visual habits. JAMA Network

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When to see a doctor (red flags)

• Any preterm infant: always follow scheduled ophthalmology visits.

• Poor fixation, not tracking faces/lights by expected ages.

• Eye crossing or drifting (strabismus) at any age beyond brief newborn misalignments.

• White reflex in photos or abnormal red reflex.

• Nystagmus (shaking eyes).

• Squinting, head tilting, getting very close to objects.

• Frequent tearing/photophobia or signs of eye pain.

• Missed milestones in motor or visual behavior.

• Any change after ROP treatment (less interest in looking, new eye turn).

• Lost/broken glasses in a child depending on full-time correction.

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What to eat & what to avoid

Do focus on:

• Breast milk (when possible) and evidence-based fortification in the NICU.

• DHA/omega-3–rich foods later in childhood (oily fish; diet guidance for the family). BMJ Nutrition

• Colorful fruits/leafy greens that provide natural carotenoids (lutein/zeaxanthin). Stem Cell Reference

• Balanced calories and protein for overall growth. BMJ Nutrition

Avoid or limit:

• Second-hand smoke exposure.

• Ultra-processed, high-sugar diets that displace nutrient-dense foods.

• Unverified supplements without neonatology/ophthalmology approval (especially Vitamin E megadoses or “stem-cell” products marketed online).

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Frequently Asked Questions

1. Is MOP the same as regular myopia?
   No. Regular myopia usually comes from a longer eye in school years. MOP often comes from front-of-eye changes after prematurity/ROP. PubMed

2. Does ROP treatment cause myopia?
   Myopia is more common and often stronger after laser than after anti-VEGF, but treatment choice is based on saving vision first. PMC

3. Will anti-VEGF harm my baby?
   It’s widely used with careful dosing and follow-up. Large studies keep watching for systemic effects; overall refractive outcomes are often better than laser. Your doctor will discuss risks/benefits for your baby. PMC

4. When will my baby get glasses?
   As soon as refraction shows a significant error that could blur vision or cause amblyopia—often in the first year for high MOP. PMC

5. Can patching cure MOP?
   Patching treats amblyopia, not the refractive error. Glasses (or contacts) still correct blur.

6. Will outdoor time help my baby?
   Outdoor time helps older children prevent new myopia. It doesn’t apply in the NICU phase but is useful later. JAMA Network

7. Is low-dose atropine good for MOP?
   It’s for school-age myopia control, not for neonates or early infancy. Decisions are case-by-case as your child grows. PMC

8. Can special “myopia-control” glasses help?
   DIMS-type lenses help older children slow progression. They’re not used in NICU infants. PMC

9. Will my child’s myopia keep getting worse?
   MOP can be high early but sometimes stabilizes. Regular checks tailor correction and amblyopia care.

10. Do supplements cure MOP?
    No. Nutrients like AA/DHA support development and may reduce severe ROP, but they don’t “cure” myopia. PubMed

11. Is surgery needed for MOP?
    Surgery is for ROP complications (e.g., detachment), not for simple myopia. Glasses/contacts correct myopia.

12. Are stem cells available to treat MOP?
    No. Stem-cell and growth-factor therapies are experimental and not approved for ROP/MOP. PMC+1

13. How often should we see the eye doctor?
    Follow the ROP follow-up schedule, then at least every few months in infancy, spacing out as advised.

14. Could screen time make things worse later?
    High screen/near time is linked to myopia risk in older kids. Build balanced habits as your child grows. JAMA Network

15. What’s the single most important thing we can do?
    Keep every appointment, use glasses full-time if prescribed, and follow amblyopia plans exactly.

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Last Updated: August 13, 2025.

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