Work

High-Resolution Characterization of Cone Photoreceptor Mosaic Alterations in Retinopathy of Prematurity Using Adaptive Optics Scanning Laser Ophthalmoscopy

Year: 2026

Type: article

Abstract: Purpose To characterize cone photoreceptor alterations using adaptive optics scanning laser ophthalmoscopy (AO-SLO) and explore their relationships with retinal structure, visual function, and ocular biometry in children with retinopathy of prematurity (ROP). Design Prospective observational case series. Participants A total of 313 eyes from 162 children were included, comprising full-term controls, preterm children without ROP, children with regressed ROP, and children with ROP treated with laser photocoagulation, intravitreal anti–vascular endothelial growth factor therapy, or combined therapy. Methods Participants underwent AO-SLO, swept-source optical coherence tomography, best-corrected visual acuity testing, and ocular biometry. Cone density, dispersion, and regularity were evaluated across retinal regions. Between-group interpretation emphasized temporal cone metrics, and secondary exploratory analyses evaluated associations with retinal structural, visual, and biometric parameters. Main Outcome Measures AO-SLO–derived cone density, cone dispersion, and cone regularity across retinal regions, with temporal cone metrics considered the main region of interest. Results Among clinically defined ROP subgroups, overall group differences in cone metrics were identified predominantly in the temporal region after multivariable adjustment (P < 0.05). In Bonferroni-adjusted pairwise comparisons, the LP+IVI clinical-background group showed lower temporal cone regularity than preterm children without ROP (94.5% vs. 96.4%; adjusted mean difference, -1.92%; Bonferroni-adjusted P = 0.001), whereas temporal cone density and dispersion showed similar directional but non-significant pairwise differences. Laser-treated eyes showed greater inner retinal thickness in selected regions (P ≤ 0.006). Temporal cone regularity showed a weak positive association with temporal inner retinal thickness (r = 0.10, GEE-derived P = 0.046; Table S6), whereas broader correlations between AO-SLO parameters and OCT measurements were generally limited. Conclusions AO-SLO identified selective temporal cone photoreceptor mosaic alterations in children with ROP, most consistently reflected by reduced temporal cone regularity, with directional differences in cone density and dispersion. These findings extend prior adaptive optics observations in ROP to a larger pediatric cohort and support AO-SLO as a complementary modality for evaluating cone spatial organization in ROP survivors.

Source: Ophthalmology Science

DOI: 10.1016/j.xops.2026.101412