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The Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) study is a multicenter study involving 23 centers and more than 100 physicians and study center coordinators throughout the United States. The goal of the study is to evaluate the safety and efficacy of retinal ablative cryotherapy for the prevention of retinal detachment and blindness in infants with severe ROP. More than 4, 000 infants with birth weights <1251 grams were enrolled in the natural history portion of the study between January 1986 and November 1987. Approximately two-thirds of the infants developed ROP and one-third did not. Two hundred ninety-one infants developed severe ROP and were enrolled in the randomized trial of cryotherapy. All infants in the randomized trial and more than 1, 000 of the remaining infants in the natural history part of the study had retinal status evaluated at ages 3 months and 1 year using fundus photographs, and at 3 months, 1, 2, 31/2, 41/2, and 51/2 years by physician's examination of the posterior pole of the retina. Visual acuity was evaluated using the Teller acuity card procedure at ages 1, 2, 31/2, 41/2, and 51/2 years, using the crowded HOTV letter acuity chart or cards at 31/2 and 41/2 years, and using the ETDRS logMAR letter acuity charts at 51/2 years. Testing was with optical correction, if needed.This paper describes visual acuity results from children who were participants in the CRYO-ROP study. The first section presents data from the large number of children in the natural history cohort, showing that the development of grating visual acuity depends on the severity of cicatricial ROP (e. g., abnormally straightened temporal retinal blood vessels, macular ectopia, retinal fold or detachment). The second part presents at comparison of grating acuity results with HOTV letter acuity results collected a ages 31/2 and 41/2 years from children in the natural history portion of the study. The final section presents results for grating acuity, HOTV letter acuity, and ETDRS letter acuity testing conducted at ages 1, 31/2 and 51/2 years, respectively, in eyes that underwent cryotherapy for severe ROP, as compared with eyes that had severe ROP but did not undergo cryotherapy. Data at all three ages were consistent in showing a clear benefit of cryotherapy in preserving visual function. However, the data also indicated that eyes in which cryotherapy has prevented blindness often do not develop visual acuity that is within the normal range when a child reaches 31/2 to 51/2 years of age.

VISUAL ACUITY DEVELOPMENT IN INFANTS AND CHILDREN WITH RETINOPATHY OF PREMATURITY