Very Preterm Infant Retinal Microanatomy at 36 Weeks' Postmenstrual Age and 2-Year Neurodevelopment.

Importance: If noninvasive optical coherence tomography (OCT) retinal imaging could predict 2-year neurodevelopment of very preterm (VPT; <32 weeks' gestational age) infants in neonatal intensive care, it might help to guide management. Objective: To evaluate whether retinal microanatomy findings on OCT in VPT infants at 36 weeks' postmenstrual age (PMA) are associated with 2-year neurodevelopmental outcomes. Design, Setting, and Participants: The prospective, longitudinal cohort study BabySTEPS (Study of Eye Imaging in Preterm Infants), which enrolled infants from August 12, 2016, through November 12, 2019, evaluated VPT infants at risk for retinopathy of prematurity at a single-center neonatal intensive care unit through their outpatient neurodevelopmental visit at age 2 years. Data analysis was conducted from January 5, 2023, to December 1, 2025. Exposure: OCT imaging of both eyes concurrent with eye examinations for retinopathy of prematurity. Main Outcomes and Measures: Multivariate linear regression analysis of associations between OCT measures of retinal layers at 36 ± 2 weeks' PMA and neurodevelopmental outcomes at 2 years, assessed by the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), Child Behavior Checklist, and Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R), adjusted for the following infant factors: gestational age (GA), small for GA at birth, mother's highest education level, and PMA at imaging. Results: In 72 infants (33 [45.8%] female; mean [SD] GA, 27.6 [2.6] weeks; birth weight, 945.5 [287.8] g) with retinal OCT imaging and neurodevelopmental follow-up at 2 years, greater retinal nerve fiber layer (RNFL) thickness was associated with higher BSID-III motor scores (mean score change per 10-µm increase in RNFL thickness, 7.50 [95% CI, 4.38-10.62]; P < .001) and cognitive scores (mean score change per 10-µm increase in RNFL thickness, 3.71 [95% CI, 0.73-6.69]; P = .02) and lower M-CHAT-R autism risk scores (mean score change per 10-µm increase in RNFL thickness, -0.64 [95% CI, -1.19 to -0.09]; P = .03) and Child Behavior Checklist internalizing problems scores (mean score change per 10-µm increase in RNFL thickness, -2.25 [95% CI, -4.41 to -0.09]; P = .04). Greater choroidal thickness was associated with higher motor scores (mean score change per 100-µm increase in choroidal thickness, 4.84 [95% CI, 0.45-9.23]; P = .03). When considered in addition to infant factors, RNFL thickness improved prediction of the BSID-III motor score (R2 increased from 0.36 to 0.53; difference, 0.17 [95% CI, 0.04-0.26]) and cognitive score (R2 increased from 0.29 to 0.35; difference, 0.06 [95% CI, 0.00-0.16]); choroidal thickness improved predictions less than RNFL thickness and did not add to the improved predictions with RNFL thickness. Conclusions and Relevance: In this cohort study, RNFL thickness in VPT infants at 36 weeks' PMA predicted motor and cognitive neurodevelopmental outcomes at age 2 years. These findings, if confirmed independently, could help guide management of VPT infants through age 2 years.