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grams at birth and controls born with normal birth weights found no differences in the rates of completion of high school, postsecondary education, or university education or the total number of years of education that they had completed (Saigal et al., 2006a).

Visual Impairment

As discussed in Chapter 10, retinopathy of prematurity (ROP) is a common complication of prematurity that increases with decreasing gestational age and birth weight. As a group, preterm children have a higher risk of impaired visual acuity than full-term children (Table 11-4). Myopia (i.e., nearsightedness) is one of the most common visual sequelae, and its incidence increases with the severity of ROP and with decreasing gestational age. Myopia occurs in 20 to 22 percent of children born with birth weights of less than 1,251 or 1,751 grams, and 4.6 percent have a high degree of myopia (i.e., ≥ 5 diopters) (O’Connor et al., 2002; Quinn et al., 1998).

Other visual problems include hyperopia and astigmatism (in 12 and 29 percent of children born at less than 29 weeks of gestation, respectively) (Hard et al., 2000). The need for glasses was higher in 7-year-olds born at gestational ages of less than 32 weeks than in controls born fullterm (13 and 4 percent, respectively) (Cooke et al., 2004). At 10 to 14 years of age, visual impairment was more common in children born with birth weights of less than 750 grams than in children born with birth weights of between 750 and 1,499 grams and children born with normal birth weights (31, 13, and 11 percent, respectively), as was the need for glasses (47, 24, and 27 percent, respectively) (Hack et al., 2000). In a British study of children born at less than 26 weeks of gestation, 24 percent of preterm 6-year-olds wore glasses, whereas 4 percent of controls with fullterm gestations did so (Marlow et al., 2005).

Strabismus (i.e., ocular misalignment, or crossed eyes) is also a frequent complication of prematurity. Strabismus has been reported in 3 percent of children born fullterm; 14 to 19 percent of children born with birth weights less than 1,500 grams, birth weights less than 1,750 grams, and gestational ages less than 29 and 32 weeks; and 24 percent of children born at gestational ages less than 26 weeks (Bremer et al., 1998; Hard et al., 2000; Marlow et al., 2005, O’Connor et al., 2002). The risk of strabismus increases with intraventricular hemorrhage, periventricular leukomalacia, and the severity of ROP (Bremer et al., 1998; Hard et al., 2000; Hardy et al., 1997; Marlow et al., 2005; O’Connor et al., 2002; O’Keefe et al., 2001). Treatments for strabismus include correction with glasses or surgery, or both. Repka and colleagues (1998) reported that 10 percent of children with severe ROP underwent surgery for strabismus.

The sequelae of strabismus include amblyopia (i.e., suppression of the

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