Impaired vision in children prenatally exposed to methadone: an observational cohort study

Hamilton, R. et al. (2023) Impaired vision in children prenatally exposed to methadone: an observational cohort study. Eye, (doi: 10.1038/s41433-023-02644-3) (Early Online Publication)

Abstract

Background/objectives: To examine prevalence of failed visual assessment at 8–10 years in children born to methadone-maintained opioid dependent (MMOD) mothers and relate this to known in utero substance exposure. Subjects/methods: Follow up of observational cohort study of methadone-exposed and comparison children matched for birthweight, gestation and postcode of residence at birth. Participants were 144 children (98 exposed, 46 comparison). Prenatal drug exposure was previously established via comprehensive maternal and neonatal toxicology. Children were invited to attend for visual assessment and casenotes were reviewed. Presence of acuity poorer than 0.2 logMAR, strabismus, nystagmus and/or impaired stereovision constituted a ‘fail’. Fail rates were compared between methadone-exposed and comparison children after adjusting for known confounding variables. Results: 33 children attended in person: data were also derived from casenote review for all children. After controlling for maternal reported tobacco use, methadone-exposed children were more likely to have a visual ‘fail’ outcome, adjusted odds ratio 2.6, 95% CI 1.1–6.2; adjusted relative risk 1.8 (95% CI 1.1–3.4). Visual ‘fail’ outcome rates did not differ between methadone-exposed children who had (n = 47) or had not (n = 51) received pharmacological treatment for neonatal abstinence/opioid withdrawal syndrome (NAS/NOWS); fail rate 62% vs 53% (95% CI of difference—11–27%). Conclusions: Children born to MMOD mothers are almost twice as likely as unexposed peers to have significant visual abnormalities at primary school age. Prenatal methadone exposure should be considered in the differential diagnosis of nystagmus. Findings support visual assessment prior to school entry for children with any history of prenatal opioid exposure. Trial registration: The study was prospectively registered on ClinicalTrials.gov (NCT03603301), https://clinicaltrials.gov/ct2/show/NCT03603301.

• Item Type: Articles
• Additional Information: This work was funded by a joint grant from Action Medical Research, Horsham, UK and the Chief Scientist Office, Edinburgh, UK (ref GN2493) and supported by The RS Macdonald Charitable Trust.
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacTier, Dr Helen and Hamilton, Dr Ruth and Spowart, Dr Katherine
• Authors: Hamilton, R., Mulvihill, A., Butler, L., Chow, A., Irving, E., McCulloch, D.L., McNeil, A., Michael, K., Spowart, K.M., Waterson-Wilson, J., and Mactier, H.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Eye
• Publisher: Springer Nature
• ISSN: 0950-222X
• ISSN (Online): 1476-5454
• Published Online: 04 July 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Eye 2023
• Publisher Policy: Reproduced under a Creative Commons License