Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. 862-863 (doi:10.1542/peds.2007-3326)
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LETTER TO THE EDITOR

Low Birth Weight and Retinal Vascular Caliber in Young Children

Ning Cheung, MBBS
Tien Y. Wong, MBBS, PhD
Centre for Eye Research Australia
University of Melbourne
Melbourne, Victoria 3002
Australia

Gerald Liew, MBBS, MMed
Centre for Vision Research
University of Sydney
Sydney, New South Wales 2000
Australia

Seang M. Saw, MBBS, PhD
Department of Community, Occupational and Family Medicine
Yong Loo Lin School of Medicine
National University of Singapore
Singapore 119275

To the Editor—

Tapp et al1 report interesting associations of low birth weight with several retinal circulatory measures. These findings support the hypothesis that a person's risk of cardiovascular disease may have its etiologic origins in early life. It is of importance that these data also suggest that retinal image analysis may offer a unique means to quantify the adverse effects of early life factors on the microvasculature in young children.

We have previously examined retinal vascular caliber changes in young children aged 7 to 9 years in Singapore.2 We found no association between birth weight and retinal vascular caliber.2 However, that analysis did not account for the effects of ocular magnification on retinal vascular caliber measurements. Given that a large proportion of participants had myopia (75.7%),2 this could have significantly confounded the results. We have recently shown that correction for ocular magnification by using the refractive status of the eye is important to minimize such confounding.3 By using this new approach, we have reanalyzed our data and show that children with lower birth weight had significantly wider retinal venular caliber, independent of age, gender, ethnicity, gestational age, BMI, and blood pressure (Table 1).


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  		TABLE 1 Relationship of Birth Weight Categories and Retinal Vascular Caliber and Linear Regression of Birth Weight on Retinal Vascular Caliber

 
Retinal venular dilation is now recognized as being associated with endothelial dysfunction markers, and shown to predict risks of stroke and coronary heart disease in adults.4,5 Our findings, in line with Tapp et al's1 hypothesis, therefore suggest that impaired fetal development may cause endothelial dysfunction in the microvasculature, predisposing children with low birth weight to develop clinical cardiovascular disease in adulthood. As described by Tapp et al,1 their study also measured retinal vascular caliber and have data on refraction. We encourage the authors to explore similar analyses to verify our findings.

FOOTNOTES

Statements appearing here are those of the writers and do not represent the offcial position of the American Academy of Pediatrics or its Committees. Comments on any topic, including the contents of PEDIATRICS, are invited from all members of the profession; those accepted for publication will not be subject to major editorial revision but generally must be no more than 400 words in length. The editors reserve the right to publish replies and may solicit responses from authors and others.

Please see www.pediatrics.org for instructions on submitting letters.

REFERENCES

  1. Tapp RJ, Williams C, Witt N, et al. Impact of size at birth on the microvasculature: the Avon Longitudinal Study of Parents and Children. Pediatrics. 2007;120 (5). Available at: www.pediatrics.org/cgi/content/full/120/5/e1225
  2. Cheung N, Islam FM, Saw SM, et al. Distribution and associations of retinal vascular caliber with ethnicity, gender, and birth parameters in young children. Invest Ophthalmol Vis Sci. 2007;48 (3):1018 –1024[Abstract/Free Full Text]
  3. Cheung N, Tong L, Tikellis G, et al. Relationship of axial length and retinal vascular caliber in children. Am J Ophthalmol. 2007;144 (5):658 –662[CrossRef][Web of Science][Medline]
  4. Wong TY, Islam FM, Klein R, et al. Retinal vascular caliber, cardiovascular risk factors, and inflammation: the Multi-Ethnic Study of Atherosclerosis (MESA). Invest Ophthalmol Vis Sci. 2006;47 (6):2341 –2350[Abstract/Free Full Text]
  5. Wong TY, Kamineni A, Klein R, et al. Quantitative retinal venular caliber and risk of cardiovascular disease in older persons: the cardiovascular health study. Arch Intern Med. 2006;166 (21):2388 –2394[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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