Ophthalmic Findings in Infants with Congenital Cyctomegalovirus Infection from The Ontario Newborn Screening Program
Authors: Kamiar Mireskandari1, Kate Leahy1, Asim Ali1, Kourosh Sabri2, Michael O'Connor3, Yiannis Iordanous4, Yi Ning Strube5, Jeffrey Pernica2, Lauren Gallagher6, Jason Brophy3, Kirk Leifso7, Michelle Barton8, Jessica Dunn9, Ari Bitnun1. 1The Hospital for Sick Children, 2McMaster University, 3Children's Hospital of Eastern Ontario, 4Ivey Eye Institute, 5Queens University, 6Newborn Screening Ontario, 7Kingston Health Sciences Centre, 8London Health Sciences Centre, 9Alberta Children’s Hospital.
Author Disclosures: K. Mireskandari: Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Santen Canada Inc, Bayer, Novartis. Membership on advisory boards or speakers’ bureaus; Description of relationship(s); Advisory Board and speaker, Advisory Board, Advisory Board. Funded grants or Clinical Trials; Name of for-profit or not-for-profit organization(s); Bayer. Funded grants or Clinical Trials; Description of relationship(s); Research Support. K. Leahy: None. A. Ali: Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Santen Canada Inc. Membership on advisory boards or speakers’ bureaus; Description of relationship(s); Advisory Board and speaker. K. Sabri: None. M. O'Connor: None. Y. Iordanous: None. Y. Strube: Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Santen Canada Inc. Membership on advisory boards or speakers’ bureaus; Description of relationship(s); Advisory Board. Patents on a drug, product or device; Name of for-profit or not-for-profit organization(s); Oxford University Press Publishing, Springer Publishing, American Academy of Pediatrics. Patents on a drug, product or device; Description of relationship(s); Royalty, Royalty, Royalty. J. Pernica: None. L. Gallagher: None. J. Brophy: None. K. Leifso: None. M. Barton: None. J. Dunn: None. A. Bitnun: None.
Abstract Body:
Purpose: Congenital cytomegalovirus (cCMV) is the most common congenital infection. Patients with cCMV can develop long-term sequelae including sensorineural hearing loss and developmental delay. Early identification enables close hearing and neurodevelopmental surveillance, and antiviral treatment in those with symptomatic infection, therefore screening for cCMV is advocated. Ophthalmic findings, such as chorioretinal scarring, have been reported rarely in infants with cCMV. We reviewed the prevalence of ocular findings among infants with cCMV identified through Newborn Screening Ontario’s Enhanced Hearing Screen, which tests for CMV and common genetic causes of hearing loss. To our knowledge, this is the largest reported cCMV cohort with ophthalmic examination from a screening program. Study Design: Retrospective review of findings from a provincial screening program Methods: All infants with a positive CMV PCR result on newborn dried blood spot testing in Ontario, between July 2019 and January 2022, were reviewed. A standard ophthalmic examination proforma was agreed upon by paediatric ophthalmologists examining infants identified through screening, prior to the commencement of the program. Data collected were vision, refraction, anterior and posterior segment findings. Fundus examinations were performed using a speculum and indentation to identify peripheral CMV lesions. Results: Of 349,428 infants born during the study period, 338,405 underwent CMV screening and 394 tested positive (0.12%). Eye examination results were available for 345 of 394 infants; 34 declined examination, five had false positive CMV tests and did not require examination, and the outcome of ten infants was unknown. Eye examinations for all except two of the 345 infants were performed by an ophthalmologist. Two infants (0.58%) had CMV-related ophthalmic findings: one had a unilateral macular scar present on day 2 of life and one had a unilateral peripheral chorioretinal scar at 2 months of age which had not been seen on initial exam on day 4 of life. Both infants were referred to ophthalmology with a clinical diagnosis of cCMV due to significant systemic manifestations, before their CMV screening results were known. In total, two of xx infants with symptomatic (xx%) and none of xx infants with asymptomatic cCMV had ophthalmologic findings of cCMV. Eight infants had refractive errors, in keeping with the general population prevalence. Conclusions: In this large cohort of cCMV infants with ophthalmic examination from a screening program, ophthalmic manifestations of cCMV were seen rarely, and only in those with symptomatic cCMV. Therefore, routine eye examinations may not be required as the standard of care for every infant with cCMV.
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