Instrument-based vision screening and outcomes in young children following prenatal exposure to buprenorphine or methadone: a retrospective cohort study

Abstract

Purpose: To compare the effects of prenatal methadone and buprenorphine exposure on visual outcomes in children. Methods: The medical records of children with history of prenatal opioid exposure who participated in instrument-based vision screening using the SPOT vision screener during ongoing visits to Cincinnati Children's Hospital Medical Center's Neonatal Opioid Withdrawal Syndrome (NOWS) Clinic from 2015 to 2021 were reviewed retrospectively. Chart review identified prenatal exposures, vision screening outcome, visual diagnoses, and visual interventions in early childhood. Logistic regression models were used to examine the extent to which prenatal exposure to methadone influenced the odds of a failed vision screen during the first 3 years of life compared with prenatal exposure to buprenorphine. Results: A total of 236 children were included. Of these, 79 (33%) had a failed vision screen. We compared outcomes of children with prenatal exposure to methadone versus buprenorphine, using an adjusted logistic regression model that accounted for birth weight, gestational age, sex, race, ethnicity, NOWS pharmacologic treatment, prenatal nicotine exposure, and prenatal polysubstance exposure. Children with prenatal methadone exposure were twice as likely to fail their vision screen (aOR 2.27; 95% CI, 1.25-4.16), and were more likely to be diagnosed with strabismus (P = 0.04). The most frequent diagnoses in this population were astigmatism (n = 31), strabismus (n = 17), and pseudostrabismus (n = 9). Conclusions: In our study cohort of 236 children, those with prenatal methadone exposure were more likely to have failed instrument-based vision screen than those with prenatal exposure to buprenorphine, even after accounting for confounding variables.