Eye Findings Following Congenital Cytomegalovirus Newborn Screening

BACKGROUND AND OBJECTIVE: Consensus guidelines have recommended eye examinations for all newborns with congenital cytomegalovirus (cCMV) infection; however, structured ophthalmic examinations are seldom reported. Existing literature suggests ocular pathology is uncommon in cCMV, particularly asymptomatic cCMV. We aimed to assess utility of ophthalmology examination in every infant with cCMV identified on newborn screening and whether alternative, risk-based strategies should be considered. DESIGN: Eye examination records were reviewed for infants who screened positive for cCMV from routinely collected newborn dried blood spot between July 2019 and January 2022 in Ontario, Canada. Prevalence of cCMV-related ophthalmic findings in infants with symptomatic and asymptomatic cCMV infection was evaluated. RESULTS: Of 394 infants who screened positive for cCMV, 347 (88.1%) had eye examinations; of these, 51 (14.7%) had symptomatic cCMV. Two infants with symptomatic cCMV had unilateral chorioretinal scars attributable to cCMV, constituting 0.58% of CMV-positive infants and 3.9% of infants with symptomatic cCMV. Both infants were referred to ophthalmology with clinically diagnosed cCMV with significant systemic manifestations, before their CMV screening results were known. No infant with asymptomatic infection had CMV-related ocular findings. CONCLUSIONS: Eye abnormalities attributable to cCMV were rarely identified through this large, population-based screening program and were not found in infants with asymptomatic cCMV. This suggests eye examination for every newborn with cCMV detected on screening is not routinely indicated. Alternative criteria for ophthalmology referral may be considered, such as infants with symptomatic cCMV and those with coexisting features their physician deems relevant.