Purpose.: We compared photoreceptor development from spectral domain optical coherence tomography (SD-OCT) imaging in very preterm infants (VPT,< 32 weeks gestational age) with those of term infants.

Methods.: The microanatomy of foveal SD-OCT images obtained at the bedside at 37 to 42 weeks term equivalent postmenstrual age (TEA) was reviewed with qualitative and quantitative analysis of retinal and especially photoreceptor layers in the macula. Measures of maturity included presence of the cone outer segment tips (COST) or the ellipsoid zone (EZ) at foveal center, distance from Bruch's membrane (BM) to the EZ at the foveal center, and radial distance from foveal center to first appearance of the EZ.

Results.: The incidence of the EZ developed at the foveal center was lower in VPT infants (9/64, 14%) versus term infants (22/47, 47%, P< 0.001) and lower in VPT infants with macular edema (3/46) versus VPT without edema (6/18, P= 0.01). Mean±SD distance from the foveal center to the visible EZ was 783±440 μm in VPT, and 492±501 μm in term infants, P= 0.002. The height of the BM-to-EZ at the foveal center did not differ in VPT versus term infants. The COST band was not visible in any infant.

Conclusions.: Photoreceptor inner and outer segment development in VPT infants appears delayed when compared to term infants, and the photoreceptor RPE junction remains immature in all infants at TEA. Delayed maturation of photoreceptors could contribute to differences in visual function in some VPT infants.