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Prematurely born infants are known to have an increased rate of ophthalmological morbidity. The aim of the present study was to investigate visual acuity and ocular alignment in a population of preterm infants in a geographical area, in infants with and without retinopathy of prematurity (ROP).A prospective population based study of ophthalmological status of preterm infants with a birth weight of 1500 g or less was performed during 3.5 years, with examinations at 6, 18, 30, and 42 months of corrected age. Visual acuity was tested using linear optotypes. Multiple regression analyses were used to analyse independent risk factors for poor vision and strabismus.Poor vision (<0.3) was detected in 2.5% (6/237) of the children. Of these, only two (0.8%) had a severe visual impairment (<0.1). Strabismus occurred in 13.5% (31/229). Children with cryotreated ROP and neurological complications ran the highest risk of poor vision and strabismus, according to multiple regression analysis. Among children without a history of ROP or neurological complications, 34% had a visual acuity <0.7 and 5.9% had strabismus, compared with 61% and 22%, respectively, among the children with ROP or neurological complications.The overall incidence of subnormal vision and strabismus in children born prematurely was higher than in a full term population of the same age. On the basis of this study, follow up of all preterm infants screened for ROP is recommended and general guidelines are suggested.