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Published on: August 14, 2013
Delayed visual attention caused by high myopic refractive error
Kimberly M Winges1, Ursula Zarpellon, Chuan Hou
1Smith-Kettlewell Eye Research Institute, 2318 Fillmore Street, San Francisco, CA 94115, USA.
Insights
Delayed visual maturation (DVM) in infants may be caused by uncorrected high myopia. Prompt refractive error assessment is crucial for diagnosing visually unresponsive infants and ensuring timely treatment.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Delayed visual maturation (DVM) is a diagnosis of exclusion for infants with poor visual behavior despite normal objective acuity.
- The etiology of DVM is complex, with various neurodevelopmental and ocular factors implicated.
- DVM is typically diagnosed retrospectively after visual recovery.
Observation:
- Two infants presented with symptoms consistent with DVM, exhibiting unresponsiveness to visual stimuli from birth.
- Objective testing revealed normal visual acuity, but both infants were later found to have significant high myopia.
- Patient 1 had -4 D (right eye) and -5 D (left eye); Patient 2 had -9 D in both eyes.
Findings:
- Immediate improvement in visually-directed behavior was observed in both infants upon spectacle correction.
- This suggests that high refractive error, specifically high myopia, was the primary cause of their apparent visual inattention.
- The findings challenge the traditional understanding of DVM and its potential causes.
Implications:
- High myopia should be considered in the differential diagnosis of infants presenting with delayed visual maturation or apparent blindness.
- Early and accurate refractive error assessment is critical for timely intervention in such cases.
- This study may improve diagnostic approaches for infants with visual impairments.
Abstract:
Delayed visual maturation (DVM) is usually a retrospective diagnosis given to infants who are born with no or poor visually-directed behavior, despite normal acuity on objective testing, but who recover months later. This condition can be organized into several types based on associated neurodevelopmental or ocular findings, but the etiology of DVM is probably complex and involves multiple possible origins. Here we report two infants who presented with delayed visual maturation (attention). They were visually unresponsive at birth but were later found to have high myopic errors. Patient 1 had -4 D right eye, -5 D left eye. Patient 2 had -9 D o.u. Upon spectacle correction at 5 and 4 months, respectively, both infants immediately displayed visually-directed behavior, suggesting that a high refractive error was the cause of inattention in these patients. These findings could add to knowledge surrounding DVM and the diagnosis of apparently blind infants. Findings presented here also indicate the importance of prompt refractive error measurement in such cases.
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