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Ophthalmological examination and VEPs in preterm children with perinatal CNS involvement
Miroslav Kuba1, Dana Liláková, Dagmar Hejcmanová
1Department of Pathophysiology, Charles University ,University Hospital, Simkova 870, 500 38, Hradec Kralove, Czech Republic. kuba@lfhk.cuni.cz
Insights
Preterm birth can affect visual pathways, with motion-sensitive visual evoked potentials (VEPs) showing more abnormalities than pattern-sensitive VEPs in children with post-hemorrhagic hydrocephalus, suggesting potential cortical visual impairment.
Area of Science:
- Ophthalmology
- Neuroscience
- Developmental Pediatrics
Background:
- Preterm birth is associated with various neurological complications.
- Post-hemorrhagic hydrocephalus is a known complication in preterm infants.
- Cortical/cerebral visual impairment (CVI) can be a consequence of these conditions.
Purpose of the Study:
- To investigate visual pathway function in children with a history of preterm birth and post-hemorrhagic hydrocephalus.
- To evaluate the utility of extended visual evoked potentials (VEPs) in detecting visual abnormalities.
- To compare the sensitivity of different VEP stimuli (pattern-reversal, motion-onset, cognitive) in this population.
Main Methods:
- Ophthalmological examinations were performed on five children (ages 4-11) with a history of preterm birth (mean gestational age 27 weeks) and perinatal post-hemorrhagic hydrocephalus.
- Extended visual evoked potentials (VEPs) were recorded using pattern-reversal, motion-onset, and cognitive visual stimuli.
- VEP parameters including responses, maturation, peak latencies, and amplitudes were analyzed.
Main Results:
- While some children had near-normal visual acuity, all examined eyes showed abnormalities in at least one VEP variant.
- Pathological VEP changes correlated with gestational age and reduced visual acuity.
- Motion-onset VEPs revealed more severe abnormalities than pattern-reversal VEPs, suggesting greater impact on the magnocellular/dorsal visual stream.
Conclusions:
- The magnocellular visual pathway may be more vulnerable in preterm children with post-hemorrhagic hydrocephalus compared to the parvocellular pathway.
- Combined pattern and motion-related VEP testing could be valuable for detecting hidden CVI in preterm infants.
- This pilot study highlights the need for further research into VEPs for assessing visual function in high-risk pediatric populations.
Abstract:
Five children with a history of preterm birth (mean gestational age of 27 weeks; birth weight 870-1,380 g) and perinatal post-hemorrhagic hydrocephalus were examined ophthalmologically at ages ranging from 4-11 years. An extended visual evoked potentials (VEPs) examination was simultaneously performed, using pattern-reversal, motion-onset, and cognitive visual stimuli. Although 3 of the 10 eyes displayed about normal visual acuity (> or =0.9), all of the examined eyes were abnormal for at least one variant of the tested VEPs. Pathological changes in VEPs (missing responses, shape abnormalities due to delayed VEPs maturation, prolonged peak latencies, and reduced amplitudes) were roughly proportional to both gestational age and reduction in visual acuity. A more severe pathology was found in the motion-onset VEPs (in all five subjects - nine eyes) when compared to the pattern-reversal VEPs (in four subjects - eight eyes). These observations suggest that the magnocellular system/dorsal stream of the visual pathway (which is particularly activated in response to motion stimuli) may be more frequently affected in preterm children than the parvocellular system/ventral stream (tested mostly by the standard pattern-reversal VEPs). This pilot study may encourage further testing of the combined pattern and motion-related VEPs examinations in preterm children as a way of detecting hidden cortical/cerebral visual impairment (CVI).
