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Evaluation of the Relationship Between Preferential Looking Testing and Visual Evoked Potentials as a Biomarker of
Sruti Raja1,2, Batool Sahar Emadi2, Eric D Gaier2,3
1Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL, United States.
Insights
Diagnosing cerebral visual impairment (CVI) in children is challenging. A significant difference between visual evoked potentials (VEPs) and preferential looking test (PLT) results may serve as a novel biomarker for CVI detection.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Genetics
Background:
- Cerebral visual impairment (CVI) is a primary cause of vision loss in children.
- Current diagnostic tools for CVI are limited, hindering timely diagnosis and intervention.
- Understanding visual acuity metrics in CVI is crucial for developing better diagnostic approaches.
Purpose of the Study:
- To investigate the relationship between visual acuity measurements from visual evoked potentials (VEPs) and preferential looking tests (PLTs) in children with CVI.
- To determine if the disparity between VEP and PLT visual acuity can serve as a biomarker for CVI.
- To analyze ophthalmic comorbidities and associated conditions in a cohort of children diagnosed with CVI.
Main Methods:
- Retrospective chart review of 218 patients with a confirmed CVI diagnosis.
- Analysis of ophthalmological assessments measuring visual acuity using VEP and PLT.
- Comparison of VEP and PLT visual acuity outcomes against expected norms and normal visual development.
Main Results:
- Children with CVI demonstrated visual acuity below expected norms on both VEP and PLT.
- VEP acuity consistently exceeded PLT acuity by one or more octaves in patients with CVI.
- This quantifiable difference between VEP and PLT was greater than observed in typical visual development.
Conclusions:
- The quantifiable disparity between VEP and PLT measurements presents a potential novel biomarker for diagnosing CVI in children.
- This finding could lead to improved diagnostic tools and earlier identification of CVI.
- Genetic disorders and ophthalmic comorbidities like nystagmus and strabismus are common in children with CVI.
Abstract:
Cerebral visual impairment (CVI) is a leading cause of visual impairment in children in developed countries, but diagnostic tools to detect CVI are limited. We sought to analyze the visual acuity of children with CVI as assessed by visual evoked potentials (VEPs) and preferential looking test (PLT) to determine whether the relationship between the visual outcomes on these two testing methods may serve as a biomarker of CVI. We performed a retrospective chart review of patients with a confirmed diagnosis of CVI and at least one ophthalmological assessment with visual acuity measured by VEP and PLT. Of the 218 patients included in the study, the most common condition associated with CVI was an underlying genetic disorder (36%, 79/218). Treatment for seizures occurred in the majority of the entire cohort of patients (80%, 175/218). Ophthalmic comorbidities included retinal disease in 23 patients, optic nerve disease in 68 patients, nystagmus in 78 patients, and strabismus in 176 patients. When assessed by either VEP or PLT, visual acuity in children with CVI fell below expected norms. At initial and final presentations, VEP acuity exceeded PLT acuity by one or more octaves, and this difference was greater than expected compared with normal visual development. We propose utilizing this quantifiable disparity between VEP and PLT as a biomarker of CVI.
