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Updated: Oct 13, 2025
A Method to Quantify Visual Information Processing in Children Using Eye Tracking
Published on: July 9, 2016
Early Screening of Visual Processing Dysfunctions in Children Born Very or Extremely Preterm
Marlou J G Kooiker1,2, Maud M van Gils1,3, Ymie J van der Zee4
1Department Neuroscience, Erasmus MC, Rotterdam, Netherlands.
Insights
Early screening for visual processing dysfunctions (VPD) in preterm infants identified a 38% risk at 1 year corrected age. Conventional eye exams were less sensitive, suggesting a need for functional assessments and continuous screening for visual brain damage.
Area of Science:
- Pediatric ophthalmology
- Neurodevelopmental pediatrics
- Visual neuroscience
Background:
- Cerebral visual impairment (CVI) and visual processing dysfunctions (VPD) affect children with early brain damage.
- VPD often remain undetected until school age, highlighting a critical diagnostic gap.
- Early detection and intervention are crucial for managing visual impairments in at-risk children.
Purpose of the Study:
- To systematically screen for VPD in very or extremely preterm infants from 1 to 2 years corrected age (CA).
- To evaluate the effectiveness of early referral and diagnostic methods for VPD.
- To assess the progression of visual orienting functions (VOF) and neurodevelopmental outcomes.
Main Methods:
- A two-step screening for VPD was conducted at 1 year CA in 48 preterm infants (<30 weeks gestation).
- Screening included neurological assessment for visual brain damage and an eye-tracking-based test of visual orienting functions (VOF).
- Children identified at risk underwent conventional ophthalmic exams and visual function assessments (VFA); VOF and neurodevelopment were reassessed at 2 years CA.
Main Results:
- 38% of infants (18/48) were classified at risk for VPD at 1 year CA.
- Conventional ophthalmic exams revealed hypermetropia (21%) and strabismus (14%), while VFA showed deficits in only one child.
- VOF screening indicated an increase in abnormal results by 2 years CA, particularly in infants initially without VPD risk, suggesting disease progression or delayed manifestation.
Conclusions:
- A significant proportion of preterm infants are at risk for VPD, but conventional diagnostics may underestimate the prevalence.
- Functional VOF assessment is a valuable complementary tool to conventional methods for early VPD detection.
- Continuous and extensive screening is recommended for preterm infants, at least until school age, to monitor visual development and manage VPD effectively.
Abstract:
Introduction: Children with early brain damage or dysfunction are at risk of developing cerebral visual impairment (CVI), including visual processing dysfunctions (VPD), which currently remain largely undetected until school age. Our aim was to systematically screen for possible VPD in children born very or extremely preterm from 1 to 2 years corrected age (CA) and to evaluate the effectiveness of early referral. Method: We included N = 48 children born < 30 weeks from 1 year CA. They underwent a two-step VPD screening based on (1) neurological signs indicative of visual brain damage evaluated by neonatologists and/or pediatric neurologist and (2) a functional assessment of visual orienting functions (VOF) with an eye tracking-based test. If at least one of these assessments was abnormal for their age, the children were classified as a risk of VPD and referred to undergo conventional visual diagnostics: ophthalmic exam and visual function assessment (VFA). At 2 years CA, VOF screening was repeated and neurodevelopment was assessed. Results: 18 children (38%) were classified as at risk of VPD at 1 year CA. 7 children had abnormal neurological signs, 5 children had abnormal VOF, and 6 children had both. Subsequent ophthalmic exams (N = 14) showed severe hypermetropia in 21% and strabismus in 14%. VFA (N = 10) showed abnormal visual function and behavior in only 1 child. At 2 years CA, the total group showed an increase in abnormal VOF. Whereas the children at risk showed some normalization, the group without VPD risk at 1 year CA showed deterioration of VOF. Neurodevelopmental outcome did not clearly differ between risk groups. Conclusion: Our findings show a substantial risk of VPD during visual screening (in 38%) at 1 year CA, but relatively few deficits on subsequent conventional ophthalmic exams and VFA. The data suggest that most conventional visual diagnostic methods at this young age are not related to the established VPD risks. VOF assessment should be used complimentary to these methods. The fact that at 2 years CA the number of children with a VPD risk based on abnormal VOF increased argues for more extensive and continuous screening in risk groups, at least until school age.
