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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.
Frontiers in Human Neuroscience
|November 18, 2021
Summary
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.
