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Vision function in children 10 years after grade 3 or 4 intraventricular haemorrhage with ventricular dilation: A
Cathy Williams1,2, Penny Warnes2, Sally Jary3
1Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK.
Insights
Children with severe intraventricular haemorrhage and ventricular dilation (IVHVD) experience significant visual impairments. Grade 4 IVHVD leads to more vision problems, impacting educational support needs.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Developmental Pediatrics
Background:
- Intraventricular haemorrhage and ventricular dilation (IVHVD) can affect neurodevelopment in children.
- Long-term visual outcomes following severe IVHVD are not fully understood.
- Understanding visual morbidity is crucial for comprehensive child development assessment.
Purpose of the Study:
- To assess visual outcomes in children 10–11 years after grade 3 or 4 IVHVD.
- To determine if the severity of IVHVD correlates with the degree of visual impairment.
- To explore associations between visual outcomes, cognitive function, and educational support needs.
Main Methods:
- A 10-year follow-up of children from a randomized trial.
- Standardized visual examinations conducted by masked testers.
- Statistical analysis of visual impairments, IVHVD grade, cognitive outcomes, and educational support.
Main Results:
- All 32 children studied had at least one visual impairment.
- Children with grade 4 IVHVD had a median of six impairments versus three for grade 3 (p=0.003).
- Each additional visual impairment correlated with increased need for educational support (OR=1.7, p=0.015).
Conclusions:
- Children with grade 3 or 4 IVHVD exhibit substantial visual morbidity by age 10–11.
- Higher grade IVHVD is associated with a greater number of vision impairments.
- Addressing unmet visual needs may improve developmental outcomes and reduce the need for extra educational support.
Aim:
We examined children 10 to 11 years after grade 3 or 4 intraventricular haemorrhage and ventricular dilation (IVHVD) and investigated whether the grade of IVHVD affected their visual outcome. We explored associations between visual outcomes with cognitive outcomes and extra support at school.
Method:
The visual examinations were part of a 10-year follow-up study for children in a randomized trial. Testers followed a protocol and were masked to whether the child had experienced grade 3 or grade 4 IVHVD and all other data.
Results:
Thirty-two children were tested: 24 were male and mean (standard deviation) age was 10 years 5 months (1 year 2 months); range 8 years 9 months to 12 years 9 months. All had at least one visual impairment. The median (interquartile range) number of impairments per child was six (six to nine) for children who experienced a grade 4 IVHVD compared with three (two to four) for children who experienced a grade 3 IVHVD (p = 0.003). Each extra vision impairment per child was associated with increased educational support at school, after adjustment for developmental age equivalence (odds ratio = 1.7 [95% confidence interval 1.1-2.6], p = 0.015).
Interpretation:
Children who experience grade 3 or 4 IVHVD have a high level of visual morbidity at age 10 to 11 years. These children may have unmet visual needs and their outcomes might improve if these needs could be addressed.
What This Paper Adds:
Parent-reported questionnaire responses underestimated directly assessed visual morbidity. Grade 4 intraventricular haemorrhage and ventricular dilatation (IVHVD) was followed by more vision impairments than grade 3 IVHVD. Simple tests of visual perceptual skills correlated with the neuropsychology tests. Children with supranuclear eye movement disorders were more likely to be receiving extra help at school. Each additional visual impairment increased the likelihood of extra educational support.
