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Visual impairment in preterm children with periventricular leukomalacia--visual, cognitive and neuropaediatric
1Department of Ophthalmology, Huddinge Hospital, Sweden.
Insights
Periventricular leukomalacia (PVL) in preterm children causes significant visual impairment and cognitive challenges. Visual perceptual difficulties exacerbate the handicap beyond acuity deficits, with some children lacking expected motor impairments.
Area of Science:
- Neuroscience
- Ophthalmology
- Developmental Pediatrics
Background:
- Periventricular leukomalacia (PVL) is a common cause of neurological damage in preterm infants.
- Visual impairment is a frequent sequela of PVL, impacting development.
- The full spectrum of functional deficits associated with PVL requires further elucidation.
Purpose of the Study:
- To assess visual function, cognitive profiles, and motor skills in preterm children with PVL.
- To understand the relationship between visual impairment, cognitive abilities, and motor function in this cohort.
- To identify unexpected clinical presentations in children with PVL.
Main Methods:
- Evaluation of 13 preterm children (aged 4-14 years) with diagnosed bilateral PVL.
- Assessment of visual function including acuity, visual fields, and ocular motility.
- Cognitive and motor function assessments, including intellectual level and profile analysis.
- Neuroimaging (CT/MRI) to confirm PVL.
Main Results:
- All children exhibited visual impairment (low acuity, crowding, visual field defects, motility issues).
- Cognitive profiles were uneven, with verbal skills often surpassing visual-spatial abilities.
- Intellectual levels ranged from normal to severe mental retardation.
- Visual perceptual difficulties significantly contributed to the visual handicap.
- Six children with confirmed PVL showed no motor impairment, contrary to expectations for cerebral palsy.
Conclusions:
- PVL in preterm children leads to complex visual and cognitive impairments, often exceeding deficits predicted by acuity alone.
- Visual perceptual deficits are a critical component of the visual handicap in PVL.
- The absence of motor impairment in a subset of children with PVL challenges typical associations with cerebral palsy, highlighting neurodevelopmental variability.
Abstract:
Thirteen preterm children, aged 4 to 14 years, with visual impairment due to periventricular leukomalacia (PVL) were evaluated for visual function, intellectual level, cognitive profile and motor function. Their visual impairment was characterized by low acuity, crowding, visual field defects and ocular motility disturbances. Their cognitive profile was uneven, often with considerably higher scores on verbal than on visual-spatial tasks. Nine children had normal intelligence, three had mild mental retardation and one had severe mental retardation. In all the children, visual impairment was complicated by visual perceptual difficulties, accounting for their greater visual handicap than would be expected from their visual acuities and strabismus alone. Though CT or MRI revealed bilateral PVL in all the children, six had no motor impairment consistent with cerebral palsy, which is an unexpected finding.