Early Screening of Visual Processing Dysfunctions in Children Born Very or Extremely Preterm.

Marlou J G Kooiker,Maud M Van Gils,Renate M C Swarte,Sjoukje Loudon,Irwin K M Reiss,Johan J M Pel,Liesbeth S Smit,Sanny Van Der Steen,Ymie J Van Der Zee,Johannes Van Der Steen

doi:10.3389/fnhum.2021.729080

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.

Highlights

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
All children who were born before 30 weeks gestational age (GA) and who participated in the outpatient clinical follow-up program of the dept
Children were excluded from participation based on the following criteria: Visual acuity below 0.05 Snellen equivalent, to ensure visibility of the eye tracking-based assessment; a high chance of epileptic activity during assessment, i.e., more than two attacks in the previous year or when actively using the anti-epileptic Vigabatrin; retinopathy of prematurity (ROP) of grade 3 or higher assessed by a pediatric ophthalmologist, to exclude severe causes of visual dysfunctions other than VPD

Summary

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. The problems children with CVI can experience already early in life range from lower-order visual sensory and oculomotor deficits to problems with information processing and higher-order visual perception problems (Dutton and Jacobson, 2001; Stiers et al, 2001). These problems can have a detrimental effect on (later) cognitive and motor development (Sonksen and Dale, 2002). It has been argued repeatedly that screening and possible intervention for CVI must take place preferably in the early years of high neuroplasticity, both by researchers (e.g., ̇Idil et al, 2021) and clinicians

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