Relationship between visual and neurodevelopmental measures at 2 years with visual acuity and stereopsis at 4.5 years in children born at risk of neonatal hypoglycaemia.

Abstract

Mild to moderate vision loss affects many children and can negatively impact a child's early literacy and academic achievement. Nevertheless, there is no consensus on which factors present in early childhood indicate the need for long-term ophthalmic follow up, particularly in children with a history of perinatal adversity. This study identified the relationship between visual, cognitive, motor and demographic factors at 2years of age and visual acuity (VA) and stereoacuity at 4.5years of age. Five hundred sixteen children identified as being at risk of neonatal hypoglycaemia were recruited soon after birth. At 2years of age, binocular VA, stereoacuity and non-cycloplegic refraction were measured and a clinical neuro-developmental assessment with the Bayley Scales of Infant Development III (BSID-III) was conducted by a trained examiner. Monocular VA and stereoacuity were measured at 4.5years of age. Three hundred twenty-eight children completed both the 2 and 4.5year vision and neurodevelopmental assessments. Multiple linear regression showed oblique astigmatism and motor function at 2years were significantly associated with VA at 4.5years of age, while spherical equivalent refraction, motor scores and stereoacuity at 2years were significantly associated with stereoacuity at 4.5years of age. BSID-III motor scores had the best sensitivity (81.8%) and specificity (51.5%) for identifying impaired stereoacuity at 4.5years. However, all measures at 2 years were poorly associated with VA at 4.5years old. Vision and neurodevelopmental measures at 2years were poorly associated with visual function at 4.5years of age. However, lower scores on tests of motor function at 2years may be associated with vision abnormalities, particularly reduced stereopsis, at 4.5years of age and referral for comprehensive vision assessment for these children may be warranted.