Teller Acuity Cards Research Articles

A computerized resolution visual acuity test in preschool and school age children.

To develop a novel approach called the Autoacuity Tester, and to evaluate its validity, especially the sensitivity and specificity for detecting amblyopia. Children aged from 3 to 12y (n=552) were enrolled in the study. The validity of the Autoacuity Tester was evaluated by comparing it to the Tumbling E Early Treatment Diabetic Retinopathy Study (ETDRS) acuity chart for school age children, and Lea Symbols and Teller acuity card (TAC) for preschool children. The repeatability was assessed by coefficient of repeatability (COR). The sensitivity and specificity for detecting amblyopia were calculated. The mean difference (95% limits of agreement) between the Autoacuity Tester and the ETDRS tests were -0.03 (-0.24, 0.19) logMAR for the school age group. In preschool children, the mean difference was 0.04 (-0.14, 0.21) logMAR between the Autoacuity Tester and the TAC and 0.00 (-0.17, 0.18) logMAR between the Autoacuity Tester and the Lea Symbols. For the school age group, the COR was 0.20 logMAR for the Autoacuity Tester and 0.18 logMAR for the ETDRS. For the preschool group, the COR was 0.13 logMAR for the Autoacuity Tester and 0.21 logMAR for TAC. The Autoacuity Tester (88%) is more sensitive than TAC (72%) in detecting amblyopia (P=0.04), while had similar specificity (92% vs 90%, P=0.20). The Autoacuity Tester provides a reliable alternative for assessing visual acuity, and offers advantage of higher testability and repeatability for preschool children.

Prenatal exposure to legacy contaminants and visual acuity in Canadian infants: a maternal-infant research on environmental chemicals study (MIREC-ID)

BackgroundPrenatal exposure to environmental contaminants can have deleterious effects on child development. While psychomotor, cognitive and behavioural outcomes have been investigated in relation to chronic exposure, the associations with visual functions remains unclear. The present study’s aim was to assess the associations of prenatal exposure to legacy persistent organic pollutants and heavy metals with visual acuity in Canadian infants. The potential protective effects of selenium against mercury toxicity were also examined.MethodsParticipants (mean corrected age = 6.6 months) were part of the Maternal-Infant Research on Environmental Chemicals (MIREC) study. Concentrations of polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), lead and mercury were measured in maternal blood during pregnancy, as well as in the cord blood. The Teller acuity card test (TAC) (n = 429) and the visual evoked potentials in a sub-group (n = 63) were used to estimate behavioural and electrophysiological visual acuity, respectively. Multivariable linear regression models were used to investigate the relationship between exposure to each contaminant and visual acuity measures, while controlling for potential confounders. Breastmilk selenium, which was available for about half of the TAC and VEP samples, was also taken into account in the mercury models as exploratory analyses.ResultsWe observed no significant associations between exposure to any contaminants and TAC. Analyses revealed a negative trend (p values < 0.1) between cord blood lead and mercury and electrophysiological visual acuity, whereas PCB and PBDE showed no association. When adding breastmilk selenium concentration to the mercury models, this association became statistically significant for cord concentrations (β = − 3.41, 95% CI = − 5.96,-0.86), but also for blood levels at 1st and 3rd trimesters of pregnancy (β = − 3.29, 95% CI = − 5.69,-0.88). However, further regression models suggested that this change in estimates might not be due to adjustment for selenium, but instead to a change in the study sample.ConclusionsOur results suggest that subtle, but detectable alterations of infant electrophysiological visual acuity can be identified in a population prenatally exposed to low mercury concentrations. Compared to behavioural visual acuity testing, electrophysiological assessment may more sensitive in detecting visual neurotoxicity in relation with prenatal exposure to mercury.

Longitudinal visual acuity development in ZIKV-exposed children

To follow the visual acuity development of children exposed to or infected with the Zika virus (ZIKV) during gestation and to relate potential visual acuity deficits to their clinical condition. In this prospective study, visual acuity was measured via Teller Acuity Cards in three groups of children: (1) those with confirmed ZIKV exposure (ZE) through the mother only, (2) those with confirmed infection (ZI), and (3) unaffected controls. Visual acuity was measured 2-4 times in each child during the first 30months of age. The study included 22 children in the ZE group, 11 in the ZI group, and 27 controls. Visual acuity developed normally in both patient groups, including infected patients (ZI) that did not manifest clinical symptoms. In a small subgroup of patients with characteristics consistent with congenital Zika syndrome (CZS), visual acuity was within normative values, with the exception of single child with chorioretinal atrophy. In this southeastern Brazil study cohort, visual acuity development seemed to progress normally in infected children without CZS symptoms.

S5A-04 SESSION 5A: GENERALITIES IN CRANIOSYNOSTOSIS – PART II OPHTHALMOLOGICAL FINDINGS IN INFANTS WITH NON-SYNDROMIC CRANIOSYNOSTOSIS.

Introduction: The aim was to report the ophthalmological findings in infants and children born with non-syndromic craniosynostosis preoperatively and 6–12 months after surgery. Methods: Infants referred to the Department of Plastic surgery, Uppsala University Hospital for surgery of craniosynostosis were examined. Patients with craniosynostosis syndromes were excluded. Preoperatively visual acuity was measured with Teller acuity cards or observation of fixation and follow. Strabismus and eye motility were noted. The refraction was measured in cycloplegia and fundoscopy was performed. The distances between inner and outer canthus were measured. The follow-up examination was performed at the children’s local hospital and data were retrieved from the medical records. Results: One hundred and twelve infants were examined preoperatively. The mean age at examination was 5.9 months. The main non-syndromic craniosynostosis was sagittal synostosis 68% (76/112). The prevalence of metopic synostosis was 17% (19/112), of unicoronar synostosis 12% (14/112) and combined synostosis 2.7% (3/112). Preoperatively, almost all infants had a visual behaviour normal for their age. The mean refraction was +2.48 Diopters (D) in their right eyes (RE) and +2.51D in their left eyes (LE). Strabismus was most common in children with unicoronar synostosis (55.5%). No infant had disc oedema or pale disc. The mean distance of inner and outer canthus was 26.7 mm and 66 mm respectively. At follow-up, 6–12 months after surgery, ninety eight children were examined. The mean age was 16.2 months. The mean refraction was +1.67D in both eyes. Postoperatively, four children with unicoronar synostosis were prescribed eyeglasses due to anisometropia and one child with metopic craniosynostosis was prescribed glasses due to high hypermetropia. Three children with strabismus preoperatively were yet to come for postoperative examination. Of the remaining six, the strabismus disappeared in three children with sagittal synostosis. In three cases, all with unicoronar synostosis the strabismus remained. Two new cases of strabismus in children operated for unicoronar synostosis were found postoperatively. One infant med combined synostosis had disc oedema Conclusion: In the present cohort of children with non-syndromic craniosynostosis, visual behaviour and refraction was normal for the age in most cases. However, children with unicoronar synostosis had higher prevalence of strabismus and anisometropia, both preoperatively and postoperatively, some of which developed after surgery, which indicates the necessity of ophthalmological evaluation both before as well as after reconstructive surgery

Visual assessment in Down Syndrome: The relevance of early visual functions.

Children with Down Syndrome (DS) have a high prevalence of ocular disorders, and even when ophthalmological deficits (i.e. refractive errors or strabismus) are corrected, visual acuity seems to have a different developmental trend compared to typical children. Unfortunately, there is no consensus about the age at which it is fundamental to perform a first comprehensive visual assessment in this population. We analyzed early visual functions in a sample of 42 Italian children with DS, in order to achieve new insights for early surveillance and intervention. DS children were evaluated with the Early Neurovisual Assessment, including Teller Acuity Cards (at 6, 12 and 18 months of age) and the Pediatric Ophthalmological Examination (within the 36th months of age). Visual acuity in our sample was lower than findings reported in the literature on healthy Italian children, but the values were within the confidence interval reported in previous studies on DS children. Moderate or severe refractive errors (> 3diopters) were present in five children (four had hyperopia and one myopia). Abnormalities in ocular motility were observed in 15 children and pathological findings for fundus oculi or lens were found in another eight. Furthermore, ophthalmological findings correlated with visual acuity at 18 months of age. According to our results, the Early Neurovisual Assessment at 18 months of life is a reliable tool for early detection of visual disorders in children with DS and it is useful for programming early intervention to promote their neurodevelopment.

Factors Associated With Lack of Vision Improvement in Children With Cortical Visual Impairment.

Improvement in vision has been noted in children with cortical visual impairment (CVI), resulting from disparate types of brain injury. The purpose of our study was to determine the risk factors associated with poor recovery of vision in this group of patients. Case records of children who were born before 2010 with at least 4 follow-up visits for CVI were reviewed for underlying etiologies of CVI, visual acuity (VA), and associated neurological and ophthalmological disorders. VA was assessed in 6 qualitative grades. Changes in VA were recorded as the difference between the grades of VA at presentation and the last follow-up visit. The outcome was calculated as a ratio of actual improvement to potential improvement in grades of qualitative VA. Multiple linear regression determined factors associated with lack of vision improvement in all children and based on etiology. Fifty-three children with CVI were identified. The median age at presentation was 13.6 months (range: 2.9-76.4 months) and the median follow-up was 5.8 years (1.1-16.3 years). CVI resulted from central nervous system (CNS) malformation (9.4%), hypoxic/inflammatory injury (15.1%), seizures (24.5%), and combined causes (51.0%). Vision improvement was noted in 83% of children. Lack of VA improvement was associated with older age at presentation in all children with CVI and within each etiological group except CNS malformation. None of the other investigated variables were associated with poor recovery of VA. Most of the children with CVI showed improvement in vision. Older age at presentation, but not etiology of CVI, was associated with poor improvement in VA.

Early intervention at home in infants with congenital brain lesion with CareToy revised: a RCT protocol

BackgroundCongenital brain lesions expose infants to be at high-risk for being affected by neurodevelopmental disorders such as cerebral palsy (CP). Early interventions programs can significantly impact and improve their neurodevelopment. Recently, in the framework of the European CareToy (CT) Project (www.caretoy.eu), a new medical device has been created to deliver an early, intensive, customized, intervention program, carried out at home by parents but remotely managed by expert and trained clinicians. Reviewing results of previous studies on preterm infants without congenital brain lesion, the CT platform has been revised and a new system created (CT-R).This study describes the protocol of a randomised controlled trial (RCT) aimed to evaluate, in a sample of infants at high-risk for CP, the efficacy of CT-R intervention compared to the Infant Massage (IM) intervention.Methods/designThis RCT will be multi-centre, paired and evaluator-blinded. Eligible subjects will be preterm or full-term infants with brain lesions, in first year of age with predefined specific gross motor abilities. Recruited infants will be randomized into CT-R and IM groups at baseline (T0). Based on allocation, infants will perform an 8-week programme of personalized CareToy activities or Infant Massage. The primary outcome measure will be the Infant Motor Profile. On the basis of power calculation, it will require a sample size of 42 infants. Moreover, Peabody Developmental Motor Scales-Second Edition, Teller Acuity Cards, standardized video-recordings of parent-infant interaction and wearable sensors (Actigraphs) will be included as secondary outcome measures. Finally, parents will fill out questionnaires (Bayley Social-Emotional, Parents Stress Index). All outcome measures will be carried out at the beginning (T0) and at end of 8-weeks intervention period, primary endpoint (T1). Primary outcome and some secondary outcomes will be carried out also after 2 months from T1 and at 18 months of age (T2 and T3, respectively). The Bayley Cognitive subscale will be used as additional assessment at T3.DiscussionThis study protocol paper is the first study aimed to test CT-R system in infants at high-risk for CP. This paper will present the scientific background and trial methodology.Trial registrationNCT03211533 and NCT03234959 (www.clinicaltrials.gov).

Visual Outcomes and Prognostic Factors of Successful Penetrating Keratoplasty in 0- to 7-Year-Old Children With Congenital Corneal Opacities.

To determine the visual acuity and prognostic factors after successful penetrating keratoplasty (PK) in 0 to 7-year-old children with congenital corneal opacities. Sixty eyes (50 patients) with clear grafts after PK for congenital corneal opacity were enrolled and followed for 6 to 82 months. Visual acuity was measured using Teller acuity cards or Snellen charts, and cycloplegic refraction and flash visual-evoked potentials were measured. Mean age at primary keratoplasty was 2.5 ± 1.7 years. The mean follow-up duration was 18.9 ± 19.3 months. Ambulatory vision (≥20/960) was achieved in 43 of 60 eyes (71.7%) at last follow-up, and 14 eyes (23.3%) had visual acuities >20/260. Compared with unilateral opacity eyes (58.8%), a significantly higher proportion of bilateral opacity eyes (88.5%) achieved ambulatory vision (P = 0.012). Of all the surgical indications, unilateral sclerocornea was associated with the worst visual outcome-only 12.5% obtained ambulatory vision. Additional intraocular surgery was also associated with a reduced ambulatory visual acuity outcome. There were no significant differences in visual acuity among the different follow-up subgroups (<12 months, 12-36 months, and >36 months after operation; P = 0.928). Patients with bilateral opacity had a higher proportion of abnormal amplitude flash visual-evoked potentials than did patients with unilateral opacity (P = 0.033). Ten of the 14 eyes that achieved 20/260 vision had corneal astigmatism ≤3 diopters. Most of the clear grafts after PK in children with congenital corneal opacities achieved ambulatory vision. The visual outcome was better in binocular opacity cases than in monocular ones.

Visual impairment evaluation in 119 children with congenital Zika syndrome

To assess visual impairment in a large sample of infants with congenital Zika syndrome (CZS) and to compare with a control group using the same assessment protocol. The study group was composed of infants with confirmed diagnosis of CZS. Controls were healthy infants matched for age, sex, and socioeconomic status. All infants underwent comprehensive ophthalmologic evaluation including visual acuity, visual function assessment, and visual developmental milestones. The CZS group included 119 infants; the control group, 85 infants. At examination, the mean age of the CZS group was 8.5±1.2months (range, 6-13months); of the controls, 8.4±1.8months (range, 5-12months; P=0.598). Binocular Teller Acuity Card (TAC) testing was abnormal in 107 CZS infants and in 4 controls (89.9% versus 5% [P<0.001]). In the study group, abnormal monocular TAC results were more frequent in eyes with funduscopic alterations (P=0.008); however, 104 of 123 structurally normal eyes (84.6%) also presented abnormal TAC results. Binocular contrast sensitivity was reduced in 87 of 107 CZS infants and in 8 of 80 controls (81.3% versus 10% [P<0.001]). The visual development milestones were less achieved by infants with CZS compared to controls (P<0.001). Infants with CZS present with severe visual impairment. A protocol for assessment of the ocular findings, visual acuity, and visual developmental milestones tested against age-matched controls is suggested.

The Ohio Contrast Cards: Visual Performance in a Pediatric Low-vision Site.

This report describes the first clinical use of the Ohio Contrast Cards, a new test that measures the maximum spatial contrast sensitivity of low-vision patients who cannot recognize and identify optotypes and for whom the spatial frequency of maximum contrast sensitivity is unknown. To compare measurements of the Ohio Contrast Cards to measurements of three other vision tests and a vision-related quality-of-life questionnaire obtained on partially sighted students at Ohio State School for the Blind. The Ohio Contrast Cards show printed square-wave gratings at very low spatial frequency (0.15 cycle/degree). The patient looks to the left/right side of the card containing the grating. Twenty-five students (13 to 20 years old) provided four measures of visual performance: two grating card tests (the Ohio Contrast Cards and the Teller Acuity Cards) and two letter charts (the Pelli-Robson contrast chart and the Bailey-Lovie acuity chart). Spatial contrast sensitivity functions were modeled using constraints from the grating data. The Impact of Vision Impairment on Children questionnaire measured vision-related quality of life. Ohio Contrast Card contrast sensitivity was always less than 0.19 log10 units below the maximum possible contrast sensitivity predicted by the model; average Pelli-Robson letter contrast sensitivity was near the model prediction, but 0.516 log10 units below the maximum. Letter acuity was 0.336 logMAR below the grating acuity results. The model estimated the best testing distance in meters for optimum Pelli-Robson contrast sensitivity from the Bailey-Lovie acuity as distance = 1.5 - logMAR for low-vision patients. Of the four vision tests, only Ohio Contrast Card contrast sensitivity was independently and statistically significantly correlated with students' quality of life. The Ohio Contrast Cards combine a grating stimulus, a looking indicator behavior, and contrast sensitivity measurement. They show promise for the clinical objective of advising the patient and his/her caregivers about the success the patient is likely to enjoy in tasks of everyday life.

The visual system in infants with microcephaly related to presumed congenital Zika syndrome

To describe and analyze ocular features in infants with microcephaly due to presumed congenital Zika syndrome. Ophthalmologic evaluation, including indirect ophthalmoscopy and eye fundus imaging, visual acuity testing with Teller Acuity Cards, and strabismus assessment were performed in infants with microcephaly at a nongovernmental organization clinic for visually disabled children. A total of 70 infants with microcephaly were referred to the clinic. Of these, 25 (mean age, 3months; 14 males) had ophthalmologic changes: 18 (26%) had intraocular abnormalities, including macular chorioretinal atrophy, mottled retinal pigment epithelium and optic nerve pallor; 7 patients (10%) had strabismus or nystagmus without intraocular abnormalities. Visual acuity was below normal range in all 11 infants tested. Ophthalmologic abnormalities occurred in 36% of the patients. Macular circumscribed chorioretinal atrophy, focal mottled retinal pigment epithelium, optic nerve pallor, early-onset strabismus, nystagmus and low visual acuity were common ophthalmological features in infants with microcephaly due to presumed congenital Zika syndrome.

A randomized clinical trial in preterm infants on the effects of a home-based early intervention with the 'CareToy System'.

CareToy system is an innovative tele-rehabilitative tool, useful in providing intensive, individualized, home-based, family-centred Early Intervention (EI) in infants. Our aim was to evaluate, through a Randomized Clinical Trial (RCT) study, the effects of CareToy intervention on early motor and visual development in preterm infants. 41 preterm infants (range age: 3.0–5.9 months of corrected age) were enrolled and randomized into two groups, CareToy and Standard Care. 19 infants randomized in CareToy group performed a 4-week CareToy program, while 22 allocated to control group completed 4 weeks of Standard Care. Infant Motor Profile (IMP) was primary outcome measure, Alberta Infant Motor Scale (AIMS) and Teller Acuity Cards were secondary ones. Assessments were carried out at baseline (T0) and at the end of CareToy training or Standard Care period (T1). T1 was the primary endpoint. After RCT phase, 17 infants from control group carried out a 4-week CareToy program, while 18 infants from the CareToy group continued with Standard Care. At the end of this phase, infants were re-assessed at T2. In RCT phase, delta IMP total score and variation and performance sub-domains were significantly higher (P<0.050) in CareToy group if compared to Standard Care group. Similar results were found for Teller Acuity Cards, while no differences between groups were found for AIMS. No differences were found in any outcome measure results (T2-T0), between infants who started CareToy training before or after one month of standard care. This RCT study confirms the results of a previous pilot study, indicating that CareToy system can provide effective home-based EI.Trial Registration: This trial has been registered at www.clinicaltrials.gov (Identifier NCT01990183).

Similarities and differences between behavioral and electrophysiological visual acuity thresholds in healthy infants during the second half of the first year of life

Behavioral and electrophysiological methods for visual acuity estimation typically correlate well in children and adult populations, but this relationship remains unclear in infants, particularly during the second half of the first year of life. It has been suggested that the agreement between both methods mostly relies on age and/or subjective acuity factors. The present study aimed at comparing acuity thresholds obtained with both approaches in a sample of healthy infants in a relatively narrow age range, that is 6-10months old. Acuity thresholds were assessed in 61 healthy infants aged between 6 and 10months using the Teller acuity cards (TAC) and sweep visual evoked potentials (sVEP). The TAC stimuli (stationary vertical gratings displayed on laminated cards) ranged from 0.31 to 38 cycles per degree (cpd). The TAC acuity threshold was estimated according to the highest spatial frequency scored by the experimenter as seen by the infant. The sVEP stimuli (high-contrast vertical gratings counter-phased at 12 reversals/s) ranged from 13.5 to 1cpd. sVEP were recorded at Oz and acuity threshold was estimated using regression linear fitting. Considering the entire sample, sVEP acuity thresholds (8.97±2.52cpd) were significantly better than TAC scores (5.58±2.95cpd), although the difference was within 1 octave for 64% of the infants. Neither Pearson nor intra-class correlations between the two methods were significant (0.18 and 0.03, respectively). While age at assessment was not related to any dependent variable (TAC, sVEP, sVEP-TAC difference score), subjective (behavioral) acuity was found to underlie the difference between the two methods. The difference between sVEP and TAC scores decreased as a function of subjective acuity, and at the highest subjective acuity level (>10cpd), TAC acuity slightly exceeded sVEP acuity. The superiority of sVEP acuity often reported in the literature was evident in our infant sample when subjective acuity (TAC) was low or moderate, but not when it was high (>10cpd). The relationship between the two estimation methods was not dependent on age, but on subjective acuity.

Longchain polyunsaturated fatty acid supplementation in preterm infants.

Controversy exists over whether longchain polyunsaturated fatty acids (LCPUFA) are essential nutrients for preterm infants because they may not be able to synthesise sufficient amounts of LCPUFA to meet the needs of the developing brain and retina. To assess whether supplementation of formula milk with LCPUFA is safe and of benefit to preterm infants. The main areas of interest were the effects of supplementation on the visual function, development and growth of preterm infants. Trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2) in the Cochrane Library (searched 28 February 2016), MEDLINE Ovid (1966 to 28 February 2016), Embase Ovid (1980 to 28 February 2016), CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1980 to 28 February 2016), MEDLINE In Process & Other Non-indexed Citations (1966 to 28 February 2016) and by checking reference lists of articles and conference proceedings. We also searched ClinicalTrials.gov (13 April 2016). No language restrictions were applied. All randomised trials evaluating the effect of LCPUFA-supplemented formula in enterally-fed preterm infants (compared with standard formula) on visual development, neurodevelopment and physical growth. Trials reporting only biochemical outcomes were not included. All authors assessed eligibility and trial quality, two authors extracted data separately. Study authors were contacted for additional information. Seventeen trials involving 2260 preterm infants were included in the review. The risk of bias varied across the included trials with 10 studies having low risk of bias in a majority of the domains. The median gestational age (GA) in the included trials was 30 weeks and median birth weight (BW) was 1300 g. The median concentration of docosahexaenoic acid (DHA) was 0.33% (range: 0.15% to 1%) and arachidonic acid (AA) 0.37% (range: 0.02% to 0.84%). Visual acuity Visual acuity over the first year was measured by Teller or Lea acuity cards in eight studies, by visual evoked potential (VEP) in six studies and by electroretinogram (ERG) in two studies. Most studies found no significant differences in visual acuity between supplemented and control infants. The form of data presentation and the varying assessment methods precluded the use of meta-analysis. A GRADE analysis for this outcome indicated that the overall quality of evidence was low. Neurodevelopment Three out of seven studies reported some benefit of LCPUFA on neurodevelopment at different postnatal ages. Meta-analysis of four studies evaluating Bayley Scales of Infant Development at 12 months (N = 364) showed no significant effect of supplementation (Mental Development Index (MDI): MD 0.96, 95% CI -1.42 to 3.34; P = 0.43; I² = 71% - Psychomotor DeveIopment Index (PDI): MD 0.23, 95% CI -2.77 to 3.22; P = 0.88; I² = 81%). Furthermore, three studies at 18 months (N = 494) also revealed no significant effect of LCPUFA on neurodevelopment (MDI: MD 2.40, 95% CI -0.33 to 5.12; P = 0.08; I² = 0% - PDI: MD 0.74, 95% CI -1.90 to 3.37; P = 0.58; I² = 54%). A GRADE analysis for these outcomes indicated that the overall quality of evidence was low. Physical growth Four out of 15 studies reported benefits of LCPUFA on growth of supplemented infants at different postmenstrual ages (PMAs), whereas two trials suggested that LCPUFA-supplemented infants grow less well. One trial reported mild reductions in length and weight z scores at 18 months. Meta-analysis of five studies (N = 297) showed increased weight and length at two months post-term in supplemented infants (Weight: MD 0.21, 95% CI 0.08 to 0.33; P = 0.0010; I² = 69% - Length: MD 0.47, 95% CI 0.00 to 0.94; P = 0.05; I² = 0%). Meta-analysis of four studies at a corrected age of 12 months (N = 271) showed no significant effect of supplementation on growth outcomes (Weight: MD -0.10, 95% CI -0.31 to 0.12; P = 0.34; I² = 65% - Length: MD 0.25; 95% CI -0.33 to 0.84; P = 0.40; I² = 71% - Head circumference: MD -0.15, 95% CI -0.53 to 0.23; P = 0.45; I² = 0%). No significant effect of LCPUFA on weight, length or head circumference was observed on meta-analysis of two studies (n = 396 infants) at 18 months (Weight: MD -0.14, 95% CI -0.39 to 0.10; P = 0.26; I² = 66% - Length: MD -0.28, 95% CI -0.91 to 0.35; P = 0.38; I² = 90% - Head circumference: MD -0.18, 95% CI -0.53 to 0.18; P = 0.32; I² = 0%). A GRADE analysis for this outcome indicated that the overall quality of evidence was low. Infants enrolled in the trials were relatively mature and healthy preterm infants. Assessment schedule and methodology, dose and source of supplementation and fatty acid composition of the control formula varied between trials. On pooling of results, no clear long-term benefits or harms were demonstrated for preterm infants receiving LCPUFA-supplemented formula.

Foveal Layer Morphology Detected on Spectral Domain Optical Coherence Tomography and its Correlation with Visual Acuity in Asian Indian Premature Infants in their First Year of Life

ABSTRACTPurpose: To report foveal microanatomy imaged on handheld spectral domain optical coherence tomography (SDOCT) and correlate it with visual acuity in Asian Indian premature infants.Methods: A retrospective analysis of 32 Asian Indian premature infants, 10 with Type 2 retinopathy of prematurity (ROP), were imaged between 3 and 12 months of corrected postmenstrual age (PMA) on the handheld SDOCT (Envisu 2300, Bioptigen, DNC, USA). The foveal findings on these images were correlated with visual acuity measured using Teller acuity cards. The study cohort was divided into three groups based on the corrected age, 3–<6 months, 6–<9 months, and 9–12 months. SDOCT images of the foveal center were analyzed for inner retinal layer (IRL) persistence or fusion and presence of the external limiting membrane (ELM), inner segment–outer segment or the ellipsoid zone (EZ), and the outer segment–retinal pigment epithelium (OS-RPE) layers.Results: The mean visual acuity of the three groups was 1.60, 1.63, and 1.23 logMAR, respectively (p < 0.001). Visual acuity significantly correlated with all four layers (IRL fusion, ELM, EZ, and OS-RPE in the 3–<6-month group [p < 0.001], IRL fusion only in 6–<9-month group (p < 0.001), and IRL fusion and EZ in the 9–12-month group (p < 0.001 and p = 0.01, respectively).Conclusions: The study provides insights into our understanding of a premature infant’s foveal maturation in the first year. Inner retinal fusion or maturation is the most important event that correlates with better visual acuity throughout the first year. In addition, between 9 and 12 months PMA, the completion of the EZ at the foveal center positively influenced visual acuity. The presence of ROP did not influence development of the layers, but the sample size was small for subgroup analysis.

Low-level prenatal lead exposure and infant sensory function.

BackgroundLead is a pervasive neurotoxicant that has been associated with poorer cognitive, behavioral, and motor outcomes in children. The effects of lead on sensory function have not been well characterized. The aim of this study was to assess the effects of prenatal lead exposure on infant sensory function, as measured by auditory brainstem response (ABR) and grating visual acuity (VA).MethodsLead was measured in maternal blood in mid- and late-pregnancy (mean gestational age = 15.5 and 39.0 weeks, respectively) and umbilical cord blood in a cohort of full-term infants in rural northeastern China. ABR latencies (peaks I, III, V) were measured in newborns during unsedated sleep (n = 315). The ABR central-to-peripheral (C-P) ratio was calculated as the ratio between the III-V and I-III interpeak intervals. VA was measured in 6-week-olds using Teller Acuity Cards (n = 1019) and assigned as the narrowest grid the infant fixated on. Multivariate linear regression was used to evaluate relationships between tertiles of mid-pregnancy, late-pregnancy, or cord lead and newborn ABR or 6-week VA.ResultsHigher late-pregnancy lead levels were associated with higher ABR C-P ratios and lower VA. In covariate-adjusted analyses, mean C-P ratios were 4.6 and 3.2 % higher in infants whose mothers had lead > 3.8 μg/dL and lead = 2–3.8 μg/dL, respectively, than for infants whose mothers had lead < 2 μg/dL (p-trend =0.002). In adjusted analyses for VA, mean scores were 8.5 and 7.2 % lower for maternal lead > 3.8 μg/dL and lead = 2–3.8 μg/dL, respectively, compared to lead < 2 μg/dL (p-trend =0.009).ConclusionAuditory and visual systems maturation appears delayed in infants with higher prenatal lead exposure during late-pregnancy, even at relatively low levels. Both systems start myelinating in late gestation and mature rapidly in infancy. Higher ABR C-P ratio and lower grating VA scores suggest effects of low-level lead exposure on sensory system myelination.Electronic supplementary materialThe online version of this article (doi:10.1186/s12940-016-0148-6) contains supplementary material, which is available to authorized users.

A pilot study on early home-based intervention through an intelligent baby gym (CareToy) in preterm infants

BackgroundCareToy is an intelligent system, inspired by baby gyms, aimed to provide an intensive, individualized, home-based and family-centred early intervention (EI) program. AimsA pilot study was carried out to explore the feasibility of CareToy intervention in preterm infants, aged 3–9 months of corrected age. MethodsTwenty low-risk preterm infants, without brain lesion or other clinical complications (14 allocated to CareToy intervention and 6 to Standard Care) were recruited. The Infant Motor Profile (IMP) was predefined as the primary outcome measure and Alberta Infant Motor Scale and Teller Acuity Cards as secondary measures. Moreover, 202 pre-programmed training scenarios were developed and instructions for the management of CareToy intervention were defined as general guidelines. Outcomes and resultsAll infants received 4 weeks of their allocated intervention and were evaluated with the selected tests before and immediately after the 4 weeks. The mean difference changes in IMP total score and Teller Acuity Cards over the intervention period were higher in the CareToy group than in the Standard Care group. Conclusions and implicationsCareToy seems a feasible device for providing EI. An adequately powered randomized clinical trial is warranted.

Visual sensory and ocular motor function in children with polymicrogyria: relationship to magnetic resonance imaging

To assess visual and ocular motor function in children with polymicrogyria (PMG). The medical records of 15 children (0.4-4years of age) with PMG documented by magnetic resonance imaging (MRI) and with age-corrected visual acuity measured by Teller acuity cards were reviewed retrospectively. Cortical function was assessed by pattern visually evoked potentials (VEP). Ocular motor function was assessed by video-oculography or clinical assessment. Results were compared to age-matched controls. Extent of PMG involvement varied from bilateral fronto-parietal to bilateral-diffuse. Nine children had involvement of the occipital lobe. Visual acuity at presentation was normal in 5 children (≥20/40 Snellen equivalent for age) and subnormal in 10 (average 20/200 equivalent). Visual acuity was similar in children with or without involvement of the occipital lobe (P=0.4). Follow-up visual acuity was available for 9 children; 3 improved and 6 failedto improve (5 of whom had seizures). PMG involving the occipital lobe significantly reduced VEP amplitude and signal-to-noise ratios. Three infants without visually-guided behaviors had VEP responses. All 3 children with cytomegalovirus-related PMG without retinal disease had preserved visual function despite generalized MRI abnormalities. All children with PMG had recordable visual function either by visual acuity or VEP testing, however the majority did not show longitudinal improvement in acuity. Seizures may impose limits on visual acuity development. Children with cytomegalovirus-related PMG, microcephaly, and developmental delay can have normal visual acuity. Children with a recordable VEP but without visually guided behaviors may have a defect in sensorimotor transformation.

Assessment of Grating Acuity in Infants and Toddlers Using an Electronic Acuity Card: The Dobson Card.

To determine if testing binocular visual acuity in infants and toddlers using the Acuity Card Procedure (ACP) with electronic grating stimuli yields clinically useful data. Participants were infants and toddlers ages 5 to 36.7 months referred by pediatricians due to failed automated vision screening. The ACP was used to test binocular grating acuity. Stimuli were presented on the Dobson Card. The Dobson Card consists of a handheld matte-black plexiglass frame with two flush-mounted tablet computers and is similar in size and form to commercially available printed grating acuity testing stimuli (Teller Acuity Cards II [TACII]; Stereo Optical, Inc., Chicago, IL). On each trial, one tablet displayed a square-wave grating and the other displayed a luminance-matched uniform gray patch. Stimuli were roughly equivalent to the stimuli available in the printed TACII stimuli. After acuity testing, each child received a cycloplegic eye examination. Based on cycloplegic retinoscopy, patients were categorized as having high or low refractive error per American Association for Pediatric Ophthalmology and Strabismus vision screening referral criteria. Mean acuities for high and low refractive error groups were compared using analysis of covariance, controlling for age. Mean visual acuity was significantly poorer in children with high refractive error than in those with low refractive error (P = .015). Electronic stimuli presented using the ACP can yield clinically useful measurements of grating acuity in infants and toddlers. Further research is needed to determine the optimal conditions and procedures for obtaining accurate and clinically useful automated measurements of visual acuity in infants and toddlers.

Early-Life Organophosphate Insecticide Exposure And Visual Acuity In Infants

Introduction: Organophosphate insecticides (OPs) are neurotoxic at high doses, however effects of low dose exposure are not well understood. Laboratory studies have shown that OPs at low doses may inhibit neuronal myelination, a process critical to visual pathway development early in life. Grating visual acuity (VA) rapidly improves in infancy, reflecting visual pathway myelination. VA might thus be sensitive to OP exposure. The aim here was to investigate the effect of prenatal OP exposure on infant VA. Methods: 24 OPs and 6 OP metabolites were measured using GC-tandem MS in umbilical cord blood plasma from infants in Fuyang County, China. VA was measured using Teller Acuity Cards at 6 wk (N=300), 9 mo (N=291), and 18 mo (N=288). Composite variables were created for total OP detects and total OP metabolite detects. Individual OPs and metabolites were analyzed as dichotomous (non-detect [ND]/detect), 3-level ordinal (ND/medium/high), or continuous, depending on detection rates. Multivariate linear regression was used to evaluate relationships between OP variables and VA. Results: 16 OPs and 6 metabolites were detected in at least one sample. Analyses of composite and dichotomous OP variables did not yield significant associations with VA. Chlorpyrifos, methamidophos, and trichlorfon were detected in 40, 66, and 56% of samples, respectively, and analyses as 3-level ordinal variables revealed suggestive, but not statistically significant, inverse associations between chlorpyrifos and trichlorfon and VA at 9 and 18 mo. Naled was detected in 94% of samples and continuous analyses found inverse associations with VA at 6 wk (β=-0.01; 95%CI:-0.02--0.001; p=0.03). Conclusions: VA in infancy may be adversely affected by certain OPs, though our results are largely inconclusive. Visual system development in infancy is critical to later learning processes and altered timing of visual pathway maturation may potentially contribute to poorer developmental outcomes later on.