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

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

*Corresponding author for this work

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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.

Original languageEnglish
Article number729080
JournalFrontiers in Human Neuroscience
Publication statusPublished - 1 Nov 2021

Bibliographical note

Funding Information:
We wish to acknowledge all involved behavioral therapists and psychologists from Royal Dutch Visio locations Rotterdam, The Hague, Goes, and Breda, neonatologists from the outpatient clinic of Neonatology (Erasmus MC Sophia Children?s hospital), and all involved ophthalmologists and orthoptists (Erasmus MC Sophia Children?s Hospital?Pediatric Ophthalmology) for their efforts. We thank Jacqueline Thijs and Jeannette Jungschlager for administrative support, and Marieke Telleman, Jan Roelof Polling, and Marieke Steendam for consultation.

Funding Information:
Financial support for this study was provided by Stichting NOVUM (stichtingnovum.org), Grant No. OI0342. The study sponsor has no involvement in study design; collection, management, analysis, and interpretation of data; writing of the report; and the decision to submit the report for publication.

Publisher Copyright:
Copyright © 2021 Kooiker, van Gils, van der Zee, Swarte, Smit, Loudon, van der Steen, Reiss, Pel and van der Steen.

Research programs

  • EMC MM-03-54-04-A


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