Abstract
Background:
Cerebral visual impairment (CVI) is a major cause of visual impairment, with very preterm birth/very low birth weight (VP/VLBW) being a major risk factor. There is no generally accepted definition of CVI. This study aims to investigate the usefulness of an empirically-based functional definition of CVI.
Methods:
One-hundred-five VP/VLBW children and 67 controls participated. CVI was defined after comprehensive oculomotor, visual sensory and perceptive assessment, and validated against vision problems in daily life and in terms of intellectual, behavioral, emotional and social functioning, as well as use of therapeutic services.
Results:
Twenty-four per cent of the VP/VLBW children met criteria for CVI, compared to 7% of controls (P = 0.006, OR: 3.86, 95% CI: 1.40–10.70). VP/VLBW children with CVI had lower performance IQ, but not verbal IQ, than those without CVI. Visual problems in daily life were confirmed in VP/VLBW children classified with CVI. Additionally, difficulties in behavioral and social functioning were most prominent among VP/VLBW children with CVI.
Conclusion:
In VP/VLBW children, CVI defined in terms of visual function deficits is accompanied by intellectual, behavioral, and social impairments, validating our operational definition of CVI. CVI might act as a marker for developmental problems in VP/VLBW children.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Hatton DD, Schwietz E, Boyer B, Rychwalski P. Babies Count: the national registry for children with visual impairments, birth to 3 years. J AAPOS 2007;11:351–5.
Rahi JS, Cable N ; British Childhood Visual Impairment Study Group. Severe visual impairment and blindness in children in the UK. Lancet 2003;362:1359–65.
Good WV, Jan JE, DeSa L, Barkovich AJ, Groenveld M, Hoyt CS. Cortical visual impairment in children. Surv Ophthalmol 1994;38:351–64.
Dutton GN, Jacobson LK. Cerebral visual impairment in children. Semin Neonatol 2001;6:477–85.
Edmond JC, Foroozan R. Cortical visual impairment in children. Curr Opin Ophthalmol 2006;17:509–12.
Fazzi E, Signorini SG, Bova SM, et al. Spectrum of visual disorders in children with cerebral visual impairment. J Child Neurol 2007;22:294–301.
Braddick O, Atkinson J, Wattam-Bell J. Normal and anomalous development of visual motion processing: motion coherence and ‘dorsal-stream vulnerability’. Neuropsychologia 2003;41:1769–84.
Kravitz DJ, Saleem KS, Baker CI, Mishkin M. A new neural framework for visuospatial processing. Nat Rev Neurosci 2011;12:217–30.
Atkinson J, Braddick O. Visual attention in the first years: typical development and developmental disorders. Dev Med Child Neurol 2012;54:589–95.
Khetpal V, Donahue SP. Cortical visual impairment: etiology, associated findings, and prognosis in a tertiary care setting. J AAPOS 2007;11:235–9.
Cooke RW, Foulder-Hughes L, Newsham D, Clarke D. Ophthalmic impairment at 7 years of age in children born very preterm. Arch Dis Child Fetal Neonatal Ed 2004;89:F249–53.
Jongmans M, Mercuri E, Henderson S, de Vries L, Sonksen P, Dubowitz L. Visual function of prematurely born children with and without perceptual-motor difficulties. Early Hum Dev 1996;45:73–82.
Geldof CJ, van Wassenaer AG, de Kieviet JF, Kok JH, Oosterlaan J. Visual perception and visual-motor integration in very preterm and/or very low birth weight children: a meta-analysis. Res Dev Disabil 2012;33:726–36.
O’Connor AR, Stephenson T, Johnson A, et al. Long-term ophthalmic outcome of low birth weight children with and without retinopathy of prematurity. Pediatrics 2002;109:12–8.
Volpe JJ. Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances. Lancet Neurol 2009;8:110–24.
Macintyre-Béon C, Young D, Dutton GN, et al. Cerebral visual dysfunction in prematurely born children attending mainstream school. Doc Ophthalmol 2013;127:89–102.
Ortibus E, Laenen A, Verhoeven J, et al. Screening for cerebral visual impairment: value of a CVI questionnaire. Neuropediatrics 2011;42:138–47.
de Kieviet JF, van Elburg RM, Lafeber HN, Oosterlaan J. Attention problems of very preterm children compared with age-matched term controls at school-age. J Pediatr 2012;161:824–9.
Geldof CJ, Oosterlaan J, Vuijk PJ, de Vries MJ, Kok JH, van Wassenaer-Leemhuis AG. Visual sensory and perceptive functioning in 5-year-old very preterm/very-low-birthweight children. Dev Med Child Neurol 2014;56:862–8.
Leavey A, Zwaigenbaum L, Heavner K, Burstyn I. Gestational age at birth and risk of autism spectrum disorders in Alberta, Canada. J Pediatr 2013;162:361–8.
Aarnoudse-Moens CS, Weisglas-Kuperus N, van Goudoever JB, Oosterlaan J. Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children. Pediatrics 2009;124:717–28.
Potharst ES, van Wassenaer AG, Houtzager BA, van Hus JW, Last BF, Kok JH. High incidence of multi-domain disabilities in very preterm children at five years of age. J Pediatr 2011;159:79–85.
van Haastert IC, Groenendaal F, Uiterwaal CS, et al. Decreasing incidence and severity of cerebral palsy in prematurely born children. J Pediatr 2011;159:86–91.e1.
Joly O, Frankó E. Neuroimaging of amblyopia and binocular vision: a review. Front Integr Neurosci 2014;8:62.
Berman JI, Glass HC, Miller SP, et al. Quantitative fiber tracking analysis of the optic radiation correlated with visual performance in premature newborns. AJNR Am J Neuroradiol 2009;30:120–4.
Groppo M, Ricci D, Bassi L, et al. Development of the optic radiations and visual function after premature birth. Cortex 2014;56:30–7.
Thompson DK, Thai D, Kelly CE, et al. Alterations in the optic radiations of very preterm children-Perinatal predictors and relationships with visual outcomes. Neuroimage Clin 2014;4:145–53.
Lindqvist S, Skranes J, Eikenes L, et al. Visual function and white matter microstructure in very-low-birth-weight (VLBW) adolescents–a DTI study. Vision Res 2011;51:2063–70.
Koldewijn K, Wolf MJ, van Wassenaer A, et al. The Infant Behavioral Assessment and Intervention Program for very low birth weight infants at 6 months corrected age. J Pediatr 2009;154:33–38.e2.
Robaei D, Rose K, Ojaimi E, Kifley A, Huynh S, Mitchell P. Visual acuity and the causes of visual loss in a population-based sample of 6-year-old Australian children. Ophthalmology 2005;112:1275–82.
Junghans B, Kiely PM, Crewther DP, Crewther SG. Referral rates for a functional vision screening among a large cosmopolitan sample of Australian children. Ophthalmic Physiol Opt 2002;22:10–25.
Hargadon DD, Wood J, Twelker JD, Harvey EM, Dobson V. Recognition acuity, grating acuity, contrast sensitivity, and visual fields in 6-year-old children. Arch Ophthalmol 2010;128:70–4.
Aring E, Grönlund MA, Andersson S, Hård AL, Ygge J, Hellström A. Strabismus and binocular functions in a sample of Swedish children aged 4-15 years. Strabismus 2005;13:55–61.
Macintyre-Beon C, Young D, Calvert J, Ibrahim H, Dutton GN, Bowman R. Reliability of a question inventory for structured history taking in children with cerebral visual impairment. Eye (Lond) 2012;26:1393.
Geldof CJ, de Kieviet JF, Dik M, Kok JH, van Wassenaer-Leemhuis AG, Oosterlaan J. Visual search and attention in five-year-old very preterm/very low birth weight children. Early Hum Dev 2013;89:983–8.
Sattler JM. Assessment of Children: Cognitive Applications. 4th edn. San Diego, CA: Jerome M. Sattler, Publisher, 2001.
Groth-Marnat G. Handbook of Psychological Assessment. Hoboken, NJ: John Wiley & Sons, 1997.
Goodman R. The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry 1997;38:581–6.
Hartman CA, Luteijn E, Serra M, Minderaa R. Refinement of the Children’s Social Behavior Questionnaire (CSBQ): an instrument that describes the diverse problems seen in milder forms of PDD. J Autism Dev Disord 2006;36:325–42.
Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd edn. Hillsdale, NJ: Lawrence Erlbaum Associates, 1988.
Acknowledgements
We are most grateful to J Atkinson, O Braddick, and J Wattam-Bell for sharing the static and motion coherence tasks, and to GN Dutton for sharing the CVI inventory. We thank M Apeldoorn, M Meijer, and S van der Zwet-Slotemaker for conducting the orthoptic assessments. This paper builds on previously published results obtained from the same sample as the sample described in the current manuscript. Previous published results concern outcomes of the assessments of visual as well as attention functioning, which has been clearly indicated in the manuscript. The current paper reports the consequences of visual deficits in other domains of functioning. Previously published results can be found here: Geldof CJA, Oosterlaan J, de Vries MJ, Kok JH, van Wassenaer-Leemhuis AG 2014 Visual Sensory and Perceptive Functioning in Five-Year-Old Very Low Birth Weight Children. Dev Med Child Neurol 56:862–8. Geldof CJA, de Kieviet JF, Dik M, Kok JH, van Wassenaer-Leemhuis AG, Oosterlaan J 2013 Visual search and attention in five-year-old very preterm/very low birth weight children. Early Hum Dev 89:983–8.
Author information
Authors and Affiliations
Corresponding author
PowerPoint slides
Rights and permissions
About this article
Cite this article
Geldof, C., van Wassenaer-Leemhuis, A., Dik, M. et al. A functional approach to cerebral visual impairments in very preterm/very-low-birth-weight children. Pediatr Res 78, 190–197 (2015). https://doi.org/10.1038/pr.2015.83
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/pr.2015.83
