Kooiker Marlou J G, van Gils Maud M, van der Zee Ymie J, Swarte Renate M C, Smit Liesbeth S, Loudon Sjoukje, van der Steen Sanny, Reiss Irwin K M, Pel Johan J M, van der Steen Johannes
Department Neuroscience, Erasmus MC, Rotterdam, Netherlands.
Royal Dutch Visio, Heerhugowaard, Netherlands.
Front Hum Neurosci. 2021 Nov 1;15:729080. doi: 10.3389/fnhum.2021.729080. eCollection 2021.
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. We included = 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. 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 ( = 14) showed severe hypermetropia in 21% and strabismus in 14%. VFA ( = 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. 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.
患有早期脑损伤或功能障碍的儿童有患脑性视觉障碍（CVI）的风险，包括视觉加工功能障碍（VPD），目前在学龄期之前这些问题在很大程度上仍未被发现。我们的目的是系统筛查出生时为极早产或超早产的儿童在矫正年龄1至2岁时可能存在的VPD，并评估早期转诊的有效性。我们纳入了48名矫正年龄1岁时出生孕周小于30周的儿童。他们接受了两步VPD筛查，第一步基于（1）由新生儿科医生和/或儿科神经科医生评估的提示视觉脑损伤的神经学体征，第二步基于一项使用眼动追踪测试对视觉定向功能（VOF）进行的功能评估。如果这些评估中至少有一项对于其年龄来说是异常的，这些儿童就被归类为有VPD风险，并被转诊去接受传统的视觉诊断：眼科检查和视觉功能评估（VFA）。在矫正年龄2岁时，重复进行VOF筛查并评估神经发育情况。18名儿童（38%）在矫正年龄1岁时被归类为有VPD风险。7名儿童有异常神经学体征，5名儿童VOF异常，6名儿童两者都有异常。随后的眼科检查（n = 14）显示21%有严重远视，14%有斜视。VFA（n = 10）仅显示1名儿童视觉功能和行为异常。在矫正年龄2岁时，总体显示VOF异常情况有所增加。有风险的儿童显示出一些恢复正常的情况，而矫正年龄1岁时无VPD风险的儿童组VOF出现恶化。风险组之间神经发育结局没有明显差异。我们的研究结果表明，在矫正年龄1岁时进行视觉筛查期间有相当比例（38%）的儿童有VPD风险，但随后的传统眼科检查和VFA显示缺陷相对较少。数据表明，在这个年幼时期，大多数传统视觉诊断方法与已确定的VPD风险无关。VOF评估应作为这些方法的补充使用。矫正年龄2岁时基于VOF异常而有VPD风险的儿童数量增加这一事实表明，应对风险组进行更广泛和持续的筛查，至少直到学龄期。
