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Duke RE, Nwachukuw J, Torty C, Okorie U, Kim MJ, Burton K, Gilbert C, Bowman R. Visual impairment and perceptual visual disorders in children with cerebral palsy in Nigeria. Br J Ophthalmol 2020; 106:427-434. [PMID: 33268343 DOI: 10.1136/bjophthalmol-2020-317768] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/27/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022]
Abstract
Cerebral palsy (CP) is the most common cause of childhood physical disability globally. This study describes the spectrum of ocular morbidity and visual impairment in a community-based (recruited by key informants) sample of children with CP in Cross River State, Nigeria. METHODS A paediatric neurologist clinically confirmed CP and assessed systemic comorbidity. Ophthalmological assessment included developmental age appropriate acuity tests, objective refraction and objective and subjective tests of perceptual visual dysfunction (PVD). RESULTS 388 children aged 4-15 years with CP were identified. Visual problems were reported by carers in only 55 (14%) cases. Binocular visual acuity impairment was seen in 20/201 by Lea symbols test (10%) and 213/388 (55%) by the mirror test. Abnormal visual fields were seen in 58/388 (14.9%); strabismus in 183 (47%) abnormal contrast sensitivity in 178 (46%) and abnormal saccades in 84 (22%), spherical refractive errors in 223 (58%), significant astigmatism in 36 (12%), accommodative dysfunction in 41 (10.6%), optic atrophy in 198 (51%). Perceptual visual disorders were present in 22 (6%) subjectively and 177 (46%) objectively. The estimated frequency of cerebral visual impairment (CVI) in children ranged from 61 (16%) to 191 (49%) if children with optic atrophy were included. CONCLUSION Children with CP have a wide spectrum of ocular morbidity and visual impairment, underestimated by carers. Children with CP require visual acuity assessments with a range of tests which account for associated comorbidities and oculomotor dysfunction. Functional vision assessments for PVD is important. CVI is common.
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Affiliation(s)
- Roseline Ekanem Duke
- Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria .,Clinical Research Unit, ITD, International Centre for Eye Health, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, London, UK
| | - Justin Nwachukuw
- Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Chima Torty
- Pediatric Neurology, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Uche Okorie
- Ophthalmology, Calabar Children's Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Min J Kim
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, London, UK
| | - Kathryn Burton
- Community Paediatrics, Cambridgeshire Community Services NHS Trust, Saint Ives, Cambridgeshire, UK
| | - Clare Gilbert
- Clinical Research Unit, ITD, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, London, UK
| | - Richard Bowman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, London, UK
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52
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Advances in the evaluation and management of cortical/cerebral visual impairment in children. Surv Ophthalmol 2020; 65:708-724. [DOI: 10.1016/j.survophthal.2020.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 12/14/2022]
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Kovarski K, Caetta F, Mermillod M, Peyrin C, Perez C, Granjon L, Delorme R, Cartigny A, Zalla T, Chokron S. Emotional face recognition in autism and in cerebral visual impairments: In search for specificity. J Neuropsychol 2020; 15:235-252. [PMID: 32920927 DOI: 10.1111/jnp.12221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/15/2020] [Indexed: 12/16/2022]
Abstract
Autism spectrum disorder (ASD) is characterized by difficulties in the social domain, but also by hyper- and hypo-reactivity. Atypical visual behaviours and processing have often been observed. Nevertheless, several similar signs are also identified in other clinical conditions including cerebral visual impairments (CVI). In the present study, we investigated emotional face categorization in groups of children with ASD and CVI by comparing each group to typically developing individuals (TD) in two tasks. Stimuli were either non-filtered or filtered by low- and high-spatial frequencies (LSF and HSF). All participants completed the autism spectrum quotient score (AQ) and a complete neurovisual evaluation. The results show that while both clinical groups presented difficulties in the emotional face recognition tasks and atypical processing of filtered stimuli, they did not differ from one another. Additionally, autistic traits were observed in the CVI group and symmetrically, some visual disturbances were present in the ASD group as measured via the AQ score and a neurovisual evaluation, respectively. The present study suggests the relevance of comparing ASD to CVI by showing that emotional face categorization difficulties should not be solely considered as autism-specific but merit investigation for potential dysfunction of the visual processing neural network. These results are of interest in both clinical and research perspectives, indicating that systematic visual examination is warranted for individuals with ASD.
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Affiliation(s)
- Klara Kovarski
- Institut de Neuropsychologie, Neurovision et Neurocognition, Hôpital Fondation Rothschild, Paris, France.,Université de Paris, CNRS, Integrative Neuroscience and Cognition Center, Paris, France, Paris, France
| | - Florent Caetta
- Institut de Neuropsychologie, Neurovision et Neurocognition, Hôpital Fondation Rothschild, Paris, France
| | - Martial Mermillod
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
| | - Carole Peyrin
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
| | - Céline Perez
- Institut de Neuropsychologie, Neurovision et Neurocognition, Hôpital Fondation Rothschild, Paris, France
| | - Lionel Granjon
- Université de Paris, CNRS, Integrative Neuroscience and Cognition Center, Paris, France, Paris, France
| | - Richard Delorme
- Department of Child and Adolescent Psychiatry, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris, France
| | - Ariane Cartigny
- Institut de Neuropsychologie, Neurovision et Neurocognition, Hôpital Fondation Rothschild, Paris, France.,Université de Paris, CNRS, Integrative Neuroscience and Cognition Center, Paris, France, Paris, France
| | - Tiziana Zalla
- Institut Jean Nicod, CNRS, Ecole Normale Supérieure, Paris, France
| | - Sylvie Chokron
- Institut de Neuropsychologie, Neurovision et Neurocognition, Hôpital Fondation Rothschild, Paris, France.,Université de Paris, CNRS, Integrative Neuroscience and Cognition Center, Paris, France, Paris, France
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Chokron S, Kovarski K, Zalla T, Dutton G. The inter-relationships between cerebral visual impairment, autism and intellectual disability. Neurosci Biobehav Rev 2020; 114:201-210. [DOI: 10.1016/j.neubiorev.2020.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/13/2020] [Accepted: 04/06/2020] [Indexed: 12/13/2022]
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Beyond the eye: Cortical differences in primary visual processing in children with cerebral palsy. NEUROIMAGE-CLINICAL 2020; 27:102318. [PMID: 32604019 PMCID: PMC7327303 DOI: 10.1016/j.nicl.2020.102318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/03/2020] [Accepted: 06/16/2020] [Indexed: 11/25/2022]
Abstract
Visual processing deficits are common in children with CP. MEG was used to image multispectral cortical oscillations during visual processing. Compared with controls, children with CP had weaker occipital oscillations. Aberrant cortical oscillations likely impact early visual processing abilities.
Despite the growing clinical recognition of visual impairments among people with cerebral palsy (CP), very few studies have evaluated the neurophysiology of the visual circuitry. To this end, the primary aim of this investigation was to use magnetoencephalography and beamforming methods to image the relative change in the alpha–beta and gamma occipital cortical oscillations induced by a spatial grating stimulus (e.g., visual contrast) that was viewed by a cohort of children with CP and typically-developing (TD) children. Our results showed that the high-contrast, visual gratings stimuli induced a decrease in alpha–beta (10 – 20 Hz) activity, and an increase in both low (40 – 56 Hz) and high (60 – 72 Hz) gamma oscillations in the occipital cortices. Compared with the TD children, the strength of the frequency specific cortical oscillations were significantly weaker in the children with CP, suggesting that they had deficient processing of the contrast stimulus. Although CP is largely perceived as a musculoskeletal centric disorder, our results fuel the growing impression that there may also be prominent visual processing deficiencies. These visual processing deficits likely impact the ability to perceive visual changes in the environment.
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Luyt K, Jary S, Lea C, Young GJ, Odd D, Miller H, Kmita G, Williams C, Blair PS, Fernández AM, Hollingworth W, Morgan M, Smith-Collins A, Thai NJ, Walker-Cox S, Aquilina K, Pople I, Whitelaw A. Ten-year follow-up of a randomised trial of drainage, irrigation and fibrinolytic therapy (DRIFT) in infants with post-haemorrhagic ventricular dilatation. Health Technol Assess 2020; 23:1-116. [PMID: 30774069 DOI: 10.3310/hta23040] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The drainage, irrigation and fibrinolytic therapy (DRIFT) trial, conducted in 2003-6, showed a reduced rate of death or severe disability at 2 years in the DRIFT compared with the standard treatment group, among preterm infants with intraventricular haemorrhage (IVH) and post-haemorrhagic ventricular dilatation. OBJECTIVES To compare cognitive function, visual and sensorimotor ability, emotional well-being, use of specialist health/rehabilitative and educational services, neuroimaging, and economic costs and benefits at school age. DESIGN Ten-year follow-up of a randomised controlled trial. SETTING Neonatal intensive care units (Bristol, Katowice, Glasgow and Bergen). PARTICIPANTS Fifty-two of the original 77 infants randomised. INTERVENTIONS DRIFT or standard therapy (cerebrospinal fluid tapping). MAIN OUTCOME MEASURES Primary - cognitive disability. Secondary - vision; sensorimotor disability; emotional/behavioural function; education; neurosurgical sequelae on magnetic resonance imaging; preference-based measures of health-related quality of life; costs of neonatal treatment and of subsequent health care in childhood; health and social care costs and impact on family at age 10 years; and a decision analysis model to estimate the cost-effectiveness of DRIFT compared with standard treatment up to the age of 18 years. RESULTS By 10 years of age, 12 children had died and 13 were either lost to follow-up or had declined to participate. A total of 52 children were assessed at 10 years of age (DRIFT, n = 28; standard treatment, n = 24). Imbalances in gender and birthweight favoured the standard treatment group. The unadjusted mean cognitive quotient (CQ) score was 69.3 points [standard deviation (SD) 30.1 points] in the DRIFT group compared with 53.7 points (SD 35.7 points) in the standard treatment group, a difference of 15.7 points, 95% confidence interval (CI) -2.9 to 34.2 points; p = 0.096. After adjusting for the prespecified covariates (gender, birthweight and grade of IVH), this evidence strengthened: children who received DRIFT had a CQ advantage of 23.5 points (p = 0.009). The binary outcome, alive without severe cognitive disability, gave strong evidence that DRIFT improved cognition [unadjusted odds ratio (OR) 3.6 (95% CI 1.2 to 11.0; p = 0.026) and adjusted OR 10.0 (95% CI 2.1 to 46.7; p = 0.004)]; the number needed to treat was three. No significant differences were found in any secondary outcomes. There was weak evidence that DRIFT reduced special school attendance (adjusted OR 0.27, 95% CI 0.07 to 1.05; p = 0.059). The neonatal stay (unadjusted mean difference £6556, 95% CI -£11,161 to £24,273) and subsequent hospital care (£3413, 95% CI -£12,408 to £19,234) costs were higher in the DRIFT arm, but the wide CIs included zero. The decision analysis model indicated that DRIFT has the potential to be cost-effective at 18 years of age. The incremental cost-effectiveness ratio (£15,621 per quality-adjusted life-year) was below the National Institute for Health and Care Excellence threshold. The cost-effectiveness results were sensitive to adjustment for birthweight and gender. LIMITATIONS The main limitations are the sample size of the trial and that important characteristics were unbalanced at baseline and at the 10-year follow-up. Although the analyses conducted here were prespecified in the analysis plan, they had not been prespecified in the original trial registration. CONCLUSIONS DRIFT improves cognitive function when taking into account birthweight, grade of IVH and gender. DRIFT is probably effective and, given the reduction in the need for special education, has the potential to be cost-effective as well. A future UK multicentre trial is required to assess efficacy and safety of DRIFT when delivered across multiple sites. TRIAL REGISTRATION Current Controlled Trials ISRCTN80286058. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 4. See the NIHR Journals Library website for further project information. The DRIFT trial and 2-year follow-up was funded by Cerebra and the James and Grace Anderson Trust.
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Affiliation(s)
- Karen Luyt
- Neonatal Neurology, University of Bristol, Bristol, UK
| | - Sally Jary
- Neonatal Neurology, University of Bristol, Bristol, UK
| | - Charlotte Lea
- Neonatal Neurology, University of Bristol, Bristol, UK
| | - Grace J Young
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - David Odd
- Neonatal Neurology, University of Bristol, Bristol, UK.,Neonatal Medicine, North Bristol NHS Trust, Bristol, UK
| | - Helen Miller
- Neonatal Neurology, University of Bristol, Bristol, UK
| | - Grazyna Kmita
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Cathy Williams
- Paediatric Ophthalmology, University of Bristol, Bristol, UK
| | - Peter S Blair
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | | | | | - Michelle Morgan
- Department of Psychology, Community Children's Health Partnership, Bristol, UK
| | | | - N Jade Thai
- Clinical Research and Imaging Centre, Bristol, UK
| | | | | | - Ian Pople
- Paediatric Neurosurgery, University Hospitals Bristol NHS Trust, Bristol, UK
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de Weger C, Boonstra N, Goossens J. Bifocals reduce strabismus in children with Down syndrome: Evidence from a randomized controlled trial. Acta Ophthalmol 2020; 98:89-97. [PMID: 31313886 PMCID: PMC7003890 DOI: 10.1111/aos.14186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 06/11/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE Children with Down syndrome (DS) more often have strabismus, refractive errors, accommodative lags and reduced visual acuity (VA) than typically developing children. In this study, we compare the effects of bifocal glasses with those of unifocal glasses in children with DS. Changes in angle of strabismus, accommodation and refractive error were analysed in this paper. METHODS In a multicentre randomized controlled trial, 119 children with DS, aged 2-16, were randomly allocated for bifocal or unifocal glasses (with full correction of refractive error in cycloplegia). The 15 centres, all in the Netherlands, followed the participants for 1 year. Changes in refractive error, accommodative accuracy, strabismus, binocularity and stereopsis were compared across 4 subsequent visits. RESULTS Refractive errors and accommodative errors showed no significant change throughout the course of our study in either intervention group. The manifest angle of strabismus, however, reduced significantly in the bifocal group. This improvement was observed shortly after the children received their new correction (~6 weeks) (linear regression: t = 3.652, p < 0.001) and remained present in the final measurements after 1 year (linear regression: t = 3.604, p < 0.001). The percentage of children with positive binocularity and stereo tests showed no significant differences between the groups. CONCLUSION Bifocals with full correction of refractive error reduce the manifest angle of strabismus within a few weeks. No effects on accommodation, refractive error, stereopsis and binocularity occurred over the course of 1 year.
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Affiliation(s)
- Christine de Weger
- Donders Institute for BrainCognition and BehaviourDepartment of Cognitive NeuroscienceRadboud University Medical Centre NijmegenNijmegenThe Netherlands
- BartiméusInstitute for the Visually ImpairedZeistThe Netherlands
| | - Nienke Boonstra
- Donders Institute for BrainCognition and BehaviourDepartment of Cognitive NeuroscienceRadboud University Medical Centre NijmegenNijmegenThe Netherlands
- Royal Dutch VisioNational Foundation for the Visually Impaired and BlindHuizenThe Netherlands
| | - Jeroen Goossens
- Donders Institute for BrainCognition and BehaviourDepartment of Cognitive NeuroscienceRadboud University Medical Centre NijmegenNijmegenThe Netherlands
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Philip SS, Guzzetta A, Chorna O, Gole G, Boyd RN. Relationship between brain structure and Cerebral Visual Impairment in children with Cerebral Palsy: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 99:103580. [PMID: 32004872 DOI: 10.1016/j.ridd.2020.103580] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Cerebral Visual Impairment (CVI) is very common yet often unrecognised visual dysfunction in children with Cerebral Palsy (CP). Magnetic Resonance Imaging (MRI) is the diagnostic tool in the investigation of brain lesions in children with CP and CVI. AIM The aim of this systematic review is to evaluate the relationship between brain structure and CVI, as determined by MRI in children with CP. METHODS AND PROCEDURES A comprehensive search of 5 database (PubMed, EMBASE, SCOPUS, CINAHL and Cochrane Database) was undertaken up until June 2019. The PRISMA checklist was then utilised to report on the process of selecting eligible papers. A total of 30 observational studies met the full inclusion criteria. Further, STROBE checklist was employed to report on the observational studies. OUTCOMES AND RESULTS Periventricular leucomalacia on MRI was found to have a strong association with CVI in all 30 studies. Only 13 (43 %) studies described dorsal and/ ventral stream dysfunction. There was ambiguity in the definition of CVI. CONCLUSIONS AND IMPLICATIONS The overall level of evidence correlating different patterns of CVI and CP (based on GMFCS, motor type and distribution) and MRI was low. Further studies utilising advances in MRI are needed to understand brain reorganisation and patterns of CVI and suggest rehabilitation therapy inclusive of vision.
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Affiliation(s)
- Swetha Sara Philip
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Brisbane, Australia.
| | - Andrea Guzzetta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Olena Chorna
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Glen Gole
- Dept of Ophthalmology, Queensland Children's Hospital, Brisbane, Australia
| | - Roslyn N Boyd
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Brisbane, Australia
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Kooiker MJG, van der Linden Y, van Dijk J, van der Zee YJ, Swarte RMC, Smit LS, van der Steen-Kant S, Loudon SE, Reiss IKM, Kuyper K, Pel JJM, van der Steen J. Early intervention for children at risk of visual processing dysfunctions from 1 year of age: a randomized controlled trial protocol. Trials 2020; 21:44. [PMID: 31915035 PMCID: PMC6950993 DOI: 10.1186/s13063-019-3936-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/26/2019] [Indexed: 11/28/2022] Open
Abstract
Background An increasing number of children are suffering from brain damage-related visual processing dysfunctions (VPD). There is currently a lack of evidence-based intervention methods that can be used early in development. We developed a visual intervention protocol suitable from 1 year of age. The protocol is structured, comprehensive and individually adaptive, and is paired with quantitative outcome assessments. Our aim is to investigate the effectiveness of this first visual intervention program for young children with (a risk of) VPD. Methods This is a single-blind, placebo-controlled trial that is embedded within standard clinical care. The study population consists of 100 children born very or extremely preterm (< 30 weeks) at 1 year of corrected age (CA), of whom 50% are expected to have VPD. First, children undergo a visual screening at 1 year CA. If they are classified as being at risk of VPD, they are referred to standard care, which involves an ophthalmic and visual function assessment and a (newly developed) visual intervention program. This program consists of a general protocol (standardized and similar for all children) and a supplement protocol (adapted to the specific needs of the child). Children are randomly allocated to an intervention group (starting upon inclusion at 1 year CA) or a control group (postponed: starting at 2 years CA). The control group will receive a placebo treatment. The effectiveness of early visual intervention will be examined with follow-up visual and neurocognitive assessments after 1 year (upon completion of the direct intervention) and after 2 years (upon completion of the postponed intervention). Discussion Through this randomized controlled trial we will establish the effectiveness of a new and early visual intervention program. Combining a general and supplement protocol enables both structured comparisons between participants and groups, and custom habilitation that is tailored to a child’s specific needs. The design ensures that all included children will benefit from participation by advancing the age at which they start receiving an intervention. We expect results to be applicable to the overall population of children with (a risk of) VPD early in life. Trial registration Netherlands Trial Register: NTR6952. Registered 19 January 2018.
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Affiliation(s)
- Marlou J G Kooiker
- Department of Neuroscience, Erasmus Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Yoni van der Linden
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, the Hague, The Netherlands
| | - Jenneke van Dijk
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, the Hague, The Netherlands
| | - Ymie J van der Zee
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, Rotterdam, The Netherlands
| | - Renate M C Swarte
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Liesbeth S Smit
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Neurology, Division of Pediatric Neurology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sanny van der Steen-Kant
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, Huizen, The Netherlands
| | - Sjoukje E Loudon
- Department of Pediatric Ophthalmology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Kees Kuyper
- Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, Rotterdam, The Netherlands
| | - Johan J M Pel
- Department of Neuroscience, Erasmus Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Johannes van der Steen
- Department of Neuroscience, Erasmus Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
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60
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Vancleef K, Janssens E, Petré Y, Wagemans J, Ortibus E. Assessment tool for visual perception deficits in cerebral visual impairment: development and normative data of typically developing children. Dev Med Child Neurol 2020; 62:111-117. [PMID: 31267521 DOI: 10.1111/dmcn.14303] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 11/27/2022]
Abstract
AIM To develop an assessment tool that measures a wide range of visual perceptual deficits common in cerebral visual impairment (CVI) and to provide normative data from typically developing children between 3 and 6 years of age. METHOD Test development reflected cross-talk between vision research and clinical relevance for CVI. The Children's Visual Impairment Test for 3- to 6-year-olds (CVIT 3-6) includes 14 subtests covering four domains of visual perception: Object Recognition, Degraded Object Recognition, Motion Perception, and Global-Local Processing. Normative data were collected from 301 typically developing children (mean age 4y 8mo [SD 9.7mo]; 148 females, 153 males). A questionnaire was administered to parents about pregnancy duration, birth, and developmental problems. RESULTS Average total CVIT 3-6 performance was 60.1 (SD 5.5) out of 70. The cut-off score for normal visual perception (53) was set at the 10th centile of scores in typically developing children. Multiple regression indicated CVIT 3-6 visual perception scores increase with age for children born at 36 weeks' gestational age or later (β=-18.03, 95% confidence interval -31.31 to -4.75). INTERPRETATION CVIT 3-6 is a tool to assess a wide range of visual perceptual deficits common in CVI. Age-dependent normative data are available because we found performance increased with age. WHAT THE PAPER ADDS A test for visual perceptual deficits common in cerebral visual impairment. Visual perceptual functions improve with age in full-term typically developing children.
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Affiliation(s)
- Kathleen Vancleef
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Brain and Cognition, KU Leuven, Leuven, Belgium.,Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Eva Janssens
- Brain and Cognition, KU Leuven, Leuven, Belgium.,Centre for Developmental Disabilities, University Hospitals Leuven, Leuven, Belgium
| | | | - Johan Wagemans
- Brain and Cognition, KU Leuven, Leuven, Belgium.,Leuven Brain Institute (LBI), KU Leuven, Leuven, Belgium
| | - Els Ortibus
- Centre for Developmental Disabilities, University Hospitals Leuven, Leuven, Belgium.,Faculty of Medicine, Department of Development and Regeneration, Department of Biomedical Sciences, KU Leuven, Leuven, Belgium
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Ortibus E, Fazzi E, Dale N. Cerebral Visual Impairment and Clinical Assessment: The European Perspective. Semin Pediatr Neurol 2019; 31:15-24. [PMID: 31548019 DOI: 10.1016/j.spen.2019.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This paper summarizes the multidisciplinary pediatric assessment methods of 3 European centers for identifying and assessing cerebral visual impairment in childhood. It describes a comprehensive neurodevelopmental assessment evaluation in which visual aspects play an important part. Developmental trajectories and the heterogeneity of the clinical picture are emphasized. Multidisciplinary ophthalmology and neurodisability/neurology teamwork together with the parent and teachers, to reach an integrated and individualized perspective for the individual child, are described. This comprehensive assessment is the starting point for habilitation programs and interventions, that can support and meet the child's needs and help them reach their optimal potential. Future developments in classification of the cerebral visual impairment conditions, building on the child's individual assessment profile, will further enhance the direction of clinical, educational, and research progress.
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Affiliation(s)
- Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Pediatric Neurology, University Hospitals Leuven, Belgium.
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Italy; Child Neurology and Psychiatry Unit, ASST Civil Hospital -Brescia, Italy; Department of Pediatric Neurology, University Hospitals Leuven, Belgium
| | - Naomi Dale
- Department of Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, and Neurodisability Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Department of Pediatric Neurology, University Hospitals Leuven, Belgium
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62
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Pehere NK, Jacob N. Understanding low functioning cerebral visual impairment: An Indian context. Indian J Ophthalmol 2019; 67:1536-1543. [PMID: 31546476 PMCID: PMC6786190 DOI: 10.4103/ijo.ijo_2089_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/25/2019] [Indexed: 12/02/2022] Open
Abstract
For several reasons, cerebral visual impairment (CVI) is emerging as a major cause of visual impairment among children in the developing world and we are seeing an increasing number of such children in our clinics. Owing to lack of early training about CVI and it being a habilitation orientated subject, we need to become equipped to optimally help the affected children. In this paper we have explained our pragmatic approach in addressing children who present with low functioning CVI. Initially we explain briefly, how vision is processed in the brain. We then present what should be specifically looked for in these children in regular clinics as a part of their comprehensive ophthalmic examination. We discuss the process of functional vision evaluation that we follow with the help of videos to explain the procedures, examples of how to convey the conclusions to the family, and how to use our findings to develop intervention guidelines for the child. We explain the difference between passive vision stimulation and vision intervention, provide some common interventions that may be applicable to many children and suggest how to infuse interventions in daily routines of children so that they become relevant and meaningful leading to effective learning experiences.
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Affiliation(s)
- Niranjan K Pehere
- Head, The David Brown Children's Eye Care Centre, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Namita Jacob
- PhD (Special Education), Program Director, Chetana Trust, 15 Arunachalam Road, Kottupuram, Chennai, Tamil Nadu, India
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Lueck AH, Dutton GN, Chokron S. Profiling Children With Cerebral Visual Impairment Using Multiple Methods of Assessment to Aid in Differential Diagnosis. Semin Pediatr Neurol 2019; 31:5-14. [PMID: 31548025 DOI: 10.1016/j.spen.2019.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cerebral (cortical) visual impairment (CVI), the primary cause of visual impairment in children in high-income countries, is increasing globally due to improved life-saving measures for premature and full-term infants. Yet the consequences of this condition are only beginning to be understood and addressed. According to the topography, site, and the extent of the pathology, the deficit may variably concern central visual functions, visual field, perception of movement, visual analysis, visual exploration, attention, or visual memory, as well as visual guidance of movement. Each affected child has a unique clinical picture, which needs to be identified and individually profiled. This is probably the underlying reason that CVI is commonly underdiagnosed or misdiagnosed, especially in children, and, as a consequence, the full range of potential behavioral outcomes are not identified and adequately addressed. The present paper shows how the use of multiple methods of assessment can improve understanding of children with CVI.
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Affiliation(s)
- Amanda H Lueck
- Department of Special Education, San Francisco State University, San Francisco, CA.
| | - Gordon N Dutton
- Department of Optometry and Visual Science, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Sylvie Chokron
- Unité Vision et Cognition, Fondation Opthalmologique Rothschild, Paris, France; Laboratoire de Psychologie de la Perception, Université Paris Descartes, Paris, France
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Fazzi E, Micheletti S, Galli J, Rossi A, Gitti F, Molinaro A. Autism in Children With Cerebral and Peripheral Visual Impairment: Fact or Artifact? Semin Pediatr Neurol 2019; 31:57-67. [PMID: 31548026 DOI: 10.1016/j.spen.2019.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to evaluate the occurrence and clinical characteristics of autism spectrum disorder in visually impaired children. In total, 273 participants, 214 with cerebral causes of vision impairment and 59 with peripheral causes, were assessed using multiple assessment methods and adapted for individuals with vision loss. We found that autism spectrum disorder was more prevalent in the visually impaired compared to general population, and that the prevalence varied according to the type of visual disorder (2.8% for cerebral and 8.4% for peripheral visual impairment). In subjects with cerebral visual impairment, the presence of autistic symptoms was consistent with the diagnosis of autism spectrum disorder. In children with peripheral visual impairment, certain symptoms related to visual loss overlapped with the clinical features of autism spectrum disorder, thus making clinical diagnosis more challenging. The development of assessment tools that take into account the type and level of visual impairment and validation testing in a larger population sample are needed in order to confirm these initial findings regarding the diagnosis of autism spectrum disorder in visually impaired children.
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Affiliation(s)
- Elisa Fazzi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Serena Micheletti
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Brescia, Italy
| | - Jessica Galli
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Rossi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Brescia, Italy
| | - Filippo Gitti
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Brescia, Italy
| | - Anna Molinaro
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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65
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Alterations in the Structural and Functional Connectivity of the Visuomotor Network of Children With Periventricular Leukomalacia. Semin Pediatr Neurol 2019; 31:48-56. [PMID: 31548024 PMCID: PMC6761984 DOI: 10.1016/j.spen.2019.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Children born preterm with periventricular leukomalacia (PVL) demonstrate increased difficulties with tasks requiring visuomotor integration. The visuomotor integration network encompasses brain regions within frontal, parietal, and occipital cortices. Because of their proximity to the lateral ventricle the underlying white matter pathways are at a high risk of damage following PVL-related hypoxic-ischemic white matter injury. This study provides an exploratory analysis of the structural and functional connections within the visuomotor integration network, along with an a priori evaluation of the superior longitudinal fasciculus, inferior fronto-occipital fasciculus, and frontal aslant tract. For each pathway, tracts within both hemispheres revealed decreased volume and number of reconstructed fibers and an increase in quantitative anisotropy and generalized fractional anisotropy. The connectivity results also indicate that there may be changes to both the structural integrity and functional integration of neural networks involved with visuomotor integration functions in children with PVL.
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66
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Sardelić E, Utrobičić DK. LONG-TERM VARIABILITY OF STRABISMUS ANGLE IN NEUROLOGICALLY IMPAIRED PREMATURE INFANTS: A 12-YEAR FOLLOW UP. Acta Clin Croat 2019; 58:473-480. [PMID: 31969760 PMCID: PMC6971793 DOI: 10.20471/acc.2019.58.03.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this retrospective study was to determine the strabismus angle variability and rationality of surgical treatment of strabismus in prematurely born children with neurological impairment during 12-year follow up. Eleven premature infants born in 2003 were included in the study and treated with equal conservative approach from 2005 until 2016. Initial esotropia was found in seven and exotropia in four of eleven children. Changes in the strabismus angle correlated significantly with aging of the children. In children with initial esotropia, the strabismus angle became less convergent (less positive), changed the orientation and became more divergent with aging. In those with initial exotropia, the angle became less divergent (more positive), changed the orientation and became more convergent. Moreover, a significant difference in the strabismus angle was found during the 12-year follow up. Based on our results, due to the variability in strabismus angle, we did not find enough evidence for optimal timing or rationality of strabismus surgery in neurologically impaired children born prematurely.
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Affiliation(s)
| | - Dobrila Karlica Utrobičić
- 1Pediatric Resident, Department of Pediatrics, Split University Hospital Centre, Split, Croatia; 2Department of Ophthalmology, Split University Hospital Centre, Split, Croatia
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67
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Weger C, Boonstra N, Goossens J. Effects of bifocals on visual acuity in children with Down syndrome: a randomized controlled trial. Acta Ophthalmol 2019; 97:378-393. [PMID: 30367541 PMCID: PMC6587837 DOI: 10.1111/aos.13944] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/04/2018] [Indexed: 11/28/2022]
Abstract
Purpose Children with Down syndrome (DS) typically have reduced visual acuity (VA) and accommodation lag, but it is unclear whether prescribed glasses should correct both distance VA (DVA) and near VA (NVA) due to the lack of RCTs. We therefore conducted a multicentre RCT to compare the effects of bifocals designed to correct both DVA and NVA with distance‐correcting unifocal glasses in children with DS. Methods A total of 119 children with DS, aged 2–16, were randomly allocated for bifocal or unifocal glasses (with full correction of refraction error in cycloplegia) in 14 Dutch hospitals and followed during 1 year. VA data were analysed in relation to baseline VA with ancova. Results Treatment groups showed no differences at baseline. Shortly after receiving new corrections (~6 weeks), uncrowded NVA (bifocals 0.18 ± 0.33 LogMar; unifocals 0.09 ± 0.19 LogMar) and crowded NVA with bifocals (bifocals 0.13 ± 0.36 LogMar; unifocals 0.08 ± 0.33 LogMar) were significantly better than at baseline, but these short‐term improvements in NVA were not significantly different between the two treatments (p > 0.151). The 1‐year treatment differences were as follows: significantly larger improvement for bifocals compared to unifocals in both uncrowded NVA (bifocals 0.23 ± 0.29 LogMar, unifocals 0.12 ± 0.30 LogMar, p = 0.045) and crowded NVA (bifocals 0.31 ± 0.28 LogMar; unifocals 0.16 ± 0.30 LogMar, p = 0.017). Improvements in DVA were comparable (bifocals 0.07 ± 0.21 LogMar, unifocals 0.08 ± 0.22 LogMar, p = 0.565). Children with poor baseline VA improved more. Accommodation lag stayed unchanged. Conclusion After one year, bifocals with full correction of ametropia led to significantly larger improvement of both uncrowded NVA and crowded NVA in children with DS with accommodation lag compared to unifocals.
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Affiliation(s)
- Christine Weger
- Department of Cognitive Neuroscience Donders Institute for Brain, Cognition and Behaviour Radboud University Medical Centre Nijmegen Nijmegen The Netherlands
- Bartiméus Institute for the Visually Impaired Zeist The Netherlands
| | - Nienke Boonstra
- Department of Cognitive Neuroscience Donders Institute for Brain, Cognition and Behaviour Radboud University Medical Centre Nijmegen Nijmegen The Netherlands
- Royal Dutch Visio National Foundation for the Visually Impaired and Blind Huizen The Netherlands
| | - Jeroen Goossens
- Department of Cognitive Neuroscience Donders Institute for Brain, Cognition and Behaviour Radboud University Medical Centre Nijmegen Nijmegen The Netherlands
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68
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Ventura CV, Ventura Filho MC, Ventura LO. Ocular Manifestations and Visual Outcome in Children With Congenital Zika Syndrome. Top Magn Reson Imaging 2019; 28:23-27. [PMID: 30817677 DOI: 10.1097/rmr.0000000000000192] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The recent Zika virus (ZIKV) outbreak and the link to birth defects in newborns exposed in utero, caught international attention. Due to its rapid spread throughout the Americas, authorities declared ZIKV a Public Health Emergency of International Concern that lasted from February to November 2016."Congenital Zika Syndrome" (CZS) is a new entity that reflects a broad spectrum of symptoms and signs observed in newborns infected by the ZIKV in utero. A recent review concluded that CZS differs from other congenital infections for its five distinct features: "(1) severe microcephaly with partially collapsed skull; (2) thin cerebral cortices with subcortical calcifications; (3) macular scarring and focal pigmentary retinal mottling; (4) congenital contractures; and (5) marked early hypertonia and symptoms of extrapyramidal involvement."Diagnosing and managing CZS has become a challenge for health professionals including ophthalmologists. The ocular manifestations of CZS are unique and have important consequences on vision. This article reviews the ocular manifestations of the CZS, addresses the visual outcomes of affected infants, and elucidates the early intervention protocols for visual improvement.
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Affiliation(s)
- Camila V Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil
- Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
| | | | - Liana O Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil
- Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
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69
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Factors Associated With Lack of Vision Improvement in Children With Cortical Visual Impairment. J Neuroophthalmol 2018; 38:429-433. [DOI: 10.1097/wno.0000000000000610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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70
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Barsingerhorn AD, Boonstra FN, Goossens J. Symbol Discrimination Speed in Children With Visual Impairments. ACTA ACUST UNITED AC 2018; 59:3963-3972. [DOI: 10.1167/iovs.17-23167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Annemiek D. Barsingerhorn
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - F. Nienke Boonstra
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, The Netherlands
- Bartiméus, Institute for the Visually Impaired, Zeist, The Netherlands
| | - Jeroen Goossens
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
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71
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Ventura LO, Ventura CV, Dias NDC, Vilar IG, Gois AL, Arantes TE, Fernandes LC, Chiang MF, Miller MT, Lawrence L. Visual impairment evaluation in 119 children with congenital Zika syndrome. J AAPOS 2018; 22:218-222.e1. [PMID: 29654909 DOI: 10.1016/j.jaapos.2018.01.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 01/04/2018] [Accepted: 01/28/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE 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. METHODS 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. RESULTS The CZS group included 119 infants; the control group, 85 infants. At examination, the mean age of the CZS group was 8.5 ± 1.2 months (range, 6-13 months); of the controls, 8.4 ± 1.8 months (range, 5-12 months; 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). CONCLUSIONS 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.
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Affiliation(s)
- Liana O Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, Pernambuco, Brazil.
| | - Camila V Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, Pernambuco, Brazil
| | - Natália de C Dias
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil
| | - Isabelle G Vilar
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil
| | - Adriana L Gois
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, Pernambuco, Brazil
| | - Tiago E Arantes
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil
| | - Luciene C Fernandes
- Department of Low Vision, Federal University of Minas Gerais, Belo Horizonte, Minas Gerias, Brazil
| | - Michael F Chiang
- Department of Ophthalmology, Casey Eye Institute at Oregon Health & Science University, Portland, Oregon
| | | | - Linda Lawrence
- Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, Kansas
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72
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Pehere N, Chougule P, Dutton GN. Cerebral visual impairment in children: Causes and associated ophthalmological problems. Indian J Ophthalmol 2018; 66:812-815. [PMID: 29785989 PMCID: PMC5989503 DOI: 10.4103/ijo.ijo_1274_17] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/14/2018] [Indexed: 11/10/2022] Open
Abstract
Purpose The aim of this study is to identify common causes, associated ophthalmological abnormalities, and systemic comorbidities in children in Andhra Pradesh, India, with cerebral visual impairment (CVI). Methods A retrospective review of case records of all children aged <16 years with diagnosis of CVI seen between January 2016 and December 2016 was carried out. Data were collected for their age, gender, cause of CVI, refraction, accommodation, anterior and posterior segment examination findings, and systemic problems. Results A total of 124 patients were identified and studied (80 boys and 44 girls, mean age 5.23 years, 44.8% aged <2 years). The most common causes of CVI were hypoxic-ischemic encephalopathy (HIE) (34.4%), undetermined etiology (32.8%), neonatal seizures, and infantile spasms (16% each). The most common presenting complaints were poor vision (76%) and squint (11.2%). Profound visual impairment was seen in 88.8%, and 11.2% had high functioning CVI. Fifty-eight (46.4%) patients had significant refractive errors, 40 (32.25%) had strabismus, 4 (3.2%) had visually significant cataract, and 40 (32%) had optic atrophy. Motor delay was observed in 39.5%, speech delay was evident in 22.4%, and cognitive delay in 16%. Conclusion HIE is the most common cause (one-third) of CVI in our population, and the majority of them presented at age <2 years (44.8%) with profound visual impairment (88.8%). A significant number of them have treatable ophthalmic conditions such as refractive errors (46.4%), accommodative insufficiency (12.1%), and cataract (3.2%), and more than one-third of them also have delay in other areas of development.
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Affiliation(s)
- Niranjan Pehere
- The David Brown Children's Eye Care Center, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Pratik Chougule
- Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Gordon N Dutton
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
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Schmetz E, Magis D, Detraux JJ, Barisnikov K, Rousselle L. Basic visual perceptual processes in children with typical development and cerebral palsy: The processing of surface, length, orientation, and position. Child Neuropsychol 2018; 25:232-262. [PMID: 29498326 DOI: 10.1080/09297049.2018.1441820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The present study aims to assess how the processing of basic visual perceptual (VP) components (length, surface, orientation, and position) develops in typically developing (TD) children (n = 215, 4-14 years old) and adults (n = 20, 20-25 years old), and in children with cerebral palsy (CP) (n = 86, 5-14 years old) using the first four subtests of the Battery for the Evaluation of Visual Perceptual and Spatial processing in children. Experiment 1 showed that these four basic VP processes follow distinct developmental trajectories in typical development. Experiment 2 revealed that children with CP present global and persistent deficits for the processing of basic VP components when compared with TD children matched on chronological age and nonverbal reasoning abilities.
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Affiliation(s)
- Emilie Schmetz
- a Research Unit on Childhood, Faculty of Psychology , Speech Therapy and Education - University of Liège , Liège , Belgique.,b Reference Center for Cerebral Palsy- University of Liège, CHR Citadelle , Liège , Belgique
| | - David Magis
- a Research Unit on Childhood, Faculty of Psychology , Speech Therapy and Education - University of Liège , Liège , Belgique
| | - Jean-Jacques Detraux
- c Department of Psychology, Faculty of Psychology , Speech Therapy and Education - University of Liège , Liège , Belgique
| | - Koviljka Barisnikov
- d Child Clinical Neuropsychology Unit, Psychology Department , FPSE - University of Geneva , Geneva , Switzerland
| | - Laurence Rousselle
- a Research Unit on Childhood, Faculty of Psychology , Speech Therapy and Education - University of Liège , Liège , Belgique
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74
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Little JA. Vision in children with autism spectrum disorder: a critical review. Clin Exp Optom 2018; 101:504-513. [PMID: 29323426 DOI: 10.1111/cxo.12651] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/25/2017] [Accepted: 11/29/2017] [Indexed: 12/21/2022] Open
Abstract
Autism spectrum disorder (ASD) is a common neurodevelopmental condition with approximately 1-2 per cent prevalence in the population. The condition has lifelong effects for the individual and family, and early intervention and management helps maximise quality of life and outcomes. Many studies of vision in ASD have attempted to link the behavioural and sensory deficits in ASD with underlying visual processing. From this work, it is clear that individuals with ASD 'see' and process the world differently, but there remain gaps in our understanding. This review will summarise our current knowledge of key aspects of visual functions and the optometric profile of ASD. This includes findings regarding visual acuity and contrast sensitivity, refractive error, eye movements, binocular vision, near visual functions and retinal structure in ASD. From this, a pattern of knowledge emerges for children with ASD: we should expect normal visual acuity; there will likely be atypical eye movements and susceptibility for subtle visuo-motor deficits, there is an increased prevalence of strabismus; an increased likelihood of astigmatism and possibly other refractive errors; attention, crowding and task complexity will likely be problematic; and retinal structure and function may be compromised. Bringing this together, these findings highlight that further work is necessary, not only to understand how higher-level functions link to behaviours, but also to ensure there is a sound understanding of the building-blocks of vision to fully grasp the profile of visual processing as a whole in ASD. This review will give a translational viewpoint for clinicians, and underline the benefits of comprehensive vision care in ASD.
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Affiliation(s)
- Julie-Anne Little
- Optometry & Vision Science Research Group, School of Biomedical Sciences, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
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Sakki HEA, Dale NJ, Sargent J, Perez-Roche T, Bowman R. Is there consensus in defining childhood cerebral visual impairment? A systematic review of terminology and definitions. Br J Ophthalmol 2017; 102:424-432. [DOI: 10.1136/bjophthalmol-2017-310694] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/28/2017] [Accepted: 10/06/2017] [Indexed: 01/24/2023]
Abstract
The childhood condition of visual difficulties caused by brain damage, commonly termed cortical or cerebral visual impairment (CVI), is well established but has no internationally accepted definition. Clarification of its core features is required to advance research and clinical practice. This systematic review aimed to identify the definitions of childhood CVI in the original scientific literature to describe and critically appraise a consensual definition of the condition. MEDLINE, EMBASE, PsychINFO, CINAHL and AMED databases were searched in January 2017. Studies were included if they (1) were published original research, (2) contained a childhood CVI sample, (3) contained a definition of CVI and (4) described their CVI identification/diagnostic method. Thematic analysis identified concepts within definitions and narrative synthesis was conducted. Of 1150 articles, 51 met inclusion criteria. Definitions were subdivided according to detail (descriptive definition, description not reaching definition status and diagnostic/operationalising criteria). Three themes concerning visual deficits, eye health and brain integrity were identified (each containing subthemes) and analysed individually across definitions. The most common themes were ‘visual impairment’ (n=20), ‘retrochiasmatic pathway damage’(n=13) and ‘normal/near normal eye health’ (n=15). The most consensual definition identified here may not be the best quality for advancing our understanding of CVI. We argue for the alternative definition: CVI is a verifiable visual dysfunction which cannot be attributed to disorders of the anterior visual pathways or any potentially co-occurring ocular impairment. We propose reporting guidelines to permit comparison across studies and increase the evidence base for more reliable clinical assessment and diagnosis.
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76
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Solebo AL, Teoh L, Rahi J. Epidemiology of blindness in children. Arch Dis Child 2017; 102:853-857. [PMID: 28465303 DOI: 10.1136/archdischild-2016-310532] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 01/25/2023]
Abstract
An estimated 1.4 million of the world's children are blind. A blind child is more likely to live in socioeconomic deprivation, to be more frequently hospitalised during childhood and to die in childhood than a child not living with blindness. This update of a previous review on childhood visual impairment focuses on emerging therapies for children with severe visual disability (severe visual impairment and blindness or SVI/BL).For children in higher income countries, cerebral visual impairment and optic nerve anomalies remain the most common causes of SVI/BL, while retinopathy of prematurity (ROP) and cataract are now the most common avoidable causes. The constellation of causes of childhood blindness in lower income settings is shifting from infective and nutritional corneal opacities and congenital anomalies to more resemble the patterns seen in higher income settings. Improvements in maternal and neonatal health and investment in and maintenance of national ophthalmic care infrastructure are the key to reducing the burden of avoidable blindness. New therapeutic targets are emerging for childhood visual disorders, although the safety and efficacy of novel therapies for diseases such as ROP or retinal dystrophies are not yet clear. Population-based epidemiological research, particularly on cerebral visual impairment and optic nerve hypoplasia, is needed in order to improve understanding of risk factors and to inform and support the development of novel therapies for disorders currently considered 'untreatable'.
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Affiliation(s)
- Ameenat Lola Solebo
- Lifecourse Epidemiology and Biostatistics Section, Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK.,Great Ormond Street Hospital/Institute of Child Heath, NIHR Biomedical Research Centre, London, UK.,Visual function and integrative epidemiology, Moorfields Eye Hospital and Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK.,Ulverscroft Vision Research Group, London, UK
| | - Lucinda Teoh
- Lifecourse Epidemiology and Biostatistics Section, Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK
| | - Jugnoo Rahi
- Lifecourse Epidemiology and Biostatistics Section, Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK.,Ulverscroft Vision Research Group, London, UK.,Great Ormond Street Hospital/Institute of Child Heath, NIHR Biomedical Research Centre, London, UK.,Visual function and integrative epidemiology, Moorfields Eye Hospital and Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK
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77
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Rossi A, Gnesi M, Montomoli C, Chirico G, Malerba L, Merabet LB, Fazzi E. Neonatal Assessment Visual European Grid (NAVEG): Unveiling neurological risk. Infant Behav Dev 2017; 49:21-30. [PMID: 28688291 DOI: 10.1016/j.infbeh.2017.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/05/2017] [Accepted: 06/07/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Andrea Rossi
- Child and Adolescent Neurology and Psychiatry Unit, Children Hospital, ASST Spedali Civili of Brescia, Italy.
| | - Marco Gnesi
- Department of Public Health, Experimental and Forensic Medicine, Section of Biostatistics and Clinical Epidemiology, University of Pavia, Italy
| | - Cristina Montomoli
- Department of Public Health, Experimental and Forensic Medicine, Section of Biostatistics and Clinical Epidemiology, University of Pavia, Italy
| | - Gaetano Chirico
- Department of Neonatology and Neonatal Intensive Care Unit, Children Hospital, ASST Spedali Civili of Brescia, Italy
| | - Laura Malerba
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Lotfi B Merabet
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | | | - Elisa Fazzi
- Child and Adolescent Neurology and Psychiatry Unit, Children Hospital, ASST Spedali Civili of Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Italy
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78
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Abstract
Cortical (cerebral) visual impairment (CVI) results from perinatal injury to visual processing structures and pathways of the brain and is the most common cause of severe visual impairment or blindness in children in developed countries. Children with CVI display a wide range of visual deficits including decreased visual acuity, impaired visual field function, as well as impairments in higher-order visual processing and attention. Together, these visual impairments can dramatically influence a child's development and well-being. Given the complex neurologic underpinnings of this condition, CVI is often undiagnosed by eye care practitioners. Furthermore, the neurophysiological basis of CVI in relation to observed visual processing deficits remains poorly understood. Here, we present some of the challenges associated with the clinical assessment and management of individuals with CVI. We discuss how advances in brain imaging are likely to help uncover the underlying neurophysiology of this condition. In particular, we demonstrate how structural and functional neuroimaging approaches can help gain insight into abnormalities of white matter connectivity and cortical activation patterns, respectively. Establishing a connection between how changes within the brain relate to visual impairments in CVI will be important for developing effective rehabilitative and education strategies for individuals living with this condition.
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79
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Martín MBC, Santos-Lozano A, Martín-Hernández J, López-Miguel A, Maldonado M, Baladrón C, Bauer CM, Merabet LB. Cerebral versus Ocular Visual Impairment: The Impact on Developmental Neuroplasticity. Front Psychol 2016; 7:1958. [PMID: 28082927 PMCID: PMC5183596 DOI: 10.3389/fpsyg.2016.01958] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/30/2016] [Indexed: 11/13/2022] Open
Abstract
Cortical/cerebral visual impairment (CVI) is clinically defined as significant visual dysfunction caused by injury to visual pathways and structures occurring during early perinatal development. Depending on the location and extent of damage, children with CVI often present with a myriad of visual deficits including decreased visual acuity and impaired visual field function. Most striking, however, are impairments in visual processing and attention which have a significant impact on learning, development, and independence. Within the educational arena, current evidence suggests that strategies designed for individuals with ocular visual impairment are not effective in the case of CVI. We propose that this variance may be related to differences in compensatory neuroplasticity related to the type of visual impairment, as well as underlying alterations in brain structural connectivity. We discuss the etiology and nature of visual impairments related to CVI, and how advanced neuroimaging techniques (i.e., diffusion-based imaging) may help uncover differences between ocular and cerebral causes of visual dysfunction. Revealing these differences may help in developing future strategies for the education and rehabilitation of individuals living with visual impairment.
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Affiliation(s)
- Maria B C Martín
- GIDFYS, European University Miguel de Cervantes Valladolid, Spain
| | - Alejandro Santos-Lozano
- GIDFYS, European University Miguel de CervantesValladolid, Spain; Research Institute of Hospital 12 de Octubre (i+12)Madrid, Spain
| | | | - Alberto López-Miguel
- Refractive Surgery and Visual Rehabilitation, Ophthalmology, Instituto Universitario de Oftalmobiología Aplicada, Eye Institute Valladolid, Spain
| | - Miguel Maldonado
- Refractive Surgery and Visual Rehabilitation, Ophthalmology, Instituto Universitario de Oftalmobiología Aplicada, Eye Institute Valladolid, Spain
| | - Carlos Baladrón
- GIDFYS, European University Miguel de Cervantes Valladolid, Spain
| | - Corinna M Bauer
- Laboratory for Visual Neuroplasticity, Massachusetts Eye and Ear Infirmary, Harvard Medical School Boston, MA, USA
| | - Lotfi B Merabet
- Laboratory for Visual Neuroplasticity, Massachusetts Eye and Ear Infirmary, Harvard Medical School Boston, MA, USA
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80
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Abstract
BACKGROUND There are very few studies on visually impaired children in Germany; therefore, the aim of this study was to investigate the current spectrum of diseases of visually impaired children and the care of these children in schools and kindergartens with aids and integrative support. PATIENTS AND METHODS In a retrospective study all children (n =303) who attended the outpatient department for the visually impaired of the University Eye Hospital Tübingen in 2013 and 2014 were evaluated. The target values were ophthalmological diagnosis, best corrected visual acuity, needs for magnification, prescribed aids, measures for early support and integrative care and inclusion during schooltime. RESULTS The most frequent diagnosis in this collective which led to visual impairment in children was optic atrophy (22.4%) followed by hereditary retinal dystrophy (18.5%), congenital nystagmus (9.9%), albinism (8.6%), retinopathy of prematurity (ROP, 7.9%), aniridia (4.6%), cerebral visual impairment (CVI, 4.3%) and severe myopia (3%). Of the children 21% suffered from multiple disabilities, 66% were visually impaired (visual acuity ≤0.3 and >0.05), 9% were severely visually impaired (visual acuity ≤0.05) and 6% were legally defined as blind (visual acuity ≤0.02). Of the schoolchildren 52% (n = 241) were able to visit a mainstream school within the framework of integrative care. For 77% of these schoolchildren integrative care was already provided by a special pedagogic institution at the time of presentation for school entry and 73% of all the schoolchildren needed magnifying aids at school: 20% used optical magnifying aids (e.g. reading stones) and 53% needed electronic magnifying aids, such as screen magnifiers or camera reading systems. CONCLUSION Particularly for children, the use of magnifying aids for reading is essential for education in schools and 73% of the children used optical or electronic devices for reading. Of the children 52% attended a mainstream school and were additionally supported by special pedagogic counseling services.
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Affiliation(s)
- E K Altpeter
- Sehbehindertenambulanz, Universitätsaugenklinik Tübingen, Elfriede-Aulhorn-Str. 7, 72076, Tübingen, Deutschland.
| | - N X Nguyen
- Sehbehindertenambulanz, Universitätsaugenklinik Tübingen, Elfriede-Aulhorn-Str. 7, 72076, Tübingen, Deutschland
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81
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Micheletti S, Palestra F, Martelli P, Accorsi P, Galli J, Giordano L, Trebeschi V, Fazzi E. Neurodevelopmental profile in Angelman syndrome: more than low intelligence quotient. Ital J Pediatr 2016; 42:91. [PMID: 27769316 PMCID: PMC5073425 DOI: 10.1186/s13052-016-0301-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Angelman Syndrome (AS) is a rare neurodevelopment disorder resulting from deficient expression or function of the maternally inherited allele of UBE3A gene. The aim of the study is to attempt at providing a detailed definition of neurodevelopmental profile in AS, with particular regard to motor, cognitive, communicative, behavioural and neurovisual, features by using standardized instruments. METHOD A total of ten subjects aged from 5 to 11 years (4 males and 6 females) with molecular confirmed diagnosis of AS (7 15q11.2-q13 deletion and 3 UBE3A mutation) were enrolled in our study. All of them underwent an assessment protocol including neurological and neurovisual examination and the evaluation of motor (Gross Motor Function Measure Scale), cognitive (Griffiths Mental Development Scale and Uzgiris-Hunt Scale); adaptive (Vineland Adaptive Behavioural Scale); communication (MacArthur-Bates Communicative Development Inventory and video-recordings children's verbal expression), behavioural aspects (IPDDAG Scale) and neurovisual aspects. RESULTS All children presented motor function involvement. A severe cognitive impairment was detected with different profiles according to the test applied. In all cases, communicative disability (phonemic inventory, word/gesture comprehension and production) and symptoms of inattention disorder were revealed. Neurovisual impairment was characterized by refractive errors, fundus oculi anomalies, strabismus and/or oculomotor dysfunction. CONCLUSION AS presents a complex neurodevelopmental profile in which several aspects play a negative role in global development leading to a severe functional impairment. Intellectual disability is not the only component because neurovisual functions and behavioural disorders may worsen the global function and are needed of specific rehabilitation programs.
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Affiliation(s)
- S Micheletti
- Unit of Child Neuropsychiatry and Early Neurorehabilitation, ASST Spedali Civili, Piazzale Spedali, Civili 1, 25123, Brescia, Italy. .,Cognition Psychology Neuroscience Lab, University of Pavia, Pavia, Italy. .,Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - F Palestra
- Unit of Child Neuropsychiatry and Early Neurorehabilitation, ASST Spedali Civili, Piazzale Spedali, Civili 1, 25123, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - P Martelli
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - P Accorsi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - J Galli
- Unit of Child Neuropsychiatry and Early Neurorehabilitation, ASST Spedali Civili, Piazzale Spedali, Civili 1, 25123, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - L Giordano
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - V Trebeschi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - E Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy
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82
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Chokron S, Dutton GN. Impact of Cerebral Visual Impairments on Motor Skills: Implications for Developmental Coordination Disorders. Front Psychol 2016; 7:1471. [PMID: 27757087 PMCID: PMC5048540 DOI: 10.3389/fpsyg.2016.01471] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/13/2016] [Indexed: 12/16/2022] Open
Abstract
Cerebral visual impairment (CVI) has become the primary cause of visual impairment and blindness in children in industrialized countries. Its prevalence has increased sharply, due to increased survival rates of children who sustain severe neurological conditions during the perinatal period. Improved diagnosis has probably contributed to this increase. As in adults, the nature and severity of CVI in children relate to the cause, location and extent of damage to the brain. In the present paper, we define CVI and how this impacts on visual function. We then define developmental coordination disorder (DCD) and discuss the link between CVI and DCD. The neuroanatomical correlates and aetiologies of DCD are also presented in relationship with CVI as well as the consequences of perinatal asphyxia (PA) and preterm birth on the occurrence and nature of DCD and CVI. This paper underlines why there are both clinical and theoretical reasons to disentangle CVI and DCD, and to categorize the features with more precision. In order to offer the most appropriate rehabilitation, we propose a systematic and rapid evaluation of visual function in at-risk children who have survived preterm birth or PA whether or not they have been diagnosed with cerebral palsy or DCD.
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Affiliation(s)
- Sylvie Chokron
- Unité Fonctionnelle Vision and Cognition, Fondation Ophtalmologique RothschildParis, France; Laboratoire de Psychologie de la Perception, UMR 8242, Centre National de la Recherche Scientifique - Université Paris-DescartesParis, France
| | - Gordon N Dutton
- Department of Vision Science, Glasgow Caledonian University Glasgow, UK
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83
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Ghate D, Vedanarayanan V, Kamour A, Corbett JJ, Kedar S. Optic nerve morphology as marker for disease severity in cerebral palsy of perinatal origin. J Neurol Sci 2016; 368:25-31. [DOI: 10.1016/j.jns.2016.06.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/07/2016] [Accepted: 06/12/2016] [Indexed: 11/29/2022]
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84
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Kiziltunc PB, Atilla H, Çalış F, Alay C. Comparison of Surgical Success for Infantile Esotropia and Strabismus Associated with Neurological Impairment. Strabismus 2016; 24:97-100. [PMID: 27532638 DOI: 10.1080/09273972.2016.1210173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Surgery for strabismus associated with neurological impairment is assumed to have unsatisfactory results in comparison with other strabismus cases. The aim of this study is to compare the surgical success rates of infantile esotropia (IE) and strabismus associated with neurological impairment. METHODS The records of 103 patients that received operations for IE and strabismus associated with neurological impairment between January 1994 and May 2014 were reviewed retrospectively. The angles of deviation and surgical success rates were evaluated at preoperative, 1-month postoperative, and 24-month postoperative visits. RESULTS Forty-five patients received operations for strabismus associated with neurological impairment (25 patients with esotropia and 20 patients with exotropia) and 58 patients for IE. Mean preoperative angles of deviation in cases with neurological impairment were 42 prism diopters (PD) for esotropia, 44.7 PD for exotropia, and 44.4 PD for IE. One patient from each group had consecutive deviation at first visit, and at last visit, 3 patients with neurological impairment and 5 patients with IE had consecutive deviations. Surgical success rates at the end of the second year were 52% for esotropia and 50% for exotropia in patients with neurological impairment and 56.8% for IE cases. CONCLUSION This study was unable to find the differences between surgical success rates in IE and strabismus associated with neurological impairment.
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Affiliation(s)
| | - Huban Atilla
- b Ankara University , Faculty of Medicine, Department of Ophthalmology , Ankara , Turkey
| | - Feyza Çalış
- c Cihanbeyli State Hospital , Konya , Turkey
| | - Cem Alay
- d Tavsanli Doctor Mustafa Kalemli State Hospital , Kutahya , Turkey
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85
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Binder NR, Kruglyakova J, Borchert MS. Strabismus in patients with cortical visual impairment: outcomes of surgery and observations of spontaneous resolution. J AAPOS 2016; 20:121-5. [PMID: 27079591 DOI: 10.1016/j.jaapos.2015.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 12/07/2015] [Accepted: 12/12/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate the rate of spontaneous resolution of strabismus in patients with cortical visual impairment (CVI) at a single center over a 10-year period and to evaluate the success rate of strabismus surgery. METHODS The medical records of patients with CVI and strabismus seen between October 2003 and October 2013 were reviewed retrospectively. Patients were classified into 4 outcome groups: (1) those who experienced spontaneous resolution of strabismus, (2) those with persistent strabismus who did not undergo surgery, (3) those who achieved postoperative alignment of ≤10(Δ); and (4) those whose final postoperative alignment was 11(Δ)-25(Δ) or >25(Δ). RESULTS A total of 70 patients were included. Of these, 11 patients (16%) experienced spontaneous resolution of strabismus, 27 (38%) were observed without receiving surgery, and 32 (46%) underwent strabismus surgery. Of these 32, 18 (56%) achieved alignment of ≤10(Δ); 9 (28%), alignment of 11(Δ)-25(Δ); and 5 (16%), alignment >25(Δ). The patients who did not undergo surgery were significantly older at presentation (36 months vs 12-15 months; P = 0.03); otherwise, there were no significant differences between groups in age at surgery or spontaneous resolution, type of strabismus, or underlying cause of CVI. CONCLUSIONS In our study cohort, a minority of patients with CVI and strabismus (16%) experienced spontaneous resolution of strabismus. Only 16% of patients undergoing surgery had poor final alignment (>25(Δ)). Strabismus surgery can be reasonably successful in properly selected patients with CVI and strabismus. These patients show considerable rates of resolution of their strabismus, either spontaneously or through surgery.
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Affiliation(s)
- Nicholas R Binder
- Keck School of Medicine, University of Southern California, Los Angeles, California; The Vision Center, Children's Hospital Los Angeles, California; Quantum Vision Centers, Belleville, Illinois.
| | - Jacqueline Kruglyakova
- Department of Biological Sciences, University of Southern California, Los Angeles, California
| | - Mark S Borchert
- Keck School of Medicine, University of Southern California, Los Angeles, California; The Vision Center, Children's Hospital Los Angeles, California
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86
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Mitry D, Williams C, Northstone K, Akter A, Jewel J, Khan N, Muhit M, Gilbert CE, Bowman R. Perceptual visual dysfunction, physical impairment and quality of life in Bangladeshi children with cerebral palsy. Br J Ophthalmol 2016; 100:1245-50. [DOI: 10.1136/bjophthalmol-2015-307296] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/02/2015] [Indexed: 11/04/2022]
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87
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Bosch DGM, Boonstra FN, de Leeuw N, Pfundt R, Nillesen WM, de Ligt J, Gilissen C, Jhangiani S, Lupski JR, Cremers FPM, de Vries BBA. Novel genetic causes for cerebral visual impairment. Eur J Hum Genet 2015; 24:660-5. [PMID: 26350515 DOI: 10.1038/ejhg.2015.186] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/26/2015] [Accepted: 07/12/2015] [Indexed: 12/14/2022] Open
Abstract
Cerebral visual impairment (CVI) is a major cause of low vision in children due to impairment in projection and/or interpretation of the visual input in the brain. Although acquired causes for CVI are well known, genetic causes underlying CVI are largely unidentified. DNAs of 25 patients with CVI and intellectual disability, but without acquired (eg, perinatal) damage, were investigated by whole-exome sequencing. The data were analyzed for de novo, autosomal-recessive, and X-linked variants, and subsequently classified into known, candidate, or unlikely to be associated with CVI. This classification was based on the Online Mendelian Inheritance in Man database, literature reports, variant characteristics, and functional relevance of the gene. After classification, variants in four genes known to be associated with CVI (AHDC1, NGLY1, NR2F1, PGAP1) in 5 patients (20%) were identified, establishing a conclusive genetic diagnosis for CVI. In addition, in 11 patients (44%) with CVI, variants in one or more candidate genes were identified (ACP6, AMOT, ARHGEF10L, ATP6V1A, DCAF6, DLG4, GABRB2, GRIN1, GRIN2B, KCNQ3, KCTD19, RERE, SLC1A1, SLC25A16, SLC35A2, SOX5, UFSP2, UHMK1, ZFP30). Our findings show that diverse genetic causes underlie CVI, some of which will provide insight into the biology underlying this disease process.
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Affiliation(s)
- Daniëlle G M Bosch
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Bartiméus Institute for the Visually Impaired, Zeist, The Netherlands.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - F Nienke Boonstra
- Bartiméus Institute for the Visually Impaired, Zeist, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole de Leeuw
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rolph Pfundt
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willy M Nillesen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joep de Ligt
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Hubrecht Institute-KNAW, University Medical Centre Utrecht, CancerGenomics.nl, Utrecht, The Netherlands
| | - Christian Gilissen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shalini Jhangiani
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - James R Lupski
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Frans P M Cremers
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bert B A de Vries
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
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88
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Ceschin R, Lee VK, Schmithorst V, Panigrahy A. Regional vulnerability of longitudinal cortical association connectivity: Associated with structural network topology alterations in preterm children with cerebral palsy. Neuroimage Clin 2015; 9:322-37. [PMID: 26509119 PMCID: PMC4588423 DOI: 10.1016/j.nicl.2015.08.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/05/2015] [Accepted: 08/24/2015] [Indexed: 01/28/2023]
Abstract
Preterm born children with spastic diplegia type of cerebral palsy and white matter injury or periventricular leukomalacia (PVL), are known to have motor, visual and cognitive impairments. Most diffusion tensor imaging (DTI) studies performed in this group have demonstrated widespread abnormalities using averaged deterministic tractography and voxel-based DTI measurements. Little is known about structural network correlates of white matter topography and reorganization in preterm cerebral palsy, despite the availability of new therapies and the need for brain imaging biomarkers. Here, we combined novel post-processing methodology of probabilistic tractography data in this preterm cohort to improve spatial and regional delineation of longitudinal cortical association tract abnormalities using an along-tract approach, and compared these data to structural DTI cortical network topology analysis. DTI images were acquired on 16 preterm children with cerebral palsy (mean age 5.6 ± 4) and 75 healthy controls (mean age 5.7 ± 3.4). Despite mean tract analysis, Tract-Based Spatial Statistics (TBSS) and voxel-based morphometry (VBM) demonstrating diffusely reduced fractional anisotropy (FA) reduction in all white matter tracts, the along-tract analysis improved the detection of regional tract vulnerability. The along-tract map-structural network topology correlates revealed two associations: (1) reduced regional posterior-anterior gradient in FA of the longitudinal visual cortical association tracts (inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, optic radiation, posterior thalamic radiation) correlated with reduced posterior-anterior gradient of intra-regional (nodal efficiency) metrics with relative sparing of frontal and temporal regions; and (2) reduced regional FA within frontal-thalamic-striatal white matter pathways (anterior limb/anterior thalamic radiation, superior longitudinal fasciculus and cortical spinal tract) correlated with alteration in eigenvector centrality, clustering coefficient (inter-regional) and participation co-efficient (inter-modular) alterations of frontal-striatal and fronto-limbic nodes suggesting re-organization of these pathways. Both along tract and structural topology network measurements correlated strongly with motor and visual clinical outcome scores. This study shows the value of combining along-tract analysis and structural network topology in depicting not only selective parietal occipital regional vulnerability but also reorganization of frontal-striatal and frontal-limbic pathways in preterm children with cerebral palsy. These finding also support the concept that widespread, but selective posterior-anterior neural network connectivity alterations in preterm children with cerebral palsy likely contribute to the pathogenesis of neurosensory and cognitive impairment in this group.
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Affiliation(s)
- Rafael Ceschin
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Vince K. Lee
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Vince Schmithorst
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Ashok Panigrahy
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Brain and Creativity Institution, University of Southern California, Los Angeles, CA, USA
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89
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Geldof CJA, van Wassenaer-Leemhuis AG, Dik M, Kok JH, Oosterlaan J. A functional approach to cerebral visual impairments in very preterm/very-low-birth-weight children. Pediatr Res 2015; 78:190-7. [PMID: 25927544 DOI: 10.1038/pr.2015.83] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/19/2015] [Indexed: 12/24/2022]
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.
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Affiliation(s)
- Christiaan J A Geldof
- 1] Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands [2] Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Amsterdam, The Netherlands
| | | | - Marjolein Dik
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Amsterdam, The Netherlands
| | - Joke H Kok
- Department of Neonatology, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- 1] Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands [2] Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
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90
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Kooiker MJG, Pel JJM, van der Steen J. The relationship between visual orienting responses and clinical characteristics in children attending special education for the visually impaired. J Child Neurol 2015; 30:690-7. [PMID: 25038127 DOI: 10.1177/0883073814539556] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 05/15/2014] [Indexed: 11/16/2022]
Abstract
We recently introduced a method based on quantification of orienting responses toward visual stimuli to assess the quality of visual information processing in children. In the present study, we examined the relationship between orienting responses and factors that are associated with visual processing impairments in current clinical practice. Response time and fixation quality to visual features such as form, contrast, motion, and color stimuli were assessed in 104 children from 1 to 12 years attending special education for the visually impaired. Using regression analysis, we investigated whether these parameters were affected by clinical characteristics of children. Response times significantly depended on stimulus type. Responses to high-contrast cartoons were significantly slower in children with a clinical diagnosis of cerebral visual impairment. Fixation quality was significantly affected by visual acuity and nystagmus. The results suggest that the quantitative measurement of orienting responses is strongly related to cerebral visual impairment in children.
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Affiliation(s)
- Marlou J G Kooiker
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, Rotterdam, the Netherlands
| | - Johan J M Pel
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, Rotterdam, the Netherlands
| | - Johannes van der Steen
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, Rotterdam, the Netherlands Royal Dutch VISIO, Huizen, the Netherlands
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91
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Ego C, Orban de Xivry JJ, Nassogne MC, Yüksel D, Lefèvre P. Spontaneous improvement in oculomotor function of children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:630-644. [PMID: 25462523 DOI: 10.1016/j.ridd.2014.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/16/2014] [Indexed: 06/04/2023]
Abstract
Eye movements are essential to get a clear vision of moving objects. In the present study, we assessed quantitatively the oculomotor deficits of children with cerebral palsy (CP). We recorded eye movements of 51 children with cerebral palsy (aged 5-16 years) with relatively mild motor impairment and compared their performance with age-matched control and premature children. Overall eye movements of children with CP are unexpectedly close to those of controls even though some oculomotor parameters are biased by the side of hemiplegia. Importantly, the difference in performance between children with CP and controls decreases with age, demonstrating that the oculomotor function of children with CP develops as fast as or even faster than controls for some visual tracking parameters. That is, oculomotor function spontaneously improves over the course of childhood. This evolution highlights the ability of lesioned brain of children with CP to compensate for impaired motor function beyond what would be achieved by normal development on its own.
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Affiliation(s)
- Caroline Ego
- ICTEAM, Université catholique de Louvain, Louvain-la-Neuve, Belgium; Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium.
| | - Jean-Jacques Orban de Xivry
- ICTEAM, Université catholique de Louvain, Louvain-la-Neuve, Belgium; Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium.
| | - Marie-Cécile Nassogne
- Neuropediatric Department, Cliniques universitaires Saint-Luc, Brussels, Belgium; Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium.
| | - Demet Yüksel
- Ophthalmology Department, Cliniques universitaires Saint-Luc, Brussels, Belgium; Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium.
| | - Philippe Lefèvre
- ICTEAM, Université catholique de Louvain, Louvain-la-Neuve, Belgium; Institute of Neuroscience (IoNS), Université catholique de Louvain, Brussels, Belgium.
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92
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Han SY, Han J, Han SH, Lee JB, Rhiu S. Ocular alignment after bilateral lateral rectus recession in exotropic children with cerebral palsy. Br J Ophthalmol 2014; 99:757-61. [PMID: 25472950 DOI: 10.1136/bjophthalmol-2014-305758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/16/2014] [Indexed: 11/04/2022]
Abstract
AIMS To compare the surgical outcomes of exotropia patients with cerebral palsy (CP) and controls without CP. METHODS 30 patients with exotropia and CP and 60 age-matched controls without CP who underwent bilateral lateral rectus (BLR) recession were retrospectively enrolled. All patients underwent BLR recession according to Parks' method. Surgical success was defined by esotropia deviation ≤5 PD (prism diopters) and exotropia deviation ≤10 PD. Success rate, cumulative probabilities of success, and postoperative change of angle deviations using a linear mixed model were evaluated. RESULTS Mean postoperative follow-up times were 21.60±8.62 months for the CP group and 25.60±10.82 months for the control group (p=0.081). Mean preoperative deviation was 30.97±10.54 PD in the CP group and 29.75±7.52 PD in the control group (p=0.530), which was reduced to 4.44±7.13 PD and 7.43±7.59 PD, respectively (p=0.093) after BLR recession. Using linear mixed model analysis, the estimated mean postoperative deviation of both groups was in the success range at all times tested. At the final visit, successful surgical outcomes were achieved in 76.7% of the CP group and 56.7% of the control group (p=0.179). Differences in the cumulative probability of surgical success were not statistically significant between the two groups (p=0.106, log rank test). CONCLUSIONS CP patients with exotropia showed successful ocular alignment comparable to that of controls after BLR recession of at least 2 years.
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Affiliation(s)
- So Young Han
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinu Han
- Department of Ophthalmology, Eye and Ear Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sueng-Han Han
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Bok Lee
- Department of Ophthalmology, Eye and Ear Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soolienah Rhiu
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
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93
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Pel JJM, Kooiker MJG, van der Does JME, Boot FH, de Faber JT, van der Steen-Kant SP, van der Steen J. Orienting responses to various visual stimuli in children with visual processing impairments or infantile nystagmus syndrome. J Child Neurol 2014; 29:1632-7. [PMID: 24334347 DOI: 10.1177/0883073813511150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Quantification of orienting responses can be used to differentiate between children with cerebral visual impairment and infantile nystagmus syndrome. To further improve the sensitivity of this method, we compared orienting responses to a Cartoon stimulus, which contains all sorts of visual information, to stimuli that contain only Contrast, Form coherence, Motion coherence, Color and Motion detection. The stimuli were shown on an eye tracker monitor using a preferential looking paradigm. We found that both groups of children showed general slowing in orienting responses compared to controls. The children with cerebral visual impairment had significantly prolonged responses to Cartoon compared to the children with nystagmus, whereas the children with nystagmus had prolonged responses to Motion detection and larger fixation areas. Previously reported differences in orienting responses to Cartoon were replicated. Application of specific visual information did not alter the sensitivity of the method to distinguish between children with visual processing deficits.
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Affiliation(s)
- J J M Pel
- Department of Neuroscience, Vestibular and ocular motor research group, Rotterdam, The Netherlands
| | - M J G Kooiker
- Department of Neuroscience, Vestibular and ocular motor research group, Rotterdam, The Netherlands
| | - J M E van der Does
- Department of Neuroscience, Vestibular and ocular motor research group, Rotterdam, The Netherlands
| | - F H Boot
- Department of Neuroscience, Vestibular and ocular motor research group, Rotterdam, The Netherlands
| | - J T de Faber
- Department of Ophthalmology, Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | | | - J van der Steen
- Department of Neuroscience, Vestibular and ocular motor research group, Rotterdam, The Netherlands Royal Dutch VISIO, Huizen, The Netherlands
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94
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Bosch DGM, Boonstra FN, Reijnders MRF, Pfundt R, Cremers FPM, de Vries BBA. Chromosomal aberrations in cerebral visual impairment. Eur J Paediatr Neurol 2014; 18:677-84. [PMID: 24912731 DOI: 10.1016/j.ejpn.2014.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 02/06/2014] [Accepted: 05/13/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cerebral visual impairment (CVI) is a disorder in projection and/or interpretation of the visual input in the brain and accounts for 27% of the visually impaired children. AIM A large cohort of patients with CVI was investigated in order to ascertain the relevance of chromosomal aberrations in the etiology of this disorder. METHODS 607 patients with CVI and a visual acuity ≤0.3 were assessed for the presence of a chromosomal aberration retrospectively. The observed aberrations were classified for pathogenicity. RESULTS A total of 98 chromosomal aberrations were found in 79 persons (13%) of the cohort. In nine persons it was not possible to classify the clinical implication of the aberration, due to lack of detailed information. In 70 persons it was possible to classify the aberration for causality: in 41 patients the aberration was associated with CVI, in 16 it was unknown and in 13 the aberration was unlikely to be associated with CVI. For four aberrations, present in 26 patients, the association with CVI has been reported before: trisomy 21, 1p36 deletion syndrome, 17p13.3 deletion syndrome (Miller-Dieker syndrome) and 22q13.3 deletion syndrome (Phelan-McDermid syndrome). The chromosomal aberrations in another 15 patients were for the first time associated with CVI. CONCLUSIONS Chromosomal aberrations associated with CVI were found in 7% (41/607) of patients, of which 37% (15/41) have not been reported before in association with CVI. Therefore, in patients with CVI chromosomal investigations should be routinely performed to warrant a good clinical diagnosis and counseling.
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Affiliation(s)
- Daniëlle G M Bosch
- Bartiméus, Institute for the Visually Impaired, Zeist, The Netherlands; Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands; Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud university medical center, Nijmegen, The Netherlands
| | - F Nienke Boonstra
- Bartiméus, Institute for the Visually Impaired, Zeist, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud university medical center, Nijmegen, The Netherlands
| | - Margot R F Reijnders
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Rolph Pfundt
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - Frans P M Cremers
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands; Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Bert B A de Vries
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud university medical center, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands.
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95
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García-Ormaechea I, González I, Duplá M, Andres E, Pueyo V. Validation of the Preverbal Visual Assessment (PreViAs) questionnaire. Early Hum Dev 2014; 90:635-8. [PMID: 25173177 DOI: 10.1016/j.earlhumdev.2014.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/01/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Visual cognitive integrative functions need to be evaluated by a behavioral assessment, which requires an experienced evaluator. The Preverbal Visual Assessment (PreViAs) questionnaire was designed to evaluate these functions, both in general pediatric population or in children with high risk of visual cognitive problems, through primary caregivers' answers. AIM We aimed to validate the PreViAs questionnaire by comparing caregiver reports with results from a comprehensive clinical protocol. STUDY DESIGN A total of 220 infants (<2 years old) were divided into two groups according to visual development, as determined by the clinical protocol. Their primary caregivers completed the PreViAs questionnaire, which consists of 30 questions related to one or more visual domains: visual attention, visual communication, visual-motor coordination, and visual processing. Questionnaire answers were compared with results of behavioral assessments performed by three pediatric ophthalmologists. RESULTS Results of the clinical protocol classified 128 infants as having normal visual maturation, and 92 as having abnormal visual maturation. The specificity of PreViAs questionnaire was >80%, and sensitivity was 64%-79%. More than 80% of the infants were correctly classified, and test-retest reliability exceeded 0.9 for all domains. CONCLUSIONS The PreViAs questionnaire is useful to detect abnormal visual maturation in infants from birth to 24months of age. It improves the anamnesis process in infants at risk of visual dysfunctions.
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Affiliation(s)
- Inés García-Ormaechea
- Ophthalmology Department, Asociación Telefónica Asistencia Minusválidos (ATAM), Madrid, Spain
| | - Inmaculada González
- Ophthalmology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain; Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | - María Duplá
- Pediatric Department, Centro de Salud San Pablo, Zaragoza, Spain
| | - Eva Andres
- Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - Victoria Pueyo
- Ophthalmology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain.
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96
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Abstract
PURPOSE OF REVIEW To describe recent evidence regarding the surgical approach of strabismus in children with various forms of developmental delay. RECENT FINDINGS There remains variability in surgical outcomes with or without dose adjustment in strabismus surgery for children with developmental delay. However, this should not deter one from performing surgery - even early surgery, as fusional potential remains possible, which can especially impact the quality of vision and quality of life in developmentally delayed children.Future prospective, comparative, long-term studies with larger sample sizes for strabismus surgery in children with developmental delay are still needed. SUMMARY Strabismus is one of the most common ophthalmologic findings in children with developmental delay. Surgical correction of strabismus in children with developmental delay is well tolerated and effective, although it remains slightly less predictable, which can depend on the specific type of delay or underlying neurological deficit. Careful consideration of types and severity of developmental delay and attempts to measure binocular potential can help guide the timing, dosage, and type of treatment.Reoperations tend to be more frequently encountered in this population, and this higher degree of variability should be addressed in the consent process.Considering adjusting the surgical dosage in this population, taking careful preoperative measurements, and checking for fusional potential should be taken into account when managing children with developmental delay.
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97
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Kooiker MJG, Pel JJM, van der Steen J. Viewing behavior and related clinical characteristics in a population of children with visual impairments in the Netherlands. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1393-1401. [PMID: 24713519 DOI: 10.1016/j.ridd.2014.03.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 06/03/2023]
Abstract
Children with visual impairments are very heterogeneous in terms of the extent of visual and developmental etiology. The aim of the present study was to investigate a possible correlation between prevalence of clinical risk factors of visual processing impairments and characteristics of viewing behavior. We tested 149 children with visual information processing impairments (90 boys, 59 girls; mean age (SD)=7.3 (3.3)) and 127 children without visual impairments (63 boys and 64 girls, mean age (SD)=7.9 (2.8)). Visual processing impairments were classified based on the time it took to complete orienting responses to various visual stimuli (form, contrast, motion detection, motion coherence, color and a cartoon). Within the risk group, children were divided into a fast, medium or slow group based on the response times to a highly salient stimulus. The relationship between group specific response times and clinical risk factors was assessed. The fast responding children in the risk group were significantly slower than children in the control group. Within the risk group, the prevalence of cerebral visual impairment, brain damage and intellectual disabilities was significantly higher in slow responding children compared to faster responding children. The presence of nystagmus, perceptual dysfunctions, mean visual acuity and mean age did not significantly differ between the subgroups. Orienting responses are related to risk factors for visual processing impairments known to be prevalent in visual rehabilitation practice. The proposed method may contribute to assessing the effectiveness of visual information processing in children.
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Affiliation(s)
- M J G Kooiker
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - J J M Pel
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - J van der Steen
- Vestibular and Ocular Motor Research Group, Department of Neuroscience, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Royal Dutch VISIO, Postbus 1180, 1270 BD Huizen, The Netherlands.
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98
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Bosch DGM, Boonstra FN, Willemsen MAAP, Cremers FPM, de Vries BBA. Low vision due to cerebral visual impairment: differentiating between acquired and genetic causes. BMC Ophthalmol 2014; 14:59. [PMID: 24886270 PMCID: PMC4021540 DOI: 10.1186/1471-2415-14-59] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 04/28/2014] [Indexed: 11/21/2022] Open
Abstract
Background To gain more insight into genetic causes of cerebral visual impairment (CVI) in children and to compare ophthalmological findings between genetic and acquired forms of CVI. Methods The clinical data of 309 individuals (mainly children) with CVI, and a visual acuity ≤0.3 were analyzed for etiology and ocular variables. A differentiation was made between acquired and genetic causes. However, in persons with West syndrome or hydrocephalus, it might be impossible to unravel whether CVI is caused by the seizure disorder or increased intracranial pressure or by the underlying disorder (that in itself can be acquired or genetic). In two subgroups, individuals with ‘purely’ acquired CVI and with ‘purely’ genetic CVI, the ocular variables (such as strabismus, pale optic disc and visual field defects) were compared. Results It was possible to identify a putative cause for CVI in 60% (184/309) of the cohort. In the remaining 40% the etiology could not be determined. A ‘purely’ acquired cause was identified in 80 of the patients (26%). West syndrome and/or hydrocephalus was identified in 21 patients (7%), and in 17 patients (6%) both an acquired cause and West and/or hydrocephalus was present. In 66 patients (21%) a genetic diagnosis was obtained, of which 38 (12%) had other possible risk factor (acquired, preterm birth, West syndrome or hydrocephalus), making differentiation between acquired and genetic not possible. In the remaining 28 patients (9%) a ‘purely’ genetic cause was identified. CVI was identified for the first time in several genetic syndromes, such as ATR-X, Mowat-Wilson, and Pitt Hopkins syndrome. In the subgroup with ‘purely’ acquired causes (N = 80) strabismus (88% versus 64%), pale optic discs (65% versus 27%) and visual field defects (72% versus 30%) could be observed more frequent than in the subgroup with ‘purely’ genetic disorders (N = 28). Conclusions We conclude that CVI can be part of a genetic syndrome and that abnormal ocular findings are present more frequently in acquired forms of CVI.
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Affiliation(s)
| | | | | | | | - Bert B A de Vries
- Department of Human Genetics, Radboud University Medical Center, P,O, Box 9101, Nijmegen, HB 6500, The Netherlands.
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99
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NR2F1 mutations cause optic atrophy with intellectual disability. Am J Hum Genet 2014; 94:303-9. [PMID: 24462372 DOI: 10.1016/j.ajhg.2014.01.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/07/2014] [Indexed: 11/21/2022] Open
Abstract
Optic nerve atrophy and hypoplasia can be primary disorders or can result from trans-synaptic degeneration arising from cerebral visual impairment (CVI). Here we report six individuals with CVI and/or optic nerve abnormalities, born after an uneventful pregnancy and delivery, who have either de novo heterozygous missense mutations in NR2F1, also known as COUP-TFI, or deletions encompassing NR2F1. All affected individuals show mild to moderate intellectual impairment. NR2F1 encodes a nuclear receptor protein that regulates transcription. A reporter assay showed that missense mutations in the zinc-finger DNA-binding domain and the putative ligand-binding domain decrease NR2F1 transcriptional activity. These findings indicate that NR2F1 plays an important role in the neurodevelopment of the visual system and that its disruption can lead to optic atrophy with intellectual disability.
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100
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Chong C, Dai S. Cross-sectional study on childhood cerebral visual impairment in New Zealand. J AAPOS 2014; 18:71-4. [PMID: 24568987 DOI: 10.1016/j.jaapos.2013.09.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 08/14/2013] [Accepted: 09/24/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the prevalence, etiology, and avoidable causes of childhood cerebral visual impairment (CVI) in New Zealand. METHODS The clinical and educational records of blind and low vision children enrolled in the Blind and Low Vision Education Network, New Zealand (BLENNZ), a national referral center, were retrospectively analyzed. The WHO Program for Prevention of Blindness (WHO/PBL) Eye Examination Record for Children with Blindness and Low Vision was used to record data from children ≤16 years of age diagnosed with CVI and visual acuity ≤6/18 enrolled with BLENNZ. Data analyzed included demographics, etiology, visual acuity, visual fields, educational setting, and rehabilitation plan. RESULTS A total of 182 children (blind, 143; low vision, 39) were included. The calculated prevalence of childhood CVI in New Zealand was 0.02%. Of these, only 21% required low vision aids. Principle causes of CVI blindness were perinatal hypoxia/asphyxia (25%), nonaccidental injury (7%), and prematurity (7%). Approximately 50% of all cases of CVI blindness were potentially avoidable; of these, 52% were caused by perinatal hypoxia and 14% by nonaccidental injury. CONCLUSIONS The conservative calculated prevalence of CVI, responsible for 30% of all childhood blindness in New Zealand, was 0.02%. The most common cause of CVI blindness in New Zealand, perinatal asphyxia, is also an avoidable cause.
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Affiliation(s)
- CheeFoong Chong
- Department of Ophthalmology, University of Auckland, New Zealand
| | - Shuan Dai
- Department of Ophthalmology, University of Auckland, New Zealand; Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, New Zealand.
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