Perception Problems Common in Adolescents Born Very Preterm

August 09, 2013

By Anne Harding

NEW YORK (Reuters Health) Aug 09 - Adolescents born at extremely low birth weight or extremely premature (ELBW/EP) are more likely than term newborns to have visual perception problems, new research confirms.

Children in the ELBW/EP group also had significantly worse visual acuity than normal controls, and they also had worse stereopsis and convergence, Dr. Carly S. Molloy of the Murdoch Children's Research Institute in Melbourne and her colleagues reported August 5 in Pediatrics.

"Notwithstanding the fact that visual acuity in most ELBW/EP adolescents is within the normal range, the current study results demonstrate support for the persistence of visual perceptual problems in ELBW/EP adolescents, which may lay the foundation to examine more complex relationships between visual perception and other visual-based cognitive and functional outcomes," Dr. Molloy and her team state.

While ocular development is known to be different in ELBW/EP children, who are also at risk of retinopathy of prematurity and periventricular white matter damage associated with poor vision, investigators have not looked at vision in children born since the early 1990s, when medical advances "dramatically" increased survival among these infants, the researchers note.

To investigate the frequency and nature of vision problems in these children, Dr. Molloy and her colleagues performed a battery of tests in 228 surviving ELBW/EP adolescents born in 1991 and 1992 and 166 randomly chosen normal birth weight controls who ranged in age from 14 to 20.

Median visual acuity was significantly worse for the ELBW/EP group compared to the controls, although median acuities for this group were within the normal range.

The ELBW/EP group was 3.22 times more likely to have abnormal stereopsis, or binocular depth perception, and 2.76 times more likely to have abnormal convergence (the ability to move both eyes inward to focus on an object up close). Scores were also significantly worse for the ELBW/EP group on tests of visual perception, including visual discrimination, visual-spatial relationships, form constancy, visual figure-ground, and visual closure.

Many ELBW/EP children may perform normally on simple tests of visual acuity, but these tests cannot identify visual perception problems, Dr. Anna O'Connor, a senior lecturer in orthoptics at the University of Liverpool in the UK, told Reuters Health. Dr. O'Connor studies vision in children, but did not take part in Dr. Molloy's research.

"If they're passing the vision test, don't assume that they can see normally," Dr. O'Connor said. While visual perception problems can't be cured, she added, individuals can learn skills to help them cope.

Follow-up is important for ELBW/EP children, so clinicians can monitor them and identify vision problems that arise, Dr. O'Connor said. These children should be seen by pediatric ophthalmologists and orthoptists, who specialize in treating binocular vision problems, she added.

While ELBW/EP children with retinopathy of prematurity or other more serious vision issues, are likely to get the care they need, those with more subtle problems "are the ones that get missed, and these are the real ones that we should be putting the flag up about," Dr. O'Connor added.


Pediatrics 2013.


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