Visuospatial skills, ocular alignment, and magnetic resonance imaging findings in very low birth weight adolescents

doi:10.1016/j.jaapos.2008.11.008

Journal of American Association for Pediatric Ophthalmology and Strabismus

Volume 13, Issue 3, June 2009, Pages 273-279

https://doi.org/10.1016/j.jaapos.2008.11.008 Get rights and content

Purpose

To describe ocular alignment and stereoacuity in adolescents with very low birth weight (VLBW) in comparison with a matched control group and to investigate associations with white matter damage of immaturity (WMDI) and visuospatial skills in the VLBW group.

Methods

Fifty-nine 15-year-old VLBW subjects and 55 age- and sex-matched controls with normal birth weight underwent examination, including measurement of ocular alignment using cover test and Maddox rod and cycloplegic refraction. Stereoacuity was assessed with the TNO test, best-corrected visual acuity with a Konstantin Moutakis letter chart, and visuospatial skills with the performance tests, defined as performance intelligence quotient (IQ), in the Wechsler Intelligence Scale for Children (WISC-III). All VLBW subjects underwent magnetic resonance imaging of the brain.

Results

Ocular misalignment was significantly more common in the VLBW group than in the control group (22% compared with 4%; p = 0.004). Exophoria, subnormal stereoacuity, and subnormal performance IQ were significantly more common in the VLBW group than in the control group (p = 0.006, p = 0.011, and p = 0.015, respectively). Ocular misalignment was associated with WMDI (p = 0.035) and subnormal performance IQ (p = 0.020). Of the VLBW subjects with ocular misalignment, 69% had WMDI and/or subnormal performance IQ.

Conclusions

The VLBW adolescents had more visuospatial problems, lower stereoacuity, and more ocular misalignment than the control subjects. Ocular misalignment was associated with visuospatial deficiencies and/or WMDI in the VLBW group and was a better predictor for visuospatial deficits than WMDI.

Section snippets

Methods and Materials

The original population-based study group comprised all live born VLBW infants (n = 107) during a 15-month period in the southeastern region of Sweden. A total of 86 children survived the neonatal period and were eligible for a follow-up study. They were screened for retinopathy of prematurity (ROP) at the age of 40 postmenstrual weeks, according to the clinical practice at the time. Two VLBW subjects had diagnosed ROP stage 2 or greater. None were treated for ROP. One infant had Down syndrome

Ocular Alignment: Qualitative Measurements

The cover test revealed no heterotropia with habitual correction in the control group, although 1 subject had esotropia detected with uncorrected cover test. Three VLBW subjects had esotropia, and 1 had exotropia and hypotropia both with and without habitual correction. Medical records disclosed 2 additional VLBW subjects who had previously been surgically treated for intermittent exotropia; in the current study they were diagnosed as having exophoria. One VLBW subject had bilateral Brown

Discussion

In this population-based study in 15-year-old VLBW subjects and control subjects, we found increased prevalence of ocular misalignment in the VLBW group. Exophoria, subnormal stereoacuity, and subnormal performance IQ were significantly more common in the VLBW group. All VLBW subjects with heterotropia had subnormal performance IQ and 3 of 4 had moderate-to-severe WMDI.

Strabismus is a well-documented complication of various cerebral abnormalities. Increased prevalence of heterotropia and

Acknowledgments

This report is part of a multidisciplinary prospective follow-up study of VLBW children and controls in Southeast Sweden. The examination at 15 years of age was planned and performed by a working group consisting of the following members in addition to the authors of this paper: Orvar Finnström, Ingemar Leijon, PO Gäddlin, Stefan Samuelsson, Marie, Wadsby, Chen Wang, Ann Hellström and Olof Flodmark. The authors are grateful to Professor Gunnar Lennerstrand for valuable comments on the

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: This research was funded by a grant from the Health Research Council in Southeast Sweden (FORSS), the County of Jönköping and Östergötland, Stiftelsen Kronprinsessan Margaretas arbetsnämnd för synskadade, St. Erik Foundation for Eye Research, and Sigvard & Marianne Bernadotte Foundation for Pediatric Ophthalmology.

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Major ArticleVisuospatial skills, ocular alignment, and magnetic resonance imaging findings in very low birth weight adolescents

Purpose

Methods

Results

Conclusions

Section snippets

Methods and Materials

Ocular Alignment: Qualitative Measurements

Discussion

Acknowledgments

Lancet

Brain Dev

The changing panorama of cerebral palsy in Sweden. IX. Prevalence and origin in the birth-year period 1995–1998

Acta Paediatr

Cerebral palsy among very preterm children in relation to gestational age and neonatal ultrasound abnormalities: the EPIPAGE Cohort Study

Pediatrics

Oculomotor control in children who were born very prematurely

Invest Ophthalmol Vis Sci

Pyramidal tract damage correlates with motor dysfunction in bilateral periventricular leukomalacia

Neuropediatrics

Clinical and MRI correlates of cerebral palsy: The European Cerebral Palsy Study

JAMA

The role of magnetic resonance imaging in elucidating the pathogenesis of cerebral palsy: A systematic review

Dev Med Child Neurol

Magnetic resonance imaging of preterm brain injury

Arch Dis Child Fetal Neonatal Ed

Strabismus in very low birth weight and/or very preterm children: Discrepancy between age of onset and start of treatment

Eur J Pediatr

Pre-term delivery and subsequent ocular development. A 7-10 year follow-up of children screened 1982-84 for ROP. 2) Binocular function

Acta Ophthalmol Scand

Visual impairment in very low birthweight children

Arch Dis Child Fetal Neonatal Ed

Prospective study of New Zealand infants with birth weight less than 1500 g and screened for retinopathy of prematurity: Visual outcome at age 7-8 years

Br J Ophthalmol

Strabismus in children of birth weight less than 1701 g

Arch Ophthalmol

The significance of ocular morbidity in very-low-birthweight infants to the Australian health service

Aust J Ophthalmol

Eye movements and binocular function in low birthweight teenagers

Acta Ophthalmol

Nystagmus in periventricular leucomalacia

Br J Ophthalmol

Visual and cerebral sequelae of very low birth weight in subjects

Arch Dis Child Fetal Neonatal Ed

Major Article
Visuospatial skills, ocular alignment, and magnetic resonance imaging findings in very low birth weight adolescents