Visual development at 5 years of age was tested in a group of 39 children who had shown severe neonatal encephalopathy or perinatal brain lesions, documented by medical history, cranial ultrasound, or MRI. In all children, grating acuity was tested during the first 2 years of life. The assessment protocol at 5 years included various visual functions (grating and resolution acuity, visual field size, depth perception, optokinetic nystagmus, and ocular motility), and neurological and cognitive development. The majority of the children showed visual disorders of different type and degree, which were not due to ophthalmological abnormalities. Visual defects correlated well with the results of early visual assessment and of neuroimaging. Visual outcome could be predicted by grating acuity at 1 to 2 years in 27 of the 39 children, by neonatal cranial ultrasound in 26 of the 32 cases examined by this technique, and by later MRI in 23 out of 27. Moreover, a significant correlation was found between visual, motor, and cognitive impairment.