Colour perception develops throughout childhood with increased risk of deficiencies in children born prematurely

Abstract

AimTo quantify the impact of prematurity on chromatic discrimination throughout childhood, from 2 to 15 years of age.MethodsWe recruited two cohorts of children, as part of the TrackAI Project, an international project with seven different study sites: a control group of full‐term children with normal visual development and a group of children born prematurely. All children underwent a complete ophthalmological exam and an assessment of colour discrimination along the three colour axes: deutan, protan and trytan using a DIVE device with eye tracking technology.ResultsWe enrolled a total of 1872 children (928 females and 944 males) with a mean age of 6.64 years. Out of them, 374 were children born prematurely and 1498 were full‐term controls. Using data from all the children born at term, reference normative curves were plotted for colour discrimination in every colour axis. Pre‐term children presented worse colour discrimination than full‐term in the three colour axes (p < 0.001). Even after removing from the comparison, all pre‐term children with any visual disorder colour discrimination outcomes remained significantly worse than those from full‐term children.ConclusionWhile colour perception develops throughout the first years of life, children born pre‐term face an increased risk for colour vision deficiencies.

Screening for colour vision deficiency is needed in all children, not just those born prematurely

“…Giving further detail on the adaptive algorithm used to estimate chromatic thresholds is important as the algorithm affects the rate of false positives and negatives on the test, and the appropriate algorithm needs careful consideration when estimating thresholds in individuals where inattention is often high. 6 InPueyo et al's study, 3 the exceptionally good performance of some children and the impossible performance of others (the scatterplots and box plots show that some children have thresholds of 0ΔE indicating ©2023FoundationActaPaediatrica.PublishedbyJohnWiley&SonsLtd.…”

“…5 ThekeyquestionthatarisesfromPueyoetal. 'sstudy 3 Unfortunately, validation data giving the sensitivity and specificity of the test for diagnosing CVD when used with children does not appear to have been published (precise details of the stimuli and adaptive procedure are also not specified). When performance is pooracrosstheboardforallcolourconditions(asinPueyoetal.…”

“…When performance is pooracrosstheboardforallcolourconditions(asinPueyoetal. 3 ), the contribution of non-colour-related factors to task performance cannotberuledout.Pueyoetal.dismissthepossibilitythatthepoor performance of the children born prematurely is due to non-colour factors such as poor attention, oculomotor control or figure-ground segmentation as they argue that these children were able to do similar tasks that did not involve colour. However, details of the other tasks are not given, data for children's performance on the other tasks is not presented, and analyses do not directly covary out performance on the other tasks to formally rule out this possibility.…”

“…In addition, inspection of the data that is presented in Pueyo et al 3 also raises a few concerns. The high incidence of outliers amongst the full-term group for tritan discrimination points to factors other than colour affecting task performance as tritan defects are extremely rare (e.g., a conservative estimate is <0.002% of the population).…”

“…One such test, ColourSpot, involves the simple task of tapping coloured dots and has validation data on 4-to 7-year-old children confirming equivalent sensitivity and specificity compared to the pseudoisochromatic Ishihara for the Unlettered test. 7 If prematurity does indeed affect all types of colour discrimination as suggested by Pueyo et al, 3 then it is essential that any screening of colour vision in children born prematurely includes a test that controls for non-colour related factors, where the test is identical to the colour vision test but where stimuli vary in a property other than colour (e.g., luminance). However, to ensure that task difficulty is not a confound, stimulus differences for the colour vision and control tests need careful equating if stimuli are pre-defined rather than defined adaptively.…”