Ophthalmological examination and VEPs in preterm children with perinatal CNS involvement

Abstract

Five children with a history of preterm birth (mean gestational age of 27 weeks; birth weight 870-1,380 g) and perinatal post-hemorrhagic hydrocephalus were examined ophthalmologically at ages ranging from 4-11 years. An extended visual evoked potentials (VEPs) examination was simultaneously performed, using pattern-reversal, motion-onset, and cognitive visual stimuli. Although 3 of the 10 eyes displayed about normal visual acuity (> or =0.9), all of the examined eyes were abnormal for at least one variant of the tested VEPs. Pathological changes in VEPs (missing responses, shape abnormalities due to delayed VEPs maturation, prolonged peak latencies, and reduced amplitudes) were roughly proportional to both gestational age and reduction in visual acuity. A more severe pathology was found in the motion-onset VEPs (in all five subjects - nine eyes) when compared to the pattern-reversal VEPs (in four subjects - eight eyes). These observations suggest that the magnocellular system/dorsal stream of the visual pathway (which is particularly activated in response to motion stimuli) may be more frequently affected in preterm children than the parvocellular system/ventral stream (tested mostly by the standard pattern-reversal VEPs). This pilot study may encourage further testing of the combined pattern and motion-related VEPs examinations in preterm children as a way of detecting hidden cortical/cerebral visual impairment (CVI).

Visual Development and Neuropsychological Profile in Preterm Children from 6 Months to School Age

“…24 Our data would therefore suggest that excitatory activity in response to visual stimulation was higher in school-age children born preterm than full-term. Although many studies using similar visual evoked potential techniques have reported otherwise (ie, lower amplitudes in preterm births), 24,70 several have shown higher amplitudes, albeit in different clinical populations. For example, Cokcay et al 71 reported high visual evoked potential amplitudes in children with occipital epilepsy, which they explained as hyperexcitability of the occipital cortical structures mostly attributable to immaturity.…”

Cerebral Visual Impairment in Children

“…Children with periventricular white matter damage commonly show reduced perception of movement, which has been demonstrated with visual evoked potentials to global motion and motion onset (Weinstein et al 2012 ;Kuba et al 2008 ). Impaired motion perception is common in children born before 34 weeks, and is more marked in those who manifest periventricular white matter lesions (Guzzetta et al 2009 ).…”

Visual evoked potentials after hematopoietic allogeneic stem cell transplantation in childhood

“…Prematurity has also previously been reported to affect the VEP results (Kuba et al, 2008). No patient had abnormal optic discs while two patients with abnormal VEP were noticed to have a clinically thin retina.…”