Perceptual Learning in Children With Infantile Nystagmus: Effects on Reading Performance

Abstract

PURPOSE. Perceptual learning improves visual acuity and reduces crowding in children with infantile nystagmus (IN). Here, we compare reading performance of 6-to 11-year-old children with IN with normal controls, and evaluate whether perceptual learning improves their reading. METHODS.Children with IN were divided in two training groups: a crowded training group (n ¼ 18; albinism: n ¼ 8; idiopathic IN: n ¼ 10) and an uncrowded training group (n ¼ 17; albinism: n ¼ 9; idiopathic IN: n ¼ 8). Also 11 children with normal vision participated. Outcome measures were: reading acuity (the smallest readable font size), maximum reading speed, critical print size (font size below which reading is suboptimal), and acuity reserve (difference between reading acuity and critical print size). We used multiple regression analyses to test if these reading parameters were related to the children's uncrowded distance acuity and/or crowding scores.RESULTS. Reading acuity and critical print size were 0.65 6 0.04 and 0.69 6 0.08 log units larger for children with IN than for children with normal vision. Maximum reading speed and acuity reserve did not differ between these groups. After training, reading acuity improved by 0.12 6 0.02 logMAR and critical print size improved by 0.11 6 0.04 logMAR in both IN training groups. The changes in reading acuity, critical print size, and acuity reserve of children with IN were tightly related to changes in their uncrowded distance acuity and the changes in magnitude and extent of crowding.CONCLUSIONS. Our findings are the first to show that visual acuity is not the only factor that restricts reading in children with IN, but that crowding also limits their reading performance. By targeting both of these spatial bottlenecks in children with IN, our perceptual learning paradigms significantly improved their reading acuity and critical print size. This shows that perceptual learning can effectively transfer to reading.

Interventions to improve functioning, participation, and quality of life in children with visual impairment: a systematic review

“…1 studies, participants had visual impairment or blindness caused by various eye conditions. 1e3,6e8,11e13, 15,16,19e21,26e28, 30,32,33,35,39,40,43,44,46,47,50,54e58,61,62,65,66,69e72,74,75,78,82e85,89e91,93, 95,96,98,104,108,110,111,119,121,123,124 In 1 study, all participants had infantile nystagmus, 51 and in 1 study, they all had glaucoma. 73 As is often the case in studies involving children, there was a large variation in the diagnoses or causes of visual impairment, but albinism, nystagmus, and retinopathy of prematurity were commonly reported.…”

“…The available fulltext articles were screened on inclusion and exclusion criteria and assessed for eligibility. Together with articles identified through searches in reference lists of previously retrieved reviews and the gray literature, this resulted in 64 articles, describing 66 different studies (28 RCTs, 3,7,13,16,19,21,32, 33,39,47,50,54,56e58,61,62,66,69,72,78,83,85,93,98,111,121,124 18 non-RCTs, 1,2,6,11,15,20,27,35,44,51,55,65,74,75,82,89,96,104 and 20 before-after comparisons (BAs) 8 articles of McMahon and Kederis described 2 different studies. 57,58,70,71 The 66 included studies were published between 1964 and 2018, and 37 (56.1%) of them were published in the last decade (2008e2018) 1e3, 13,15,16,19e21,27,28, 30,32,33,35,39,40,43,46,51,54,62,65,69e71,73e75,78,82,83,85,89,91,96,98,104,110,111,124 ( Table 1).…”

“…57,58,70,71 The 66 included studies were published between 1964 and 2018, and 37 (56.1%) of them were published in the last decade (2008e2018) 1e3, 13,15,16,19e21,27,28, 30,32,33,35,39,40,43,46,51,54,62,65,69e71,73e75,78,82,83,85,89,91,96,98,104,110,111,124 ( Table 1). Most of the studies were conducted in the United States, 7,11,12,26,35,44,47,55e58,61,65,66,70e72,78,84,91,93,95,121 1 in Canada, 8 11 in Europe (i.e., United Kingdom, 50,108,119 Germany, 6 the Netherlands, 13,27,51,83,89 and Greece 69,82 ), 28 in Asian countries (i.e., Iran, 54 Turkey, 1,15,16,30,104,110,111,123,124 India, 20,21,28,39,40,43,46,62,74,75,90,96 Jordan, 2 Pakistan, 85 Japan, 97 Taiwan, 19 and Thailand 3,98 ), a...…”

“…57 Fourteen studies reported a cutoff criterion for visual acuity. 1,11,13,21,27,28,30,35,47,51,54,75,78,89 Slightly more often, studies reported the degree of visual impairment (e.g., severe visual impairment, legal blindness) or fulfillment of certain criteria for low vision (e.g., the criteria for low vision of the WHO or the ICD criteria). 1,6,16,20,39,40,44,50,56,62,69,75,90,93,96,104,110,111,121 In some cases, authors quantified the number of participants with a certain degree of visual impairment, that is, how many participants had visual impairment and how many participants were blind.…”

“…With respect to reading performance, interventions included (braille) reading training, 47,50,57,58 (training in) the use of optical aids, 26,35,110 and crowded training. 51 Studies investigating social skills used social skills training, 93,124 assertiveness training, 61 communication training, 44,72 and visual perception training 111 as intervention. Viewing behavior was investigated by interventions on video games 78 and training in visual aids.…”