Orientation and motion-specific visual cortex responses in infants born preterm

Development of Higher-Level Vision: A Network Perspective

Most studies on the development of the visual system have focused on the mechanisms shaping early visual stages up to the level of primary visual cortex (V1). Much less is known about the development of the stages after V1 that handle the higher visual functions fundamental to everyday life. The standard model for the maturation of these areas is that it occurs sequentially, according to the positions of areas in the adult hierarchy. Yet, the existing literature reviewed here paints a different picture, one in which the adult configuration emerges through a sequence of unique network configurations that are not mere partial versions of the adult hierarchy. In addition to studying higher visual development per se to fill major gaps in knowledge, it will be crucial to adopt a network-level perspective in future investigations to unravel normal developmental mechanisms, identify vulnerabilities to developmental disorders, and eventually devise treatments for these disorders.

Longitudinal study of infants receiving extra motor stimulation, full‐term control infants, and infants born preterm: High‐density EEG analyses of cortical activity in response to visual motion

Electroencephalography was used to investigate the effects of extrastimulation and preterm birth on the development of visual motion perception during early infancy. Infants receiving extra motor stimulation in the form of baby swimming, a traditionally raised control group, and preterm born infants were presented with an optic flow pattern simulating forward and reversed self‐motion and unstructured random visual motion before and after they achieved self‐produced locomotion. Extrastimulated infants started crawling earlier and displayed significantly shorter N2 latencies in response to visual motion than their full‐term and preterm peers. Preterm infants could not differentiate between visual motion conditions, nor did they significantly decrease their latencies with age and locomotor experience. Differences in induced activities were also observed with desynchronized theta‐band activity in all infants, but with more mature synchronized alpha–beta band activity only in extrastimulated infants after they had become mobile. Compared with the other infants, preterm infants showed more widespread desynchronized oscillatory activities at lower frequencies at the age of 1 year (corrected for prematurity). The overall advanced performance of extrastimulated infants was attributed to their enriched motor stimulation. The poorer responses in the preterm infants could be related to impairment of the dorsal visual stream that is specialized in the processing of visual motion.

Motion perception and its disorders

As we live in a dynamic world, motion is a fundamental aspect of our visual experience. The advent of computerized stimuli has allowed controlled study of a wide array of motion phenomena, including global integration and segmentation, speed and direction discrimination, motion aftereffects, the optic flow that accompanies self-motion, perception of object form derived from motion cues, and point-light biological motion. Animal studies first revealed the existence of a motion-selective region, the middle temporal (MT) area, also known as V5, located in the lateral occipitotemporal cortex, followed by areas such as V5A (also known as MST, the middle superior temporal area), V6/V6A, the ventral intraparietal area, and others. In humans there are rare cases of bilateral lesions of the V5/V5A complex causing cerebral akinetopsia, a severe impairment of motion perception. Unilateral V5/V5A lesions are more common but cause milder asymptomatic deficits, often limited to the contralateral hemifield, while parietal lesions can impair perception of point-light biological motion or high-level motion tasks that are attentionally demanding. Impairments of motion perception have also been described in optic neuropathy, particularly glaucoma, as well as Alzheimer's disease, Parkinson's disease with dementia, and dementia with Lewy body disease. Prematurity with or without periventricular leukomalacia and developmental syndromes such as Williams' syndrome, autism, and dyslexia have also been associated with impaired motion perception, suggesting a developmental vulnerability of the dorsal pathway.

Cortical thickness of primary visual cortex correlates with motion deficits in periventricular leukomalacia

Impairments of visual motion perception and, in particular, of flow motion have been consistently observed in premature and very low birth weight subjects during infancy. Flow motion information is analyzed at various cortical levels along the dorsal pathways, with information mainly provided by primary and early visual cortex (V1, V2 and V3). We investigated the cortical stage of the visual processing that underlies these motion impairments, measuring Grey Matter Volume and Cortical Thickness in 13 children with Periventricular Leukomalacia (PVL). The cortical thickness, but not the grey matter volume of area V1, correlates negatively with motion coherence sensitivity, indicating that the thinner the cortex, the better the performance among the patients. However, we did not find any such association with either the thickness or volume of area MT, MST and areas of the IPS, suggesting damage at the level of primary visual cortex or along the optic radiation.

Use of complex visual stimuli allows controlled recruitment of cortical networks in infants

OBJECTIVE

To characterize cortical networks activated by patterned visual stimuli in infants, and to evaluate their potential for assessment of visual processing and their associations with neurocognitive development.

METHODS

Three visual stimuli, orientation reversal (OR), global form (GF), and global motion (GM), were presented to cohort of five-month-old infants (N = 26). Eye tracker was used to guide the stimulation and to choose epochs for analysis. Visual responses were recorded with electroencephalography and analysed in source space using weighted phase lag index as the connectivity measure. The networks were quantified using several metrics that were compared between stimuli and correlated to cognitive outcomes.

RESULTS

Responses to OR/GF/GM stimuli were observed in nearly all (96/100/100%) recordings. All stimuli recruited cortical networks that were partly condition-specific in their characteristics. The more complex GF and GM conditions recruited wider global networks than OR. Additionally, strength of the GF network showed positive association with later cognitive performance.

CONCLUSIONS

Network analysis suggests that visual stimulation recruits large-scale cortical networks that extend far beyond the conventional visual streams and that differ between stimulation conditions.

SIGNIFICANCE

The method allows controlled recruitment of wide cortical networks, which holds promise for the early assessment of visual processing and its related higher-order cognitive processes.

Effects of Early Intervention on Visual Function in Preterm Infants: A Randomized Controlled Trial

Objectives: To determine the effectiveness of an early intervention program in enhancing visual function in very preterm infants. Methods: We conducted a RCT. We included preterm infants born between 25⁺⁰ and 29⁺⁶ weeks of gestational age (GA), without severe morbidities, and their families. Infants were randomized to either receive Standard Care (SC) or Early Intervention (EI). SC, according to NICU protocols, included Kangaroo Mother Care and minimal handling. EI included, in addition to routine care, parental training according to the PremieStart program, and multisensory stimulation (infant massage and visual interaction) performed by parents. Visual function was assessed at term equivalent age (TEA) using a prevalidated battery evaluating ocular spontaneous motility, ability to fix and follow a target, reaction to color, stripes discrimination and visual attention at distance. Results: Seventy preterm (EI n = 34, SC n = 36) infants were enrolled. Thirteen were excluded according to protocol. Fifty-seven infants (EI = 27, SC = 30) were assessed at TEA. The two groups were comparable for parental and infant characteristics. In total, 59% of infants in the EI group achieved the highest score in all the nine assessed items compared to 17% in the SC group (p = 0.001): all infants in both groups showed complete maturation in four items, but EI infants showed more mature findings in the other five items (ocular motility both spontaneous and with target, tracking arc, stripes discrimination and attention at distance). Conclusions: Our results suggest that EI has a positive effect on visual function maturation in preterm infants at TEA. Trial Registration: clinicalTrial.gov (NCT02983513).

Brainstem as a developmental gateway to social attention

BACKGROUND

Evolution preserves social attention due to its key role in supporting survival. Humans are attracted to social cues from infancy, but the neurobiological mechanisms for the development of social attention are unknown. An evolutionary-based, vertical-hierarchical theoretical model of self-regulation suggests that neonatal brainstem inputs are key for the development of well-regulated social attention.

METHODS

Neonates born preterm (N = 44, GA 34 w.) were recruited and diagnosed at birth as a function of their auditory brainstem evoked responses (ABR). Participants enrolled in a prospective 8-year-long, double-blind, follow-up study comparing participants with brainstem dysfunctions and well-matched controls. Groups had comparable fetal, neonatal, and familial characteristics. Methods incorporated EEG power analysis and gaze tracking during the Attention Network Test (ANT, four cue types, and two targets) and a Triadic Gaze Engagement task (TGE, three social cue levels).

RESULTS

Results showed that neonatal brainstem compromise is related to long-term changes in Alpha- and Theta-band power asymmetries (p < .034, p < .016, respectively), suggesting suppressed bottom-up input needed to alert social attention. Gaze tracking indicated dysregulated arousal-modulated attention (p < .004) and difficulty in gaze engagement to socially neutral compared to nonsocial cues (p < .012).

CONCLUSIONS

Integrating models of Autism and cross-species data with current long-term follow-up of infants with discrete neonatal brainstem dysfunction suggests neonatal brainstem input as a gateway for bottom-up regulation of social attention.

Visual perception skills: a comparison between patients with Noonan syndrome and 22q11.2 deletion syndrome

Ventral and dorsal streams are visual pathways deputed to transmit information from the photoreceptors of the retina to the lateral geniculate nucleus and then to the primary visual cortex (V1). Several studies investigated whether one pathway is more vulnerable than the other during development, and whether these streams develop at different rates. The results are still discordant. The aim of the present study was to understand the functionality of the dorsal and the ventral streams in two populations affected by different genetic disorders, Noonan syndrome (NS) and 22q11.2 deletion syndrome (22q11.2DS), and explore the possible genotype-phenotype relationships. 'Form coherence' abilities for the ventral stream and 'motion coherence' abilities for the dorsal stream were evaluated in 19 participants with NS and 20 participants with 22q11.2DS. Collected data were compared with 55 age-matched controls. Participants with NS and 22q11.2DS did not differ in the form coherence task, and their performance was significantly lower than that of controls. However, in the motion coherence task, the group with NS and controls did not differ, and both obtained significantly higher scores than the group with 22q11.2DS. Our findings indicate that deficits in the dorsal stream are related to the specific genotype, and that in our syndromic groups the ventral stream is more vulnerable than the dorsal stream.

The Davida Teller Award Lecture, 2016: Visual Brain Development: A review of "Dorsal Stream Vulnerability"-motion, mathematics, amblyopia, actions, and attention

Research in the Visual Development Unit on "dorsal stream vulnerability' (DSV) arose from research in two somewhat different areas. In the first, using cortical milestones for local and global processing from our neurobiological model, we identified cerebral visual impairment in infants in the first year of life. In the second, using photo/videorefraction in population refractive screening programs, we showed that infant spectacle wear could reduce the incidence of strabismus and amblyopia, but many preschool children, who had been significantly hyperopic earlier, showed visuo-motor and attentional deficits. This led us to compare developing dorsal and ventral streams, using sensitivity to global motion and form as signatures, finding deficits in motion sensitivity relative to form in children with Williams syndrome, or perinatal brain injury in hemiplegia or preterm birth. Later research showed that this "DSV" was common across many disorders, both genetic and acquired, from autism to amblyopia. Here, we extend DSV to be a cluster of problems, common to many disorders, including poor motion sensitivity, visuo-motor spatial integration for planning actions, attention, and number skills. In current research, we find that individual differences in motion coherence sensitivity in typically developing children are correlated with MRI measures of area variations in parietal lobe, fractional anisotropy (from TBSS) of the superior longitudinal fasciculus, and performance on tasks of mathematics and visuo-motor integration. These findings suggest that individual differences in motion sensitivity reflect decision making and attentional control rather than integration in MT/V5 or V3A. Its neural underpinnings may be related to Duncan's "multiple-demand" (MD) system.

Development of Visual Motion Perception for Prospective Control: Brain and Behavioral Studies in Infants

During infancy, smart perceptual mechanisms develop allowing infants to judge time-space motion dynamics more efficiently with age and locomotor experience. This emerging capacity may be vital to enable preparedness for upcoming events and to be able to navigate in a changing environment. Little is known about brain changes that support the development of prospective control and about processes, such as preterm birth, that may compromise it. As a function of perception of visual motion, this paper will describe behavioral and brain studies with young infants investigating the development of visual perception for prospective control. By means of the three visual motion paradigms of occlusion, looming, and optic flow, our research shows the importance of including behavioral data when studying the neural correlates of prospective control.

Regional vulnerability of longitudinal cortical association connectivity: Associated with structural network topology alterations in preterm children with cerebral palsy

Preterm born children with spastic diplegia type of cerebral palsy and white matter injury or periventricular leukomalacia (PVL), are known to have motor, visual and cognitive impairments. Most diffusion tensor imaging (DTI) studies performed in this group have demonstrated widespread abnormalities using averaged deterministic tractography and voxel-based DTI measurements. Little is known about structural network correlates of white matter topography and reorganization in preterm cerebral palsy, despite the availability of new therapies and the need for brain imaging biomarkers. Here, we combined novel post-processing methodology of probabilistic tractography data in this preterm cohort to improve spatial and regional delineation of longitudinal cortical association tract abnormalities using an along-tract approach, and compared these data to structural DTI cortical network topology analysis. DTI images were acquired on 16 preterm children with cerebral palsy (mean age 5.6 ± 4) and 75 healthy controls (mean age 5.7 ± 3.4). Despite mean tract analysis, Tract-Based Spatial Statistics (TBSS) and voxel-based morphometry (VBM) demonstrating diffusely reduced fractional anisotropy (FA) reduction in all white matter tracts, the along-tract analysis improved the detection of regional tract vulnerability. The along-tract map-structural network topology correlates revealed two associations: (1) reduced regional posterior-anterior gradient in FA of the longitudinal visual cortical association tracts (inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, optic radiation, posterior thalamic radiation) correlated with reduced posterior-anterior gradient of intra-regional (nodal efficiency) metrics with relative sparing of frontal and temporal regions; and (2) reduced regional FA within frontal-thalamic-striatal white matter pathways (anterior limb/anterior thalamic radiation, superior longitudinal fasciculus and cortical spinal tract) correlated with alteration in eigenvector centrality, clustering coefficient (inter-regional) and participation co-efficient (inter-modular) alterations of frontal-striatal and fronto-limbic nodes suggesting re-organization of these pathways. Both along tract and structural topology network measurements correlated strongly with motor and visual clinical outcome scores. This study shows the value of combining along-tract analysis and structural network topology in depicting not only selective parietal occipital regional vulnerability but also reorganization of frontal-striatal and frontal-limbic pathways in preterm children with cerebral palsy. These finding also support the concept that widespread, but selective posterior-anterior neural network connectivity alterations in preterm children with cerebral palsy likely contribute to the pathogenesis of neurosensory and cognitive impairment in this group.

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

The aim of this semilongitudinal study was to investigate the development of central visual pathways in children born preterm but without major neurologic impairments and to establish their cognitive and behavioral profile at school age. Ten children born preterm were assessed at 6 months and at school age, using visual evoked potentials at both time points and cognitive and behavioral tests at school age. We also tested 10 age-matched children born full-term. At 6 months' corrected age, we found no significant differences between preterm and full-term groups for either amplitude or latency of N1 and P1 components. At school age, the preterm group manifested significantly higher N1 amplitudes and tended to show higher P1 amplitudes than the full-term group. We found no significant differences in cognitive and behavioral measures at school age. These results suggest that preterm birth affects visual pathways development, yet the children born preterm did not manifest cognitive problems.

Early childhood development of visual texture segregation in full-term and preterm children

To date, very little is known about the normal development trajectory of visual texture segregation, or how it is affected by preterm birth. The goal of this study was to characterize the development of visual texture segregation using texture segregation visual evoked potentials (tsVEPs) in children born full-term and children born preterm without major neurological impairment. Forty-five full-term and 43 preterm children were tested at either 12, 24 or 36 months of age (corrected age for prematurity at 12 and 24 months old). VEPs were obtained using two lower-level stimuli defined by orientation (oriVEP) and two higher-level stimuli defined by texture (texVEP). TsVEP was obtained by dividing by two the subtraction of oriVEP from texVEP. Results show a clear maturation of the processes underlying visual texture segregation in the full-term group, with a significant N2 latency reduction between 12 and 36 months of age for all conditions. Significant N2 amplitude reduction was observed for oriVEP between 12 and 24 months, as well as for texVEP between 12 and 24 months, and 12 and 36 months. Comparison between full-term and preterm children indicated significantly lower N2 amplitude for the preterm group at 12 months for oriVEP and texVEP. These differences were no longer apparent at 24 months of age, suggesting that children born preterm catch up with their full-term counterparts somewhere between 12 and 24 months of age. Our results appear to reflect a maturational delay in preterm children in both lower-level and higher-level visual processing during, at least, early childhood.

Transplanted glial restricted precursor cells improve neurobehavioral and neuropathological outcomes in a mouse model of neonatal white matter injury despite limited cell survival

OBJECTIVE

Neonatal white matter injury (NWMI) is the leading cause of cerebral palsy and other neurocognitive deficits in prematurely-born children, and no restorative therapies exist. Our objective was to determine the fate and effect of glial restricted precursor cell (GRP) transplantation in an ischemic mouse model of NWMI.

METHODS

Neonatal CD-1 mice underwent unilateral carotid artery ligation on postnatal-Day 5 (P5). At P22, intracallosal injections of either enhanced green fluorescent protein (eGFP) + GRPs or saline were performed in control and ligated mice. Neurobehavioral and postmortem studies were performed at 4 and 8 weeks post-transplantation.

RESULTS

GRP survival was comparable at 1 month but significantly lower at 2 months post-transplantation in NWMI mice compared with unligated controls. Surviving cells showed better migration capability in controls; however, the differentiation capacity of transplanted cells was similar in control and NWMI. Saline-treated NWMI mice showed significantly altered response in startle amplitude and prepulse inhibition (PPI) paradigms compared with unligated controls, while these behavioral tests were completely normal in GRP-transplanted animals. Similarly, there was significant increase in hemispheric myelin basic protein density, along with significant decrease in pathologic axonal staining in cell-treated NWMI mice compared with saline-treated NWMI animals.

INTERPRETATION

The reduced long-term survival and migration of transplanted GRPs in an ischemia-induced NWMI model suggests that neonatal ischemia leads to long-lasting detrimental effects on oligodendroglia even months after the initial insult. Despite limited GRP-survival, behavioral, and neuropathological outcomes were improved after GRP-transplantation. Our results suggest that exogenous GRPs improve myelination through trophic effects in addition to differentiation into mature oligodendrocytes.

Gaze Following Is Accelerated in Healthy Preterm Infants

Gaze following is an essential human communication cue that orients the attention of two interacting people to the same external object. This capability is robustly observed after 7 months of age in full-term infants. Do healthy preterm infants benefit from their early exposure to face-to-face interactions with other humans to acquire this capacity sooner than full-term infants of the same chronological age, despite their immature brains? In two different experiments, we demonstrated that 7-month-old preterm infants performed like 7-month-old full-term infants (with whom they shared the same chronological age) and not like 4-month-old full-term infants (with whom they shared the same postmenstrual age). The duration of exposure to visual experience thus appears to have a greater impact on the development of early gaze following than does postmenstrual age.

In search of biomarkers in psychiatry: EEG-based measures of brain function

Current clinical parameters used for diagnosis and phenotypic definitions of psychopathology are both highly variable and subjective. Intensive research efforts for specific and sensitive biological markers, or biomarkers, for psychopathology as objective alternatives to the current paradigm are ongoing. While biomarker research in psychiatry has focused largely on functional neuroimaging methods for identifying the neural functions that associate with psychopathology, scalp electroencephalography (EEG) has been viewed, historically, as offering little specific brain source information, as scalp appearance is only loosely correlated to its brain source dynamics. However, ongoing advances in signal processing of EEG data can now deliver functional EEG brain-imaging with distinctly improved spatial, as well as fine temporal, resolution. One computational approach proving particularly useful for EEG cortical brain imaging is independent component analysis (ICA). ICA decomposition can be used to identify distinct cortical source activities that are sensitive and specific to the pathophysiology of psychiatric disorders. Given its practical research advantages, relatively low cost, and ease of use, EEG-imaging is now both feasible and attractive, in particular for studies involving the large samples required by genetically informative designs to characterize causal pathways to psychopathology. The completely non-invasive nature of EEG data acquisition, coupled with ongoing advances in dry, wireless, and wearable EEG technology, makes EEG-imaging increasingly attractive and appropriate for psychiatric research, including the study of developmentally young samples. Applied to large genetically and developmentally informative samples, EEG imaging can advance the search for robust diagnostic biomarkers and phenotypes in psychiatry.

Ventral stream sensitivity in "healthy" preterm-born adolescents: psychophysical and neuropsychological evaluation

BACKGROUND

Deficits of motion processing have been reported in premature and very low birth-weight subjects during infancy, childhood and adolescence. Less is known about ventral stream functioning in preterms.

AIM

The aim of this study is to investigate ventral stream functioning in a sample of "healthy" adolescents born preterm with normal outcome and without brain damage.

STUDY DESIGN

We enrolled thirty preterm-born adolescents (mean age: 14.2years, mean gestational age 28.9weeks, mean birth weight 1097g), and 34 age-matched term-born controls (mean age: 14.5years). All subjects were administered a psychophysical test known as "Form Coherence Task" and a comprehensive standardized battery of neuropsychological tests suitable for investigating ventral stream functioning including Street Completion Test, Poppelreuter-Ghent Test and the first part of the Visual Object and Space Perception (VOSP) battery. Dorsal stream visual functioning was investigated by the second part of the VOSP.

RESULTS

Preterm (PT) subjects showed the same results in all "ventral" tasks with respect to full-term controls without any correlation to gestational age or birth weight. We found a significant negative correlation between Form Coherence Task and Letters Task (p=.014) and between Form Coherence and Silhouette Tasks (p=.017). No correlation was observed between Form Coherence Task and Street and Ghent Tests. A statistical difference was instead found between PTs and controls in two tasks of the VOSP battery that mostly involve the dorsal stream.

CONCLUSIONS

Preterm birth per se (in absence of evident brain lesions) is not sufficient to compromise the development of ventral pathway.

Limitations on the developing preterm brain: impact of periventricular white matter lesions on brain connectivity and cognition

Brain lesions to the white matter in peritrigonal regions, periventricular leukomalacia, in children who were born prematurely represent an important model for studying limitations on brain development. The lesional pattern is of early origin and bilateral, that constrains the compensatory potential of the brain. We suggest that (i) topography and severity of periventricular lesions may have a long-term predictive value for cognitive and social capabilities in preterm birth survivors; and (ii) periventricular lesions may impact cognitive and social functions by affecting brain connectivity, and thereby, the dissociable neural networks underpinning these functions. A further pathway to explore is the relationship between cerebral palsy and cognitive outcome. Restrictions caused by motor disability may affect active exploration of surrounding and social participation that may in turn differentially impinge on cognitive development and social cognition. As an outline for future research, we underscore sex differences, as the sex of a preterm newborn may shape the mechanisms by which the developing brain is affected.

Motion perception in children with foetal alcohol syndrome

AIM

To evaluate the visual magnocellular pathway by a coherent motion perception test in children with foetal alcohol syndrome (FAS).

METHODS

Eighty-nine children (49 with verified FAS and 40 without FAS) aged from 10 to 16 years were included into the study. Both the study and the control group were children living in orphanages. A coherent motion perception test was used. The test consisted of 150 white moving dots on a black background presented in different signal-to-noise ratio conditions. The task was direction detection of the coherently moving dots whose percentage decreased at each step.

RESULTS

A significant difference between the two groups was found (p = 0.018). Children with FAS had lower coherent motion perception ability in all the signal-to-noise ratio conditions. A significant difference between difficulty levels (p < 0.001) was found for all subjects in both groups - decreasing the stimulus signal-to-noise level decreased the motion perception score. In both groups, the motion perception score differed for vertical and horizontal stimuli (p = 0.003) with better performance with vertical stimuli.

CONCLUSION

Impaired motion perception in FAS children could be indicative of a dorsal stream developmental dysfunction resulting from alcohol brain damage.

Defective motion processing in children with cerebral visual impairment due to periventricular white matter damage

AIM

We sought to characterize visual motion processing in children with cerebral visual impairment (CVI) due to periventricular white matter damage caused by either hydrocephalus (eight individuals) or periventricular leukomalacia (PVL) associated with prematurity (11 individuals).

METHOD

Using steady-state visually evoked potentials (ssVEP), we measured cortical activity related to motion processing for two distinct types of visual stimuli: 'local' motion patterns thought to activate mainly primary visual cortex (V1), and 'global' or coherent patterns thought to activate higher cortical visual association areas (V3, V5, etc.). We studied three groups of children: (1) 19 children with CVI (mean age 9y 6mo [SD 3y 8mo]; 9 male; 10 female); (2) 40 neurologically and visually normal comparison children (mean age 9y 6mo [SD 3y 1mo]; 18 male; 22 female); and (3) because strabismus and amblyopia are common in children with CVI, a group of 41 children without neurological problems who had visual deficits due to amblyopia and/or strabismus (mean age 7y 8mo [SD 2y 8mo]; 28 male; 13 female).

RESULTS

We found that the processing of global as opposed to local motion was preferentially impaired in individuals with CVI, especially for slower target velocities (p=0.028).

INTERPRETATION

Motion processing is impaired in children with CVI. ssVEP may provide useful and objective information about the development of higher visual function in children at risk for CVI.

Orientation-reversal VEP: comparison of phase and peak latencies in adults and infants

The peak latency of pattern-reversal (PR)-VEP has been found to develop rapidly, reaching the adult level around 15 weeks of age. However, the development of orientation-reversal (OR)-VEP, reflecting the specific spatial organization of cortical receptive fields, still remains unknown. OR-VEP was tested in 81 adults at 1-12 reversals/sec (r/s) and 94 infants (age 4-79 weeks) at 2-8r/s. OR data at 4r/s from an additional 123 infants (age 4.0-20.3 weeks) studied previously were also analyzed. In addition to peak transient latencies at 1-4r/s, latency values derived from the gradient of phase against temporal frequency in steady-state recording were also calculated. For both adults and infants, no significant latency differences in the initial positive peaks were found among the low reversal rates. The calculated latency was statistically longer than the transient latency in both groups. While the transient latency asymptoted to adult value of 102 ms at around 50 weeks of age, the calculated latency, unlike that for PR-VEP, showed little variation across the age span. The data suggest a dominant effect of transmission delay on the initial peak in infancy, which reduces with age. However, the overall timing of the cortical response to orientation change remains slower than for pattern reversal in the fully developed visual cortex. Upon reaching maturity, the latencies of the initial positive peak in both pattern and orientation VEPs may arise from the same level of cortical processing in V1, but the overall time course reflected in the steady-state phase continues to show a much more prolonged response to orientation change than the transmission delay seen in the transient VEPs.

Visual perception in preterm children: what are we currently measuring?

Over the past two decades, cerebral visual impairment has been recognized as a principal deficit in preterm children, and in particular those with cerebral palsy. We review the current knowledge of visual processing deficits in these children, and provide an overview of the tools for assessing cerebral visual impairment. Commercially available instruments are usually directed at evaluating visuospatial skills rather than detecting object recognition difficulties. Particularly in children aged 3 years or younger and in children with multiple handicaps, cerebral visual impairment is difficult to diagnose. This difficulty may be attributable to limitations specific to the instrument, such as a test that is inappropriate for age, or to child-specific limitations such as motor impairment or speech delay. We therefore include an overview of relevant neuroimaging findings reported in these children, focusing on the most recent imaging modalities. Novel techniques such as diffusion tensor imaging may provide sensitive markers of cerebral visual impairment in situations where clinical diagnosis is difficult, and such approaches may allow for early intervention.

Development of smooth pursuit eye movements in very prematurely born infants: 2. The low-risk subgroup

AIM

To investigate the impact of premature birth on visual tracking in a group of 37 infants, born before the 32nd gestational weeks (mean 29 + 6 weeks) and diagnosed as being without major neonatal complications. This paper is a part of the LOVIS study (Strand Brodd, Ewald, Grönqvist, Holmström, Strömberg, Von Hofsten, et al. Acta Pediatrica, 2011).

METHODS

At 2 and 4 months corrected age, eye and head movements were measured when the infant tracked a moving object. The eye movements were analysed in terms of smooth pursuit and saccades (Vision Res, 37, 1997, 1799; Exp Brain Res, 146, 2002, 257). Accuracy of gaze, proportion of smooth pursuit, head movements and saccades were calculated.

RESULTS

  Between 2 and 4 months of age, all infants improved their ability to smoothly pursue a moving object. However, at both occasions, the preterm infants had less proportion smooth pursuit than the full-term infants. The groups did not differ with respect to gaze and head movements, but the saccade frequency was higher for the very preterms in some of the conditions.

CONCLUSION

The development of smooth pursuit in the low-risk preterm infant group was strongly delayed compared to typically developed infants. Thus, the 2 months or more extra visual experience did not have a distinguishable positive effect on visuo-motor development as expressed in smooth pursuit.

Development of human visual function

By 1985 newly devised behavioral and electrophysiological techniques had been used to track development of infants' acuity, contrast sensitivity and binocularity, and for clinical evaluation of developing visual function. This review focus on advances in the development and assessment of infant vision in the following 25 years. Infants' visual cortical function has been studied through selectivity for orientation, directional motion and binocular disparity, and the control of subcortical oculomotor mechanisms in fixation shifts and optokinetic nystagmus, leading to a model of increasing cortical dominance over subcortical pathways. Neonatal face processing remains a challenge for this model. Recent research has focused on development of integrative processing (hyperacuity, texture segmentation, and sensitivity to global form and motion coherence) in extra-striate visual areas, including signatures of dorsal and ventral stream processing. Asynchronies in development of these two streams may be related to their differential vulnerability in both acquired and genetic disorders. New methods and approaches to clinical disorders are reviewed, in particular the increasing focus on paediatric neurology as well as ophthalmology. Visual measures in early infancy in high-risk children are allowing measures not only of existing deficits in infancy but prediction of later visual and cognitive outcome. Work with early cataract and later recovery from blinding disorders has thrown new light on the plasticity of the visual system and its limitations. The review concludes with a forward look to future opportunities provided by studies of development post infancy, new imaging and eye tracking methods, and sampling infants' visual ecology.

Does preterm birth affect global and configural processing differently?

AIM

We investigated whether preterm birth affects later visuocognitive function and, in particular, whether it affects global and configural perceptual processing differently.

METHOD

We compared the performance of 21 healthy preterm children (8 females, 13 males; mean age 7 y 8 mo, SD 8 mo; mean gestational age 29.3 wks, SD 1.9; mean birthweight 1186.5 g, SD 377.2) with that of a matched term comparison group (8 females, 13 males; mean age 7 y 11 mo, SD 1 y 1 mo; mean gestational age >37 wks; mean birthweight >2500 g) in two perceptual tasks pinpointing differences between local and global and between local and configural processing.

RESULTS

There was no difference between preterm and term children's global processing, as both groups showed a bias towards global information (preterm: t[1,20]=2.6, p=0.01; comparison group: t[1,20]=3.0, p=0.01). By contrast, no such typical pattern of performance was found for configural processing as, unlike the comparison group (t[1,20]=7.1, p<0.001), preterm children preferentially relied on local rather than on configural information (t[1,20]=-15.4, p<0.001).

INTERPRETATION

These findings suggest that preterm birth may have a greater influence on the development of later perceptual skills than originally envisaged. We discuss the results according to the current and dominant view of the visual system.

Visual function at 35 and 40 weeks' postmenstrual age in low-risk preterm infants

OBJECTIVES

The objectives of this study were to (1) assess visual function in low-risk preterm infants at 35 and 40 weeks' postmenstrual age, (2) compare preterm visual abilities at term-equivalent age with term-born infants, and (3) evaluate effects of preterm extrauterine life on early visual function.

METHODS

Visual function was assessed by using a validated test battery at 35 and 40 weeks' postmenstrual age in 109 low-risk preterm infants who were born at <31 weeks' gestation. The preterm findings were compared with data from term-born infants collected by using the same test protocol.

RESULTS

All preterm infants completed both assessments. The 35-week responses were generally less mature than those at 40 weeks. Preterm infants at both ages were significantly more mature than term-born infants for ocular movements and vertical and arc tracking and at 40 weeks for stripe discrimination. In contrast, tracking a colored stimulus, attention at distance, and stripe discrimination were more mature at term age (in both term-born and preterm infants) than at 35 weeks.

CONCLUSIONS

Our findings provide data for visual function at 35 and 40 weeks' postmenstrual age in low-risk preterm infants. The results suggest that early extrauterine experience may accelerate the maturation of aspects of visual function related to ocular stability and tracking but does not seem to affect other aspects that may be more cortically mediated.