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Kelbsch C, Spieth B, Zrenner E, Besch D, Straßer T. PandAcuity in paediatrics: a novel clinical measure of visual function based on the panda illusion. Br J Ophthalmol 2023; 107:582-586. [PMID: 34789454 PMCID: PMC10086294 DOI: 10.1136/bjophthalmol-2021-319935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/31/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To evaluate the PandAcuity test for visual function testing in a paediatric cohort and to examine its agreement with conventional visual acuity (VA) testing. METHODS PandAcuity scores were determined in 152 children (77 males) aged between 3 and 15 years after VA testing (LEATM-test, E-chart, Landolt-C-rings or numbers). The PandAcuity test consisted of illusions made up from silhouettes of animals 'hidden' within zig-zag-patterns of decreasing spatial frequencies. Correlation analyses between PandAcuity score and VA were performed. RESULTS 150 children completed the test in at least one eye, 148 in both eyes. The PandAcuity test demonstrated good test-retest reliability (intraclass correlation coefficient=0.89) between two runs. VA and PandAcuity score showed a medium to large correlation (Spearman's ρ=0.52, p<0.0001). 93% of the children's visual impairment was classified in the same range by both test types. Receiver operating characteristic analysis of predicted visual impairment showed an excellent agreement with the classification based on VA testing (AUC=0.84). CONCLUSION The PandAcuity test is rapid, simple and well accepted, rendering it a suitable supplement for the clinical assessment of VA in children. Because of its counterintuitive application (a higher number of correctly identified images means worse VA), it can be used to cross-validate conventional acuity tests to assure children's compliance.
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Affiliation(s)
- Carina Kelbsch
- University Eye Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Bettina Spieth
- University Eye Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Eberhart Zrenner
- Werner Reichardt Centre for Integrative Neuroscience (CIN), University of Tuebingen, Tuebingen, Germany
- Institute for Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
| | - Dorothea Besch
- University Eye Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Torsten Straßer
- University Eye Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
- Institute for Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
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Sumalini R, Satgunam P. Grating acuity tests for infants, young children and individuals with disabilities: A review of recent advances. Semin Ophthalmol 2023; 38:76-84. [PMID: 36073743 DOI: 10.1080/08820538.2022.2116987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Accurate measurement of visual acuity is important in managing any ocular condition. Measuring visual acuity has always remained a challenge in infants, young children and individuals with disabilities who are unable to respond verbally. A variety of pediatric acuity tests that include both grating and recognition acuities have been described in the literature, some of which are outdated. This review paper aims to summarize the currently available and recently developed grating acuity tests that can be used for infants, young children and individuals with disabilities. METHODS A review of literature was carried out to identify tests that were currently available and recently developed. Additionally, search was also done on popular search engines and websites of companies. Tests identified were screened for availability and investigated for validity through published research in peer-reviewed journals. RESULTS A total of eight grating acuity tests were identified, out of which six of them were paper-based tests. The remaining two tests were app-based tests with established data for the typically developing pediatric cohort. The repeatability indices were available only for four grating acuity tests. CONCLUSIONS This review paper summarizes the basic features of the grating acuity tests and importantly, the parameters that determine the clinical utility of the tests such as the testability, acuity range, specific cohort studied, testing time and reliability indices. The paper also discusses the recent technological advancements in the field of acuity testing for the pediatric cohort and its comparisons with the conventional methods when available.
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Affiliation(s)
- Rebecca Sumalini
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India.,Institute for Vision Rehabilitation, L V Prasad Eye Institute, Hyderabad, India.,School of Health Sciences, Division of Optometry and Visual Sciences, City, University of London, London, UK
| | - PremNandhini Satgunam
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India
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Sumalini R, Satgunam P, Subramanian A, Conway M. Clinical Utility of ‘Peekaboo Vision’ Application for Measuring Grating Acuity in Children with Down Syndrome. Br Ir Orthopt J 2022; 18:18-26. [PMID: 35601243 PMCID: PMC9075052 DOI: 10.22599/bioj.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022] Open
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Martin GC, Robert MP, Challe G, Trinh NTH, Attié-Bitach T, Brémond-Gignac D, Bodaghi B, Abadie V. Functional Vision Analysis in Patients With CHARGE Syndrome. J Pediatr Ophthalmol Strabismus 2020; 57:120-128. [PMID: 32203596 DOI: 10.3928/01913913-20200207-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 01/13/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate functional vision in patients with CHARGE syndrome (coloboma, heart defects, atresia of the choanae, retardation of growth and development, genital and urinary anomalies, and ear anomalies) by using a new questionnaire entitled VISIOCHARGE. METHODS Ophthalmological data including fundus description and visual acuity, when available, were extracted from the charts of 83 patients with CHARGE syndrome, and the VISIOCHARGE questionnaire was prospectively mailed to 55 of those patients. The answers from the 36 responders (18 males) allowed for the calculation of three scores that assessed distance vision, near vision, and overall ability scores. RESULTS Visual acuity measurements were extracted from the charts of 20 of the 36 patients. The mean visual acuity was 20/50. The mean distance vision score of 0.62 ± 0.30 and near vision score of 0.78 ± 0.23 were correlated with visual acuity in the 20 patients (ρ = 0.64, P = .002 and ρ = 0.61, P = .005, respectively) and were associated with the severity of colobomatous malformation (P = .049 and P = .008, respectively). Severity of the ocular malformation was not associated with the overall ability score (P = .64). CONCLUSIONS The VISIOCHARGE questionnaire is feasible for patients with CHARGE syndrome and may help in the assessment of visual function. The mean visual acuity and answers to the VISIOCHARGE questionnaire showed relatively good visual skills in patients with CHARGE syndrome in everyday life, even in those with bilateral colobomas, which contrasts with the pessimistic conclusions usually resulting from the initial fundus examination. [J Pediatr Ophthalmol Strabismus. 2020;57(2):120-128.].
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Morale SE, Hughbanks-Wheaton DK, Cheng C, Subramanian V, O'Connor AR, Birch EE. Visual Acuity Assessment of Children with Special Needs. ACTA ACUST UNITED AC 2017; 62:90-8. [DOI: 10.3368/aoj.62.1.90] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | - Dianna K. Hughbanks-Wheaton
- Retina Foundation of the Southwest
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Anna R. O'Connor
- Directorate of Orthoptics, University of Liverpool, Liverpool, United Kingdom
| | - Eileen E. Birch
- Retina Foundation of the Southwest
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
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Similarities and differences between behavioral and electrophysiological visual acuity thresholds in healthy infants during the second half of the first year of life. Doc Ophthalmol 2017; 134:99-110. [PMID: 28220265 DOI: 10.1007/s10633-017-9576-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Behavioral and electrophysiological methods for visual acuity estimation typically correlate well in children and adult populations, but this relationship remains unclear in infants, particularly during the second half of the first year of life. It has been suggested that the agreement between both methods mostly relies on age and/or subjective acuity factors. The present study aimed at comparing acuity thresholds obtained with both approaches in a sample of healthy infants in a relatively narrow age range, that is 6-10 months old. METHODS Acuity thresholds were assessed in 61 healthy infants aged between 6 and 10 months using the Teller acuity cards (TAC) and sweep visual evoked potentials (sVEP). The TAC stimuli (stationary vertical gratings displayed on laminated cards) ranged from 0.31 to 38 cycles per degree (cpd). The TAC acuity threshold was estimated according to the highest spatial frequency scored by the experimenter as seen by the infant. The sVEP stimuli (high-contrast vertical gratings counter-phased at 12 reversals/s) ranged from 13.5 to 1 cpd. sVEP were recorded at Oz and acuity threshold was estimated using regression linear fitting. RESULTS Considering the entire sample, sVEP acuity thresholds (8.97 ± 2.52 cpd) were significantly better than TAC scores (5.58 ± 2.95 cpd), although the difference was within 1 octave for 64% of the infants. Neither Pearson nor intra-class correlations between the two methods were significant (0.18 and 0.03, respectively). While age at assessment was not related to any dependent variable (TAC, sVEP, sVEP-TAC difference score), subjective (behavioral) acuity was found to underlie the difference between the two methods. The difference between sVEP and TAC scores decreased as a function of subjective acuity, and at the highest subjective acuity level (>10 cpd), TAC acuity slightly exceeded sVEP acuity. CONCLUSIONS The superiority of sVEP acuity often reported in the literature was evident in our infant sample when subjective acuity (TAC) was low or moderate, but not when it was high (>10 cpd). The relationship between the two estimation methods was not dependent on age, but on subjective acuity.
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Yadav NK, Ciuffreda KJ. Objective assessment of visual attention in mild traumatic brain injury (mTBI) using visual-evoked potentials (VEP). Brain Inj 2014; 29:352-65. [DOI: 10.3109/02699052.2014.979229] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yadav NK, Ciuffreda KJ. Optimization of the pattern visual evoked potential (VEP) in the visually-normal and mild traumatic brain injury (mTBI) populations. Brain Inj 2013; 27:1631-42. [PMID: 24111626 DOI: 10.3109/02699052.2013.844856] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE The purpose of this study was to assess the effect of check size (CS) and contrast (C) on VEP amplitude and latency in visually-normal (VN) and in mild traumatic brain injury (mTBI) adults to develop an optimized test protocol in each group. RESEARCH DESIGN AND METHODS Subjects were comprised of VN (n = 19) and individuals with mTBI (n = 16). Full-field, pattern VEP testing was employed with three different CSs (10, 20 and 40 min arc) and at two C levels (20 and 85%). RESULTS There was a significant effect of CS and C on the VEP amplitude and latency in both groups. The 20 min arc CS at both contrast levels produced the largest VEP amplitude, in conjunction with normative latency values, in both populations. There was a significant differential effect of CS and C on VEP responses in the visually symptomatic vs. asymptomatic mTBI sub-groups. A significant correlation was found between time since their most recent brain injury and VEP amplitude for the 20 min arc CS at low contrast. CONCLUSIONS Use of the 20 min arc CS at both contrast levels represents an optimized clinical VEP test protocol in both the VN and mTBI groups. This protocol is rapid, high yield, and targeted for each diagnostic group.
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Affiliation(s)
- Naveen K Yadav
- SUNY State College of Optometry, Department of Biological and Vision Sciences , New York City, NY , USA
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Ferziger NB, Nemet P, Brezner A, Feldman R, Galili G, Zivotofsky AZ. Visual assessment in children with cerebral palsy: implementation of a functional questionnaire. Dev Med Child Neurol 2011; 53:422-8. [PMID: 21309767 DOI: 10.1111/j.1469-8749.2010.03905.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to evaluate an interdisciplinary visual assessment for multiply challenged children diagnosed with cerebral palsy (CP). METHOD A comprehensive ophthalmological assessment together with a visual classification scale (VCS) and a questionnaire evaluating daily visual function were completed regarding 77 children (41 females, 36 males; age range 3-20y; mean age 8 y 3 mo [SD 4 y 3 mo]; Gross Motor Function Classification System [GMFCS] level V; Manual Ability Classification System level V) who were diagnosed with CP (79.2% spastic quadriplegia, 6.5% athetoid quadriplegia, 10.4% mixed type, 3.9% hemiplegia). All participants had severe to profound motor and intellectual disability and an inability to communicate consistently through either verbal or assisted communication. The interrater and test-retest reliability of the questionnaire and its validity in comparison with the VCS were examined. In addition, the contribution of ophthalmological testing in predicting daily visual function was assessed. RESULTS The ophthalmological examination revealed three diagnostic subgroups: a group with cerebral visual impairment (CVI), a group with optic atrophy, and a group without visual impairment. The questionnaire was found to have high values of interrater reliability (interclass correlation coefficient [ICC]=0.873; 95% confidence interval [CI] 0.762-0.935) and test-retest reliability (ICC=0.988; 95% CI 0.964-0.996). Validity was established for the questionnaire factors: task-orientated visual function (r=0.802; 95% CI 0.669-0.885) and basic visual skills (r=0.691; 95% CI 0.504-0.816). The questionnaire provided information about daily visual performance not available from one-time ophthalmological testing, particularly for participants diagnosed with CVI. The visual performance scale significantly predicted daily visual function for all groups. INTERPRETATION This study highlights the benefits of implementing a diagnostic performance scale as well as a reliable functional questionnaire to achieve a precise visual assessment of children with severe neurological impairment.
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Affiliation(s)
- Naomi B Ferziger
- The Gonda Multidisciplinary Brain Research Centre, Bar Ilan University, Ramat Gan, Israel.
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Lundy C, Hill N, Wolsley C, Shannon M, McClelland J, Saunders K, Jackson J. Multidisciplinary assessment of vision in children with neurological disability. THE ULSTER MEDICAL JOURNAL 2011; 80:21-7. [PMID: 22347736 PMCID: PMC3281250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/29/2010] [Indexed: 10/25/2022]
Abstract
INTRODUCTION There is no consensus as to the best method of assessing vision in children with neurological disability. There are a variety of tests and approaches that can be used. It is important to look at models of assessment that identify the visual diagnosis and provide appropriate feedback and explanation to parents, carers and educational professionals. METHODS This study reports on the results of comprehensive visual assessments of fifty children with neurological disability over a three year period. It focuses on the feedback from families and professionals after the assessment report was disseminated. RESULTS The majority of families and professionals strongly agreed that a specialist assessment was needed in this population. Parents and professionals particularly valued the written report which provided guidance on appropriate visual material including advice relevant to education. CONCLUSION This study highlights the importance of specialist teams engaging with local child development services and indicates how partnership working can potentially be emotionally supportive as well as developmentally beneficial.
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Affiliation(s)
- Claire Lundy
- Evelina Children's Hospital, Guys and St Thomas' NHS Foundation Trust
| | - Nan Hill
- Community Paediatrics, Belfast Health and Social Care Trust
| | | | - Myrtle Shannon
- Vision Science Research Group, School of Biomedical Sciences, University of Ulster
| | - Julie McClelland
- Vision Science Research Group, School of Biomedical Sciences, University of Ulster
| | - Kathryn Saunders
- Vision Science Research Group, School of Biomedical Sciences, University of Ulster
| | - Jonathan Jackson
- Department of Ophthalmology Royal Victoria Hospital/Queens University Belfast
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O'Reilly M, Vollmer B, Vargha-Khadem F, Neville B, Connelly A, Wyatt J, Timms C, de Haan M. Ophthalmological, cognitive, electrophysiological and MRI assessment of visual processing in preterm children without major neuromotor impairment. Dev Sci 2010; 13:692-705. [PMID: 20712735 DOI: 10.1111/j.1467-7687.2009.00925.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michelle O'Reilly
- Developmental Cognitive Neuroscience Unit, UCL Institute of Child Health, London, UK.
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Yadav NK, Almoqbel F, Head L, Irving EL, Leat SJ. Threshold determination in sweep VEP and the effects of criterion. Doc Ophthalmol 2009; 119:109-21. [PMID: 19554357 DOI: 10.1007/s10633-009-9177-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 06/04/2009] [Indexed: 11/25/2022]
Abstract
In order to develop criteria for the range of data points used for regression line fitting in sweep visually evoked potential (sVEP), which would be objective, clearly specified and give good repeatability and validity, and in order to investigate the effect of luminance on sVEP measurement, visual acuity (VA) and contrast sensitivity (CS) were measured with sVEP in adults aged 17-30 years and children aged 6-8 years. Six to ten participants took part in each experiment. Five criteria (C0-C4) for fitting the regression line were implemented. Test-retest repeatability and validity against psychophysical thresholds at three luminance levels were considered for thresholds and the number of acceptable readings. There were significant effects of criteria (repeated measures ANOVAs, P < 0.05). The criteria, C2 and C3 (based on the range over which the signal-to-noise ratio >or=1), consistently gave better VA and CS, more viable readings, better agreement with psychophysical thresholds in adults and better repeatability than the other criteria. In the case of adults, C2 gave thresholds that were not significantly different from the psychophysical thresholds (P > 0.05). There was little effect of luminance over the 25-100 cd/m(2) range used. Overall, C2 performed the best and would be the criterion of choice, giving better repeatability, better validity and more viable plots.
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Pieh C, McCulloch DL, Shahani U, Mactier H, Bach M. Maturation of steady-state flicker VEPs in infants: fundamental and harmonic temporal response frequencies. Doc Ophthalmol 2008; 118:109-19. [DOI: 10.1007/s10633-008-9145-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 08/06/2008] [Indexed: 11/30/2022]
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McCulloch DL, Mackie RT, Dutton GN, Bradnam MS, Day RE, McDaid GJ, Phillips S, Napier A, Herbert AM, Saunders KJ, Shepherd AJ. A visual skills inventory for children with neurological impairments. Dev Med Child Neurol 2007; 49:757-63. [PMID: 17880645 DOI: 10.1111/j.1469-8749.2007.00757.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Children with neurological impairments often have visual deficits that are difficult to quantify. We have compared visual skills evaluated by carers with results of a comprehensive visual assessment. Participants were 76 children with mild to profound intellectual and/or motor impairment (33 males, 43 females; age range 7mo-16y; mean age 5y 1mo [SD 4y 2mo]) who completed a visual skills inventory before attending a special vision clinic. The inventory included 16 questions about visual skills and responses to familiar situations. Responses were augmented by taking a structured clinical history, compared with visual evoked potential (VEP) and/or acuity card measures of visual acuity, and examined using exploratory factor analysis. Acuity ranged from normal to no light perception, and was positively associated with responses to individual questions. After excluding four uninformative questions, an association between the remaining questions and two significant independent factors was found. Factor 1 was associated with questions about visual recognition (e.g. 'Does your child see a small silent toy?') and these items were correlated with both the VEP and acuity card thresholds. Factor 2 was associated primarily with questions about visually mediated social interactions (e.g. 'Does he/she return your silent smile?'). Evaluation of visual skills in children with neurological impairment can provide valid information about the quality of children's vision. Questions with the highest validity for predicting vision are identified.
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Affiliation(s)
- D L McCulloch
- Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.
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Jackson AJ, Saunders KJ. The optometric assessment of the visually impaired infant and young child. Ophthalmic Physiol Opt 2002. [DOI: 10.1111/j.0275-5408.1999.tb00018.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. Jonathan Jackson
- Department of OphthalmologyRoyal Victoria Hospital/Queens UniversityBelfastBT12 6DANorthern IrelandUK
- Department of OptometryUniversity of UlsterColeraineNorthern IrelandUK
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Westall CA, Ainsworth JR, Buncic JR. Which ocular and neurologic conditions cause disparate results in visual acuity scores recorded with visually evoked potential and teller acuity cards? J AAPOS 2000; 4:295-301. [PMID: 11040480 DOI: 10.1067/mpa.2000.107898] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We investigated whether disparity between visually evoked potential (VEP) acuity scores and Teller Acuity Card (TAC) scores varied according to presence of ocular or neurologic conditions. METHODS Charts from 175 children (mean age, 34.8 months; range, 3 to 158 months) referred for visual acuity testing were examined. All children had been tested with pattern-alternation VEP and TAC and had undergone a complete eye examination. VEP and TAC acuity scores were relative to age-expected acuity scores for each acuity test. The absence and degree of macular abnormality, retinal abnormality, optic nerve hypoplasia, optic nerve atrophy, cortical visual impairment, developmental delay, cerebral palsy, seizures, and nystagmus were noted. Analysis of variance models were used to determine whether differences between VEP and TAC scores varied according to the presence of specific deficits. Logistic regression analysis determined whether degree of specific deficits was associated with a greater chance of inconsistency between VEP and TAC scores (>0.3 log unit difference). RESULTS Inconsistent scores were found in 48% of children. Developmental delay was associated with relatively poorer TAC than VEP score, and the chance of inconsistency increased with severity of developmental delay. CONCLUSIONS Diagnosis-dependent variability exists between TAC and VEP scores. Therefore knowledge of the clinical picture is necessary in interpretation of VEP and TAC scores. It is not clear which test is more useful when a disparity exists, either from this or previous studies. When visual acuity is assessed longitudinally in a given child, then consistency in method for acuity assessment is important.
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Affiliation(s)
- C A Westall
- Department of Ophthalmology, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada.
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Cassidy L, Taylor D, Harris C. Abnormal supranuclear eye movements in the child: a practical guide to examination and interpretation. Surv Ophthalmol 2000; 44:479-506. [PMID: 10906380 DOI: 10.1016/s0039-6257(00)00114-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abnormal eye movements in the infant or voting child can be congenital or acquired. They may be a result of abnormal early visual development or a sign of underlying neurologic or neuromuscular disease. It is important to be able to detect these abnormalities and to distinguish them from normal but immature eye movements. The spectrum of disease in children differs from that in adults. Serious, potentially fatal but treatable disorders can be acquired in infancy, and abnormal eye movements in a sometimes apparently well child should never be labeled as congenital or benign without careful investigation. Eye movement analysis can indicate the presence of an underlying condition and help the clinician to classify different neurologic diseases. It is important to carefully examine the ocular motor system in any children at risk of neurologic disease. This review provides a practical guide to the examination and interpretation of eye movements in the child and includes recent literature on eye movement disorders of childhood. We describe supranuclear abnormalities of the ocular motor system in the order in which we would normally examine it: saccades, pursuit, convergence, vestibulo-ocular reflex, and optokinetic nystagmus. Nystagmus, internuclear ophthalmoplegia, cranial nerve abnormalities, and "miswiring" phenomena (such as Duane's syndrome and synergistic divergence) are not discussed.
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Affiliation(s)
- L Cassidy
- Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom
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McCulloch DL, Orbach H, Skarf B. Maturation of the pattern-reversal VEP in human infants: a theoretical framework. Vision Res 1999; 39:3673-80. [PMID: 10746137 DOI: 10.1016/s0042-6989(99)00091-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Visual evoked potentials to pattern reversal (PR-VEPs) are used to assess the integrity and maturation of the visual pathways in infants and young children. To establish normal ranges and to facilitate interpolation, we consider the maturation rate of PR-VEPs using published normative data. Curves based on the logistic function (a sigmoid model) are introduced and compared with three other models: (1) the power law function; (2) the sum of two decaying exponentials; and (3) a two-stage linear model. Although methods vary somewhat, remarkable consistency among laboratories is found for the maturation of the major positivity (P1) of PR-VEP. The P1 occurs at approximately 260 ms in neonates and is quite variable. It matures rapidly before 12-14 weeks of age and becomes much less variable. The logistic model provides a parsimonious description of P1 maturation with most rapid maturation at around 6 weeks of age for large patterns and around 9 weeks for small patterns. As inter-laboratory agreement is generally good, the normal ranges based on this model could be used in centres, which do not have their own normative databases for infant VEPs.
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Affiliation(s)
- D L McCulloch
- Department of Vision Sciences, Glasgow Caledonian University, UK.
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Porro G, Wittebol-Post D, Van Nieuwenhuizen O, Schenk Rootlieb AJ, Treffers WF. Longitudinal follow-up of grating acuity in children affected by cerebral palsy: results of a 5 year study. Eye (Lond) 1999; 12 ( Pt 5):858-62. [PMID: 10070524 DOI: 10.1038/eye.1998.218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To analyse the natural course of visual acuity in subjects affected by cerebral palsy. METHODS During the past 5 years, 16 children underwent repeated grating acuity measurements using the acuity card procedure. At the end of the follow-up final grating acuity was compared with linear acuity obtained using standard optotypes. RESULTS A good or moderate improvement in grating acuity was shown by 14 subjects. However, the general development of grating acuity showed a protracted course and early values did not correlate with final grating acuity (r = 0.20). Moreover, most of the children showed subnormal vision when measured with standard optotypes. CONCLUSION Clinicians should remain optimistic about the potential for some visual development in children affected by cerebral palsy. However, great caution should be exercised in extrapolating information from early grating acuity measurements. Regular assessments with the acuity card procedure are necessary in order to gain an insight into the natural course of visual development in children affected by cerebral palsy.
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Affiliation(s)
- G Porro
- F.C. Donders Institute of Ophthalmology, University Hospital, Utrecht, The Netherlands
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21
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Porro G, Dekker EM, Van Nieuwenhuizen O, Wittebol-Post D, Schilder MB, Schenk-Rootlieb AJ, Treffers WF. Visual behaviours of neurologically impaired children with cerebral visual impairment: an ethological study. Br J Ophthalmol 1998; 82:1231-5. [PMID: 9924323 PMCID: PMC1722409 DOI: 10.1136/bjo.82.11.1231] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Visual functions of neurologically impaired children with permanent cerebral visual impairment (CVI) can be difficult to determine. This study investigated the behavioural profile of CVI children by means of ethological observations in order to gain a better understanding of their visual functions. METHODS Video registrations of nine subjects who were unable to undergo more orthodox methods of visual function testing were observed and analysed by an ethologist. RESULTS A series of behaviours (direct signs) and supportive or confirming behavioural elements (indirect signs) indicating some visual perception in the children were found. CONCLUSION Detailed ethological observations of visual behaviour were shown to be useful for analysing visual functions of children with permanent CVI.
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Affiliation(s)
- G Porro
- F C Donders Institute of Ophthalmology, Faculty of Medicine, Utrecht University, Netherlands
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22
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Saunders KJ, Brown G, McCulloch DL. Pattern-onset visual evoked potentials: more useful than reversal for patients with nystagmus. Doc Ophthalmol 1998; 94:265-74. [PMID: 9682995 DOI: 10.1007/bf02582984] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The visual evoked potential is often used to assess visual function in neurologically impaired patients, a group in whom nystagmus is a common feature. Pattern-reversal stimuli are commonly used to produce visual evoked potentials in clinical practice. Previous reports have shown that this stimulus is not optimal when subjects have nystagmus. The present study aimed to compare the efficacy of pattern-onset and reversal stimuli when used to measure visual evoked potentials from subjects with idiopathic nystagmus. METHODS In five adults with congenital nystagmus and 10 visually normal adults, VEPs were recorded and reproduced for checkerboard stimuli of two sizes (120' and 60'). Each size was presented as both pattern-onset and reversal check. RESULTS Visually normal adults demonstrated similar visual evoked potential amplitudes and quality in response to pattern-reversal and pattern-onset. However, in the presence of nystagmus, visual evoked potentials recorded to pattern-reversal stimuli were significantly smaller and of poorer quality than those obtained to pattern-onset stimuli (analysis of variance p<0.05; Kendall's tau, p<0.05). CONCLUSIONS Pattern-onset stimuli produce larger and clearer visual evoked potentials in patients with nystagmus compared with those produced to pattern-reversal stimuli.
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Affiliation(s)
- K J Saunders
- Department of Vision Science, Glasgow Caledonian University, UK
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23
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Clarke MP, Mitchell KW, Gibson M. The prognostic value of flash visual evoked potentials in the assessment of non-ocular visual impairment in infancy. Eye (Lond) 1997; 11 ( Pt 3):398-402. [PMID: 9373485 DOI: 10.1038/eye.1997.84] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The results of flash visual evoked potentials (VEPs) in 44 infants blind or severely visually impaired from non-ocular causes are presented, and related to the subsequent visual outcome. Ocular causes of visual impairment were excluded by clinical examination and electroretinography. Using a 2 x 2 contingency table, a significant association between VEP and outcome was demonstrated (chi 2 = 3.51, 1 d.f., p = 0.05). Of 13 infants with normal VEPs, 11 demonstrated substantial visual improvement (negative predictive value = 84.6%). However, of the 31 with abnormal VEPs, only 14 remained severely impaired/blind; the other 17 demonstrating visual improvement (positive predictive value = 45.1%). The sensitivity of the method was high in that 14 of 16 (87.5%) infants who remained impaired/blind had abnormal VEPs, but specificity was low as only 11 of 28 (39.3%) who showed visual improvement had normal VEPs. The accuracy of the technique was therefore low, 25 of 44 (56.8%) being true positive/ negative. With regard to visual outcome when faced with an apparently blind infant, it is important not to be too pessimistic for, as is shown in this study, 28 of 44 demonstrated substantial improvement. There are no absolute indicators of prognosis, but the presence of structural cerebral lesions and a history of either neonatal meningitis or encephalopathy are relatively bad prognostic signs. The flash VEP, despite its limitations, is a useful prognostic tool, particularly in those apparently blind infants whose normal ocular examination/electroretinogram is accompanied by normal VEPs. Those with abnormal VEPs, however, do not necessarily have a poor prognosis, but should be followed-up as maturational changes and/or improvements in function of the sensory pathway will be reflected in the evoked potentials.
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Affiliation(s)
- M P Clarke
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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24
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Evenhuis HM, Mul M, Lemaire EK, de Wijs JP. Diagnosis of sensory impairment in people with intellectual disability in general practice. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 1997; 41 ( Pt 5):422-429. [PMID: 9373823 DOI: 10.1111/j.1365-2788.1997.tb00730.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The present authors have participated in the development of a Dutch consensus on the early detection, diagnosis and treatment of hearing and visual impairment in children and adults with intellectual disability. They argue that the early detection of sensory impairment in babies and children with intellectual disability should primarily be a responsibility of paediatricians and youth health physicians. General practitioners should be aware of the necessity of screening and should check whether this has been done when children visit the surgery. It is stressed that the general practitioner should play a more active role in the detection of age-related sensory loss in older adults with intellectual disability, and the assessment of younger adults whose sensory functions have never or incompletely been evaluated. Annual sensory screening is certainly not necessary, but annual otoscopy to detect impacted earwax or unidentified middle ear infection, as well as checks of the proper use of glasses and hearing aids, are suggested. Most adults with mild or moderate intellectual disability can be assessed with methods that are normally used by general practitioners. Uncooperative people should be referred for screening with specialized methods. A low-threshold referral system (e.g. via district expert teams) has been outlined.
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Affiliation(s)
- H M Evenhuis
- Hooge Burch Centre for People with Intellectual Disability, Zwammerdam, the Netherlands
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25
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Aylward EH, Burt DB, Thorpe LU, Lai F, Dalton A. Diagnosis of dementia in individuals with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 1997; 41 ( Pt 2):152-164. [PMID: 9161927 DOI: 10.1111/j.1365-2788.1997.tb00692.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The foremost impediment to progress in the understanding and treatment of dementia in adults with intellectual disability is the lack of standardized criteria and diagnostic procedures. Standardized criteria for the diagnosis of dementia in individuals with intellectual disability are proposed, and their application is discussed. In addition, procedures for determining whether or not criteria are met in individual cases are outlined. It is the intention of the authors, who were participants of an International Colloquium on Alzheimer Disease and Mental Retardation, that these criteria be appropriate for use by both clinicians and researchers. Their use will improve communication among clinicians and researchers, and will allow researchers to test hypotheses concerning discrepancies in findings among research groups (e.g. dementia prevalence ranges and age of onset).
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Affiliation(s)
- E H Aylward
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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