C Williams, P Warnes, S Jary , G Young, P Blair, H Miller, C Benton, M Morgan, C Lea, D Odd, I Pople, W Hollingsworth, K Aquilina, A Smith-Collins, A Whitelaw and K Luyt . (CW to be  introduced by A Whitelaw)

Institution(s)

Bristol Medical School, University of Bristol; University Hospitals Bristol NHS Foundation Trust; School of Psychological Science, University of Bristol

Introduction (include hypothesis)

There are very few data about visual sequelae after ventricular dilation (VD) following intraventricular haemorrhage (IVH). In an opportunistic study, we hypothesized (a) that the nature and/or severity of vision problems in childhood would relate to the grade of previous IVH and (b) that clinical visuocognitive test results would correlate with spatial cognitive ability scores in standard psychological tests.

Methods (include source of funding and ethical approval if required)

Children who as babies had participated in the DRIFT study were invited to a multidisciplinary review at age 10-11 years (1). The protocol involved a visual assessment including standard orthoptic tests and additional oculomotor and visuocognitive tasks. We used age-appropriate norms or clinical convention to identify visual impairments. The vision testers were masked to the child’s grade of IVH and the results of their other assessments. Funding: NIHR HTA (12/35/61); Ethical approval: Health Research Authority (14/SW/1078).

Results

Thirty two children completed the vision assessment. The median number of impairments per child was greater after Grade 4 IVH than after Grade 3 IVH (9 vs 2; p =0.003). Impaired oculomotor abilities were associated with lower scores in the spatial ability cluster of psychology tests but were unrelated to verbal ability scores. By contrast, visual acuity and visuocognitive impairments were associated with both reduced verbal ability and reduced spatial ability scores. After adjustment for overall cognitive scores, each additional vision problem increased the Odds Ratio (95% CI) of a child having a statement of educational special needs or equivalent (SEN): adjusted OR=1.7 (1.1 to 2.6; p=0.015). All children with impaired acuity had SEN, and children with impaired eye movements but normal acuity also had greater risk of SEN: adjusted OR = 20.6 (1.4 – 313.0.; p=0.029).

Conclusions

There is a high level of visual morbidity after VD with IVH, especially after Grade 4 IVH. Visual impairments may confound children’s cognitive ability scores and supportive interventions for visual problems may improve their cognitive and developmental outcomes. Follow-up after IVH should include appropriate vision assessments.

References

Luyt K, Jary S, Lea C, Young GJ, Odd D, Miller H, et al. Health Technol Assess. 2019;23(4):1-116.