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Preterm birth & Visual Impairment

Preemie Issues - a quick look

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Preterm infants are at greater risk for both short and long term difficulties. The tinier and earlier a preemie is born the greater the risk for complications.


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Preemie Babies are not just tiny...

Premature babies are not just tiny; they are at risk for a number of health concerns, including breathing difficulties, brain injury, eye disorders, infection, bowel problems and heart dysfunction.
The issues surrounding preterm birth can be complex but we have tried to cover everything you may want to know. If you have any questions please ask them in our forums.


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Preterm birth & Visual Impairment

Preterm babies are more likely than babies born at term to have significant abnormalities of all parts of the visual system, leading to reduced vision.

The visual impairments resulting from preterm birth encompass a wide spectrum, ranging from extremely subtle difficulties to total blindness.

Visual Impairments

Visual problems in preterm children

  • Reduced visual acuity
  • Refraction errors
  • Myopia
  • Hypermetropia
  • Anisometropia
  • Astigmatism
  • Reduced depth perception
  • Strabismus
  • Problems with saccadic eye movements
  • Nystagmus

Incidence of visual problems for preemie children

The rate of visual problems in preterm children is influenced by a number of factors, which includes how early and how tiny your baby was born, whether they have brain injury, or retinopathy of prematurity. It is not easy to predict which preemies will end up with visual problems but the following rates will give you an idea of the types and incidence of some visual problems.

Visual Function Incidence
Blindness less than 1% to 5%
Visual acuity 8% to 20%
Refractive errors 3% to 33%
Strabismus 5% to 39%
Depth Perception 8% to 50%
Refractive errors 3% to 33%
Contrast sensitivity 10% to 60%
Oculomotor control 10% to 25%
Visual fields 5% to 23%

Learn more about Visual development

Definitions of visual impairments

This section describes a number of impairments that are usually detected with standard visual screening measures, such as visual acuity, refractive errors, and strabismus, as well as more subtle visual impairments, such as depth perception, contrast sensitivity, nystagmus, and visual fields;

  • Visual acuity:
    is clearness or sharpness of vision. Visual acuity is most often assessed by measuring someone’s ability to identify black symbols, such as letters of the alphabet, on a white background at a standardised distance as the size of the symbols is varied.
  • Refractive error:
    Is an error in the focusing of light by the eye and a common reason for reduced visual acuity. Refractive error occurs when there is a mismatch between the axial length of the eye and its optical components (lens and corneal curvature). People with refraction error often have blurry vision. There are different types of refractive error.
  • Myopia:
    also referred to as near- or short-sighted, is a refractive error of eye such that near objects are seen clearly but distant objects appeared blurred. The eyeball is generally too long, or the cornea too curved, so images are focused before the retina
  • Hypermetropia:
    also referred to as far- or long-sightedness, typically affects vision of near objects due to a short eyeball or a problem with the lens, such that light focuses to a point behind the retina rather than directly on it
  • Anisometropia:
    is a condition in which the eyes have unequal refractive power (i.e. different states of myopia or hypermetropia)
  • Astigmatism:
    is an image distortion that results from an improperly shaped cornea (i.e. the curvature of the cornea is not the same in all directions). It causes out-of-focus vision
  • Strabismus:
    Strabismus is a condition in which the eyes are not properly aligned and typically results in a lack of coordination between the extraocular muscles. This incoordination prevents the eyes from gazing at the same point in space, and thus preventing binocular vision, which may adversely affect depth perception. One eye may look straight ahead, while the other eye turns inward, outward, upward or downward. Strabismus may cause reduced vision, or amblyopia, in the weaker eye.
  • Amblyopia:
    a condition when vision is reduced because either or both eyes and the brain are not working together properly. Also known as lazy eye. Amblyopia normally only affects one eye, but it is possible to be amblyopic in both eyes if both are similarly deprived of a good, clear visual image.
  • Nystagmus:
    refers to rapid involuntary movements that may cause one or both eyes to move from side to side, up and down or around in circles. The condition is caused by an abnormal function in the areas of the brain that control eye movements. Nystagmus may be either present at birth or develop later in life.
  • Contrast sensitivity:
    measures the ability to detect slight changes in luminance across space. It is the ability to see objects that may not be outlined clearly or that do not stand out from their background. The ability to see a shade of gray on a white background or to see white on a light gray background
  • Stereopsis:
    Is the process in visual perception leading to the sensation of depth from the two slightly different projections of the world onto the retinas of the two eyes. The differences in the two retinal images are called horizontal disparity, retinal disparity, or binocular disparity. The differences arise from the eyes' different positions in the head. Stereopsis is most commonly referred to as depth perception

 


Technical Reference List

Burgess, P., & Johnson, A. (1991). Ocular defects in infants of extremely low birth weight and low gestational age. British Journal of Ophthalmology, 75(2), 84-87.
Cioni, G., Bertuccelli, B., Boldrini, A., Canapicchi, R., Fazzi, B., Guzzetta, A., et al. (2000). Correlation between visual function, neurodevelopmental outcome, and magnetic resonance imaging findings in infants with periventricular leucomalacia. Arch Dis Child Fetal Neonatal Ed, 82(2), 134-140.
Cooke, R. W., Foulder-Hughes, L., Newsham, D., & Clarke, D. (2004). Ophthalmic impairment at 7 years of age in children born very preterm. Arch Dis Child Fetal Neonatal Ed, 89(3), 249-253.
Dowdeswell, H. J., Slater, A. M., Broomhall, J., & Tripp, J. (1995). Visual deficits in children born at less than 32 weeks' gestation with and without major ocular pathology and cerebral damage. British Journal of Ophthalmology, 79(5), 447-452.
Downie, A. L. S., Jakobson, L. S., Frisk, V., & Ushycky, I. (2003). Periventricular brain injury, visual motion processing, and reading and spelling abilities in children who were extremely low birthweight. Journal of International Neuropsychology Society, 9(3), 440-449.
Evensen, K. A. I., Lindqvist, S., Indredavik, M. S., Skranes, J., Brubakk, A.-M., & Vik, T. (2009). Do visual impairments affect risk of motor problems in preterm and term low birth weight adolescents? Eur J Paediatr Neurol, 13(1), 47-56.
Fielder, A. R. (1998). The impact of low birth weight on the visual pathway. Br J Ophthalmol, 82(1), 1-2.
Fily, A., Pierrat, V., Delporte, V., Breart, G., & Truffert, P. (2006). Factors associated with neurodevelopmental outcome at 2 years after very preterm birth: the population-based Nord-Pas-de-Calais EPIPAGE cohort. Pediatrics, 117(2), 357-366.
Jongmans, M. J., Mercuri, E., Henderson, S., de Vries, L., Sonksen, P., & Dubowitz, L. (1996). Visual function of prematurely born children with and without perceptual-motor difficulties. Early Human Development, 45(1-2), 73-82.
McGinnity, F. G., & Bryars, J. H. (1992). Controlled study of ocular morbidity in school children born preterm. British Journal of Ophthalmology, 76(9), 520-524.
O'Connor, A. R., & Fielder, A. R. (2008). Long term ophthalmic sequelae of prematurity. Early Human Development, 84(2), 101-106.
O'Connor, A. R., Stephenson, T., Johnson, A., Tobin, M. J., Ratib, S., Moseley, M., et al. (2004). Visual function in low birthweight children. Br J Ophthalmol, 88(9), 1149-1153.
Powls, A., Botting, N., Cooke, R. W., Stephenson, G., & Marlow, N. (1997). Visual impairment in very low birthweight children. Arch Dis Child Fetal Neonatal Ed, 76(2), 82-87.
Schalij-Delfos, N. E., de Graaf, M. E., Treffers, W. F., Engel, J., & Cats, B. P. (2000). Long term follow up of premature infants: detection of strabismus, amblyopia, and refractive errors. British Journal of Ophthalmology, 84(9), 963-967.
Stephenson, T., Wright, S., O'Connor, A. R., Fielder, A. R., Johnson, A., Ratib, S., et al. (2007). Children born weighing less than 1701 g: visual and cognitive outcomes at 11-14 years. Archives of Disease in Childhood. Fetal and Neonatal Edition, 92(4), F265-270.
Theng, J. T., Wong, T. Y., & Ling, Y. (2000). Refractive errors and strabismus in premature Asian infants with and without retinopathy of prematurity. Singapore Medical Journal, 41(8), 393-397.
WHO. (1992). International statistical classification of diseases and health related problems (10th revision ed.). Geneva: World Health Organization.
Wilson-Costello, D., Friedman, H., Minich, N., Siner, B., Taylor, H. G., Schluchter, M., et al. (2007). Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000-2002. Pediatrics, 119(1), 37-45.

 

 



AlbertEinstein_iconOne of the greatest minds in history, Albert Einstein was born preterm.

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Preemie, Premmie, or Prem?

Most babies spend between 38 and 42 weeks in their mother’s uterus. So, technically a preterm birth, preemie, premmie, or prem, is an infant who is born less than 37 completed gestational weeks. 


Read More: Defining Preterm birth


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