Higher visual function deficits are independent of visual acuity measures in children with cerebral visual impairment.

IF 2.4 3区 医学 Q3 NEUROSCIENCES Frontiers in Human Neuroscience Pub Date : 2024-10-15 eCollection Date: 2024-01-01 DOI:10.3389/fnhum.2024.1451257
A Chandna, M Wong, S Veitzman, E Menjivar, A Kulkarni
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Abstract

Cerebral visual impairment (CVI), the leading cause of bilateral visual impairment in children, is often characterized by visual acuity (VA) loss and higher visual function deficits (HVFDs). However, the relationship between VA loss and HVFDs remains unknown. A previous study using the Higher Visual Function Question Inventory (HVFQI) demonstrated that normal VA did not preclude HVFDs. In this prospective controlled study of children with CVI, we examine the relationship between HVFDs and degrees of VA loss to refine our understanding of this relationship. We introduce two new indices-HVFD spectrum and severity-to provide a comprehensive view of how CVI affects the individual child and the entire cohort. We also performed an analysis to determine the effectiveness of the HVFQI in eliciting HVFDs and present a preliminary analysis of the relationship between HVFDs and age. The study participants included 59 children with CVI (age: 9.87 ± 3.93 years [mean ± SD]; binocular VA: 0.35 ± 0.34 log MAR.) and 120 neurotypical (NT) children with normal visual acuity (age: 8.7 ± 2.8 years; binocular VA: 0.14 ± 0.16 logMAR). Clinical history and notes independently confirmed the diagnosis of CVI. Parents were interviewed with the HVFQI, and their responses were recorded using a five-level Likert scale. Mann-Whitney U-test (MWU) determined the ability of HVFQI to distinguish between CVI and NT participants; Fisher's exact test (FET) and d-variable Hilbert-Schmidt independence criteria (dHSIC) assessed the independence between HVFDs and VA. The average spectrum (range 0-1) and severity (range 1-5) indices for CVI (spectrum: 0.65 ± 0.24, severity: 3.1 ± 0.77) and NT (spectrum: 0.12 ± 0.17, severity: 1.42 ± 0.49) were markedly different. MWU (p-value <0.00001) confirmed the ability of HVFQI to distinguish CVI from NT children for both indices. The FET reported a p-value of 0.202, which indicates that the data does not exhibit any relation between the HVFDs severity and VA. Analysis using dHSIC supports these findings (p-value 0.784). Based on these results, we urge that all children with suspected CVI need to be assessed for HVFDs in addition to VA measures. The HVFQI can potentially increase our understanding of the neural basis of visual perception, cognition, and visually guided action and lead us toward a conceptual model of CVI, translating to clinical practice improvements.

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脑性视力障碍儿童较高的视觉功能障碍与视敏度测量无关。
脑性视力损伤(CVI)是导致儿童双侧视力损伤的主要原因,通常表现为视力(VA)下降和高级视觉功能障碍(HVFDs)。然而,视力损失与高级视功能障碍之间的关系仍然未知。之前一项使用高级视觉功能问题量表(HVFQI)进行的研究表明,正常视力并不排除HVFDs。在这项针对 CVI 儿童的前瞻性对照研究中,我们研究了 HVFD 与 VA 缺失程度之间的关系,以加深我们对这种关系的理解。我们引入了两个新的指数--HVFD 频谱和严重程度,以便全面了解 CVI 对儿童个体和整个群体的影响。我们还进行了一项分析,以确定 HVFQI 在激发 HVFD 方面的有效性,并对 HVFD 与年龄之间的关系进行了初步分析。研究对象包括 59 名患有 CVI 的儿童(年龄:9.87 ± 3.93 岁 [平均 ± SD];双眼 VA:0.35 ± 0.34 log MAR.)和 120 名视力正常的神经典型 (NT) 儿童(年龄:8.7 ± 2.8 岁;双眼 VA:0.14 ± 0.16 logMAR)。临床病史和记录可独立确诊为 CVI。家长接受了 HVFQI 问卷调查,他们的回答采用五级李克特量表记录。曼-惠特尼U检验(MWU)确定了HVFQI区分CVI和NT参与者的能力;费雪精确检验(FET)和d变量希尔伯特-施密特独立性标准(dHSIC)评估了HVFD和VA之间的独立性。CVI(频谱:0.65 ± 0.24,严重程度:3.1 ± 0.77)和 NT(频谱:0.12 ± 0.17,严重程度:1.42 ± 0.49)的平均频谱指数(范围 0-1)和严重程度指数(范围 1-5)明显不同。MWU(p-值 p-值为 0.202,表明 HVFDs 严重程度与 VA 之间不存在任何关系。使用 dHSIC 进行的分析也支持上述结果(p 值为 0.784)。基于这些结果,我们呼吁所有疑似 CVI 儿童除 VA 测量外,还需要进行 HVFDs 评估。HVFQI 有可能加深我们对视觉感知、认知和视觉引导行动的神经基础的理解,并引导我们建立 CVI 的概念模型,从而改进临床实践。
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来源期刊
Frontiers in Human Neuroscience
Frontiers in Human Neuroscience 医学-神经科学
CiteScore
4.70
自引率
6.90%
发文量
830
审稿时长
2-4 weeks
期刊介绍: Frontiers in Human Neuroscience is a first-tier electronic journal devoted to understanding the brain mechanisms supporting cognitive and social behavior in humans, and how these mechanisms might be altered in disease states. The last 25 years have seen an explosive growth in both the methods and the theoretical constructs available to study the human brain. Advances in electrophysiological, neuroimaging, neuropsychological, psychophysical, neuropharmacological and computational approaches have provided key insights into the mechanisms of a broad range of human behaviors in both health and disease. Work in human neuroscience ranges from the cognitive domain, including areas such as memory, attention, language and perception to the social domain, with this last subject addressing topics, such as interpersonal interactions, social discourse and emotional regulation. How these processes unfold during development, mature in adulthood and often decline in aging, and how they are altered in a host of developmental, neurological and psychiatric disorders, has become increasingly amenable to human neuroscience research approaches. Work in human neuroscience has influenced many areas of inquiry ranging from social and cognitive psychology to economics, law and public policy. Accordingly, our journal will provide a forum for human research spanning all areas of human cognitive, social, developmental and translational neuroscience using any research approach.
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