Early visual training and environmental adaptation for infants with visual impairment

Elisa Fazzi, Serena Micheletti, Stefano Calza, Lotfi Merabet, Andrea Rossi, Jessica Galli, Early Visual Intervention Study Group, Patrizia Accorsi, Anna Alessandrini, Alice Bertoletti, Elena Campostrini, Nicole D'Adda, Alessandra Franzoni, Elisa Fumagalli, Erica Grassi Scalvini, Paola Martelli, Melissa Marras, Anna Molinaro, Mario Motta, Nadia Pasini, Lorenzo Pinelli, Francesco Semeraro, Elisa Fazzi, Serena Micheletti, Stefano Calza, Lotfi Merabet, Andrea Rossi, Jessica Galli, Early Visual Intervention Study Group, Patrizia Accorsi, Anna Alessandrini, Alice Bertoletti, Elena Campostrini, Nicole D'Adda, Alessandra Franzoni, Elisa Fumagalli, Erica Grassi Scalvini, Paola Martelli, Melissa Marras, Anna Molinaro, Mario Motta, Nadia Pasini, Lorenzo Pinelli, Francesco Semeraro

Abstract

Aim: To evaluate the effectiveness of early visual training and environmental adaptation on visual function and neurological development in infants with visual impairment.

Method: This was a pilot intervention clinical trial study. Thirty infants (mean age 5.9mo, SD 2.1mo, range 4-11mo; 16 males, 14 females) with peripheral visual impairment (PVI, n=15) or cerebral visual impairment (CVI, n=15) participated in a 6-month visual intervention programme. Thirty matched infants (mean age 6mo, SD 1.4mo, range 4-9mo; 18 males, 12 females) served as a comparison group. Primary outcome measures were visual acuity, contrast sensitivity, and qualitative ocular motor functions. Secondary outcomes were scores on the Griffiths Mental Developmental Scales (GMDS).

Results: The treatment group showed a significant improvement in all the primary outcomes (p<0.01). The comparison group improved only in visual acuity and contrast sensitivity (p<0.01). The treatment group showed greater improvement than the comparison group in visual fixation (p=0.033) and smooth pursuit (p<0.01). The CVI subgroup showed greater improvement in visual acuity than the PVI subgroup (p<0.01). GMDS subscales of hand-eye coordination (p=0.01) and performance (p<0.01) increased in the treatment group, while the total score of the comparison group decreased, driven by language (p=0.039) and hand-eye coordination (p=0.025) subscales.

Interpretation: Results suggest that, in infants with visual impairment, visual function and certain developmental outcomes improve in response to early visual training and environmental adaptation, in an interactive context. What this paper adds Early visual training and environmental adaptation are associated with enhanced visual acuity and smooth pursuit. Early visual training and environmental adaptation are associated with an improvement of neurological developmental outcome. Performance, hand-eye coordination, and language scores in Griffiths Mental Developmental Scales increase after visual training. After training, visual acuity improves more in infants with cerebral rather than anterior visual impairment. Type and complexity of visual impairment contribute to determine infants' response to training.

© 2021 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.

Figures

Figure 1
Figure 1
Primary outcomes.
Figure 2
Figure 2
Secondary outcomes.

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