Ophthalmic disorder may affect visuo-attentional performance in childhood.

The aim of this study was to explore the visuo-attentional skills of children with an ophthalmic disorder. Twenty-four patients and 60 healthy controls between the ages 4 and 7 years, all right-handed with normal or corrected-to-normal close visual acuity, were divided into four age groups. Patients' diagnoses included refractive disorders (e.g., myopia, hypermetropia), strabismus, amblyopia, cataract, and nystagmus. All participants performed nine paper-and-pencil visuospatial tasks aiming to assess selective attention (cancellation tasks), spatial working memory (symbol orientation task), fine visual analysis (embedded figures test), and simple perceptual analysis (shape-matching task). In healthy children, the results showed that performance on all visuo-attentional tasks improved with age. While perception, orientation of attention, and visual working memory develop by the time children begin school (age 5), more sophisticated abilities such as attention disengagement and motor control continue to develop during late childhood. Moreover, a spatial bias in attention orienting appeared with reading acquisition (6-7 years). In ophthalmic children, at 4 years of age defects were observed in all assessed functions, but at 7 years an attentional deficit was virtually the only one remaining. Overall, the results demonstrate that children with an ophthalmologic disorder may experience difficulties with visuospatial tasks despite corrected-to-normal visual acuity.

Assessment of visuo-attentional abilities in young children with or without visual disorder: toward a systematic screening in the general population.

In young children, visual attention, analysis or memory is only rarely evaluated. Moreover, tools to test for such higher-order visual capacities in children are limited. In an attempt to develop and refine such tools, we selected nine tests to assess visuo-attentional abilities before formal reading education (grade 1). The battery consisted of gaze fixation, visual field, visual extinction, binocular visual pursuit, visual memory, "A" cancellation, Teddy bears cancellation, embedded figures, and matching tasks. This battery was used in the general population (n=110) to calculate cut-off scores identifying the lower 5% of the general population to obtain a screening measure for neurovisual disabilities in children. To evaluate our battery's sensitivity and specificity to neurovisual disorders over ophthalmological diseases, a neurovisual group (n=9) and an ophthalmologic group (n=13) also completed the tests. Overall, all but three tests of the battery could be used to discriminate between neurovisual and ophthalmologic children. The ophthalmologic children failed the visual field extent examination and the cancellation tasks, consistent with deleterious effects of ophthalmologic disease on visual perception as well as higher-order vision. Using the cut-off scores, the battery identified only 2 out of 13 ophthalmologic patients, but 5 out of 9 neurovisual patients. In the general population, these cut-off scores identified seven children. These children were previously undiagnosed with any disability (i.e., no diagnosis of ophthalmological, neurological, or psychiatric disease) and thus did not receive any rehabilitation. This preliminary study highlights the necessity for a neurovisual disorder screening tool for young children.