Impact of low vision and blindness on characteristics of developmental delay in children younger than 6 years

Abstract

BACKGROUND

Visual impairment during early childhood can hinder motor, language, and social development, yet data on its developmental impact across common pediatric ocular diseases remain limited.

AIM

To investigate the developmental impact of low vision and blindness on children under six with common ocular diseases.

METHODS

This retrospective study reviewed records of new patients under six with visual impairment at Siriraj Hospital’s low vision rehabilitation center (January 2017-October 2022). We collected ocular, systemic, and developmental data; recorded visual acuity in the better-seeing eye after refractive correction; and assessed developmental domains with the Denver II. Univariable and multivariable logistic regression identified factors associated with developmental delay.

RESULTS

A total of 161 pediatric patients (mean age 24.9 ± 18.9 months) were enrolled and evaluated based on their ability to fix on and follow an object or light source. Some were further assessed using the Allen picture chart and all had visual acuity worse than 1.07 ± 0.58 LogMAR, and 83.2% were identified as having global developmental delay (GDD). The three most common ocular causes were cortical visual impairment (CVI), optic neuropathy/atrophy, and optic nerve hypoplasia. Extremely poor visual acuity (inability to fixate and follow) was significantly associated with GDD [adjusted odds ratio (AOR) 41.0] and delays in all developmental domains: Gross motor (AOR 10.0), fine motor (AOR 12.8), language (AOR 5.3), and personal-social skills (AOR 13.4) (P ≤ 0.002). Multiple disabilities, most often visual impairment with cerebral palsy, were also significantly associated with gross motor delays (AOR 7.7) and fine motor delays (AOR 4.0) (P < 0.05). CVI was also related to delays in language and personal-social skills (AOR 9.1 each) (P < 0.05).

CONCLUSION

This study underscores the developmental issues in children with visual impairment, especially those with poorer acuity, CVI, and multiple disabilities. Significant delays were observed in all domains, including GDD. A timely referral to specialists is strongly recommended.

Keywords: Children; Developmental delay; Low vision; Thailand; Visual impairment

Core Tip: In this study of 161 children under 6 years, 83.2% of visually impaired patients were identified as having global developmental delay, a proportion markedly higher than reported in prior studies. Children unable to fixate and follow objects had 41-fold increased odds of global developmental delay, with significant delays across all domains—gross motor, fine motor, language, and personalsocial skills. Cortical visual impairment and the presence of multiple disabilities emerged as key risk factors. These findings highlight the high prevalence and significant associations of developmental delay in young children with visual impairment and underscore the importance of timely, multidisciplinary intervention.