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

Table 1 Demographic data on characteristics of visual impairment/disability and systemic risks for developmental delay, n (%)

Demographic data	Total, n = 161
Diagnosis (eye)
Cortical visual impairment	37 (23.0)
Optic neuropathy/atrophy	26 (16.1)
Optic nerve hypoplasia	15 (9.3)
Retinopathy of prematurity	12 (7.5)
Microphthalmos/anophthalmos	11 (6.8)
Delay in visual maturation	10 (6.2)
Leber’s congenital amaurosis	6 (3.7)
Achromatopsia	5 (3.1)
Foveal hypoplasia	4 (2.5)
Retinal coloboma	4 (2.5)
Congenital cataract	4 (2.5)
Persistent fetal vasculature	3 (1.9)
Congenital glaucoma	3 (1.9)
Others1	21 (13.0)
Visual acuity (better eye)
Not fix and follow	73 (45.3)
Poor/fair fix and follow	38 (23.6)
Good fix and follow	50 (31.1)
Disability type
Visual impairment only	100 (62.1)
Cerebral palsy with VI (multiple disabilities)	54 (33.5)
Autistic with VI (multiple disabilities)	1 (0.6)
Hearing impairment with VI (multiple disabilities)	13 (8.1)
Prenatal risk
Genetic disorders	25 (15.5)
Cerebral dysgenesis	54 (33.5)
Intrauterine infections	7 (4.3)
Perinatal risk
Preterm, GA < 32 weeks	17 (10.5)
Preterm, GA 32-36 weeks	24 (14.9)
VLBW (< 1500 g)	16 (9.9)
LBW (1500-2500 g)	31 (19.3)
Birth asphyxia	23 (14.3)
Postnatal risk
CNS infection	3 (1.9)
Head trauma	7 (4.3)
History of developmental stimulation elsewhere
No	129 (80.1)
Yes	32 (19.9)

¹Other ocular diseases include Peter's anomaly, microcornea/sclerocornea, cone/rod dystrophy, familial exudative vitreoretinopathy, congenital stationary night blindness, chorioretinitis, macular scar, vitreous/retinal hemorrhage, retinal detachment, retinoblastoma, congenital nystagmus, congenital ptosis, congenital myopathy.

VI: Visual impairment; GA: Gestational age; VLBW: Very low birth weight; LBW: Low birth weight; CNS: Central nervous system.

Table 2 Factors associated with global developmental delay in children with visual impairment, n (%)

Factors	Global developmental delay
			Univariable analysis		Multivariable analysis
	Yes, n = 134	No, n = 27	OR (95%CI)	P valuea	AOR (95%CI)	P valueb
Eye disease
Cortical visual impairment	36 (26.9)	1 (3.7)	9.6 (1.3-73.0)	0.01	4.0 (0.5-35.3)	0.212
Visual acuity
Not fix and follow	72 (53.7)	1 (3.7)	52.1 (6.7-405.8)	< 0.001	41.0 (5.2-324.8)	< 0.001b
Poor/fair fix and follow	33 (24.6)	5 (18.5)	4.8 (1.6-14.3)	0.005	3.9 (1.3-12.3)	< 0.018b
Good fix and follow	29 (21.6)	21 (77.8)	Reference		Reference
Multiple disabilities	58 (43.3)	3 (11.1)	6.1 (1.8-21.3)	0.002	3.8 (1.0-14.8)	0.55
Hx previous stimulation1	32 (23.9)	0		0.006

^aP value < 0.2 indicates significant.

^bP value < 0.05 indicates significant.

¹Hx previous stimulation, history of developmental stimulation elsewhere.

OR: Odds ratio; AOR: Adjusted odds ratio.

Table 3 Factors associated with gross and fine motor skills in children with visual impairment, n (%)

Factors	Gross motor						Fine motor
	DQ		Univariable analysis		Multivariable analysis		DQ		Univariable analysis		Multivariable analysis
	< 70, n = 124	≥ 70, n = 37	OR (95%CI)	P valuea	AOR (95%CI)	P valueb	< 70, n = 127	≥ 70, n = 34	OR (95%CI)	P valuea	AOR (95%CI)	P valueb
Eye disease
Cortical visual impairment	37 (29.8)	0	-	< 0.001	-	-	35 (27.6)	2 (5.9)	6.1 (1.4-26.8)	0.010	2.6 (0.5-13.0)	0.251
Retinopathy of prematurity	7 (5.4)	6 (15.8)	0.3 (0.1-0.9)	0.031	0.2 (0.0-2.1)	0.176	-	-	-	-	-	-
Visual acuity
Not fix and follow	67 (54.0)	6 (16.2)	8.8 (3.2-24.)	< 0.001	10.0 (3.0-33.0)	< 0.001b	69 (54.3)	4 (11.8)	15.9 (5.0-50.3)	< 0.001	12.8 (3.8-42.0)	< 0.001b
Poor/fair fix and follow	29 (23.4)	9 (24.3)	2.5 (1.0-6.4)	0.051	2.7 (0.8-8.9)	0.101	32 (25.2)	6 (17.6)	4.9 (1.8-13.8)	< 0.001	4.3 (1.4-12.8)	< 0.001b
Good fix and follow	28 (22.6)	22 (59.5)	Reference		Reference		26 (20.5)	24 (70.6)	Reference		Reference
Multiple disabilities	58 (46.8)	3 (8.1)	10.0 (2.9-34.1)	< 0.001	7.7 (2.0-29.7)	0.003b	57 (44.9)	4 (11.8)	6.2 (2.0-18.4)	< 0.001	4.0 (1.9-13.2)	0.026b
Prenatal risk
Cerebral dysgenesis	49 (39.5)	5 (13.5)	4.2 (1.5-11.5)	0.005	3.1 (1.0-9.7)	0.056	47 (37.0)	7 (20.6)	2.3 (0.9-5.6)	0.101	1.9 (0.7-5.4)	0.229
Perinatal risk
GA < 32 weeks	10 (8.1)	7 (18.9)	0.4 (0.1-1.1)	0.071	0.9 (0.1-7.6)	0.892	-	-	-	-	-	-
GA 32-36 weeks	19 (15.3)	5 (13.5)	1.0 (0.3-2.9)	1.000	0.7 (0.2-2.8)	0.597	-	-	-	-	-	-
GA ≥ 37 weeks	95 (76.6)	25 (67.6)	Reference		Reference		-	-	-	-	-	-
Hx previous stimulation1	31 (25.0)	1 (2.7)	12.0 (1.6-91.2)	0.004	6.9 (0.7-64.6)	0.089	32 (25.2)	0	-	0.001	-	-

^aP < 0.2 indicates significant.

^bP < 0.05 indicates significant.

¹Hx previous stimulation, history of developmental stimulation elsewhere.

OR: Odds ratio; AOR: Adjusted odds ratio; DQ: Developmental quotient; GA: Gestational age.

Table 4 Factors associated with language and personal-social skills in children with visual impairment

Factors	Language						Personal and social
	DQ		Univariable analysis		Multivariable analysis		DQ		Univariable analysis		Multivariable analysis
	< 70, n = 122	≥ 70, n = 39	OR (95%CI)	P valuea	AOR (95%CI)	P valueb	< 70, n = 122	≥ 70, n = 39	OR (95%CI)	P valuea	AOR (95%CI)	P valueb
Eye disease
Cortical visual impairment	36 (29.5)	1 (2.6)	15.9 (2.1-120.3)	< 0.001	9.1 (1.1-75.4)	0.040b	36 (29.5)	1 (2.6)	15.9 (2.1-120.3)	< 0.001	9.1 (1.1-75.9)	0.041b
Optic nerve hypoplasia	14 (11.5)	1 (2.6)	4.9 (0.6-38.7)	0.120	6.0 (0.5-66.3)	0.145	-	-	-	-	-	-
Retinopathy of prematurity	7 (5.7)	5 (12.8)	0.4 (0.1-1.4)	0.165	0.4 (0.1-1.5)	0.155	-	-	-	-	-	-
Delay visual maturation	10 (8.2)	0	-	0.120	-	-	10 (8.2)	0	-	0.120	-	-
Visual acuity
Not fix and follow	65 (53.3)	8 (20.5)	6.9 (2.8-17.4)	< 0.001	5.3 (1.8-15.3)	0.002b	69 (56.6)	4 (10.3)	18.7 (5.9-59.1)	< 0.001	13.4 (4.0-44.7)	< 0.001b
Poor/fair fix and follow	30 (24.6)	8 (20.5)	3.2 (1.2-8.3)	< 0.001	3.1 (0.9-10.0)	0.062	29 (23.8)	9 (23.1)	3.5 (1.4-8.9)	0.009	2.5 (0.9-7.0)	0.074
Good fix and follow	27 (22.1)	23 (59.0)	Reference		Reference		24 (19.7)	26 (66.7)	Reference		Reference
Multiple disabilities	55 (45.1)	6 (15.4)	4.5 (7.8-11.6)	0.001	2.8 (0.9-8.5)	0.076	55 (45.1)	6 (15.4)	4.5 (1.8-11.6)	0.001	2.4 (0.8-7.1)	0.108
Prenatal risk
Cerebral dysgenesis	46 (37.7)	8 (20.5)	2.3 (1.0-5.5)	0.053	1.0 (0.3-3.5)	0.943	-	-	-	-	-	-
Intrauterine infections	3 (2.5)	4 (10.3)	0.2 (0.5-1.0)	0.059	0.2 (0.0-1.6)	0.134	-	-	-	-	-	-
Perinatal risk
Birth asphyxia	-	-	-	-	-	-	21 (17.2)	2 (5.1)	3.8 (0.9-17.2)	0.069	1.9 (0.4-10.5)	0.446
Postnatal risk
Head trauma	-	-	-	-	-	-	7 (5.7)	0	-	0.197	-	-
Hx previous stimulation1	31 (25.4)	1 (2.6)	12.9 (1.7-98.3)	0.002	7.3 (0.9-60.4)	0.064	30 (24.6)	2 (5.1)	6.0 (1.4-26.5)	0.010	4.2 (0.8-20.9)	0.083

^aP < 0.2.

^bP < 0.05.

¹Hx previous stimulation, history of developmental stimulation elsewhere.

OR: Odds ratio; AOR: Adjusted odds ratio; DQ: Developmental quotient.