Structural retinal changes and visual field loss across timing of damage in children with cerebral visual impairment

PURPOSE: To investigate structural changes in the retina and optic nerve head (ONH) of children with cerebral visual impairment (CVI) across different timing of damage (TOD), and to relate these structural changes to visual field (VF) loss severity and pattern. METHODS: Ninety-five children with CVI and 47 age-matched controls underwent optical coherence tomography (OCT) and static VF testing. TOD was categorized as prenatal, preterm, perinatal, postnatal, genetic or combined. Four OCT parameters were analysed (peripapillary retinal nerve fibre layer [pRNFL] thickness, ganglion cell inner plexiform layer [GCIPL] thickness, optic disc area (DA), cup-to-disc ratio [CDR]); for VF, we used mean defect (MD) and VF loss pattern. Generalized linear mixed-effects models were used to compare the OCT parameters between TOD categories and controls. The relationship between OCT parameters and MD was assessed with Spearman correlation. RESULTS: pRNFL and GCIPL thickness were significantly reduced for the preterm (p < 0.001), perinatal (p = 0.003), postnatal (p = 0.001) and genetic (p < 0.001) categories. DA was smaller for the genetic category (p = 0.014), and CDR was larger for the preterm (p = 0.03), perinatal (p = 0.03) and postnatal (p = 0.02) categories. MD was associated with pRNFL (ρ = -0.35, p = 0.001) and GCIPL thickness (ρ = -0.28, p = 0.01); especially in cases with profound VF loss, the VF loss pattern agreed well with that of GCIPL thinning. CONCLUSION: CVI is associated with structural changes in the inner retinal layers and ONH, in a TOD-specific manner. Structural changes relate to MD and VF loss patterns.