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How to Help Children with Neurodevelopmental and Visual

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How to Help Children with Neurodevelopmental and Visual Review Br J Ophthalmol: first published as 10.1136/bjophthalmol-2013-304225 on 24 October 2013. Downloaded from How to help children with neurodevelopmental and visual problems: a scoping review C Williams,1,2 K Northstone,1 C Borwick,1,3 M Gainsborough,4 J Roe,5 S Howard,4 S Rogers,5 J Amos,4 J M Woodhouse3 ▸ Additional material is ABSTRACT METHODS published online only. To view Children with visual impairment and a condition affecting We formed a scoping group and we defined a PICO please visit the journal online (http://dx.doi.org/10.1136/ their neurodevelopment (children with VND) may require (Population, Intervention, Comparator, Outcome) bjophthalmol-2013-304225). extensive and specialised help but evidence on the most format to structure the literature search. Our popula- 1 effective strategies for visual improvement is lacking. We tion of interest comprised those aged less than School of Social and fi fi and Community Medicine, de ned a PICO format (Population, Intervention, 18 years with a clearly de ned vision problem a University of Bristol, Bristol, Comparator, Outcome) for a scoping review and clearly defined neurodevelopmental problem. We Somerset, UK systematically searched 13 databases. Two reviewers wrote and updated a protocol. We followed the 2 University Hospitals Bristol assessed the abstracts for inclusion and a third arbitrated recommendations listed in the PRISMA statement as NHS Trust, Bristol, Somerset, UK in cases of disagreement. We abstracted data from far as were applicable for a scoping review (see 3Cardiff School of Optometry included studies. We found 4450 abstracts from which attached checklist in online supplementary appendix and Vision Science, Cardiff we identified 107 papers for inclusion. Of these, 42 1). We considered any intervention and planned ini- University, Cardiff, UK 4 related to interventions involving a change in visual tially to include studies only if there was a placebo or Community Child Health input or function: 5 controlled trials, 8 before and after alternative treatment as comparator. This was revised Partnership, North Bristol NHS Trust, Bristol, Somerset, UK studies and 29 case reports. The strongest evidence after pilot searches yielded very few such studies: we 5Children and Young People’s supported the provision of spectacles to improve distance therefore present all studies we found and have used Services, Bristol City or near vision and the use of ultraviolet light as the Oxford Centre for Evidence Based Medicine Government, Bristol, environmental modification for training. Less strong but (OCEBM) levels table as an aid to seeing at a glance Somerset, UK suggestive evidence supported training/practice routines the likely strength of evidence provided by the 9 Correspondence to to improve acuity or oculomotor control. Interventions experimental studies we have included. Cathy Williams, School of exist to help children with VND and current Our information specialist (CB) searched the fol- Social and Community recommendations that they are assessed by a vision lowing databases in January 2011: ASSIA (CSA); Medicine, University of Bristol, specialist are supported by the evidence. More AMED (OVID); CINAHL (EBSCO); Cochrane Oakfield House, Oakfield Grove, Clifton, Bristol, information is needed on the effectiveness of training/ Library; Embase (OVID); Medline (OVID); Somerset BS8 2BN, UK; practice programmes which may promote improved PsychINFO (OVID); SCOPUS; Web of Science; ISI [email protected] function, and of environmental modifications to facilitate Proceedings (conference papers); Dissertation engagement of children with VND with the Express (Proquest); ETHoS and Index to Theses. Received 23 August 2013 Revised 13 September 2013 surroundings. No date delimiters were set. The results were Accepted 23 September 2013 downloaded into EndNote and duplicates were Published Online First removed. Hand-searches were carried out of the http://bjo.bmj.com/ 24 October 2013 supplements to Developmental Medicine and Child Neurology. A sample search is shown in online sup- plementary appendix 2. INTRODUCTION Two authors (CW and KN) independently Severe visual impairment or blindness in children is reviewed each abstract and decided whether they 1 often associated with other impairments. Children should be included or excluded according to the on October 2, 2021 by guest. Protected copyright. with neurodevelopmental disorders have an PICO, or whether more information was needed to increased prevalence of visual impairments and the make this decision. A third author ( JMW) arbi- Royal College of Ophthalmologists2 and the UK trated in cases where there was disagreement and government National Service Framework for consensus was reached. The full text of all papers Disabled Children3 recommend that such children identified as having potential for inclusion was have a routine vision check as part of their multi- requested excluding those not in English or disciplinary care. unavailable electronically or by interlibrary loan. Assessment and management of children with One author abstracted data from papers (CW) and visual and neurodevelopmental problems (VND) another checked the data (KN), using predesigned will differ according to their cognitive and motor checklists.10 development and day-to-day activities. We found systematic reviews or guidelines summarising the RESULTS evidence supporting paediatric vision problem such As shown in figure 1, after the initial selection – as amblyopia,4 6 congenital cataract7 or retinopathy process there were 107 papers for inclusion, of of prematurity,8 but none specifically relevant to which 1 was a systematic review, 5 were controlled To cite: Williams C, children with VND. We therefore carried out a clinical trials (CCTs), 11 were before/after studies, Northstone K, Borwick C, scoping review of the literature to identify studies 49 were single experimental case design studies et al. Br J Ophthalmol of interventions that are used for children with (where all subjects are described individually) and – 2014;98:6 12. VND. 41 were observational case series or reports. We 6 Williams C, et al. Br J Ophthalmol 2014;98:6–12. doi:10.1136/bjophthalmol-2013-304225 Review Br J Ophthalmol: first published as 10.1136/bjophthalmol-2013-304225 on 24 October 2013. Downloaded from Figure 1 Flow chart showing numbers of studies included and excluded. CCT, controlled clinical trial; PICO, Population, Intervention, Comparator, Outcome; SR, systematic review. http://bjo.bmj.com/ on October 2, 2021 by guest. Protected copyright. present here the findings for the 42 of these studies that revision of their existing spectacles were given new spectacles involved manipulating or improving the child’s visual input— either immediately, or after a 2-month delay during which the these were 5 controlled trials, 8 before and after studies study was conducted. Observers (trained staff members) then (described in table 1) and 29 case reports/series. noted whether any prespecified behaviours changed during the The studies using non-vision based interventions for example, study. A number of visual behaviours such as making eye behavioural strategies and communication aids will be presented contact, accuracy of reaching behaviour and recognising simple separately in another publication. pictures were described as being improved in the ‘given specta- cles immediately’ group (n=73), but not in the delayed specta- Interventions to improve distance vision cles group (n=56) or in children with no need for glasses, some Spectacles of whom had been given ‘placebo’ spectacles as a form of We found a CCT, a before/after study and a number of case control. However the placebo group also improved in some reports describing the effects of prescribing distance spectacles measures such as recognising pictures and the observers were for children with VND. The CCT11 involved four groups of not masked as to the study group. children with VND with a variety of diagnoses attending spe- The before/after study12 used visual evoked potentials (VEPs) cialist schools. Children needing spectacles for the first time or as the outcome. Improved (larger) VEP recordings were seen in Williams C, et al. Br J Ophthalmol 2014;98:6–12. doi:10.1136/bjophthalmol-2013-304225 7 Review Br J Ophthalmol: first published as 10.1136/bjophthalmol-2013-304225 on 24 October 2013. Downloaded from Table 1 Table of experimental studies included in the review OCEBM Factors that might lead to level of Ref year Design Participants Intervention or prevent bias Size of effect evidence9 11 1980 Controlled 131 with intellectual Distance spectacles vs Observers not masked 81% compliance at 8 weeks. Variable 3 trial disability and refractive errors none effects on multiple behaviours ≥+2.0D, ≤0.5D, ≥1D anisometropia 12 1987 Before/after 105 with intellectual Distance spectacles Observers not masked but also Qualitative results given—VEPs larger 3 disability and refractive errors used VEPs as objective after spectacles given in 58 of the 105. ≥+2.5D, ≤−3.0D, ≥1.5D outcome measure Some anecdotes of marked anisometropia or astigmatism improvements in awareness 23 1991 Controlled 17 (of 58) with severe visual Individualised vision A third of participants Separate data for children with VND 3 trial impairment diagnosed training programme vs allocated by non-random not given but qualitatively VND group <13 months of age and with general development procedure. did better in vision training arm as severe learning difficulties programme Masked
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