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Vision impairments common in infants with Zika virus syndrome
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Vision impairment is a pervasive finding in infants with microcephaly related to congenital Zika virus syndrome, according to research.
In one Brazilian study, Islane Verçosa, MD, and colleagues analyzed ocular features in 70 such infants and found ophthalmic changes in 25 (36%). Visual acuity tested in 11 infants was below normal in all 11. Intraocular changes included macular chorioretinal atrophy, mottled retinal pigment epithelium and optic nerve pallor; non-intraocular changes included strabismus or nystagmus.
In another Brazilian study, Liana O. Ventura, MD, PhD, and colleagues found visual impairment in all 32 infants they examined.
“When evaluating visual function and visual milestones, all evaluated children presented abnormality in at least one of the visual function and visual developmental milestone tests,” Ventura and colleagues wrote.
The researchers related the visual impairment to the extensive damage to the central nervous system, regardless of fundus involvement.
“Given that all children presented with neurological and neuroimaging abnormalities, that less than half presented with retinal and/or optic nerve findings and that all presented with visual impairment, we believe that cortical/cerebral visual impairment is the main cause of visual impairment in children with [congenital Zika syndrome,” Ventura and colleagues wrote.
In an editorial related to both studies, S. Grace Prakalapakorn, MD, MPH, and colleagues wrote, “Even before [Zika virus] was recognized as a cause of birth defects, its effects on the eyes were suspected” and “our knowledge of the structural effects of [Zika virus] infection on the eye and on vision with or without concomitant structural anomalies is still growing.”
Prakalapakorn and colleagues suggested that the findings of the two Brazilian studies add evidence that “cortical visual impairment might be the most common cause of blindness among children with [congenital Zika syndrome].” – by Rebecca L. Forand
Disclosure: No products or companies that would require financial disclosure are mentioned in this article.
Perspective
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Roberto Warman, MD
There are two papers in the August 2017 edition of J AAPOS addressing visual function in congenital Zika syndrome infants. The study of Liana Ventura et al. includes 32 infants with microcephaly, 14 (44%) of whom have retinal/optic nerve findings, and the study of Islane Verçosa et al have 70 infants with microcephaly, 25 (36%) of whom had ocular abnormalities and 18 (26%) had retina/optic nerve abnormalities. Both studies describe the same type of findings with optic atrophy, mottled retinal pigment epithelium and macular chorioretinal atrophy lesions. However, the main point they emphasize are the significant associated neurological deficits and developmental delay in congenital Zika syndrome, and decreased visual function is usually severe and present in a significant amount of infants even in the absence of ocular abnormalities. The clear implication is that cortical visual impairment is the most significant cause of decreased visual function, maybe present in 100% of infants as in the first study. Therefore, the recommendation is that all infants with suspected or confirmed congenital Zika syndrome with or without microcephaly should have an early evaluation of visual function by an experienced pediatric ophthalmologist and multispecialty intervention should be attempted early to attempt at least partial rehabilitation in this devastating condition.
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