Anatomical, Functional And Neuro-Cognitive Outcomes After Sight Restoration In Infants And Toddlers With Congenital Bilateral Visual Axis Opacities

Visual stimulus forms a large proportion of brain input, and it is proven that visual skills are directly linked with intellectual development. Children with decreased visual input in early life have consistently shown impairment of brain’s functional connections. However, if these children undergo timely sight restoration, their cognition might significantly increase. This study explored the neuro-cognitive outcomes after sight restoration in infants and toddlers with congenital bilateral visual axis opacities and compared the neuro-cognition of these children with that of the normal population. Further, the degree of anatomical and functional outcomes post-surgery was compared with the degree of neuro-cognitive outcomes achieved.

An ambispective observational study in which ten children having bilateral congenital cataract and ten children having bilateral congenital corneal opacity who presented to a tertiary healthcare centre in India (Dr. R. P. Centre for Ophthalmic Sciences) between January 2024 and March 2025 and underwent sight restorative surgery (either lens aspiration with or without intra-ocular lens implantation or keratoplasty in either eye) below the age of three years were included.

Twenty children with bilateral corneal or lenticular opacities dense enough to preclude the view of fundus were identified. After taking informed consent from the guardian, their anatomical features (grade of lenticular or corneal opacity), functional status (visual fixation using Cardiff test) and neuro-cognitive status (using Developmental Assessment Scale for Indian Infants- DASII score) were recorded pre-surgery and three months post-surgery. The mental and motor quotient of the DASII score was compared with the normal value for the age-matched population. The difference in DASII score pre-and post-surgery was analyzed and compared between the congenital cataract and the congenital corneal opacity groups.

The motor (73.49) and mental (80.62) quotient of the DASII score of the study population pre-surgery was significantly lower than that of the normal population (85) (p=0.0003, 0.03). There was a significant improvement in both motor (p=0.0005) and mental (p=0.001) components of the score post-surgery. The motor (81.09) and mental (84.74) quotient post-surgery was not significantly different (p=0.058, 0.46) from the population mean (85). The group with congenital cataract showed better visual recovery (90% with > 6/60 visual acuity) compared to the congenital corneal opacity group (50% with > 6/60 visual acuity) but there was no significant difference in the improvement of motor (p=0.2) or mental (p=0.6) score between the two groups.

The results indicate that children deprived of vision since birth showed deficiencies in neuro-cognitive development compared to their peers. Sight restoration surgery significantly improved the motor and mental capabilities of these children and even brought them to near normal levels highlighting the close association between visual stimulus and cognitive development. Further, the amount of visual recovery did not significantly affect the amount of cognitive improvement from which we can conclude that by providing even a small amount of visual stimulus to congenitally blind children, we can support their neurological development.