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PubMed1989

Binocularity and single cell acuity are related in striate cortex of corpus callosum sectioned and normal cats.

Cats with corpus callosum section at 4-37 postnatal days underwent electrophysiological recording in striate cortex after they reached adulthood. Single cells were examined to determine both their ocular dominance and spatial frequency threshold (acuity). Data were analyzed for each cat according to the extent of binocular interaction (binocularity) and the mean striate acuity. Both visual functions were found to be significantly related to the age at which the corpus callosum section occurred, with the greatest deficits in visual function resulting from callosum section at the younger ages. There was a significant relationship between striate binocularity and acuity in the callosum sectioned, as well as in normal, cats. This suggests that visual resolution is at least partially determined by the ability to integrate information from both eyes.

Animals↗

PubMed1998

The functional anatomy of attention to visual motion. A functional MRI study.

Attention can enhance or modulate neural responses to stimuli at early and late stages of sensory processing. We were interested in the modulatory effect of attention to visual motion on cortical responses as measured by functional MRI. Subjects were scanned during repeated presentations of identical stimuli (visual motion) while only the attentional component of the task was varied. Enhanced haemodynamic responses during attentive conditions defined an occipitoparietofrontal system, including sensory and association areas, as well as the medial thalamus and superior colliculus. Attentional modulation was not restricted to extrastriate areas (including V3a and the V5 complex) but was also evident, to a lesser degree, in early visual areas close to the calcarine fissure (V1/V2 border). Attention-related enhancement of cortical responsiveness is discussed in terms of data that implicate modulatory short-term changes in synaptic efficacy and reciprocal connections between striate, extrastriate, parietal and frontal areas. Given the similarity of our attentional network to that controlling eye movements, the results of this study are in accord with theories linking oculomotor control and attention.

Attention↗

PubMed1997

Influence of glaucomatous visual field loss on health-related quality of life.

We examined the influence of glaucomatous visual field defects on vision-targeted and generic health-related quality of life. Vision-targeted and generic health status were assessed across 5 glaucoma treatment categories and a normal reference group from 5 tertiary care ophthalmology practices during regularly scheduled eye care visits. The sample consisted of 147 patients who were members of specific glaucoma treatment categories and 44 reference group patients. For patients with glaucoma, eligibility included a diagnosis of glaucoma at least 1 year prior to enrollment and no evidence of other eye disease. Participants completed 2 vision-targeted surveys, the National Eye Institute Visual Functioning Questionnaire and the VF-14, and a generic health-related quality of life measure, the Medical Outcomes Study 36-Item Short Form. Data from automated perimetry (Humphrey Field Analyzer 24-2, Humphrey Instruments, San Leandro, Calif) were used to generate Advanced Glaucoma Intervention Study scores for all participants. The Medical Outcomes Study 36-Item Short Form scores from glaucoma and reference group participants collected on a random half of the sample were similar. However, comparisons of the vision-targeted surveys demonstrated significant mean differences on 7 of 11 National Eye Institute Visual Functioning Questionnaire scales, and a trend toward significant differences for the VF-14 (P < .07 by linear regression). Greater visual field defects in the better eye were significantly associated with poorer National Eye Institute Visual Functioning Questionnaire scores (P < .05), as well as with worse VF-14 scores. These findings were most dramatic for patients with the most severe field loss in the better eye. Vision-targeted questionnaires were more sensitive than a generic health-related quality of life measure to differences between glaucoma and normal reference participants. Our findings indicate that self-reports of vision-targeted health-related quality of life are sensitive to visual field loss and may be useful in tandem with the clinical examination to fully understand outcomes of treatment for glaucoma.

Adult↗

PubMed2006

Purkinje cells in the lateral cerebellum of the cat encode visual events and target motion during visually guided reaching.

In this study the receipt of visual information by the lateral cerebellum and its contribution to a motor output was studied using single unit recording of cerebellar cortical neurones in cats trained to perform visually guided reaching. The activity of Purkinje cells and other cortical neurones in the lateral cerebellum was investigated in relation to various aspects of the task, such as visual events, parameters of target movement, and limb and eye movements. Two-thirds (66%) of Purkinje cells tested could signal simple visual events, such as a flash of light. Neurones were also capable of detecting other less potent, but behaviourally important visual events, such as a 'GO' signal (LED brightening). Half of the cells tested were responsive to the on-going motion of the visual target, displaying tonically altered discharge rates for as long as it was moving, and a 'preferred' target velocity. A small proportion of cells showed short latency visual modulation that persisted during the forelimb reach. Anatomical tracing studies confirmed that the recordings were obtained from the D1 zone of crus I. In summary, cells in this region of lateral cerebellar cortex perform simple visual functions, such as event detection, but also more complex visual functions, such as encoding parameters of target motion, and their visual responsiveness is appropriate for a role in accurate visually guided reaching to a moving target.

Animals↗

PubMed2000

Neurotoxic and pharmacokinetic responses to trichloroethylene as a function of exposure scenario.

Strategies are needed for assessing the risks of exposures to airborne toxicants that vary over concentrations and durations. The goal of this project was to describe the relationship between the concentration and duration of exposure to inhaled trichloroethylene (TCE), a representative volatile organic chemical, tissue dose as predicted by a physiologically based pharmacokinetic model, and neurotoxicity. Three measures of neurotoxicity were studied: hearing loss, signal detection behavior, and visual function. The null hypothesis was that exposure scenarios having an equivalent product of concentration and duration would produce equal toxic effects, according to the classic linear form of Haber's Rule ((italic)C(/italic) times t = k), where C represents the concentration, t, the time (duration) of exposure, and k, a constant toxic effect. All experiments used adult male, Long-Evans rats. Acute and repeated exposure to TCE increased hearing thresholds, and acute exposure to TCE impaired signal detection behavior and visual function. Examination of all three measures of neurotoxicity showed that if Haber's Rule were used to predict outcomes across exposure durations, the risk would be overestimated when extrapolating from shorter to longer duration exposures, and underestimated when extrapolating from longer to shorter duration exposures. For the acute effects of TCE on behavior and visual function, the estimated concentration of TCE in blood at the time of testing correlated well with outcomes, whereas cumulative exposure, measured as the area under the blood TCE concentration curve, did not. We conclude that models incorporating dosimetry can account for differing exposure scenarios and will therefore improve risk assessments over models considering only parameters of external exposure.

Animals↗

PubMed1994

Vitreous surgery in children.

This study examines the results of research on the surgical treatment of children with various vitreous diseases. Vitrectomy was performed on 44 eyes in children, from four months to fifteen years of age, suffering from the following diseases: lensectomy complications as vitreocorneal adhesions or immersion of lens mass into the vitreous; persistent hyperplastic primary vitreous (PHPV), trauma consequences, uveitis and eyeball subatrophy. Preoperational examination included measurement of visual acuity, biomicroscopy, direct and indirect ophthalmoscopy, tonography, ultrasonography and electrophysiological examinations. Vitreotome 'ocutome' was used to perform the operations. A transcyliar approach was used in all but 14 cases, for which the operations were performed by limbal incision. Improvement of visual functions was noted in 28 eyes (63.3%), and relatively good visual function was achieved in 7 eyes (16.9%). Visual acuity remained unchanged in 6 eyes (13.6%) because of severe amblyopia, although the transparency of optic zone was restored and the fundus did become visible. IN 10 (22.7%) of the children visual acuity could not be measured because of too young an age. One day after surgery a cellular suspension in the vitreous was observed in many eyes. This however, resolved within 3 days. Intraocular pressure usually returned during the first week after surgery. Hypotonia remained for 1-2 months after subtotal vitrectomy. The transcyliar extraction of pathological vitreous in children is generally a less traumatic and more convenient means of intravitreal manipulation, but 2 cases of intraoperational hemophthalmia suggested that iridiocyclitis is a contraindication for transcyliar approach. Transcorneal extraction is a less traumatic surgical method in such cases.

Adolescent↗

PubMed1992

Contrast and glare sensitivity. Association with the type and severity of the cataract.

PURPOSE: Contrast and glare sensitivity tests are now being used as adjuncts to visual acuity in the assessment of visual function. Limited data are available on the associations of the former tests with cataract type and severity. The aim of the study is to assess these associations using standardized techniques. METHODS: Contrast sensitivity tests (using the Pelli-Robson chart) and glare sensitivity tests (using the Vistech MCT 8000) were done on 128 patients with cataracts and no other ocular disease and on 29 control volunteers. The cataracts were graded using the Lens Opacities Classification System II (LOCS II). Data from the left eyes were analyzed using logistic regression models. RESULTS: Contrast sensitivity loss was associated with cataract severity for cortical (P less than 0.0001) and posterior subcapsular (P = 0.0001) cataracts and with decreased visual acuity (P = 0.0001). Night and day glare sensitivity were each associated only with increased severity of posterior subcapsular cataracts (P less than or equal to 0.003) and with decreased visual acuity (P less than 0.001). Additional analyses showed that contrast and glare sensitivity were similar in eyes with no cataracts and early cataracts. CONCLUSION: These results suggest that the Pelli-Robson Chart and the Vistech MCT 8000 are good techniques for evaluating visual function in moderate to advanced cataracts. However, for early cataracts, other techniques need to be explored to assess visual function loss.

Adult↗

PubMed1984

Effects of enucleation of the nondeprived eye on stimulus deprivation amblyopia in monkeys.

The effects of enucleation of the nondeprived eye on the visual function of the deprived eye were studied in two rhesus monkeys reared with long-term lid suture. The lids of one eye of each monkey were surgically fused at the age of approximately 1 month. The lids were opened at ages 19 months and 22 months, and the nondeprived eyes were enucleated at age 57 months. Three measures of visual function (spatial modulation sensitivity, temporal modulation sensitivity, and increment-threshold spectral sensitivity) were determined for the nondeprived and deprived eyes before enucleation and for the deprived eyes during a 9-month period following enucleation. Neither the spatial nor temporal modulation sensitivity measurements showed significant recovery of visual function. The postenucleation spectral sensitivity data showed some recovery of sensitivity over the long wavelength region of the spectrum during the first 3 months, but there was no further recovery over the next 6 months. Therefore, the results of the experiments show that enucleation of the nondeprived eye of monkeys with severe stimulus deprivation amblyopia does not result in a significant functional improvement of the deprived eye.

Accommodation, Ocular↗

PubMed2005

Analysis of retinal nerve fiber layer and optic nerve head in glaucoma with different reference plane offsets, using optical coherence tomography.

PURPOSE: To evaluate the performance of retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) parameters analyzed with different offsets of reference plane in detecting early glaucomatous changes and in correlation with visual function using optical coherence tomography (OCT). METHODS: This was a cross-sectional study consisting of 41 normal subjects and 30 with early and 40 with advanced glaucoma. RNFL thickness and ONH parameters were measured with reference planes positioned at 95, 150, and 205 microm above the level of retinal pigment epithelium (RPE). Discriminating power for early glaucoma detection and correlation with visual field MD for each parameter at different levels of reference plane were compared by using the analyses of area under the receiver operating characteristic curves (AUCs) and linear regression, respectively. RESULTS: All ONH measurements were significantly different between normal and glaucoma groups, irrespective of the level of reference plane. In normal eyes, changing the reference plane position resulted in significant differences in ONH measurements. Among all the parameters examined, integrated rim volume and RNFL thickness measured at 150 microm above the RPE showed the largest AUC (0.966) for early glaucoma detection, and the strongest correlation with visual function (r = 0.793), respectively. CONCLUSIONS: OCT analysis of the ONH and RNFL is useful for early glaucoma detection. Among the three reference planes examined in this study, measurements analyzed at 150 microm above the RPE demonstrated the best performance for glaucoma detection and correlation with visual function. Compared with ONH measurements, RNFL thickness may be a better indicator, reflecting retinal ganglion cell function and monitoring disease progression.

Cross-Sectional Studies↗

PubMed1986

Esterman disability rating in severe glaucoma.

Forty-two patients with severe visual loss from glaucoma were assigned an Esterman visual function score according to their performance on a binocular visual field test using an automated perimeter. (The Esterman score has been adopted by the AMA as a new standard for rating visual field disability.) The visual function score was correlated with patient responses to questions about perceived visual disability. Monocular visual field results from both eyes using automated suprathreshold static and manual kinetic perimetry were also compared to the binocular Esterman test results. The binocular Esterman test rapidly provided information concerning visual field disability which correlated well with combined monocular results, and with an objectivity lacking in patient responses to a disability questionnaire.

Adult↗

PubMed2004

Appropriateness ratings in cataract surgery.

This study aimed to evaluate the appropriateness of cataract surgery and identify the characteristics of patients and surgeons, clinical and functional outcomes, and surgical methods associated with appropriate cataract surgery. For this purpose, Korean cases of cataract surgery were rated as either 'necessity', 'appropriate', 'uncertain' or 'inappropriate', based on RAND/UCLA Ratings. For this assessment, the cases of 222 patients who underwent cataract surgery, on either one or both eyes, were studied. The surgeries were performed by 20 ophthalmologists practicing at one of fourteen medical institutions (university hospitals and general hospitals). Patients were interviewed and clinical data collected. The Doctors were questioned with self-entered questionnaire forms. The medical records were also examined to gain an understanding of the surgical process. The ratings were as follows: 30.6% (68 patients) of surgeries belonged to the bracket "necessity", 46.4% (103 patients) to "appropriate", 15.3% (34 patients) to "uncertain" and 7.7% (17 patients) to "inappropriate". In this study, "necessity" and "appropriate" were defined as "appropriate" (77.0%, 171 patients), and "uncertain" and "inappropriate" as "inappropriate" (23.0%, 51 patients). The low preoperative Snellen visual acuity and visual function, advanced age and male patients were associated with appropriate surgery. It is concluded that appropriate surgery was related to the clinical and functional outcomes (visual acuity and visual function) and patient characteristics (age and male).

Aged↗

PubMed2006

Assessment of vision-related quality of life in an older population subsample: The Blue Mountains Eye Study.

PURPOSE: To assess visual functioning and vision-specific health-related quality of life (HRQOL) in an older, community-dwelling-based population subsample, using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). METHODS: Three-quarters (76%, n = 892) of Extension Blue Mountains Eye Study participants (aged > or = 50 years, mean 60.8 years) completed the self-administered NEI-VFQ-25, an instrument consisting of 12 dimensions and one summary composite score, and comprehensive eye examinations, including monocular distance visual acuity. Visual impairment was defined as visual acuity < 6/12. Unilateral and bilateral visual impairment was defined by the worse eye and better eye, respectively. Correctable visual impairment was defined as that which improved, and non-correctable visual impairment as that which persisted after subjective refraction. Mild visual impairment was defined as visual acuity < 6/12 but > or = 6/24, moderate as < 6/24 but > or = 6/60, and severe as < 6/60. RESULTS: There were no significant differences in age, sex, or vision status between NEI-VFQ-25 responders and non-responders. Men had significantly better scores in three subscales than women but there were no significant differences in their overall composite scores (men 88.5+/- 0.5; women 88.1+/- 0.4). Persons aged 60-69 years had the best NEI-VFQ-25 profiles (mean composite score +/- standard error, 90.2 +/- 0.5; 50-59 years, 88.5 +/- 0.4; > or =70 years, 86.2 +/- 0.8). Presenting bilateral visual impairment (77.1 +/- 1.4) was associated with significantly poorer functioning than unilateral (87.5 +/- 0.8) or no visual impairment (89.4 +/- 0.3). Increasing levels of impairment were associated with poorer levels of visual functioning. The impact of impairment was principally from non-correctable (49.2 +/- 2.6) rather than refractive impairments (85.3 +/- 1.4), although the latter accounted for over three-quarters (77.5%) of presenting bilateral impairment. Non-correctable unilateral impairment (85.3 +/- 1.1) was associated with poorer functioning than no impairment. CONCLUSIONS: The findings from this community-dwelling older population show that the NEI-VFQ-25 differentiates well between various levels of visual impairment with regard to the magnitude of their impact on vision-specific quality of life. Greater impacts were noted among persons with bilateral compared to unilateral impairment, with increasing impacts at greater severities of visual impairment. Visual impairment from refractive errors is more frequent than from underlying pathologic disorders, but the impact of correctable visual impairment was considerably milder than the impact of non-correctable visual impairment.

Aged↗

PubMed1997

Function and visual impairment in a population-based study of older adults. The SEE project. Salisbury Eye Evaluation.

PURPOSE: The Salisbury Eye Evaluation (SEE) project investigates the impact of vision on functional status in a population-based sample of elderly persons. The prevalence of self-reports of functional status and the association with visual acuity loss are described. METHODS: A random sample of men and women 65 to 84 years of age from Salisbury, Maryland were recruited for home interviews and clinic examinations. Of the eligible sample, 78% responded to the home questionnaire and 65% responded to the questionnaire and the clinic examination. Binocular visual acuity of each person was measured using ETDRS charts and protocols. Questions were asked concerning activities of daily living, instrumental activities of daily living, physical function, social interaction, and activities of daily vision. Analyses of the association of presenting visual acuity worse than 20/40 with the measures of function were carried out and adjusted for age, race, and sex. RESULTS: All measures of functional status showed a decline with age; women and blacks were more likely to report difficulties. The age-adjusted proportions of those with visual impairment were not significantly different between men and women (7.2% versus 6.7%; P = 0.60). Black persons had almost twice the rate (10.4%) of white persons (5.6%; P < 0.001). Age, race, gender, and visual impairment were all significantly related to declines in functional status in multivariate models. CONCLUSIONS: Data on functional status in the project population were similar to national data and confirmed higher rates of disability in women and blacks. Binocular visual acuity worse than 20/40 appeared to have an impact on all the self-report measures of functional status. Further analyses on the interaction of vision with other comorbid conditions on function status clearly are indicated.

Activities of Daily Living↗

PubMed1989

Improved reading performance using individualized compensation filters for observers with losses in central vision.

By boosting the amplitudes of the intermediate spatial frequencies more than the amplitude of the lower spatial frequencies, reading performance improved significantly when observers with losses in central vision read words that were filtered. Words that were filtered using an image enhancement function based on an observer's losses in visual function relative to a normal observer (1) reduced the magnification (30-70% less magnification was needed) and (2) increased the reading rate (2-3 times), measured in words per minute. The greater the loss in central visual function, the more individualized compensation filters reduced the magnification needed for word recognition. Individualized compensation filters improved the clarity and visibility of words for low vision observers. This study also found that the shape of the enhancement function was important to determine the optimum compensation filter for improving reading performance. In addition, the individualized compensation filters can be implemented by inexpensive hardware, for example in a closed circuit television (CCTV), to provide a significantly more effective low vision aid for observers with losses in central vision to read text, than is provided using only magnification.

Adult↗

PubMed1994

Spatial summation of the differential light threshold as a function of visual field location and age.

Static differential light thresholds were measured as a function of stimulus size (Goldmann sizes I-V) along four visual field meridia (75, 165, 255 and 345 degrees) with the Humphrey Field Analyzer 640. Data were obtained for both young (n = 10, age 23.6 +/- 2.9 years) and elderly (n = 10, age 72.0 +/- 5.2 years) normal subjects. The resulting peripheral spatial summation curves could be equated to the foveal data simply by a change in size scale, which increased linearly with eccentricity. E2 values, expressing the eccentricity at which stimulus size must double for performance to remain comparable to the fovea, were in the order of 3-9 degrees. Whilst the rate of scale change is approximately the same for both young and elderly observers, differences in performance can be explained by a combination of lower sensitivity and a bias in sensitivity towards larger stimulus sizes with increasing age.

Adult↗

PubMed1992

Intracavitary brachytherapy of cystic craniopharyngiomas.

Visual function, endocrinological status, and radiological outcome are reported in 31 patients harboring a cystic craniopharyngioma, who underwent 35 intracavitary brachytherapy procedures with yttrium-90. In 26 of these patients intracavitary brachytherapy was the primary treatment. The follow-up period ranged from 2 to 80 months (41 +/- 22 months, mean +/- standard deviation). Five patients died from tumor-related causes. Endocrine recovery was modest. Prior to brachytherapy, visual acuity was diminished in 38 eyes and field defects were present in 46. Funduscopy before treatment revealed optic atrophy in 47% of the eyes. Visual acuity improved in 29% of the eyes studied, remained stable in 13%, and deteriorated in 58%. Visual field defects improved in 28% of the eyes studied, remained stable in 20%, and deteriorated in 52%. The possible causes for deterioration in visual function are discussed. Complete resolution of 10 cysts was noted. In 12 patients the size of the cyst decreased; however, in three of these patients new cyst formation took place. The cyst size stabilized in six cases and increased in three. Although there is still a substantial degree of visual function deterioration following intracavitary brachytherapy, morbidity is otherwise low, making this treatment modality a reasonable alternative to craniotomy.

Adolescent↗

PubMed1985

Vision: a multimodal sense.

There is growing evidence for parallel processing of visual information. Visual information, spatially or temporally distinct, is transmitted to various regions of the brain. This paper presents clinical and anatomical evidence for parallel processing in the human visual system. The neuro-ophthalmologist often has psychophysical evidence for the separation of visual functions. Our own investigations have demonstrated that brightness sense and other visual functions may be impaired out of proportion to visual acuity in diseases of the optic nerve. Classes of retinal ganglion cells have been morphologically and physiologically described in several experimental animals. No such classification of retinal ganglion cell types has been made in man. However, psychophysical and retinal electrophysiological human studies suggest the segregation of human retinal ganglion cells into classes which subserve different functions. A new staining method (PPD) has made it possible to directly study the visual pathways in man. With this method, we have documented several previously undescribed human visual pathways to different brain visual nuclei: the lateral geniculate nucleus, the pretectum, the superior colliculus, the pulvinar, and three nuclei of the hypothalamus (SCN, PVN, SON). We have also developed a method which permits the accurate and rapid measurement of human retinal ganglion cell axon diameters through the optic nerve and through the fascicles of optic fibers entering several of these recently described visual nuclei. There is evidence for three size classes of axons which differentially distribute to the visual nuclei. These studies emphasize the need for overcoming the constraints of thinking that vision is the same as seeing.(ABSTRACT TRUNCATED AT 250 WORDS)

Eye Diseases↗

PubMed2003

Visual, cognitive, and language assessments at 39 months: a follow-up study of children fed formulas containing long-chain polyunsaturated fatty acids to 1 year of age.

OBJECTIVE: Docosahexaenoic acid (DHA) and arachidonic acid (ARA) are long-chain polyunsaturated fatty acids found in breast milk and recently added to infant formulas. Their importance in infant nutrition was recognized by the rapid accretion of these fatty acids in the brain during the first postnatal year, reports of enhanced intellectual development in breastfed children, and recognition of the physiologic importance of DHA in visual and neural systems from studies in animal models. These considerations led to clinical trials to evaluate whether infant formulas that are supplemented with DHA or both DHA and ARA would enhance visual and cognitive development or whether conversion of linoleic acid and alpha-linolenic acid, the essential fatty acid precursors of ARA and DHA, respectively, at the levels found in infant formulas is sufficient to support adequately visual and cognitive development. Visual and cognitive development were not different with supplementation in some studies, whereas other studies reported benefits of adding DHA or both DHA and ARA to formula. One of the first trials with term infants that were fed formula supplemented with DHA or both DHA and ARA evaluated growth, visual acuity (Visual Evoked Potential; Acuity Card Procedure), mental and motor development (Bayley Scales of Infant Development), and early language development (MacArthur Communicative Developmental Inventories). Growth, visual acuity, and mental and motor development were not different among the 3 formula groups or between the breastfed and formula-fed infants in the first year of life. At 14 months of age, infants who were fed the formula with DHA but no ARA had lower vocabulary production and comprehension scores than infants who were fed the unsupplemented control formula or who were breastfed, respectively. The present follow-up study evaluated IQ, receptive and expressive vocabulary, visual-motor function, and visual acuity of children from the original trial when they reached 39 months of age. METHODS: Infants were randomized within 1 week after birth and fed a control formula (n = 65), one containing DHA (n = 65), or one containing both ARA and DHA (n = 66) to 1 year of age. A comparison group (n = 80) was exclusively breastfed for at least 3 months after which the infants continued to be exclusively breastfed or were supplemented with and/or weaned to infant formula. At 39 months, standard tests of IQ (Stanford Binet IQ), receptive vocabulary (Peabody Picture Vocabulary Test-Revised), expressive vocabulary (mean length of utterance), visual-motor function (Beery Visual-Motor Index), and visual acuity (Acuity Card Procedure) were administered. Growth, red blood cell fatty acid levels, and morbidity also were evaluated. RESULTS: Results were analyzed using analysis of variance or linear regression models. The regression model for IQ, receptive and expressive language, and the visual-motor index controlled for site, birth weight, sex, maternal education, maternal age, and the child's age at testing. The regression model for visual acuity controlled for site only. A variable selection model also identified which of 22 potentially prognostic variables among different categories (feeding groups, the child and family demographics, indicators of illness since birth, and environment) were most influential for IQ and expressive vocabulary. A total of 157 (80%) of the 197 infants studied at 12 months participated in this follow-up study. Characteristics of the families were representative of US families with children up to 5 years of age, and there were no differences in the demographic or family characteristics among the randomized formula groups. As expected, the formula and breastfed groups differed in ethnicity, marital status, parental education, and the prevalence of smoking. Sex, ethnicity, gestational age at birth, and birth weight for those who participated at 39 months did not differ from those who did not. The 12-month Bayley mental and motor scores and 14-month vocabulary scores of the children who participated also were were not different from those who did not. At 39 months, IQ, receptive and expressive language, visual-motor function, and visual acuity were not different among the 3 randomized formula groups or between the breastfed and formula groups. The adjusted means for the control, ARA+DHA, DHA, and breastfed groups were as follows: IQ scores, 104, 101, 100, 106; Peabody Picture Vocabulary Test, 99.2, 97.2, 95.1, 97.4; mean length of utterance, 3.64, 3.75, 3.93, 4.08; the visual-motor index, 2.26, 2.24, 2.05, 2.40; and visual acuity (cycles/degree), 30.4, 27.9, 27.5, 28.6, respectively. IQ was positively associated with female sex and maternal education and negatively associated with the number of siblings and exposure to cigarette smoking in utero and/or postnatally. Expressive language also was positively associated with maternal education and negatively associated with the average hours in child care per week and hospitalizations since birth but only when the breastfed group was included in the analysis. The associations between maternal education and child IQ scores are consistent with previous reports as are the associations between prenatal exposure to cigarette smoke and IQ and early language development. Approximately one third of the variance for IQ was explained by sex, maternal education, the number of siblings, and exposure to cigarette smoke. Growth achievement, red blood cell fatty acid levels, and morbidity did not differ among groups. CONCLUSIONS: We reported previously that infants who were fed an unsupplemented formula or one with DHA or with both DHA and ARA through 12 months or were breastfed showed no differences in mental and motor development, but those who were fed DHA without ARA had lower vocabulary scores on a standardized, parent-report instrument at 14 months of age when compared with infants who were fed the unsupplemented formula or who were breastfed. When the infants were reassessed at 39 months using age-appropriate tests of receptive and expressive language as well as IQ, visual-motor function and visual acuity, no differences among the formula groups or between the formula and breastfed groups were found. The 14-month observation thus may have been a transient effect of DHA (without ARA) supplementation on early vocabulary development or may have occurred by chance. The absence of differences in growth achievement adds to the evidence that DHA with or without ARA supports normal growth in full-term infants. In conclusion, adding both DHA and ARA when supplementing infant formulas with long-chain polyunsaturated fatty acids supports visual and cognitive development through 39 months.

Arachidonic Acid↗