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A Comparison of 3 Methods

Alki Liasis, PhD; Ken K. Nischal, FRCOphth; Bronwen Walters, BSc; Dorothy Thompson, PhD; Sharon Hardy, MSc; Anthony Towell, PhD; David Dunaway, FRCS; Barry Jones, FRCS; Robert Evans, FRCS; Richard Hayward, FRCS

Arch Ophthalmol. 2006;124:1119-1126.

Objective  To compare visual acuity, optic disc appearance, and transient pattern reversal visual evoked potentials as markers of possible visual dysfunction in children with syndromic craniosynostosis.

Methods  Serial visual acuity, optic disc appearance, and pattern reversal visual evoked potential data were recorded in 8 patients with syndromic craniosynostosis before and after cranial vault expansion. The pattern reversal visual evoked potentials were analyzed using linear regression modeling, applied to the N80 to P100 amplitude.

Results  Serial optic disc appearances were available for all 8 patients and visual acuities for 7 patients. The visual acuity deteriorated in only 1 patient, improved in 4, and fluctuated in 2, before surgery. Of the 8 patients, 3 showed no papilledema in either eye at any time, 3 showed progressive bilateral swelling before surgery, and 2 exhibited only unilateral disc swelling. In all 8 patients, there was a trend for the N80 to P100 amplitude to decrease before surgery and to increase, in all but 2 patients, after surgery.

Conclusions  This study suggests that neither optic disc appearance nor visual acuity assessment alone is a reliable marker of potential visual dysfunction in children with syndromic craniosynostosis. It also suggests that the pattern reversal visual evoked potential can provide early evidence of visual dysfunction before vault expansion surgery in these children; this dysfunction may recover postoperatively.

Author Affiliations: Department of Ophthalmology (Drs Liasis, Nischal, and Thompson and Mss Walters and Hardy) and Craniofacial Unit (Drs Nischal, Dunaway, Jones, Evans, and Hayward), Great Ormond Street Hospital for Children NHS Trust; Visual Science Unit, Institute of Child Health, University College London (Drs Liasis, Nischal, and Thompson and Mss Walters and Hardy); and Department of Psychology, University of Westminster (Drs Liasis and Towell), London, England.

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