Delayed visual maturation

Dear Sir,
my daughter visited a child opthalmologist at 3 months because she was not focusing and her eyes were all over the place making fast moves up, left and right (not nystagmus)... Her eye exam came back clean, so we visited an child neurologist for consultation, but she found no neurological problems. She sent us for a brain ultrasound which came back clean as well, so, in absence of other symptoms, the diagnosis was delayed visual maturation. Now, at 4 months she is still not focusing, not making eye contact, not following objects, although her eyes move a little bit more normally than before. Would you recommend other tests (such as an MRI) or should we just wait and see? The ophtalmologist asked to see her again at 10 months, you find this is appropriate or should we have another test sooner than that? Thanks in advance for your answer.

[Houman Vosoghi, MD]

Get another opinion from another pediatric ophthalmologist.  There are tests that can be done to figure out whether she has a normal retinal response to light or not.  You may also consider seeing an ocular geneticist who can to electroretinal studies on her if necessary.  But first go see a second pediatric ophthalmologist.

HV

[mgi78]

Hi again and thanks for your answer. This morning we had our appointment with a second pediatric ophtalmologist, this time in our local Children's Hospital and she is specialised in the electroretinal studies you talked about. She told us that our daughter's eyes have normal retinal response to light and therefore, it is not necessary to perform the visual evoked potentials. She confirmed the delayed visual maturation and she added that she wants to see her again at 10 months of age, that this is something she has seen many times before but, if it was her own child, she would do an MRI, just to calm herself down.
I forgot to mention before that my daughter's gestational age was 38 weeks (so, no prematurity) and she is a rather large baby for her age (appr. 9 kilos) but head circumference OK.
My question is what would you do if it were your child? I am reading so many things in the Internet (CVI etc.) and I am going crazy here....
Thanks again for your interest!

[mgi78]

If there were indeed a problem in her head, would the ultrasound have shown it? - or, at least, would it have shown something that would make us suspicious?

[Houman Vosoghi, MD]

Ultrasound is a rough test and can not show all abnormalities.  If the pediatric ophthalmologist told me that she would get an MRI for her own child, I would follow that advice.  The only concern with an MRI as far as I am aware is the risk from anesthesia/sedation as a baby can not stay still for the test.  That's what I would do for my own child if the specialist even mentioned it.

HV

[mgi78]

A related discussion, Nystagmus - Developmental delay was started.