Visual perceptive functioning in Japanese schoolchildren born with very low birth weight

Visual perceptive functioning in Japanese schoolchildren born with very low birth weight | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Visual perceptive functioning in Japanese schoolchildren born with very low birth weight Miho Fukui, Shuichi Shimakawa, Tomohito Okumura, Hikaru Tsuda-Kitahara, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4153602/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Aug, 2025 Read the published version in BMC Pediatrics → Version 1 posted 13 You are reading this latest preprint version Abstract Background We aimed to use the Wide-range Assessment of Vision-related Essential Skills (WAVES) to evaluate the visual perception of Japanese schoolchildren born weighing < 1500 g, who did not need support class and had an average IQ score. Methods The very-low birth weight infant group (VLBWI group) included 38 (17 male, 21 female) first-grade elementary schoolchildren born between April 2009 and March 2013 at Osaka Medical College Hospital and Saiseikai Suita Hospital. The scores for the 10 subtests and 4 indices of WAVES were calculated for all participants and compared to the WAVES normative database of schoolchildren in the same grade (C group). We assessed whether clinical history was associated with WAVES score in the VLBWI group. Results Compared with the C group, the participants in the VLBWI group had significantly lower scores for form tracing (success and rate scores), figure-ground speed, discrimination accuracy, visual memory, copying, and the indices of WAVES, except for the eye-hand coordination general index. The scores for line tracing (ratio) and eye-hand coordination accuracy index were significantly lower in participants who were born at gestational age < 28 weeks than in those born at gestational age ≥ 28 weeks. Copying performance was significantly lower in participants with than without chronic lung disease. Conclusion This is the first study to evaluate the visual perception of schoolchildren born weighing < 1500 g in Japan. We report lower scores of WAVES’ subtests on processing speed in these children, implying they might have increased risk of poor school performance and learning disabilities. visual perception low birth weight preterm birth cerebral visual impairment Wide-range Assessment of Vision-Related Essential Skills Figures Figure 1 Background Preterm/low birth weight infant mortality has decreased dramatically since the advent of neonatal intensive care units; however, children born preterm and with low birth weight or those born smaller than normal for gestational age have increased risk for developmental disabilities, school failure, and behavioral and psychiatric problems [ 1 – 4 ]. In recent years, there has been increasing interest in cerebral visual impairment (CVI) in children [ 5 ]. CVI is a condition in which damage to the retrochiasmal visual pathways results in visual perceptual deficits in the absence of any major ocular disease [ 5 – 7 ]. It arises from conditions that cause abnormal development of, or damage to, the brain, affecting the visual pathways and disrupting normal visual function. Conditions leading to CVI often occur perinatally, with the most common cause being hypoxic-ischemic injury [ 5 ]. CVI is also frequently reported among children born prematurely without obvious past history of hypoxic-ischemic injury, as their prematurity results in an increased risk of insult to the developing brain [ 5 ]. Advances in medical care have resulted in an increased survival rate among extremely premature and low birth weight neonates, which is likely to have contributed to the increased prevalence of CVI [ 5 ]. Furthermore, visual perception has been linked to academic performance, such as mathematics, reading, and spelling performance, in children born prematurely [ 1 , 4 ]. Therefore, evaluation of visual perception in preterm infants is important [ 5 ]. The assessment of cerebral visual problems in children is currently performed in several ways [ 7 ], and visual-perceptual assessment batteries, such as the Developmental Test of Visual Perception (DTVP), are often employed [ 8 ]. As culture and ethnicity affect visual perceptual ability [ 9 , 10 ], a visual-perceptual assessment battery using normative values from Japanese children needs to be established for accurate evaluation. However, in Japan, there was an absence of standardized visual-perceptual assessment batteries using Japanese normative data for clinical and research assessment purposes [ 9 , 10 ]. Thus, we have created and published an assessment tool, termed the Wide-range Assessment of Vision-related Essential Skills (WAVES), for assessing both non-motor visual perception and visual-motor integration skills based on normative data from Japanese children [ 10 ]. WAVES has been validated and proved to be internally consistent when compared to other established tools, such as the DTVP, for assessing visual perception [ 10 ]. Furthermore, visual processing speed assessment is a strong feature of WAVES, as it measures both the speed and accuracy of eye-hand coordination (line tracing and form tracing subtests). Previous studies have reported that visual processing speed predicts reading fluency [ 10 , 11 ]; moreover, the rate of reading disability in schoolchildren born with low birth weight was higher than the estimated prevalence of dyslexia in Japan [ 12 ]. Therefore, in schoolchildren born with low birth weight, the visual processing speed may be slower. In addition, accurate but very slow eye-hand coordination or fast but very inaccurate eye-hand coordination has been related to writing difficulty. Eye-hand coordination affects a wide range of adaptive abilities, including motor skills, such as handwriting and academic achievement [ 10 , 13 ]; however, the speed and accuracy of eye-hand coordination in children born low birth weight has not been evaluated. In the present study, we aimed to use WAVES in order to evaluate the visual perception, including the visual processing speed, and risk factors for reading disability of schoolchildren born weighing less than 1500 g who did not need support class and had an average intelligence quotient (IQ) score. Methods Participants This study was approved by the ethics committee of Osaka Medical and Pharmaceutical University Hospital (approval number: 1783-4). Informed consent was obtained from the participants’ parents. The very-low birth weight infant group (VLBWI group) (Table 1 ) in the present study included 38 (17 male, 21 female) first-grade elementary schoolchildren [mean age = 7.49 y, standard deviation (SD) = 0.29 y] who were born weighing less than 1500 g (mean gestational weight = 996 g, SD = 279 g) between April 2009 and March 2013 at Osaka Medical College Hospital and Saiseikai Suita Hospital. There were no schoolchildren using support classes. The mean gestational age at birth was 28.5 weeks (SD = 16.3 days). Normal intelligence was defined as a full-scale intelligence quotient of 80 or higher on the Wechsler Intelligence Scale for Children, fourth edition (WISC-IV). The average full-scale intelligence quotient was 98.4 (SD = 10.4, range = 82–120). The average values of the four secondary indices of the Wechsler Scale, namely verbal comprehensive index, perceptual reasoning index (PRI), working memory index, and processing speed index (PRI), were 99.3 (SD = 14.2, range = 74–127), 99.4 (SD = 11.3, range = 76–120), 93.9 (SD = 15.2, range = 68–126), and 100 (SD = 13.0, range = 76–138), respectively. Regarding the clinical history of the participants in the VLBWI group (Table 2 ), the mean Apgar score 5 min was 7 (SD = 1.69, range: 2–9), and the number of participants who had birth weight < 1000 g, were small for gestational age, were born at gestational age < 32 weeks, were born at gestational age < 28 weeks, had an Apgar score 5 min < 7, had chronic lung disease (CLD), were on steroid treatment for CLD, had retinopathy of prematurity (ROP), and received laser treatment for ROP were 23, 13, 36, 20, 9, 10, 2, 15, and 6 out of 38 participants, respectively. Table 1 Group characteristics of participants Characteristics VLBWI group (n = 38) C group (n = 601) Age, y [mean (SD)] 7.49 (0.29) 7.18 (0.33) Sex, male/female 17/21 295/306 Mean gestational age (range) 28 wk 3 d (26 wk 0 d–32 wk 6 d) Mean birth weight, g (range) 996 (396–1492) WISC-IV FSIQ [mean (SD), range] 98.4 (10.4), 82–120 VCI [mean (SD), range] 99.3 (14.2), 74–127 PRI [mean (SD), range] 99.4 (11.3), 76–120 WMI [mean (SD), range] 93.8 (15.3), 68–126 PSI [mean (SD), range] 100 (13.0), 76–138 C, control; FSIQ, full-scale intelligence quotient; PRI, perceptual reasoning index; PSI, processing speed index; SD, standard deviation; VLBWI, very low birth weight infant; WISC-IV, Wechsler Intelligence Scale for Children fourth edition, VCI: verbal comprehension index, WMI: working memory index Table 2 Characteristics of participants in the VLBWI group Characteristics n = 38 Sex, male/female 17/21 Mean birth weight, g (range) 996 (396–1492) Participants with birth weight < 1000 g (rate) 23(60.5%) Participants born small for gestational age* (rate) 13 (34.2%) Mean gestational age, wk and d (range) 28 wk 3 d (26 wk 0 d–32 wk 6 d) Participants with gestational age < 32 wk (rate) 36 (94.7%) Participants with gestational age < 28 wk (rate) 20 (52.6%) Mean Apgar score 5 min (range) 7 (4–9) Participants with Apgar score 5 min < 7 (rate) 9 (21.1%) Participants with chronic lung disease 10 (26.3%) Participants who received steroid treatment for chronic lung disease 2 (5.2%) Participants with retinopathy of prematurity (rate) 15 (39.5%) Participants who received laser treatment for retinopathy of prematurity (rate) 6 (15.8%) *Small for gestational age defined as < 10th percentile for Japanese reference norms. VLBWI, very low birth weight infant Participants without reported histories of sensory impairment or brain damage (intraventricular hemorrhage, periventricular leukomalacia, or cerebral palsy) were included. All children were screened for ROP, and received evidence-based treatment. Utilizing WAVES data, participants in the VLBWI group were compared to a control group (C group) of Japanese first-grade elementary schoolchildren. The C group comprised 601 (295 male, 306 female; mean age = 7.18 y, SD = 0.33 y; Table 1 ) children with normal birth weight who did not receive any remedial education. However, the children who were born weighing less than 1500 g were not excluded in the C group. All children in both the VLBWI and C groups were native Japanese-speaking children. Children with diagnosed congenital disorders and chronic diseases that may affect cognition were excluded from both groups for all analyses. Procedures All participants were evaluated for sex, age, and the calculated scores of the 10 subtests and 4 indices of WAVES, and comparisons were made between the VLBWI and C groups. All evaluations were performed by examiners who were blinded to the study groups and perinatal outcomes. In the VLBWI group, we analyzed the differences in the score for each subtest and index of WAVES based on certain clinical characteristics and histories. In schoolchildren born low with birth weight, gestational age, ROP, and CLD are known to be risk factors for the development of reading disability [ 12 ]; therefore, the relationship between these scores and the presence or absence of these risk factors was assessed. We assessed the relationship between the WAVES scores and the following developmental risk factors: presence or absence of gestational age at birth of ≤ 28 weeks, the development of CLD, and ROP [ 12 , 14 ]. We could not apply multiple regression analysis because some of the variables were not normally distributed. However, as ROP is known to be related to gestational age and the development of CLD [ 15 , 16 ], the relationship between these clinical histories and the presence or absence of ROP was also assessed. WAVES WAVES is a newly developed visual perception test designed to assess visual perception and eye-hand coordination skills and was published in Japan [ 10 ]. A unique aspect of WAVES is that it measures visual perceptual speed in addition to accuracy. Participants were instructed to complete each item as quickly as possible and time limitations were set for completing most of the subtests. Approximately 40 to 50 minutes are required to complete all the basic subtests for 6- to 12-year-old children. WAVES has the following 10 basic subtests (Fig. 1 ): 1) line tracing (success score and rate score): drawing precise straight lines as accurately and quickly as possible within one minute. The success score is the number of line tracings accurately drawn within one minute, which indicates the drawing speed with accuracy. The rate score is the ratio of the number of line tracings accurately drawn divided by the number of total line tracings drawn (regardless of whether they were successfully drawn or not), which indicates accurate drawing; 2) form tracing (success score and rate score): drawing small circles, triangles, and squares as accurately and quickly as possible within one minute. The success and rate scores are calculated in the same way as above and indicate drawing speed with accuracy and accurate drawing, respectively; 3) number comparisons I; 4) number comparisons II: answering whether two digits strings (split bilaterally) are the same, different by one digit, or different by two digits. The difference between subtests I and II is based on whether digit strings are arranged at regular or irregular intervals; 5) discrimination speed: finding the same figure within similar figures as quickly as possible within the time limit; 6) figure-ground speed: finding a figure within four overlapped figures as quickly as possible within the time limit; 7) visual closure speed: finding the target figure within four incomplete fragmented figures as quickly as possible; 8) discrimination accuracy: accurately finding the same figure among similar figures in time; 9) visual memory: choosing 5 target figures from 20 figures after memorizing the target figures in 30 seconds; and 10) copying: drawing simple figures as accurately as possible inside the grid box. Raw scores from these subtests were converted into the following four scaled scores: eye-hand coordination general index (ECGI), eye-hand coordination accuracy index (ECAI), visual perception index (VPI), and visual-perceptual eye-hand composite index (VPECI). The EGCI was designed as a general indicator of eye-hand coordination speed (including some aspects of accuracy) calculated from the success score of line and form tracing. The ECAI is a general indicator of eye-hand coordination accuracy calculated from the rate of line and form tracing. The VPI is calculated using the scores from the following five subtest scores: number comparison I, discrimination speed, discrimination accuracy, visual memory, and copying, which mainly measure visual attention and perception. The scores from the seven basic subtests were also summed to generate a total WAVES VPECI score, referred to as the VPI and eye-hand coordination index (ECGI and ECAI). For the present investigation, we used the scaled scores from the basic subtests and the index scores to make comparisons between the VLBWI and C groups. Data analysis We analyzed the difference in sex ratio between the VLBWI and C groups using Fisher’s exact test and the age at which WAVES was performed using the Mann–Whitney U test. In the process of developing WAVES, it was found that age was positively associated with the score for each subtest of WAVES. In our study, we found a statistically significant difference between the VLBWI and C groups regarding the age at which WAVES was performed. Therefore, differences in scores for the 10 subtests and 4 indices of WAVES were examined using analysis of covariance (ANCOVA), with age at which WAVES was conducted entered as a covariate. Regarding the analysis of the relationship between developmental risk factors and the scores for each subtest and index of WAVES in the VLBWI group, we used the Shapiro–Wilk W test to determine whether the variables could be adequately modeled by a normal distribution. However, as some of the variables were not normally distributed, we could not conduct multiple regression analysis. Therefore, we analyzed the differences in each subtest score of WAVES, such as gestational age, CLD, and ROP, based on the risk for reading disability in schoolchildren, as per past reports [ 12 , 14 ], in the VLBWI group using the Mann–Whitney U test. We also assessed the relationship between gestational age and the development of CLD and the presence or absence of ROP using Fisher’s exact test. P -values < 0.05 were considered statistically significant for all statistical tests. Results Comparison between the VLBWI and C groups The clinical characteristics of the VLBWI and C groups are shown in Table 1 . The sex distribution between the VLBWI group and the C group was not statistically different. The age at which WAVES was performed was higher in the VLBWI group than in the C group (p < 0.001). Differences in scores for the 10 subtests and 4 indices of WAVES were examined with ANCOVA, with the age at which WAVES was conducted entered as a covariate (Table 3 ). The scores for form tracing (success and rate scores), figure-ground speed, discrimination accuracy, visual memory, copying, and three of the indices (ECAI, VPI, and VPECI) were significantly lower in the VLBWI group than in the C group. Table 3 Comparison of the subtest score of WAVES between the VLBWI and C groups VLBWI group C group ANCOVA, F value P value Subtest of WAVES Line tracing (success score) 79.4 ± 31.6 70.9 ± 26.8 1.088 0.297 Line tracing (rate score) 0.857 ± 0.0931 0.839 ± 0.108 0.053 0.817 Form tracing (success score) 13.0 ± 5.18 14.5 ± 5.38 6.254 < 0.05 Form tracing (rate score) 0.613 ± 0.212 0.697 ± 0.119 9.821 < 0.01 Number comparison I 11.6 ± 3.82 11.3 ± 4.03 0.780 0.377 Number comparison II 9.45 ± 4.41 9.33 ± 3.98 1.575 0.210 Discrimination speed 11.5 ± 3.52 11.2 ± 3.73 0.150 0.699 Figure-ground speed 9.74 ± 3.14 10.1 ± 3.01 3.911 < 0.05 Visual closure speed 10.7 ± 3.41 10.8 ± 3.56 1.686 0.195 Discrimination accuracy 6.29 ± 1.78 6.70 ± 1.88 4.257 < 0.05 Visual memory 13.0 ± 3.36 14.6 ± 3.45 10.757 < 0.005 Copying 14.9 ± 5.55 17.0 ± 5.38 10.904 < 0.005 Indices of WAVES ECGI 92.7 ± 15.7 100 ± 14.7 1.668 0.197 ECAI 95.0 ± 16.8 100 ± 16.4 4.071 < 0.05 VPI 96.9 ± 13.4 99.8 ± 15.0 10.185 < 0.005 VPECI 92.5 ± 15.2 100 ± 15.5 11.908 < 0.005 ANCOVA, analysis of covariance; C, control; ECAI, eye-hand coordination accuracy index; ECGI, eye-hand coordination general index; VLBWI, very low birth weight infant; VPEI, visual-perceptual eye-hand composite index; VPI, visual perception index; WAVES, Wide-range Assessment of Vision-Related Essential Skills Developmental risk factors and the scores of WAVES in the VLBWI group In the VLBWI group, we analyzed the differences in clinical characteristics and histories of each subtest score and WAVES index. However, the presence or absence of ROP was not correlated with the WAVES score. As shown in Table 4 , the scores of line tracing (ratio) and ECAI were significantly lower in participants who were born at < 28 weeks of gestational age than those born at ≥ 28 weeks. The score for copying was significantly lower in participants with CLD than in those without CLD. Furthermore, it was also confirmed that the presence or absence of ROP was not associated with the presence or absence of CLD, nor was it associated with gestational age. Table 4 Scores of subtests and index influenced by selected clinical history in the VLBWI group ECAI, eye-hand coordination accuracy index; VLBWI, very low birth weight infant Developmental risk Mean (1st quartile – 3rd quartile) Mann–Whitney U test P value Gestational age < 28 weeks (n = 20) ≥ 28 weeks (n = 18) Line tracing (ratio score) 9.5 (6–11) 12 (10–12) < 0.05 ECAI 92 (82.3–99.5) 101 (95.8–112) < 0.05 Chronic lung disease Presence (n = 10) Absence (n = 28) Copying 5 (3.25–7) 9 (6.75–12) < 0.05 Discussion In the present study, visual perceptual deficits were found in Japanese schoolchildren born weighing less than 1500 g compared to a comparator group, as assessed by WAVES—a comprehensive approach to visual-perceptual assessment. This study is the first evaluation of schoolchildren born in the Japanese regional neonatal intensive care units and the first investigation using the visual-perceptual assessment battery developed in our laboratory. Considering a visual-perceptual assessment battery with normative values from Japanese children needs to be established for accurate evaluation, it was important that our investigation be conducted using WAVES. The scores of three indices, ECAI, VPI, and VPECI, in the participants in the VLBWI group were significantly lower than those of the C group participants. The ECAI is a general indicator of eye-hand coordination accuracy, the VPI mainly measures visual attention and perception, and the VPECI adds an eye-hand coordination index to the VPI. Therefore, diffuse deficit of visual perception ability was found in the VLBWI. According to Perez-Roche’s report, a diffuse pattern of visual perception deficit was found in children born premature and small for gestational age compared to children born premature who are not small for gestational age [ 17 ], consistent with our results. However, Geldof et al. noted that evaluations required subtests measuring specific visual perceptive functions instead of general indices to elucidate the nature of visual perceptual deficits observed in children born preterm with low birth weight. In addition, because WAVES evaluates the visual processing speed, new findings were obtained from the subtest. The subtests, which evaluate the visual processing speed, were figure-ground, visual closure, and discrimination in WAVES. The visual discrimination of WAVES, both speed and accuracy, could be assessed [ 10 ]. Regarding the results of figure-ground and visual closure in the present study, only the processing speed of figure-ground was significantly lower in the VLBWI group compared to the C group. In a past report involving participants from Spain and The Netherlands, the accuracy of figure-ground and the accuracy and processing speed of visual closure were evaluated in children born preterm, including those with birth weights greater than 1500 g [ 13 , 17 ]. Regarding the processing speed of visual closure, our data was consistent with previous reports. On the other hand, low performance of the processing speed of figure-ground in the children born weighing less than 1500 g has not previously been reported. In general, a trade-off effect between speed and accuracy has been observed [ 10 ]. However, combining our results with those of past reports, both processing speed and accuracy were lower in children born weighing less than 1500 g and preterm; therefore, a trade-off effect was not observed. Whether lower performance of both processing speed and accuracy is a characteristic of children born at low birth weight requires further investigation, since previously reported data and our current data differ in the participant characteristics (i.e., preterm births and birth weights less than 1500 g). In addition, for the visual discrimination of WAVES, both speed and accuracy could be assessed. We found that only discrimination accuracy was lower in the VLBWI group compared to the C group. Conversely, in a previous study, both speed and accuracy showed lower performance [ 18 ]. Of course, it cannot be ruled out that the discrepancy between study results may be related to differences in study design, including the setting, selection and exclusion criteria, follow-up rates, and applied test norms [ 19 ]. Bucher et al. indicated that the reaction time of the visual discrimination task significantly decreased as the performance IQ in WISC III increased. In our study, the average values of PRI (mean = 99.4, SD = 11.3, range = 76–120) and PSI (mean = 100, SD = 13.0, range = 76–138) of WISC IV were higher than the performance IQ of WISC III (mean = 95, SD = 12.9, range = 69–119) reported by Butcher et al. Therefore, the difference of performance IQ of WISC III might have affected the processing speed of the visual discrimination. Regarding differences in the assessment battery, the same stimuli were not used to assess the tasks for discrimination accuracy and discrimination speed in WAVES; however, both accuracy and speed of visual discrimination in the study by Bucher et al. may have been assessed by the same stimuli for all the tasks. In WAVES, visual processing speed was assessed in the task while reducing the cognitive load on visual information processing because we considered it to be an accurate visual processing speed. In preterm children, poorer motor skill and difficulty in controlling attention affected processing speed [ 18 ]. Accurate processing, except for processing speed, may be deficient in the children born weighing less than 1500 g in the subtest of visual discrimination. Further investigations are needed to evaluate discrimination with WAVES in children born preterm. Tracing, which is an assessment task of eye-hand coordination, was also significantly lower in the VLBWI group. Children were required to draw small circles, triangles, and squares following visual boundaries as accurately and quickly as possible. The success and rate scores indicated the drawing speed with accuracy and rate of accurate drawing, respectively. From our investigation, both success and rate score of the figure trace were significantly lower in the VLBWI group than in the C group. Processing speed and accuracy had previously not been evaluated in children born with low birth weight. The score for eye-hand coordination accuracy was low, which was not due to prioritizing speed in the VLBWI group. A trade-off effect was not found in the VLBWI group for form-tracing. Eye-hand coordination is involved in visual-motor functions, and previous reports have shown that visual-motor integration can predict a child’s future handwriting skills and academic performance in reading, writing, and mathematics [ 10 , 19 ]. Given several reports have shown that children born preterm have visual-motor impairment and poor motor function, and it is well known that they have a risk of poor school performance and learning disabilities, further investigation is needed to determine whether the score of form tracing is implicated in school performance in Japanese schoolchildren and the Japanese language. Regarding the relationship between risk factors for reading disability and WAVES scores in VLBWI, there was no difference found in the WAVES score between the participants with and without ROP in the VLBWI group. However, the accuracy of line tracing and ECAI was lower in VLBWI born at < 28 weeks of gestational age compared to those born at ≥ 28 weeks, and the score for copying was lower in VLBWI with a past history of CLD compared to those without. ROP has been reported as a risk factor for reading disorders, and ROP affects visual function, such as strabismus, abnormal refraction, and abnormal contrast sensitivity in childhood [ 12 ]. However, from our results, visual perception and eye-hand coordination might not be related to reading fluency in the children with past history of ROP. It has also been reported that the DTVP score is not related to ROP but rather is related to changes in the brain microstructure in preterm participants (i.e., the size of the corpus callosum and interhemispheric connections) [ 20 ]. It is interesting to note that gestational age and CLD were related to the scores of the only subtests involving hand motor function. Especially, regarding children with CLD, reduced pulmonary function and chronic hypoxia affect motor skills [ 14 ]. In a past report, children’s visual motor integration was related to reading and mathematics performance [ 21 ]. Further investigations are needed to elucidate whether reading disability in schoolchildren born at less than 28 weeks of gestational age or with past history of CLD is related to the subtest outcomes. The strength of this study lies in it being the first evaluation of schoolchildren born in the Japanese regional neonatal intensive care units and the first investigation using the WAVES based on normative data from Japanese children. The scores of several subtests and indices were significantly lower in the VLBWI group compared to those in the C group. The children in the VLBWI group did not need support classes and they had an average IQ performance; however, it is an important finding that they have an increased risk of poor school performance and learning disabilities. This study has several limitations. The gestational age and birth weight of the participants in the C group could not be investigated. It is estimated that the prevalence of children with very low birth weight in 2015 was 0.8% in the Japanese population. Hence, the inclusion of children with very low birth weights in the C group may be negligible. Due to the small sample size of the VLBWI group, some of the variables were not normally distributed; therefore, we could not apply multiple regression analysis to ascertain the associations between the scores for each subtest and indices of WAVES and the clinical characteristics and histories of the participants in the VLBWI group. Conclusion This study is the first to investigate infants born in the Japanese regional neonatal intensive care units using the visual-perceptual assessment battery developed at our laboratory. From our investigation, it was identified that the processing speed of figure-ground and processing speed and accuracy of form tracing were significantly lower in the VLBWI group than in the C group. While children in the VLBWI group did not need support class and had an average IQ, they did have an increased risk of poor school performance and learning disabilities. Abbreviations CLD; chronic lung disease, CVI; cerebral visual impairment, DTVP; Developmental Test of Visual Perception, ECAI; eye-hand coordination accuracy index, ECGI; eye-hand coordination general index, IQ; intelligence quotient, PRI; perceptual reasoning index, PSI; processing speed index, ROP; retinopathy of prematurity, VPECI; visual-perceptual eye-hand composite index, VPI; visual perception index WAVES; Wide-range Assessment of Vision-related Essential Skills, WISC-IV; Wechsler Intelligence Scale for Children, fourth edition Declarations Ethics approval and consent to participate : All procedures used in this research were approved by the ethics committee of Osaka Medical and Pharmaceutical University Hospital (approval number: 1783-4). Informed consent was obtained from the patient's legal guardian for publication of this report. Consent for publication : Not applicable. Availability of data and materials : The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Competing interests : The authors declare that they have no competing interests. Funding : This work was supported by Japan Society for the Promotion of Science KAKENHI Grant Number JP18K13229. Author Contributions M.F., H. T-K., and S.S. substantially contributed to the study conceptualization. M.F., S.S., and T.O. significantly contributed to data analysis and interpretation. A.A. substantially contributed to the manuscript drafting. All authors critically reviewed and revised the manuscript draft and approved the final version for submission. Acknowledgments We are grateful to Dr. Tohru Ogihara, Dr. Satoru Ogawa, Dr. Ryoichi Ban, Dr. Seigo Hira, and Dr. Shigeo Yamaoka for recruiting the cases born at low birth weight. We would like to thank Editage (www.editage.com) for English language editing. 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A validity of the Wide-range Assessment of Vision-related Essential Skills in Japanese Children with Learning Problems. Optom Vis Sci. 2020;97:275-285. Lobier M, Dubois M, Valdois S. The role of visual processing speed in reading speed development. PLoS One. 2013;8:e58097. Takeuchi A, Koeda T, Takayanagi T, Sato K, Sugino N, Bonno M, et al. Reading difficulty in school-aged very low birth weight infants in Japan. Brain Dev. 2016;38:800-6. Geldof CJ, van Wassenaer AG, de Kieviet JF, Kok JH, Oosterlaan J. Visual perception and visual-motor integration in very preterm and/or very low birth weight children: a meta-analysis. Res Dev Disabil. 2012;33:726-36. Short EJ, Klein NK, Lewis BA, Fulton S, Eisengart S, Kercsmar C, et al. Cognitive and academic consequences of bronchopulmonary dysplasia and very low birth weight: 8-year-old outcomes. Pediatrics . 2003;112,e359. Böhm B, Katz-Salamon M. Cognitive development at 5.5 years of children with chronic lung disease of prematurity. Arch Dis Child Fetal Neonatal Ed 2003;88:F101-5. Yassin SA, Al-Dawood AJ, Al-Zamil WM, Al-Ghamdi MA, Al-Khudairy ZN. Comparative study of visual dysfunctions in 6-10-year-old very preterm- and full-term-born children. Int Ophthalmol. 2019;39:1437-43. Perez-Roche T, Altemir I, Giménez G, Prieto E, González I, Peña-Segura JL, et al. Effect of prematurity and low birth weight in visual abilities and school performance. Res Dev Disabil. 2016;59:451-7. Butcher PR, Bouma A, Stremmelaar EF, Bos AF, Smithson M, Van Braeckel KN. Visuospatial perception in children born preterm with no major neurological disorders. Neuropsychology. 2012;26:723-34. Evensen KAI, Ustad T, Tikanmäki M, Haaramo P, Kajantie E. Long-term motor outcomes of very preterm and/or very low birth weight individuals without cerebral palsy: A review of the current evidence. Semin Fetal Neonatal Med. 2020;25:101116. Kwinta P, Herman-Sucharska I, Leśniak A, Klimek M, Karcz P, Durlak W, et al. Relationship between Stereoscopic Vision, Visual Perception, and Microstructure Changes of Corpus Callosum and Occipital White Matter in the 4-Year-Old Very Low Birth Weight Children. Biomed Res Int. 2015;2015:842143. Sortor JM, Kulp MT. Are the results of the Beery-Buktenica Developmental Test of Visual-Motor Integration and its subtests related to achievement test scores? Optom Vis Sci. 2003;80:758–763. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 26 Aug, 2025 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 14 Nov, 2024 Reviews received at journal 13 Sep, 2024 Reviewers agreed at journal 20 Aug, 2024 Reviews received at journal 04 Jun, 2024 Reviewers agreed at journal 21 May, 2024 Reviews received at journal 09 Apr, 2024 Reviewers agreed at journal 31 Mar, 2024 Reviewers agreed at journal 28 Mar, 2024 Reviewers invited by journal 28 Mar, 2024 Editor assigned by journal 28 Mar, 2024 Editor invited by journal 27 Mar, 2024 Submission checks completed at journal 27 Mar, 2024 First submitted to journal 23 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4153602","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":285893160,"identity":"4e492127-e169-4635-af78-f0b772712b25","order_by":0,"name":"Miho Fukui","email":"","orcid":"","institution":"Osaka Ohtani University","correspondingAuthor":false,"prefix":"","firstName":"Miho","middleName":"","lastName":"Fukui","suffix":""},{"id":285893161,"identity":"a9cc3e5f-5091-4436-b99d-081a57454090","order_by":1,"name":"Shuichi Shimakawa","email":"data:image/png;base64,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","orcid":"","institution":"Osaka Medical and Pharmaceutical University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Shuichi","middleName":"","lastName":"Shimakawa","suffix":""},{"id":285893162,"identity":"d352d8f3-7b3e-49ff-8d69-8b24a66169df","order_by":2,"name":"Tomohito Okumura","email":"","orcid":"","institution":"Osaka Medical and Pharmaceutical University","correspondingAuthor":false,"prefix":"","firstName":"Tomohito","middleName":"","lastName":"Okumura","suffix":""},{"id":285893163,"identity":"910c5b0d-ad02-4fdf-ae70-e5535db0156f","order_by":3,"name":"Hikaru Tsuda-Kitahara","email":"","orcid":"","institution":"Osaka Medical and Pharmaceutical University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hikaru","middleName":"","lastName":"Tsuda-Kitahara","suffix":""},{"id":285893164,"identity":"b2e8959c-95d4-443c-9ecb-0e08c64b469d","order_by":4,"name":"Akira Ashida","email":"","orcid":"","institution":"Osaka Medical and Pharmaceutical University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Akira","middleName":"","lastName":"Ashida","suffix":""}],"badges":[],"createdAt":"2024-03-23 09:01:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4153602/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4153602/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12887-025-06023-7","type":"published","date":"2025-08-26T15:57:48+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53878022,"identity":"033dfe9c-255b-4e08-bd4f-c74a022e2cc1","added_by":"auto","created_at":"2024-04-01 16:57:50","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":177009,"visible":true,"origin":"","legend":"\u003cp\u003eSample figures for the Wide-range Assessment of Vision-related Essential Skills subtests. Descriptions of the subtests are given in the Material and Methods section.\u003c/p\u003e","description":"","filename":"R3Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4153602/v1/7b3a5029b5bfc728de6b0632.png"},{"id":90345176,"identity":"90af6679-865c-449d-959f-cfe8bc3e09cd","added_by":"auto","created_at":"2025-09-01 16:10:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":889477,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4153602/v1/4ee21761-0ea7-40af-8604-3f2ace3433af.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Visual perceptive functioning in Japanese schoolchildren born with very low birth weight","fulltext":[{"header":"Background","content":"\u003cp\u003ePreterm/low birth weight infant mortality has decreased dramatically since the advent of neonatal intensive care units; however, children born preterm and with low birth weight or those born smaller than normal for gestational age have increased risk for developmental disabilities, school failure, and behavioral and psychiatric problems [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent years, there has been increasing interest in cerebral visual impairment (CVI) in children [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. CVI is a condition in which damage to the retrochiasmal visual pathways results in visual perceptual deficits in the absence of any major ocular disease [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It arises from conditions that cause abnormal development of, or damage to, the brain, affecting the visual pathways and disrupting normal visual function. Conditions leading to CVI often occur perinatally, with the most common cause being hypoxic-ischemic injury [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. CVI is also frequently reported among children born prematurely without obvious past history of hypoxic-ischemic injury, as their prematurity results in an increased risk of insult to the developing brain [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Advances in medical care have resulted in an increased survival rate among extremely premature and low birth weight neonates, which is likely to have contributed to the increased prevalence of CVI [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Furthermore, visual perception has been linked to academic performance, such as mathematics, reading, and spelling performance, in children born prematurely [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, evaluation of visual perception in preterm infants is important [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe assessment of cerebral visual problems in children is currently performed in several ways [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and visual-perceptual assessment batteries, such as the Developmental Test of Visual Perception (DTVP), are often employed [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. As culture and ethnicity affect visual perceptual ability [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], a visual-perceptual assessment battery using normative values from Japanese children needs to be established for accurate evaluation. However, in Japan, there was an absence of standardized visual-perceptual assessment batteries using Japanese normative data for clinical and research assessment purposes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Thus, we have created and published an assessment tool, termed the Wide-range Assessment of Vision-related Essential Skills (WAVES), for assessing both non-motor visual perception and visual-motor integration skills based on normative data from Japanese children [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. WAVES has been validated and proved to be internally consistent when compared to other established tools, such as the DTVP, for assessing visual perception [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Furthermore, visual processing speed assessment is a strong feature of WAVES, as it measures both the speed and accuracy of eye-hand coordination (line tracing and form tracing subtests). Previous studies have reported that visual processing speed predicts reading fluency [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]; moreover, the rate of reading disability in schoolchildren born with low birth weight was higher than the estimated prevalence of dyslexia in Japan [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, in schoolchildren born with low birth weight, the visual processing speed may be slower. In addition, accurate but very slow eye-hand coordination or fast but very inaccurate eye-hand coordination has been related to writing difficulty. Eye-hand coordination affects a wide range of adaptive abilities, including motor skills, such as handwriting and academic achievement [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]; however, the speed and accuracy of eye-hand coordination in children born low birth weight has not been evaluated.\u003c/p\u003e \u003cp\u003eIn the present study, we aimed to use WAVES in order to evaluate the visual perception, including the visual processing speed, and risk factors for reading disability of schoolchildren born weighing less than 1500 g who did not need support class and had an average intelligence quotient (IQ) score.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003e This study was approved by the ethics committee of Osaka Medical and Pharmaceutical University Hospital (approval number: 1783-4). Informed consent was obtained from the participants\u0026rsquo; parents. The very-low birth weight infant group (VLBWI group) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) in the present study included 38 (17 male, 21 female) first-grade elementary schoolchildren [mean age\u0026thinsp;=\u0026thinsp;7.49 y, standard deviation (SD)\u0026thinsp;=\u0026thinsp;0.29 y] who were born weighing less than 1500 g (mean gestational weight\u0026thinsp;=\u0026thinsp;996 g, SD\u0026thinsp;=\u0026thinsp;279 g) between April 2009 and March 2013 at Osaka Medical College Hospital and Saiseikai Suita Hospital. There were no schoolchildren using support classes. The mean gestational age at birth was 28.5 weeks (SD\u0026thinsp;=\u0026thinsp;16.3 days). Normal intelligence was defined as a full-scale intelligence quotient of 80 or higher on the Wechsler Intelligence Scale for Children, fourth edition (WISC-IV). The average full-scale intelligence quotient was 98.4 (SD\u0026thinsp;=\u0026thinsp;10.4, range\u0026thinsp;=\u0026thinsp;82\u0026ndash;120). The average values of the four secondary indices of the Wechsler Scale, namely verbal comprehensive index, perceptual reasoning index (PRI), working memory index, and processing speed index (PRI), were 99.3 (SD\u0026thinsp;=\u0026thinsp;14.2, range\u0026thinsp;=\u0026thinsp;74\u0026ndash;127), 99.4 (SD\u0026thinsp;=\u0026thinsp;11.3, range\u0026thinsp;=\u0026thinsp;76\u0026ndash;120), 93.9 (SD\u0026thinsp;=\u0026thinsp;15.2, range\u0026thinsp;=\u0026thinsp;68\u0026ndash;126), and 100 (SD\u0026thinsp;=\u0026thinsp;13.0, range\u0026thinsp;=\u0026thinsp;76\u0026ndash;138), respectively. Regarding the clinical history of the participants in the VLBWI group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), the mean Apgar score 5 min was 7 (SD\u0026thinsp;=\u0026thinsp;1.69, range: 2\u0026ndash;9), and the number of participants who had birth weight\u0026thinsp;\u0026lt;\u0026thinsp;1000 g, were small for gestational age, were born at gestational age\u0026thinsp;\u0026lt;\u0026thinsp;32 weeks, were born at gestational age\u0026thinsp;\u0026lt;\u0026thinsp;28 weeks, had an Apgar score 5 min\u0026thinsp;\u0026lt;\u0026thinsp;7, had chronic lung disease (CLD), were on steroid treatment for CLD, had retinopathy of prematurity (ROP), and received laser treatment for ROP were 23, 13, 36, 20, 9, 10, 2, 15, and 6 out of 38 participants, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGroup characteristics of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVLBWI group (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eC group (n\u0026thinsp;=\u0026thinsp;601)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge, y [mean (SD)]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.49 (0.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.18 (0.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSex, male/female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17/21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e295/306\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMean gestational age (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 wk 3 d\u003c/p\u003e \u003cp\u003e(26 wk 0 d\u0026ndash;32 wk 6 d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMean birth weight, g (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e996 (396\u0026ndash;1492)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eWISC-IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFSIQ\u003c/p\u003e \u003cp\u003e[mean (SD), range]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.4 (10.4), 82\u0026ndash;120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVCI\u003c/p\u003e \u003cp\u003e[mean (SD), range]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.3 (14.2), 74\u0026ndash;127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePRI\u003c/p\u003e \u003cp\u003e[mean (SD), range]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.4 (11.3), 76\u0026ndash;120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWMI\u003c/p\u003e \u003cp\u003e[mean (SD), range]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93.8 (15.3), 68\u0026ndash;126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePSI\u003c/p\u003e \u003cp\u003e[mean (SD), range]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (13.0), 76\u0026ndash;138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eC, control; FSIQ, full-scale intelligence quotient; PRI, perceptual reasoning index; PSI, processing speed index; SD, standard deviation; VLBWI, very low birth weight infant; WISC-IV, Wechsler Intelligence Scale for Children fourth edition, VCI: verbal comprehension index, WMI: working memory index\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of participants in the VLBWI group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;38\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, male/female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17/21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean birth weight, g (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e996 (396\u0026ndash;1492)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants with birth weight\u0026thinsp;\u0026lt;\u0026thinsp;1000 g (rate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(60.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants born small for gestational age* (rate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (34.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean gestational age, wk and d (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 wk 3 d (26 wk 0 d\u0026ndash;32 wk 6 d)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants with gestational age\u0026thinsp;\u0026lt;\u0026thinsp;32 wk (rate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (94.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants with gestational age\u0026thinsp;\u0026lt;\u0026thinsp;28 wk (rate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (52.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Apgar score 5 min (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (4\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants with Apgar score 5 min\u0026thinsp;\u0026lt;\u0026thinsp;7 (rate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants with chronic lung disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants who received steroid treatment for chronic lung disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants with retinopathy of prematurity (rate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (39.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants who received laser treatment for retinopathy of prematurity (rate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (15.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e*Small for gestational age defined as \u0026lt;\u0026thinsp;10th percentile for Japanese reference norms.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eVLBWI, very low birth weight infant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eParticipants without reported histories of sensory impairment or brain damage (intraventricular hemorrhage, periventricular leukomalacia, or cerebral palsy) were included. All children were screened for ROP, and received evidence-based treatment.\u003c/p\u003e \u003cp\u003eUtilizing WAVES data, participants in the VLBWI group were compared to a control group (C group) of Japanese first-grade elementary schoolchildren. The C group comprised 601 (295 male, 306 female; mean age\u0026thinsp;=\u0026thinsp;7.18 y, SD\u0026thinsp;=\u0026thinsp;0.33 y; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) children with normal birth weight who did not receive any remedial education. However, the children who were born weighing less than 1500 g were not excluded in the C group.\u003c/p\u003e \u003cp\u003eAll children in both the VLBWI and C groups were native Japanese-speaking children. Children with diagnosed congenital disorders and chronic diseases that may affect cognition were excluded from both groups for all analyses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eProcedures\u003c/h2\u003e \u003cp\u003eAll participants were evaluated for sex, age, and the calculated scores of the 10 subtests and 4 indices of WAVES, and comparisons were made between the VLBWI and C groups. All evaluations were performed by examiners who were blinded to the study groups and perinatal outcomes.\u003c/p\u003e \u003cp\u003eIn the VLBWI group, we analyzed the differences in the score for each subtest and index of WAVES based on certain clinical characteristics and histories. In schoolchildren born low with birth weight, gestational age, ROP, and CLD are known to be risk factors for the development of reading disability [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]; therefore, the relationship between these scores and the presence or absence of these risk factors was assessed. We assessed the relationship between the WAVES scores and the following developmental risk factors: presence or absence of gestational age at birth of \u0026le;\u0026thinsp;28 weeks, the development of CLD, and ROP [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. We could not apply multiple regression analysis because some of the variables were not normally distributed. However, as ROP is known to be related to gestational age and the development of CLD [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], the relationship between these clinical histories and the presence or absence of ROP was also assessed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eWAVES\u003c/h2\u003e \u003cp\u003eWAVES is a newly developed visual perception test designed to assess visual perception and eye-hand coordination skills and was published in Japan [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. A unique aspect of WAVES is that it measures visual perceptual speed in addition to accuracy. Participants were instructed to complete each item as quickly as possible and time limitations were set for completing most of the subtests. Approximately 40 to 50 minutes are required to complete all the basic subtests for 6- to 12-year-old children.\u003c/p\u003e \u003cp\u003eWAVES has the following 10 basic subtests (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e): 1) line tracing (success score and rate score): drawing precise straight lines as accurately and quickly as possible within one minute. The success score is the number of line tracings accurately drawn within one minute, which indicates the drawing speed with accuracy. The rate score is the ratio of the number of line tracings accurately drawn divided by the number of total line tracings drawn (regardless of whether they were successfully drawn or not), which indicates accurate drawing; 2) form tracing (success score and rate score): drawing small circles, triangles, and squares as accurately and quickly as possible within one minute. The success and rate scores are calculated in the same way as above and indicate drawing speed with accuracy and accurate drawing, respectively; 3) number comparisons I; 4) number comparisons II: answering whether two digits strings (split bilaterally) are the same, different by one digit, or different by two digits. The difference between subtests I and II is based on whether digit strings are arranged at regular or irregular intervals; 5) discrimination speed: finding the same figure within similar figures as quickly as possible within the time limit; 6) figure-ground speed: finding a figure within four overlapped figures as quickly as possible within the time limit; 7) visual closure speed: finding the target figure within four incomplete fragmented figures as quickly as possible; 8) discrimination accuracy: accurately finding the same figure among similar figures in time; 9) visual memory: choosing 5 target figures from 20 figures after memorizing the target figures in 30 seconds; and 10) copying: drawing simple figures as accurately as possible inside the grid box.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRaw scores from these subtests were converted into the following four scaled scores: eye-hand coordination general index (ECGI), eye-hand coordination accuracy index (ECAI), visual perception index (VPI), and visual-perceptual eye-hand composite index (VPECI). The EGCI was designed as a general indicator of eye-hand coordination speed (including some aspects of accuracy) calculated from the success score of line and form tracing. The ECAI is a general indicator of eye-hand coordination accuracy calculated from the rate of line and form tracing. The VPI is calculated using the scores from the following five subtest scores: number comparison I, discrimination speed, discrimination accuracy, visual memory, and copying, which mainly measure visual attention and perception. The scores from the seven basic subtests were also summed to generate a total WAVES VPECI score, referred to as the VPI and eye-hand coordination index (ECGI and ECAI). For the present investigation, we used the scaled scores from the basic subtests and the index scores to make comparisons between the VLBWI and C groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eWe analyzed the difference in sex ratio between the VLBWI and C groups using Fisher\u0026rsquo;s exact test and the age at which WAVES was performed using the Mann\u0026ndash;Whitney \u003cem\u003eU\u003c/em\u003e test. In the process of developing WAVES, it was found that age was positively associated with the score for each subtest of WAVES. In our study, we found a statistically significant difference between the VLBWI and C groups regarding the age at which WAVES was performed. Therefore, differences in scores for the 10 subtests and 4 indices of WAVES were examined using analysis of covariance (ANCOVA), with age at which WAVES was conducted entered as a covariate.\u003c/p\u003e \u003cp\u003eRegarding the analysis of the relationship between developmental risk factors and the scores for each subtest and index of WAVES in the VLBWI group, we used the Shapiro\u0026ndash;Wilk W test to determine whether the variables could be adequately modeled by a normal distribution. However, as some of the variables were not normally distributed, we could not conduct multiple regression analysis. Therefore, we analyzed the differences in each subtest score of WAVES, such as gestational age, CLD, and ROP, based on the risk for reading disability in schoolchildren, as per past reports [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], in the VLBWI group using the Mann\u0026ndash;Whitney U test. We also assessed the relationship between gestational age and the development of CLD and the presence or absence of ROP using Fisher\u0026rsquo;s exact test. \u003cem\u003eP\u003c/em\u003e-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant for all statistical tests.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eComparison between the VLBWI and C groups\u003c/h2\u003e \u003cp\u003eThe clinical characteristics of the VLBWI and C groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The sex distribution between the VLBWI group and the C group was not statistically different. The age at which WAVES was performed was higher in the VLBWI group than in the C group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Differences in scores for the 10 subtests and 4 indices of WAVES were examined with ANCOVA, with the age at which WAVES was conducted entered as a covariate (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The scores for form tracing (success and rate scores), figure-ground speed, discrimination accuracy, visual memory, copying, and three of the indices (ECAI, VPI, and VPECI) were significantly lower in the VLBWI group than in the C group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the subtest score of WAVES between the VLBWI and C groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVLBWI group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eC group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eANCOVA, \u003cem\u003eF\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubtest of WAVES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLine tracing (success score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e79.4\u0026thinsp;\u0026plusmn;\u0026thinsp;31.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e70.9\u0026thinsp;\u0026plusmn;\u0026thinsp;26.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.297\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLine tracing (rate score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.857\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0931\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.839\u0026thinsp;\u0026plusmn;\u0026thinsp;0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.817\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForm tracing (success score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForm tracing (rate score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.613\u0026thinsp;\u0026plusmn;\u0026thinsp;0.212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.697\u0026thinsp;\u0026plusmn;\u0026thinsp;0.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.821\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber comparison I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e11.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber comparison II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.45\u0026thinsp;\u0026plusmn;\u0026thinsp;4.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscrimination speed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e11.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.699\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFigure-ground speed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.74\u0026thinsp;\u0026plusmn;\u0026thinsp;3.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.911\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisual closure speed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e10.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscrimination accuracy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisual memory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCopying\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e14.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e17.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.904\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndices of WAVES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECGI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e92.7\u0026thinsp;\u0026plusmn;\u0026thinsp;15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e100\u0026thinsp;\u0026plusmn;\u0026thinsp;14.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.668\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECAI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e95.0\u0026thinsp;\u0026plusmn;\u0026thinsp;16.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e100\u0026thinsp;\u0026plusmn;\u0026thinsp;16.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVPI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e96.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e99.8\u0026thinsp;\u0026plusmn;\u0026thinsp;15.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVPECI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e92.5\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e100\u0026thinsp;\u0026plusmn;\u0026thinsp;15.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.908\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eANCOVA, analysis of covariance; C, control; ECAI, eye-hand coordination accuracy index; ECGI, eye-hand coordination general index; VLBWI, very low birth weight infant; VPEI, visual-perceptual eye-hand composite index; VPI, visual perception index; WAVES, Wide-range Assessment of Vision-Related Essential Skills\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDevelopmental risk factors and the scores of WAVES in the VLBWI group\u003c/h2\u003e \u003cp\u003eIn the VLBWI group, we analyzed the differences in clinical characteristics and histories of each subtest score and WAVES index. However, the presence or absence of ROP was not correlated with the WAVES score. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the scores of line tracing (ratio) and ECAI were significantly lower in participants who were born at \u0026lt;\u0026thinsp;28 weeks of gestational age than those born at \u0026ge;\u0026thinsp;28 weeks. The score for copying was significantly lower in participants with CLD than in those without CLD. Furthermore, it was also confirmed that the presence or absence of ROP was not associated with the presence or absence of CLD, nor was it associated with gestational age.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eScores of subtests and index influenced by selected clinical history in the VLBWI group\u003c/b\u003e ECAI, eye-hand coordination accuracy index; VLBWI, very low birth weight infant\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDevelopmental risk\u003c/p\u003e \u003cp\u003eMean (1st quartile \u0026ndash; 3rd quartile)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMann\u0026ndash;Whitney U test\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;28 weeks (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;28 weeks (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLine tracing (ratio score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.5 (6\u0026ndash;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (10\u0026ndash;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECAI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (82.3\u0026ndash;99.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (95.8\u0026ndash;112)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic lung disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresence (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbsence (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCopying\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (3.25\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (6.75\u0026ndash;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the present study, visual perceptual deficits were found in Japanese schoolchildren born weighing less than 1500 g compared to a comparator group, as assessed by WAVES\u0026mdash;a comprehensive approach to visual-perceptual assessment. This study is the first evaluation of schoolchildren born in the Japanese regional neonatal intensive care units and the first investigation using the visual-perceptual assessment battery developed in our laboratory. Considering a visual-perceptual assessment battery with normative values from Japanese children needs to be established for accurate evaluation, it was important that our investigation be conducted using WAVES.\u003c/p\u003e \u003cp\u003e The scores of three indices, ECAI, VPI, and VPECI, in the participants in the VLBWI group were significantly lower than those of the C group participants. The ECAI is a general indicator of eye-hand coordination accuracy, the VPI mainly measures visual attention and perception, and the VPECI adds an eye-hand coordination index to the VPI. Therefore, diffuse deficit of visual perception ability was found in the VLBWI. According to Perez-Roche\u0026rsquo;s report, a diffuse pattern of visual perception deficit was found in children born premature and small for gestational age compared to children born premature who are not small for gestational age [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], consistent with our results. However, Geldof et al. noted that evaluations required subtests measuring specific visual perceptive functions instead of general indices to elucidate the nature of visual perceptual deficits observed in children born preterm with low birth weight. In addition, because WAVES evaluates the visual processing speed, new findings were obtained from the subtest.\u003c/p\u003e \u003cp\u003eThe subtests, which evaluate the visual processing speed, were figure-ground, visual closure, and discrimination in WAVES. The visual discrimination of WAVES, both speed and accuracy, could be assessed [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Regarding the results of figure-ground and visual closure in the present study, only the processing speed of figure-ground was significantly lower in the VLBWI group compared to the C group. In a past report involving participants from Spain and The Netherlands, the accuracy of figure-ground and the accuracy and processing speed of visual closure were evaluated in children born preterm, including those with birth weights greater than 1500 g [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Regarding the processing speed of visual closure, our data was consistent with previous reports. On the other hand, low performance of the processing speed of figure-ground in the children born weighing less than 1500 g has not previously been reported. In general, a trade-off effect between speed and accuracy has been observed [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, combining our results with those of past reports, both processing speed and accuracy were lower in children born weighing less than 1500 g and preterm; therefore, a trade-off effect was not observed. Whether lower performance of both processing speed and accuracy is a characteristic of children born at low birth weight requires further investigation, since previously reported data and our current data differ in the participant characteristics (i.e., preterm births and birth weights less than 1500 g).\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIn addition, for the visual discrimination of WAVES, both speed and accuracy could be assessed. We found that only discrimination accuracy was lower in the VLBWI group compared to the C group. Conversely, in a previous study, both speed and accuracy showed lower performance [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Of course, it cannot be ruled out that the discrepancy between study results may be related to differences in study design, including the setting, selection and exclusion criteria, follow-up rates, and applied test norms [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Bucher et al. indicated that the reaction time of the visual discrimination task significantly decreased as the performance IQ in WISC III increased. In our study, the average values of PRI (mean\u0026thinsp;=\u0026thinsp;99.4, SD\u0026thinsp;=\u0026thinsp;11.3, range\u0026thinsp;=\u0026thinsp;76\u0026ndash;120) and PSI (mean\u0026thinsp;=\u0026thinsp;100, SD\u0026thinsp;=\u0026thinsp;13.0, range\u0026thinsp;=\u0026thinsp;76\u0026ndash;138) of WISC IV were higher than the performance IQ of WISC III (mean\u0026thinsp;=\u0026thinsp;95, SD\u0026thinsp;=\u0026thinsp;12.9, range\u0026thinsp;=\u0026thinsp;69\u0026ndash;119) reported by Butcher et al. Therefore, the difference of performance IQ of WISC III might have affected the processing speed of the visual discrimination. Regarding differences in the assessment battery, the same stimuli were not used to assess the tasks for discrimination accuracy and discrimination speed in WAVES; however, both accuracy and speed of visual discrimination in the study by Bucher et al. may have been assessed by the same stimuli for all the tasks. In WAVES, visual processing speed was assessed in the task while reducing the cognitive load on visual information processing because we considered it to be an accurate visual processing speed. In preterm children, poorer motor skill and difficulty in controlling attention affected processing speed [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Accurate processing, except for processing speed, may be deficient in the children born weighing less than 1500 g in the subtest of visual discrimination. Further investigations are needed to evaluate discrimination with WAVES in children born preterm.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eTracing, which is an assessment task of eye-hand coordination, was also significantly lower in the VLBWI group. Children were required to draw small circles, triangles, and squares following visual boundaries as accurately and quickly as possible. The success and rate scores indicated the drawing speed with accuracy and rate of accurate drawing, respectively. From our investigation, both success and rate score of the figure trace were significantly lower in the VLBWI group than in the C group. Processing speed and accuracy had previously not been evaluated in children born with low birth weight. The score for eye-hand coordination accuracy was low, which was not due to prioritizing speed in the VLBWI group. A trade-off effect was not found in the VLBWI group for form-tracing. Eye-hand coordination is involved in visual-motor functions, and previous reports have shown that visual-motor integration can predict a child\u0026rsquo;s future handwriting skills and academic performance in reading, writing, and mathematics [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Given several reports have shown that children born preterm have visual-motor impairment and poor motor function, and it is well known that they have a risk of poor school performance and learning disabilities, further investigation is needed to determine whether the score of form tracing is implicated in school performance in Japanese schoolchildren and the Japanese language.\u003c/p\u003e \u003cp\u003eRegarding the relationship between risk factors for reading disability and WAVES scores in VLBWI, there was no difference found in the WAVES score between the participants with and without ROP in the VLBWI group. However, the accuracy of line tracing and ECAI was lower in VLBWI born at \u0026lt;\u0026thinsp;28 weeks of gestational age compared to those born at \u0026ge;\u0026thinsp;28 weeks, and the score for copying was lower in VLBWI with a past history of CLD compared to those without. ROP has been reported as a risk factor for reading disorders, and ROP affects visual function, such as strabismus, abnormal refraction, and abnormal contrast sensitivity in childhood [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, from our results, visual perception and eye-hand coordination might not be related to reading fluency in the children with past history of ROP. It has also been reported that the DTVP score is not related to ROP but rather is related to changes in the brain microstructure in preterm participants (i.e., the size of the corpus callosum and interhemispheric connections) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. It is interesting to note that gestational age and CLD were related to the scores of the only subtests involving hand motor function. Especially, regarding children with CLD, reduced pulmonary function and chronic hypoxia affect motor skills [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In a past report, children\u0026rsquo;s visual motor integration was related to reading and mathematics performance [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Further investigations are needed to elucidate whether reading disability in schoolchildren born at less than 28 weeks of gestational age or with past history of CLD is related to the subtest outcomes.\u003c/p\u003e \u003cp\u003eThe strength of this study lies in it being the first evaluation of schoolchildren born in the Japanese regional neonatal intensive care units and the first investigation using the WAVES based on normative data from Japanese children. The scores of several subtests and indices were significantly lower in the VLBWI group compared to those in the C group. The children in the VLBWI group did not need support classes and they had an average IQ performance; however, it is an important finding that they have an increased risk of poor school performance and learning disabilities.\u003c/p\u003e \u003cp\u003eThis study has several limitations. The gestational age and birth weight of the participants in the C group could not be investigated. It is estimated that the prevalence of children with very low birth weight in 2015 was 0.8% in the Japanese population. Hence, the inclusion of children with very low birth weights in the C group may be negligible. Due to the small sample size of the VLBWI group, some of the variables were not normally distributed; therefore, we could not apply multiple regression analysis to ascertain the associations between the scores for each subtest and indices of WAVES and the clinical characteristics and histories of the participants in the VLBWI group.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study is the first to investigate infants born in the Japanese regional neonatal intensive care units using the visual-perceptual assessment battery developed at our laboratory. From our investigation, it was identified that the processing speed of figure-ground and processing speed and accuracy of form tracing were significantly lower in the VLBWI group than in the C group. While children in the VLBWI group did not need support class and had an average IQ, they did have an increased risk of poor school performance and learning disabilities.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCLD; chronic lung disease, CVI; cerebral visual impairment, DTVP; Developmental Test of Visual Perception, ECAI; eye-hand coordination accuracy index, ECGI; eye-hand coordination general index, IQ; intelligence quotient, PRI; perceptual reasoning index, PSI; processing speed index, ROP; retinopathy of prematurity, VPECI; visual-perceptual eye-hand composite index, VPI; visual perception index WAVES; Wide-range Assessment of Vision-related Essential Skills, WISC-IV; Wechsler Intelligence Scale for Children, fourth edition\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eAll procedures used in this research were approved by the ethics committee of Osaka Medical and Pharmaceutical University Hospital (approval number: 1783-4).\u0026nbsp;Informed consent was obtained from the patient\u0026apos;s legal guardian for publication of this report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e:\u0026nbsp;Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e:\u0026nbsp;The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u0026nbsp;This work was supported by Japan Society for the Promotion of Science KAKENHI Grant Number JP18K13229.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;\u003cstrong\u003eM.F., H. T-K., and S.S.\u0026nbsp;\u003c/strong\u003esubstantially contributed to the study conceptualization.\u003cstrong\u003e\u0026nbsp;M.F., S.S., and T.O.\u003c/strong\u003e significantly contributed to data analysis and interpretation.\u003cstrong\u003e\u0026nbsp;A.A.\u003c/strong\u003e substantially contributed to the manuscript drafting. \u003cstrong\u003eAll authors\u003c/strong\u003e critically reviewed and revised the manuscript draft and approved the final version for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to Dr. Tohru Ogihara, Dr. Satoru Ogawa, Dr. Ryoichi Ban, Dr. Seigo Hira, and Dr. Shigeo Yamaoka for recruiting the cases born at low birth weight. We would like to thank Editage (www.editage.com) for English language editing.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eDavis DW, Burns BM, Wilkerson SA, Steichen JJ. Visual perceptual skills in children born with very low birth weights. J Pediatr Health Care. 2005;19:363-8.\u003c/li\u003e\n \u003cli\u003eChen JH, Claessens A, Msall ME. Prematurity and school readiness in a nationally representative sample of Australian children: does typically occurring preschool moderate the relationship? Early Hum Dev. 2014;90:73-9.\u003c/li\u003e\n \u003cli\u003eGarfield CF, Karbownik K, Murthy K, Falciglia G, Guryan J, Figlio DN, et al. Educational Performance of Children Born Prematurely. JAMA Pediatr. 2017;171:764-70.\u003c/li\u003e\n \u003cli\u003eStarnberg J, Norman M, Westrup B, Domell\u0026ouml;f M, Berglund SK. Lower cognitive test scores at age 7 in children born with marginally low birth weight. Pediatr Res. 2018;83:1129-35.\u003c/li\u003e\n \u003cli\u003eMcConnell EL, Saunders KJ, Little JA. What assessments are currently used to investigate and diagnose cerebral visual impairment (CVI) in children? A systematic review. Ophthalmic Physiol Opt. 2021;41:224-44.\u003c/li\u003e\n \u003cli\u003eSakki HEA, Dale NJ, Sargent J, Perez-Roche T, Bowman R. Is there consensus in defining childhood cerebral visual impairment? A systematic review of terminology and definitions. Br J Ophthalmol. 2018;102:424-32.\u003c/li\u003e\n \u003cli\u003eOrtibus E, Lagae L, Casteels I, Demaerel P, Stiers P. Assessment of cerebral visual impairment with the L94 visual perceptual battery: clinical value and correlation with MRI findings. Dev Med Child Neurol. 2009;51:209-17.\u003c/li\u003e\n \u003cli\u003eGeldof CJ, Oosterlaan J, Vuijk PJ, de Vries MJ, Kok JH, van Wassenaer-Leemhuis AG. Visual sensory and perceptive functioning in 5-year-old very preterm/very-low-birthweight children. Dev Med Child Neurol. 2014;56:862-8.\u003c/li\u003e\n \u003cli\u003eLim CY, Tan PC, Koh C, Koh E, Guo H, Yusoff ND, et al. Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery-VMI): lessons from exploration of cultural variations in visual-motor integration performance of preschoolers. Child Care Health Dev. 2015;41:213-21.\u003c/li\u003e\n \u003cli\u003eOkumura T, Miura T, Nakanishi M, Fukui M, Toshikawa M, Shimakawa S, et al. A validity of the Wide-range Assessment of Vision-related Essential Skills in Japanese Children with Learning Problems. Optom Vis Sci. 2020;97:275-285.\u003c/li\u003e\n \u003cli\u003eLobier M, Dubois M, Valdois S. The role of visual processing speed in reading speed development. PLoS One. 2013;8:e58097.\u003c/li\u003e\n \u003cli\u003eTakeuchi A, Koeda T, Takayanagi T, Sato K, Sugino N, Bonno M, et al. Reading difficulty in school-aged very low birth weight infants in Japan. Brain Dev. 2016;38:800-6.\u003c/li\u003e\n \u003cli\u003eGeldof CJ, van Wassenaer AG, de Kieviet JF, Kok JH, Oosterlaan J. Visual perception and visual-motor integration in very preterm and/or very low birth weight children: a meta-analysis. Res Dev Disabil. 2012;33:726-36.\u003c/li\u003e\n \u003cli\u003eShort EJ, Klein NK, Lewis BA, Fulton S, Eisengart S, Kercsmar C, et al. Cognitive and academic consequences of bronchopulmonary dysplasia and very low birth weight: 8-year-old outcomes. \u003cem\u003ePediatrics\u003c/em\u003e. 2003;112,e359.\u003c/li\u003e\n \u003cli\u003eB\u0026ouml;hm B, Katz-Salamon M. Cognitive development at 5.5 years of children with chronic lung disease of prematurity. Arch Dis Child Fetal Neonatal Ed 2003;88:F101-5.\u003c/li\u003e\n \u003cli\u003eYassin SA, Al-Dawood AJ, Al-Zamil WM, Al-Ghamdi MA, Al-Khudairy ZN. Comparative study of visual dysfunctions in 6-10-year-old very preterm- and full-term-born children. Int Ophthalmol. 2019;39:1437-43.\u003c/li\u003e\n \u003cli\u003ePerez-Roche T, Altemir I, Gim\u0026eacute;nez G, Prieto E, Gonz\u0026aacute;lez I, Pe\u0026ntilde;a-Segura JL, et al. Effect of prematurity and low birth weight in visual abilities and school performance. Res Dev Disabil. 2016;59:451-7.\u003c/li\u003e\n \u003cli\u003eButcher PR, Bouma A, Stremmelaar EF, Bos AF, Smithson M, Van Braeckel KN. Visuospatial perception in children born preterm with no major neurological disorders. Neuropsychology. 2012;26:723-34.\u003c/li\u003e\n \u003cli\u003eEvensen KAI, Ustad T, Tikanm\u0026auml;ki M, Haaramo P, Kajantie E. Long-term motor outcomes of very preterm and/or very low birth weight individuals without cerebral palsy: A review of the current evidence. Semin Fetal Neonatal Med. 2020;25:101116.\u003c/li\u003e\n \u003cli\u003eKwinta P, Herman-Sucharska I, Leśniak A, Klimek M, Karcz P, Durlak W, et al. Relationship between Stereoscopic Vision, Visual Perception, and Microstructure Changes of Corpus Callosum and Occipital White Matter in the 4-Year-Old Very Low Birth Weight Children. Biomed Res Int. 2015;2015:842143.\u003c/li\u003e\n \u003cli\u003eSortor JM, Kulp MT. Are the results of the Beery-Buktenica Developmental Test of Visual-Motor Integration and its subtests related to achievement test scores? Optom Vis Sci. 2003;80:758\u0026ndash;763.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"visual perception, low birth weight, preterm birth, cerebral visual impairment, Wide-range Assessment of Vision-Related Essential Skills","lastPublishedDoi":"10.21203/rs.3.rs-4153602/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4153602/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWe aimed to use the Wide-range Assessment of Vision-related Essential Skills (WAVES) to evaluate the visual perception of Japanese schoolchildren born weighing\u0026thinsp;\u0026lt;\u0026thinsp;1500 g, who did not need support class and had an average IQ score.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe very-low birth weight infant group (VLBWI group) included 38 (17 male, 21 female) first-grade elementary schoolchildren born between April 2009 and March 2013 at Osaka Medical College Hospital and Saiseikai Suita Hospital. The scores for the 10 subtests and 4 indices of WAVES were calculated for all participants and compared to the WAVES normative database of schoolchildren in the same grade (C group). We assessed whether clinical history was associated with WAVES score in the VLBWI group.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eCompared with the C group, the participants in the VLBWI group had significantly lower scores for form tracing (success and rate scores), figure-ground speed, discrimination accuracy, visual memory, copying, and the indices of WAVES, except for the eye-hand coordination general index. The scores for line tracing (ratio) and eye-hand coordination accuracy index were significantly lower in participants who were born at gestational age\u0026thinsp;\u0026lt;\u0026thinsp;28 weeks than in those born at gestational age\u0026thinsp;\u0026ge;\u0026thinsp;28 weeks. Copying performance was significantly lower in participants with than without chronic lung disease.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis is the first study to evaluate the visual perception of schoolchildren born weighing\u0026thinsp;\u0026lt;\u0026thinsp;1500 g in Japan. We report lower scores of WAVES\u0026rsquo; subtests on processing speed in these children, implying they might have increased risk of poor school performance and learning disabilities.\u003c/p\u003e","manuscriptTitle":"Visual perceptive functioning in Japanese schoolchildren born with very low birth weight","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-01 16:57:45","doi":"10.21203/rs.3.rs-4153602/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-14T08:24:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-13T18:52:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2024-08-20T08:31:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-04T06:16:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"11761020600370652994932504694753661406","date":"2024-05-21T06:12:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-09T20:32:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"b4cef926-9513-4bcc-9326-0598fb0bdfbd","date":"2024-03-31T17:35:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"287b93a3-f15c-4c49-8fcb-9a4b2e06bef6","date":"2024-03-28T09:20:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-28T09:15:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-28T09:13:31+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-27T18:06:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-27T17:57:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2024-03-23T08:59:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"11be3890-235e-4ec7-a32d-09c6dc6dd3bf","owner":[],"postedDate":"April 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-01T16:07:01+00:00","versionOfRecord":{"articleIdentity":"rs-4153602","link":"https://doi.org/10.1186/s12887-025-06023-7","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2025-08-26 15:57:48","publishedOnDateReadable":"August 26th, 2025"},"versionCreatedAt":"2024-04-01 16:57:45","video":"","vorDoi":"10.1186/s12887-025-06023-7","vorDoiUrl":"https://doi.org/10.1186/s12887-025-06023-7","workflowStages":[]},"version":"v1","identity":"rs-4153602","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4153602","identity":"rs-4153602","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}