Ophthalmological outcomes, visual perception, fine motor precision, and visual-motor integration in children born very preterm.

The sample size at 12 years was relatively small (59 preterm, 46 controls), limiting statistical power for subgroup analyses. A priori sample size calculation was not performed. Dropout rates were significant (54% follow-up for ophthalmological exams), and children with IVH were less likely to participate, potentially biasing results against finding effects of brain injury. Neonatal brain injury was assessed via ultrasound, which may miss subtle injuries. Diagnoses of cerebral visual impairment, intellectual disability, and cerebral palsy were made clinically outside the study protocol, introducing potential variability. The study did not include a formal assessment of general intelligence, which explains approximately 25% of VMI variance.

The study was funded by several Swedish foundations and research councils (Ögonfonden, Stiftelsen Kronprinsessan Margaretas Arbetsnämnd för Synskadade, Linnéa och Josef Carlssons Stiftelse, Synskadades Vänner i Uppsala, Stiftelsen Promobilia, Vetenskapsrådet). No commercial conflicts of interest were declared.

Do not assume that visual-motor integration deficits in children born very preterm are solely due to cerebral visual impairment or intellectual disability. The study found that ophthalmological factors like visual acuity and stereopsis, even without these diagnoses, were significant predictors of VMI performance. Screening and treating refractive errors and strabismus may improve functional outcomes.