Table 5.
Comparison of ocular findings and visual assessment among infants/children with suspected or confirmed antenatal zika virus (ZIKV) infection previously reported and in this report.
| Zin et al. [8] | Vercosa et al. [7] | Ventura et al. [6] | Ventura et al. [5] | Portnoi Baran et al. [11] | Lima et al. [12] | Current Report | |
|---|---|---|---|---|---|---|---|
| Year published | 2018 | 2017 | 2017 | 2018 | 2019 | 2020 | |
| Subjects | Infants with suspected ZIKV infection a | Infants with microcephaly due to presumed congenital zika syndrome | Infants with neurologic or neuro-radiologic abnormalities with laboratory confirmed ZIKV infection b | Infants born with laboratory confirmed ZIKV infection b | Children exposed to or infected by ZIKV during gestation c | Children exposed to or infected by ZIKV during gestation with at least 2 eye examinations c | Infants/children with suspected ZIKV infection d |
| Location | Brazil | Brazil | Brazil | Brazil | Brazil | Brazil | USVI |
| n | 173 | 70 | 32 | 119 | 47 | 33 | 81 |
| Age (months) | 3–6 (range) | 3.7 (mean, n = 25) e |
5.7 (mean) | 8.5 (mean) | 6.5 (mean) | NR | 9.1 (mean) |
| All findings listed below are by subject unless otherwise noted | |||||||
| Structural Eye Abnormality | 26% (45/173) | 26% (18/70) | 44% (14/32) | 46% (104/227) of eyes |
2.1% (1/47) | 3.0% (1/33) | 3% (2/81) |
|
2% (4/173) | 0% (0/70) | 0% (0/32) | NR | NR | NR | 1% (1/81) |
|
26% (45/173) | 26% (18/70) | 44% (14/32) | NR | 2.1% (1/47) | 3.0% (1/33) | 1% (1/81) |
| Retinal abnormality | 19% (33/173) | 26% (18/70) | 28% of eyes (18/64) | 32% (74/234) of eyes |
2.1% (1/47) | 3.0% (1/33) | 0% (0/81) |
| Optic nerve abnormality | 22% (38/173) | 14% (10/70) | 17% of eyes (11/64) | 27% (63/235) of eyes |
NR | NR | 1% (1/81) |
| Microcephaly | 36% (62/173) | 100% (70/70) | 100% (32/32) | 89% (100/113) | 8.5% (4/47) | 12.1% (4/33) | 6% (5/81) |
| Visual impairment | 30% (52/173) e | 100% (11/11) f | 100% (32/32) g | 90% (204/227) of eyes h |
10.6% (5/47) f | 3.0% (1/33) f | 26% (19/72) i |
| Among those with microcephaly | 71% (44/62) | 100% (11/11) | 100% (32/32) | NR | 50.0% (2/4) | 25.0% (1/4) | 20% (1/5) |
| Among those with abnormal eye structure | 84% (38/45) | 100% (8/8) | 100% (14/14) | 96% (100/104) of eyes |
100.0% (1/1) | 100.0% (1/1) | 0% (0/2) |
| Among those with normal eye structure | 11% (14/128) | 100% (3/3) | 100% (18/18) | 85% (104/123) of eyes |
8.7% (4/46) | 0.0% (0/32) | 27% (19/70) |
| Among those with normal eye structure, neurologically normal, and no microcephaly or nystagmus | 0% (0/87) | not applicable | not applicable | NR | 7.0% (3/43) among those without microcephaly and/or structural ophthalmic abnormalities | 0% (0/29) among those without microcephaly and/or structural ophthalmic abnormalities | 26% (13/51) |
| Type of visual acuity testing | Fix & Follow | Teller acuity card | Teller acuity card | Teller acuity card | Teller acuity card | Teller acuity card | NR |
| Abnormalities of the following: | |||||||
| Visual acuity testing | 30% (52/173) | 100% (11/11) | 73% (22/30) of subjects 78% (47/60) of eyes |
90% (107/119) of subjects 90% (210/233) of eyes |
10.6% (5/47) | 3.0% (1/33) | NR |
| Visual function testing | NR | NR | 71% (22/31) | NR | NR | NR | 27% (19/72) |
| Accommodation | NR | NR | 36% (5/14) | NR | NR | NR | 1% (1/71) |
| Hiding Heidi 5% contrast testing | NR | NR | 65% (20/31) | 81% (87/107) | NR | NR | 24% (18/75) |
| Shift of gaze | NR | NR | 42% (13/31) | NR | NR | NR | 8% (6/77) |
| Visual field test | NR | NR | NR | 45% (41/91) | NR | NR | 1% (1/73) |
| Visual developmental milestone | NR | NR | 97% (30/31) | 93% (100/108) | NR | NR | 3% (2/78) |
| Strabismus | 14% (24/173) | 14% (10/70) | 75% (24/32) | 80% (95/119) | NR | NR | 1% (1/78) |
| Nystagmus | 16% (27/173) | 9% (6/70) | 28% (9/32) | 45% (54/119) | NR | NR | 0% (0/80) |
NR, not reported; USVI, United States Virgin Islands. a Based on positive reverse transcription polymerase chain reaction (RT-PCR) testing during pregnancy or infancy, prenatal ultrasound suspicious for ZIKV, or born with clinical manifestations of congenital ZIKV infection. b Based on the antibody-capture enzyme-linked immunosorbent assay method on cerebrospinal fluid. c Based on positive quantitative reverse transcription PCR (RT-qPCR) from urine and/or blood samples from mothers during pregnancy or children with positive result within 10 days of birth. Inconclusive RT-qPCR results were confirmed with ZIKV IgG and IgM serology. d Based on recent ZIKV infection detected by Zika ribonucleic acid nucleic acid test on any maternal, placental, fetal, or infant specimen or recent ZIKV or flavivirus infection detected by serologic tests of maternal, fetal, or infant specimen. e For 25 children with ocular abnormalities. f Extrapolated based on abnormal visual acuity testing, the term “visual impairment” not defined in report. g Based on abnormal Teller Acuity Card vision testing and/or abnormal visual function (Hiding Heidi contrast test, shift of gaze, light perception, response to the human face) or visual developmental milestone testing. h Based on abnormal Teller Acuity Card vision testing and/or abnormal visual function (Hiding Heidi contrast test, shift of gaze, visual field test, accommodation, light perception, response to the human face) or visual developmental milestone testing. i Based on abnormal visual function (Hiding Heidi contrast test, shift of gaze, visual field test, and accommodation) or visual developmental milestone testing.