The diagnosis and management of neonatal hypoglycemia has been widely debated for more than 40 years, with authorities recommending lower¹ and higher² thresholds for intervention and treatment, reflecting the paucity of high-quality evidence to guide management.³ The results of population studies^4,5 have suggested that neonatal hypoglycemia may be one of the most readily preventable causes of neurodevelopmental impairment and learning disorders, but there is also the potential for iatrogenic harm from increased intervention, including decreased breastfeeding and altered cortical development from pain-induced stress with heel lancing.⁶

Current standard treatment for unilateral amblyopia involves refractive correction followed by patching or atropine penalization of the fellow eye.^1,2 Since 2006, a number of novel binocular treatments for amblyopia have been developed,^3-8 a subset of which involve presenting high-contrast stimuli to the amblyopic eye and different, lower-contrast stimuli to the fellow eye (contrast balancing).^3,9 This treatment principle was implemented in a falling-blocks video game,¹⁰ which showed promising results in children^11-13 and adults^14,15 with amblyopia. The Binocular Treatment of Amblyopia Using Videogames study was a randomized double-masked clinical trial to evaluate the effectiveness of a home-based version of a binocular video game against a placebo video game for improving visual functions in children 7 years and older and adults.

Prenatal exposure to recreational drugs impairs motor and cognitive development; however it is currently unknown whether visual brain areas are affected. To address this question, we investigated the effect of prenatal drug exposure on global motion perception, a behavioural measure of processing within the dorsal extrastriate visual cortex that is thought to be particularly vulnerable to abnormal neurodevelopment. Global motion perception was measured in one hundred and forty-five 4.5-year-old children who had been exposed to different combinations of methamphetamine, alcohol, nicotine and marijuana prior to birth and 25 unexposed children. Self-reported drug use by the mothers was verified by meconium analysis. We found that global motion perception was impaired by prenatal exposure to alcohol and improved significantly by exposure to marijuana. Exposure to both drugs prenatally had no effect. Other visual functions such as habitual visual acuity and stereoacuity were not affected by drug exposure. Prenatal exposure to methamphetamine did not influence visual function. Our results demonstrate that prenatal drug exposure can influence a behavioural measure of visual development, but that the effects are dependent on the specific drugs used during pregnancy.

The dorsal visual processing stream that includes V1, motion sensitive area V5 and the posterior parietal lobe, supports visually guided motor function. Two recent studies have reported associations between global motion perception, a behavioural measure of processing in V5, and motor function in pre-school and school aged children. This indicates a relationship between visual and motor development and also supports the use of global motion perception to assess overall dorsal stream function in studies of human neurodevelopment. We investigated whether associations between vision and motor function were present at 2 years of age, a substantially earlier stage of development. The Bayley III test of Infant and Toddler Development and measures of vision including visual acuity (Cardiff Acuity Cards), stereopsis (Lang stereotest) and global motion perception were attempted in 404 2-year-old children (±4 weeks). Global motion perception (quantified as a motion coherence threshold) was assessed by observing optokinetic nystagmus in response to random dot kinematograms of varying coherence. Linear regression revealed that global motion perception was modestly, but statistically significantly associated with Bayley III composite motor (r2=0.06, P<0.001, n=375) and gross motor scores (r2=0.06, p<0.001, n=375). The associations remained significant when language score was included in the regression model. In addition, when language score was included in the model, stereopsis was significantly associated with composite motor and fine motor scores, but unaided visual acuity was not statistically significantly associated with any of the motor scores. These results demonstrate that global motion perception and binocular vision are associated with motor function at an early stage of development. Global motion perception can be used as a partial measure of dorsal stream function from early childhood.