Early Visual Development in Albinism

BACKGROUND: Visual system development is incomplete at birth, and while fixation and tracking usually emerge within the first weeks of life, some infants show delayed visual development (DVDev). This is frequently observed in infants with albinism, yet the timing of visual attentiveness and subsequent visual acuity development remains unclear. METHODS: In this retrospective cohort study, 69 infants and toddlers (0-3 years) diagnosed with albinism were included. DVDev was defined as delayed or absent fixation and tracking beyond the expected developmental timeframe. Time to visual attentiveness was analysed using interval-censored survival analysis. Visual acuity was assessed longitudinally using Teller Acuity Cards. Flash visual evoked potentials (fVEPs) were compared between visually attentive and not attentive infants. RESULTS: DVDev status could be determined in 60 infants with albinism, of whom 55 (91.7%) had DVDev and 5 (8.3%) did not. Visual attentiveness emerged at a median age of 3.2 months (IQR 2.6-3.8). Following onset of visual attentiveness, visual acuity showed a catch-up phase during the first 6 months, after which development stabilised at the lower end of normative reference values. fVEP analyses showed no differences in P2 amplitude, peak time or root mean square amplitude between visually attentive and not visually attentive infants. CONCLUSIONS: DVDev is a common early feature of albinism and should be considered part of its early developmental profile. Visual attentiveness was estimated to emerge within the first 6 months of life, with visual acuity showing a rapid improvement during this period, providing a framework for early clinical assessment and counselling.