Infant Visual Acuity and Relationships with Diet and Nutrition

  • Michelle P. Judge
  • Carol J. Lammi-Keefe
  • Holiday Durham


Visual processing involves the retina, thalamus, and primary visual cortex and cognitive response to visual information involves the integration of various cortical regions. Measures of infant visual acuity have focused on two main aspects of the visual system; retinal development using electroretinogram (ERG) and visual processing at the level of the primary visual cortex. Visual evoked potential (VEP) and behavioral assessments such as the forced-choice preferential looking are two measures involving processing at or beyond the level of the primary visual cortex. VEP measures cortical response directly and has less inherent variability. Forced-choice preferential looking procedures provide insight regarding the integration of visual information beyond the primary visual cortex. The retinal photoreceptors and the gray matter of the cortex have high docosahexaenoic acid (DHA, 22:6 n-3) content. The majority of research investigating functional outcomes in human infants has repeatedly demonstrated better visual function related to the provision of DHA during the prenatal and postnatal periods in comparison to infants who were not supplemented. Multiple independent research groups have documented that pregnant women have DHA intakes well below current recommendations. In turn, DHA deficits during the prenatal period place the developing fetus at risk for interruptions in visual system development. Although breast milk is the best source of DHA for infants during the postnatal period DHA supplementation is necessary for formula-fed infants. The three main sources of DHA and arachidonic acid oil considered used in infant formulas: marine, egg phospholipid, and single-cell oils. Of the three, single-cell oils are the most efficacious for supplementation of formula-fed infants and women of child-bearing age. Increased efforts toward community-based educational programs targeting women of child-bearing age aimed to increase DHA intake are highly important. Interruptions in visual development can delay the achievement of other developmental milestones with important long-term implications.


Arachidonic Acid Gestational Diabetes Mellitus Infant Formula Visual Evoke Potential Primary Visual Cortex 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Acuity card procedure


Arachidonic acid single-cell oil


Docosahexaenoic acid


Docosahexaenoic acid single-cell oil




Forced-choice preferential looking


G-protein coupled reaction




Long chain polyunsaturated fatty acid




Single-cell oil


Visual evoked potential


  1. Auestad N, Innis SM. Am J Clin Nutr. 2000;71:312S–4.PubMedGoogle Scholar
  2. Auestad N, Montalto MB, Hall RT, Fitzgerald KM, Wheeler RE, Connor WE, et al. Pediatr Res. 1997;41:1–10.PubMedCrossRefGoogle Scholar
  3. Auestad N, Halter R, Hall RT, Blatter M, Bogle ML, Burks W, et al. J Pediatr. 2001;108:372–81.CrossRefGoogle Scholar
  4. Bazan NG, Scott BL. J Med Sci. 1990;48:97–107.Google Scholar
  5. Bertenthal BI. Annu Rev Psychol. 1996;47:431–59.PubMedCrossRefGoogle Scholar
  6. Birch E, Birch DG, Hoffman D. J Pediatr Opthalmol Strabismus. 1993a;30:33–8.Google Scholar
  7. Birch E, Birch DG, Hoffman D, Everett M, Uauy R. J Pediatr Ophthalmol Strabismus. 1993b;30:33–8.PubMedGoogle Scholar
  8. Birch EE, Garfield S, Hoffman DR, Uauy R, Birch DG. Dev Med Child Neurol. 2000;42:174–81.PubMedCrossRefGoogle Scholar
  9. Boswell K, Koskelo EK, Carl L, Glaza S, Hensen DJ, Williams KD, et al. Food Chem Toxicol. 1996;34:585–93.PubMedCrossRefGoogle Scholar
  10. Bowen RA, Clandinin MT. J Neurochem. 2002;83:764–74.PubMedCrossRefGoogle Scholar
  11. Carlson SE, Werkman SH. Lipids. 1996;31:85–90.PubMedCrossRefGoogle Scholar
  12. Carlson SE, Cooke R, Werkman S, Tolley EA. Lipids. 1992a;27:901–7.PubMedCrossRefGoogle Scholar
  13. Carlson SE, Cooke RJ, Rhodes JM, Peeples J, Werkman SH. J Pediatr. 1992b;120:159–67.CrossRefGoogle Scholar
  14. Carlson SE, Werkman S, Peeples JM, Cooke RJ, Tolley EA. Proc Natl Acad Sci. 1993;90:1073–7.PubMedCrossRefGoogle Scholar
  15. Carlson SE, Ford AJ, Werkman SH, Peeples JM, Koo WK. Pediatr Res. 1996;39:882–8.PubMedCrossRefGoogle Scholar
  16. Cheruku SR, Montgomery-Downs HE, Farkas SL, Thoman EB, Lammi-Keefe CJ. Am J Clin Nutr. 2002;76:608–13.PubMedGoogle Scholar
  17. Clandinin MT, CJ LS, Heim T, Sawyer PR, Chance GW. Early Hum Dev. 1980;4:121–9.PubMedCrossRefGoogle Scholar
  18. Denomme J, Stark KD, Holub BJ. J Nutr. 2005;135(2):206–11.PubMedGoogle Scholar
  19. Fox P. Fetal and neonatal physiology, vol 1. Philadelphia: W.B. Saunders Company; 1998. p. 489–504.Google Scholar
  20. Hoffman DR, Birch EE, Castaneda YS, Fawcett SL, Wheaton DH, Birch DG, et al. J Pediatr. 2003;142:669–77.PubMedCrossRefGoogle Scholar
  21. Innis SM, Elias SL. Am J Clin Nutr. 2003;77:473–8.PubMedGoogle Scholar
  22. Innis SM, Nelson CM, Rioux FM, King JD. Am J Clin Nutr. 1994;60:347–52.PubMedGoogle Scholar
  23. Innis SM, Nelson CM, Lwanga D, Rioux FM, Walsen P. Am J Clin Nutr. 1996;64:40–6.PubMedGoogle Scholar
  24. Innis SM, Akrabawi SS, Diersen-Schade DA, Dobson VM, Guy DG. Lipids. 1997;32:63–72.PubMedCrossRefGoogle Scholar
  25. Jorgensen HM, Hernell O, Lund P, Holmer G, Michaelsen KF. Lipids. 1996;31:99–105.PubMedCrossRefGoogle Scholar
  26. Judge MP, Harel O, Lammi-Keefe CJ. Lipids. 2007;42:117–22.PubMedCrossRefGoogle Scholar
  27. Kellman PJ, Banks MS. Infant visual perception. In: Kuhn D, Siegler RS, editors. Handbook of child psychology: cognition, perception, and language, vol 2. New York: Wiley; 1998. p. 103–46.Google Scholar
  28. Kolb B, Whishaw IQ. Organization of the nervous system. In: Atkinson RC, Lindzey G, Thompson RF, editors. Fundamentals of human neuropsychology. New York: Worth Publishers; 2003. p. 46–74.Google Scholar
  29. Koletzko B, Lien E, Agostoni C, Böhles H, Compoy C, Cetin I, et al. J Perinat Med. 2008;36:5–14.Google Scholar
  30. Lewis NM, Widga AC, Buck JS, Frederick AM. J Agromedicine. 1995;2:49–56.CrossRefGoogle Scholar
  31. Loosemore ED, Judge MP, Lammi-Keefe CJ. Lipids. 2004;39:421–4.PubMedCrossRefGoogle Scholar
  32. Makrides M, Simmer K, Goggin M, Gibson RA. Pediatr Res. 1993;33:425–7.PubMedGoogle Scholar
  33. Makrides M, Neumann M, Simmer K, Pater J, Gibson R. Lancet. 1995;345:1463–8.PubMedCrossRefGoogle Scholar
  34. Malcolm CA, Hamilton R, McCulloch DL, Montgomery C, Weaver LT. Invest Opthalmol Vis Sci. 2003a;44:3685–91.CrossRefGoogle Scholar
  35. Malcolm CA, McCulloch DL, Montgomery C, Shepherd A, Weaver LT. Arch Dis Child Fetal Neonatal Ed. 2003b;88:F383–90.PubMedCrossRefGoogle Scholar
  36. Mitchell DC, Niu SL, Litman BJ. J Pediatr. 2003;143:880–6.Google Scholar
  37. Neuringer M. Am J Clin Nutr. 2000;71:256S–67.PubMedGoogle Scholar
  38. Neuringer M, Jeffrey BG. J Pediatr. 2003;143:S87–95.PubMedCrossRefGoogle Scholar
  39. Neuringer M, Connor WE, Barstad L, Luck S. Proc Natl Acad Sci. 1986;83:4021–5.PubMedCrossRefGoogle Scholar
  40. Niu SL, Mitchell DC, Litman BJ. J Biol Chem. 2001;276:42807–11.PubMedCrossRefGoogle Scholar
  41. Nui SL, Mitchell DC, Lim SY, Wen ZM, Kim HY, Salem N, et al. J Biol Chem. 2004;279:31098–104.CrossRefGoogle Scholar
  42. O’Connor DL, Hall R, Adamkin D, Auestad N, Castillo M, Connor WE, et al. J Pediatr. 2001;108:359–71.CrossRefGoogle Scholar
  43. Olsen SF, Secher NJ. Br Med J. 2002;324:447–50.CrossRefGoogle Scholar
  44. Olsen SF, Hansen HS, Secher NJ, Jensen B, Sandstrom B. Br. J Nutr. 1995;73:397–404.CrossRefGoogle Scholar
  45. Salem Jr N, Litman B, Kim HY, Gawrisch K. Lipids. 2001;36:945–59.PubMedCrossRefGoogle Scholar
  46. Sarkadi-Nagy E, Wijendran V, Diau GY, Chao AC, Hsieh AT, Turpeinen A, et al. Pediatr Res. 2003;54:244–52.PubMedCrossRefGoogle Scholar
  47. Simopoulos AP, Leaf A, Salem N. Prostaglandins Leukot Essent Fatty Acids. 2000;83:119–21.CrossRefGoogle Scholar
  48. Uauy R, Hoffman DR, Birch EE, Birch DG, Jameson DM, Tyson J. J Pediatr. 1994;124:612–20.PubMedCrossRefGoogle Scholar
  49. Von Hofsten C. J Exp Child Psychol. 1980;30:369–82.CrossRefGoogle Scholar
  50. Wijendran V, Bendel RB, Couch SC, Philipson EH, Cheruku S, Lammi-Keefe CJ. Lipids. 2000;35:927–31.PubMedCrossRefGoogle Scholar
  51. Zigmond MJ, Bloom FE, Landis SC, Roberts JL, Squire LR. Fundamental Neuroscience. San Diego: Academic; 1999.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Michelle P. Judge
    • 1
  • Carol J. Lammi-Keefe
  • Holiday Durham
  1. 1.School of NursingUniversity of ConnecticutMansfieldUSA

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