{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:40:43Z","timestamp":1792611643601,"version":"4.5.0"},"reference-count":48,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T00:00:00Z","timestamp":1721865600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Hypovitaminosis A is a leading cause of preventable childhood blindness, especially in developing nations. Vitamin A is a fat\u2010soluble essential micronutrient that serves vital functions in the visual system and in regulating bone resorption. We report on a series of four children with mixed nutritional and compressive optic neuropathy and provide a review of the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective observational study of four males (ages 9\u201312), three with autism spectrum disorder who presented with loss of vision and multiple vitamin deficiencies including hypovitaminosis A.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients presented with unexplained visual loss or a change in visual behaviour. All patients had severely restricted diet comprising of predominantly carbohydrates. Two of the four cases demonstrated optic nerve pallor at initial presentation with marked optic atrophy developing in all patients over time. Electrophysiology available in two patients demonstrated optic nerve dysfunction with preserved retinal function. Extensive investigations revealed profound deficiency in multiple vitamins including vitamin A (&lt;0.1\u20130.2\u2009\u03bcmol\/L, normal\u2009=\u20090.9\u20131.7\u2009\u03bcmol\/L). Three patients also had low vitamin B12 (90\u2013111\u2009pmol\/L, normal\u2009=\u2009170\u2013800\u2009pmol\/L) with normal folate. All four cases had radiological evidence of skull base thickening indicative of low vitamin A. Genetic testing did not find any relevant pathogenic variants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hypovitaminosis A is a crucial form of nutritional deprivation that results in significant visual loss with potential hyperostosis and optic nerve compression exacerbating nutritional optic neuropathy. Additional micronutrient deficiencies usually co\u2010exist and may contribute. Extra vigilance in vitamin replacement is required of clinicians with patients with autism who have restricted diets.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jpc.16624","type":"journal-article","created":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T07:33:57Z","timestamp":1721892837000},"page":"516-525","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Optic neuropathy from hypovitaminosis\n                    <scp>A<\/scp>\n                    in a series of children with severe dietary restrictions"],"prefix":"10.1111","volume":"60","author":[{"given":"Jane","family":"Shi","sequence":"first","affiliation":[{"name":"Faculty of Medical and Health Sciences University of Auckland  Auckland New Zealand"},{"name":"Ophthalmology Greenlane Clinical Centre, Te Whatu Ora \u2013 Health New Zealand  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Caldwell","sequence":"additional","affiliation":[{"name":"Radiology Auckland City Hospital, Te Whatu Ora \u2013 Health New Zealand  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo","family":"Sheck","sequence":"additional","affiliation":[{"name":"Faculty of Medical and Health Sciences University of Auckland  Auckland New Zealand"},{"name":"Ophthalmology Greenlane Clinical Centre, Te Whatu Ora \u2013 Health New Zealand  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bobby","family":"Tsang","sequence":"additional","affiliation":[{"name":"Faculty of Medical and Health Sciences University of Auckland  Auckland New Zealand"},{"name":"Paediatrics Waitemata, Te Whatu Ora \u2013 Health New Zealand  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Alekzander","sequence":"additional","affiliation":[{"name":"Paediatrics Counties Manukau, Te Whatu Ora \u2013 Health New Zealand  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Escardo\u2010Paton","sequence":"additional","affiliation":[{"name":"Ophthalmology Greenlane Clinical Centre, Te Whatu Ora \u2013 Health New Zealand  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea L","family":"Vincent","sequence":"additional","affiliation":[{"name":"Faculty of Medical and Health Sciences University of Auckland  Auckland New Zealand"},{"name":"Ophthalmology Greenlane Clinical Centre, Te Whatu Ora \u2013 Health New Zealand  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Spooner","sequence":"additional","affiliation":[{"name":"Paediatric Neurology Starship Childrens Hospital, Te Whatu Ora \u2013 Health New Zealand  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Heppner","sequence":"additional","affiliation":[{"name":"Faculty of Medical and Health Sciences University of Auckland  Auckland New Zealand"},{"name":"Paediatric Neurosurgery Starship Childrens Hospital, Te Whatu Ora \u2013 Health New Zealand  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Danesh\u2010Meyer","sequence":"additional","affiliation":[{"name":"Faculty of Medical and Health Sciences University of Auckland  Auckland New Zealand"},{"name":"Ophthalmology Greenlane Clinical Centre, Te Whatu Ora \u2013 Health New Zealand  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8834-6641","authenticated-orcid":false,"given":"Sarah","family":"Hull","sequence":"additional","affiliation":[{"name":"Faculty of Medical and Health Sciences University of Auckland  Auckland New Zealand"},{"name":"Ophthalmology Greenlane Clinical Centre, Te Whatu Ora \u2013 Health New Zealand  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,7,25]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Global Prevalence of Vitamin A Deficiency in Populations at Risk 1995\u20132005: WHO Global Database on Vitamin A Deficiency","author":"WHO","year":"2009"},{"key":"e_1_2_7_3_1","article-title":"Vision loss in a healthy child: A case of vitamin A deficiency","volume":"14","author":"Garza NJ","year":"2022","journal-title":"Cureus"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu9030190"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/ncomms14898"},{"key":"e_1_2_7_6_1","unstructured":"World Health Organization.International classification of diseases for mortality and morbidity statistics (11th revision).2018."},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/1028415X.2021.1892252"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000185254"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaapos.2023.05.009"},{"key":"e_1_2_7_10_1","first-page":"75","article-title":"Unilateral compressive optic neuropathy due to skull hyperostosis secondary to nutritional vitamin A deficiency","volume":"12","author":"Zayed MG","year":"2015","journal-title":"Clin. Cases Miner. Bone Metab."},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaapos.2021.03.004"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10633-022-09918-3"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10633-022-09914-7"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/pch\/pxy058"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0255924"},{"key":"e_1_2_7_16_1","first-page":"43","article-title":"Vitamin A deficiency in the captive African lion cub Panthera loe (Linnaeus, 1758)","volume":"42","author":"Bartsch RC","year":"1975","journal-title":"Onderstepoort J. Vet. Res."},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1941.sp003916"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-0813.1977.tb00168.x"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.4102\/jsava.v76i3.414"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1638\/2010-0038.1"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1638\/2007-0157.1"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/3-540-31220-X_9"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10633-014-9473-7"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.c.31836"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)01233-7"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/1028415X.2018.1464819"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/0883073809333541"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1086\/346066"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/ceo.14279"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43058-022-00373-4"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1096\/fj.09-132548"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1042\/bj3090721"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1968.00980050779019"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/100.1.129"},{"key":"e_1_2_7_35_1","first-page":"374","article-title":"The local action of vitamin A on bone","volume":"84","author":"Barnicot NA","year":"1950","journal-title":"J. Anat."},{"key":"e_1_2_7_36_1","article-title":"Optic neuropathy in an autistic child with vitamin A deficiency: A case report and literature review","volume":"14","author":"Cheah J","year":"2022","journal-title":"Cureus"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/104063870601800617"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.3945\/jn.115.229708"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0007-1935(17)39804-4"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1210\/er.2012-1071"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23031014"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/ncp.10899"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu12092653"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu11081876"},{"key":"e_1_2_7_45_1","volume-title":"Vitamin A Supplements: A Guide to Their Use in the Treatment and Prevention of Vitamin A Deficiency and Xerophthalmia","author":"Force WUIT, UNICEF, Group IVAC, Organization WH","year":"1997"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1111\/ane.13438"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2015-209413"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1947.sp004178"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jand.2020.10.017"}],"container-title":["Journal of Paediatrics and Child Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jpc.16624","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T23:40:41Z","timestamp":1729035641000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jpc.16624"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,25]]},"references-count":48,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1111\/jpc.16624"],"URL":"https:\/\/doi.org\/10.1111\/jpc.16624","archive":["Portico"],"relation":{},"ISSN":["1034-4810","1440-1754"],"issn-type":[{"value":"1034-4810","type":"print"},{"value":"1440-1754","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,25]]},"assertion":[{"value":"2023-11-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}