Rehabilitation of cortical visual impairment in children

Cortical Visual Impairment (CVI) is a condition of bilateral visual loss due to injury of visual areas in the brain without significant eye or anterior visual pathway impairment. Perinatal hypoxic ischemic encephalopathy (HIE) and postnatal anoxia are frequent etiologies of CVI and tend to result in more extensive gray and white matter injury affecting optic radiations and visual cortex. Often these children have other significant neurological disabilities and seizures as well. This article provides an analysis of a clinical database of children with CVI evaluated between January 1996 and March 2003. The results of an intensive visual stimulation program were retrospectively examined. Criteria were set to extract a fairly homogeneous group of 21 children with CVI due to perinatal HIE or postnatal anoxia who had extensive gray and white matter injury and multiple neurological deficits; 20 of 21 (95%) had symptomatic epilepsy as well. Subjects entered the study with responses ranging from just a pupillary light reflex to rudimentary perception of outline. Each subject underwent an at-home treatment program. Twenty of 21 children (95%) manifested significant improvement after 4 to 13 months on the program. Results indicate that even in this challenging group, there may be considerable neuroplasticity in visual systems leading to reintegration and visual recovery.