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Published on: July 9, 2016
Cortical visual impairment in children
1Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas 77030, USA. jedmond@bcm.tmc.edu
Insights
Cortical visual impairment is a growing cause of childhood vision loss, often resulting from hypoxic ischemic brain injury. Understanding these injuries is key to addressing diverse visual disabilities in children.
Area of Science:
- Pediatric Ophthalmology
- Neuroscience
- Developmental Pediatrics
Background:
- Cortical visual impairment (CVI) is an increasing cause of vision loss in children.
- Improved survival rates of premature infants contribute to the rise of CVI.
- CVI encompasses a spectrum of visual deficits, from severe impairment to cognitive visual dysfunction.
Purpose of the Study:
- To review the causes and manifestations of cortical visual impairment in children.
- To differentiate the effects of hypoxic ischemic injury in preterm versus term infants.
- To highlight the range of visual disabilities associated with CVI.
Main Methods:
- Review of current literature on cortical visual impairment.
- Analysis of injury patterns in preterm and term infants.
- Examination of ocular and visual system abnormalities resulting from brain injury.
Main Results:
- Hypoxic ischemic injury to brain watershed areas is the primary cause of CVI.
- Preterm infants typically experience injury around ventricles; term infants show injury between major arteries.
- Damage to peristriate cortex can lead to cognitive visual dysfunction, and anterior visual pathways may be affected.
- Ocular and visual system abnormalities differ between preterm and term infants due to distinct injury patterns.
Conclusions:
- Cortical visual impairment is a significant cause of pediatric vision loss.
- The etiology of CVI involves hypoxic ischemic brain injury with varied manifestations.
- CVI presents a wide range of visual impairments, including cognitive visual dysfunction.
Purpose Of Review:
Cortical visual impairment is rapidly becoming a leading cause of visual loss in children in developed countries predominately because of the improved survival rates of premature infants over the past decade.
Recent Findings:
Most cases of cortical visual impairment arise from hypoxic ischemic injury to watershed areas of the brain. In the preterm infant the watershed areas are in the subcortex around the ventricles, while in the term infant the watershed areas are between the major arteries with injury to the subcortex and cortex. Therefore, preterm and term injury will manifest different ocular and visual system abnormalities as a result of this damage. Cognitive visual dysfunction, a type of cortical visual impairment, may occur in cases of damage to the peristriate cortex (association areas of the brain). The anterior visual pathways may also be damaged in a retrograde, transsynaptic fashion in cases of cortical visual impairment.
Summary:
Cortical visual impairment is a prevalent cause of visual loss in children. It encompasses a wide range of visual disabilities from no light reception to normal visual acuity with cognitive visual dysfunction.
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