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Published on: March 17, 2023
Diagnosing cerebral visual impairment in children with good visual acuity
Maria van Genderen1, Marjoke Dekker, Florine Pilon
1Department of Ophthalmology, Bartiméus Institute for the Visually Impaired. mvgenderen@bartimeus.nl
Insights
An abnormal medical history, particularly related to prematurity or perinatal hypoxia, is a key indicator for diagnosing cerebral visual impairment (CVI) in children. Other signs like cerebral palsy and visual field defects also support CVI diagnosis.
Area of Science:
- Ophthalmology
- Pediatrics
- Neurology
Background:
- Cerebral visual impairment (CVI) diagnosis in children with good visual acuity presents diagnostic challenges.
- Identifying specific clinical indicators is crucial for timely and accurate diagnosis in general ophthalmic settings.
Purpose of the Study:
- To identify key clinical elements that facilitate the diagnosis of CVI in children with normal visual acuity.
- To differentiate CVI from other conditions in children with suspected visual impairment.
Main Methods:
- Retrospective investigation of clinical characteristics in 30 children with CVI and 23 controls.
- Evaluation included medical history, MRI, visual acuity, crowding ratio (CR), visual field, and ophthalmologic/orthoptic exams.
- Assessed the utility of a CVI questionnaire for diagnostic support.
Main Results:
- Abnormal pre- or perinatal history (e.g., prematurity, hypoxia) was present in 83% of CVI cases, versus 0% in controls.
- Cerebral palsy, visual field defects, and partial optic atrophy were exclusive to the CVI group.
- A crowding ratio (CR) ≥2.0 was observed in 41% of CVI cases, suggesting dorsal stream dysfunction; CVI questionnaires showed high false-positive rates.
Conclusions:
- An abnormal pre- or perinatal medical history is the strongest risk factor for CVI in children.
- Clinical signs such as cerebral palsy, visual field defects, partial optic atrophy, and a CR ≥2 support CVI diagnosis.
- CVI questionnaires are not recommended for screening due to excessive false positives.
Purpose:
To identify elements that could facilitate the diagnosis of cerebral visual impairment (CVI) in children with good visual acuity in the general ophthalmic clinic.
Methods:
We retrospectively investigated the clinical characteristics of 30 children with good visual acuity and CVI and compared them with those of 23 children who were referred with a suspicion of CVI, but proved to have a different diagnosis. Clinical characteristics included medical history, MRI findings, visual acuity, crowding ratio (CR), visual field assessment, and the results of ophthalmologic and orthoptic examination. We also evaluated the additional value of a short CVI questionnaire.
Results:
Eighty-three percent of the children with an abnormal medical history (mainly prematurity and perinatal hypoxia) had CVI, in contrast with none of the children with a normal medical history. Cerebral palsy, visual field defects, and partial optic atrophy only occurred in the CVI group. 41% of the children with CVI had a CR ≥2.0, which may be related to dorsal stream dysfunction. All children with CVI, but also 91% of the children without CVI gave ≥3 affirmative answers on the CVI questionnaire.
Conclusion:
An abnormal pre- or perinatal medical history is the most important risk factor for CVI in children, and therefore in deciding which children should be referred for further multidisciplinary assessment. Additional symptoms of cerebral damage, i.e., cerebral palsy, visual field defects, partial optic atrophy, and a CR ≥2 may support the diagnosis. CVI questionnaires should not be used for screening purposes as they yield too many false positives.
