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Published on: July 9, 2016
Cerebral visual impairment in children: Causes and associated ophthalmological problems
Niranjan Pehere1, Pratik Chougule2, Gordon N Dutton3
1The David Brown Children's Eye Care Center, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India.
Insights
Hypoxic-ischemic encephalopathy is a leading cause of cerebral visual impairment (CVI) in Indian children, often presenting with profound vision loss and treatable eye conditions. Early detection and intervention are crucial for managing CVI and associated developmental delays.
Area of Science:
- Ophthalmology
- Pediatrics
- Neurology
Background:
- Cerebral visual impairment (CVI) significantly impacts child development.
- Understanding the causes and associated conditions in specific populations is essential for targeted interventions.
Purpose of the Study:
- To identify common causes of CVI in children in Andhra Pradesh, India.
- To document associated ophthalmological abnormalities and systemic comorbidities in these children.
Main Methods:
- Retrospective review of case records of children (<16 years) diagnosed with CVI.
- Data collected included age, gender, cause of CVI, ophthalmic findings, and systemic problems.
Main Results:
- Hypoxic-ischemic encephalopathy (HIE) was the most common cause (34.4%), followed by undetermined etiology (32.8%).
- Most children presented with profound visual impairment (88.8%), often before age 2 (44.8%).
- Common ophthalmological issues included refractive errors (46.4%), strabismus (32.25%), and optic atrophy (32%).
- Developmental delays were frequent, including motor (39.5%), speech (22.4%), and cognitive (16%).
Conclusions:
- HIE is a primary cause of CVI in this population, with a high prevalence of profound visual impairment.
- A significant proportion of children have treatable ophthalmic conditions like refractive errors and cataracts.
- CVI in children is often associated with delays in other developmental areas, necessitating comprehensive management.
Purpose:
The aim of this study is to identify common causes, associated ophthalmological abnormalities, and systemic comorbidities in children in Andhra Pradesh, India, with cerebral visual impairment (CVI).
Methods:
A retrospective review of case records of all children aged <16 years with diagnosis of CVI seen between January 2016 and December 2016 was carried out. Data were collected for their age, gender, cause of CVI, refraction, accommodation, anterior and posterior segment examination findings, and systemic problems.
Results:
A total of 124 patients were identified and studied (80 boys and 44 girls, mean age 5.23 years, 44.8% aged <2 years). The most common causes of CVI were hypoxic-ischemic encephalopathy (HIE) (34.4%), undetermined etiology (32.8%), neonatal seizures, and infantile spasms (16% each). The most common presenting complaints were poor vision (76%) and squint (11.2%). Profound visual impairment was seen in 88.8%, and 11.2% had high functioning CVI. Fifty-eight (46.4%) patients had significant refractive errors, 40 (32.25%) had strabismus, 4 (3.2%) had visually significant cataract, and 40 (32%) had optic atrophy. Motor delay was observed in 39.5%, speech delay was evident in 22.4%, and cognitive delay in 16%.
Conclusion:
HIE is the most common cause (one-third) of CVI in our population, and the majority of them presented at age <2 years (44.8%) with profound visual impairment (88.8%). A significant number of them have treatable ophthalmic conditions such as refractive errors (46.4%), accommodative insufficiency (12.1%), and cataract (3.2%), and more than one-third of them also have delay in other areas of development.
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