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Updated: Dec 25, 2025
Author Spotlight: Insights into Visual Cortex Research Through Wide-View fMRI Mapping
Published on: December 8, 2023
Advances in the evaluation and management of cortical/cerebral visual impairment in children
Melinda Y Chang1, Mark S Borchert1
1Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA; Roski Eye Institute, University of Southern California, Los Angeles, CA, USA.
Insights
Cortical/cerebral visual impairment (CVI) is a growing cause of vision loss in children, often linked to brain injury. Early diagnosis and environmental support are key, though specific treatments are still under investigation.
Area of Science:
- Pediatric ophthalmology
- Neuroscience
- Developmental pediatrics
Background:
- Cortical/cerebral visual impairment (CVI) is the leading cause of childhood vision impairment globally.
- Hypoxic-ischemic encephalopathy, especially in premature infants, is the most common cause of CVI.
- Neurologic comorbidities complicate the diagnosis and characterization of visual deficits in affected children.
Purpose of the Study:
- To review the current understanding of pediatric CVI, including its causes, diagnostic challenges, and management strategies.
- To highlight the role of neuroimaging and genetic testing in identifying underlying conditions.
- To discuss potential future therapeutic approaches and the need for standardized research methods.
Main Methods:
- Review of existing literature on pediatric CVI.
- Discussion of diagnostic tools such as caregiver questionnaires and advanced neuroimaging (fMRI, DTI).
- Exploration of genetic testing for associated syndromes.
Main Results:
- CVI diagnosis is challenging due to associated neurological issues.
- Neuroimaging and genetic testing offer insights into CVI's structural and etiological basis.
- No definitive therapy exists, but supportive care and environmental modifications are crucial.
Conclusions:
- Advances in neonatal care may reduce CVI incidence.
- Visual stimulation and stem cell therapies are being explored but require rigorous trials.
- Optimizing the child's environment and managing comorbidities are essential for improving visual function.
Abstract:
Cortical/cerebral visual impairment (CVI) is the most frequent cause of pediatric visual impairment in developed countries and is increasing in prevalence in developing nations. The most common underlying etiology is hypoxic-ischemic encephalopathy, particularly in premature children. Other causes include seizures, hydrocephalus, trauma, and infections. Because of neurologic comorbidities, children with CVI often present challenges in diagnosis and characterization of visual deficits. Caregiver questionnaires may aid in assessment of visual functioning, while newer types of neuroimaging, including functional neuroimaging and diffusion tensor magnetic resonance imaging, may provide further insights on structure-function relationships. Genetic testing may assist in identification of underlying genetic or metabolic syndromes. Although no standard therapy for pediatric CVI exists, advances in care of preterm children and those with hypoxic-ischemic encephalopathy may in future reduce the incidence of this disorder. In addition, various methods of visual stimulation and stem cells have been advocated as treatment for pediatric CVI. Future controlled trials using standardized methods of visual assessment are necessary to establish whether these interventions are superior to observation. Practitioners should work with families and teachers of children with CVI to optimize their environment for visual functioning. Comorbid ocular and systemic disorders, which are common, should be managed appropriately.
