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Physician Prescribing and Referral Patterns in Children with Cerebral Visual Impairment
Melissa L Rice, Monica A Sandoval1, Katherine M Castleberry1
1Division of Pediatric Ophthalmology/Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Children with cerebral visual impairment (CVI) often do not receive appropriate glasses, especially those with severe CVI. Correctly prescribing glasses is crucial for improving visual outcomes and quality of life for these children.
Area of Science:
- Ophthalmology
- Pediatrics
- Neuroscience
Background:
- Cerebral visual impairment (CVI) is a primary cause of vision impairment in children within developed nations.
- Timely and appropriate interventions for CVI are essential for optimizing visual function and enhancing life quality.
Purpose of the Study:
- To investigate the prescribing practices for corrective lenses and referral patterns for visual rehabilitation in pediatric patients diagnosed with CVI.
Main Methods:
- A retrospective analysis of medical records for 194 children with CVI treated at Cincinnati Children's Hospital Medical Center between 2008 and 2018.
- Refractive error was assessed based on American Academy of Ophthalmology guidelines.
- CVI severity was categorized using the CVI Range scoring system.
Main Results:
- 35% of children with CVI received glasses for significant refractive error, while 10% with refractive error did not.
- Children with less severe CVI were more likely to be prescribed glasses compared to those with more severe CVI.
- A significant disparity in glasses prescription was observed based on CVI severity and visual function.
Conclusions:
- Children with severe CVI and significant refractive errors were less likely to be prescribed glasses, potentially hindering visual rehabilitation.
- Inconsistent prescription of glasses for children with CVI may limit access to necessary visual rehabilitation services.
- Ophthalmologists and healthcare providers must ensure accurate and timely prescription of glasses for all children with CVI to maximize visual potential.
Significance:
Cerebral visual impairment (CVI) is the leading cause of visual impairment in the developed world. Providing children with CVI with the appropriate treatment ensures the best possible visual outcome and potentially improves quality of life.
Purpose:
The purpose of this study was to determine physician prescribing and visual rehabilitation referral patterns in children with CVI.
Methods:
A retrospective chart review was completed on children with CVI examined at Cincinnati Children's Hospital Medical Center from January 1, 2008, to March 1, 2018. Significant refractive error warranting correction was determined using the American Academy of Ophthalmology Preferred Guidelines and the American Association for Pediatric Ophthalmology and Strabismus Vision Screening Committee Guidelines. The CVI Range was used as a surrogate to categorize CVI severity.
Results:
A total of 194 children were included. Sixty-eight (35%) had refractive error warranting correction and were prescribed glasses (group RC), 99 (51%) did not have refractive error warranting correction and were not prescribed glasses (group NRNC), 20 (10%) had refractive error warranting correction but were not prescribed glasses (group RNC), and 7 (4%) did not have refractive error warranting correction but were prescribed glasses (group NRC). There was greater than one-line Snellen equivalent difference between group RC (20/156) and group RNC (20/221). There was greater than six-line Snellen equivalent difference between group NRNC (20/149) and group NRC (20/35). Mean CVI Range score 2 values for each group were 5.9, 4.6, 4.8, and 7.1.
Conclusions:
Children with less severe CVI were less likely to have significant refractive error but given glasses. Despite significant refractive error, children with more severe CVI were not prescribed glasses. Children with very low visual function were not prescribed glasses as frequently, possibly limiting their visual rehabilitation. Providers should ensure that all children with CVI are correctly prescribed glasses to provide the best possible visual outcome.
