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Updated: Aug 30, 2025
A Method to Quantify Visual Information Processing in Children Using Eye Tracking
Published on: July 9, 2016
Longitudinal neurological analysis of moderate and severe pediatric cerebral visual impairment
Andres Jimenez-Gomez1, Kristen S Fisher2,3, Kevin X Zhang4,5
1Neuroscience Center, Joe DiMaggio Children's Hospital, Hollywood, FL, United States.
Insights
Cerebral visual impairment (CVI) in children is linked to perinatal factors, epilepsy, and cerebral palsy. Early interventions, especially glasses, significantly improve vision outcomes in pediatric CVI patients.
Area of Science:
- Pediatric Neurology
- Neuro-ophthalmology
- Developmental Pediatrics
Background:
- Cerebral visual impairment (CVI) is the leading cause of vision loss in children, with increasing prevalence globally.
- Understanding predictors of outcome in pediatric CVI is limited, particularly concerning neurologic, developmental, and ophthalmic factors.
Purpose of the Study:
- To identify neurologic, developmental, and ophthalmic predictors of outcome in pediatric patients with CVI.
- To evaluate the impact of various interventions on the longitudinal CVI grade.
Main Methods:
- Retrospective chart review of 249 pediatric CVI patients (2010-2019).
- Stratification by CVI severity and longitudinal follow-up.
- Analysis using linear mixed-effect models to assess outcome predictors.
Main Results:
- Perinatal history (HIE), epilepsy, cerebral palsy, and abnormal fundoscopy were negatively associated with CVI grade change.
- Interventional therapies, particularly glasses, significantly improved CVI grade compared to no therapy.
- Genetic anomalies and specific epilepsy traits were noted in a significant proportion of patients.
Conclusions:
- Neurologic and developmental factors like perinatal history and epilepsy influence CVI prognosis.
- Early intervention therapies, including vision correction, demonstrate significant benefits for vision function in pediatric CVI.
- Identifying at-risk individuals through these factors can guide timely visual evaluations.
Introduction:
Cerebral visual impairment (CVI) results from damage to cerebral visual processing structures. It is the most common cause of pediatric visual impairment in developed countries and rising in prevalence in developing nations. There is currently limited understanding on how neurologic, developmental, and ophthalmic factors predict outcome for pediatric CVI.
Method:
A retrospective manual chart review of pediatric CVI patients seen at the tertiary pediatric hospital neurology and neuro-ophthalmology service between 2010 and 2019 was conducted. Patients were stratified into severity groups (based on a custom CVI grading score), and followed over time to identify outcome predictors. Collected baseline characteristics included perinatal, genetic, developmental, and neurologic history, along with neuroimaging and fundoscopic findings on examination. Longitudinal data collected included age, seizure control, and type of therapy received. Linear mixed-effect models were used for longitudinal CVI grade outcome analysis.
Results:
A total of 249 individuals spanning 779 patient visits were identified. Mean age at diagnosis was 18.8 ± 16.8 months (2-108 months). About 64.3% were born at term age. Perinatal history revealed hypoxic ischemic encephalopathy (HIE) in 16.5%, intraventricular hemorrhage (IVH) in 11.6%, and seizures in 21.7%. At presentation, 60.3% had a diagnosis of cerebral palsy and 84.7% had developmental delay. Among all subjects, 78.6% had epilepsy; 33.8% had an epileptic encephalopathy, with spasms/hypsarrhythmia being most common. Abnormal neuroimaging was present in 93.8%. Genetic anomalies were present in 26.9%. Baseline visual examination revealed no blink-to-light (BTL) in 24.5%; only BTL in 34.5%, fixation/tracking in 26.5%, and optokinetic drum follow in 14.4%. Longitudinal data analysis showed that perinatal history of HIE, a positive epilepsy history, using multiple (≥3) epilepsy medications, cerebral palsy, and abnormal fundoscopic findings were all negatively associated with CVI grade change over time. After controlling for significant confounders, receiving any type of therapy [early childhood intervention (ECI), physical and occupational therapy (PT/OT), refractive error correction or glasses] was significantly associated with longitudinal improvement in CVI grade compared to patients who did not receive any therapy, with glasses yielding the largest benefit.
Conclusion:
This study offers extensive insights into neurologic, developmental and ophthalmologic features in patients with moderate to severe CVI. In concordance with previous findings, aspects of perinatal history and epilepsy/seizure control may help inform severity and prognosis in the general neurology or ophthalmology clinic. Conversely, these aspects, as well as genetic and specific epilepsy traits may alert vision health care providers in the clinic to pursue visual evaluation in at-risk individuals. Longitudinal follow-up of CVI patients showed that interventional therapies demonstrated vision function improvement greater than no therapy and maturational development.
