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Parent-Reported Visual Concerns in Children with Cerebral Visual Impairment Presenting to a Pediatric Neurology
Rebecca Sumalini1,2,3, Premalatha Errolla4, Lokesh Lingappa4
1Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India.
Insights
Parental reports of visual concerns in children with cerebral visual impairment (CVI) are common. Assessing eye contact, face recognition, and visual functions like grating acuity can aid in diagnosis and management of CVI.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Developmental Pediatrics
Background:
- Cerebral visual impairment (CVI) is a leading cause of visual deficit in children, often presenting with developmental delays.
- Pediatricians and neurologists are frequently the first specialists to evaluate children with suspected CVI, with vision assessments typically being referral-based.
- Understanding parental perspectives on visual concerns is crucial for early identification and intervention in pediatric CVI.
Purpose of the Study:
- To document visual concerns reported by parents of children with CVI in a pediatric neurology clinic setting.
- To investigate the relationship between reported visual concerns, functional vision measures, and specific visual functions.
- To inform clinical practice regarding the assessment of visual difficulties in children with CVI.
Main Methods:
- A cross-sectional study involving 73 children (age 7 months–7 years) diagnosed with CVI.
- Parental reports of visual concerns were collected via open-ended statements and categorized.
- Functional vision was assessed using the CVI Range, with grating acuity and contrast sensitivity measured using standardized tools.
Main Results:
- Sixty-eight parents (93%) reported 14 unique visual concerns, with difficulty maintaining eye contact and recognizing faces being most frequent in early CVI phases.
- Visual concerns were more prevalent in lower functional vision phases (Phase 1: 43%, Phase 2: 40.6%) compared to higher phases (Phase 3: 16.2%).
- Grating acuity, contrast sensitivity, and chronological age significantly predicted functional vision (r² = 0.77, p < 0.001).
Conclusions:
- Incorporating targeted questions about eye contact and face recognition into pediatric neurology history-taking is recommended for children with CVI.
- Assessing grating acuity and contrast sensitivity is important when visual concerns are present in children with CVI.
- A low functional vision score necessitates referral for comprehensive eye examination and vision rehabilitation services.
Purpose:
Children with cerebral visual impairment (CVI) present with delayed developmental milestones. Pediatricians and pediatric neurologists are usually the first point of contact, and eye exam largely remains referral based. This study documented the visual concerns reported by parents of children with CVI visiting a pediatric neurology clinic. Additionally, we investigated the association between visual concerns, functional vision measures and visual functions.
Patients And Methods:
A cross-sectional study was undertaken in children with CVI (chronological age range: 7 months-7 years). Visual concerns reported by the parents/caregivers were documented as open-ended statements. Additionally, a functional vision assessment was conducted using the CVI Range instrument with phase 1, 2 and 3 indicating low, moderate and high visual functioning, respectively. Grating acuity and contrast sensitivity were measured using Teller acuity cards-II and Ohio contrast cards respectively.
Results:
A total of 73 children (mean age of 2.84 ± 1.87 years) were recruited. Sixty-eight parents reported visual concerns that were broadly grouped into 14 unique concerns. Nineteen parents (27.9%) reported more than one visual concern. Difficulty maintaining eye contact and recognizing faces were the top two visual concerns in phases 1 and 2. Missing objects in the lower visual field was the top concern in phase 3. A larger number of visual concerns were reported in phase 1 (43%) than phase 2 (40.6%) and phase 3 (16.2%). Multiple regression analysis revealed that grating acuity, contrast sensitivity and chronological age were able to predict the functional vision, F (3, 55) = 63.0, p < 0.001, r2 = 0.77.
Conclusion:
Targeted questions enquiring about eye contact and face recognition can be included in history elicitation in children with CVI in pediatric neurology clinics. In the presence of visual concerns, it will be important to assess grating acuity and contrast sensitivity. A poor functional vision score requires referral for eye examination and vision rehabilitation services.
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