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Childhood cerebral visual impairment subtype classification based on an extensive versus a limited test battery
Jannet Philip1,2, Bianca Huurneman1,3, Nomdo M Jansonius4,5
1Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands.
Insights
An extensive test battery provides more detailed classification of cerebral visual impairment (CVI) subtypes in children compared to a limited one. The extensive approach identified a new subtype, aiding in a better understanding of CVI diagnosis.
Area of Science:
- Ophthalmology and Neuroscience
- Pediatric Visual Impairment Research
Background:
- Cerebral visual impairment (CVI) in children presents diagnostic challenges.
- Subtyping CVI is crucial for targeted interventions and understanding visual processing deficits.
- The diagnostic value of comprehensive versus limited test batteries for CVI classification is not fully established.
Purpose of the Study:
- To classify cerebral visual impairment (CVI) subtypes in children.
- To compare the added value of an extensive test battery versus a limited test battery for CVI subtype classification.
Main Methods:
- Seventy-five children with diagnosed CVI were analyzed.
- An extensive test battery (including visual acuity, contrast sensitivity, ocular alignment, eye movement analysis, visual field analysis, optic nerve head evaluation, and visual perception) and a limited test battery (excluding eye movement and visual field analysis) were employed.
- Principal component analysis (PCA) followed by cluster analysis was performed on data from both batteries to identify CVI subtypes.
Main Results:
- The extensive test battery identified four CVI subtypes, while the limited battery identified three.
- A novel subtype, 'lower-level visual function deficits,' was identified exclusively by the extensive battery, characterized by deficits in lower-level visual functions and abnormal eye movements.
- The extensive battery provided a more detailed classification, revealing additional visual pathway defects and abnormal eye movement behaviors in certain subtypes compared to the limited battery.
Conclusions:
- The study successfully established data-driven CVI subtype classifications.
- An extensive test battery offers significant added value over a limited battery for accurate and comprehensive CVI classification in children.
- These findings provide a new direction for CVI diagnosis and classification strategies.
Purpose:
To classify CVI subtypes and compare the added value of an extensive test battery over a limited test battery in subtype classification of cerebral visual impairment (CVI) in children.
Methods:
Seventy-five children with a clinical diagnosis of CVI (median [IQR] age: 9 [7-12] years) were identified from the medical records. The extensive test battery included visual acuity, contrast sensitivity, ocular alignment, eye movement analysis, visual field analysis, optic nerve head evaluation, and evaluation of visual perception. The limited test battery included visual acuity, contrast sensitivity, ocular alignment, and evaluation of visual perception. Principal component analysis (PCA) followed by cluster analysis was done, for both test batteries separately, to determine the optimum subtype classification for CVI.
Results:
Fifty-one participants with an extensive test battery with mild to moderate visual impairment were included in the main analysis. This resulted in four CVI subtypes for the extensive test battery (subtle characteristics, higher-level visual function deficits, lower-level visual function deficits, and higher- and lower- level visual function deficits) and three CVI subtypes for the limited test battery (subtle characteristics, higher-level visual function deficits, and higher- and lower- level visual function deficits). There were significant differences between the subtypes for 9 out of 10 measures of the extensive and all 4 measures of the limited test battery (p < 0.05). The subtle characteristics subtype (extensive n = 19, limited n = 15) showed near normal lower and higher-level visual functions in both test batteries. The higher-level visual function deficits subtype (extensive n = 18, limited n = 24) showed near normal visual acuity combined with significant visual perceptual deficits in both test batteries; accompanied by visual pathways defects and abnormal eye movement behavior in the extensive test battery. The higher- and lower- level visual function deficits subtype (extensive n = 4, limited n = 12) showed both higher and lower-level visual function deficits in both test batteries, but application of the extensive test battery revealed additional visual pathways defects and abnormal eye movement behavior. The lower-level visual function deficits CVI subtype (extensive n = 10) was a new subtype identified by the extensive test battery. This subtype showed lower-level visual function deficits together with abnormal eye movement measures.
Conclusion:
This data-driven study has provided meaningful CVI subtype classifications based on the outcomes of various key functional and structural measures in CVI diagnosis. Comparison of the extensive test battery to the limited test battery revealed the added value of an extensive test battery in classifying CVI. The outcomes of this study, therefore, have provided a new direction in the area of CVI classification.
