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Preverbal visual assessment for screening cerebral visual impairment: Diagnostic accuracy and clinical utility
Karen L Harpster1,2,3, Terry L Schwartz4,5, Alaina Johnson6
1Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
The Preverbal Visual Assessment (PreViAs) effectively screens for cerebral visual impairment (CVI) in at-risk children. High concern in visual processing on PreViAs indicates potential CVI, warranting further evaluation.
Area of Science:
- Pediatric Ophthalmology
- Developmental Neuroscience
- Clinical Vision Science
Background:
- Cerebral visual impairment (CVI) significantly impacts child development.
- Early detection of CVI is crucial for timely intervention.
- Effective screening tools are needed for identifying children at risk for CVI.
Purpose of the Study:
- To assess the diagnostic accuracy of the Preverbal Visual Assessment (PreViAs) in identifying cerebral visual impairment (CVI).
- To evaluate the relationship between PreViAs results and confirmed CVI diagnoses in young children.
Main Methods:
- Retrospective chart review of children evaluated between May 2018 and May 2023.
- Inclusion criteria: completed CVI interdisciplinary clinic or occupational therapy vision evaluation and a PreViAs.
- Statistical analysis included sensitivity, specificity, AUC, and Fisher's exact test.
Main Results:
- 98 children (81 with CVI, 17 without) met criteria; ages 3-50 months.
- Visual processing domain of PreViAs showed highest concern frequency (94% CVI vs. 76% non-CVI).
- Visual processing achieved highest sensitivity (93.8%); visual attention showed balanced sensitivity (71.6%) and specificity (58.8%).
Conclusions:
- The PreViAs demonstrates utility as a sensitive screening tool for CVI in high-risk pediatric populations.
- Concerns identified in the visual processing domain of PreViAs are strongly associated with CVI.
- Referral for interdisciplinary CVI evaluation is recommended for children with PreViAs concerns.
Aim:
To evaluate the relationship between Preverbal Visual Assessment (PreViAs) results and cerebral visual impairment (CVI) diagnosis.
Method:
This single-center retrospective chart review included children who completed a CVI interdisciplinary clinic or occupational therapy vision evaluation between May 2018 and May 2023 and had a completed PreViAs. Data were extracted from the electronic medical record. Data analysis included sensitivity, specificity, area under the curve, and Fisher's exact test.
Results:
Of the 205 charts screened, 98 met study criteria (81 with CVI, 17 without); ages ranged from 3 to 50 months. The mean age of children with CVI was 15.41 months (SD = 8.93) and without was 13.24 months (SD = 5.98). Among the PreViAs domains, visual processing showed the highest frequency of concern (CVI = 94%; non-CVI = 76%), while visual attention had the lowest (CVI = 72%; non-CVI = 41%). Visual processing demonstrated the highest sensitivity (93.8%), whereas visual attention showed the best balance of sensitivity (71.6%) and specificity (58.8%). Area under the curve ranged from 0.59 to 0.66. All domains demonstrated significant differences between children with and without CVI (Fisher's exact test, p < 0.05).
Interpretation:
Effective screening tools are critical for detection of CVI. The PreViAs is a sensitive screening tool in children at high risk for CVI. Children with concerns on the PreViAs should be referred for an interdisciplinary CVI evaluation.
