An abnormal pre- or perinatal medical history is the most important risk factor for CVI in children, and therefore in deciding which children should be referred for further multidisciplinary assessment. Additional symptoms of cerebral damage, i.e., cerebral palsy, visual field defects, partial optic atrophy, and a CR ≥2 may support the diagnosis. CVI questionnaires should not be used for screening purposes as they yield too many false positives.
Aim
To estimate how many children in mainstream primary schools have cerebral visual impairment (CVI)‐related vision problems and to investigate whether some indicators might be useful as red flags, if they were associated with increased risk for these problems.
Method
We conducted a survey of primary school children aged 5 to 11 years, using whether they were getting extra educational help and/or teacher‐ and parent‐reported behaviour questionnaires to identify children at risk for CVI. These and a random 5% sample were assessed for CVI‐related vision problems. We compared the usefulness of potential red flags using likelihood ratios.
Results
We received questionnaires on 2298 mainstream‐educated children and examined 248 children (152 [61%] males, 96 females [39%]; mean age 8y 1mo, SD 20mo, range 5y 6mo–11y 8mo). We identified 78 out of 248 children (31.5% of those examined, 3.4% of the total sample), who had at least one CVI‐related vision problem. The majority (88%) were identified by one or more red flag but none were strongly predictive. Fewer than one in five children with any CVI‐related vision problem had reduced visual acuity.
Interpretation
Children with CVI‐related vision problems were more prevalent than has been appreciated. Assessment of at‐risk children may be useful so that opportunities to improve outcomes for children with CVI‐related vision problems are not missed.
With commonly available tests the CR can easily be determined in school age children. For children >6 years of age, a CR > 2.0 (i.e. at least 3 lines difference between the result of a single optotype acuity test and a line acuity test) is suspicious and warrants further investigation. It may, for example, be a sign of cerebral visual impairment (CVI).
We designed a cerebral visual impairment (CVI)–experience toolbox containing simulation exercises to let professionals experience the complexity of visual information processing and to get an impression of what it means to have CVI. We measured the benefits of the CVI Experience toolbox by using questionnaires during three CVI seminars with professionals ( n = 69). These seminars started with a slide presentation on CVI followed by the CVI experience toolbox. We presented the professionals with the same survey on their knowledge of CVI at the start of the seminar, after the presentation, and after the toolbox. Professionals with more previous CVI experience started on average with a higher score. The final end score, however, did not seem to depend on previous experience. Furthermore, the added value of the experience toolset was quite independent of the added value of the presentation. The results indicate that both the presentationand the experience toolboxadd to the understanding of CVI.
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