Is there consensus in defining childhood cerebral visual impairment? A systematic review of terminology and definitions

Abstract

The childhood condition of visual difficulties caused by brain damage, commonly termed cortical or cerebral visual impairment (CVI), is well established but has no internationally accepted definition. Clarification of its core features is required to advance research and clinical practice. This systematic review aimed to identify the definitions of childhood CVI in the original scientific literature to describe and critically appraise a consensual definition of the condition. MEDLINE, EMBASE, PsychINFO, CINAHL and AMED databases were searched in January 2017. Studies were included if they (1) were published original research, (2) contained a childhood CVI sample, (3) contained a definition of CVI and (4) described their CVI identification/diagnostic method. Thematic analysis identified concepts within definitions and narrative synthesis was conducted. Of 1150 articles, 51 met inclusion criteria. Definitions were subdivided according to detail (descriptive definition, description not reaching definition status and diagnostic/operationalising criteria). Three themes concerning visual deficits, eye health and brain integrity were identified (each containing subthemes) and analysed individually across definitions. The most common themes were visual impairment' (n=20), 'retrochiasmatic pathway damage'(n=13) and 'normal/near normal eye health' (n=15). The most consensual definition identified here may not be the best quality for advancing our understanding of CVI. We argue for the alternative definition: verifiable visual dysfunction which cannot be attributed to disorders of the anterior visual pathways or any potentially co-occurring ocular impairment. We propose reporting guidelines to permit comparison across studies and increase the evidence base for more reliable clinical assessment and diagnosis.

Health‐related quality of life, pain, and fatigue in young adults with cerebral palsy

“…In the interview and the clinical history, the following condition-specific clinical items were collected and confirmed by chart reviews: (1) any known genetic/chromosomal disorder; (2) epilepsy, defined as current diagnosis of epilepsy; (3) osteoporosis, screened through history of any pathological fractures; (4) medications, including muscle tone management; (5) cerebral visual impairment, defined as a dysfunction of vision, not attributable to primary ocular impairments or lesions in the anterior visual pathways, as diagnosed by a neuro-ophtalmologist and/or child neurologist; 23 (6) sleep problems, identified by asking participants to rate their general sleep quality and quantity as problematic or not, followed by questions on sleep medications; (7) prescribed walking aids, orthotics, and other assistive devices; (8) whether the individual was registered at adult rehabilitation services; and (9) contacts with a medical doctor in the last 12 months on CP-related issues.…”

Clinical use of the Insight Inventory in cerebral visual impairment and the effectiveness of tailored habilitational strategies

“…Cerebral visual impairment (CVI) refers to visual impairment caused by pathology in the retrogeniculate visual pathways and visual association areas of the brain. 1,2 CVI is the most common cause of visual impairment in children in industrialized countries 3,4 but evidence about effective assessment and management strategies is lacking. 1,2 Standard visual acuity testing is an insufficient method of quantifying CVI in children as it does not detect visual-perceptual or perceptuomotor disorders.…”

“…1,2 CVI is the most common cause of visual impairment in children in industrialized countries 3,4 but evidence about effective assessment and management strategies is lacking. 1,2 Standard visual acuity testing is an insufficient method of quantifying CVI in children as it does not detect visual-perceptual or perceptuomotor disorders. 5 A validated clinical question set, the Insight Inventory, has been developed as a 52-item checklist for structured history-taking, which assesses a wide range of features of CVI.…”

Deficiencia visual cerebral. ¿Cuánto y cómo ve mi hijo?

“…Internacionalmente se utiliza el acrónimo CVI, derivado tanto de las siglas en inglés de deficiencia cortical visual (Cortical Visual Impairment), término más usado en Norteamérica, o de deficiencia visual cerebral (Cerebral Visual Impairment), que es el más utilizado en Europa. Otras terminologías como ceguera cortical o ceguera cerebral no se usan prácticamente en los artículos especializados (Sakki et al, 2017). Aquí se ha decidido usar deficiencia visual cerebral ya que engloba mejor al grupo de personas con deficiencia visual a causa de enfermedades y/o problemas neurológicos, que afectan tanto a las áreas corticales y no corticales del cerebro (Frebel, 2007).…”