Profiling Children With Cerebral Visual Impairment Using Multiple Methods of Assessment to Aid in Differential Diagnosis

Abstract

Cerebral (cortical) visual impairment (CVI) is the primary cause of visual impairment in children in high-income countries. It is increasing globally due to improved life-saving measures for premature and full-term infants. Yet the consequences of this condition are only beginning to be understood and addressed. In contrast to visual impairment due to refractive error and disorders of the eye, there is limited public awareness of CVI, and the consequent impairment of a variety of visual capabilities may go unidentified, adversely affecting cognitive, motor, and social development. CVI refers to visual perception deficits not related to the peripheral (i.e., prechiasmatic) system disorder, but rather, to injury to brain areas serving assimilation, integration, and interpretation of visual information. According to the topography, site, and the extent of the pathology, the deficit may variably concern central visual functions, the visual field, perception of movement, visual analysis, visual exploration and attention, or visual memory, as well as visual guidance of movement. Each affected child has a unique clinical picture, which needs to be identified and individually profiled. This is probably the underlying reason that CVI is commonly underdiagnosed, especially in children, and, as a consequence, the full range of potential behavioral outcomes are not identified and adequately addressed. The present paper shows how the use of multiple methods of assessment can improve the understanding of children with CVI.

The inter-relationships between cerebral visual impairment, autism and intellectual disability

“…CVI includes deficits in primary visual functions, and also, all cognitive and motor aspects of vision. As the impairments of visual perception and cognition due to CVI and their impact have yet to be fully understood, they are currently being studied to provide understanding of how they may contribute to the complex puzzle of disorders of learning, developmental coordination, and social-interaction (Chokron and Dutton, 2016;Fazzi et al, 2019;Lehman, 2012;Lueck and Dutton, 2015;Lueck et al, 2019).…”

Cortical visual impairment: Diagnostic criteria and treatment elements

“…Stoga takozvanu radnu definiciju oči su redu, ali ne i mozak treba dopuniti naznakom da se stepen vizuelne disfunkcije kod CVI ne može objasniti oboljenjem vizuelnog sistema pre hijazme (Martín et al, 2016;Sakki et al, 2018). Cerebralno oštećenje vida je krovni termin koji obuhvata vizuelne i vizuelno-perceptivne smetnje koje nisu direktno povezane s oštećenjem perifernog dela vizuelnog sistema, već s disfunkcijama cerebralnih područja uključenih u integraciju i interpretaciju vizuelnih informacija (Goodale, 2013;Lueck, Dutton, & Chokron, 2019). Bez posebnog koda i deskriptora u Međunardnoj klasifikaciji bolesti (ICD) terminološka neujednačenost ostaje nerešena, pa izbor sredstava za procenu i dijagnostiku i dalje zavisi od njihove dostupnosti i nahođenja kliničara i istraživača.…”

Ophthalmologic approach to babies with cerebral visual impairment

“…1 In addition, disorders that may present with symptoms and findings similar to those of CVI, such as autism spectrum disorders, developmental coordination disorders, delayed visual maturation, learning difficulties, bilateral central scotoma, dyskinetic eye movement disorders, and mental retardation, should be kept in mind in the differential diagnosis. 19,20 In CVI, ocular structures are generally completely normal, or the pathologies are not sufficient to explain visual loss. In these patients, some parts of the brain, such as the visual cortex or visual pathways, are damaged, and abnormal findings can be detected by imaging methods.…”