Visual Function and Neuropsychological Profile in Children with Cerebral Visual Impairment

Abstract

Cerebral Visual Impairment (CVI) has become the leading cause of children’s visual impairment in developed countries. Since CVI may negatively affect neuropsychomotor development, an early diagnosis and characterization become fundamental to define effective habilitation approaches. To date, there is a lack of standardized diagnostic methods to assess CVI in children, and the role of visual functions in children’s neuropsychological profiles has been poorly investigated. In the present paper, we aim to describe the clinical and neuropsychological profiles and to investigate the possible effects of visual functions on neuropsychological performance of a cohort of children diagnosed with CVI. Fifty-one children with CVI were included in our retrospective analysis (inclusion criteria: verbal IQ > 70 in Wechsler scales; absence of significant ocular involvement). For each participant, we collected data on neuropsychological assessment (i.e., cognitive, cognitive visual, and learning abilities), basic visual functions (e.g., Best Corrected Visual Acuity—BCVA, contrast sensitivity, and ocular motor abilities) and global development features (e.g., neurological signs and motor development delay) based on standardized tests, according to patients’ ages. The results showed that oculomotor dysfunction involving saccades and smooth pursuit may be a core symptom of CVI and might have a significant impact on cognitive visual and other neuropsychological abilities. Furthermore, visual acuity and contrast sensitivity may influence cognitive, cognitive visual, and academic performances. Our findings suggest the importance of a comprehensive assessment of both visual and neuropsychological functions in children when CVI is suspected, which is needed to provide a more comprehensive functional profile and define the best habilitation strategy to sustain functional vision.

Visual function in children with Joubert syndrome

“…because of saccadic dysfunction or nystagmus) can affect visual performance, particularly in visual crowding conditions, and have a negative impact on cognitive and academic performance (especially reading). 44,45 Our work mainly focused on the first two components of visual function (i.e. to see and to look) because it was not possible to gather comparable data on visual cognitive aspects (owing to the wide range of age and severity of clinical picture).…”

“…The inability to start and maintain proper target fixation (e.g. because of saccadic dysfunction or nystagmus) can affect visual performance, particularly in visual crowding conditions, and have a negative impact on cognitive and academic performance (especially reading) 44, 45 . Our work mainly focused on the first two components of visual function (i.e.…”

Visual and cognitive profiles in children with and without cerebral visual impairment

“…The outcome in visual-perceptual abilities is not comparable because the authors only reported data on 27 subjects. In the study by Morelli et al (2022), 51 children with a neurological diagnosis were assessed at an average age of 9 years (range: 5-18 years). Eye movement disorders were identified as 'core symptom of CVI', in particular disordered saccadic and smooth pursuit eye movements present at an early stage.…”

Toward Removing Barriers in the Evaluation, Diagnosis, and Care of Individuals With Cerebral Visual Impairments

“…Without early identification and continued follow up, results from CVI anomalies can cascade and become ingrained into other functional domains such as language, gross and fine motor, socialization, and cognition (Lueck et al, 2021). These more complex and confounding consequences may not be identified and addressed through available educational assessments and can lead to additional functional and learning needs down the line for students who have CVI (Lueck et al, 2021; Morelli et al, 2022).…”

“…Because CVI is so varied in its expression, the types of educational interventions required are extensive and need to address multidimensional concerns that go beyond vision and visual-perceptual skills. This includes vision use in functional tasks, decoding multisensory information, compensatory strategies, consideration of CVI's broader impact on other domains of function (Bauer et al, 2023; Ben Itzhak et al, 2021; Chorna et al, 2017; Lueck & Dutton, 2015; Morelli et al, 2022; Overbeek et al, 2022; Philip, n.d.; Pilling, 2023; Weden et al, 2022). Moreover, interventions are not just visual or related to other domains of development or functional skills; many with CVI have developed issues with confidence, have anxiety, social difficulties and mental health problems including depression.…”