104 Assessing vision in non-verbal children with severe disability: outcomes of assessments in different settings

Abstract

Background Children with disability are at increased risk of visual problems, often arising directly from underlying cerebral pathology. The use of the term ‘cerebral visual impairment’ (CVI) is increasing although a clear definition is lacking. Visual difficulties may include reduced acuity, oculomotor impairment and poor visual attention. However non-visual factors such as cognitive or social impairment may also impact on responsiveness to visual materials, creating assessment challenges. Aims A retrospective review was conducted of 26 children with severe disability (severe movement limitation and no/minimal speech) and possible severe visual impairment who were all seen within Ophthalmology and Neurodisability, over a 4 year period Apr 2013 – Mar 2017). Data was extracted on the reason for referral, vision history details, type of assessments conducted, interpretation of findings, and consequent practical advice. Results An ophthalmological assessment was usually preceded by Orthoptic assessment and always included refraction, fundoscopy and basic fixing/following responses as well as history taking. Acuity measures, where obtained, sometimes lacked interpretation. The term CVI was used without precise specification and practical advice was not always given. Regular reviews over long time periods were noted for some children. A longer multidisciplinary Neurodisability assessment included more extensive history taking and considered a wider range of influences on poor visual responses; some children diagnosed with CVI by Ophthalmology were found during Neurodisability assessment to have alternative reasons for poor visual responses. Conclusion Ophthalmology assessment is an essential part of vision evaluation in children with severe neurodisability, however, conclusions from vision assessment are sometimes not clearly drawn and opportunities to ensure appropriate functional adaptation of visual materials may be missed. In addition, non-visual influences on visual responses may not be identified. A detailed multidisciplinary neurodevelopmental assessment can provide more precise explanations of poor visual responses plus detailed practical advice relevant to overall neurodevelopmental status.