Cerebral Visual Impairment in Children

Abstract

Cerebral visual impairment (CVI) is vision loss as a result of damage to the retrogeniculate pathway of the visual system in the absence of any ocular pathology and with the improvement of perinatal care and increased survival of the preterm babies, it accounts for the leading cause of visual impairment today. Perinatal hypoxic ischemic encephalopathy has been the most common cause of CVI. Morphology of lesion due to hypoxic ischemic injuries to the retrogeniculate visual pathways varies with the timing of the event and the mechanism. Injury during the first trimester results in congenital malformations. Liquefaction necrosis and tissue resorption without any gliotic changes are the major pathological changes. However, damage during the late second to third trimester causes periventricular leukomalacia from ischemic damage followed by gliosis of the subcortical areas. A careful assessment of functional vision as well as level of visual acuity is the first and foremost step in managing these children. Rehabilitation strategies form the backbone of complete management of children with CVI. Every child needs different and special services based on their functional visual and neurological deficit. A multidisciplinary approach is always the mainstay of treatment. Nevertheless, parental education and their cooperation optimises the management outcomes in children with cerebral visual impairment. Prompt diagnosis and timely intervention in terms of neurological, ophthalmological and rehabilitation services always has a rewarding result for children with CVI and their parents.