Cortical Visual Impairment In Children Research Articles

Children With Cortical Visual Impairment and Complex Communication Needs: Identifying Gaps Between Needs and Current Practice.

Purpose This scoping study sought to establish a baseline for how well the needs of children with cortical visual impairment (CVI) who use augmentative and alternative communication (AAC) are currently aligned with the services available to them. CVI is the most common cause of visual impairment in children today, and AAC methods rely heavily on vision. Yet, the prevalence of CVI in children who use AAC methods is not yet known, and there is virtually no research concerning use of AAC with children with CVI. Our overarching goals were to identify barriers and suggest priorities for improving outcomes for these children. Method Surveys were distributed anonymously online to professionals from multiple disciplines in different school-based settings and to parents of children with CVI who use AAC. Results School-based professionals identified many barriers, including a lack of knowledge and skills about CVI and about AAC, limited access to training and experts, and concerns about services being delivered in isolated silos with limited time allotted for interprofessional collaboration and planning. Parent reported that their children (M age = 11 years) continued to rely predominantly on body-based forms of communication and lacked access to symbolic language, which, in AAC, is primarily visually based. Conclusions The barriers to services identified by school-based professionals indicate a need to develop and disseminate reliable information about CVI and AAC, both at a preservice and in-service level and, while doing so, to respect the diversity of stakeholders who need this information, including parents. Future research on what types of AAC approaches support the development of language and communication skills for children with CVI is essential.

Cortical Visual Impairment in Children − Aetiology, Clinical Findings and Neurological Findings

Objectives: To evaluate the demographic profile, aetiology, systemic and ocular associations and findings on neuroimaging, of children with cortical visual impairment (CVI) at a tertiary eye hospital in South India. Materials and Methods: Records of 85 children with CVI, undertaking visual stimulation therapy (VST), were retrospectively analysed between March 2016 and March 2018. The data obtained was analysed for the age and gender profile, aetiology, cycloplegic refraction, fundus evaluation, MRI findings, pre and post visual stimulation therapy vision. Other associated ocular and neurological abnormalities were also noted. Results: The records of 63 boys and 22 girls were analysed. The mean age was 1.93 years with 58.8% aged esotropia) in 40 (47%), nystagmus in 34 (40%) while pale disc in 31 (36.5%) patients. Fifty-five(64.7%) children had associated developmental delay, while 40 (47%) had seizures. Other neurological associations noted were, cerebral palsy (14.1%), microcephaly (14.1%), hearing loss in 5 and hemiparesis in 1 patient. MRI abnormalities were present in 65 (76.4%), with ischemic encephalopathy (32.9%) being the most common change noted. Conclusion: In our study cohort, HIE was found to be the most common cause of CVI, with refractive error and strabismus being the common ocular associations, while seizures and developmental delay were the common neurological associations. Neuroimaging showed that the structural insult was at both the cortical and white matter levels.

Cortical Visual Impairment in Congenital Cytomegalovirus Infection.

To describe the presentation, evolution, and long-term outcome of cortical visual impairment (CVI) in patients with symptomatic congenital cytomegalovirus (CMV) infection, and to identify risk factors for the development of CVI in patients with symptomatic congenital CMV. Retrospective subanalysis of a long-term prospective cohort study with data gathered from 1982 to 2013. Eleven of 77 (14.3%) patients with symptomatic CMV, 0 of 109 with asymptomatic CMV, and 51 control patients had CVI. Overall, patients with symptomatic CMV had worse vision than patients with asymptomatic CMV, who in turn had worse vision than control patients. Microcephaly, intracranial calcification, dilatation of ventricles, encephalomalacia, seizure at birth, optic atrophy, chorioretinitis/retinal scars, strabismus, and neonatal onset of sensorineural hearing loss were risk factors associated with CVI. CVI may result from symptomatic congenital CMV infection. The relationship of CVI and its risk factors in patients with CMV suggests the potential to predict the development of CVI through predictive modeling in future research. Early screening of CVI in children born with symptomatic congenital CMV can facilitate educational, social, and developmental interventions. [J Pediatr Ophthalmol Strabismus. 2019;56(3):194-202.].

A pilot study regarding basic knowledge of "cortical visual impairment in children" among ophthalmologists.

Purpose:A pilot study was done to evaluate knowledge regarding “cortical visual impairment (CVI) in children” among ophthalmologists.Methods:This study was conducted during the annual conference of a zonal ophthalmological society. All ophthalmologists who attended the conference were requested to participate in this study. Those who agreed were given a validated questionnaire to assess knowledge regarding CVI. Cronbach's alpha of the questionnaire was 0.6. Participants were asked to respond to multiple choice questions by choosing the single best option. The responses obtained were then evaluated.Results:The total number of registered delegates in the conference was 448. A total of 103 ophthalmologists showed interest to participate in the study with a response rate of 22.9%. Only 89/103 interested delegates were included in the study as remaining were unaware of CVI. No participant gave correct answers to all questions. Although more than 80% of them knew the most common association (87%) and site of pathology (84%), only 52% were sure about clinical features and even lesser respondents (39%) knew that magnetic resonance imaging is the correct investigation of choice. The majority responded correctly that these children need eye examination (89%) and can be managed by rehabilitation through multidisciplinary approach (82%), but only 58% could recognize differential diagnoses and had a correct idea regarding the prognosis of CVI. There was no correlation between the number of patients diagnosed per month by the respondent with knowledge of the disease.Conclusion:In this pilot study, ophthalmologists were found to have limited knowledge regarding clinical features, investigation, differential diagnosis, and visual prognosis of CVI in children. There is a need to improve awareness regarding CVI among ophthalmologists.

Cortical visual impairment in children with acute encephalitis syndrome

Background: Acute encephalitis syndrome (AES) is one of cortical visual impairment (CVI) causes. There were only few studies about cortical visual involvement in children with AES. Objective: To describe CVI in children with AES. Methods: This study included all children with AES during January to March 2014, were examined for visual evoked potential (VEP) to evaluate cortical visual pathway. AES was defined as clinical condition characterized by acute onset of fever, a change in mental status, and/or new onset of seizures. CVI was defined as vision loss caused by central nervous system damage confirmed by VEP. Results: There were 9 children with AES and all showed bilateral CVI. The age range between 6 to 48 months old, with 7 males and 2 females. Visual evoked potential result showed 8 children with demyelinating type and 1 with axonal type. Conclusion: Type of CVI caused by AES can be demyelinating type or axonal type.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.249-251

Human Embryonic Stem Cell Therapy in Cerebral Palsy Children with Cortical Visual Impairment: A Case Series of 40 Patients

Background: Use of human embryonic stem cells (hESCs) has been explored for treatment of cortical visual impairment (CVI) in children with cerebral palsy (CP). Objectives: The study evaluated efficacy and safety of hESC therapy in 40 CP children with CVI. Methods: The study had four treatment phases (T1, T2, T3, and T4) separated by gap phases. Patients were evaluated for visual impairment using Nutech Functional Scores (NFS). Results: Of 40 patients included in study, 8 had NFS level (were blind/ had no perception of light); 16 had level2 (perception of light); 10 had level (could identify blurred images); and 6 had level 4 (could see objects up to a distance of 25 cm from the eye). After therapy, 27 patients gained normal vision; 10 patients could see objects 25 cm from the eye; 2 patients could see blurred images; and 1 had perception of light. Overall, 39 patients showed improvement in NFS by at least one level. In SPECT scan, 2 patients had normal perfusion, 18 had significant improvement and 3 had moderate improvement. Conclusion: Use of hESC therapy in patients with CVI showed beneficial results for treatment of CVI in children with CP.

Cortical visual impairment in children

Cortical visual impairment (CVI) is a major cause of visual loss in children worldwide. The definition of this condition is constantly evolving with respect to definition, identifying those at risk and technology for diagnosis. These advances can be used for early diagnosis, design of accommodations and services, as well as future therapies and prevention strategies. Clinical questionnaires are being developed and tested for reliability in an attempt to identify those at risk for CVI. The definition is constantly being modified and now includes deficits in vision-guided motor planning and higher level executive functions. Neuroimaging techniques, such as MRI, functional MRI, and diffusion tensor imaging; electrophysiologic testing, such as sweep visual-evoked potentials; and perceptual testing, allow for further refinements in correlating structural defects and deficits in function. Recent developments will allow identification of those children at risk for CVI and earlier interventions for specific deficits. A child's performance is built on previously mastered skills, making timely prediction of deficits and intervention essential.

Cortical visual impairment in children - A new challenge for the future?

Cortical visual impairment in children - A new challenge for the future?

Guest Editors’ Page

Issues related to vision and the brain have been moving to the forefront of medical, educational, and rehabilitation services for children and adults with vision impairment over the past 10 years. In our commentary, covering some 60 years, we address the relatively recent increase in the numbers of children and adults with vision conditions related to brain injury, which parallel developments occurring when our professional field began, and when large numbers of wounded veterans returned blinded from combat during World War II. Then as now, professionals who work with children and adults with new, emerging causes of vision loss needed exposure to curricula containing relevant information. Today the challenge is to provide information and skills relevant to the interplay between the brain and vision to meet the needs of a burgeoning population. A number of faculty have provided perspectives in this issue of the Journal of Visual Impairment & Blindness (JVIB) on the extent to which this material has been included in their programs, and they have highlighted the challenges associated with them. Terminology is also a significant issue that must be considered by the medical, rehabilitation, and special education communities. Terminology affects the identification of conditions and those who experience them, qualification for services, and data collection methods. It can also affect the ways in which education and rehabilitation treatment options and programs are developed, as well as the content of personnel preparation programs and the types of personnel preparation programs that must address issues related to vision and the brain. The commentary by Colenbrander in this issue of the journal addresses terminology. For the remainder of this editorial, we will use the terms CVI/ABI (cerebral visual impairment/acquired brain injury) to refer to visual impairment and visual dysfunction due to brain injury (including traumatic brain injury, TBI) in children and adults. This special issue of JVIB contains articles that address many of the challenges confronting today's practitioner. Lueck's commentary examines changes in our understanding of the nature of CVI in children. The slow emergence of multidisciplinary services that address CVI/ABI has made it difficult for many to find appropriate, comprehensive assistance. The impact of CVI/ABI on families and access to appropriate services comes to the foreground in the article by Jackel and colleagues. Assessment provides the basis for these services, and the article by Newcomb discusses one assessment tool developed to evaluate the traditional hallmarks of cortical visual impairment in children. Changes over time seen in children with cortical visual impairment using this instrument are discussed in the Research Report by Roman Lantzy and Lantzy. Intervention is another major concern for adults and children with CVI/ABI. Lam and his colleagues present a case study that includes intervention recommendations for a child with near-normal visual acuity but whose brain injury still leads to visual processing difficulties that severely affect functional vision. Relevant to adults, Kingston and colleagues present a case study from assessment to intervention that reflects a model program under development at the U.S. Department of Veterans Affairs (VA) medical center in Palo Alto, California. This presentation emphasizes the importance of multidisciplinary teams and the impact of multifaceted forms of assessment and interventions on maximizing outcomes. Now that we have mentioned the range of topics that are included in this special issue, topics that cover a great deal of ground, we would like to discuss areas that have not been covered. We do this to emphasize the broad scope of material that must be addressed as our field develops an evidenced-based body of knowledge that leads to adequate and appropriate services for children and adults with CVI/ABI. …

Cortical visual impairment in children

Cortical visual impairment is rapidly becoming a leading cause of visual loss in children in developed countries predominately because of the improved survival rates of premature infants over the past decade. Most cases of cortical visual impairment arise from hypoxic ischemic injury to watershed areas of the brain. In the preterm infant the watershed areas are in the subcortex around the ventricles, while in the term infant the watershed areas are between the major arteries with injury to the subcortex and cortex. Therefore, preterm and term injury will manifest different ocular and visual system abnormalities as a result of this damage. Cognitive visual dysfunction, a type of cortical visual impairment, may occur in cases of damage to the peristriate cortex (association areas of the brain). The anterior visual pathways may also be damaged in a retrograde, transsynaptic fashion in cases of cortical visual impairment. Cortical visual impairment is a prevalent cause of visual loss in children. It encompasses a wide range of visual disabilities from no light reception to normal visual acuity with cognitive visual dysfunction.

Cortical visual impairment in children with infantile spasms

Background: Infantile spasms are often associated with cortical visual impairment. Method: We report a series of 10 patients with infantile spasms, hypsarrhythmic electroencephalograms, and developmental delay, (ie, West syndrome), who presented with severe visual inattention despite a normal ocular examination. Results: At follow-up (14 months to 6 years), 5 patients (50%) had no improvement in their visual behaviour. Although some degree of improvement was observed in the others, their visual function remained abnormal. All patients had moderate or severe mental retardation. Conclusions: The clinical features of West syndrome are reviewed, and the cause of the associated cortical visual impairment is discussed. Cortical visual impairment with infantile spasms is an important association, which pediatric ophthalmologists should recognize. (J AAPOS 2000;4:175–8)

Cortical visual impairment in children with infantile spasms

Cortical visual impairment in children with infantile spasms

Chronic cortical visual impairment in children: aetiology, prognosis, and associated neurological deficits

BACKGROUND/AIMSTo evaluate prevalence, aetiology, prognosis, and associated neurological and ophthalmological problems in children with cortical visual impairment (CVI).METHODSThe records of 7200 outpatients seen in the paediatric ophthalmology practice over the...

Understanding Cortical Visual Impairment in Children

This article presents a review of the literature and a case study on a child with cortical visual impairment. The literature review covers the diagnosis, etiology, prevalence, prognosis, and a comparison of the differences between children with cortical visual impairment and those with ocular impairment. The case study presents occupational therapy intervention strategies specific to cortical visual impairment and results of treatment.

Cortical Visual Impairment in Children

Cortical visual impairment (CVI) in children is most commonly caused by peri- or post-natal hypoxia-ischemia, but may also occur following other insults, e.g., trauma, epilepsy, infections, drugs or poisons, and certain neurologic diseases. The disorder differs considerably in etiology, physical findings, and, perhaps, prognosis, from the cortical blindness seen in adults. The same event that causes CVI by damaging the geniculate and/or extrageniculate visual pathways may also damage other areas of the brain, or the retina, optic nerves, or chiasm. Thus, children with CVI often have other neurological problems. Diagnosis may require the participation of a multidisciplinary team and the use of special visual testing techniques. Due to the uncertainty concerning the prognosis in CVI, clinicians should remain optimistic about the child's potential for some vision recovery.