Vision Center Research Articles

Agreement of findings of glaucoma screening between trained vision center technicians and glaucoma specialists at a tertiary hospital in South India.

Purpose:To study the agreement of findings of glaucoma screening between trained vision center (VC) technicians and glaucoma specialists in patients referred from VC to the glaucoma services of a tertiary eye care hospital in south India.Methods:This was a retrospective study comparing the findings of the VC technicians and the specialists of the glaucoma services in the base hospital, in patients referred from 13 VCs between January and June 2019. Medical records of 277 referred patients (out of 533 referrals) who attended the glaucoma clinic were analyzed.Results:Of the 277 patients, 111 (40%) were confirmed having glaucoma, 133 (48%) were suspects, 29 (10.4%) were normal, and four (1.4%) had other pathology. The mean age of the patients was 59.7 ± 13 years and 60.6% were females. There was no statistically significant difference between the mean intraocular pressure (IOP) measured (17 ± 7.2 mmHg at the VC and 18 ± 8.7 mmHg at the clinic, p = 0.16) and the cup-to-disc ratio (CDR) (0.7 ± 0.13 at the VC and 0.6 ± 0.18 at the clinic, p = 0.57). Bland–Altman plots with 95% limits of agreement supported that mean differences were close to zero, and the intraclass correlation coefficient at 95% CI showed good consistency between the measurement of IOP (0.78 [0.74 to 0.81]) and CDR (0.90 [0.88 to 0.92]) at the base hospital and vision center.Conclusion:There is good agreement between the findings of VC technicians and glaucoma specialists. VC technicians can help in detecting glaucoma in the community.

Causes of Blindness and Visual Impairment in Early Childhood at a Low Vision Service in Mexico City: A 15-year Review

ABSTRACT Purpose: To evaluate the causes of blindness and visual impairment in children aged 0–7 years attending a Low Vision Centre in Mexico City, Mexico. Methods: Clinical records for patients aged 0–7 years attending the Centre from 2001 to 2015 were retrospectively reviewed. Causes of blindness and visual impairment, affected anatomy, and suspected time period of insult were recorded. Results: 1487 patients were included, 45.9% girls and 54.1% boys. Mean age of presentation was 39 months (SD 27.9 months). 36.0% had associated co-morbidities in addition to their ophthalmic pathology. 39.7% presented with developmental or psychomotor delay. Leading diagnoses were Retinopathy of Prematurity (ROP) (19.6%), optic nerve atrophy (11.5%), and congenital cataract (9.5%). The most affected anatomical regions were retina (33.8%), optic nerve (16.6%), and lens (10.5%). Half of all cases (50.9%) had insults in the prenatal period. Children with developmental delay were more likely to present before the age of one. There is a significant difference in risk of delayed presentation according to diagnosis. Only 13.5% of children with optic nerve atrophy presented to the Centre before the age of one, compared to 28.4% of children with ROP and 23.4% of children with cataract. Conclusion: The most common diagnoses for blindness and visual impairment among children were ROP, optic nerve atrophy, and congenital cataract. Late presentation to the Centre was common. There were significant differences in risk of delayed presentation depending on diagnosis. Co-existing systemic conditions and developmental and psychomotor delay were also common among patients attending the Centre.

Telemedicine and GM-2 gangliosidosis (Tay-Sachs) disease - A new savior on the horizon during COVID-19 pandemic.

A 5-month-old term infant with delayed milestones referred by a neonatologist was examined at the vision center using a pediatric fundus camera (3nethra Neo, Forus Health, India)[1] during the COVID-19 (coronavirus disease 2019) pandemic in rural west Uttar Pradesh, India. History of consanguinity was present. A cherry-red spot was noticed at the posterior pole in both eyes.[2] The patient was sent back and magnetic resonance imaging and blood tests were done that revealed white matter demyelination in the periventricular area and decreased level of hexosaminidase A and B (quantitative GM2 gangliosidosis 55.79 nmol/mg)[3] suggestive of Tay–Sachs disease. Telemedicine while bridging the health care gap in the rural–urban divide, bridged the gap between the suspicion and the diagnosis, too [Fig. 1].Figure 1: Use of pediatric fundus camera for detection of Tay–Sachs diseaseFinancial support and sponsorship Nil. Conflicts of interest None of the authors have any proprietary interests or conflicts of interest related to this submission.

Prevalence of Refractive Errors in the Total Population and the Analysis of Myopic Progression in Adults Aged 20 to 39 in the Urban Area of Tirana, Albania

This study is a retrospective analysis of data stored digitally for 13 years in a Vision Center located in the urban area of Tirana, Albania. In a population of 19,686 people (39.5% M and 60.5% F) who met the criteria, there was a prevalence of astigmatism 42% (12% only astigmatism, 30% associated with hyperopia or myopia), myopia 25%, hyperopia 22% and 24% presbyopic prescriptions for the medium and near distance. The myopia progression study (mean spherical equivalent) indicates that 20% of people had no change, 42% had an increase in myopic correction from 0.25D to 0.50D, 17% from 0.75D to 1.00D, 11% from 1.25D to 1.50D, 5% from 1.75D to 2.00D and 5% of the population had myopic progression greater than 2.00D.

Contact Lens Wear, Corneal Complications, and U.S. Service Member Readiness.

Ulcerative keratitis (UK), or corneal ulcer, is a sight-threatening and readiness-lowering medical condition that begins with a corneal infiltrative event (CIE). Contact lens (CL) wear poses a particular risk for a CIE and therefore is restricted for most active duty service members (SMs). In this study, we explored a large Department of Defense/Veterans Affairs (DoD/VA) database to estimate the prevalence of UK and CIE and their association with CL wear. The DoD/VA Defense and Veterans Eye Injury Vision Registry, an initiative of the DoD/VA Vision Center of Excellence, was explored using natural language processing software to search for words and diagnostic codes that might identify cornea injuries and CL wear. The effect of UK and CIE on readiness was explored by evaluating the duration between the first and final visits noted in the database. A total of 213 UK cases were identified among the 27,402 SMs for whom data were recorded in Defense and Veterans Eye Injury Vision Registry. The odds ratios of UK and CIE being associated with CL wear were 13.34 and 2.20, respectively. A less specific code (superficial corneal injury) was found to be the most commonly used diagnosis in the database, and the odds ratio of CL wearers having that diagnosis was 2.25. CL-wearing patients with corneal disease also required more clinic encounters than those who did not wear CLs. This study supports the current restriction on CL wear among nonpilot active duty SMs and quantifies the significantly enhanced risk of developing corneal ulcers posed by that habit.

Exploratory Analysis of Qualitative MR Imaging Features for the Differentiation of Glioblastoma and Brain Metastases.

ObjectivesTo identify qualitative VASARI (Visually AcceSIble Rembrandt Images) Magnetic Resonance (MR) Imaging features for differentiation of glioblastoma (GBM) and brain metastasis (BM) of different primary tumors.Materials and MethodsT1-weighted pre- and post-contrast, T2-weighted, and T2-weighted, fluid attenuated inversion recovery (FLAIR) MR images of a total of 239 lesions from 109 patients with either GBM or BM (breast cancer, non-small cell (NSCLC) adenocarcinoma, NSCLC squamous cell carcinoma, small-cell lung cancer (SCLC)) were included. A set of adapted, qualitative VASARI MR features describing tumor appearance and location was scored (binary; 1 = presence of feature, 0 = absence of feature). Exploratory data analysis was performed on binary scores using a combination of descriptive statistics (proportions with 95% binomial confidence intervals), unsupervised methods and supervised methods including multivariate feature ranking using either repeated fitting or recursive feature elimination with Support Vector Machines (SVMs).ResultsGBMs were found to involve all lobes of the cerebrum with a fronto-occipital gradient, often affected the corpus callosum (32.4%, 95% CI 19.1–49.2), and showed a strong preference for the right hemisphere (79.4%, 95% CI 63.2–89.7). BMs occurred most frequently in the frontal lobe (35.1%, 95% CI 28.9–41.9) and cerebellum (28.3%, 95% CI 22.6–34.8). The appearance of GBMs was characterized by preference for well-defined non-enhancing tumor margin (100%, 89.8–100), ependymal extension (52.9%, 36.7–68.5) and substantially less enhancing foci than BMs (44.1%, 28.9–60.6 vs. 75.1%, 68.8–80.5). Unsupervised and supervised analyses showed that GBMs are distinctively different from BMs and that this difference is driven by definition of non-enhancing tumor margin, ependymal extension and features describing laterality. Differentiation of histological subtypes of BMs was driven by the presence of well-defined enhancing and non-enhancing tumor margins and localization in the vision center. SVM models with optimal hyperparameters led to weighted F1-score of 0.865 for differentiation of GBMs from BMs and weighted F1-score of 0.326 for differentiation of BM subtypes.ConclusionVASARI MR imaging features related to definition of non-enhancing margin, ependymal extension, and tumor localization may serve as potential imaging biomarkers to differentiate GBMs from BMs.

Effects Of Home-Based Convergence Insufficiency Vision Therapy On Accommodation Among School Going Children

Effects of home-based convergence insufficiency vision therapy on accommodation among school going children 
 Wekesa Andrew1, Wanzala Maximilla1
 1Masinde Muliro University of Science and Technology Kakamega, Kenya.
 
 Abstract 
 Background: Convergence and accommodation are always yoked together and any adjustment on the former affects the later. The most effective treatment for convergence insufficiency (CI) is vision therapy.
 Aim/Purpose: To determine the effects of home-based vision therapy on accommodation in school-going with CI attending the Masinde Muliro University Academic Vision Center in Kenya.
 Methods: A clinical experimental design involving 23 participants with the mean age of 14±2.4 years, were recruited into the study, however, only 18 were assessed after the therapy. The study took 9 weeks thus majority lost contact while others moved out of the town. Home-based vision therapy which is undertaken at home using a pencil or broke strings. During the therapy, accommodative values were monitored which were; negative relative accommodation, positive relative accommodation, dynamic accommodation, accommodative facility and near point of accommodation. Paired t-test used to compare mean values before and after the therapy.
 Results: The mean value of negative relative accommodation (NRA) before (mention what the mean values were here) and after (mention what the mean values were here) home-based therapy was statistically significant (p=0.01). However, the mean values before and after home-based therapy for the near point of accommodation (NPA), dynamic (Lag), relativity (PRA) and facility (MAF) showed no difference (p> 0.05). The mean value of the NRA before and after office-based vision therapy was statistically significant (p=0.01).
 Conclusion: The use of home-based vision therapy for the patients with CI had significant effects on accommodation changing from a lower limit to average after the therapy.
 
 Keywords: Convergence insufficiency, Accommodation, Home-based vision therapy.

Value of routine evaluation in asymptomatic soft contact lens wearers

ObjectivesLimited literature supports the value of routine contact lens examinations. The purpose of this study is to document complications diagnosed when subjectively successful planned replacement soft contact lens patients are evaluated to renew their existing contact lens prescriptions. MethodsAsymptomatic soft contact lens patients who presented to the University Eye Center at Ketchum Health (Anaheim, CA) and the Eye and Vision Center at the Massachusetts College of Pharmacy and Health Sciences (Worcester, MA) for routine contact lens comprehensive exams to renew existing contact lens prescriptions were professionally evaluated and their complications documented. All subjects presented without complaint and had a history of subjectively successful planned replacement soft lens wear for at least 1 year. ResultsA total of 202 subjects were recruited from both sites (age range 16–72 years; 76 male, 126 female; spherical contact lens optical power equivalent range: +7.75D to −19.25D). Considering health issues, one hundred and five (52%) patients were found to exhibit at least one undiagnosed complication (95% CI: 0.45-0.59): 70% were diagnosed with contact lens driven ocular complications; 54% were diagnosed with non-contact lens driven ocular health issues; and 4% showed signs of undiagnosed systemic disease. Of note, complication prevalence increases to 72% overall if both contact lens fit issues and contact lens care compliance problems are included as complications in analysis. ConclusionsA striking ocular health and contact lens complication rate in asymptomatic soft contact lens wearers is demonstrated across two different study sites. This data suggests that asymptomatic as well as symptomatic contact lens wearers require routine professional evaluations.

Pedestrian Detection at Night in Infrared Images Using an Attention-Guided Encoder-Decoder Convolutional Neural Network

Pedestrian-related accidents are much more likely to occur during nighttime when visible (VI) cameras are much less effective. Unlike VI cameras, infrared (IR) cameras can work in total darkness. However, IR images have several drawbacks, such as low-resolution, noise, and thermal energy characteristics that can differ depending on the weather. To overcome these drawbacks, we propose an IR camera system to identify pedestrians at night that uses a novel attention-guided encoder-decoder convolutional neural network (AED-CNN). In AED-CNN, encoder-decoder modules are introduced to generate multi-scale features, in which new skip connection blocks are incorporated into the decoder to combine the feature maps from the encoder and decoder module. This new architecture increases context information which is helpful for extracting discriminative features from low-resolution and noisy IR images. Furthermore, we propose an attention module to re-weight the multi-scale features generated by the encoder-decoder module. The attention mechanism effectively highlights pedestrians while eliminating background interference, which helps to detect pedestrians under various weather conditions. Empirical experiments on two challenging datasets fully demonstrate that our method shows superior performance. Our approach significantly improves the precision of the state-of-the-art method by 5.1% and 23.78% on the Keimyung University (KMU) and Computer Vision Center (CVC)-09 pedestrian dataset, respectively.

Primary eye care in India - The vision center model.

The World Health Organization (WHO) Global Action Plan (GAP) 2014-19 emphasize providing Comprehensive Eye Care (CEC) using the health system approach to achieve Universal Eye Health Coverage (UEHC). An important aspect of CEC is Primary Eye Care (PEC). The scope of PEC varies significantly with primary health workers providing PEC in most parts of the developing world, whereas in developed nations PEC is provided by specialized personnel such as optometrists. This article focuses on delivery of PEC models in India, specifically through the vision center (VC) approach. VCs are part of a larger eye care network and provide PEC in remote rural areas of the country. The authors describe the how PEC is delivered in more than 300 VCs operated by six mentor hospitals in India under the Global Sight Initiative (GSI). Key factors compared include: The role of leadership; human resource planning, including recruitment and retention; service delivery; leveraging technology for planning and reaching key populations; financial sustainability; supply chain management; and quality and monitoring. It also discusses issues to be considered to strengthen VCs as we move ahead towards our collective goal of achieving UEHC and eliminating avoidable blindness.

Community eye-health and vision center guidelines during COVID-19 pandemic in India.

The severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has disrupted our society on an unprecedented scale since its inception in December 2019. As the health-care system is finally re-organizing to mitigate the impact of the pandemic, it was necessary to re-structure primary eye care (PEC) activities as well on the same lines. A consensus meeting was held with leading eye-care experts on 2nd May 2020 to prepare a roadmap for PEC in the days to come. Guidelines are needed for PEC activities like vision testing, refraction, optical dispensing, counseling, etc., Some of the activities at vision centers (VCs) may be postponed or modified in light of the current pandemic situation. PEC workers need to strictly follow social distancing norms (minimum 3 feet) for minimizing risk of exposure and need access to appropriate personal protective equipment (PPE), like gloves, masks and shields while examining beneficiaries. For optometrists, sterilization of instruments and encouraging the people to remain silent during the examination is recommended. Because conjunctivitis may be an early sign which can present at VCs, extra precautions in the form of PPE has to be ensured while examining such patients. This is also an opportunity to start running telemedicine clinics for all emergent cases that cannot be managed at the primary level. The guidelines also need to be updated based on the context of the working environment and changes in government directives from time to time.

Commentary: Preferred practice pattern for primary eye care in the context of COVID-19 in L V Prasad Eye Institute network in India.

Commentary: Preferred practice pattern for primary eye care in the context of COVID-19 in L V Prasad Eye Institute network in India.

Low vision center evaluation of twin patients with retinal dystrophy

Resumo E relatado o caso de duas pacientes gemelares identicas do sexo feminino portadoras de distrofia retiniana em investigacao. A principal hipotese diagnostica e a amaurose congenita de leber. Foi realizada avaliacao pelo setor de visao subnormal em centro oftalmologico, com orientacao de uso de recursos opticos e nao opticos para melhoria principalmente das relacoes socioeducativas das pacientes.

Low Vision Assessment: Complications from Juvenile Rhumethoid Arthritis

Background: Juvenile Rheumatoid Arthritis (JRA) is an inflammatory disease that affects the joints of children and is associated with ocular complications, like uveitis and cataract. Patients with such complications can benefit from a low vision assessment to improve their functionality and their quality of life. In this case study, the importance of early detection and management of ocular complications of JRA, as well as visual rehabilitation through a low vision assessment, are highlighted and discussed. Case Presentation: A 12-year-old female of East Indian descent presented to the Low Vision Center of the University of the West Indies Optometry Eye Unit, bilaterally aphakic (absence of crystalline lens) as a result of complications she developed secondary to a systemic condition diagnosed as JRA. She presented with a distance visual acuity of 2.30 logMAR in the RE, and 1.64 logMAR in the LE, at near she was able to read 8.0 M and 3.2 M at a distance of 8 cm for RE & LE respectively. She has a history of ocular disorder secondary to JRA such as cataract, uveitis, upon low vision assessment a new spectacle prescription and an illuminated stand magnifier of 8D was issued, the patient was satisfied with the outcome of the treatment, management and low vision device issued. Conclusion: At the end of the low vision assessment, the patient was extremely satisfied and looked forward to the prospect of returning to school. Although JRA can have severe ocular complications, with the correct management, a patient’s quality of life can be dramatically improved thus stressing the importance of these types of visual assessments.

Quality of eyeglass prescriptions from a low-cost wavefront autorefractor evaluated in rural India: results of a 708-participant field study

ObjectiveTo assess the quality of eyeglass prescriptions provided by an affordable wavefront autorefractor operated by a minimally trained technician in a low-resource setting.Methods and Analysis708 participants were recruited from consecutive...

Health-related quality of life and related factors among older adults with visual impairments

Aim was to explore the health-related quality of life (HRQoL) and related factors among older adults with visual impairment (VI). A total of 39 independently living subjects aged ⩾65 years (83 ± 6.5), referred to the Low Vision Center of the Oulu University Hospital, Finland during one year participated in the study. The participants had low vision or blindness as defined by the World Health Organization (WHO). The 15D, a generic HRQoL instrument, was used to assess the HRQoL, and an ophthalmic examination was performed to assess vision. A population-based control group ( n = 1074) was available for comparison. The mean 15D index scores for the participants and the control group were 0.768 ( SD = 0.089) and 0.827 ( SD = 0.044), respectively, ( p < .002). In the dimensions of move ( p < .05), see ( p < .001), breath ( p < .05), usual activities ( p < .001), depression ( p < .05), and distress ( p < .05), the study participants scored statistically significantly lower than the control group. However, the participants had better mental function scores (0.856 vs 0.773, p < .05). Among the participants, there was no difference in the 15D by gender (men 0.755, women 0.774, p > .05), habitation (alone 0.768, with someone 0.770, p > .05), or age ( r = –.084), nor did the extent of low vision appear to affect the 15D index in this material. The older adults with VI had poorer 15D index score than Finnish population of equal age, but they scored better in the dimension of mental function. Mental skills may indeed be crucial for independent living despite VI.

Central Corneal Thickness Variances Among Different Asian Ethnicities in Glaucoma and Nonglaucoma Patients

To compare the central corneal thickness (CCT) between different ethnicities and particularly Asian subethnic groups that may contribute to the different glaucoma diagnoses using the optical low-coherence reflectometry technique. A retrospective study of 6 years including 1512 eyes of 929 patients of the Beckman vision center, University of California, San Francisco from 2011 to 2017 had their biometric parameters, including CCT, measured with the Lenstar. Patients were categorized into African Americans, Caucasians, Hispanics, Pacific Islanders, and Asians. Asians were further subcategorized into Chinese, Vietnamese, Koreans, Filipinos, and Japanese. Among 1356 patients who had their CCT measured by Lenstar from 2011 to 2017, 1512 eyes of 929 patients were included. The study population included 462 Caucasians (52.96%), 60 African Americans (6.46%), 92 Hispanics (9.9%), 32 Pacific Islanders (3.44%), 130 Chinese (13.99%), 52 Filipinos (5.6%), 37 Vietnamese (3.98%), 34 Koreans (3.66%), and 30 Japanese (3.23%). African Americans had the thinnest CCT with a mean of 518.62±40.3 followed by Asians with a mean of 539.29±34.1. Among the Asian study sample, the Chinese had the thinnest CCT with a mean of 537.66±32.5. CCT was adjusted for age, sex, glaucoma diagnosis, diabetes status, and prostaglandin analogs use for >12 months. Optical low-coherence reflectometry is a widely used technology, which can measure CCT. Our study confirms that African Americans have the thinnest corneas followed by Asians. In the latter group, relatively thin CCT may partly explain their high rates of normal-tension glaucoma.

Combined phacoemulsification and viscocanalostomy with Ologen implant versus combined phacoemulsification and viscocanalostomy

BackgroundTo study the efficacy of the biodegradable collagen implant Ologen® as an adjuvant in phaco-viscocanalostomy in patients with coexisting cataract and primary open angle glaucoma.MethodsThis prospective, interventional, randomized clinical study was done at Alpha Vision Center, Zagazig, Egypt. Patients with coexisting cataract and glaucoma were randomized to receive either phaco-viscocanalostomy (Phacovisco group) (39 eyes) or phaco-viscocanalostomy with Ologen® implant (OloPhacovisco group) (40 eyes). Follow-up period was 2 years. Nd:YAG laser goniopuncture was done in cases where the intraocular pressure (IOP) was elevated above 21 mmHg after discontinuation of corticosteroid eye drops at any follow-up visit.ResultsNo significant operative or postoperative complications (other than failure) were encountered in either group. At 2 years follow-up, the mean IOP level was statistically significantly decreased in the OloPhacovisco group (p = 0.02) and complete success occurred in 23 eyes (59.0%) in the Phacovisco group and in 32 eyes (80.0%) in the OloPhacovisco group. There was a statistically significant higher success rate regarding complete success in patients that received Ologen® implant (p = 0.04).ConclusionsOlogen® implant improved the success rate of phaco-viscocanalostomy. Larger studies with longer follow-up periods may be required to confirm these findings.Trial registrationThis trial was retrospectively registered on 20/12/2018 under the number (NCT03782051).

PERCEIVING THE PHYSICAL ENVIRONMENT AND ITS RELATION TO PSYCHOLOGICAL ADJUSTMENT AND PSYCHOLOGICAL HARDNESS IN A SAMPLE OF BOTH SEXES BLIND ADOLESCENTS A COMPARATIVE STUDY BETWEEN TWO SAMPLESOF BIRTH AND NON-BIRTH BLIND ADOLESCENTS

The current study objective is exploring the relationship between perceiving the physical environment and both psychological adjustment and psychological hardness in a sample of both sexes of blind adolescents. The study sample consists of (170) blind persons, divided into (42) of birth-blindness males and (44) infected blind males. The female sample consists of (41) female items of birth-blindness and (43) infected blind females. The research hypotheses indicate a significant statistical correlation exists between psychological adjustment level and psychological hardness level in a sample of male birth and non-birth blind persons. There is also a significant statistical correlation exists between psychological adjustment level and psychological hardness level in a sample of birth and non-birth blind females. The researchers use the descriptive-correlative-comparative method; using in addition scale of perceiving the physical environment - scale of psychological adjustment and scale of psychological hardness to check validity of the research hypotheses. The study results indicate a significant correlation exists at (0.05) level between perceiving the physical environment and both psychological adjustment and psychological hardness in birth and non-birth blind adolescents. Results also indicate that there is correlation between psychological adjustment level and psychological hardness level in a sample of birth and non-birth blind adolescent females at (0.05) significance level. The researchers recommend the necessity for preparing therapy programs for improving psychological adjustment and psychological hardness in those with visual impairment using the assisting co-technology designed for those lost their sight at late age stage; working as well on establishing centers for equal education opportunities along the line of Ain Shams University Electronic Vision Center.

Factors Associated With Lack of Vision Improvement in Children With Cortical Visual Impairment.

Improvement in vision has been noted in children with cortical visual impairment (CVI), resulting from disparate types of brain injury. The purpose of our study was to determine the risk factors associated with poor recovery of vision in this group of patients. Case records of children who were born before 2010 with at least 4 follow-up visits for CVI were reviewed for underlying etiologies of CVI, visual acuity (VA), and associated neurological and ophthalmological disorders. VA was assessed in 6 qualitative grades. Changes in VA were recorded as the difference between the grades of VA at presentation and the last follow-up visit. The outcome was calculated as a ratio of actual improvement to potential improvement in grades of qualitative VA. Multiple linear regression determined factors associated with lack of vision improvement in all children and based on etiology. Fifty-three children with CVI were identified. The median age at presentation was 13.6 months (range: 2.9-76.4 months) and the median follow-up was 5.8 years (1.1-16.3 years). CVI resulted from central nervous system (CNS) malformation (9.4%), hypoxic/inflammatory injury (15.1%), seizures (24.5%), and combined causes (51.0%). Vision improvement was noted in 83% of children. Lack of VA improvement was associated with older age at presentation in all children with CVI and within each etiological group except CNS malformation. None of the other investigated variables were associated with poor recovery of VA. Most of the children with CVI showed improvement in vision. Older age at presentation, but not etiology of CVI, was associated with poor improvement in VA.