Cortical visual dysfunction in children: A clinical study

Abstract

Damage to the cerebral cortex was responsible for impairment in vision in 90 of 130 consecutive children referred to the Vision Assessment Clinic in Glasgow. Cortical blindness was seen in 16 children. Only 2 were mobile, but both showed evidence of navigational blind-sight. Cortical visual impairment, in which it was possible to estimate visual acuity but generalised severe brain damage precluded estimation of cognitive visual function, was observed in 9 children. Complex disorders of cognitive vision were seen in 20 children. These could be divided into five categories and involved impairment of: (1) recognition, (2) orientation, (3) depth perception, (4) perception of movement and (5) simultaneous perception. These disorders were observed in a variety of combinations. The remaining children showed evidence of reduced visual acuity and/ or visual field loss, but without detectable disorders of congnitive visual function. Early recognition of disorders of cognitive vision is required if active training and remediation are to be implemented.

Association of binocular lower visual field impairment, impaired simultaneous perception, disordered visually guided motion and inaccurate saccades in children with cerebral visual dysfunction—a retrospective observational study

“…Unlike the original descriptions, in which what is now recognised as dorsal stream dysfunction was ostensibly absolute in nature, the problems described in this paper are variable in degree, perhaps because of incomplete damage and the potential for recovery in the developing brain of a child. 1 Lower visual field impairment varied from being peripheral only, to affecting almost all of the lower field below the midline, but no lower scotomatous visual field loss was identified. This implies that the fibres subserving the lowermost visual field are closest to the lateral ventricles.…”

“…The protocol of assessment has been described previously. 1 Briefly, visual acuity is measured using tests appropriate to the child's ability. Colour vision (using Ishihara plates and/or the Panel D15 test) and contrast sensitivity (using the Pelli Robson chart) are measured when possible.…”

“…Structured clinical history taking, seeking evidence of all aspects of cognitive visual function 3 is carried out using a protocol developed from the initial cohort of children seen. 1 All 364 sets of case records were reviewed and 40 cases were identified, in which there appeared to be a common pattern of visual dysfunction in the context of a visual acuity of 6/60 or better. The features, which were present in a variety of combinations comprised (a) peripheral lower visual field impairment, (b) evidence of impaired simultaneous perception, (c) inaccuracy of visually guided movement of the limbs (in particular the legs), (d) inaccurate eye movements, and (e) impaired recognition and/or route finding.…”

“…1,2 Over 50% of children with hydrocephalus, for example, may have significant difficulties interpreting visual input. 3 Occipital PVL is probably one of the commonest causes of such visual impairment, which is frequently associated with peripheral lower visual field deficits.…”

Subnormal visual perception in school-aged ex-preterm patients in a paediatric eye clinic

“…Vision may be variable, and paradoxes in visual behaviour that are difficult to understand are common. [12][13][14][15] Visual perceptual problems may cause serious visual impairment despite good VA and normal visual fields.…”