Profile of Cerebral Visual Impairment in Children with Cerebral Palsy at a Tertiary Care Referral Center in Southern India

What assessments are currently used to investigate and diagnose cerebral visual impairment (CVI) in children? A systematic review

“…The remaining article was a short report discussing validation of the visual skills inventory questionnaire 27 . All other articles reported a visual acuity measurement, 20 (43.5%) reported measuring the participants’ refractive status, 11,20,21,28–44 26 (56.5%) documented that a visual field assessment was conducted 7,11,21,28,31,32,35–38,40–42,44–56 and 26 (56.5%) reported assessment of ocular health 7,11,20–22,28–36,40–44,46,48,51,57–60 . Five (11.1%) articles documented assessment of contrast sensitivity, 21,37,38,42,61 seven (15.6%) reported measuring stereopsis 21,35,37,38,42,48,49 and four (8.9%) articles measured accommodative accuracy 32,40,42,49 …”

“…Neuroimaging was reported in 29 (63.0%) articles. The most commonly reported imaging technique was MRI ( n = 22) 20,21,28–34,41,44,45,47,48,50,51,56–58,64–66 . Ten articles reported use of CT scans 20,21,29–31,35,46,51,58,65 and five reported use of ultrasound 29,31,45,48,51 .…”

“…Three articles reported observation of the child’s spontaneous visual behaviour, 21,49,51 while another reported ophthalmological observation of the child 60 . One article reported clinical observation in accordance with Huo’s criteria, 11,22 and two articles reported children underwent ‘clinical observation’ but did not detail what this entailed 41,54 . Roman‐Lantzy advocates for observing a child’s visual behaviour in a range of settings, in addition to presenting the child with different visual stimuli during the clinical assessment in order to assess how the child responds or interacts with these stimuli 70…”

“…Children with CVI often present with oculomotor deficits 1,20 including nystagmus, 20,21 strabismus 20,84 and abnormal saccadic and smooth pursuit eye movements 1,21 . Thirty‐two articles (69.6%) reported carrying out an ocular movement assessment 7,11,20,21,29–38,40–46,55,57–60,65,68 and 26 (56.5%) an ocular posture/alignment assessment 11,20,21,29–38,40–45,48–50,55,58,59,66 . Of those who specified details of the ocular movement assessment, six included saccadic eye movement assessment, 21,34,36,42,49,66 four smooth pursuits, 21,42,57,65 nine assessed the optokinetic nystagmus response (OKN), 21,32,41,45,46,49,51,57,65 eight assessed the child’s ability to fix and follow, 21,29,32,34,44,49,50,57 and two assessed convergence 38,42 .…”

“…Fifteen articles (32.6%) reported use of at least one clinical electrophysiology method to measure brain or visual function in response to visual stimuli. Eleven of these reported use of visual evoked potentials (VEPs), 21,22,29,33,46,48,51,57,59,65,67 five articles used electroretinography (ERG) 33,43,44,46,57 and seven used electroencephalography (EEG) 21,22,33,34,41,46,51 . Each of these electrophysiology techniques measure different functions; ERGs assess the functional integrity of the retina, 93 VEPs are used to determine the integrity of the visual pathways from the macula to the visual cortex 94 and EEG is used in the diagnosis of neurological disease and to monitor brain activity 95 …”