Setting up of a cerebral visual impairment clinic for children: Challenges and future developments

Abstract

Aim:The aim of this study is to describe the setting up of a cerebral visual impairment (CVI) clinic in a tertiary care hospital in South India and to describe the spectrum of cases seen.Materials and Methods:The CVI clinic, set up in February 2011, receives interdisciplinary input from a core team involving a pediatrician, neurologist, psychiatrist, occupational therapist, pediatric ophthalmologist, and an optometrist. All children, <18 years of age, with cerebral palsy (CP), learning disability, autism, neurodegenerative diseases, and brain trauma are referred to the clinic for functional vision assessment and opinion for further management.Results:One thousand four hundred and seventy-eight patients were seen in the CVI clinic from February 2011 to September 2015. Eighty-five percent of the patients were from different parts of India. In the clinic, 61% had CP, 28% had seizure disorders, autism was seen in 9.5%, and learning disability, neurodegenerative conditions, and brain injury together constituted 1.5%. Most of the children (45%) had moderate CP. Forty percent of CVI was due to birth asphyxia, but about 20% did not have any known cause for CVI. Seventy percent of patients, who came back for follow-up, were carrying out the habilitation strategies suggested.Conclusions:Average attendance of over 300 new patients a year suggests a definite need for CVI clinics in the country. These children need specialized care to handle their complex needs. Although difficult to coordinate, an interdisciplinary team including the support groups and voluntary organizations is needed to facilitate the successful implementation of such specialized service.

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 …”

“…This resulted in a considerable amount of missing neuroimaging data and a lack of consistency in the type of neuroimaging assessment undertaken i.e., some participants may have had a CT scan, while others had a MRI scan. Five articles did not report which neuroimaging technique had been used, but simply stated that neurological assessments were performed or results were available from medical notes 11,42,49,67,68 …”

<p>Neuro-ophthalmological manifestations of tuberous sclerosis: current perspectives</p>

“…Management is primarily supportive, with regular eye examinations, refractive correction if needed, and referral to vision support services as early as possible. Given the complexity of these cases, interdisciplinary specialized care is the preferred model, with coordination between ophthalmology, neurology, psychiatry, occupational therapy, and primary care 59…”

A pilot study regarding basic knowledge of “cortical visual impairment in children” among ophthalmologists

“…We searched the PubMed with keywords “CVI” or “cerebral visual impairment” and “prevalence” and “India” and “children,” and only five articles could be retrieved. [ 10 11 12 13 14 ] The scarcity of Indian literature in this area could be ascribed to inadequate information among ophthalmologists. Similarly, we searched the PubMed with the keywords “knowledge” and “CVI” and “ophthalmologist.” This search retrieved 8 articles, but none of them was related to the assessment of knowledge among ophthalmologists.…”

“…Similarly, we searched the PubMed with the keywords “knowledge” and “CVI” and “ophthalmologist.” This search retrieved 8 articles, but none of them was related to the assessment of knowledge among ophthalmologists. [ 10 15 16 17 18 19 20 21 ]…”