Parent-Reported Visual Concerns in Children with Cerebral Visual Impairment Presenting to a Pediatric Neurology Clinic

Abstract

Rebecca Sumalini,1– 3 Premalatha Errolla,4 Lokesh Lingappa,4 Miriam Conway,3 Ahalya Subramanian,3 PremNandhini Satgunam1 1Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India; 2Institute for Vision Rehabilitation, L V Prasad Eye Institute, Hyderabad, India; 3Division of Optometry and Vision Sciences, City, University of London, London, United Kingdom; 4Department of Pediatric Neurology, Rainbow Children’s Hospitals, Hyderabad, IndiaCorrespondence: Rebecca Sumalini, Brien Holden Institute of Optometry and Vision Sciences, Institute for Vision Rehabilitation, L V Prasad Eye Institute, Hyderabad, India, Tel [phone], Email [email protected]: Children with cerebral visual impairment (CVI) present with delayed developmental milestones. Pediatricians and pediatric neurologists are usually the first point of contact, and eye exam largely remains referral based. This study documented the visual concerns reported by parents of children with CVI visiting a pediatric neurology clinic. Additionally, we investigated the association between visual concerns, functional vision measures and visual functions.Patients and Methods: A cross-sectional study was undertaken in children with CVI (chronological age range: 7 months-7 years). Visual concerns reported by the parents/caregivers were documented as open-ended statements. Additionally, a functional vision assessment was conducted using the CVI Range instrument with phase 1, 2 and 3 indicating low, moderate and high visual functioning, respectively. Grating acuity and contrast sensitivity were measured using Teller acuity cards-II and Ohio contrast cards respectively.Results: A total of 73 children (mean age of 2.84 ± 1.87 years) were recruited. Sixty-eight parents reported visual concerns that were broadly grouped into 14 unique concerns. Nineteen parents (27.9%) reported more than one visual concern. Difficulty maintaining eye contact and recognizing faces were the top two visual concerns in phases 1 and 2. Missing objects in the lower visual field was the top concern in phase 3. A larger number of visual concerns were reported in phase 1 (43%) than phase 2 (40.6%) and phase 3 (16.2%). Multiple regression analysis revealed that grating acuity, contrast sensitivity and chronological age were able to predict the functional vision, F (3, 55) = 63.0, p < 0.001, r2 = 0.77.Conclusion: Targeted questions enquiring about eye contact and face recognition can be included in history elicitation in children with CVI in pediatric neurology clinics. In the presence of visual concerns, it will be important to assess grating acuity and contrast sensitivity. A poor functional vision score requires referral for eye examination and vision rehabilitation services.Keywords: functional vision, neurological visual impairment, CVI range, Teller acuity cards-II, Ohio contrast cards

Keywords

• functional vision
• neurological visual impairment
• cvi range
• teller acuity cards-ii and ohio contrast cards