Cerebral visual impairment (CVI) overlooked: A retrospective review of missed opportunities to diagnose CVI.

purposeCerebral Visual Impairment (CVI) is the leading cause of paediatric visual impairment in developed countries. Earlier diagnosis provides access to early intervention, which may improve visual function, functional vision and developmental outcomes. The purpose of this study was to determine the age and timing of CVI diagnosis and the severity of CVI.

methodA retrospective review of medical records was completed. Children with CVI were identified by billing diagnosis codes at a single centre from 1 January 2008 to 1 March 2018. CVI severity was determined using the CVI Range Rating 2. Linear regression assessed the effect of diagnosis timing on CVI Range scores as the dependent variable, adjusting for age.

resultsOne hundred and ninety-four children with CVI met inclusion. The mean age at the initial ophthalmology visit was 3.6 ± 4.4 years (6 weeks to 20 years 4 months). The mean age at CVI diagnosis was 4.6 ± 4.7 years (9 weeks to 20 years 4 months) and the mean time from first ophthalmology visit to diagnosis was 1.0 ± 1.9 years (0 days to 9 years 2 months). Earlier diagnosis was associated with more severe CVI. Sixty percent of children (116/194) were assessed with the CVI Range. Those with lower range scores (i.e., more severe CVI) were more likely to be diagnosed at the first visit. Delayed diagnosis was more common in children with higher range scores (milder CVI).

conclusionsIdentification of CVI in children is often delayed in the absence of significant vision impairment. Early screening, assessment and diagnosis are critical to ensure access to early intervention and adaptations that may improve visual function and quality of life. Frequent screenings for young children at risk for CVI using validated screening questionnaires, along with targeted history taking and the development of sensitive assessment tools, should be a research priority.