ArticleThe British and Irish orthoptic journal2025
Identification of Suspect-Cerebral Visual Impairment in Children with Special Needs: Moving Towards an Inclusive Diagnostic Process.
Article in The British and Irish orthoptic journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Cerebral Visual Impairment (CVI) accounts for most visual impairment in children in the developed world. A significant proportion of children in special needs education demonstrate atypical visual function, yet referral thresholds for onward assessments are not defined. We sought to describe the elements of a visual function assessment that might indicate a threshold for referral into CVI diagnostic pathways. Method: We undertook a retrospective analysis of 50 consecutive records of children attending a specialist visual assessment clinic. Visual ability was documented, including visual acuity, contrast sensitivity, visual field, eye movements, visual attention, accommodation, and optic disc appearance. The aim of this retrospective case note review was to examine the pattern of visual assessment outcomes that raised suspicion of CVI in a cohort of children with special needs. Results: Atypical response to three or more testing domains was associated with a diagnosis of CVI. Mean age of children was 6.6 years (range 1-16). There was no statistical difference in the mean number of test domains completed by those with/without CVI. (7.3 vs. 8.3; p = 0.5). Children with CVI showed a statistically higher mean number of atypical responses compared with non-CVI patients (4.2 vs. 0.4; p = 0.015). Discussion: Our findings are in keeping with other studies that indicate that detecting atypical eye movements, visual field, and/or visual attention play a key role in highlighting children who warrant comprehensive assessment for CVI. Facilitating eye health professionals to identify and refer on those children with evidence of CVI-related behaviors will further our endeavors to provide an inclusive approach to diagnosis in a high-risk group.
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