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Mooney SW, Alam NM, Sciarabba MJ, Sheldon KR, Prusky GT. Quantitative patterns of visual impairment and recovery in children with brain injury. RESEARCH SQUARE 2024:rs.3.rs-4511323. [PMID: 39149459 PMCID: PMC11326396 DOI: 10.21203/rs.3.rs-4511323/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Brain injury can cause many distinct types of visual impairment in children, but these deficits are difficult to quantify due to co-morbid deficits in communication and cognition. Clinicians must instead rely on low-resolution, subjective judgements of simple reactions to handheld stimuli, which limits treatment potential. We have developed an interactive assessment program called the Visual Ladder, which uses gaze-based responses to intuitive, game-like tasks to address the lack of broad-spectrum quantified data on the visual abilities of children with brain injury. Here, we present detailed metrics on eye movements, field asymmetries, contrast sensitivity, and other critical visual abilities measured longitudinally using the Ladder in hospitalized children with varying types and degrees of brain injury, many of whom were previously considered untestable. Our findings show which abilities are most likely to exhibit recovery and reveal how distinct patterns of task outcomes defined unique diagnostic clusters of visual impairment.
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Affiliation(s)
- Scott W.J. Mooney
- Burke Neurological Institute, White Plains, NY, USA
- Blythedale Children’s Hospital, Valhalla, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Nazia M. Alam
- Burke Neurological Institute, White Plains, NY, USA
- Blythedale Children’s Hospital, Valhalla, NY, USA
| | | | | | - Glen T. Prusky
- Burke Neurological Institute, White Plains, NY, USA
- Blythedale Children’s Hospital, Valhalla, NY, USA
- Weill Cornell Medicine, New York, NY, USA
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Silveira S, Kelly N, Wright R. Australian children with cerebral visual impairment: using what we know now to improve future approaches. Strabismus 2023; 31:253-261. [PMID: 37997430 DOI: 10.1080/09273972.2023.2272675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
PURPOSE Little has been reported on Australian children with Cerebral Vision Impairment (CVI). This paper aims to present the outcome of an audit focussed on children with the primary diagnosis of CVI, using findings from the Australian Childhood Vision Impairment Register (ACVIR). METHODS Records on 132 children (49% girls, 51% boys) from ACVIR data gathered from both the child's parent/guardian and their eye health professional were reviewed. The child's demographics, level of vision impairment, birth history, diagnostic journey, secondary ocular diagnoses, comorbidities and low vision support were analyzed. Several correlations were investigated using a Kendall's tau-b analysis including the relationship between vision and age of diagnosis; level of vision and developmental delay; and age of suspicion of visual impairment and age of diagnosis. RESULTS The most common level of visual impairment was blindness (39%), and most children were suspected and diagnosed of visual impairment in the first 6 months of life. The majority of children were born full term (72%), weighing >2000gms (84%). Nearly half of the cohort of children (48%) had a secondary ocular diagnosis with 44% having nystagmus. The majority of children (80%) had additional health problems, and 85% of children had additional disabilities, with 79% having developmental delay. CONCLUSION While the findings of this audit cannot be generalized to a wider population of Australian children with CVI, the outcome encourages continued discussion on CVI, to explore comprehensive assessment approaches which facilitate timely and accurate diagnosis.
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Affiliation(s)
- Susan Silveira
- NextSense, NextSense Institute, North Rocks, NSW
- Macquarie School of Education, Faculty of Arts, Macquarie University, Macquarie Park, NSW
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McDowell N, Butler P. Validation of the Austin Assessment: A screening tool for cerebral visual impairment related visual issues. PLoS One 2023; 18:e0293904. [PMID: 37917596 PMCID: PMC10621811 DOI: 10.1371/journal.pone.0293904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/21/2023] [Indexed: 11/04/2023] Open
Abstract
Cerebral visual impairment is the most common cause of vision impairment affecting children in the economically developed world with a prevalence rate of approximately 3.4%. Currently there are limited options for screening for cerebral visual impairment, resulting in many children going undiagnosed, especially those that have normal visual acuity. The aim of this research was to validate an iPad App called the Austin Assessment, which was developed as a potential screening tool for cerebral visual impairment related visual issues. The research involved three separate phases: (1) creating a database of normative ranges for children aged 5-18 across the different variables of the Austin Assessment, (2) using the Austin Assessment to screen children aged 5-13 to assess the effectiveness of the Austin Assessment as a screening tool for CVI related visual issues, and (3) conducting specific validation research assessing children using the Austin Assessment and an already validated visual search tool. Each phase used different quantitative research methodologies to help show the effectiveness of the Austin Assessment as a screening tool for cerebral visual impairment related visual issues. From phase one of the research, thresholds were established for three variables of the Austin Assessment for the age groupings of 5-8, 9-12 and 13-18. If a child meets one of these thresholds this indicates further assessment is required to determine if they do in fact have cerebral visual impairment related visual issues. Phase two identified 17 children out of 270 who had clinical findings indicating visual issues; potentially indicative of CVI; investigation into the nature of these visual issues is ongoing. Phase three found that the Austin Assessment has moderate diagnostic value for each age group, with good sensitivity and specificity, making it effective at distinguishing those children who have visual issues from those who have typical vision. Further investigation is needed to confirm this initial validation.
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Affiliation(s)
- Nicola McDowell
- Institute of Education, Massey University, Auckland, New Zealand
| | - Philippa Butler
- Institute of Education, Massey University, Auckland, New Zealand
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Weisser-Pike O, Mitchell AW, Cordova L. Occupational Therapy Assessments of Cortical or Cerebral Visual Impairment: A Systematic Review. Am J Occup Ther 2023; 77:7706205160. [PMID: 37971385 DOI: 10.5014/ajot.2023.050313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
IMPORTANCE Cortical or cerebral visual impairment (CVI), a leading cause of visual dysfunction in children across the globe, can result in delayed development of fine and gross motor skills, functional mobility, and socialization, which affects all areas of occupation. No assessments are recommended for occupational therapy practitioners working with children with CVI. OBJECTIVE To appraise the measurement properties and clinical utility of CVI assessments appropriate for use by occupational therapy practitioners. DATA SOURCES MEDLINE via PubMed, Scopus, and Web of Science. STUDY SELECTION AND DATA COLLECTION We followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines for systematic reviews of patient-reported outcome measures for relevant studies. FINDINGS A total of 590 records yielded 15 studies of the measurement properties of 12 assessment tools, 8 patient-reported outcome measures and 4 clinician-reported or performance-based outcome measures. We report on the quality of measurement properties of 10 of the 12 outcome measures. None had high-quality evidence of content validity, structural validity, or test-retest reliability. Most had indeterminate internal consistency as a result of a lack of confirmatory factor analysis. Three instruments demonstrated high quality and sufficient construct validity. CONCLUSIONS AND RELEVANCE On the basis of the COSMIN guidelines, all 12 outcome measures have the potential to be recommended but require further study before definitive recommendations can be made. What This Article Adds: This is the first systematic review of assessments of CVI feasible for use by occupational therapy practitioners. High-quality studies of measurement properties are lacking. Further examination of the measurement properties of outcome measures is required.
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Affiliation(s)
- Orli Weisser-Pike
- Orli Weisser-Pike, OTD, OTR/L, CLVT, SCLV, FAOTA, is Associate Professor, University of Tennessee Health Science Center, College of Health Professions, University of Tennessee, Memphis;
| | - Anita Witt Mitchell
- Anita Witt Mitchell, PhD, OTR, FAOTA, is retired. At the time of the study, Mitchell was Professor, College of Health Professions, University of Tennessee Health Science Center, University of Tennessee, Memphis
| | - Leah Cordova
- Leah Cordova, MLIS, is Health Librarian, Chamberlain University, Chicago, IL. At the time of the study, she was Health Librarian, University of Tennessee Health Science Center, Memphis
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Merabet LB, Manley CE, Pamir Z, Bauer CM, Skerswetat J, Bex PJ. Motion and form coherence processing in individuals with cerebral visual impairment. Dev Med Child Neurol 2023; 65:1379-1386. [PMID: 37012700 PMCID: PMC10795851 DOI: 10.1111/dmcn.15591] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 04/05/2023]
Abstract
AIM Using a visual psychophysical paradigm, we sought to assess motion and form coherence thresholds as indices of dorsal and ventral visual stream processing respectively, in individuals with cerebral visual impairment (CVI). We also explored potential associations between psychophysical assessments and brain lesion severity in CVI. METHOD Twenty individuals previously diagnosed with CVI (mean age = 17 years 11 months [SD 5 years 10 months]; mean Verbal IQ = 86.42 [SD 35.85]) and 30 individuals with neurotypical development (mean age = 20 years 1 month [SD 3 years 8 months]; mean Verbal IQ = 110.05 [SD 19.34]) participated in the study. In this two-group comparison, cross-sectional study design, global motion, and form pattern coherence thresholds were assessed using a computerized, generalizable, self-administrable, and response-adaptive psychophysical paradigm called FInD (Foraging Interactive D-prime). RESULTS Consistent with dorsal stream dysfunction, mean global motion (but not form) coherence thresholds were significantly higher in individuals with CVI compared to controls. No statistically significant association was found between coherence thresholds and lesion severity. INTERPRETATION These results suggest that the objective assessment of motion and form coherence threshold sensitivities using this psychophysical paradigm may be useful in helping to characterize perceptual deficits and the complex clinical profile of CVI. WHAT THIS PAPER ADDS In participants with cerebral visual impairment (CVI), motion (but not form) coherence thresholds were significantly higher compared to controls. These psychophysical results support the notion of dorsal stream dysfunction in CVI.
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Affiliation(s)
- Lotfi B. Merabet
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Claire E. Manley
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Zahide Pamir
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Bilkent University, Department of Psychology, Ankara, Turkey
| | - Corinna M. Bauer
- Lab for Neuroimaging and Vision Science, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jan Skerswetat
- Translational Vision Lab, Department of Psychology, Northeastern University, Boston, MA, USA
| | - Peter J. Bex
- Translational Vision Lab, Department of Psychology, Northeastern University, Boston, MA, USA
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Manley CE, Walter K, Micheletti S, Tietjen M, Cantillon E, Fazzi EM, Bex PJ, Merabet LB. Object identification in cerebral visual impairment characterized by gaze behavior and image saliency analysis. Brain Dev 2023; 45:432-444. [PMID: 37188548 PMCID: PMC10524860 DOI: 10.1016/j.braindev.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 05/17/2023]
Abstract
Individuals with cerebral visual impairment (CVI) have difficulties identifying common objects, especially when presented as cartoons or abstract images. In this study, participants were shown a series of images of ten common objects, each from five possible categories ranging from abstract black & white line drawings to color photographs. Fifty individuals with CVI and 50 neurotypical controls verbally identified each object and success rates and reaction times were collected. Visual gaze behavior was recorded using an eye tracker to quantify the extent of visual search area explored and number of fixations. A receiver operating characteristic (ROC) analysis was also carried out to compare the degree of alignment between the distribution of individual eye gaze patterns and image saliency features computed by the graph-based visual saliency (GBVS) model. Compared to controls, CVI participants showed significantly lower success rates and longer reaction times when identifying objects. In the CVI group, success rate improved moving from abstract black & white images to color photographs, suggesting that object form (as defined by outlines and contours) and color are important cues for correct identification. Eye tracking data revealed that the CVI group showed significantly greater visual search areas and number of fixations per image, and the distribution of eye gaze patterns in the CVI group was less aligned with the high saliency features of the image compared to controls. These results have important implications in helping to understand the complex profile of visual perceptual difficulties associated with CVI.
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Affiliation(s)
- Claire E Manley
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - Kerri Walter
- Translational Vision Lab. Department of Psychology, Northeastern University, Boston, MA, USA
| | - Serena Micheletti
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matthew Tietjen
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - Emily Cantillon
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - Elisa M Fazzi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Peter J Bex
- Translational Vision Lab. Department of Psychology, Northeastern University, Boston, MA, USA
| | - Lotfi B Merabet
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA.
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Kascak K, Keller E, Dodds C. Use of Goal Attainment Scaling to Measure Educational and Rehabilitation Improvements in Children with Multiple Disabilities. Behav Sci (Basel) 2023; 13:625. [PMID: 37622765 PMCID: PMC10451652 DOI: 10.3390/bs13080625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
With a focus on children with multiple disabilities (CMD), the purpose of this quality improvement project was to elevate educational measurement and practices involving CMD. Using the goal attainment scaling (GAS) methodology, this project was conducted within a public charter school, Pattison's Academy for Comprehensive Education (PACE), focusing on 31 CMD and measuring student improvement and program effectiveness. For 2010-2011 and 2011-2012, improvements were demonstrated for the majority of CMD by meeting or exceeding their goals. Goal attainment scaling was able to capture improvement in educational and rehabilitation goals in the majority of CMD. Goal attainment scaling can provide an indication of a program's effectiveness. The use of GAS in CMD has potential to maximize participation across the school setting where all children in the United States commonly develop and learn skills as well as find meaning.
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Affiliation(s)
- Kimberly Kascak
- Office of Interprofessional Initiatives, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Everette Keller
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Cindy Dodds
- College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA;
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Pilling RF, Allen L, Bowman R, Ravenscroft J, Saunders KJ, Williams C. Clinical assessment, investigation, diagnosis and initial management of cerebral visual impairment: a consensus practice guide. Eye (Lond) 2023; 37:1958-1965. [PMID: 36258009 PMCID: PMC10333179 DOI: 10.1038/s41433-022-02261-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/01/2022] [Accepted: 09/12/2022] [Indexed: 11/08/2022] Open
Abstract
Cerebral Visual Impairment (CVI) is a common condition in the UK. Patients with conditions associated with CVI are frequently seen in paediatric ophthalmology clinics offering eye care professionals an opportunity to identify children proactively. In most cases CVI occurs as part of a neurodevelopmental condition or as a feature of multiple and complex disabilities. However, CVI can also be seen in children with apparently typical development. In some cases, high contrast visual acuity is normal and in other cases severely impaired. As such, identification of CVI requires evaluation of aspects of visual performance beyond high contrast acuity and consideration that visual function of those with CVI may fluctuate. Few paediatric ophthalmologists have received formal training in CVI. The detection and diagnosis of CVI varies across the UK and patients report hugely different experiences. A diagnosis of CVI is made based on professional clinical judgement and it is recognised that individual perspectives and local practice in the specific methodologies of assessment will vary. A systematic review and survey of professionals is underway to attempt to reach agreement on diagnostic criteria. Nonetheless, established pathways and published protocols can offer guidance on how a paediatric ophthalmology service can approach assessment of the child with suspected CVI. The purpose of this paper is to present a summary of research and clinical practice methods for detecting and diagnosing CVI in a paediatric ophthalmology outpatient setting. It represents current understanding of the topic and acknowledges the evolving nature of both practice and the evidence-base. A rapid literature review was undertaken to identify articles relating to clinical investigation of children with CVI. A focus group of QTVI and subject matter experts from sight loss charities was undertaken to address areas which were not covered by the literature review.
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Affiliation(s)
- Rachel Fiona Pilling
- University of Bradford, Bradford, England.
- Department of Ophthalmology, Bradford Teaching Hospitals, Bradford, UK.
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Pilling RF, Allen L, Anketell P, Bullaj R, Harwood J, Little S. Visual Behaviours (ViBes) in Cerebral Visual Impairment: Validating a Descriptive Tool to Support Diagnosis and Monitoring. Br Ir Orthopt J 2023; 19:44-51. [PMID: 37332843 PMCID: PMC10275135 DOI: 10.22599/bioj.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/05/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Cerebral visual impairment (CVI) is the most common cause of visual impairment in children in the UK. Diagnosis is based on identification of visual behaviours (ViBes) relating to visual dysfunction. Examination techniques and inventories have been developed to elicit these in children with a developmental age of two years or more. The absence of a structured approach to recording visual behaviours in children with complex needs is a barrier to diagnosis. The aim of the study was to develop a matrix of visual behaviours seen in pre-verbal and pre-motor children with visual impairment and establish its content validity and inter-rater reliability. Methods ViBe content validation:: Visual behaviour descriptors relating to visual function were collated and categorised by expert consensus of vision professionals into a matrix composed of three functions (attention, field/fixation, motor response) and five levels (0 = no awareness; 1 = visual awareness; 2 = visual attention; 3 = visual detection; 4 = visual understanding).ViBe inter-rater reliability:: The participants (two orthoptists, an optometrist, an ophthalmologist and two qualified teachers of the visually impaired) used the ViBe matrix to independently score each of 17 short video clips of children demonstrating visual behaviours seen in CVI. Results The ViBe matrix will be presented. Cohen's kappa for the matrix was 0.67, demonstrating moderate-to-strong inter-rater reliability. Conclusion The development of standardised descriptors can support clinicians and teachers in identifying areas of concern for children with complex needs. In addition, the ViBe matrix could be utilised in research, clinical and diagnostic reports to clearly communicate the areas of visual dysfunction and track progress resulting from interventions. Key Points The absence of a structured approach to recording visual behaviours in children with complex needs is a barrier to diagnosis.The ViBe matrix offers descriptors relating to visual behaviours and has demonstrated acceptable inter-rater reliability.The tool may support the identification and diagnosis of cerebral visual impairment in a population of children who cannot access standard testing.
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Delay A, Rice M, Bush E, Harpster K. Interventions for children with cerebral visual impairment: A scoping review. Dev Med Child Neurol 2023; 65:469-478. [PMID: 36217216 DOI: 10.1111/dmcn.15431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022]
Abstract
AIM To examine the nature and scope of the literature on interventions implemented for children with cerebral visual impairment (CVI). METHOD Using a scoping review methodology, a systematic search of the literature was conducted using four databases including PubMed, Web of Science, Scopus, and Embase. Titles and abstracts were screened and data were extracted and synthesized from full-text, eligible studies. Twenty-three articles were identified and evaluated using quality criteria. RESULTS Twenty-three of the 895 studies were included with children aged between 1 month and 17 years 6 months. Interventions were grouped into six categories including visual stimulation, task/environmental adaptations, vision training, acupuncture, stem cell transplantation, and transcranial electric stimulation. Outcome measures examined changes in visual function, functional vision, and visual processing. INTERPRETATION Intervention research for children with CVI is in its infancy. Interventions for children with CVI may be beneficial; however, comparing results is difficult due to inconsistency in outcome measures. Most of the intervention studies had lower-level evidence and included small sample sizes. High-quality studies with larger samples and comparison groups are needed to fully understand which evidence-based interventions are most effective for children with CVI. With the incidence of CVI increasing, further development and validation of intervention methods is imperative. WHAT THIS PAPER ADDS Intervention studies for children with cerebral visual impairment (CVI) are sparse. Most intervention studies for children with CVI have low-level evidence with low critical appraisal scores. High-quality, controlled intervention studies are needed to guide families and clinicians toward evidence-based practice.
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Affiliation(s)
- Ariana Delay
- Department of Occupational Therapy, Huntington University, Fort Wayne, IN, USA
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Melissa Rice
- Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elsie Bush
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Karen Harpster
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Rehabilitation, Exercise, and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
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Chokron S, Dutton GN. From vision to cognition: potential contributions of cerebral visual impairment to neurodevelopmental disorders. J Neural Transm (Vienna) 2023; 130:409-424. [PMID: 36547695 DOI: 10.1007/s00702-022-02572-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
Vision has a crucial role to play in human development and functioning. It is, therefore, not surprising that vision plays a fundamental role in the development of the child. As a consequence, an alteration in visual function is, therefore, likely to hinder the child's development. Although ocular disorders are well known, diagnosed and taken into account, cerebral visual impairments (CVI) resulting from post-chiasmatic damage are largely underdiagnosed. However, among the disorders resulting from an episode of perinatal asphyxia and/or associated with prematurity, or neonatal hypoglycaemia, CVIs are prominent. In this article, we focus on the role of the possible effects of CVI on a child's learning abilities, leading to major difficulty in disentangling the consequences of CVI from other neurodevelopmental disorders (NDD) such as dyslexia, dyscalculia, dysgraphia, attention-deficit/hyperactivity disorder (ADHD), developmental coordination disorder (DCD) and autism spectrum disorders (ASD). Although we focus here on the possible overlap between children with CVI and children with other NDD, De Witt et al. (Wit et al. Ear Hear 39:1-19, 2018) have raised exactly the same question regarding children with auditory processing disorders (the equivalent of CVI in the auditory modality). We underline how motor, social and cognitive development as well as academic success can be impaired by CVI and raise the question of the need for systematic evaluation for disorders of vision, visual perception and cognition in all children presenting with a NDD and/or previously born under adverse neurological conditions.
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Affiliation(s)
- Sylvie Chokron
- INCC, CNRS, UMR8002, Université de Paris-Cité, Paris, France.
- Institut de Neuropsychologie, Neurovision et Neurocognition, Hôpital-Fondation A. de Rothschild, Paris, France.
| | - Gordon N Dutton
- Department of Vision Science, Glasgow Caledonian University, Glasgow, UK
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Zihl J, Unterberger L, Lippenberger M. Visual and cognitive profiles in children with and without cerebral visual impairment. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2023. [DOI: 10.1177/02646196221149564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Reliable differentiation of visual-perceptual difficulties in children with and without cerebral visual impairment (CVI) can often pose a diagnostic challenge. We, therefore, assessed the visual-perceptual profile in 94 children with and 77 children without suspected CVI between the ages of 8 and 17 years in a non-clinical setting, using a screening questionnaire and standardized visual-perceptual tests. Children with suspected CVI reported more frequently greater visual difficulties, had lower visual acuity, and were significantly impaired in visual search tests, in visual form and object perception, in visual space perception, and in visual text processing. There were no significant differences between groups in stereopsis, fixation stability, motility, horizontal saccadic eye movements, and convergence and accommodation. Cognitive performance in auditory attention and verbal short-term and working memory was similar in both groups. Our results indicate that the use of an appropriate questionnaire and specific visual-perceptual tests enables valid diagnostic detection of CVI. The additional use of cognitive tests also allows differentiation between primary and secondary impairments in visual perception.
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Handley S, Bowman R, Liasis A, Rahi JS. Homonymous hemianopia in childhood: a systematic scoping review protocol. BMJ Open Ophthalmol 2022. [DOI: 10.1136/bmjophth-2022-001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
IntroductionCerebral visual impairment (CVI) is the leading cause of visual impairment in childhood in western countries. This encompasses a heterogeneous group of disorders and a spectrum of types of visual impairments. Research is required to explore specific subtypes of CVI and the specific needs of these groups to provide more individualised patient care. One type of CVI is homonymous hemianopia (HH), the absence of vision on one side due to an insult to the postchiasmal visual pathways in one hemisphere of the brain. The scoping review aims to map the nature, features and volume of the existing literature around HH in infancy, childhood and young adolescence.Methods and analysisWe will perform a scoping review of the literature relating to HH in children (0–18 years old). The review will follow the PRISMA extension for scoping reviews checklist to ensure reporting integrity. We will conduct electronic database searches including CENTRAL, CINAHL, MEDLINE (PubMed) and PsycINFO. We will also carry out a ‘grey literature’ and internet search for studies or materials not formally published. Two researchers will independently review abstracts yielded from the search strategy for study inclusion.DisseminationThis review will inform health professionals and other stakeholders working within this growing population of children with CVI. Our review will summarise the literature relating to this specific subgroup of CVI, and will identify gaps that require further research and development towards specific care of children with this form of CVI.
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Zhang X, Manley CE, Micheletti S, Tesic I, Bennett CR, Fazzi EM, Merabet LB. Assessing visuospatial processing in cerebral visual impairment using a novel and naturalistic static visual search task. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 131:104364. [PMID: 36334401 DOI: 10.1016/j.ridd.2022.104364] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/15/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cerebral visual impairment (CVI) is a brain based visual disorder associated with the maldevelopment of central visual pathways. Individuals with CVI often report difficulties finding a target of interest in cluttered and crowded visual scenes. However, it remains unknown how manipulating task demands and other environmental factors influence visual search performance in this population. AIM We developed a novel and naturalistic virtual reality (VR) based static visual search task combined with eye tracking called the "virtual toy box" to objectively assess visual search performance in CVI. METHODS AND PROCEDURES A total of 38 individuals with CVI (mean age 13.18 years ± 3.58 SD) and 53 controls with neurotypical development (mean age 15.25 years ± 5.72 SD) participated in the study. In a first experiment, study subjects were instructed to search for a preselected toy presented among a varying number of surrounding distractor toys (set size ranging from 1 to 36 items). In a second experiment, we assessed the effects of manipulating item spacing and the size of the visual area explored (field of view; FOV). OUTCOMES AND RESULTS Behavioral outcomes collected were success rate, reaction time, gaze error, visual search area, and off-screen percent (an index of task compliance). Compared to age-matched controls, participants with CVI showed an overall impairment with respect to all the visual search outcomes of interest. Specifically, individuals with CVI were less likely and took longer to find the target, and search patterns were less accurate and precise compared to controls. Visual search response profiles were also comparatively less efficient and were associated with a slower initial pre-search (visual orienting) response as indexed by higher slope and intercept values derived from the analysis of reaction time × set size functions. Search performance was also more negatively affected in CVI at the smallest as well as largest spacing conditions tested, while increasing FOV was associated with greater decreased gaze accuracy and precision CONCLUSIONS AND IMPLICATIONS: These results are consistent with a general profile of impaired visual search abilities in CVI as well as worsening performance with increased visual task demands and an overall sensitivity to visual clutter and crowding. The observed profile of impaired visual search performance may be associated with dysfunctions related to how visual selective attention is deployed in individuals with CVI.
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Affiliation(s)
- Xin Zhang
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - Claire E Manley
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - Serena Micheletti
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Isidora Tesic
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Christopher R Bennett
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - Elisa M Fazzi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lotfi B Merabet
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA.
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15
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Philip SS, Guzzetta A, Gole GA, Boyd RN. Clinimetric properties of visuo-perceptual and visuo-cognitive assessment tools used for children with cerebral visual impairment and cerebral palsy or developmental delay: a systematic review. Disabil Rehabil 2022; 44:6984-6996. [PMID: 34787029 DOI: 10.1080/09638288.2021.1990421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The aim of this systematic review is to evaluate the psychometrics and clinical utility of visuo-perceptual and visuo-cognitive assessment tools in children with cerebral visual impairment (CVI) and cerebral palsy (CP) or neurodevelopmental delay (DD). MATERIALS AND METHODS Five databases (PubMed, EMBASE, SCOPUS, CINAHL, and Cochrane Database) were comprehensively searched from 1970 till June 2021. The PRISMA checklist was utilised to report on the process of selecting eligible papers. The methodological quality of included studies was evaluated using COnsenus-based Standards for the selection of health Measurement INstrument (COSMIN) checklist. RESULTS Of the 26 assessment tools identified, only seven tools had psychometric evidence supporting their use. Based on COSMIN guidelines, 60% of included studies were rated as inadequate or doubtful for their methodological quality of measurement properties, with equal number being rated as indeterminate on the overall rating. CONCLUSIONS Cerebral visual impairment due to its varied clinical presentation is often missed in children with CP and DD. There is a paucity of studies reporting on the validity and reliability of functional vision tools. Further studies are needed to conduct high-quality psychometric reporting using the updated COSMIN guidelines to identify appropriate functional vision tools for children with CP or DD.Implications for rehabilitationThere are paucity of studies evaluating the validity and reliability of existing perceptual and cognitive assessment tools in children with cerebral visual impairment (CVI) and cerebral palsy (CP).Development of age-appropriate assessment tools evaluating all aspects of functional vision will assist in providing more holistic child-centric rehabilitation programs.A combination of detailed perinatal history, direct observation, and clinical assessments of functional vision are important to recognise CVI in children with CP.
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Affiliation(s)
- Swetha Sara Philip
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, Brisbane, Australia.,Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Australia
| | - Andrea Guzzetta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Glen A Gole
- Mayne Academy of Paediatrics, The University of Queensland, Brisbane, Australia
| | - Roslyn N Boyd
- The University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, Brisbane, Australia
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16
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Chang KJ, Wu HY, Yarmishyn AA, Li CY, Hsiao YJ, Chi YC, Lo TC, Dai HJ, Yang YC, Liu DH, Hwang DK, Chen SJ, Hsu CC, Kao CL. Genetics behind Cerebral Disease with Ocular Comorbidity: Finding Parallels between the Brain and Eye Molecular Pathology. Int J Mol Sci 2022; 23:9707. [PMID: 36077104 PMCID: PMC9456058 DOI: 10.3390/ijms23179707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
Cerebral visual impairments (CVIs) is an umbrella term that categorizes miscellaneous visual defects with parallel genetic brain disorders. While the manifestations of CVIs are diverse and ambiguous, molecular diagnostics stand out as a powerful approach for understanding pathomechanisms in CVIs. Nevertheless, the characterization of CVI disease cohorts has been fragmented and lacks integration. By revisiting the genome-wide and phenome-wide association studies (GWAS and PheWAS), we clustered a handful of renowned CVIs into five ontology groups, namely ciliopathies (Joubert syndrome, Bardet-Biedl syndrome, Alstrom syndrome), demyelination diseases (multiple sclerosis, Alexander disease, Pelizaeus-Merzbacher disease), transcriptional deregulation diseases (Mowat-Wilson disease, Pitt-Hopkins disease, Rett syndrome, Cockayne syndrome, X-linked alpha-thalassaemia mental retardation), compromised peroxisome disorders (Zellweger spectrum disorder, Refsum disease), and channelopathies (neuromyelitis optica spectrum disorder), and reviewed several mutation hotspots currently found to be associated with the CVIs. Moreover, we discussed the common manifestations in the brain and the eye, and collated animal study findings to discuss plausible gene editing strategies for future CVI correction.
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Affiliation(s)
- Kao-Jung Chang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Hsin-Yu Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | | | - Cheng-Yi Li
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Yu-Jer Hsiao
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Yi-Chun Chi
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Tzu-Chen Lo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - He-Jhen Dai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Yi-Chiang Yang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Ding-Hao Liu
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - De-Kuang Hwang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Chih-Chien Hsu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chung-Lan Kao
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
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17
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Manley CE, Bennett CR, Merabet LB. Assessing Higher-Order Visual Processing in Cerebral Visual Impairment Using Naturalistic Virtual-Reality-Based Visual Search Tasks. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1114. [PMID: 35892617 PMCID: PMC9331719 DOI: 10.3390/children9081114] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022]
Abstract
Cerebral visual impairment (CVI) is a brain-based disorder associated with the maldevelopment of central visual pathways. Individuals with CVI often report difficulties with daily visual search tasks such as finding a favorite toy or familiar person in cluttered and crowded scenes. We developed two novel virtual reality (VR)-based visual search tasks combined with eye tracking to objectively assess higher order processing abilities in CVI. The first (virtual toybox) simulates a static object search, while the second (virtual hallway) represents a dynamic human search task. Participants were instructed to search for a preselected target while task demand was manipulated with respect to the presence of surrounding distractors. We found that CVI participants (when compared to age-matched controls) showed an overall impairment with visual search on both tasks and with respect to all gaze metrics. Furthermore, CVI participants showed a trend of worsening performance with increasing task demand. Finally, search performance was also impaired in CVI participants with normal/near normal visual acuity, suggesting that reduced stimulus visibility alone does not account for these observations. This novel approach may have important clinical utility in helping to assess environmental factors related to functional visual processing difficulties observed in CVI.
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Affiliation(s)
| | | | - Lotfi B. Merabet
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA; (C.E.M.); (C.R.B.)
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18
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Boonstra FN, Bosch DGM, Geldof CJA, Stellingwerf C, Porro G. The Multidisciplinary Guidelines for Diagnosis and Referral in Cerebral Visual Impairment. Front Hum Neurosci 2022; 16:727565. [PMID: 35845239 PMCID: PMC9280621 DOI: 10.3389/fnhum.2022.727565] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Cerebral visual impairment (CVI) is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in CVI according to the grade method. Patients and Methods We developed the guidelines according to the GRADE method 5 searches on CVI (children, developmental age ≤ 18 years) were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic. Results Based on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23 (out of 1,007). 2. Ophthalmological and orthoptic assessment 37 (out of 816). 3. Neuropsychological assessment 5 (out of 716). 4. Neuroradiological evaluation and magnetic resonance imaging (MRI) 9 (out of 723). 5. Genetic assessment 5 (out of 458). Conclusion In medical history taking, prematurity low birth weight and APGAR (Appearance, Pulse, Grimace, Activity, Respiration) Scores (<5) are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups (extremely preterm). In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments (neurological or genetic) can be necessary to complete the diagnosis of CVI and/or to reveal the etiology.
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Affiliation(s)
- Frouke N. Boonstra
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre Nijmegen, Nijmegen, Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
- *Correspondence: Frouke N. Boonstra,
| | | | - Christiaan J. A. Geldof
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands
| | - Catharina Stellingwerf
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands
| | - Giorgio Porro
- Department of Ophthalmology, UMC Utrecht and Amphia Hospital Breda, Breda, Netherlands
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19
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Pathophysiological Heterogeneity of the BBSOA Neurodevelopmental Syndrome. Cells 2022; 11:cells11081260. [PMID: 35455940 PMCID: PMC9024734 DOI: 10.3390/cells11081260] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/17/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
The formation and maturation of the human brain is regulated by highly coordinated developmental events, such as neural cell proliferation, migration and differentiation. Any impairment of these interconnected multi-factorial processes can affect brain structure and function and lead to distinctive neurodevelopmental disorders. Here, we review the pathophysiology of the Bosch–Boonstra–Schaaf Optic Atrophy Syndrome (BBSOAS; OMIM 615722; ORPHA 401777), a recently described monogenic neurodevelopmental syndrome caused by the haploinsufficiency of NR2F1 gene, a key transcriptional regulator of brain development. Although intellectual disability, developmental delay and visual impairment are arguably the most common symptoms affecting BBSOAS patients, multiple additional features are often reported, including epilepsy, autistic traits and hypotonia. The presence of specific symptoms and their variable level of severity might depend on still poorly characterized genotype–phenotype correlations. We begin with an overview of the several mutations of NR2F1 identified to date, then further focuses on the main pathological features of BBSOAS patients, providing evidence—whenever possible—for the existing genotype–phenotype correlations. On the clinical side, we lay out an up-to-date list of clinical examinations and therapeutic interventions recommended for children with BBSOAS. On the experimental side, we describe state-of-the-art in vivo and in vitro studies aiming at deciphering the role of mouse Nr2f1, in physiological conditions and in pathological contexts, underlying the BBSOAS features. Furthermore, by modeling distinct NR2F1 genetic alterations in terms of dimer formation and nuclear receptor binding efficiencies, we attempt to estimate the total amounts of functional NR2F1 acting in developing brain cells in normal and pathological conditions. Finally, using the NR2F1 gene and BBSOAS as a paradigm of monogenic rare neurodevelopmental disorder, we aim to set the path for future explorations of causative links between impaired brain development and the appearance of symptoms in human neurological syndromes.
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20
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Mooney SWJ, Alam NM, Prusky GT. Tracking-Based Interactive Assessment of Saccades, Pursuits, Visual Field, and Contrast Sensitivity in Children With Brain Injury. Front Hum Neurosci 2021; 15:737409. [PMID: 34776907 PMCID: PMC8586078 DOI: 10.3389/fnhum.2021.737409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/07/2021] [Indexed: 11/15/2022] Open
Abstract
Visual deficits in children that result from brain injury, including cerebral/cortical visual impairment (CVI), are difficult to assess through conventional methods due to their frequent co-occurrence with cognitive and communicative disabilities. Such impairments hence often go undiagnosed or are only determined through subjective evaluations of gaze-based reactions to different forms, colors, and movements, which limits any potential for remediation. Here, we describe a novel approach to grading visual health based on eye movements and evidence from gaze-based tracking behaviors. Our approach—the “Visual Ladder”—reduces reliance on the user’s ability to attend and communicate. The Visual Ladder produces metrics that quantify spontaneous saccades and pursuits, assess visual field responsiveness, and grade spatial visual function from tracking responses to moving stimuli. We used the Ladder to assess fourteen hospitalized children aged 3 to 18 years with a diverse range of visual impairments and causes of brain injury. Four children were excluded from analysis due to incompatibility with the eye tracker (e.g., due to severe strabismus). The remaining ten children—including five non-verbal children—were tested multiple times over periods ranging from 2 weeks to 9 months, and all produced interpretable outcomes on at least three of the five visual tasks. The results suggest that our assessment tasks are viable in non-communicative children, provided their eyes can be tracked, and hence are promising tools for use in a larger clinical study. We highlight and discuss informative outcomes exhibited by each child, including directional biases in eye movements, pathological nystagmus, visual field asymmetries, and contrast sensitivity deficits. Our findings indicate that these methodologies will enable the rapid, objective classification and grading of visual impairments in children with CVI, including non-verbal children who are currently precluded from most vision assessments. This would provide a much-needed differential diagnostic and prognostic tool for CVI and other impairments of the visual system, both ocular and cerebral.
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Affiliation(s)
- Scott W J Mooney
- Burke Neurological Institute, White Plains, NY, United States.,Blythedale Children's Hospital, Valhalla, NY, United States
| | - Nazia M Alam
- Burke Neurological Institute, White Plains, NY, United States.,Blythedale Children's Hospital, Valhalla, NY, United States
| | - Glen T Prusky
- Burke Neurological Institute, White Plains, NY, United States.,Blythedale Children's Hospital, Valhalla, NY, United States.,Weill Cornell Medicine, New York, NY, United States
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21
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Chandna A, Ghahghaei S, Foster S, Kumar R. Higher Visual Function Deficits in Children With Cerebral Visual Impairment and Good Visual Acuity. Front Hum Neurosci 2021; 15:711873. [PMID: 34867236 PMCID: PMC8636735 DOI: 10.3389/fnhum.2021.711873] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/07/2021] [Indexed: 01/25/2023] Open
Abstract
In clinical practice Cerebral Visual Impairment (CVI) is typically diagnosed by observation of abnormal visually guided behaviors which indicate higher visual function deficits (HVFDs) suggesting abnormal brain development or brain damage in a child with a suitable clinical history. HVFDs can occur even in the presence of good visual acuity and may remain undiagnosed because the good visual acuity does not prompt further investigation. This leads to a lack of understanding of the child's visual perceptual difficulties. In a prospective study, we determined the spectrum of HVFDs in a group of children with history suggestive of brain damage or disruption of brain development and an independent diagnosis of CVI in comparison with typically developing children with a structured 51 question inventory, the Higher Visual Function Question Inventory (HVFQI-51) adapted from the Cerebral Vision Impairment Inventory, CVI-I. Here, we show that the HVFQI-51 can detect a range of HVFDs in children with CVI with good visual acuity and clearly distinguishes these children from typically developing children. HVFDs in our study group could mostly be attributed to dorsal stream visual processing dysfunction though the spectrum varied between children. We report on the inclusion of the "not applicable" response option in analysis providing a picture of HVFDs more in tune with the overall disability of each child. We also propose a subset of 11 questions (Top-11) which discriminate between children with CVI vs. behaviors seen in typical children: this provides both a potential screening tool for initial assessment of HVFDs and a measure of CVI-related impairment, and needs further validation in a secondary independent sample.
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Affiliation(s)
- Arvind Chandna
- The Smith-Kettlewell Eye Research Institute, San Francisco, CA, United States
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Saeideh Ghahghaei
- The Smith-Kettlewell Eye Research Institute, San Francisco, CA, United States
| | - Susan Foster
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Ram Kumar
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
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22
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Chokron S, Kovarski K, Dutton GN. Cortical Visual Impairments and Learning Disabilities. Front Hum Neurosci 2021; 15:713316. [PMID: 34720906 PMCID: PMC8548846 DOI: 10.3389/fnhum.2021.713316] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Abstract
Medical advances in neonatology have improved the survival rate of premature infants, as well as children who are born under difficult neurological conditions. As a result, the prevalence of cerebral dysfunctions, whether minimal or more severe, is increasing in all industrialized countries and in some developing nations. Whereas in the past, ophthalmological diseases were considered principally responsible for severe visual impairment, today, all recent epidemiological studies show that the primary cause of blindness and severe visual impairment in children in industrialized countries is now neurological, with lesions acquired around the time of birth currently comprising the commonest contributor. The resulting cortical or cerebral visual impairments (CVIs) have long been ignored, or have been confused either with other ophthalmological disorders causing low vision, or with a range of learning disabilities. We present here the deleterious consequences that CVI can have upon learning and social interaction, and how these can be given behavioral labels without the underlying visual causes being considered. We discuss the need to train and inform clinicians in the identification and diagnosis of CVI, and how to distinguish the diagnosis of CVI from amongst other visual disorders, including the specific learning disorders. This is important because the range of approaches needed to enhance the development of children with CVI is specific to each child's unique visual needs, making incorrect labeling or diagnosis potentially detrimental to affected children because these needs are not met.
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Affiliation(s)
- Sylvie Chokron
- Hôpital Fondation Adolphe de Rothschild, Paris, France
- INCC UMR 8002, CNRS, Université de Paris, Paris, France
| | - Klara Kovarski
- Hôpital Fondation Adolphe de Rothschild, Paris, France
- INCC UMR 8002, CNRS, Université de Paris, Paris, France
| | - Gordon N. Dutton
- Department of Vision Science, Glasgow Caledonian University, Glasgow, United Kingdom
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23
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Pease A, Goodenough T, Borwick C, Watanabe R, Morris C, Williams C. Development of a core outcome set for evaluative research into paediatric cerebral visual impairment (CVI), in the UK and Eire. BMJ Open 2021; 11:e051014. [PMID: 34588256 PMCID: PMC8483040 DOI: 10.1136/bmjopen-2021-051014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Cerebral visual impairment (CVI) comprises a heterogeneous group of brain-related vision problems. A core outcome set (COS) represents the most important condition-specific outcomes according to patients, carers, professionals and researchers. We aimed to produce a COS for studies evaluating interventions for children with CVI, to increase the relevance of research for families and professionals and thereby to improve outcomes for affected children. DESIGN We used methods recommended by the Core Outcome Measures in Effectiveness Trials Initiative. These included a proportionate literature review of outcomes used in previous studies; qualitative interviews with children and families; a two-round Delphi survey involving parents, children and professionals and a consensus meeting to ratify the most important outcomes. SETTING Telephone interviews and online Delphi surveys of participants who all lived in UK or Eire. PARTICIPANTS Eighteen parents and six young people were interviewed. Delphi participants (n=80 did both rounds) included professionals working with children who have CVI (teachers, orthoptists, ophthalmologists, optometrists, qualified teachers for visually impaired, family members (parents and siblings) and affected children. RESULTS The literature review included 13 studies yielding 37 outcomes. Qualitative interviews provided 22 outcomes. After combining and refining similar items, the first round contained 23 outcomes and the second 46. At the consensus meeting, 5 attendees recommended 27 outcomes for inclusion in the CVI COS, of which 15 were ratified as most important, including 4 related to vision; 1 to family well-being; 1 to adults around the child being informed about CVI and the rest to the child's abilities to engage with people and surroundings. CONCLUSIONS Good engagement from participants led to the development of a COS. Future research will be useful to identify the best ways to measure COS items and potentially to update this COS as more interventions for CVI are developed. TRIAL REGISTRATION NUMBER ISRCTN13762177.
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Affiliation(s)
- Anna Pease
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Cath Borwick
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Rose Watanabe
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Cathy Williams
- Bristol Medical School, University of Bristol, Bristol, UK
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24
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McConnell EL, Saunders KJ, Little J. What assessments are currently used to investigate and diagnose cerebral visual impairment (CVI) in children? A systematic review. Ophthalmic Physiol Opt 2021; 41:224-244. [PMID: 33368471 PMCID: PMC8048590 DOI: 10.1111/opo.12776] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/10/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Cerebral visual impairment (CVI) is the leading cause of childhood visual impairment in the developed world. Despite this, there are no agreed clinical guidelines for the investigation and diagnosis of the condition. Before development of such guidelines can commence, it is important to recognise which approaches are currently employed. This systematic review evaluated the literature to identify which methods of assessment are currently used to investigate and diagnose childhood CVI. METHODS Medline, Embase, CINAHL, Scopus and the Cochrane Library databases were systematically searched in January 2020 using defined search terms. Articles were included if they: (i) were research papers, conference abstracts or research protocols published in peer-reviewed scientific journals, or relevant textbooks; (ii) included a clinical investigation of CVI in children; (iii) provided an explanation or criteria to diagnose CVI and (iv) were specifically investigating cerebral/cortical visual impairment. Methods used to a) assess and b) diagnose CVI were extracted from included articles. 'Assessment scores' were assigned for each method employed by researchers to investigate and diagnose CVI to quantify and compare approaches between articles. A quality grading was also applied to each article. RESULTS Of 6454 identified articles, 45 met the inclusion criteria. From these, 10 categories of assessment utilised within included articles were identified: (1) Medical history, (2) Vision assessment/ophthalmologic examination, (3) Neuroimaging, (4) Visual behaviour and direct observation, (5) Structured history-taking, (6) Visual perception tests, (7) Ocular movement and posture assessment, (8) Intelligence/IQ assessment, (9) Clinical electrophysiology and (10) Neurodevelopmental tests. In terms of diagnostic criteria, the most commonly reported approach was one of exclusion, i.e., CVI was diagnosed when visual dysfunction could not be attributed to abnormalities detected in the anterior visual pathway. CONCLUSION There is a lack of common practice in the approaches used by clinicians to investigate and diagnose CVI in children. At present, a 'diagnosis of exclusion' remains the most common means to diagnose CVI. Development of clinical guidelines for assessment and diagnosis are necessary to ensure consistency in the diagnosis of CVI and the timely implementation of support to alleviate the impact of CVI on the child's daily living.
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Affiliation(s)
- Emma L McConnell
- Centre for Optometry and Vision ScienceSchool of Biomedical SciencesUlster UniversityColeraineNorthern IrelandUK
- Northern Ireland Clinical Research FacilitySchool of Medicine, Dentistry and Biomedical Sciences, Queen's University BelfastBelfastNorthern IrelandUK
- NICRN Vision, Belfast Health and Social Care TrustBelfastNorthern IrelandUK
| | - Kathryn J Saunders
- Centre for Optometry and Vision ScienceSchool of Biomedical SciencesUlster UniversityColeraineNorthern IrelandUK
| | - Julie‐Anne Little
- Centre for Optometry and Vision ScienceSchool of Biomedical SciencesUlster UniversityColeraineNorthern IrelandUK
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