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Borba R, Freitas T, Marques C, Nóbrega L, Higino T, Rocha C, Ventura CV, Sallum J, Ventura LO. Long-term visual and neurodevelopmental outcomes in children with Congenital Zika Syndrome after undergoing strabismus surgery. Strabismus 2024; 32:91-101. [PMID: 38773721 PMCID: PMC11208075 DOI: 10.1080/09273972.2024.2346551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Purpose: To assess long-term visual and neurodevelopmental outcomes in children with congenital Zika syndrome (CZS) after strabismus surgery. Methods: A consecutive sample of five children with CZS who underwent strabismus surgery was enrolled. All children underwent a standardized pre- and postoperative protocol including binocular best-corrected visual acuity (BCVA) using the Teller Acuity Cards II (TAC II), ocular alignment, functional vision using the functional vision developmental milestones test (FVDMT), and neurodevelopmental milestone evaluation using the Bayley Scales of Infant Development-Third Edition (BSID-III). Scores of the FVDMT outcomes considering the child's developmental age based on the BSID-III score were compared with scores from postoperative assessment. Results: Five children with CZS (3 girls, 2 boys) were enrolled with a mean age at baseline (preoperative) of 35.0 ± 0.7 months (range, 34-36 months) and at final assessment of 64.4 ± 0.5 months (range, 64-65 months). Preoperative BCVA was 1.2 ± 0.5 logMAR and at final assessment 0.7 ± 0.1 logMAR. Successful strabismus surgery outcome was maintained in 4/5 (80.0%) of children at final assessment. The children's BSID-III scores showed significant neurodevelopment delay at the initial assessment (corresponding developmental mean age was 4.7 months) and at their final assessment (corresponding developmental mean age was 5.1 months). There was improvement or stability in 34/46 items evaluated in the FVDMT (73.9%) when comparing baseline with 2-year follow-up. Conclusions: Strabismus surgery resulted in long-term ocular alignment in the majority of children with CZS. All the children showed improvement or stability in more than 70.0% of the functional vision items assessed. Visual and neurodevelopmental dysfunction may be related to complex condition and associated disorders seen in CZS including ocular, neurological, and skeletal abnormalities.
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Affiliation(s)
- Raíne Borba
- Rehabilitation Center, Altino Ventura Foundation, Recife, PE, Brazil
| | - Tatiane Freitas
- Rehabilitation Center, Altino Ventura Foundation, Recife, PE, Brazil
| | - Cláudia Marques
- Rehabilitation Center, Altino Ventura Foundation, Recife, PE, Brazil
| | - Lucélia Nóbrega
- Rehabilitation Center, Altino Ventura Foundation, Recife, PE, Brazil
| | - Taciana Higino
- Department of Research, Altino Ventura Foundation, Recife, PE, Brazil
| | - Camilla Rocha
- Department of Research, Altino Ventura Foundation, Recife, PE, Brazil
| | - Camila V. Ventura
- Department of Research, Altino Ventura Foundation, Recife, PE, Brazil
- Department of Ophthalmology, HOPE Eye Hospital, Recife, PE, Brazil
| | - Juliana Sallum
- Department of Ophthalmology, Federal University of São Paulo, SP, Brazil
| | - Liana O. Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, PE, Brazil
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2
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Shaw E, Flitcroft I, Bowman R, Baker K. Cerebral visual impairment: genetic diagnoses and phenotypic associations. J Med Genet 2024; 61:605-612. [PMID: 38458753 PMCID: PMC11137471 DOI: 10.1136/jmg-2023-109670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/19/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Cerebral visual impairment (CVI) is the most common form of paediatric visual impairment in developed countries. CVI can arise from a host of genetic or acquired causes, but there has been limited research to date on CVI in the context of genetic disorders. METHODS We carried out a retrospective analysis of genotypic and phenotypic data for participants with CVI within the DECIPHER database and 100 000 Genomes Project (100KGP). RESULTS 158 individuals with CVI were identified across both cohorts. Within this group, pathogenic or likely pathogenic sequence variants in 173 genes were identified. 25 of these genes already have known associations with CVI, while the remaining 148 are candidate genes for this phenotype. Gene ontology analysis of the CVI gene sets from both DECIPHER and 100KGP suggests that CVI has a similar degree of genetic heterogeneity to other neurodevelopmental phenotypes, and a strong association with genetic variants converging on ion channels and receptor functions. Individuals with a monogenic disorder and CVI have a higher frequency of epilepsies and severe neurodisability than individuals with a monogenic disorder but not CVI. CONCLUSION This study supports the availability of genetic testing for individuals with CVI alongside other neurodevelopmental difficulties. It also supports the availability of ophthalmological screening for individuals with genetic diagnoses linked to CVI. Further studies could elaborate on the links between specific genetic disorders, visual maturation and broader neurodevelopmental characteristics.
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Affiliation(s)
- Emogene Shaw
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - Ian Flitcroft
- Children's University Hospital, Temple Street, Dublin, Ireland
- Trinity College, Dublin, Ireland
| | - Richard Bowman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Kate Baker
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
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3
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Pamir Z, Manley CE, Bauer CM, Bex PJ, Dilks DD, Merabet LB. Visuospatial processing in early brain-based visual impairment is associated with differential recruitment of dorsal and ventral visual streams. Cereb Cortex 2024; 34:bhae203. [PMID: 38795357 DOI: 10.1093/cercor/bhae203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/25/2024] [Indexed: 05/27/2024] Open
Abstract
Visuospatial processing impairments are prevalent in individuals with cerebral visual impairment (CVI) and are typically ascribed to "dorsal stream dysfunction" (DSD). However, the contribution of other cortical regions, including early visual cortex (EVC), frontal cortex, or the ventral visual stream, to such impairments remains unknown. Thus, here, we examined fMRI activity in these regions, while individuals with CVI (and neurotypicals) performed a visual search task within a dynamic naturalistic scene. First, behavioral performance was measured with eye tracking. Participants were instructed to search and follow a walking human target. CVI participants took significantly longer to find the target, and their eye gaze patterns were less accurate and less precise. Second, we used the same task in the MRI scanner. Along the dorsal stream, activation was reduced in CVI participants, consistent with the proposed DSD in CVI. Intriguingly, however, visual areas along the ventral stream showed the complete opposite pattern, with greater activation in CVI participants. In contrast, we found no differences in either EVC or frontal cortex between groups. These results suggest that the impaired visuospatial processing abilities in CVI are associated with differential recruitment of the dorsal and ventral visual streams, likely resulting from impaired selective attention.
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Affiliation(s)
- Zahide Pamir
- Department of Psychology & Department of Neuroscience, Bilkent University, Üniversiteler, Çankaya/Ankara 06800, Turkey
- Aysel Sabuncu Brain Research Center, Bilkent University, Üniversiteler, Çankaya/Ankara 06800, Turkey
| | - Claire E Manley
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA 02114, USA
| | - Corinna M Bauer
- Lab for Neuroimaging and Vision Science, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 125 Nashua St. Suite 660, Boston, MA 02114, USA
| | - Peter J Bex
- The Translational Vision Laboratory, Department of Psychology, Northeastern University, 105-107 Forsyth St #125, Boston, MA 02115, USA
| | - Daniel D Dilks
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, USA
| | - Lotfi B Merabet
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA 02114, USA
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4
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Leahy KE, Lo-Cao E, Jamieson RV, Grigg JR. Managing the apparently blind child presenting in the first year of life: A review. Clin Exp Ophthalmol 2024; 52:452-463. [PMID: 38240137 DOI: 10.1111/ceo.14348] [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: 08/15/2023] [Revised: 11/21/2023] [Accepted: 12/15/2023] [Indexed: 06/14/2024]
Abstract
Severe vision impairment and blindness in childhood have a significant health burden on the child, family and society. This review article seeks to provide a structured framework for managing the apparently blind child presenting in the first year of life, starting from a comprehensive history and examination. Different investigation modalities and the increasingly important role of genetics will also be described, in addition to common causes of severe vision impairment. Crucially, a systematic approach to the blind infant is key to correct diagnoses and timely management. Incorrect diagnoses can be costly to all involved, however it is important to note that diagnoses can change with ongoing follow-up and investigations. Furthermore, the modern age of ophthalmology requires a multi-disciplinary approach and close collaboration with specialists including paediatricians, neurologists and geneticists, in addition to rehabilitation and low vision services, to ensure the best care for these vulnerable infants.
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Affiliation(s)
- Kate E Leahy
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
- Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Edward Lo-Cao
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
- Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Robyn V Jamieson
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
- Eye Genetics Research Unit, Children's Medical Research Institute, Save Sight Institute, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
- Discipline of Genetic Medicine, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - John R Grigg
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
- Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Eye Genetics Research Unit, Children's Medical Research Institute, Save Sight Institute, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
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5
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Hu W, Foord C, Hsu J, Fan L, Corley MJ, Bhatia TN, Xu S, Belchikov N, He Y, Pang AP, Lanjewar SN, Jarroux J, Joglekar A, Milner TA, Ndhlovu LC, Zhang J, Butelman E, Sloan SA, Lee VM, Gan L, Tilgner HU. ScISOr-ATAC reveals convergent and divergent splicing and chromatin specificities between matched cell types across cortical regions, evolution, and in Alzheimer's Disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.24.581897. [PMID: 38464236 PMCID: PMC10925193 DOI: 10.1101/2024.02.24.581897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Multimodal measurements have become widespread in genomics, however measuring open chromatin accessibility and splicing simultaneously in frozen brain tissues remains unconquered. Hence, we devised Single-Cell-ISOform-RNA sequencing coupled with the Assay-for-Transposase-Accessible-Chromatin (ScISOr-ATAC). We utilized ScISOr-ATAC to assess whether chromatin and splicing alterations in the brain convergently affect the same cell types or divergently different ones. We applied ScISOr-ATAC to three major conditions: comparing (i) the Rhesus macaque (Macaca mulatta) prefrontal cortex (PFC) and visual cortex (VIS), (ii) cross species divergence of Rhesus macaque versus human PFC, as well as (iii) dysregulation in Alzheimer's disease in human PFC. We found that among cortical-layer biased excitatory neuron subtypes, splicing is highly brain-region specific for L3-5/L6 IT_RORB neurons, moderately specific in L2-3 IT_CUX2.RORB neurons and unspecific in L2-3 IT_CUX2 neurons. In contrast, at the chromatin level, L2-3 IT_CUX2.RORB neurons show the highest brain-region specificity compared to other subtypes. Likewise, when comparing human and macaque PFC, strong evolutionary divergence on one molecular modality does not necessarily imply strong such divergence on another molecular level in the same cell type. Finally, in Alzheimer's disease, oligodendrocytes show convergently high dysregulation in both chromatin and splicing. However, chromatin and splicing dysregulation most strongly affect distinct oligodendrocyte subtypes. Overall, these results indicate that chromatin and splicing can show convergent or divergent results depending on the performed comparison, justifying the need for their concurrent measurement to investigate complex systems. Taken together, ScISOr-ATAC allows for the characterization of single-cell splicing and chromatin patterns and the comparison of sample groups in frozen brain samples.
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Affiliation(s)
- Wen Hu
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
- Center for Neurogenetics, Weill Cornell Medicine, New York, NY, USA
| | - Careen Foord
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
- Center for Neurogenetics, Weill Cornell Medicine, New York, NY, USA
| | - Justine Hsu
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
- Center for Neurogenetics, Weill Cornell Medicine, New York, NY, USA
| | - Li Fan
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
- Helen and Robert Appel Alzheimer's Disease Research Institute
| | - Michael J Corley
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Tarun N Bhatia
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Siwei Xu
- Department of Computer Science, University of California, Irvine, CA, USA
| | - Natan Belchikov
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
- Center for Neurogenetics, Weill Cornell Medicine, New York, NY, USA
- Physiology, Biophysics & Systems Biology Program, Weill Cornell Medicine, New York, NY, USA
| | - Yi He
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
- Center for Neurogenetics, Weill Cornell Medicine, New York, NY, USA
| | - Alina Ps Pang
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Samantha N Lanjewar
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Julien Jarroux
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
- Center for Neurogenetics, Weill Cornell Medicine, New York, NY, USA
| | - Anoushka Joglekar
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
- Center for Neurogenetics, Weill Cornell Medicine, New York, NY, USA
| | - Teresa A Milner
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Lishomwa C Ndhlovu
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Jing Zhang
- Department of Computer Science, University of California, Irvine, CA, USA
| | - Eduardo Butelman
- Neuropsychoimaging of Addiction and Related Conditions Research Program, Dept. of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven A Sloan
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Virginia My Lee
- Center for Neurodegenerative Disease Research, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Li Gan
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
- Helen and Robert Appel Alzheimer's Disease Research Institute
| | - Hagen U Tilgner
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
- Center for Neurogenetics, Weill Cornell Medicine, New York, NY, USA
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6
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Walter K, Manley CE, Bex PJ, Merabet LB. Visual search patterns during exploration of naturalistic scenes are driven by saliency cues in individuals with cerebral visual impairment. Sci Rep 2024; 14:3074. [PMID: 38321069 PMCID: PMC10847433 DOI: 10.1038/s41598-024-53642-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/03/2024] [Indexed: 02/08/2024] Open
Abstract
We investigated the relative influence of image salience and image semantics during the visual search of naturalistic scenes, comparing performance in individuals with cerebral visual impairment (CVI) and controls with neurotypical development. Participants searched for a prompted target presented as either an image or text cue. Success rate and reaction time were collected, and gaze behavior was recorded with an eye tracker. A receiver operating characteristic (ROC) analysis compared the distribution of individual gaze landings based on predictions of image salience (using Graph-Based Visual Saliency) and image semantics (using Global Vectors for Word Representations combined with Linguistic Analysis of Semantic Salience) models. CVI participants were less likely and were slower in finding the target. Their visual search behavior was also associated with a larger visual search area and greater number of fixations. ROC scores were also lower in CVI compared to controls for both model predictions. Furthermore, search strategies in the CVI group were not affected by cue type, although search times and accuracy showed a significant correlation with verbal IQ scores for text-cued searches. These results suggest that visual search patterns in CVI are driven mainly by image salience and provide further characterization of higher-order processing deficits observed in this population.
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Affiliation(s)
- Kerri Walter
- Translational Vision Lab, Department of Psychology, Northeastern University, Boston, MA, USA
| | - Claire E Manley
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, USA
| | - 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, 20 Staniford Street, Boston, MA, 02114, USA.
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7
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Crotti M, Genoe S, Ben Itzhak N, Mailleux L, Ortibus E. The relation between neuroimaging and visual impairment in children and adolescents with cerebral palsy: A systematic review. Brain Dev 2024; 46:75-92. [PMID: 38016876 DOI: 10.1016/j.braindev.2023.11.002] [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] [Received: 05/12/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The structure-function relation between magnetic resonance imaging (MRI) and visual impairment (VI) in children with cerebral palsy (CP) has not been fully unravelled. The present systematic review aims to summarize the relation between brain lesions on MRI and VI in children and adolescents with CP. METHODS PubMed, Embase, Web of Science Core Collection, and Cochrane Database were systematically searched according to the PRISMA checklist. A total of 45 articles met the inclusion criteria. RESULTS White matter lesions were most frequently associated with VI. Only 25 studies described lesions within specific structures, mainly in the optic radiations. Only four studies reported on the thalamus. 8.4% of children with CP showed no brain abnormalities on MRI. Diffusion-weighted MRI studies showed that decreased structural connectivity in the optic radiations, superior longitudinal fasciculus, posterior limb of the internal capsule, and occipital lobe is associated with more severe VI. CONCLUSIONS All types of brain lesions lead to visual dysfunctions, arguing for a comprehensive visual assessment in all children with CP. Whereas white matter damage is a well-known contributor, the exact contribution of specific visual structures requires further investigation, to enable early prediction, detection, and intervention.
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Affiliation(s)
- Monica Crotti
- KU Leuven, Department of Development and Regeneration, B-3000 Leuven, Belgium; KU Leuven, Child and Youth Institute, B-3000 Leuven, Belgium.
| | - Sarah Genoe
- KU Leuven, Faculty of Medicine, B-3000 Leuven, Belgium.
| | - Nofar Ben Itzhak
- KU Leuven, Department of Development and Regeneration, B-3000 Leuven, Belgium; KU Leuven, Child and Youth Institute, B-3000 Leuven, Belgium.
| | - Lisa Mailleux
- KU Leuven, Child and Youth Institute, B-3000 Leuven, Belgium; KU Leuven, Department of Rehabilitation Sciences, Research group for Neurorehabilitation, B-3000 Leuven, Belgium.
| | - Els Ortibus
- KU Leuven, Department of Development and Regeneration, B-3000 Leuven, Belgium; KU Leuven, Child and Youth Institute, B-3000 Leuven, Belgium.
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8
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Imamoglu EY, Acar Z, Karatoprak EY, Ozumut SH, Ocak SY, Imamoglu S, Ovalı F. Neurological and Visual Outcomes in Infants and Toddlers Following Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy. Pediatr Neurol 2024; 151:131-137. [PMID: 38157718 DOI: 10.1016/j.pediatrneurol.2023.11.002] [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] [Received: 01/29/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The majority of studies have investigated neurodevelopmental outcomes, whereas visual impairment is less explored in children with a history of neonatal (hypoxic-ischemic) encephalopathy. Our aim was to perform a detailed neurological and visual assessment and also to investigate the presence of cerebral visual impairment in infants and toddlers with neonatal encephalopathy. METHODS Thirty participants with a history of neonatal encephalopathy, who had been hospitalized for therapeutic hypothermia, underwent a detailed neurological examination at age five to 36 months. Age-matched, 30 healthy children were also enrolled as a control group. All children in the study and control groups received neurological and a comprehensive ophthalmologic examination, including visual field and visual acuity. Presence of cerebral visual impairment was also evaluated clinically. RESULTS Rates of cerebral palsy, severe motor impairment, cognitive impairment, epilepsy, and cerebral visual impairment were found to be 20%, 10%, 15.3%, 10%, and 20%, respectively. When compared with healthy controls, oculomotor functions, pupillary light response, refractive parameters, anterior/posterior segment examinations, ocular visual impairment rates, and last, visual acuities were found similar. However, we found a statistically significant increase in visual field defects in our study group. CONCLUSIONS It could be better to perform a comprehensive ophthalmologic examination including visual field, visual acuity, and oculomotor functions by a pediatric ophthalmologist to accurately diagnose neurovisual deficits in infants following therapeutic hypothermia. Early identification and rehabilitation of the visual deficits might improve the neurodevelopment in these children.
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Affiliation(s)
- Ebru Yalin Imamoglu
- Neonatology Department, Goztepe Prof. Dr. Suleyman Yalcın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Zeynep Acar
- Pediatric Ophthalmology Department, Haydarpaşa Numune Training and Research Hospital, Saglık Bilimleri University, Istanbul, Turkey
| | - Elif Yuksel Karatoprak
- Pediatric Neurology Department, Goztepe Prof. Dr. Suleyman Yalcın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Sibel Hatice Ozumut
- Neonatology Department, Goztepe Prof. Dr. Suleyman Yalcın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Serap Yurttaser Ocak
- Ophthalmology Department, Istanbul Prof. Dr. Cemil Tascıoglu City Hospital, Saglık Bilimleri University, Istanbul, Turkey
| | - Serhat Imamoglu
- Ophthalmology Department, Haydarpaşa Numune Training and Research Hospital, Saglık Bilimleri University, Istanbul, Turkey
| | - Fahri Ovalı
- Neonatology Department, Goztepe Prof. Dr. Suleyman Yalcın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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9
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Foscan M, Luparia A, Molteni F, Bianchi E, Gandelli S, Pagliano E, Fedrizzi E. Development of a Play-Based Motor Learning Approach (A.MO.GIOCO) in Children with Bilateral Cerebral Palsy: Theoretical Framework and Intervention Methodology. CHILDREN (BASEL, SWITZERLAND) 2024; 11:127. [PMID: 38275437 PMCID: PMC10814252 DOI: 10.3390/children11010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
The early intervention of motor training based on specific tasks and parent empowerment represents the new paradigm for the rehabilitation of children with Cerebral Palsy (CP). However, most published studies address the problem of the effectiveness of rehabilitation intervention without describing the treatment methodology or briefly mentioning it. The purpose of the study is to illustrate the development of a play-based motor learning approach titled A.MO.GIOCO (Apprendimento MOtorio nel GIOCO) and its systematization. Fifteen children aged between 2 and 6 years with bilateral CP will be enrolled and treated for 6-8 weeks (48 h). Motor Teaching methods applied by senior therapists have been extensively described, starting from rehabilitation goals and proposed therapeutic play activities, tailored to the functional profile of each child. This child-friendly rehabilitative approach (A.MO.GIOCO) refers to the systemic cognitive model of learning and movement control and is implemented in the context of spontaneous play activities and in the therapist-child-family interaction. In this study the theoretical framework of the approach and the process followed by the therapists to transfer it into rehabilitative practice are highlighted. As a result, an operational guide has been created. Further studies will explore the efficacy of the proposed standardized approach.
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Affiliation(s)
- Maria Foscan
- Fondazione IRCCS Istituto Neurologico C. Besta, 20133 Milano, Italy; (M.F.); (S.G.); (E.F.)
| | - Antonella Luparia
- Istituto Neurologico Nazionale IRCCS Fondazione C. Mondino, 27100 Pavia, Italy;
| | | | - Elisa Bianchi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy;
| | - Shari Gandelli
- Fondazione IRCCS Istituto Neurologico C. Besta, 20133 Milano, Italy; (M.F.); (S.G.); (E.F.)
| | - Emanuela Pagliano
- Fondazione IRCCS Istituto Neurologico C. Besta, 20133 Milano, Italy; (M.F.); (S.G.); (E.F.)
| | - Ermellina Fedrizzi
- Fondazione IRCCS Istituto Neurologico C. Besta, 20133 Milano, Italy; (M.F.); (S.G.); (E.F.)
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10
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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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Philip J, Huurneman B, Jansonius NM, Cillessen AHN, Boonstra FN. Childhood cerebral visual impairment subtype classification based on an extensive versus a limited test battery. Front Neurosci 2023; 17:1266201. [PMID: 37954874 PMCID: PMC10637406 DOI: 10.3389/fnins.2023.1266201] [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: 08/02/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose To classify CVI subtypes and compare the added value of an extensive test battery over a limited test battery in subtype classification of cerebral visual impairment (CVI) in children. Methods Seventy-five children with a clinical diagnosis of CVI (median [IQR] age: 9 [7-12] years) were identified from the medical records. The extensive test battery included visual acuity, contrast sensitivity, ocular alignment, eye movement analysis, visual field analysis, optic nerve head evaluation, and evaluation of visual perception. The limited test battery included visual acuity, contrast sensitivity, ocular alignment, and evaluation of visual perception. Principal component analysis (PCA) followed by cluster analysis was done, for both test batteries separately, to determine the optimum subtype classification for CVI. Results Fifty-one participants with an extensive test battery with mild to moderate visual impairment were included in the main analysis. This resulted in four CVI subtypes for the extensive test battery (subtle characteristics, higher-level visual function deficits, lower-level visual function deficits, and higher- and lower- level visual function deficits) and three CVI subtypes for the limited test battery (subtle characteristics, higher-level visual function deficits, and higher- and lower- level visual function deficits). There were significant differences between the subtypes for 9 out of 10 measures of the extensive and all 4 measures of the limited test battery (p < 0.05). The subtle characteristics subtype (extensive n = 19, limited n = 15) showed near normal lower and higher-level visual functions in both test batteries. The higher-level visual function deficits subtype (extensive n = 18, limited n = 24) showed near normal visual acuity combined with significant visual perceptual deficits in both test batteries; accompanied by visual pathways defects and abnormal eye movement behavior in the extensive test battery. The higher- and lower- level visual function deficits subtype (extensive n = 4, limited n = 12) showed both higher and lower-level visual function deficits in both test batteries, but application of the extensive test battery revealed additional visual pathways defects and abnormal eye movement behavior. The lower-level visual function deficits CVI subtype (extensive n = 10) was a new subtype identified by the extensive test battery. This subtype showed lower-level visual function deficits together with abnormal eye movement measures. Conclusion This data-driven study has provided meaningful CVI subtype classifications based on the outcomes of various key functional and structural measures in CVI diagnosis. Comparison of the extensive test battery to the limited test battery revealed the added value of an extensive test battery in classifying CVI. The outcomes of this study, therefore, have provided a new direction in the area of CVI classification.
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Affiliation(s)
- Jannet Philip
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Bianca Huurneman
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Nomdo M. Jansonius
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Graduate School of Medical Science, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Frouke N. Boonstra
- Royal Dutch Visio, National Foundation for the Visually Impaired and Blind, Huizen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
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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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Smitha KS, Kurbet B, Kamate M, Veenish S. Cerebral visual impairment and effect of phase-wise stimulation strategies-An interim analysis. Indian J Ophthalmol 2023; 71:3318-3321. [PMID: 37787228 PMCID: PMC10683693 DOI: 10.4103/ijo.ijo_33_23] [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: 01/04/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 10/04/2023] Open
Abstract
Context Cerebral visual impairment (CVI) is an overarching term, defined as a brain-based visual impairment with onset in childhood, unexplained by an ocular disorder and associated with unique visual and behavioral characteristics. Good vision and awareness of visual function in a child are highly essential as neuroplasticity is maximum in the first three years of life and response to intervention is utmost in this period. Awareness is lacking regarding CVI, and the diagnosis is largely missed. This can be easily addressed if a structured approach is employed. Purpose This study aims to evaluate the etiology and radiological correlation with the severity of CVI and outcome after structured intervention in children with CVI. Settings and Design Prospective-interventional study. Methods and Material Children attending the Child Development Centre (CDC) of a tertiary care hospital in North Karnataka and diagnosed with CVI in the age group of six months to 12 years and meeting the sampling criteria were screened and enrolled consecutively after obtaining parental consent/assent. Statistical analysis used is nonparametric test with SPSS software. Results Age showed a significant association with the phase of CVI. Perinatal insult was associated significantly with the severity of CVI. Magnetic resonance imaging (MRI) findings did not hamper the recovery of CVI. Conclusions Enrolment in early intervention programs tailored according to child's specific needs should be encouraged, with stress on ophthalmic screening of preterm and high-risk babies with perinatal hypoxia and history of convulsions, as early as six months.
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Affiliation(s)
- KS Smitha
- Department of Ophthalmology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Bhagyajyothi Kurbet
- Department of Ophthalmology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Mahesh Kamate
- Department of Pediatrics, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Samvedya Veenish
- Department of Ophthalmology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
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Morelli F, Catalano G, Scognamillo I, Balzarotti N, Luparia A, Olivier L, Bertone C, Gori M, Signorini S. Visual Function and Neuropsychological Profiling of Idiopathic Infantile Nystagmus. Brain Sci 2023; 13:1348. [PMID: 37759948 PMCID: PMC10526276 DOI: 10.3390/brainsci13091348] [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: 08/10/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Though considered a benign condition, idiopathic infantile nystagmus (IIN) may be associated with decreased visual acuity and oculo-motor abnormalities, resulting in developmental delays and poor academic performance. Nevertheless, the specific visual function profile of IIN and its possible impact on neuropsychological development have been poorly investigated. To fill this gap, we retrospectively collected the clinical data of 60 children presenting with IIN over a 10-year period (43 male; mean age of 7 years, range of 2 months-17 years, 9 months). The majority of the subjects in our cohort presented with reduced visual acuity for far distances and normal visual acuity for near distances, associated with oculo-motor abnormalities. The overall scores of cognitive and visual-cognitive tests were in the normal range, but revealed peculiar cognitive and visual-cognitive profiles, defined by specific frailties in processing speed and visual-motor integration. The same neuropsychological profiles characterize many neurodevelopmental disorders and may express a transnosographic vulnerability of the dorsal stream. As the first study to explore the neuropsychologic competencies in children with IIN, our study unveils the presence of subclinical frailties that need to be addressed to sustain academic and social inclusion.
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Affiliation(s)
- Federica Morelli
- Department of Brain and Behavioral Sciences, University of Pavia, Via Agostino Bassi 21, 27100 Pavia, Italy; (F.M.); (I.S.)
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; (A.L.); (L.O.); (S.S.)
| | - Guido Catalano
- Department of Brain and Behavioral Sciences, University of Pavia, Via Agostino Bassi 21, 27100 Pavia, Italy; (F.M.); (I.S.)
| | - Ilaria Scognamillo
- Department of Brain and Behavioral Sciences, University of Pavia, Via Agostino Bassi 21, 27100 Pavia, Italy; (F.M.); (I.S.)
| | - Nicolò Balzarotti
- Unit for Visually Impaired People, Istituto Italiano di Tecnologia, Via Enrico Melen 82, 16100 Genova, Italy; (N.B.); (M.G.)
| | - Antonella Luparia
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; (A.L.); (L.O.); (S.S.)
| | - Lucrezia Olivier
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; (A.L.); (L.O.); (S.S.)
| | - Chiara Bertone
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, IRCCS Fondazione Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy;
| | - Monica Gori
- Unit for Visually Impaired People, Istituto Italiano di Tecnologia, Via Enrico Melen 82, 16100 Genova, Italy; (N.B.); (M.G.)
| | - Sabrina Signorini
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy; (A.L.); (L.O.); (S.S.)
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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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Federici A, Bennett CR, Bauer CM, Manley CE, Ricciardi E, Bottari D, Merabet LB. Altered neural oscillations underlying visuospatial processing in cerebral visual impairment. Brain Commun 2023; 5:fcad232. [PMID: 37693815 PMCID: PMC10489293 DOI: 10.1093/braincomms/fcad232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 06/16/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023] Open
Abstract
Visuospatial processing deficits are commonly observed in individuals with cerebral visual impairment, even in cases where visual acuity and visual field functions are intact. Cerebral visual impairment is a brain-based visual disorder associated with the maldevelopment of central visual pathways and structures. However, the neurophysiological basis underlying higher-order perceptual impairments in this condition has not been clearly identified, which in turn poses limits on developing rehabilitative interventions. Using combined eye tracking and EEG recordings, we assessed the profile and performance of visual search on a naturalistic virtual reality-based task. Participants with cerebral visual impairment and controls with neurotypical development were instructed to search, locate and fixate on a specific target placed among surrounding distractors at two levels of task difficulty. We analysed evoked (phase-locked) and induced (non-phase-locked) components of broadband (4-55 Hz) neural oscillations to uncover the neurophysiological basis of visuospatial processing. We found that visual search performance in cerebral visual impairment was impaired compared to controls (as indexed by outcomes of success rate, reaction time and gaze error). Analysis of neural oscillations revealed markedly reduced early-onset evoked theta [4-6 Hz] activity (within 0.5 s) regardless of task difficulty. Moreover, while induced alpha activity increased with task difficulty in controls, this modulation was absent in the cerebral visual impairment group identifying a potential neural correlate related to deficits with visual search and distractor suppression. Finally, cerebral visual impairment participants also showed a sustained induced gamma response [30-45 Hz]. We conclude that impaired visual search performance in cerebral visual impairment is associated with substantial alterations across a wide range of neural oscillation frequencies. This includes both evoked and induced components suggesting the involvement of feedforward and feedback processing as well as local and distributed levels of neural processing.
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Affiliation(s)
| | - Christopher R Bennett
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Corinna M Bauer
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Claire E Manley
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | | | | | - Lotfi B Merabet
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
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Weden K, DeCarlo DK, Barstow E. A Scoping Review of Intervention for Pediatric Cerebral Visual Impairment: Calling All Pediatric Occupational Therapists. Occup Ther Health Care 2023; 37:326-356. [PMID: 37139689 PMCID: PMC10950195 DOI: 10.1080/07380577.2023.2172761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/22/2023] [Indexed: 05/05/2023]
Abstract
Cerebral visual impairment is the leading cause of low vision in children, and functional gains can be achieved with intervention. To date there exists no evidence-based intervention protocol to guide rehabilitation therapists. This scoping review was conducted to synthesize the evidence currently available and explore current interventions in order to guide future research. This review identified five types of interventions for cerebral visual impairment; habilitation, visual stimulation, video game, color tent, and medical and also evidenced the need for standardized, objective measures of function for this population.
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Affiliation(s)
- Kathleen Weden
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, USA
| | - Dawn K. DeCarlo
- Department of Ophthalmology & Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Elizabeth Barstow
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, USA
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18
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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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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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Bullaj R, Dyet L, Mitra S, Bunce C, Clarke CS, Saunders K, Dale N, Horwood A, Williams C, St Clair Tracy H, Marlow N, Bowman R. Effectiveness of early spectacle intervention on visual outcomes in babies at risk of cerebral visual impairment: a parallel group, open-label, randomised clinical feasibility trial protocol. BMJ Open 2022; 12:e059946. [PMID: 36130761 PMCID: PMC9494562 DOI: 10.1136/bmjopen-2021-059946] [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: 11/23/2022] Open
Abstract
INTRODUCTION Hypoaccommodation is common in children born prematurely and those with hypoxic ischaemic encephalopathy (HIE), with the potential to affect wider learning. These children are also at risk of longer-term cerebral visual impairment. It is also well recognised that early intervention for childhood visual pathology is essential, because neuroplasticity progressively diminishes during early life. This study aims to establish the feasibility and acceptability of conducting a randomised controlled trial to test the effectiveness of early near vision correction with spectacles in infancy, for babies, at risk of visual dysfunction. METHODS AND ANALYSIS This is a parallel group, open-label, randomised controlled (feasibility) study to assess visual outcomes in children with perinatal brain injury when prescribed near vision spectacles compared with the current standard care-waiting until a problem is detected. The study hypothesis is that accommodation, and possibly other aspects of vision, may be improved by intervening earlier with near vision glasses. Eligible infants (n=75, with either HIE or <29 weeks preterm) will be recruited and randomised to one of three arms, group A (no spectacles) and two intervention groups: B1 or B2. Infants in both intervention groups will be offered glasses with +3.00 DS added to the full cycloplegic refraction and prescribed for full time wear. Group B1 will get their first visit assessment and intervention at 8 weeks corrected gestational age (B1) and B2 at 16 weeks corrected gestational age. All infants will receive a complete visual and neurodevelopmental assessment at baseline and a follow-up visit at 3 and 6 months after the first visit. ETHICS AND DISSEMINATION The South-Central Oxford C Research Ethics Committee has approved the study. Members of the PPI committee will give advice on dissemination of results through peer-reviewed publications, conferences and societies. TRIAL REGISTRATION NUMBER ISRCTN14646770, NCT05048550, NIHR ref: PB-PG-0418-20006.
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Affiliation(s)
- Raimonda Bullaj
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Leigh Dyet
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Subhabrata Mitra
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Catey Bunce
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Caroline S Clarke
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kathryn Saunders
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Naomi Dale
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Anna Horwood
- School of Psychology, University of Reading, Reading, UK
| | - Cathy Williams
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Richard Bowman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Ophthalmology, University College London Institute of Child Health, London, UK
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22
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Ye H, Liu Q, Zhan Q, Zhang Y, Du X, Zhang X, Di Y, Qiao T. Surgical outcomes and observation in exotropia cerebral palsy children with cortical visual impairment. BMC Ophthalmol 2022; 22:364. [PMID: 36076198 PMCID: PMC9461160 DOI: 10.1186/s12886-022-02581-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Cortical visual impairment (CVI) is the common cause of pediatric visual impairment in cerebral palsy (CP) while exotropia is the most common strabismus associated with CP. We aim to observe the strabismic surgery outcomes in pediatric patients with CP and CVI. METHOD Our medical records were collected from pediatric patients treated in our hospital from May 1, 2017 to Jan 1, 2022. With normal intelligence assessment and diagnosis of exotropia in children with CP and CVI, microsurgeries were performed under intravenous combined inhalation anesthesia. The strabismus was examined by the prism test under best vision correction and the contrast sensitivity testing (CST) was measured at five levels of spatial frequencies. RESULT A total of 38 exotropia patients with CP and CVI were identified and included for analysis during the study period with age ranged from 5 to 12 years (mean 8.45 years) and mean follow up duration was 8.7 months (6-42 months). After bilateral lateral rectus recession (with/without medial rectus resection or inferior oblique transposition), the exotropia amount of participants were obviously revealed from - 30 ~ - 140 (median, IQR: - 50, 40) prism diopters (PD) preoperatively to 0 ~ - 15 (0, 5) PD postoperatively. Statistically significantly improvements were observed at all levels of spatial frequency on CST postoperatively, especially at high spatial frequency areas (p < 0.05). CONCLUSION Our results demonstrated that the effect of strabismus surgery on exotropia in children with CP and CVI were stable and monocular contrast sensitivity post- operation increased significantly at all spatial frequencies levels.
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Affiliation(s)
- Haiyun Ye
- Department of Ophthalmology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Qingyu Liu
- Department of Ophthalmology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Qijia Zhan
- Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Yidan Zhang
- Department of Ophthalmology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Xiaodong Du
- Department of Ophthalmology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Xiaoxiao Zhang
- Department of Ophthalmology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Yue Di
- Department of Ophthalmology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Tong Qiao
- Department of Ophthalmology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China.
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Jimenez-Gomez A, Fisher KS, Zhang KX, Liu C, Sun Q, Shah VS. Longitudinal neurological analysis of moderate and severe pediatric cerebral visual impairment. Front Hum Neurosci 2022; 16:772353. [PMID: 36051970 PMCID: PMC9425457 DOI: 10.3389/fnhum.2022.772353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 06/28/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Cerebral visual impairment (CVI) results from damage to cerebral visual processing structures. It is the most common cause of pediatric visual impairment in developed countries and rising in prevalence in developing nations. There is currently limited understanding on how neurologic, developmental, and ophthalmic factors predict outcome for pediatric CVI. Method A retrospective manual chart review of pediatric CVI patients seen at the tertiary pediatric hospital neurology and neuro-ophthalmology service between 2010 and 2019 was conducted. Patients were stratified into severity groups (based on a custom CVI grading score), and followed over time to identify outcome predictors. Collected baseline characteristics included perinatal, genetic, developmental, and neurologic history, along with neuroimaging and fundoscopic findings on examination. Longitudinal data collected included age, seizure control, and type of therapy received. Linear mixed-effect models were used for longitudinal CVI grade outcome analysis. Results A total of 249 individuals spanning 779 patient visits were identified. Mean age at diagnosis was 18.8 ± 16.8 months (2–108 months). About 64.3% were born at term age. Perinatal history revealed hypoxic ischemic encephalopathy (HIE) in 16.5%, intraventricular hemorrhage (IVH) in 11.6%, and seizures in 21.7%. At presentation, 60.3% had a diagnosis of cerebral palsy and 84.7% had developmental delay. Among all subjects, 78.6% had epilepsy; 33.8% had an epileptic encephalopathy, with spasms/hypsarrhythmia being most common. Abnormal neuroimaging was present in 93.8%. Genetic anomalies were present in 26.9%. Baseline visual examination revealed no blink-to-light (BTL) in 24.5%; only BTL in 34.5%, fixation/tracking in 26.5%, and optokinetic drum follow in 14.4%. Longitudinal data analysis showed that perinatal history of HIE, a positive epilepsy history, using multiple (≥3) epilepsy medications, cerebral palsy, and abnormal fundoscopic findings were all negatively associated with CVI grade change over time. After controlling for significant confounders, receiving any type of therapy [early childhood intervention (ECI), physical and occupational therapy (PT/OT), refractive error correction or glasses] was significantly associated with longitudinal improvement in CVI grade compared to patients who did not receive any therapy, with glasses yielding the largest benefit. Conclusion This study offers extensive insights into neurologic, developmental and ophthalmologic features in patients with moderate to severe CVI. In concordance with previous findings, aspects of perinatal history and epilepsy/seizure control may help inform severity and prognosis in the general neurology or ophthalmology clinic. Conversely, these aspects, as well as genetic and specific epilepsy traits may alert vision health care providers in the clinic to pursue visual evaluation in at-risk individuals. Longitudinal follow-up of CVI patients showed that interventional therapies demonstrated vision function improvement greater than no therapy and maturational development.
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Affiliation(s)
- Andres Jimenez-Gomez
- Neuroscience Center, Joe DiMaggio Children’s Hospital, Hollywood, FL, United States
| | - Kristen S. Fisher
- Division of Pediatric Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Kevin X. Zhang
- Division of Pediatric Ophthalmology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Medical Scientist Training Program, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Qin Sun
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Veeral S. Shah
- Division of Pediatric Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Division of Pediatric Ophthalmology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, United States
- Baylor College of Medicine, Cullen Eye Institute, Houston, TX, United States
- Department of Ophthalmology, Texas Children’s Hospital, Houston, TX, United States
- *Correspondence: Veeral S. Shah, ;
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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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25
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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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26
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The speed acuity test as a diagnostic aid in cerebral visual impairment. Sci Rep 2022; 12:10596. [PMID: 35732797 PMCID: PMC9217927 DOI: 10.1038/s41598-022-14673-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 04/21/2022] [Indexed: 11/12/2022] Open
Abstract
One of the characteristics of children with cerebral visual impairments (CVI) is that they need more time to process visual information. However, currently, few tests are available that can reliably measure visual processing speed. The speed acuity test, a discrimination reaction-time test in which participants indicate the orientation of Landolt-C symbols as quickly and accurately as possible, was specifically developed to determine the time a child needs to discern visual details. The test measures both the accuracy and the latency of the responses for nine different optotype sizes in order to control for decreased visual acuity. The results show that children with CVI need significantly more time to respond to the largest optotype sizes than age-matched normally sighted children and children with visual impairments due to an ocular disorder (VIo). This effect is independent of the time it takes to make a motor response. However, the reaction-time difference between the children with CVI and VIo is not seen for optotype sizes at the acuity threshold. Together with reaction times on visual and auditory detection tasks as controls, reaction times measured in the speed-acuity test allow for acceptable discrimination (AUC in ROC analysis: 0.81) between CVI and VIo.
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27
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Morelli F, Aprile G, Martolini C, Ballante E, Olivier L, Ercolino E, Perotto E, Signorini S. Visual Function and Neuropsychological Profile in Children with Cerebral Visual Impairment. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060921. [PMID: 35740858 PMCID: PMC9221908 DOI: 10.3390/children9060921] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/08/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022]
Abstract
Cerebral Visual Impairment (CVI) has become the leading cause of children’s visual impairment in developed countries. Since CVI may negatively affect neuropsychomotor development, an early diagnosis and characterization become fundamental to define effective habilitation approaches. To date, there is a lack of standardized diagnostic methods to assess CVI in children, and the role of visual functions in children’s neuropsychological profiles has been poorly investigated. In the present paper, we aim to describe the clinical and neuropsychological profiles and to investigate the possible effects of visual functions on neuropsychological performance of a cohort of children diagnosed with CVI. Fifty-one children with CVI were included in our retrospective analysis (inclusion criteria: verbal IQ > 70 in Wechsler scales; absence of significant ocular involvement). For each participant, we collected data on neuropsychological assessment (i.e., cognitive, cognitive visual, and learning abilities), basic visual functions (e.g., Best Corrected Visual Acuity—BCVA, contrast sensitivity, and ocular motor abilities) and global development features (e.g., neurological signs and motor development delay) based on standardized tests, according to patients’ ages. The results showed that oculomotor dysfunction involving saccades and smooth pursuit may be a core symptom of CVI and might have a significant impact on cognitive visual and other neuropsychological abilities. Furthermore, visual acuity and contrast sensitivity may influence cognitive, cognitive visual, and academic performances. Our findings suggest the importance of a comprehensive assessment of both visual and neuropsychological functions in children when CVI is suspected, which is needed to provide a more comprehensive functional profile and define the best habilitation strategy to sustain functional vision.
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Affiliation(s)
- Federica Morelli
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.A.); (C.M.); (L.O.); (E.E.); (E.P.); (S.S.)
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
- Correspondence:
| | - Giorgia Aprile
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.A.); (C.M.); (L.O.); (E.E.); (E.P.); (S.S.)
| | - Chiara Martolini
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.A.); (C.M.); (L.O.); (E.E.); (E.P.); (S.S.)
| | - Elena Ballante
- BioData Science Center, IRCCS Mondino Foundation, 27100 Pavia, Italy;
- Political and Social Sciences, University of Pavia, 27100 Pavia, Italy
| | - Lucrezia Olivier
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.A.); (C.M.); (L.O.); (E.E.); (E.P.); (S.S.)
| | - Elisa Ercolino
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.A.); (C.M.); (L.O.); (E.E.); (E.P.); (S.S.)
| | - Eleonora Perotto
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.A.); (C.M.); (L.O.); (E.E.); (E.P.); (S.S.)
| | - Sabrina Signorini
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.A.); (C.M.); (L.O.); (E.E.); (E.P.); (S.S.)
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28
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Fonteyn-Vinke A, Huurneman B, Boonstra FN. Viewing Strategies in Children With Visual Impairment and Children With Normal Vision: A Systematic Scoping Review. Front Psychol 2022; 13:898719. [PMID: 35783772 PMCID: PMC9248372 DOI: 10.3389/fpsyg.2022.898719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/19/2022] [Indexed: 11/25/2022] Open
Abstract
Viewing strategies are strategies used to support visual information processing. These strategies may differ between children with cerebral visual impairment (CVI), children with ocular visual impairment, and children with normal vision since visual impairment might have an impact on viewing behavior. In current visual rehabilitation practice a variety of strategies is used without consideration of the differences in etiology of the visual impairment or in the spontaneous viewing strategies used. This systematic scoping review focuses on viewing strategies used during near school-based tasks like reading and on possible interventions aimed at viewing strategies. The goal is threefold: (1) creating a clear concept of viewing strategies, (2) mapping differences in viewing strategies between children with ocular visual impairment, children with CVI and children with normal vision, and (3) identifying interventions that can improve visual processing by targeting viewing strategies. Four databases were used to conduct the literature search: PubMed, Embase, PsycINFO and Cochrane. Seven hundred and ninety-nine articles were screened by two independent reviewers using PRISMA reporting guidelines of which 30 were included for qualitative analysis. Only five studies explicitly mentioned strategies used during visual processing, namely gaze strategies, reading strategies and search strategies. We define a viewing strategy as a conscious and systematic way of viewing during task performance. The results of this review are integrated with different attention network systems, which provide direction on how to design future interventions targeting the use of viewing strategies to improve different aspects of visual processing.
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Affiliation(s)
- Anke Fonteyn-Vinke
- Royal Dutch Visio, Nijmegen, Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
| | - Bianca Huurneman
- Royal Dutch Visio, Nijmegen, Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
- *Correspondence: Bianca Huurneman
| | - Frouke N. Boonstra
- Royal Dutch Visio, Nijmegen, Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
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Chandwani R, Harpster K, Kline JE, Mehta V, Wang H, Merhar SL, Schwartz TL, Parikh NA. Brain microstructural antecedents of visual difficulties in infants born very preterm. Neuroimage Clin 2022; 34:102987. [PMID: 35290855 PMCID: PMC8918861 DOI: 10.1016/j.nicl.2022.102987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/12/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
Infants born very preterm (VPT) are at risk of later visual problems. Although neonatal screening can identify ophthalmologic abnormalities, subtle perinatal brain injury and/or delayed brain maturation may be significant contributors to complex visual-behavioral problems. Our aim was to assess the micro and macrostructural antecedents of early visual-behavioral difficulties in VPT infants by using diffusion MRI (dMRI) at term-equivalent age. We prospectively recruited a cohort of 262 VPT infants (≤32 weeks gestational age [GA]) from five neonatal intensive care units. We obtained structural and diffusion MRI at term-equivalent age and administered the Preverbal Visual Assessment (PreViAs) questionnaire to parents at 3-4 months corrected age. We used constrained spherical deconvolution to reconstruct nine white matter tracts of the visual pathways with high reliability and performed fixel-based analysis to derive fiber density (FD), fiber-bundle cross-section (FC), and combined fiber density and cross-section (FDC). In multiple logistic regression analyses, we related these tract metrics to visual-behavioral function. Of 262 infants, 191 had both high-quality dMRI and completed PreViAs, constituting the final cohort: mean (SD) GA was 29.3 (2.4) weeks, 90 (47.1%) were males, and postmenstrual age (PMA) at MRI was 42.8 (1.3) weeks. FD and FC of several tracts were altered in infants with (N = 59) versus those without retinopathy of prematurity (N = 132). FDC of the left posterior thalamic radiations (PTR), left inferior longitudinal fasciculus (ILF), right superior longitudinal fasciculus (SLF), and left inferior fronto-occipital fasciculus (IFOF) were significantly associated with visual attention scores, prior to adjusting for confounders. After adjustment for PMA at MRI, GA, severe retinopathy of prematurity, and total brain volume, FDC of the left PTR, left ILF, and left IFOF remained significantly associated with visual attention. Early visual-behavioral difficulties in VPT infants are preceded by micro and macrostructural abnormalities in several major visual pathways at term-equivalent age.
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Affiliation(s)
- Rahul Chandwani
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Karen Harpster
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Rehabilitation, Exercise, and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Julia E Kline
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Ved Mehta
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Hui Wang
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; MR Clinical Science, Philips, Cincinnati, OH, United States
| | - Stephanie L Merhar
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Terry L Schwartz
- Division of Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Nehal A Parikh
- Center for Prevention of Neurodevelopmental Disorders, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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30
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Taha Najim R, Mybeck L, Andersson S, Andersson Grönlund M. Thinner peripapillary retinal nerve fibre layer and macular retinal thickness in adolescents with surgically treated hydrocephalus in infancy. Acta Ophthalmol 2022; 100:673-681. [PMID: 35507694 DOI: 10.1111/aos.15162] [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: 11/21/2021] [Revised: 03/21/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To map the morphology of the retina and optic disc in adolescents with surgically treated hydrocephalus (HC) in infancy and to compare the results with healthy controls. METHODS The study comprised 26 adolescents (16 male, mean age 15 years) with HC and 31 sex- and aged-matched controls. The following optical coherence tomography (OCT) parameters were obtained: macular retinal thickness (MRT) and volume (MRV), thickness of the macular and peripapillary retinal nerve fibre layer (ppRNFL), and area of the optic disc, cup and rim. RESULTS The MRT was thinner amongst those with HC compared with controls (right eye (RE) 262.2 ± 15.3 and 275.8 ± 15.1 μm; p = 0.0051), and the MRV was smaller (RE 7.37 ± 0.36 and 7.83 ± 0.35 mm3 ; p = 0.0002). The HC group showed a thinner ppRNFL (RE 88.3 ± 14.9 and 103.5 ± 8.1 μm; p = 0.0002) but a thicker central macular RNFL (RE 11.6 ± 10.4 and 2.07 ± 3.00 μm; p = <0.0001) and foveal minimum (RE 211.1 ± 32.0 and 186.3 ± 15.9 μm; p = 0.0013). Optic disc variables showed no difference between groups. Correlations were found in the HC group between best corrected visual acuity (expressed in logMAR) and ppRNFL (RE r = -0.56, p = 0.018), and disc area (RE r = -0.52, p = 0.033). CONCLUSION Thinner ppRNFL and MRT and smaller MRV were found in adolescents with surgically treated HC in infancy compared with controls. In contrast, the central macular RNFL and foveal minimum were thicker. Further studies are required to evaluate the diagnostic value of OCT to indicate increased intracranial pressure timely and follow-up in individuals with surgically treated HC.
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Affiliation(s)
- Rezhna Taha Najim
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Ophthalmology Region Västra Götaland, Sahlgrenska University Hospital Mölndal Sweden
| | - Lovisa Mybeck
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Susann Andersson
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Ophthalmology Region Västra Götaland, Sahlgrenska University Hospital Mölndal Sweden
| | - Marita Andersson Grönlund
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Deparment of Ophthalmology Faculty of Medicine and Health, Örebro University Örebro Sweden
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Howes J, Thompson D, Liasis A, Oluonye N, Dale N, Bowman R. Prognostic value of transient pattern visual evoked potentials in children with cerebral visual impairment. Dev Med Child Neurol 2022; 64:618-624. [PMID: 34841523 DOI: 10.1111/dmcn.15108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 01/26/2023]
Abstract
AIM To investigate whether pattern reversal visual evoked potentials (PRVEPs) could predict future visual acuity in infants with cerebral visual impairment (CVI). METHOD Fifty-five children (27 males, 28 females) with severe CVI seen in the ophthalmology department of a specialist children's hospital were identified retrospectively. Behavioural visual acuity and visual evoked potentials (VEPs) at presentation (time 1, T1) were compared with final visual acuity at late preschool/early school age (time 2, T2). Predictors of visual acuity at T2 were identified using univariate and multivariate logistic and linear regression analysis. RESULTS Median age was 14 months at T1 (range: 6-44mo) and 63 months at T2 (range: 29-150mo). The presence of a PRVEP produced by a check width of 50' (minutes of arc) or smaller (T1) predicted (p=0.05) the presence of measurable preferential looking acuity at T2. The presence of PRVEP to check widths of 25' or smaller (T1) predicted (p=0.02) better preferential looking acuity (logMAR-equivalent) scores at T2. The latter association was independent of presenting acuity at T1. INTERPRETATION The presence of PRVEPs to check widths of 50' and 25' in infancy provided useful information. VEPs in young children with CVI may have prognostic value regarding future acuity.
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Affiliation(s)
- Jessica Howes
- University College London Medical School, London, UK
| | - Dorothy Thompson
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Alki Liasis
- Children's Hospital of Pittsburgh University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ngozi Oluonye
- Neurodisability Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Naomi Dale
- Developmental Vision Clinic Service Neurodisability Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Richard Bowman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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32
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Galli J, Loi E, Molinaro A, Calza S, Franzoni A, Micheletti S, Rossi A, Semeraro F, Fazzi E. Age-Related Effects on the Spectrum of Cerebral Visual Impairment in Children With Cerebral Palsy. Front Hum Neurosci 2022; 16:750464. [PMID: 35308614 PMCID: PMC8924515 DOI: 10.3389/fnhum.2022.750464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background Cerebral Visual Impairment (CVI) is a very common finding in children affected by Cerebral Palsy (CP). In this paper we studied the characteristics of CVI of a large group of children with CP and CVI, describing their neurovisual profiles according to three different age subgroups (subgroup 1: infants 6 months–2 years; subgroup 2: pre-school age 3–5 years; subgroup 3: school age ≥ 6 years). Methods We enrolled 180 subjects (104 males, mean age 66 ± 42.6 months; range 6–192 months) with CP and CVI for the study. We carried out a demographic and clinical data collection, neurological examination, developmental or cognitive assessment, and a video-recorded visual function assessment including an evaluation of ophthalmological characteristics, oculomotor functions, and basic visual functions. In school-aged children, we also performed an evaluation of their cognitive-visual profiles. Results There were signs of CVI in all the three subgroups. Subgroup 1 (62 children) and subgroup 2 (50 children) were different for fixation (p = 0.02), visual acuity (p = 0.03) and contrast sensitivity (p < 0.01), being more frequently impaired in younger children. Comparing subgroup 2 with subgroup 3 (68 children), the older children presented more frequently myopia (p = 0.02) while the younger ones esotropia (p = 0.02) and alteration in smooth pursuit (p = 0.03) and saccades (p < 0.01). Furthermore, fixation, smooth pursuit, visual acuity, contrast sensitivity and visual filed (p < 0.01) were more frequently impaired in younger children (subgroup 1) compared to the older ones. Multiple correspondence analysis (MCA) confirmed the different neurovisual profiles according to age: younger children with CP showed more signs of CVI compared to the older ones. 34 out of 68 children belonging to subgroup 3 underwent the cognitive visual evaluation; an impairment of cognitive visual skills was detected in 21 subjects. Conclusion Younger children with CP showed more signs of CVI compared to the older ones, likely for the physiological maturation of visual system and mechanisms of neuroplasticity. In this direction, we suggest an early neurovisual evaluation to detect any weak visual functions.
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Affiliation(s)
- Jessica Galli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
- *Correspondence: Jessica Galli,
| | - Erika Loi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Anna Molinaro
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Stefano Calza
- BDbiomed, BODaI Lab, University of Brescia, Brescia, Italy
| | - Alessandra Franzoni
- Department of Neurological and Vision Sciences, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Serena Micheletti
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Andrea Rossi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Francesco Semeraro
- Department of Neurological and Vision Sciences, ASST Spedali Civili of Brescia, Brescia, Italy
- Eye Clinic, University of Brescia, Brescia, Italy
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
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Neural correlates associated with impaired global motion perception in cerebral visual impairment (CVI). Neuroimage Clin 2022; 32:102821. [PMID: 34628303 PMCID: PMC8501506 DOI: 10.1016/j.nicl.2021.102821] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/07/2021] [Accepted: 09/07/2021] [Indexed: 12/17/2022]
Abstract
Cerebral visual impairment (CVI) is associated with impaired global motion processing. Mean motion coherence thresholds was higher in individuals with CVI. fMRI responses in area hMT+ showed an aberrant response profile in CVI. White matter tract reconstruction revealed cortico-cortical dysmyelination in CVI.
Cerebral visual impairment (CVI) is associated with a wide range of visual perceptual deficits including global motion processing. However, the underlying neurophysiological basis for these impairments remain poorly understood. We investigated global motion processing abilities in individuals with CVI compared to neurotypical controls using a combined behavioral and multi-modal neuroimaging approach. We found that CVI participants had a significantly higher mean motion coherence threshold (determined using a random dot kinematogram pattern simulating optic flow motion) compared to controls. Using functional magnetic resonance imaging (fMRI), we investigated activation response profiles in functionally defined early (i.e. primary visual cortex; area V1) and higher order (i.e. middle temporal cortex; area hMT+) stages of motion processing. In area V1, responses to increasing motion coherence were similar in both groups. However, in the CVI group, activation in area hMT+ was significantly reduced compared to controls, and consistent with a surround facilitation (rather than suppression) response profile. White matter tract reconstruction obtained from high angular resolution diffusion imaging (HARDI) revealed evidence of increased mean, axial, and radial diffusivities within cortico-cortical (i.e. V1-hMT+), but not thalamo-hMT+ connections. Overall, our results suggest that global motion processing deficits in CVI may be associated with impaired signal integration and segregation mechanisms, as well as white matter integrity at the level of area hMT+.
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34
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Sakki H, Dale NJ, Mankad K, Sargent J, Talenti G, Bowman R. Exploratory Investigation of Brain MRI Lesions According to Whole Sample and Visual Function Subtyping in Children With Cerebral Visual Impairment. Front Hum Neurosci 2022; 15:765371. [PMID: 35069150 PMCID: PMC8770951 DOI: 10.3389/fnhum.2021.765371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background: There is limited research on brain lesions in children with cerebral visual impairment (CVI) of heterogeneous etiologies and according to associated subtyping and vision dysfunctions. This study was part of a larger project establishing data-driven subtypes of childhood CVI according to visual dysfunctions. Currently there is no consensus in relation to assessment, diagnosis and classification of CVI and more information about brain lesions may be of potential diagnostic value. Aim: This study aimed to investigate overall patterns of brain lesions and associations with level of visual dysfunction and to compare the patterns between the classification subgroups in children with CVI. Methods: School-aged children with CVI received ophthalmological and neuro-psychological/developmental assessments to establish CVI-related subtyping. Other pediatric information was collected from medical records. MRI scans were coded according to a semi-quantitative template including brain regions (right hemisphere, left hemisphere, visual pathways) and summed for total scores. Non-parametric analyses were conducted. Results: 28 children had clinical brain MRI scans available [44% of total sample, Group A (lower severity of visual dysfunctions) n = 16, Group B (higher severity) n = 12]. Total brain scores ranged between 0 and 18 (Group A mdn = 7, IQR = 0.8–10.0, Group B mdn = 10, IQR = 6.5–11.8) and were widespread across regions. 71 per cent had post-geniculate visual pathway damage. The median total brain and hemisphere scores of Group B were higher than subgroup A but differences did not reach statistical significance. No statistically significant associations were found between brain scores and vision variables (acuity, contrast sensitivity). Conclusion: This study found a spread of lesions across all regions on the brain scans in children with congenital CVI. The majority had damage in the postgeniculate visual pathways and visual cortex region suggesting this is an area of interest and potentially informative for diagnosis. However the subtyping classification did not show differences in number or region of lesions though the trend was higher toward Group B. This study confirms the complex diffuse and variable nature of brain lesions in children with congenital CVI, many of whom have other neurological impairments.
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Affiliation(s)
- Hanna Sakki
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Naomi J. Dale
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Neurodisability Service, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- *Correspondence: Naomi J. Dale,
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Jenefer Sargent
- Neurodisability Service, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Giacomo Talenti
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Bowman
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Ophthalmology Department, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
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35
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Signorini S, Luparia A, Cappagli G, Perotto E, Antonini M, Morelli F, Aprile G, Ballante E, Figini S, Borgatti R. Visual Function Score: A New Clinical Tool to Assess Visual Function and Detect Visual Disorders in Children. Front Pediatr 2022; 10:868974. [PMID: 35558364 PMCID: PMC9087345 DOI: 10.3389/fped.2022.868974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION A comprehensive assessment of visual functioning at an early age is important not only for identifying and defining visual impairment but also for planning personalized rehabilitation programs based on the visual diagnosis. Since existing tools to evaluate visual functioning present some important limitations (e.g., they are based on qualitative reports, they do not take into account environmental adaptations of visual testing or they have not been formally validated as clinical instruments), the present work has the main aim to propose a new clinical tool (Visual Function Score, VFS) to detect and define visual disorders at an early age. METHODS The Visual Function Score was administered to one hundred visually impaired children (age range 4 months to 17.75 years old) in the form of a professional-reported protocol for a total of 51 items, each of which is assigned a score from 1 to 9 (or from 0 to 9 in some specific cases). The VFS produces three sub-scores and a global score (from 0 to 100), resulting in a quantitative evaluation of visual functioning. RESULTS The VFS can detect the well-known differences between different types of visual impairment (cerebral, oculomotor, and peripheral or grouped as central and peripheral) and takes into account different environments in the definition of a quantitative score of visual functioning. DISCUSSION Overall, the use of a quantitative tool to evaluate visual functions and functional vision such as the VFS would be fundamental to monitor the progresses of patients over time in response to rehabilitation interventions.
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Affiliation(s)
- Sabrina Signorini
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy.,Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Antonella Luparia
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giulia Cappagli
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Eleonora Perotto
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Mauro Antonini
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Federica Morelli
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Giorgia Aprile
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Ballante
- BioData Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Political and Social Sciences, University of Pavia, Pavia, Italy
| | - Silvia Figini
- BioData Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Political and Social Sciences, University of Pavia, Pavia, Italy
| | - Renato Borgatti
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
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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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37
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Chandna A, Nichiporuk N, Nicholas S, Kumar R, Norcia AM. Motion Processing Deficits in Children With Cerebral Visual Impairment and Good Visual Acuity. Invest Ophthalmol Vis Sci 2021; 62:12. [PMID: 34779820 PMCID: PMC8606874 DOI: 10.1167/iovs.62.14.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose We sought to characterize neural motion processing deficits in children with cerebral visual impairment (CVI) who have good visual acuity using an objective, quantifiable method (steady-state visual evoked potentials [SSVEPs]). Methods We recorded SSVEPs in response to three types of visual motion – absolute motion and more complex relative and rotary motion, comparing them to form-related vernier and contour responses. We studied a group of 31 children with CVI diagnosed via detailed clinical examinations and 28 age-matched healthy controls. Results Using measurements made at the appropriate response harmonics of the stimulation frequency, we found significant deficits in cerebral processing of relative and rotary motion but not of absolute motion in children with CVI compared with healthy controls. Vernier acuity, in keeping with good recognition acuity in both groups, was not different, nor were contour-related form responses. Conclusions Deficits for complex motion but relative sparing of elementary motion and form-related signals suggests preferential damage to extra-striate visual motion areas in children with CVI. The fact that these preferential losses occur in the absence of significant acuity loss indicates that they are not secondary to reduced visual acuity, but rather are an independent vulnerability in CVI. These results corroborate parental and caregivers’ reports of difficulties with tasks that involve motion perception in children with CVI.
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Affiliation(s)
- Arvind Chandna
- Smith-Kettlewell Eye Research Institute, San Francisco, California, United States.,Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Nikolay Nichiporuk
- Smith-Kettlewell Eye Research Institute, San Francisco, California, United States
| | - Spero Nicholas
- Smith-Kettlewell Eye Research Institute, San Francisco, California, United States
| | - Ram Kumar
- Alder Hey Children's Hospital, Liverpool, United Kingdom
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Bennett CR, Bauer CM, Bex PJ, Bottari D, Merabet LB. Visual search performance in cerebral visual impairment is associated with altered alpha band oscillations. Neuropsychologia 2021; 161:108011. [PMID: 34474066 PMCID: PMC8488018 DOI: 10.1016/j.neuropsychologia.2021.108011] [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: 04/29/2021] [Revised: 07/30/2021] [Accepted: 08/26/2021] [Indexed: 11/15/2022]
Abstract
Individuals with cerebral visual impairment (CVI) often present with deficits related to visuospatial processing. However, the neurophysiological basis underlying these higher order perceptual dysfunctions have not been clearly identified. We assessed visual search performance using a novel virtual reality based task paired with eye tracking to simulate the exploration of a naturalistic scene (a virtual toy box). This was combined with electroencephalography (EEG) recordings and an analysis pipeline focusing on time frequency decomposition of alpha oscillatory activity. We found that individuals with CVI showed an overall impairment in visual search performance (as indexed by decreased success rate, as well as increased reaction time, visual search area, and gaze error) compared to controls with neurotypical development. Analysis of captured EEG activity following stimulus onset revealed that in the CVI group, there was a distinct lack of strong and well defined posterior alpha desynchronization; an important signal involved in the coordination of neural activity related to visual processing. Finally, an exploratory analysis revealed that in CVI, the magnitude of alpha desynchronization was associated with impaired visual search performance as well as decreased volume of specific thalamic nuclei implicated in visual processing. These results suggest that impairments in visuospatial processing related to visual search in CVI are associated with alterations in alpha band oscillations as well as early neurological injury at the level of visual thalamic nuclei.
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Affiliation(s)
- Christopher R Bennett
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Corinna M Bauer
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - 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, MA, USA.
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Fazzi E, Micheletti S, Calza S, Merabet L, Rossi A, Galli J. Early visual training and environmental adaptation for infants with visual impairment. Dev Med Child Neurol 2021; 63:1180-1193. [PMID: 34813110 PMCID: PMC8518055 DOI: 10.1111/dmcn.14865] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/04/2022]
Abstract
AIM To evaluate the effectiveness of early visual training and environmental adaptation on visual function and neurological development in infants with visual impairment. METHOD This was a pilot intervention clinical trial study. Thirty infants (mean age 5.9mo, SD 2.1mo, range 4-11mo; 16 males, 14 females) with peripheral visual impairment (PVI, n=15) or cerebral visual impairment (CVI, n=15) participated in a 6-month visual intervention programme. Thirty matched infants (mean age 6mo, SD 1.4mo, range 4-9mo; 18 males, 12 females) served as a comparison group. Primary outcome measures were visual acuity, contrast sensitivity, and qualitative ocular motor functions. Secondary outcomes were scores on the Griffiths Mental Developmental Scales (GMDS). RESULTS The treatment group showed a significant improvement in all the primary outcomes (p<0.01). The comparison group improved only in visual acuity and contrast sensitivity (p<0.01). The treatment group showed greater improvement than the comparison group in visual fixation (p=0.033) and smooth pursuit (p<0.01). The CVI subgroup showed greater improvement in visual acuity than the PVI subgroup (p<0.01). GMDS subscales of hand-eye coordination (p=0.01) and performance (p<0.01) increased in the treatment group, while the total score of the comparison group decreased, driven by language (p=0.039) and hand-eye coordination (p=0.025) subscales. INTERPRETATION Results suggest that, in infants with visual impairment, visual function and certain developmental outcomes improve in response to early visual training and environmental adaptation, in an interactive context. What this paper adds Early visual training and environmental adaptation are associated with enhanced visual acuity and smooth pursuit. Early visual training and environmental adaptation are associated with an improvement of neurological developmental outcome. Performance, hand-eye coordination, and language scores in Griffiths Mental Developmental Scales increase after visual training. After training, visual acuity improves more in infants with cerebral rather than anterior visual impairment. Type and complexity of visual impairment contribute to determine infants' response to training.
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Affiliation(s)
- Elisa Fazzi
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly,Unit of Child Neurology and PsychiatryASST Spedali Civili of BresciaBresciaItaly
| | - Serena Micheletti
- Unit of Child Neurology and PsychiatryASST Spedali Civili of BresciaBresciaItaly
| | - Stefano Calza
- Unit of Biostatistics and BioinformaticsDepartment of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Lotfi Merabet
- The Laboratory for Visual NeuroplasticityDepartment of OphthalmologyMassachusetts Eye and EarHarvard Medical SchoolBostonMAUSA
| | - Andrea Rossi
- Unit of Child Neurology and PsychiatryASST Spedali Civili of BresciaBresciaItaly
| | - Jessica Galli
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly,Unit of Child Neurology and PsychiatryASST Spedali Civili of BresciaBresciaItaly
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Rice ML, Sandoval MA, Castleberry KM, Schwartz TL. Physician Prescribing and Referral Patterns in Children with Cerebral Visual Impairment. Optom Vis Sci 2021; 98:1078-1084. [PMID: 34524214 DOI: 10.1097/opx.0000000000001775] [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: 11/25/2022] Open
Abstract
SIGNIFICANCE Cerebral visual impairment (CVI) is the leading cause of visual impairment in the developed world. Providing children with CVI with the appropriate treatment ensures the best possible visual outcome and potentially improves quality of life. PURPOSE The purpose of this study was to determine physician prescribing and visual rehabilitation referral patterns in children with CVI. METHODS A retrospective chart review was completed on children with CVI examined at Cincinnati Children's Hospital Medical Center from January 1, 2008, to March 1, 2018. Significant refractive error warranting correction was determined using the American Academy of Ophthalmology Preferred Guidelines and the American Association for Pediatric Ophthalmology and Strabismus Vision Screening Committee Guidelines. The CVI Range was used as a surrogate to categorize CVI severity. RESULTS A total of 194 children were included. Sixty-eight (35%) had refractive error warranting correction and were prescribed glasses (group RC), 99 (51%) did not have refractive error warranting correction and were not prescribed glasses (group NRNC), 20 (10%) had refractive error warranting correction but were not prescribed glasses (group RNC), and 7 (4%) did not have refractive error warranting correction but were prescribed glasses (group NRC). There was greater than one-line Snellen equivalent difference between group RC (20/156) and group RNC (20/221). There was greater than six-line Snellen equivalent difference between group NRNC (20/149) and group NRC (20/35). Mean CVI Range score 2 values for each group were 5.9, 4.6, 4.8, and 7.1. CONCLUSIONS Children with less severe CVI were less likely to have significant refractive error but given glasses. Despite significant refractive error, children with more severe CVI were not prescribed glasses. Children with very low visual function were not prescribed glasses as frequently, possibly limiting their visual rehabilitation. Providers should ensure that all children with CVI are correctly prescribed glasses to provide the best possible visual outcome.
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Affiliation(s)
| | - Monica A Sandoval
- Division of Pediatric Ophthalmology/Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Katherine M Castleberry
- Division of Pediatric Ophthalmology/Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Pamir Z, Bauer CM, Bennett CR, Kran BS, Merabet LB. Visual perception supported by verbal mediation in an individual with cerebral visual impairment (CVI). Neuropsychologia 2021; 160:107982. [PMID: 34364903 DOI: 10.1016/j.neuropsychologia.2021.107982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
Cerebral visual impairment (CVI) often presents with deficits associated with higher order visual processing. We report a case of an individual with CVI who uses a verbal mediation strategy to perceive and interact with his visual surroundings. Visual perceptual performance was assessed using a virtual reality based visual search task combined with eye tracking. Functional magnetic resonance imaging (fMRI) was employed to identify the neural correlates associated with this strategy. We found that when using verbal mediation, the individual could readily detect and track the target within the visual scene which was associated with robust activation within a network of occipito-parieto-temporal visual cortical areas. In contrast, when not using verbal mediation, the individual was completely unable to perform the task, and this was associated with dramatically reduced visual cortical activation. This unique compensatory strategy may be related to the individual's use of verbal working memory for the purposes of understanding complex visual information.
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Affiliation(s)
- Zahide Pamir
- The Laboratory for Visual Neuroplasticity. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Corinna M Bauer
- The Laboratory for Visual Neuroplasticity. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Christopher R Bennett
- The Laboratory for Visual Neuroplasticity. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Barry S Kran
- New England College of Optometry, Boston, MA, USA; NECO Clinical Network, Perkins School for the Blind, Watertown, MA, USA
| | - Lotfi B Merabet
- The Laboratory for Visual Neuroplasticity. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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West MR, Borchert MS, Chang MY. Ophthalmologic characteristics and outcomes of children with cortical visual impairment and cerebral palsy. J AAPOS 2021; 25:223.e1-223.e6. [PMID: 34271208 DOI: 10.1016/j.jaapos.2021.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cortical visual impairment (CVI) is the most common cause of pediatric visual impairment in developed countries, and cerebral palsy (CP) is diagnosed in approximately half of children with CVI. It is unknown whether children with CVI who also have CP (CVI+CP) have different characteristics and outcomes (with regard to visual acuity, strabismus, and response to strabismus surgery) than children with CVI without CP (CVI-CP). METHODS The medical records of all children with CVI, with and without CP, evaluated at our institution between 2013 and 2019 were retrospectively reviewed. Presentation and outcomes of children with CVI+CP were compared to those with CVI-CP. RESULTS A total of 151 children with CVI+CP and 153 children with CVI-CP were included. Children with CVI+CP were more likely to be diagnosed with significant refractive error (53.6% vs 41.2%; P = 0.03), optic atrophy (46.4% vs 32.7%; P = 0.01), and strabismus (82.8% vs 72.5%; P = 0.03) at presentation. Good ocular alignment after strabismus surgery was achieved in 30% of children with CVI+CP and 63.6% of children with CVI-CP (P = 0.48). Of 9 children with long-term (≥8 years) postoperative follow-up, 100% of CVI-CP patients achieved good outcomes compared with 0% of CVI+CP patients (P = 0.0079). Visual acuity at presentation and the percentage of patients who experienced improvement in visual acuity did not differ between groups. CONCLUSIONS In our study cohort, children with CVI+CP had a higher likelihood of ophthalmic comorbidities and may have worse long-term strabismus surgery outcomes than children with CVI-CP.
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Affiliation(s)
- Michael R West
- University of Southern California, Los Angeles, California
| | - Mark S Borchert
- University of Southern California, Los Angeles, California; Children's Hospital Los Angeles, Los Angeles, California
| | - Melinda Y Chang
- University of Southern California, Los Angeles, California; Children's Hospital Los Angeles, Los Angeles, California.
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43
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Goodenough T, Pease A, Williams C. Bridging the Gap: Parent and Child Perspectives of Living With Cerebral Visual Impairments. Front Hum Neurosci 2021; 15:689683. [PMID: 34305554 PMCID: PMC8295497 DOI: 10.3389/fnhum.2021.689683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/10/2021] [Indexed: 01/25/2023] Open
Abstract
Cerebral Visual Impairment (CVI) is an umbrella term which includes abnormalities in visual acuity, or contrast sensitivity or colour; ocular motility; visual field and the conscious and unconscious filtering or processing of visual input. Children with CVI have specific needs and problems relating to their development from infancy to adulthood which can impact on their wellbeing. Recent research indicates the complexities of living with CVI but there remains limited information of the full impact of CVI on families' everyday lives. The qualitative interviews reported here explored families' experiences to discover the impact of CVI on all aspects of everyday life. Parents and children (aged 6-18) were invited to participate in semi-structured interviews, either face to face, by phone or video call between January 2018 and February 2019. Topics covered everyday practicalities of living with CVI, focusing on challenges and what worked well at school and home. Interviews were audio-recorded and subject to thematic analysis to look for patterns across the data. Twenty families took part in interviews, with eight children/young people within those families contributing interviews of their own. Four themes were developed from the interviews: (1) Assessment and understanding implications of CVI, (2) Education, (3) Family life, (4) Psychological wellbeing and quality of life. The interviews provide valuable insights into the impact of living with CVI and highlight the need for more awareness of the condition among professionals in both health and education settings.
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Affiliation(s)
- Trudy Goodenough
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Anna Pease
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Cathy Williams
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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Williams C, Pease A, Warnes P, Harrison S, Pilon F, Hyvarinen L, West S, Self J, Ferris J. Cerebral visual impairment-related vision problems in primary school children: a cross-sectional survey. Dev Med Child Neurol 2021; 63:683-689. [PMID: 33533021 DOI: 10.1111/dmcn.14819] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 01/16/2023]
Abstract
AIM To estimate how many children in mainstream primary schools have cerebral visual impairment (CVI)-related vision problems and to investigate whether some indicators might be useful as red flags, if they were associated with increased risk for these problems. METHOD We conducted a survey of primary school children aged 5 to 11 years, using whether they were getting extra educational help and/or teacher- and parent-reported behaviour questionnaires to identify children at risk for CVI. These and a random 5% sample were assessed for CVI-related vision problems. We compared the usefulness of potential red flags using likelihood ratios. RESULTS We received questionnaires on 2298 mainstream-educated children and examined 248 children (152 [61%] males, 96 females [39%]; mean age 8y 1mo, SD 20mo, range 5y 6mo-11y 8mo). We identified 78 out of 248 children (31.5% of those examined, 3.4% of the total sample), who had at least one CVI-related vision problem. The majority (88%) were identified by one or more red flag but none were strongly predictive. Fewer than one in five children with any CVI-related vision problem had reduced visual acuity. INTERPRETATION Children with CVI-related vision problems were more prevalent than has been appreciated. Assessment of at-risk children may be useful so that opportunities to improve outcomes for children with CVI-related vision problems are not missed.
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Affiliation(s)
- Cathy Williams
- Bristol Medical School, University of Bristol, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Anna Pease
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Penny Warnes
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sean Harrison
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Florine Pilon
- Bartimeus Centre for Complex Visual Disorders, Zeist, the Netherlands
| | - Lea Hyvarinen
- Rehabilitation Sciences, TU Dortmund University, Dortmund, Germany
| | - Stephanie West
- University Hospital Southampton NHS Trust, Southampton, UK
| | - Jay Self
- University Hospital Southampton NHS Trust, Southampton, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - John Ferris
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
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Sinha M, Dasgupta T. A web browsing interface for people with severe speech and motor impairment. JOURNAL OF ENABLING TECHNOLOGIES 2021. [DOI: 10.1108/jet-07-2020-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The Web has become an indispensable medium used by people across the world for education, information, entertainment, social interaction as well as for various daily activities involving shopping and employment-related tasks. It is therefore becoming increasingly essential that the Web must be accessible to all people to provide equal access and equal opportunity. This is specifically more important for people with various kind of disabilities. Several initiatives such as development of Web accessibility guidelines, tools and technologies have been undertaken to make the Web usable for people with different disabilities. However, only a handful of them are aimed at people with Severe Speech and Motor Impairment (SSMI). This paper aims to present a Web browsing interface for people with severe speech and motor impairment.
Design/methodology/approach
The browser allows easy dissemination of information through World Wide Web for people with SSMI. The browser is augmented with both automatic as well as manual scanning mechanisms through which a motor disorder person can access the browser graphical user interface (GUI). Further, the browser provides an intelligent content scanning mechanism through which the Web contents can be accessed with less time and cognitive effort. Along with the desktop version, WebSanyog is successfully ported on Android-based tablets to make the system portable.
Findings
The system has been exhaustively field tested by people with SSMI. The browser has been deployed at the Indian Institute of Cerebral Palsy (IICP), Kolkata. The performance of the browser has been measured in terms of three parameters: The Task execution time (TET); Error rates analysis (ER); and Overall usability score by the subject. The evaluation results suggests that the proposed Web browsing interface is effective in terms of task execution time, cognitive effort and overall user satisfaction.
Originality/value
The browser GUI is integrated with an automatic scanning mechanism as an alternate way to access and navigate through Web pages, instead of using keyboard and mouse. The browser provides novel content access mechanisms that makes navigating through Web page contents like links, images and embedded videos easier and faster. To facilitate text entry, the browser provides two different options, namely, the predictive virtual scanning keyboard and a novel icon-based query entry scheme that allows generating search queries through the selection of multiple icons.
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46
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Kelly JP, Phillips JO, Saneto RP, Khalatbari H, Poliakov A, Tarczy-Hornoch K, Weiss AH. Cerebral Visual Impairment Characterized by Abnormal Visual Orienting Behavior With Preserved Visual Cortical Activation. Invest Ophthalmol Vis Sci 2021; 62:15. [PMID: 33984120 PMCID: PMC8132015 DOI: 10.1167/iovs.62.6.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Children with cerebral visual impairment (CVI) often have abnormal visual orienting behaviors due to impaired or damaged visual cortex. Alternatively, visual-cortical function is intact but visual information is not transformed downstream into an appropriate oculomotor output (visuomotor dysfunction). We examined visual, anatomic, and oculomotor assessments to distinguish visuomotor dysfunction from CVI associated with severely reduced visual-cortical response. Methods We reviewed the medical records from children with CVI having abnormal visual orienting behaviors, normal ocular examinations, and born near term. Relevant data were visual evoked potentials (VEPs), Teller card acuity, eye movements recorded by video-oculography (VOG), and neuroimaging (magnetic resonance imaging [MRI]) including diffusion tensor imaging (DTI) tractography. Results Thirty subjects had visuomotor dysfunction based on a normal VEP; of these 33% had a normal MRI and 67% had white matter abnormalities associated with metabolic disease and/or decreased volume of brain parenchyma. VOG recordings showed smooth pursuit gains were uniformly reduced and saccades were dysmetric but followed the main sequence. Ten subjects had severe CVI based on VEPs at noise levels; visual acuities and MRI findings overlapped those of the visuomotor dysfunction group. Developmental delay, seizures, microcephaly, and hypotonia were common across all groups. All subjects with an abnormal conventional MRI had abnormal metrics on DTI tractography from the occipital lobe. Conclusions A subset of patients with CVI have abnormal visual orienting behaviors despite a normal VEP (visuomotor dysfunction). A majority have abnormal white matter metrics on tractography suggesting a downstream defect in sensorimotor transformation. Clinically, visuomotor dysfunction is indistinguishable from severe CVI.
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Affiliation(s)
- John P Kelly
- Roger H. Johnson Vision Clinic, Seattle Children's Hospital, Division of Ophthalmology, Seattle, Washington, United States.,University of Washington, Department of Ophthalmology, Seattle, Washington, United States
| | - James O Phillips
- Roger H. Johnson Vision Clinic, Seattle Children's Hospital, Division of Ophthalmology, Seattle, Washington, United States.,University of Washington School of Medicine, Department of Otolaryngology, Seattle, Washington, United States
| | - Russell P Saneto
- Seattle Children's Hospital, Department of Neurology/Division of Pediatric Neurology, Neuroscience Institute, Seattle, Washington, United States
| | - Hedieh Khalatbari
- Seattle Children's Hospital, Department of Radiology, Seattle, Washington, United States
| | - Andrew Poliakov
- Seattle Children's Hospital, Department of Radiology, Seattle, Washington, United States
| | - Kristina Tarczy-Hornoch
- Roger H. Johnson Vision Clinic, Seattle Children's Hospital, Division of Ophthalmology, Seattle, Washington, United States.,University of Washington, Department of Ophthalmology, Seattle, Washington, United States
| | - Avery H Weiss
- University of Washington, Department of Ophthalmology, Seattle, Washington, United States
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47
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Philip SS, Dutton GN. Identifying and characterising cerebral visual impairment in children: a review. Clin Exp Optom 2021; 97:196-208. [PMID: 24766507 DOI: 10.1111/cxo.12155] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/24/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Swetha Sara Philip
- Dept of Ophthalmology, Christian Medical College and Hospital, Vellore, Tamil Nadu, South India
| | - Gordon N Dutton
- Department of Vision Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, United Kingdom
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Kayaarasi Ozturker Z, Akar S. Periventricular leukomalacia mimicking normal-tension glaucoma: a case report. Clin Exp Optom 2021; 104:807-808. [PMID: 33689645 DOI: 10.1080/08164622.2021.1880864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
| | - Serpil Akar
- Ophthalmology Department, Baskent University, Istanbul Hospital, Istanbul, Turkey
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Sakki H, Bowman R, Sargent J, Kukadia R, Dale N. Visual function subtyping in children with early-onset cerebral visual impairment. Dev Med Child Neurol 2021; 63:303-312. [PMID: 33111315 DOI: 10.1111/dmcn.14710] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
AIM To develop a data-driven subgrouping method to identify and profile subtypes of early-onset childhood cerebral visual impairment (CVI). METHOD Sixty-three children with suspected or diagnosed congenital CVI were recruited (28 males, 35 females, median age=8y, range=5-16y). Cognitive, basic, and higher-order vision functions were assessed and quality of life, functional vision questionnaire, neurodevelopmental, and ophthalmological data were collected. Cluster analysis and other statistical analyses were undertaken to determine and validate the subgrouping. RESULTS Forty-three participants completing the full test battery were included in cluster analysis, revealing two subgroups. Group A1 (n=15) showed selective visual perception and visuomotor deficits. Group A2 (n=28) showed more severe and broader visual perception and visuomotor deficits, and variable visual acuity. A third, lower-functioning group, Group B (n=20), was differentiated and showed significant visual acuity reduction compared with Group A (p<0.001, V=0.69). External validation showed significant cooccurring ophthalmological (e.g. strabismus p<0.001, V=0.59) and motor impairment differences (χ2 =16.26, p<0.001, V=0.51) between the three groups. All groups had lowered parent-reported quality of life and everyday functional vision. INTERPRETATION Statistical analyses revealed three subgroups with differentiated vision function characteristics on a gradient of severity. The subgrouping method provides the first steps in developing a novel classification system to underpin future clinical diagnostics and profiling of early-onset CVI. WHAT THIS PAPER ADDS Three data-driven subgroups of vision function deficits were identified. A similar severity gradient was shown in cooccurring cognitive and neurodevelopmental deficits. Reported quality of life and functional vision difficulties were low across all groups.
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Affiliation(s)
- Hanna Sakki
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Richard Bowman
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Jenefer Sargent
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Roopen Kukadia
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Naomi Dale
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK
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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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