CP and Vision

[Maggie Knoll]

Hi,

I’ve come across a lot of questions and information sharing that kids w/ CP have impaired vision. Can you explain why this occurs? Is this based on the location of injury? Or are there more reasons? I know that retinopathy of prematurity might be common with kids if they were premature, so we can potentially assume this is also a reason for the impaired vision?

Additionally, is it more common to see fluctuating visual deficits for these kids? Why?

Thank you!

[Jessica Lewis]

Great questions! Visual impairment in children with CP is very common. The most common cause is your original thought about the location of injury and how it affects the visual pathways, especially in children with periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), hypoxic-ischemic injury. Damage to the optic radiations, occipital cortex, or dorsal visual stream can result in cerebral visual impairment (CVI). So the eyes are structurally sound, but the brain has a really hard time processing visual input. Another cause of visual impairment can be ocular motor dysfunction like strabismus, nystagmus, or poor tracking due to impaired motor control of the extraocular muscles. A third cause of visual impairment is purely due to conditions related to prematurity, such as retinopathy of prematurity and optic nerve hypoplasia. These conditions are just simply more common in premature infants and therefore can be seen in children with CP.

Fluctuating visual performance is also common, especially in kids with CVI. Since CVI is a problem with the brain processing information (rather than the eye itself) vision can vary depending on fatigue, environmental complexity, cognitive load, posture, or seizure activity. A child do a great job visually attending in a quiet, supported setting but struggle in a busy environment or when working hard to maintain posture. This is why CVI is so tricky!

[Maggie Knoll]

Thank you! This was helpful. Is CVI diagnosed with MRI and through a visit to a developmental ophthalmologist or optometrist? When might I be concerned about this condition and refer a child out? If they haven’t already been diagnosed.

[Jessica Lewis]

From what I understand, MRI findings help support the diagnosis of CVI, but they cannot provide definitive evidence. A developmental ophthalmologist or pediatric neuro-ophthalmologist has to make the diagnosis based on visual behaviors they see during evaluations. I think I might be on high alert to make a referral if a kiddo of mine has a history of prematurity, HIE, PVL, CP, or some other neurologic condition and was demonstrating inconsistent visual attention, having difficulty with visual complexity, or showing a preference for movement or light. I think if you’re seeing visual behaviors that are not lining up with regular vision exam findings and are starting to interfere with participation and their mobility, referral to a specialized ophthalmologist would be reasonable.

[Helen Carey]

Here are some additional resources!
https://www.nei.nih.gov/eye-health-information/eye-conditions-and-diseases/cerebral-visual-impairment-cvi

https://www.pedneur.com/article/S0887-8994%2817%2930544-1/abstract

[Helen Carey]

Hi,
Here are some additional resources:

http://dx.doi.org/10.1016/j.pediatrneurol.2017.07.011

https://www.nei.nih.gov/eye-health-information/eye-conditions-and-diseases/cerebral-visual-impairment-cvi

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