Cortical, or cerebral, visual impairment (CVI) results from damage to posterior pathways in the brain and is not explained by ocular disease. It is a leading cause of pediatric visual impairment in developed economies.
Despite this statistic, the diagnosis may be overlooked or missed, delaying vision services that may aid a child in fully accessing visual experiences and subsequent learning.
A new AAP clinical report provides information to help pediatricians and pediatric subspecialists identify children with CVI early and initiate the process of accessing care, services and education that will aid them in reaching their full potential.
The clinical report Diagnosis and Care of Children with Cortical Visual Impairment is available at https://doi.org/10.1542/peds.2024-068465 and will be published in the December issue of Pediatrics. It is from the AAP Section on Ophthalmology, AAP Council on Children with Disabilities, American Association of Ophthalmology and Strabismus, American Academy of Ophthalmology and American Association of Certified Orthoptists.
Identifying CVI
Routine vision screening that identifies amblyogenic risk factors may not identify brain-based visual impairment in children with CVI. As a result, parents may be frustrated when they are concerned about their child’s vision but are told the eyes are normal.
Furthermore, children most at risk for CVI may have other neurocognitive, neurodevelopmental and medically complex issues, making it challenging to diagnose CVI.
The clinical report reviews history-taking, including potential etiologies and comorbidities helpful in identifying those at increased risk for CVI. The report also describes characteristics that may be displayed by children with CVI, such as abnormal visual behaviors, delayed response to visual tasks and difficulty finding an object in a complex environment.
Methods of visual assessment are described in the report, and information is provided on vision and educational services and other supports available for children with CVI.
Recommendations for pediatric clinicians
- Be knowledgeable of presumptive causes of CVI and directed history-taking about visual behavior to identify children with CVI and refer them for ophthalmologic and neurologic examination.
- Improve communication among the child’s team, including the family.
- Address disparities in the medical care of children with CVI by providing screening and equitable access to care.
- Optimize transition planning for young adults with CVI though early planning and identification of special vision needs.
- Support funding for evidence-based research on screening, diagnosis and treatment modalities.
- Improve professional education regarding CVI for all members of the multidisciplinary team caring for children with CVI.
Dr. Lehman is a lead author of the clinical report and a member of the AAP Section on Ophthalmology.
