Profile of cerebral visual impairment in children less than 7 years – A prospective observational study

Abstract

To study the incidence of cerebral visual impairment among children with history of perinatal neurological insult and congenital brain anomalies and to analyze the outcome following visual intervention programme. A prospective interventional study, examining 100 children less than 7 years over a period of 1 year. All children with history of perinatal hypoxia, neonatal hypoglycemia, neonatal seizures, infantile spasm, epilepsy, congenital hydrocephalus, congenital brain anomalies, CNS infections, traumatic brain injury and post cardiac surgery, excluding children with ocular visual impairment.  Of the 100 children studied, the incidence of CVI was 87%. The associated ocular problems were found to be low visual acuity seen in 85%, strabismus in 25%, refractive error in 39%, Nystagmus in 21% and oculomotor apraxia in 6%. The most common etiology was hypoxic ischemic encephalopathy, contributing to 30% of the cases and most common MRI findings were periventricular leukomalacia, seen in 42%. CVI Range was used for functional visual assessment. Visual intervention rather than visual stimulation was taught to the primary care giver and children were followed up every 3 months. 26% of children had improved in their functional vision after 6 months of Individualized intervention.  Early identification and individualized visual intervention, integrating them into many activities of the child across the whole day, form a crucial part of the visual outcome. Improvement in vision creates access to a world of cognitive and motor development.