Cerebral visual impairment in children: Multicentric study determining the causes, associated neurological and ocular findings, and risk factors for severe vision impairment

Purpose: To evaluate the causes, associated neurological and ocular findings in children with cerebral visual impairment (CVI), and to identify risk factors for severe vision impairment. Methods: A multicenter, retrospective, cross?sectional analysis was carried out from January 2017 to December 2019 on patients less than 16 years of age with a diagnosis of CVI. Results: A total of 405 patients were included of which 61.2% were male and 38.8% were female. The median age at presentation was 4 years (range 3 months to 16 years). Antenatal risk factors were present in 14% of the cases. The most common cause of CVI was hypoxic?ischemic encephalopathy (35.1%), followed by seizure associated with brain damage (31.3%). The most common neurological finding was seizure (50.4%), followed by cerebral palsy (13.6%). Associated ophthalmological findings were significant refractive error (63.2%), esotropia (22.2%), exotropia, (38%), nystagmus (33.3%), and optic nerve atrophy (25.9%). Severe visual impairment (<20/200) was associated with optic atrophy (odds ratio: 2.9, 95% confidence interval: 1.4–6.0; P = 0.003) and seizure disorder (odds ratio: 1.9, 95% confidence interval: 1.2–3.3; P = 0.012). Conclusion: The various ophthalmic, neurological manifestations and etiologies could guide the multidisciplinary team treating the child with CVI in understanding the visual impairment that affects the neuro development of the child and in planning rehabilitation strategies

O Estabelecimento da Atenção Conjunta em um Bebê com Deficiência Visual Severa / Establishment of Joint Attention in a Baby with Severe Visual Impairment

Resumo Atenção conjunta é uma capacidade relacional triádica, estabelecida na interação bebê-parceiro-objeto. É verificada pela direção do olhar ao olhar/ação do outro, sendo relatada como atenção visual conjunta. Pergunta-se como seria estabelecida em crianças cegas ou com deficiências visuais. Assim, investigou-se se e como ocorreriam construção, estabelecimento e manutenção da atenção conjunta em bebê com deficiência visual. Conduziu-se um estudo de caso de um bebê (inicialmente com sete meses), com videogravações, por quatro meses, na residência. A análise foi microgenética. Verificou-se que a atenção conjunta estabeleceu-se, foi construída e se manteve a partir de pistas não visuais, como táteis, olfativas, hápticas e sonoras. Adicionalmente, a emoção foi elemento favorecedor da atenção conjunta.

Abstract Joint attention is considered a triadic relational capacity, established in interaction baby-object-partner. It is verified by the direction of the gaze to another's look / action, being reported as joint visual attention. One may wonder how it would be established in blind or visually impaired children. Thus, it was investigated, if and how would occur construction, establishment and maintenance of joint attention in a baby with severe visual impairment. It was conducted a case study of a baby (first seven months), with video recordings, in residence. The analysis was microgenetic. It was verified that joint attention is established and maintained from non-visual cues, like tactile, olfactory, haptic and audible. Emotion was element to facilitate joint attention.

Causes of blindness and severe visual impairment among children enrolled in an early intervention and preschool program of a school for the blind in the Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To identify the avoidable causes of childhood blindness and visual impairment in a school of the blind in the Philippines.</p> <p style="text-align: justify;"><strong>METHODS:</strong> The medical records of students enrolled at the Resources for the Blind early intervention and preschool program from 1999 to 2012 were reviewed. Demographic characteristics and causes of visual disability were abstracted and tabulated.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> A total of 90 records were included in the study. Eighty six (76.7%) had visual acuity classified as blind (<20/400) or severe visual impairment (<20/200 - 20/400, 18.9%). Majority (69.8%) were below 6 years of age and most (44.2%) were below 1 year. Retinopathy of prematurity was the most common cause (47.7%), followed by retinablastoma (11.6%). Perinatal factors accounted for most of the etiologic causes (58.1%) of visual loss.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> More than half of the causes of severe visual impairment and blindness were potentially avoidable, with retinopathy of prematurity as the leading etiology.</p>