Disentangling How the Brain is "Wired" in Cortical (Cerebral) Visual Impairment.

Cortical (cerebral) visual impairment (CVI) results from perinatal injury to visual processing structures and pathways of the brain and is the most common cause of severe visual impairment or blindness in children in developed countries. Children with CVI display a wide range of visual deficits including decreased visual acuity, impaired visual field function, as well as impairments in higher-order visual processing and attention. Together, these visual impairments can dramatically influence a child's development and well-being. Given the complex neurologic underpinnings of this condition, CVI is often undiagnosed by eye care practitioners. Furthermore, the neurophysiological basis of CVI in relation to observed visual processing deficits remains poorly understood. Here, we present some of the challenges associated with the clinical assessment and management of individuals with CVI. We discuss how advances in brain imaging are likely to help uncover the underlying neurophysiology of this condition. In particular, we demonstrate how structural and functional neuroimaging approaches can help gain insight into abnormalities of white matter connectivity and cortical activation patterns, respectively. Establishing a connection between how changes within the brain relate to visual impairments in CVI will be important for developing effective rehabilitative and education strategies for individuals living with this condition.

A telephone survey of low vision services in U.S. schools for the blind and visually impaired.

The scope of clinical low vision services and access to comprehensive eye care through U.S. schools for the blind and visually impaired is not well known. Advances in medicine and educational trends toward inclusion have resulted in higher numbers of visually impaired children with additional cognitive, motor, and developmental impairments enrolled in U.S. schools for the blind and visually impaired. The availability and frequency of eye care and vision education services for individuals with visual and multiple impairments at schools for the blind is explored in this report using data collected in a 24-item telephone survey from 35 of 42 identified U.S. schools for the blind. The results indicate that 54% of the contacted schools (19) offer clinical eye examinations. All of these schools provide eye care to the 6 to 21 age group, yet only 10 schools make this service available to children from birth to 3 years of age. In addition, two thirds of these schools discontinue eye care when the students graduate or transition to adult service agencies. The majority (94.7%) of eye care is provided by optometrists or a combination of optometry and ophthalmology, and 42.1% of these schools have an affiliation with an optometric institution. When there is a collaborative agreement, clinical services for students are available more frequently. The authors find that questions emerge regarding access to care, identification of appropriate models of care, and training of educational/medical/optometric personnel to meet the needs of a very complex patient population.