EPOS

European Paediatric Ophthalmological Society

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Cerebral visual impairment in children with good visual acuity.

van Genderen Maria¹, Boonstra Nienke¹, Schuil José¹, Tijmes Nel¹, Bals Irmgard^1
1Bartiméus Institute for the Visually Impaired

Introduction: In ophthalmic practice, children with cerebral visual impairment (CVI) that have good visual acuity may constitute a diagnostic challenge. The purpose of this study was to assess the value of medical history taking, a short questionnaire, and visual function testing in establishing the diagnosis. Methods: Thirty children, mean age 7 years, with a visual acuity > 0.4, were diagnosed with CVI by child psychologists. Eleven children had a visual acuity ≥ 0.8. We retrospectively evaluated their medical history, clinical characteristics, and answers of their parents to a short questionnaire, consisting of 15 questions on dorsal and ventral stream problems. Results: 29/30 children had a clinical history of perinatal problems, one had a developmental brain abnormality. 20/30 children had abnormal MRI findings, 15/30 had visual field abnormalities. In 18 children, reading vision was significantly worse than distance vision. In all children, the questionnaire yielded at least three positive answers. The majority of children had dorsal stream damage. Conclusions: In children with normal vision, a medical history of perinatal problems combined with affirmative answers on a short questionnaire is a strong indicator of CVI. Visual field testing, assessing reading vision and MRI may support the diagnosis, but results of these tests may be normal.