PCVIS Board Members Dr. Sharon Lehman and Dr. Melinda Chang, along with their co-author Dr. Larry Yin, published Diagnosis and Care of Children With Cerebral/Cortical Visual Impairment: Clinical Report in the December issue of Pediatrics from the American Academy of Pediatrics. The report is written to help pediatricians and other clinicians identify and refer patients with suspected CVI and provide the next steps after diagnosis.
Lehman SS, Yin L, Chang MY, et al; American Academy of Pediatrics, Section on Ophthalmology, Council on Children with Disabilities; American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology; American Association of Certified Orthoptists Diagnosis and Care of Children With Cerebral/Cortical Visual Impairment: Clinical Report. Pediatrics. 2024;154(6): e2024068465
The authors write, “...routine vision screening may not accurately identify the brain-based visual impairment in children with CVI. Moreover, children with CVI often have medical complexity with other neurocognitive impairments and serious medical conditions that can make the diagnosis of CVI more difficult.”
They emphasize that knowledge of the characteristics of CVI and its risk factors will help doctors identify and diagnose children with CVI, and then refer them for evaluation by the appropriate vision services organization. The report complements other vision screening policies to ensure both ocular and brain-based visual impairments may be diagnosed.
10 highlights
1 CVI is the leading cause of visual impairment in the United States and other nations with developed economies. It is “emerging as a significant threat to vision in regions of the world with developing economies.”
2 The National Institutes for Health (NIH) CVI Working Group recently published a working definition of CVI.
3 Comorbidities include cerebral palsy, intellectual disability, developmental delays, sensorineural hearing loss, microcephaly, neurodevelopmental disorders such as autism spectrum disorder, and more.
4 It can be difficult to assess vision in children with multiple disabilities. Their responses in the clinical setting may not represent how they use their vision in familiar places.
5 “Children at risk for CVI because of history, behavioral characteristics of CVI noted on physical examination, or abnormalities on the [Visual System Assessment in Infants, Children, and Young Adults by Pediatricians] should be referred for pediatric ophthalmologic evaluation.”
6 Children with CVI may also have ocular visual impairment, requiring further evaluation and treatment.
7 Following diagnosis, a child should be referred for a vision services evaluation. “CVI interferes with a child’s ability to access his or her educational materials providing medical necessity for vision services regardless of degree of disability.”
8 When a pediatrician has concerns about a child’s visual function, he or she may request a vision services evaluation before formal diagnosis (e.g., if the wait for a pediatric ophthalmology appointment is lengthy).
9 Early diagnosis and referral to vision services “may allow a child with CVI to engage more fully in school, activities of daily living, vocational pursuits, and recreational activities.”
10 Though there is little evidence-based research on transitional services for patients with visual impairment, accommodations can help young adults with CVI continue with educational, vocational, and recreational activities.
Sharon Lehman, MD, is a member of the PCVIS Board and an attending pediatric ophthalmologist at Wills Eye Hospital in Philadelphia, Pennsylvania where she practices and teaches ophthalmology fellows, residents, and medical students. Dr. Lehman held the position of Chief of Ophthalmology for 25 years at Nemours Children’s Hospital in Wilmington, Delaware.
Melinda Chang, MD, is a member of the PCVIS Board and a Pediatric Neuro-ophthalmologist at Children’s Hospital Los Angeles. Dr. Chang’s research includes methods to assess visual function and functional vision in CVI and autism.
Special thanks to Drs. Lehman, Chang, and Yin for writing this paper.