Medical Professionals

How Doctors Diagnose CVI

Cortical Visual Impairment (CVI) is typically diagnosed by a medical doctor, usually an ophthalmologist, neuro-ophthalmologist, neurologist, and in some cases, an optometrist. The child should have a complete eye examination. While some children with CVI have a co-existing ocular condition, this condition does not fully explain their visual loss. Children may need to be followed over time or undergo a workup to exclude other causes of vision loss, such as inherited retinal disorders or delayed visual maturation.

Professionals can make a diagnosis if their patient meets the following criteria:

1 The child has a neurologic condition affecting the visual pathways in the developing brain.

2 There is a visual dysfunction that cannot be explained by an ocular abnormality. 

3 The visual deficits involve visual acuity, contrast sensitivity, visual fields, and/or higher-order visual processing.

4 The visual dysfunction cannot be explained by autism, dyslexia, or another disorder of learning, language, or social communication.

What to look for during an exam

  • Absent or clumsy visually guided motor response
  • Preferentially responds to a flashing light toy or brightly colored object (usually yellow or red) with ocular following, smiling, or head/truncal movements
  • The child responds more vigorously with visual stimulation approaching from one side of the visual field or the other
  • Delayed response to visual stimuli
  • Takes longer to fix and follow, or to re-fixate to target in peripheral vision
  • Looking up or away while looking at an object
  • Parent or vision teacher history that the child interacts visually in a more focused way with an uncluttered workspace and lower sensory complexity
  • Parent history of child preferring to gaze at lights
  • Parent history of child not responding to people or large objects from across the room

The ophthalmologist’s role

The ophthalmologist is an important member of the multidisciplinary team that cares for a child with CVI.

During the history taking, it is important to solicit observations of visual performance from the family and other members of the child’s care team. A child’s performance in a limited examination time, in an unfamiliar place when he may be tired and hungry, may not be representative of true function. It is often the occupational or physical therapist who first notes a visual field defect in a patient.

A full ophthalmologic examination, including cycloplegic refraction, should be performed to assess visual acuity, look for characteristics of CVI, and identify the presence of clinically significant ocular conditions. Visual performance can be maximized by treating any ocular comorbidities, including any significant refractive errors. Dynamic retinoscopy is a useful tool to evaluate for accommodative insufficiency.

It is vital for the ophthalmologist to make and document the diagnosis of CVI, as well as reduced visual acuity, if present. Patients may qualify for services based on the level of visual impairment, especially if a patient has a chronic visual condition that will impair educational progress. Further assistance for interventions or accommodations that may help a patient reach his or her full potential depends on the diagnosis made by the ophthalmologist.

When appropriate, a referral for an evaluation for vision services from the appropriate agency should be made. The referral for infants and children prior to the third birthday can be made through their early intervention program or appropriate state agency, depending upon the patient’s state of residence. The referral for children age three and older is made through the school district or appropriate state agency. The designated service providers are typically a Teacher of Students with Visual Impairment (TVI) and Certified Orientation and Mobility Specialist (COMS).

Individualized Family Service Plan (IFSP)

Children up to age 3 who have a disability may be eligible for early intervention services provided through an Individualized Family Service Plan, or IFSP, under Part C of the Individuals with Disabilities Education Act

Individualized Education Plan (IEP)

Children with a disability that interferes with education who attend a school with federal funding may qualify for an individualized educational plan, or IEP, under the Individuals with Disabilities Education Act

After the Diagnosis

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