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Silveira S, Kelly N, Wright R. Australian children with cerebral visual impairment: using what we know now to improve future approaches. Strabismus 2023; 31:253-261. [PMID: 37997430 DOI: 10.1080/09273972.2023.2272675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
PURPOSE Little has been reported on Australian children with Cerebral Vision Impairment (CVI). This paper aims to present the outcome of an audit focussed on children with the primary diagnosis of CVI, using findings from the Australian Childhood Vision Impairment Register (ACVIR). METHODS Records on 132 children (49% girls, 51% boys) from ACVIR data gathered from both the child's parent/guardian and their eye health professional were reviewed. The child's demographics, level of vision impairment, birth history, diagnostic journey, secondary ocular diagnoses, comorbidities and low vision support were analyzed. Several correlations were investigated using a Kendall's tau-b analysis including the relationship between vision and age of diagnosis; level of vision and developmental delay; and age of suspicion of visual impairment and age of diagnosis. RESULTS The most common level of visual impairment was blindness (39%), and most children were suspected and diagnosed of visual impairment in the first 6 months of life. The majority of children were born full term (72%), weighing >2000gms (84%). Nearly half of the cohort of children (48%) had a secondary ocular diagnosis with 44% having nystagmus. The majority of children (80%) had additional health problems, and 85% of children had additional disabilities, with 79% having developmental delay. CONCLUSION While the findings of this audit cannot be generalized to a wider population of Australian children with CVI, the outcome encourages continued discussion on CVI, to explore comprehensive assessment approaches which facilitate timely and accurate diagnosis.
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Affiliation(s)
- Susan Silveira
- NextSense, NextSense Institute, North Rocks, NSW
- Macquarie School of Education, Faculty of Arts, Macquarie University, Macquarie Park, NSW
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Galli J, Loi E, Strobio C, Micheletti S, Martelli P, Merabet LB, Pasini N, Semeraro F, Fazzi E. Neurovisual profile in children affected by Angelman syndrome. Brain Dev 2023; 45:117-125. [PMID: 36344336 DOI: 10.1016/j.braindev.2022.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/09/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Angelman syndrome (AS) is a rare neurogenetic disorder caused by altered expression of the maternal copy of the UBE3A gene. Together with motor, cognitive, and speech impairment, ophthalmological findings including strabismus, and ocular fundus hypopigmentation characterize the clinical phenotype. The aim of this study was to detail the neurovisual profile of children affected by AS and to explore any possible genotype-phenotype correlations. METHODS Thirty-seven children (23 females, mean age 102.8 ± 54.4 months, age range 22 to 251 months) with molecular confirmed diagnosis of AS were enrolled in the study. All underwent a comprehensive video-recorded neurovisual evaluation including the assessment of ophthalmological aspects, oculomotor functions, and basic visual abilities. RESULTS All children had visual impairments mainly characterized by refractive errors, ocular fundus changes, strabismus, discontinuous/jerky smooth pursuit and altered saccadic movements, and/or reduced visual acuity. Comparing the neurovisual profiles between the deletion and non-deletion genetic subgroups, we found a significant statistical correlation between genotype and ocular fundus hypopigmentation (p = 0.03), discontinuous smooth pursuit (p < 0.05), and contrast sensitivity abnormalities (p < 0.01) being more frequent in the deletion subgroup. CONCLUSIONS Subjects affected by AS present a wide spectrum of neurovisual impairments that lead to a clinical profile consistent with cerebral visual impairment (CVI). Moreover, subjects with a chromosome deletion show a more severe visual phenotype with respect to ocular fundus changes, smooth pursuit movements, and contrast sensitivity. Early detection of these impaired visual functions may help promote the introduction of neurovisual habilitative programs which can improve children's visual, neuromotor, and cognitive outcomes.
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Affiliation(s)
- Jessica Galli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Erika Loi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Caterina Strobio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Serena Micheletti
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Paola Martelli
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Lotfi B Merabet
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Nadia Pasini
- Department of Neurological and Vision Sciences, ASST Spedali Civili of Brescia, Italy
| | - Francesco Semeraro
- Department of Neurological and Vision Sciences, ASST Spedali Civili of Brescia, Italy; University of Brescia, Eye Clinic, Brescia, Italy
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
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Morelli F, Aprile G, Martolini C, Ballante E, Olivier L, Ercolino E, Perotto E, Signorini S. Visual Function and Neuropsychological Profile in Children with Cerebral Visual Impairment. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060921. [PMID: 35740858 PMCID: PMC9221908 DOI: 10.3390/children9060921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/08/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022]
Abstract
Cerebral Visual Impairment (CVI) has become the leading cause of children’s visual impairment in developed countries. Since CVI may negatively affect neuropsychomotor development, an early diagnosis and characterization become fundamental to define effective habilitation approaches. To date, there is a lack of standardized diagnostic methods to assess CVI in children, and the role of visual functions in children’s neuropsychological profiles has been poorly investigated. In the present paper, we aim to describe the clinical and neuropsychological profiles and to investigate the possible effects of visual functions on neuropsychological performance of a cohort of children diagnosed with CVI. Fifty-one children with CVI were included in our retrospective analysis (inclusion criteria: verbal IQ > 70 in Wechsler scales; absence of significant ocular involvement). For each participant, we collected data on neuropsychological assessment (i.e., cognitive, cognitive visual, and learning abilities), basic visual functions (e.g., Best Corrected Visual Acuity—BCVA, contrast sensitivity, and ocular motor abilities) and global development features (e.g., neurological signs and motor development delay) based on standardized tests, according to patients’ ages. The results showed that oculomotor dysfunction involving saccades and smooth pursuit may be a core symptom of CVI and might have a significant impact on cognitive visual and other neuropsychological abilities. Furthermore, visual acuity and contrast sensitivity may influence cognitive, cognitive visual, and academic performances. Our findings suggest the importance of a comprehensive assessment of both visual and neuropsychological functions in children when CVI is suspected, which is needed to provide a more comprehensive functional profile and define the best habilitation strategy to sustain functional vision.
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Affiliation(s)
- Federica Morelli
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.A.); (C.M.); (L.O.); (E.E.); (E.P.); (S.S.)
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
- Correspondence:
| | - Giorgia Aprile
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.A.); (C.M.); (L.O.); (E.E.); (E.P.); (S.S.)
| | - Chiara Martolini
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.A.); (C.M.); (L.O.); (E.E.); (E.P.); (S.S.)
| | - Elena Ballante
- BioData Science Center, IRCCS Mondino Foundation, 27100 Pavia, Italy;
- Political and Social Sciences, University of Pavia, 27100 Pavia, Italy
| | - Lucrezia Olivier
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.A.); (C.M.); (L.O.); (E.E.); (E.P.); (S.S.)
| | - Elisa Ercolino
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.A.); (C.M.); (L.O.); (E.E.); (E.P.); (S.S.)
| | - Eleonora Perotto
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.A.); (C.M.); (L.O.); (E.E.); (E.P.); (S.S.)
| | - Sabrina Signorini
- Developmental Neuro-Ophthalmology Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.A.); (C.M.); (L.O.); (E.E.); (E.P.); (S.S.)
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Galli J, Loi E, Molinaro A, Calza S, Franzoni A, Micheletti S, Rossi A, Semeraro F, Fazzi E. Age-Related Effects on the Spectrum of Cerebral Visual Impairment in Children With Cerebral Palsy. Front Hum Neurosci 2022; 16:750464. [PMID: 35308614 PMCID: PMC8924515 DOI: 10.3389/fnhum.2022.750464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background Cerebral Visual Impairment (CVI) is a very common finding in children affected by Cerebral Palsy (CP). In this paper we studied the characteristics of CVI of a large group of children with CP and CVI, describing their neurovisual profiles according to three different age subgroups (subgroup 1: infants 6 months–2 years; subgroup 2: pre-school age 3–5 years; subgroup 3: school age ≥ 6 years). Methods We enrolled 180 subjects (104 males, mean age 66 ± 42.6 months; range 6–192 months) with CP and CVI for the study. We carried out a demographic and clinical data collection, neurological examination, developmental or cognitive assessment, and a video-recorded visual function assessment including an evaluation of ophthalmological characteristics, oculomotor functions, and basic visual functions. In school-aged children, we also performed an evaluation of their cognitive-visual profiles. Results There were signs of CVI in all the three subgroups. Subgroup 1 (62 children) and subgroup 2 (50 children) were different for fixation (p = 0.02), visual acuity (p = 0.03) and contrast sensitivity (p < 0.01), being more frequently impaired in younger children. Comparing subgroup 2 with subgroup 3 (68 children), the older children presented more frequently myopia (p = 0.02) while the younger ones esotropia (p = 0.02) and alteration in smooth pursuit (p = 0.03) and saccades (p < 0.01). Furthermore, fixation, smooth pursuit, visual acuity, contrast sensitivity and visual filed (p < 0.01) were more frequently impaired in younger children (subgroup 1) compared to the older ones. Multiple correspondence analysis (MCA) confirmed the different neurovisual profiles according to age: younger children with CP showed more signs of CVI compared to the older ones. 34 out of 68 children belonging to subgroup 3 underwent the cognitive visual evaluation; an impairment of cognitive visual skills was detected in 21 subjects. Conclusion Younger children with CP showed more signs of CVI compared to the older ones, likely for the physiological maturation of visual system and mechanisms of neuroplasticity. In this direction, we suggest an early neurovisual evaluation to detect any weak visual functions.
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Affiliation(s)
- Jessica Galli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
- *Correspondence: Jessica Galli,
| | - Erika Loi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Anna Molinaro
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Stefano Calza
- BDbiomed, BODaI Lab, University of Brescia, Brescia, Italy
| | - Alessandra Franzoni
- Department of Neurological and Vision Sciences, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Serena Micheletti
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Andrea Rossi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Francesco Semeraro
- Department of Neurological and Vision Sciences, ASST Spedali Civili of Brescia, Brescia, Italy
- Eye Clinic, University of Brescia, Brescia, Italy
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
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Moon JH, Kim GH, Kim SK, Kim S, Kim YH, Kim J, Kim JK, Noh BH, Byeon JH, Yeom JS, Eun BL, Eun SH, Choi J, Chung HJ. Development of the Parental Questionnaire for Cerebral Visual Impairment in Children Younger than 72 Months. J Clin Neurol 2021; 17:354-362. [PMID: 34184442 PMCID: PMC8242312 DOI: 10.3988/jcn.2021.17.3.354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Cerebral visual impairment (CVI) is an underdiagnosed condition in children, and its assessment tools have focused on older children. We aimed to develop a parental questionnaire for cerebral visual impairment (PQCVI) for screening CVI in young children. Methods The PQCVI comprised 23 questions based on a modified version of Houliston and Dutton's questionnaire for older children. The PQCVI with neurocognitive function tests was applied to 201 child-parent pairs with typically developing children younger than 72 months (age 32.4±20.1 months, mean±standard deviation). The children were classified into six age groups. The normative data, cutoff scores, and internal reliability were assessed and item analysis was performed. We referred to the total score for all questions as the cerebral visual function (CVF) score. Results The normative data showed that the CVF score and the scores corresponding to ventral-stream and dorsal-stream visual functions plausibly increased with age. The scores rapidly reached 90% of their maximum values up to the age of 36 months, after which they increased slowly. Cronbach's alpha for all questions across all age groups was 0.97, showing excellent consistency. The item difficulty and item discrimination coefficients showed that the questions were generally adequate for this age stage. Conclusions The PQCVI items produced reliable responses in children younger than 72 months. The rapid increase in scores before the age of 3 years supports the importance of early identification of CVI. Following additional clinical verification, the PQCVI may be useful for CVI screening.
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Affiliation(s)
- Jin Hwa Moon
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Gun Ha Kim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Sung Koo Kim
- Department of Pediatrics, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Korea
| | - Seunghyo Kim
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Young Hoon Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - JoonSik Kim
- Department of Pediatrics, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jin Kyung Kim
- Department of Pediatrics, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Byoungho H Noh
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea
| | - Jung Hye Byeon
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jung Sook Yeom
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Baik Lin Eun
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - So Hee Eun
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jieun Choi
- Department of Pediatrics, Seoul National University College of Medicine, SMC-SNU Boramae Medical Center, Seoul, Korea
| | - Hee Jung Chung
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
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