Cerebral Visual Impairment (CVI) is the leading cause of childhood visual impairment in the developed world. Despite its prevalence, the methods for investigating and diagnosing CVI in children remain varied and inconsistent. A recent systematic review by McConnell et al. (2021) titled "What assessments are currently used to investigate and diagnose cerebral visual impairment (CVI) in children?" sheds light on the current practices and highlights the need for standardized clinical guidelines.
As practitioners, it is crucial to stay updated with the latest research to enhance our diagnostic and assessment skills. This blog post aims to summarize the key findings from the review and provide actionable insights for improving CVI diagnosis and assessment in children.
Key Findings from the Systematic Review
The review identified ten categories of assessments used to investigate and diagnose CVI in children:
- Medical history
- Vision assessment/ophthalmologic examination
- Neuroimaging
- Visual behavior and direct observation
- Structured history-taking
- Visual perception tests
- Ocular movement and posture assessment
- Intelligence/IQ assessment
- Clinical electrophysiology
- Neurodevelopmental tests
The most commonly reported diagnostic approach was one of exclusion, where CVI is diagnosed when visual dysfunction cannot be attributed to abnormalities in the anterior visual pathway.
Implementing the Findings in Practice
To enhance the outcomes for children with CVI, practitioners can take the following steps:
1. Comprehensive Medical History
Gathering a detailed medical history is fundamental. This includes prenatal, perinatal, and postnatal factors, as well as any neurological conditions that may contribute to CVI.
2. Multi-Modal Vision Assessments
Incorporate a combination of vision assessments, including ophthalmologic examinations and visual behavior observations. This holistic approach ensures a thorough evaluation of the child's visual capabilities.
3. Utilize Neuroimaging
Neuroimaging techniques such as MRI can provide valuable insights into the structural aspects of the brain that may be contributing to visual impairment. Collaborate with neurologists and radiologists to interpret these findings effectively.
4. Structured History-Taking and Observation
Implement structured history-taking tools and direct observation techniques to assess visual behavior. These methods can help identify specific visual deficits and guide intervention strategies.
5. Standardized Visual Perception Tests
Use standardized visual perception tests to assess higher-order visual processing skills. These tests can help differentiate between CVI and other visual impairments.
6. Collaboration with Multidisciplinary Teams
Work closely with a multidisciplinary team, including optometrists, neurologists, and educators, to ensure a comprehensive approach to diagnosis and intervention. This collaboration can lead to more effective and tailored support for the child.
Encouraging Further Research
While the review by McConnell et al. provides a valuable overview of current practices, it also highlights the need for further research to develop standardized clinical guidelines. Practitioners are encouraged to contribute to this body of research by documenting their assessment methods and outcomes, participating in clinical trials, and sharing their findings with the broader community.
By staying informed and engaged with the latest research, we can collectively improve the diagnosis and management of CVI in children, ultimately enhancing their quality of life and educational outcomes.
To read the original research paper, please follow this link: What assessments are currently used to investigate and diagnose cerebral visual impairment (CVI) in children? A systematic review.
