Children With Severe Cerebral Visual Impairment Less Likely To Receive Glasses

Despite substantial refractive error, children with severe cerebral visual impairment (CVI) are less likely to be prescribed glasses than children with less severe CVI, according to study results published in Optometry and Vision Science. 

The report points out that CVI is the leading cause of bilateral visual impairment among children in the developed world. Researchers performed a retrospective chart review study of 194 children with CVI evaluated at Cincinnati Children’s Hospital Medical Center between January 1, 2008 and March 1, 2018. Exclusion criteria included children with optic nerve atrophy with nystagmus and children with a concurrent diagnosis of autism spectrum disorder. 

The American Academy of Ophthalmology Preferred Guidelines and the American Association for Pediatric Ophthalmology and Strabismus Vision Screening Committee guidelines were used to ascertain whether significant refractive error warranted correction. The investigators used the CVI range as a substitute to classify CVI severity. 

Mean age at first reported cerebral visual impairment diagnosis was 4.6±4.7 years (age range, 2 months to 20 years 4 months). Of the 194 participants, over half were boys (111), and most were White (80%). The researchers found that 68 (35%) had a refractive error that warranted correction and were prescribed glasses, 99 (51%) did not have refractive error which warranted correction and were not prescribed glasses, 20 (10%) had a refractive error that warranted spectacle correction but were not prescribed glasses, and 7 (4%) did not have refractive error that warranted spectacle correction but were prescribed glasses.

A difference of greater than 1-line Snellen equivalent was noted between the group with refractive error corrected (20/156) and the group with refractive error not corrected (20/221). A difference of greater than 6-line Snellen equivalent was noted between the group with no refractive error and not corrected (20/149) and the group with no refractive error and corrected (20/35). 

The mean CVI range score 2 values were the following: refractive error corrected group (5.9), refractive error and not corrected group (4.8), no refractive error and not corrected group (4.6), and no refractive error and corrected group (7.1). 

Limitations of the study included the retrospective design and only children with CVI were enrolled. 

“Children with very low visual function were not prescribed glasses as frequently, possibly limiting their visual rehabilitation,” according to the researchers. “Providers should ensure that all children with CVI are correctly prescribed glasses to provide the best possible visual outcome.”

Reference

Rice ML, Sandoval MA, Castleberry KM, Schwartz TL. Physician prescribing and referral patterns in children with cerebral visual impairment. Optom Vis Sci. Published online September 1, 2021. doi:10.1097/OPX.0000000000001775