Ocular and cerebral causes of visual impairment in young children and a new scoring system to evaluate visual function

• Published in: International ophthalmology Vol. 42; no. 6; pp. 1897 - 1904
• Main Authors: Bingöl-Kızıltunç, Pınar, Şahlı, Esra, Bektaş, Ömer, Akıncı Göktaş, Özben, Yüksel, Merve Feyza, İdil, Aysun
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01-06-2022; Springer Nature B.V
• Subjects: Albinism; Blindness; Brain damage; Children; Encephalopathy; Evaluation; Fixation; Hypoxia; Impairment; Ischemia; Magnetic resonance imaging; Medicine; Medicine & Public Health; Neuroimaging; Neurological diseases; Nystagmus; Ophthalmology; Opto-kinetics; Original Paper; Pathology; Patients; Seizures; Vision; Visual aspects; Visual impairment; Visual perception; Hypoxic ischemic encephalopathy; Cerebral visual impairment; Low vision; Visual function; Blindness
• ISSN: 1573-2630; 0165-5701; 1573-2630
• DOI: 10.1007/s10792-021-02187-0

Purpose
Childhood blindness is important cause contributing to the burden of blindness. It is necessary to identify the most frequently observed diseases in different populations. We aimed to demonstrate clinical features of low vision children and to evaluate the factors affecting visual function by a new visual function scoring system.
Methods
Two hundred forty nine children between the age of 6 months and 3 years were included. Visual function was scored from 0 to 15 according to; response to threat, light, object, presence of fixation, duration of fixation, following of light and object in horizontal, vertical, oblique, and circular gazes, optokinetic nystagmus. Patients were classified according to neurological diagnosis and cranial magnetic resonance imaging findings. Correlation between visual function score and ocular and neurologic findings were evaluated.
Results
While 136 patients (54.6%) had cerebral visual impairment (CVI), 89 (35.7%) had ocular pathology, 24 patients (9.6%) had combined pathology. The most common ocular and cerebral pathologies were oculocutaneous albinism (23.9%) and hypoxic ischemic encephalopathy (HIE) (27.5%), respectively. Patients with CVI had lower visual function than ocular pathologies. Neurological structural disorders and HIE had worse visual function. Widespread involvement of brain had lower visual function score. Seizure negatively affected visual function.
Conclusions
Cerebral causes were found in approximately half of infants and children with low vision who were referred to our center for visual habilitation. The visual function scoring system we developed in this study will provide an opportunity to be objective in the follow-up of babies and in evaluating the effectiveness of visual habilitation programs.