Vision and Associated Conditions
in Students with MIVI
By Dr. Dixie Mercer
And
Debbie “Cricket” Nelson
Cerebral Palsy
•Any number of neurological disorders because of
injury to the brain, that appear in infancy or early
childhood and permanently affect body movement
and muscle coordination but don’t worsen over
time.
•Vision problems
•Strabismus
•Nystagmus
•Cortical Blindness
•Hemnianopsia
•Other Problems
•Muscle tone
•Difficulties swallowing, sucking, speaking
•Hearing problems
•Speech problems
•Seizures
Cerebral Palsy
CHARGE • C Coloboma defects of the
Syndrome eyeball and cranial nerve
abnormalities
Rare disorder
• H  Heart defects
• A  Atresia of the choanae
Happens during
early fetal
development
Affects multiple
organ systems
(blocked nasal breathing passages)
• R  Retardation of growth and
development
• G  Genital and urinary
abnormalities
• E  Ear abnormalities and
hearing loss
CHARGE
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CAUSES VISION LOSS in 80%-90% of cases
Coloboma (like a cleft) of the eye
Coloboma of the iris, retina, choroid, macula or disc
Microphthalmos (small eye)
Anophthalmos (missing eye)
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Visual field loss, typically in the superior (upper) field
Blind spots
Acuity problems
Extra sensitivity to bright lights (even indoors)
Monocular vision
Lack of depth perception
• There are only a handful of documented examples of
more than one child with CHARGE in a family.
CHARGE Syndrome
Cortical Visual Impairment (CVI)
•A neurological visual disorder.
•It is the fastest growing visual impairment diagnosis today.
•It involves a disturbed visual sense because of widespread
brain disturbance and damage.
Definition for Educational Purposes:
Cortical visual impairment (CVI) is a neurological
disorder, which results in unique visual responses to
people, educational materials, and to the environment.
When students with these visual/behavioral
characteristics are shown to have loss of acuity or
judged by their performance to be visually impaired,
they are considered to have CVI.
CVI
Cytomegalovirus (CMV)
(si-to-MEG-a-lo-vi-rus)
A member of the herpes virus family, it is the most common congenital
(present at birth) infection in the United States. ~30,000 children each year!
• Vision Problems:
– Central vision loss
– Blurred vision
– Cortical vision
impairment
– Blindness
– Scarring of the retina
– Swelling and irritation of
the eye (uveitis)
– Retinitis
– Photophobia (light
• Other Problems:
– Hearing loss
– Mental disability
– Small head
– Lack of coordination
– Seizures
– Death
– Vision loss
CMV
cytomegalovirus
(si-to-MEG-a-lo-vi-rus)
Encephalitis
An acute infection and inflammation of the brain.
The most common cause of this is viral infections
Associated Vision Problems
• Light Sensitivity
• Double Vision
• If in the Occipital lobe:
Responsible for
interpreting visual input
from the eyes
Other Problems
• Unsteady gait
• Disorientation
• Body Stiffness
• Muscle weakness
• Permanent brain damage
• Parietal lobe: Processes
information from the senses
and controls walking,
posture, and head and eye
movements.
Hydrocephalus
Abnormal buildup of the brain’s normal water-like fluid (cerebrospinal fluid or CSF).
 A disturbance of formation, flow, or absorption of cerebrospinal fluid (CSF)
that leads to an increase in volume occupied by this fluid in the CNS
Associated Vision Problems
Other Problems
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Eyes fixed downward
Swelling of the optic disk
Blurred vision
Blindness
Increased pressure on the
optic nerves
• Eyes that appear crossed
• Uncontrolled eye
movements
Unusually large head
Seizures
Developmental delay
Poor coordination
Developmental delays
Learning disabilities
Mental retardation
Slow movement, lethargy,
other physical disabilities.
Meningitis
•An inflammation of the meninges, the membranes that cover the
brain and spinal cord.
•Usually caused by bacteria or viruses, but it can also be caused by
certain medications or illnesses.
Associated Vision Problems
•Blindness
•Double vision
•Cortical visual impairment
•Photophobia
•Blurry or hazy vision
•Problems with depth perception
•Partial loss of the visual field
•Loss of central vision
Microcephaly
• A medical condition in which the circumference of the head is smaller
than normal because the brain has not developed properly or has stopped
growing.
•Vision problems:
•CVI
•Eye development problems
•Structural impairment
•Damage to one or more parts of the eye
•Refractive errors
•Vision fluctuation
•Other problems:
•Convulsions & seizures
•Mental retardation
•Developmental delays
•Delayed motor functions and speech
•Facial distortions
•Dwarfism
•Hyperactivity
Microcephaly
Retinopathy of Prematurity (ROP)
•A potentially blinding eye disorder that primarily affects
premature infants weighing about 2¾ pounds (1250
grams) or less that are born before 31 weeks of gestation
(A full-term pregnancy has a gestation of 38–42 weeks).
•One of the most common causes of visual loss in
childhood and can lead to lifelong vision impairment and
blindness.
•Usually develops in both eyes.
•Caused by disorganized growth of retinal blood vessels,
resulting in scarring and retinal detachment.
Retinopathy of Prematurity (ROP)
Severity described in Stages:
•Stages 1 & 2 do not lead to blindness, but can
progress to the more severe stages.
•Stage 3 has a 50% likelihood of progressing to
retinal detachment.
•Stage 4 is partial retinal detachment
•Stage 5 is total retinal detachment
http://www.aboutkidshealth.ca/En/ResourceCentres/PrematureBabies/AboutPrematureBabies/OtherCo
nditions/Pages/Retinopathy-of-Prematurity-ROP.aspx
Shaken Baby Syndrome (SBS) or
Abusive Head Trauma (AHT)
 A severe form of head injury caused by
violently shaking an infant or child.
• Associated Vision Problems
– Partial or total blindness
– Unequal pupil size
– Inability to focus the eyes
– Inability to track movement
– Retinal hemorrhages
Shaken Baby Syndrome (SBS) or
Abusive Head Trauma (AHT)
Other Problems:
• Damage to the spinal cord and
neck
• Permanent brain damage
• Severe neurological
consequences
• Life-threatening central nervous
system dysfunction
• Fractures of the ribs, skull and
bones.
• Decreased level of consciousness
• Difficulty staying awake
• Breathing problems
• Poor eating
• Pale or bluish skin
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Seizures
Cerebral palsy
Partial or total blindness
Limp arms and legs or
rigidity/posturing
Learning disabilities
Physical disabilities
Hearing impairment
Speech disabilities
Behavior disorders
Cognitive impairment
Developmental delays
Extreme irritability
Paralysis
Shaken Baby Syndrome (SBS)
Spina Bifida
“Cleft spine”; a neural tube birth defect in which the backbone and
spinal canal do not close before birth
Incomplete closure of the spine
Associated Visual Characteristics
• Cerebral Visual Impairment (CVI)
• Visual Field Loss
• Optic Atrophy
• Nystagmus
• Depth Perception problems
• Problems recognizing
faces/places/items, etc.
• Strabismus
• Hydrocephalus can put pressure on
the optic nerve
Problems
• Hydrocephalus
• Syringomyelia
• Hip dislocation
• Loss of bladder or bowel control
• Partial or complete lack of
sensation
• Partial or complete paralysis of
the legs
• Weakness of the hips, legs, or
feet of a newborn
• Abnormal feet or legs (such as a
clubfoot)
Traumatic Brain Injury
•Blurry or double vision (diplopia)
•Anxiety, nervousness
•Behavioral changes:
•difficulty controlling urges (disinhibition)
•impulsiveness
•inappropriate laughter
•irritability
•Depression
•Difficulty concentrating or thinking
•Difficulty finding words or understanding the speech
of others (aphasia)
•Slurred and/or slowed speech
•Difficulty swallowing (dysphagia)
•Dizziness, lightheadedness
Traumatic Brain Injury cont’d
•Headaches
•Difficulty in coordination of movements
•Loss of balance; difficulty walking or sitting
•Loss of memory
•Muscle stiffness and/or spasms
•Seizures
•Sleep difficulties (more or less sleep than preinjury)
•Tingling, numbness, pain, or other sensations
•Sense of spinning (vertigo)
•Weakness in one or more limbs, facial muscles, or
on an entire side of the body
Common Causes of TBI
Motor vehicle, bicycle, or vehiclepedestrian mishaps (more than 50%)
Falls (approximately 25%)
Violence (nearly 20%)
About 3% of injuries are the result of sport injuries
Shaken Baby Syndrome is a form of TBI
Usher Syndrome
• Inherited.
•The most common condition that affects both hearing and
vision.
•Progressive hearing & vision loss.
•Retinitis Pigmentosa, or RP
•night-blindness
•peripheral vision loss
•tunnel vision
•Hearing loss
•Severe balance problems.
•Other problems:
•Delayed language skills
•Delayed motor skills
Usher Syndrome
The optic nerve (arrow) looks very pale,
the vessels (stars) are very thin,
and there is characteristic pigment, called
bone spicules (double arrows).