American Academy of Optometry
Diagnosis and Therapeutic Intervention
of Vision Function
and Functional Vision Anomalies in
Pediatric Cortical Visual Impairment
Dominick M. Maino, OD, MEd, FAAO, FCOVD-A
Professor, Pediatrics/Binocular Vision
Illinois Eye Institute/Illinois College of Optometry
3241 S. Michigan Ave Chicago, Il.
dmaino@ico.edu 312-949-7282
MainosMemos.com
Lyons Family Eye Care
3250 N. Lincoln Ave
Chicago, Il 60657
LyonsFamilyEyeCare.com
Presentation Outline
Abstract
This course identifies the causes of PCVI, describes the diagnostic criteria used and
discusses the diagnosis and therapy. Problem-solving strategies are presented. A
multidisciplinary approach and how to network with related disciplines are discussed
and finally, the use of social media to disseminate information about PCVI is presented
as well.
Participant Expectations
1. Define pediatric cortical visual impairment (PCVI).
2. Describe the diagnostic criteria utilized in occupational therapy, teachers of the
visually impaired, optometry and ophthalmology.
3. Discuss the management and treatment techniques utilized in occupational therapy,
teachers of the visually impaired, optometry and ophthalmology.
4. Demonstrate problem-solving strategies when evaluating the new PCVI patient.
5. Develop a multidisciplinary approach to the newly diagnosed PCVI patient.
6. Network with professionals in related medical and educational disciplines who can
serve as resources for improved vision care for PCVI patients.
7. Identify the causes of PCVI.
8. Discuss research topics which further the knowledge base of PCVI.
9. The use of social media and the internet to disseminate information about PCVI.
1. Define pediatric cortical visual impairment (PCVI).
Definition confusing, misunderstood and imprecise.
Pediatric Cerebral Visual Impairment (PCVI).
Pediatric Cortical Visual Impairment
Delayed Visual Development
North America: Cortical Visual Impairment
Elsewhere: Cerebral Visual Impairment
History of PCVI
Cerebral visual impairment: inclusive term
Classification of CVI
Ocular visual impairment: Refractive state. Optics, Eye health
Cerebral visual impairment: Neuro-pathway problems, cortical problems, oculomotor
dysfunction, vision information processing (dorsal and ventral streaming processing
mechanisms)
Delayed Visual Maturation (DVM)
For more in depth information please see: Maino D. Pediatric Cerebral Visual Impairment. Optom Vis Dev
2012:43(3):115-120 (available from http://www.slideshare.net/DMAINO/maino-cortical-visual-impairment)
2. Describe the diagnostic criteria utilized in optometry and ophthalmology
Need to assess vision function and functional vision
History
All the usual questions AND
General/Motor/Visual/Auditory Development
Daily Living Skills
Skills needed for Learning
Vision function
Clarity of vision (visual acuity, contrast sensitivity, refractive error)
Oculomotor ability (basic extra-ocular muscle assessment, pursuits
and saccades; convergence and divergence)
Accommodation (focusing)
Binocularity/Fusion/Stereopsis/Depth perception (3D vision)
Eye health
Biomicroscopy
Dilated Fundus Evaluation
Visual Fields
Special diagnostic tools
EOG (electrooculogram)
ERG (electroretinogram)
VER/VEP (visually evoked response visual evoked potential)
TOVA (Test of Variables Attention)
Visagraph/Computerized Assessment of Eye Movements
(Various Video demonstrations)
Functional vision
Functionally induced disability that overlays pathologically induced disability
Uncorrected refractive error/Constant Strabismus
Amblyopia
Strabismus
Oculomotility Disorders
Accommodative Disorders
Binocular Vision Disorders
Down Syndrome Review (see Woodhouse M. Maino D. Down Syndrome. In Taub M, Bartuccio M, Maino D.
(Eds) Visual Diagnosis and Care of the Patient with Special Needs; Lippincott Williams & Wilkins. New York, NY;2012:3140.)
Cerebral Palsy Review (see Taub MB, Reddell AS. Cerebral Palsy. In Taub M, Bartuccio M, Maino D. (Eds)
Visual Diagnosis and Care of the Patient with Special Needs; Lippincott Williams & Wilkins. New York, NY;2012:21-30.)
Vision information processing (VIP)/Visual perceptual skills
Laterality/Directionality
Visual motor integration
Non-motor perceptual skills
Auditory perceptual/processing
3. Discuss the management and treatment techniques utilized in optometry and
ophthalmology
Treatment begins with the basics.
Vision function
Refractive error & quality of life
Spectacles therapeutic
Eye health
Treatment with spectacles
multi-focal prescription/bifocal
prism
occlusion
task specific glasses
high “+” adds (magnification)
Low Vision Aids
Vision Therapy/Vision Rehabilitation/Vision Stimulation
Oculomotor/hand-eye
Biocular
Binocular
Integration/Stabilization
Visual stimulation
Vision information processing
Vestibular/Vision
Computer applications
Medications and Alternative Therapies
Medications: Prescribed many more medications
Higher affinity for adverse effects due to systemic/environmental factors
Seldom complain of symptoms related to their disability, systemic anomalies, or
medication side effects
Alternative and complementary medical therapies
Traditional allopathic approaches
Mental illnesses in children
Pediatric Bipolar disorder
Pediatric depression
Major environmental hazard: People
do not know how to respond
make assumptions
true for lay individuals, teacher, health care professionals
Other
4. Demonstrate problem-solving strategies when evaluating the new PCVI patient
5. Develop a multidisciplinary approach to the newly diagnosed PCVI patient
6. Network with professionals in related medical and educational disciplines who
can serve as resources for improved vision care for PCVI patients
Case reviews
Case #1
Case #2
Case #3
8. Discuss research topics which further the knowledge base of PCVI.
9. The use of social media and the internet to disseminate information about
PCVI.
Resources
Facebook (http://www.facebook.com/Thinkingoutsidethelightbox
Pinterest http://pinterest.com/achampine0302/cortical-visual-impairment-cvigoodies/
Blogs http://www.MainosMemos.com
Dutton GN, Bax M. Visual impairment in children due to damage to the brain. Mac Kieth Press.
London, UK. 2010
Taub M, Bartuccio M, Maino D. (Eds) Visual Diagnosis and Care of the Patient with Special Needs.
Lippincott, Williams & Wilkins. New York, NY;2012.
Hyvarinen L, Jacob N. What and How Does This Child See? VISITEST Ldt, Helsinki, Finland. 2011.
Suter PS, Harvey LH. Vision rehabilitation: Multidisciplinary care of the patient following brain injury.
CRC Press, Boca Raton. 2011.
Kapoor N, Ciuffreda K. Vision Problems. In Silver JM, McAllister TW, Yudofsky SC.(eds) Textbook of
Traumatic Brain Injury. American Psychiatric Publishing, Inc. Washington, DC. 2011:365-73.
Roman-Lantzy, C. Cortical visual impairment: An approach to assessment and intervention. AFB
Press, NY, NY 2007.
Baker-Nobles L, Rutherford A. Understanding cortical visual impairment in children, Amer J
Occupational Therap.1995;49(9): 899-903
Kozeis N. Brain visual impairment in childhood: mini review Hippokratia. 2010 Oct-Dec; 14(4): 249–
251.PMCID: (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031318/)
Boot FH, Pel JJ, van der Steen J, Evenhuis HM. Cerebral Visual Impairment: which perceptive visual
dysfunctions can be expected in children with brain damage? A systematic review. Res Dev
Disabil. 2010 Nov-Dec;31(6):1149-59. doi: 10.1016/j.ridd.2010.08.001. Epub 2010 Sep 6.
Pediatric Visual Diagnosis Fact Sheet. CORTICAL VISUAL IMPAIRMENT: BLIND BABIES
FOUNDATION http://66.147.244.207/~blindbab/wp-content/uploads/2010/08/Fact-Sheet-CVIREVISED-FINAL.pdf
Table 1
Medication Side Effects
Antipsychotics
Antidepressants
Anticonvulsants
Anti-Parkisons
Tranquilizers
Antianxiety
Systemic Side Effects
Oculovisual Side Effects
Bone marrow depression
Blurred vision
Muscle spasms/twitches
Light sensitivity
Breast enlargement (M & F)
Visual Disturbances
High body temperature
Mydriasis
Abdominal pain/constipation
Blurred vision
Abnormal dreams/thinking
Increased risk of Glaucoma
Abnormal ejaculation/orgasm
Visual Disturbances
Anxiety
Photophobia
Memory problems/amnesia
Blurred vision
Sedation
Dimming of vision
Insomnia
Diplopia
Bronchitis
Involuntary eye movements
Fluid retention
Dry eye
Abnormal dreams/insomnia
Vision abnormalities
Increased muscle tone/weakness
Blurred vision
Involuntary movements
Mydriasis
Hallucinations
Decreased accommodation
Breast development in men
Risk of narrow angle GLC
Breathing problems
Cycloplegia/Mydriasis
Insomnia
Decreased vision
Tardive dyskinesia
Capsular cataract
Anemia
Decreased accommodation
Seizures
Nystagmus
Blood disorders
Diplopia
Unusual excitement
Mydriasis