The Importance of Early Identification and Referral of Children and Adults with

or At-Risk for CVI: 4 Take Aways

May 28th, 2015Tracy Evans Luiselli, Ed.D., New England Consortium

Take Away #1: Leading Cause of Visual Impairment in

Children in the United StatesCortical Visual Impairment (CVI) is now recognized as the leading cause of visual impairment in children, in the United States.

International Implications

• CVI is also emerging as an important cause of blindness in developing countries, with increasing survival of children who have experienced perinatal hypoxia (asphyxia).

Take Away #2: Important to Review the Individual’s

History and Determine Etiologies (Related to CVI)

• Identification of the condition most commonly associated with CVI will help to lead to earlier identification and intervention

• Teachers and case workers need to review the individuals history and medical records, and conduct family interviews in order to gather accurate information.

CVI Red Flag Conditions:

Congenital: • Asphyxia and Perinatal Hypoxic-Ischemic Encephalopathy (HIE)• Intraventricular Hemorrhage (IVH)• Periventricular Leukomalacia (PVL)• Cerebral Vascular Accident/Cerebral Artery Infarction (stroke)• Infection – CMV, Meningitis• Structural Abnormalities• Metabolic Conditions

Acquired:• Childhood/Progressive Diseases• SIDS • Trauma (Roman-Lantzy, C (2011). pp 11-19)

Traumatic Brain Injury (TBI): a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain and is often associated with CVI

• 1.7 million civilian brain injuries in the U.S. (annually)

• More than 266,000 service members sustained a TBI (2000-2012)

• “Signature” wound of the wars in Iraq and Afghanistan (BrainLineMilitary.org)

• Abusive Head Trauma or SB Syndrome (often underreported and undiagnosed)

Where have we been and where are we going?

CVI Deafblind Census Data (2004-2013) https://nationaldb.org/childcount

YEAR YES CVI Total National Deafblind Census

2004 1481 9516

2005 1648 9658

2006 1218 6978

2007* Split Year 2382 10174

2008 2528 9827

2009 2578 9200

2010 2618 9320

2011 2670 9387

2012 2754 9525

2013 2816 9454

Take Away #3: Early Medical Diagnosis and Referral

• It is important for pediatricians and ophthalmologists to look for and recognize CVI as a cause of visual impairment in all children AND refer to MCB and related agencies.

TAKE AWAY #4: Why is Early Identification and Referral Important?

Recognizing CVI is the first step toward rehabilitation and prevention

Children and adults often require modifications in the examination techniques to accurately assess vision and (i.e., materials, location, pace, selective pairing with other sensory modalities)

Conventional acuity measurements often give an erroneous picture. Example: Child has an acuity of 20/40 with single letters but functions with severely reduced vision in complex, inconsistent and unfamiliar environments.

Prognosis for Improvement of Visual Impairment - OFTEN improves given early diagnosis and intervention (longitudinal studies)

References Newcomb, S. (2010). The reliability of the CVI Range: a functional vision assessment for children with cortical visual impairment. Journal of Visual Impairment & Blindness, October, 637-647. Roman-Lantzy, C. (2007). Cortical Visual Impairment: An Approach to Assessment and Intervention. New York: AFB Press.