Cerebral visual impairment-related vision problems in primary school children: a cross-sectional survey.

AIM: To estimate how many children in mainstream primary schools have cerebral visual impairment (CVI)-related vision problems and to investigate whether some indicators might be useful as red flags, if they were associated with increased risk for these problems. METHOD: We conducted a survey of primary school children aged 5 to 11 years, using whether they were getting extra educational help and/or teacher- and parent-reported behaviour questionnaires to identify children at risk for CVI. These and a random 5% sample were assessed for CVI-related vision problems. We compared the usefulness of potential red flags using likelihood ratios. RESULTS: We received questionnaires on 2298 mainstream-educated children and examined 248 children (152 [61%] males, 96 females [39%]; mean age 8y 1mo, SD 20mo, range 5y 6mo-11y 8mo). We identified 78 out of 248 children (31.5% of those examined, 3.4% of the total sample), who had at least one CVI-related vision problem. The majority (88%) were identified by one or more red flag but none were strongly predictive. Fewer than one in five children with any CVI-related vision problem had reduced visual acuity. INTERPRETATION: Children with CVI-related vision problems were more prevalent than has been appreciated. Assessment of at-risk children may be useful so that opportunities to improve outcomes for children with CVI-related vision problems are not missed.

The impact of an eye drop booklet on distress in children when receiving eye drops.

PURPOSE: Child- and family-centered care is an increasingly important area in healthcare. Up to now, little attention has been paid to the experience of children and their parents in ophthalmological healthcare. During their conversations at Bartiméus, children indicated that the administration of eye drops constituted the most stressful element that needed to be improved. This study describes the amount of distress experienced by children when receiving eye drops. Furthermore, it investigates the value and impact of the developed eye drop booklet, for children and parents. METHODS: In this multicenter study on distress related to the administration of eye drops, 370 children participated with ocular disorders or Cerebral Visual Impairment CVI (4-12 years), from four ophthalmology outpatient clinics. Half of the children, randomly chosen, were presented with a booklet before receiving eye drops. A faces scale together with a numeric scale (0-10) was used to determine the level of distress before and after the eye drops were administered. Parents were asked how satisfied they were about using the booklet. RESULTS: The average distress score of the children who did receive a booklet was 3.40 at T1 and 2.70 at T2, and, of the children who did not receive a booklet, this was 3.69 at T1 and 2.97 at T2. The largest levels of distress were found in children between the ages of 7 and 9. The majority of parents indicated to appreciate the booklet, scoring it at 7.6 on a scale of 1 to 10. Furthermore, 91% of them considered the booklet a good idea or good preparation, 69% found it to have a positive effect on their child, and 83% would use it again. CONCLUSIONS: At T1 and T2, the differences in the children's distress scores were not statistically significant between the booklet group and the group who did not use the booklet. Children, generally, anticipated greater discomfort than what they actually experienced during the administration of eye drops. For most children, the booklet had a positive effect on their distress levels, but not for all. A large majority of parents noticed the added value of the booklet for their child. They were very positive and wanted to continue using the booklet in the future, as it appeared to give their child a sense of control during the administration of eye drops.

Diagnosing cerebral visual impairment in children with good visual acuity.

PURPOSE: To identify elements that could facilitate the diagnosis of cerebral visual impairment (CVI) in children with good visual acuity in the general ophthalmic clinic. METHODS: We retrospectively investigated the clinical characteristics of 30 children with good visual acuity and CVI and compared them with those of 23 children who were referred with a suspicion of CVI, but proved to have a different diagnosis. Clinical characteristics included medical history, MRI findings, visual acuity, crowding ratio (CR), visual field assessment, and the results of ophthalmologic and orthoptic examination. We also evaluated the additional value of a short CVI questionnaire. RESULTS: Eighty-three percent of the children with an abnormal medical history (mainly prematurity and perinatal hypoxia) had CVI, in contrast with none of the children with a normal medical history. Cerebral palsy, visual field defects, and partial optic atrophy only occurred in the CVI group. 41% of the children with CVI had a CR ≥2.0, which may be related to dorsal stream dysfunction. All children with CVI, but also 91% of the children without CVI gave ≥3 affirmative answers on the CVI questionnaire. CONCLUSION: An abnormal pre- or perinatal medical history is the most important risk factor for CVI in children, and therefore in deciding which children should be referred for further multidisciplinary assessment. Additional symptoms of cerebral damage, i.e., cerebral palsy, visual field defects, partial optic atrophy, and a CR ≥2 may support the diagnosis. CVI questionnaires should not be used for screening purposes as they yield too many false positives.

Crowding ratio in young normally sighted children.

PURPOSE: To determine normal values of the crowding ratio (CR) in children. METHODS: Of 62 normally sighted primary school children aged 4-12 years old the CR was determined both for distance and near vision. The examinations were performed using commonly available test charts based on the LEA symbols. RESULTS: At near, the CR was significantly better than at distance and for all ages <2.0. The upper limit of the CR at distance was <2.0 from age six. CONCLUSION: With commonly available tests the CR can easily be determined in school age children. For children >6 years of age, a CR > 2.0 (i.e. at least 3 lines difference between the result of a single optotype acuity test and a line acuity test) is suspicious and warrants further investigation. It may, for example, be a sign of cerebral visual impairment (CVI).