When speaking about visual impairment, we often think about issues that directly concern the eyes or conditions that worsen over time or with age. However, another type of vision loss has been on the rise in our country in recent years — Cerebral Vision Impairment (CVI). Also known as Cortical Vision Impairment, it is a brain-based vision impairment that affects how the brain processes visual information, even when the eyes seem healthy. While this vision loss may be congenital, rarely is it ever because of genetics. In many cases, CVI can be prevented or at least treated before it’s too late.
Causes of CVI
Numerous risk factors present themselves before, during and after birth, but there are two major contributors to CVI — hypoxic brain injury and neonatal hypoglycemic brain injury. Dr Rebecca Sumalini Chakram, an optometrist at LV Prasad Eye Institute, says, “Hypoxic brain injury occurs when the infant’s brain does not receive enough oxygen or blood flow. It is usually caused by difficulties during labour and delivery and other complications.”
“Neonatal hypoglycemic brain injury occurs when a child is not timely fed and their blood sugar levels drop, which can lead to seizures,” says Dr Lokesh Lingappa, a consultant child and adolescent neurologist at Rainbow Children’s Hospital, Banjara Hills. “It impacts the visual cortex of the brain, so children who suffer these injuries end up severely impaired,” he adds. Gestational diabetes, premature birth and infections also increase the likelihood of hypoxia and hypoglycemia.
Why it goes undiagnosed
“Children with CVI often experience other delays in development alongside their visual impairment,” states Dr Lokesh, adding, “So, other developmental milestones like rolling over and speaking may take precedence.” Only those specific issues are treated but to no avail, and any vision impairment continues to go unnoticed until the child begins school, where there is more visual demand.
“It is important for parents to recognise any delays in visual milestones within the first three months,” Dr Rebecca asserts, further noting, “If the child is unable to recognise faces, make eye contact or grab objects, they should be taken to a paediatrician.” From there, a child can be referred to a neurologist, who can then assess their birth history, MRI scans and visual behaviour to make a diagnosis.
Reducing the burden of CVI
It takes a village to raise a child, and once a child has been diagnosed with CVI, it requires a comprehensive team of medical experts to rehabilitate them — paediatricians, ophthalmologists, optometrists, neurologists, physiotherapists, special educators, behavioural therapists, speech therapists and more. “The first 1,000 days of a child’s life are when there is the most scope for improvement. In the critical period, that is, up to seven to eight years of age, we need to begin other therapies,” she explains.
The earlier the rehabilitation begins, the better — early intervention with an individualised, interdisciplinary approach is key to a child’s overall development.
Both doctors also emphasise the need for parent support groups. Rehabilitation is a long-term commitment and depending on the severity of the child’s impairment, it could take years for a child to reach a given milestone. In a world where disability is already so difficult to cope with, it is essential for parents to be kind and patient regarding their child. A support group can help them stay on track and remind them that they’re not alone.
Healthcare professionals and parents both play a crucial role in preventing and detecting CVI. Awareness and proper training among medical professionals — especially those involved in antenatal and neonatal care — are necessary to ensure the right call is made when any birth complications arise. New parents should also be educated on the importance of breastfeeding and the developmental milestones to anticipate. Such preventative measures are the first step to reducing the burden of CVI, so no child has to suffer.