Visual impairment and perceptual visual disorders in children with cerebral palsy in Nigeria. Issue 3 (2nd December 2020)

• Record Type: Journal Article
• Authors: Duke, Roseline Ekanem; Nwachukuw, Justin; Torty, Chima; Okorie, Uche; Kim, Min J; Burton, Kathryn; Gilbert, Clare; Bowman, Richard
• Is Part Of: British journal of ophthalmology. Volume 106:Issue 3(2022)
• Page Start: 427
• Page End: 434
• Publication Date: 2020-12-02
• Subjects: visual perception -- epidemiology -- child health (paediatrics); Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2020-317768
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Cerebral palsy (CP) is the most common cause of childhood physical disability globally. This study describes the spectrum of ocular morbidity and visual impairment in a community-based (recruited by key informants) sample of children with CP in Cross River State, Nigeria. Methods: A paediatric neurologist clinically confirmed CP and assessed systemic comorbidity. Ophthalmological assessment included developmental age appropriate acuity tests, objective refraction and objective and subjective tests of perceptual visual dysfunction (PVD). Results: 388 children aged 4–15 years with CP were identified. Visual problems were reported by carers in only 55 (14%) cases. Binocular visual acuity impairment was seen in 20/201 by Lea symbols test (10%) and 213/388 (55%) by the mirror test. Abnormal visual fields were seen in 58/388 (14.9%); strabismus in 183 (47%) abnormal contrast sensitivity in 178 (46%) and abnormal saccades in 84 (22%), spherical refractive errors in 223 (58%), significant astigmatism in 36 (12%), accommodative dysfunction in 41 (10.6%), optic atrophy in 198 (51%). Perceptual visual disorders were present in 22 (6%) subjectively and 177 (46%) objectively. The estimated frequency of cerebral visual impairment (CVI) in children ranged from 61 (16%) to 191 (49%) if children with optic atrophy were included. Conclusion: Children with CP have a wide spectrum of ocular morbidity and visual impairment, underestimated by carers. Children with CP require visual acuity assessments with a range of tests which account for associated comorbidities and oculomotor dysfunction. Functional vision assessments for PVD is important. CVI is common.