What Is A Cortical Visual Impairment (CVI)?
Cortical visual impairment (CVI) is a form of vision loss that results from damage to your child’s visual cortex as opposed to a defect in their eyes. It is a serious condition characterized by significant visual dysfunction and is caused by a birth injury to your child’s visual pathways and structures that occurs during perinatal development.
Depending on the exact location and severity of the damage, children with CVI may exhibit a variety of vision issues and impairments. The most often observed impairment is in the way visual processing works and the impact it has on your child’s learning and development.
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The Signs of Perinatal Hypoxia
Perinatal asphyxia, sometimes called birth asphyxia, is the result of your newborn not receiving enough oxygen before, during, or immediately after their birth. In some cases, perinatal asphyxia can result in cortical visual impairment (CVI). Symptoms of perinatal asphyxia include:
- Low heart rate
- Poor skin color
- Low Apgar score
- Weak muscle tone
- Abnormal fetal heart rate
- Meconium stained amniotic fluid
- Low pH levels indicating too much acid
This decrease in oxygen causes chemical changes in your baby’s body, such as an excessive build-up of acid in their blood.
The Visual Cortex
Your child’s visual cortex is the part of their brain that processes visual signals. As the core cortical region of your child’s brain, the visual cortex receives, integrates, and processes visual information as it is relayed via their retinas. The visual cortex is found in the occipital lobe of the primary cerebral cortex–the most posterior region of your baby’s brain.
The Symptoms of Cortical Visual Impairment (CVI)
Cortical visual impairment (CVI) is now the leading cause of congenital visual impairment in children in the United States. Children with CVI will often display motor and cognitive impairments typically associated with cerebral palsy. CVI is a major cause of low vision in children in pediatric and neonatal care and is characterized in many combinations and degrees. CVI is common in children with cerebral palsy and is easily identified using a structured approach to medical history and observance of symptoms.
If your child has a cortical visual impairment (CVI), they might display symptoms like decreased visual acuity and perception, an impaired visual field, and impairments in higher-order visual processing and attention. Your child’s doctor will perform specific medical and vision tests to reach a conclusive diagnosis.
The Causes of My Child’s Cortical Visual Impairment (CVI)
Clinical testing and examinations indicate the cause of cortical visual impairment (CVI) as an abnormal medical history. Primary causes include:
- Perinatal hypoxia
An abnormal prenatal or perinatal medical history is the most significant risk factor for CVI. Your son or daughter with CVI may exhibit symptoms like low Apgar scores, cerebral palsy, visual field defects, and partial optic atrophy.
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Interpreting the Apgar Score
The Apgar score is generated from two quick tests performed on each newborn–once at one minute after birth, then again at five minutes after birth. The Apgar test examines your baby’s breathing, heart rate, muscle tone, reflexes, and skin color and then rates each aspect between zero and two.
- Breathing Effort: not breathing = 0, slow or irregular breathing = 1, crying well = 2
- Heart Rate: no heartbeat = 0, less 100 bpm = 1, greater than 100 bpm = 2
- Muscle Tone: loose and floppy = 0, some muscle tone = 1, active motion = 2
- Reflexes: no reaction = 0, grimacing = 1, vigorous cry = 2
- Skin Color: pale blue = 0, pink with blue extremities = 1, entire pink body = 2
The one-minute score defines how well your baby tolerated the birth process. The five-minute score defines how well the baby tolerates being outside your womb.
How Is Cortical Visual Impairment Diagnosed?
A diagnosis of Cortical Visual Impairment is typically made for children who display abnormal visual responses that cannot be credited to the eyes themselves. Cortical Visual Impairment is typically diagnosed when a medical professional carefully examine your child’s eyes.
An eye exam can show anomalies of your baby’s optic nerves such as paleness and large cups. Your child’s pupils may react normally during this examination. Your baby may show signs of an inability to fixate or follow stimulation—even when the stimulation is intense.
In addition to a thorough eye exam, doctors and specialists will measure your baby’s visual acuity. Their health care team will also assess your child’s visually guided responses, especially the way they reach and the way they scan their environment. Your son or daughter might also be referred to a pediatric low vision specialist for further evaluation.
How Do Cortical Visual Impairments Affect the Development of an Infant?
Cortical Visual Impairments affect the development of an infant because Cortical visual impairment is a primary cause of blindness in children. In child development, vision precedes action with most infants experiencing a visual relationship with their environment before learning to act in it. Infants up to eighteen months of age typically display a compulsive response to reach, grasp, and manipulate small objects in front of them—both a motor and visual behavior.
The development and growth of your child’s perceptual and motor skills include spatial orientation, hand-to-eye, foot-to-eye, and hand-to-foot-to-eye coordination. It also includes balance and body awareness and is dependent on an effective visual system and good control of your child’s eye muscles.
Cerebral Visual Impairment is damage or malfunction of the visual pathways or visual centers in your child’s brain. Rather than a single diagnosis, Cerebral Visual Impairment is a catchall term for a variety of visual impairments due to brain damage or dysfunction and is a developmental coordination disorder.
Developmental Coordination Disorder
Developmental coordination disorder is a catchall term for several types of motor deficits. It is a childhood disorder that leads to poor coordination and clumsiness. If your child has developmental coordination disorder, he might have difficulty holding things and have an unsteady gait. Your child may also bump into other children or trip over his own feet.
Developmental coordination disorder can be a standalone condition or can occur along with attention deficit hyperactivity disorder and other learning disorders like communication disorders or disorders of written expression. Symptoms of developmental coordination disorder include:
- Problems with motor coordination
- Delays in sitting up, crawling, and walking
- Problems sucking and swallowing
- Difficulty with gross motor skill coordination
- Problems with visual or fine motor coordination
Treatment for developmental coordination disorder can include physical education and perceptual motor training. While developmental coordination disorder will not worsen over time, most cases will continue into adulthood.
Fine and Gross Motor Skills
As your child ages, cognitive development skills include personal development and social development as your child learns to adjust to society and its demands. These skills help your child establish and maintain independence. Typical development of gross motor skills includes:
- The use of the large muscles in their arms and legs
- The ability to stand alone by age one
- The ability to walk by twelve to fifteen months
- The ability to climb steps with assistance by eighteen months
- The ability to jump in place by age two
Fine motor skills require the use of the small muscles in your child’s fingers and hands. Typical development of fine motor skills includes:
- The ability to scribble by eighteen months
- The ability to use a spoon by age two
- The ability to copy a circle by age two
- The ability to makes towers consisting of four cubes by age two
If you believe Cortical Visual Impairments affect the development of your infant, your child’s doctor will be able to measure and assess their gross and fine motor skills and create a treatment plan for any perceived developmental delays.
How a Child with Cortical Visual Impairments Is Evaluated and Monitored
A child who has been diagnosed with Cortical Visual Impairment will have a thorough eye exam and objective assessment of their visual abilities. Your child’s visual acuity can be extremely poor in infancy and remain poor as they age. Some children may have a gradual improvement in visual acuity. In most children with Cortical Visual Impairment, acuity will not reach normal levels.
Rehabilitation and education are critical for children with Cortical Visual Impairments. Specialized services from trained, experienced teachers are important for your child’s development and education. Your son or daughter with this diagnosis should receive a prompt referral to your state’s services for visually impaired children. They will also be given specific recommendations based on a clinical assessment of their visual abilities including visual acuity and visual fields.
Your child’s teacher should assess their broader visual behaviors. Along with other therapists, they should design interventions that meet your child’s specific needs as well as provide support services for when your son or daughter reaches school age.
What Are The Effects Of Cortical Visual Impairments?
The effects of Cortical Visual Impairments on visual development may vary slightly from child to child. Some children may experience partial vision recovery while others may experience improvements in visual acuity and in orienting themselves to stimuli in their peripheral view. Effective treatment and management of intractable seizures may result in an improvement in your child’s visual behavior.
Cortical Visual Impairment can be an isolated condition, or it can accompany anterior visual pathway dysfunction. Cortical Visual Impairment is a major cause of low vision in children and can take shape in a variety of combinations and degrees. It is a common occurrence in children with cerebral palsy. Some effects of Cortical Visual Impairments may include:
- Your child might experience visual motor disturbances such as moving his eyes to direct his visual attention to a specific object. Your child might also fixate on an object, shift his fixation and gaze to a new object, and master fine motor tasks like copying a drawing. Visual motor disturbances are typically associated with posterior parietal lobe lesions and are thought to result from damage to the dorsal visual association pathway.
- Your son or daughter might experience visual spatial disturbances like the localization of objects or the judgment of the direction and distance of an object. Visual spatial disturbances can also impact the way your child orients and positions their body in relation to their physical world. You might think of it as the “Where is it?” aspect of your child’s vision. This visual issue is often associated with posterior parietal lobe lesions.
- Your child might experience visual perceptual disturbances such as discrimination, recognition, and integration of objects and visual images. You can think of it as the “What is it?” aspect of your child’s vision. Visual perceptual disturbances are typically associated with inferior posterior temporal lobe lesions due to the ventral visual pathway.
Specific visual cognitive dysfunctions are common in children with traumatic brain injuries. Your child’s health care team will discuss the cause of the brain injury that led to their diagnosis of Cortical Visual Impairment. They can also help you understand the full effects of Cortical Visual Impairments and how your child’s future will be impacted.
Defining Low Vision
If your child has low vision, it can mean they have vision impairments that cannot be corrected with the help of glasses, surgery, or medication. Low vision affects everyone differently and often requires unconventional vision-improvement approaches that focus on each child’s specific medical issue.
If doctors suspect your child of having low vision, they may recommend expert intervention, a low vision assessment, and a comprehensive vision exam. There may be one or more causes of low vision in your infant. Brain injury is among the most common of these causes.
What Are Short- And Long-Term Effects Of Cortical Visual Impairments?
Premature infants are more prone to significant visual abnormalities, with the most common ones being retinopathy of prematurity. The damage from retinopathy of prematurity can vary between minor to extremely severe. Premature infants also have higher rates of cortical visual impairment, which is largely associated with neonatal brain injury. In the long-term, children with a cortical visual impairment might develop glaucoma and retinal detachments.
Currently, cortical visual impairment is the primary cause of visual impairment in children. A majority of the children showed improved visual acuity levels after two years of follow-ups. The children with better visual acuity levels at follow-up were also more prone to favorable cognitive outcomes.
Premature Infants Are More Prone to Visual Abnormalities
Premature infants are those babies who are born prior to complete 37 weeks of gestation. Prematurity can be caused by maternal health conditions, pregnancy with multiple babies, a weakened cervix that dilates too soon, or an infection of your urinary tract or amniotic membranes.
Premature infants are susceptible to visual and other abnormalities because they may have organs that are not fully developed, lower birth weights, and the potential for other complications. Potential complications of prematurity include delays in growth and development, mental or physical disabilities, and the visual condition known as retinopathy of prematurity that can result in low vision or blindness.
Retinopathy of Prematurity
Retinopathy of prematurity is an eye disorder caused by abnormal blood vessel growth in the retinas of your child’s eyes. It is a condition that strikes premature infants, especially those born prior to thirty-one weeks of gestation. Treatment for retinopathy of prematurity varies according to the level of severity and may include laser therapy, cryotherapy, and medications.
In the short term, most cases of retinopathy of prematurity resolve on their own without treatment and cause no damage. If your child is diagnosed with an advanced case of retinopathy of prematurity, their long-term prognosis might include permanent vision problems or vision loss.
Cortical Visual Impairment and Specialized Rehabilitation and Education
The short and long term effects of cortical visual impairments may lead to specialized rehabilitation and education for your child. Concern for your child’s education and their future is sure to be at the top of your list of questions. Rehabilitation and education are an important part of ensuring a good outcome for your child.
Your child with cortical visual impairment will need the help and guidance of trained, experienced teachers. Immediately after your child receives a confirmed diagnosis, you should be offered a referral for your child to the services your state provides to children with visual impairments. Those services may include specific suggestions that align with your child’s measurable visual abilities.
Teachers of students with visual impairments should work on developing interventions that meet the specific needs of your child. When your child reaches school age, they may also be provided with additional support services.
Can Cortical Visual Impairments Be Confused For Other Ailments Or Diseases?
In some cases, Cortical Visual Impairments can be confused for other ailments or diseases. Among the confusing diagnostic ailments or diseases your child might receive are:
- Delayed visual maturation
- Autism spectrum disorders
- Dyskinetic eye movement disorders
- Profound mental retardation
If you are concerned about your child’s initial diagnosis, consult their doctor immediately. Your child’s doctor and other members of their medical team are equipped to help you understand their definitive and final diagnosis and what that diagnosis means for your child’s vision, education, and future.
Delayed Visual Maturation
Among the other ailments or diseases, Cortical Visual Impairments might be confused for delayed visual maturation. Delayed visual maturation is symbolized by visual unresponsiveness during your child’s early infancy. If your child was diagnosed with delayed visual maturation, they would usually see a spontaneous improvement to normal vision levels. Additionally, children with delayed visual maturation usually display normal brain stem function.
Autism Spectrum Disorders
Autism spectrum disorder is a condition related to brain development. It affects the way your child perceives, understands, and socializes with others and can result in difficulty with social interaction and communication. The disorder is noted as a spectrum because of its wide range of symptoms and severity. Autism spectrum disorder includes autism, Asperger’s syndrome, childhood disintegrative disorder, and an unspecified form of pervasive developmental disorder.
Dyskinetic Eye Movement Disorders
Dyskinetic eye movement disorders are visual impairments due to an eye movement disorder in children who were also diagnosed with dyskinetic cerebral palsy. Nerve lesions that cause dyskinetic cerebral palsy typically involve ocular movements. Children with dyskinetic eye movement disorders may have a visual function that is slow, variable, and highly inefficient. They might also be misdiagnosed as blind, due to cortical visual impairment.
Profound Mental Retardation
Health care professionals like doctors and nurses rely on developmental screening to tell if your child is developing basic skills when they should. Developmental screening can also show if your child is having difficulty learning. Developmental screening is a tool that can help identify cases where your child may need the attention and care of a specialist. Each childhood age group has a wide range of growth and behavior and it may be natural for your child to reach certain milestones ahead of or behind established trends. These screenings can help uncover intellectual disabilities, also known as mental retardation.
Dyskinetic Cerebral Palsy
Cerebral palsy is the most common motor disability in children. It affects their ability to move, maintain balance, and maintain posture. Children with cerebral palsy may also have related conditions like intellectual disabilities, seizures, vision problems, hearing problems, difficulty speaking, and spine or joint problems.
There are four primary types of cerebral palsy including spastic, ataxic, mixed, and dyskinetic. Children with dyskinetic cerebral palsy will experience trouble controlling their hand movements as well as the movement of their arms, feet, and legs which can make sitting and walking difficult. For these children, movements are uncontrollable and might also be slow, writhing, rapid, or jerky. If your child has dyskinetic cerebral palsy, it might also affect their face and tongue making it difficult to suck, swallow, or talk.
Can Cortical Visual Impairment Be A Precursor To Other Ailments Or Diseases?
Premature infants experience higher rates of cortical visual impairment often related to neonatal brain injury. In later years, Cortical Visual Impairments might be a precursor to other ailments like glaucoma and retinal detachments.
Glaucoma is a disease of the eyes that cause vision loss. Glaucoma will typically occur when pressure from extra fluid in your baby’s eyeball damages their optic nerve. Vision loss as a result of glaucoma is usually slow, progresses over time, and may result in long-lasting vision loss and blindness if left untreated.
Treatment for glaucoma can include prescription eye drops to decrease pressure in your baby’s eye. In some cases of glaucoma, your child’s doctor might suggest a surgical correction. A diagnosis of glaucoma will also necessitate frequent and ongoing examinations to monitor the pressure in your child’s eyes.
Retinal detachment happens when your child’s retina becomes separated from its underlying layer. Your child’s doctor or another member of their health care team will diagnose retinal detachment by examining their eye with a specialized medical instrument called an ophthalmoscope.
In most cases, retinal detachment is a repairable condition and can result in improved vision if corrected early. When your child’s retina detaches, it separates from its blood supply and, unless reattached, can lead to permanent damage caused by the lack of blood.
How Doctors Determine Prematurity
While the premature birth of your infant is not a result of Cortical Visual Impairment, premature infants are more prone to a diagnosis of periventricular leukomalacia which can lead to Cortical Visual Impairment.
A premature infant is one who is born before the completion of thirty-seven weeks of gestation or more than three weeks prior to your anticipated due date. Prematurity can be caused by:
- A weakened cervix that dilates too early
- A history of premature birth
- A urinary tract infection
- An infection of the amniotic membranes
- A premature rupturing of your membranes
Premature infants might experience difficulty breathing and have trouble maintaining consistent body temperature. Premature infants might experience long-lasting effects that include delayed growth and development, mental or physical delays, and visual problems that can result in low vision or blindness.
Periventricular leukomalacia is a brain injury typically observed in very premature infants. Periventricular leukomalacia injures the white matter around the brain’s fluid-filled ventricles. The white matter in your infant’s brain conveys information between his nerve cells, spinal cord, and between one part of their brain and the other.
In addition to extreme prematurity, periventricular leukomalacia is also common in infants with low birth weight and is the second most commonly seen birth complication that involves your child’s central nervous system. It damages the nerve pathways in your child’s brain that control motor movements. Infants with periventricular leukomalacia are at higher risk of having cerebral palsy.
Do Cortical Visual Impairments Impact Other Organs Within the Body?
Cortical visual impairments do not impact other organs within the body. However, its causes can impact the organs in your baby’s body.
Causes of Cortical Visual Impairment and How They Affect Bodily Organs
Common causes of cortical visual impairment include hypoxic-ischemic encephalopathy, traumatic brain injury, infections, periventricular leukomalacia, and metabolic disorders. The impacts on other organs depend on the condition that caused your child’s cortical visual impairments.
Infants with hypoxic-ischemic encephalopathy, also known as perinatal asphyxia, might display signs of injury to one or more of their organs. Perinatal asphyxia can cause cortical visual impairment as well as harm other organs within your child’s body, including impact to their:
- The heart that causes poor color and low blood pressure
- Lungs that causes difficulty breathing and low oxygen levels
- The brain that causes lethargy, seizures, or coma
- Kidneys that causes a reduced output of urine
- The liver that causes trouble digesting milk
- Blood-forming system that causes a low platelet count and bleeding
Are There Medical Or Surgical Options Available To Treat Cortical Visual Impairments?
As a parent, you want to consider all potential treatments available to improve the outcome for your child following a diagnosis of cortical visual impairments. Along with other suggested treatment options, you might wonder about the medical or surgical options available to treat cortical visual impairments.
For children with cortical visual impairments, the best treatment options appear to be rehabilitation and education. Although cortical visual impairment is the most typical cause of permanent visual impairment in children, its diagnosis indicates abnormal visual responses that are not attributed to your child’s eyes. Rather cortical visual impairments are caused by brain dysfunction due primarily to a lack of oxygen.
If your child has been diagnosed with cortical visual impairment, they may be able to experience some partial visual development and recovery. Effective management of persistent seizures can often lead to improved visual behaviors for your child.
Seizures and Seizure Treatments for Babies
A seizure is a periodic disturbance of the electrical activity in your child’s brain caused by temporary brain dysfunction. An older infant or young child might show symptoms of a seizure that include shaking or jerking in all or part of their body. A seizure might be less obvious in a newborn with symptoms like lip-smacking, involuntary chewing, or periodic limpness.
If your child appears to be having a seizure, they will be given antiseizure medications. A seizure in your newborn might be the result of temporary metabolic abnormalities or a more serious disorder like a brain malformation, an injury to their brain during pregnancy, or a lack of oxygen during birth.
What Is The Recovery Process Following A Cortical Visual Impairment Diagnosis?
The recovery process following a cortical visual impairment diagnosis will depend on the cause of your child’s cortical visual impairment. Each cause that can contribute to cortical visual impairment will have its own treatment and recovery process.
Common causes of cortical visual impairment in infants and young children include:
- Hypoxic-ischemic encephalopathy in full-term babies
- Periventricular leukomalacia in premature babies
- Viral meningitis
An Overview of Cortical Visual Impairment
Cortical Visual Impairment is a type of vision loss caused by damage to the visual cortex rather than by any defect in your child’s eye. Your baby’s occipital lobe is the center where their brain processes visual input. A traumatic brain injury can cause Cortical Visual Impairment.
Cortical Visual Impairment (CVI) is the leading cause of permanent visual impairment in children. Brain dysfunction may cause abnormal visual responses. If your child suffers from Cortical Visual Impairment, they may not reach toward objects.
Put a Birth Injury Lawyer to Work on Your Cortical Visual Impairment Lawsuit
If your child was diagnosed with cortical visual impairment, start looking for ways to help them recover, adapt, and live a full, happy life. Your child’s medical team can help you understand the recovery process following a cortical visual impairment diagnosis.
An attorney can help you understand the legal avenues you have that can help you afford the best medical care for your son or daughter. Contact the Birth Injury Lawyers Group today at (800) 222-9529 for a free review of your child’s cortical visual impairment birth injury lawsuit with an attorney near you.