Neurological Vision Impairment Lawyers | Birth Injury Lawyers Group

What Is Neurological Visual Impairment (NVI)?

Neurological visual impairment is a problem with the way the brain functions, not the way the eyes function. It sometimes has other scientific names and is usually caused by a dangerous lack of oxygen before birth. Children with neurological visual impairment (NVI) often have disorders of other areas of neurological function as well.

If your child suffers from neurological visual impairment, they might also have seizures, intellectual disabilities, and cerebral palsy. When a child suffers from loss of vision caused by an injury to their brain, their visual impairment is often profound. A common cause of permanent vision loss in children, neurological visual impairment means your child has problems with their eyesight even though their eyes actually work normally. Rather the damage is to the visual part of their brain. In other words, your baby’s eyes are not affected, but their brain might be.

Dysfunction of your infant’s brain versus a dysfunction of their eyes is often the reason behind the impairment. It is not caused by any abnormal ocular structures or eye movements. If your child has a neurological visual impairment, they may experience difficulty fixating on and following even the most intense stimulation. They may also have trouble responding to faces and will usually not reach toward objects.

Causes of Neurological Visual Impairment (NVI)

Causes of neurological visual impairment include damage to the gray matter (cortical), white matter (subcortical), or both areas of your infant’s brain. Damaged brain tissue or seizures can lead to a case of neurological visual impairment. Some common causes of this devastating visual impairment in infants and young children include:

Hypoxic-ischemic encephalopathy in full-term infants
Periventricular leukomalacia in premature infants
Neonatal hypoglycemia

Your child’s medical team may be able to determine and help you understand the cause of the neurological visual impairment your son or daughter is suffering.

Are There Physical Symptoms Of Neurological Visual Impairments?

A diagnosis of neurological visual impairments can include things like photophobia and trouble seeing objects that are positioned on a cluttered background. Your child might also display physical symptoms of neurological visual problems, known as cortical visual impairments that can include one or more of the following:

Exhaustion from performing visual tasks
Paying better attention to moving versus still objects
Diminished responses to visual objects when other things are happening in the background like music or voices
Diminished responses to objects when your child is being touched
A preoccupation with or sensitivity to light
Preferring not to look directly at faces
Inability to follow an object with their eyes
Blurry vision
Narrowing sight out of the sides of their eyes

While some children might eschew palpable, tangible stimulation, others may prefer it all together. Your child’s teachers and other caregivers might express concern for their preference to reach for an object without appearing to look at either the object or their own hand as the child reaches out. When these symptoms are noted, a thorough examination should be performed to reach a conclusive diagnosis and establish a prognosis for your child’s future.

Parents May Notice a Different Set of Symptoms

Behaviors reported by parents and teachers might include:

Different reactions to the same sight
Preferring familiar sights and objects
Looking out of the sides of their eyes when reaching for something
Preferring colorful sights and objects
Preferring objects in motion
Trouble choosing an object out of a group
Becoming easily distracted by sounds and voices

If you notice any of these symptoms in your child, consult a physician immediately for a definitive diagnosis. Your child’s health care team will help you create a plan for rehabilitation and education.

In all children with neurological visual impairment (NVI), services of trained and experienced teachers are very important for the child’s development and education.

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Can A Neurological Vision Impairment Be Inherited?

Neurological vision impairment can be inherited, in rare instances. Occasionally, a metabolic disorder can cause global damage to the brain. This can then cause neurological vision impairment and other neurological symptoms.

In most cases, though, neurological vision impairments are not inherited. Instead, they are the result of a lack of adequate oxygen to the brain before, during, or just after the baby’s birth.

Inherited traits such as metabolic disorders lie far outside the most common causes of neurological vision impairments, although it is possible and does occur. If you have a family history of a metabolic disorder or have concerns about your baby, discuss them with a trusted doctor. The sooner you get a diagnosis and treatment begins for a treatable metabolic disorder, the better the outcome for your child.

With proper management, you may be able to help your child avoid the brain injuries that lead to neurological vision impairments and other neurologic conditions.

Understanding How a Metabolic Disorder Can Cause Brain Injury and Neurological Vision Impairments

Babies who have a metabolic disorder are generally born with the condition, and many of them are inherited through genetic information passed down from one or both parents. At its very basic, this type of disorder involves an error of metabolism. The baby lacks the ability to metabolize and rid their body of some type of toxic substance.

During pregnancy, the baby suffers no ill effects from a metabolic disorder because the placenta handles the job of metabolizing all toxins and other substances. When a baby with a metabolic disorder is born, they usually have no symptoms. For this reason, hospitals should run blood tests on all newborns to rule out dangerous metabolic conditions before brain damage can occur.

Without treatment, a process begins:

The baby’s body cannot metabolize a toxic substance.
This substance will build up in the baby’s tissues, including the brain.
An accumulation of this toxic substance in the brain begins to cause damage.

In some cases, babies become ill and suffer brain injuries within hours of birth. In others, it could take years. You may be unaware of your child’s condition until they develop symptoms of neurological damage, possibly including neurological vision impairment.

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Do Previous Injuries Result In A Neurological Visual Impairment Diagnosis In An Infant Or Newborn?

Previous injuries can result in a neurological visual impairment diagnosis in an infant or newborn, but the most common cause of this type of birth injury is an injury to the central nervous system. In almost every case, neurological vision impairment is the result of a global or multifocal insult to the brain that causes problems processing visual stimuli as well as additional medical conditions.

Some commonly co-occurring conditions include epilepsy and cerebral palsy.

Head Trauma Accounts for a Small Percentage of Neurological Vision Impairments

While head trauma to a growing fetus, newborn, or infant causes only a small percentage of neurological vision impairments, traumatic brain injuries do contribute to this condition.

According to one study published in the British Journal of Ophthalmology of more than 7,200 babies, the top causes of this condition include:

Perinatal (before, during, or immediately following birth) hypoxia, 22%
Cerebral vascular accident, 14%
Meningitis, 12%
Acquired (after birth) hypoxia, 10%

Head trauma played a causative role in only 4.1% of the neurological vision impairment cases included in the study. These represented both accidental head injuries such as car accidents, drops, and falls, as well as non-accidental trauma.

Almost All Cases of Head Trauma That Leads to Neurological Vision Impairment Are Preventable

When a traumatic brain injury is diffuse, it can affect the brain in many of the same ways as hypoxia. This may occur as a result of injuries or abuse, including shaken baby syndrome.

In general, a condition that affects a large part of the brain is much more likely to cause neurological vision impairments than a condition that only affects a small area. While it is possible, it is rare that damage to the brain would only affect higher vision processing and cause no other ill effects.

According to the Journal of Medicine and Life, some of the leading causes of traumatic brain injuries in children under the age of three include:

Improper use of forceps or vacuum extractors during delivery
Child abuse
Falls or drops
Motor vehicle accidents

As you can see, a traumatic brain injury in an infant or newborn is almost always the result of negligence or an intentional act. None of these injuries occur spontaneously. A newborn should never suffer this type of injury or lasting effects.

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Is A Neurological Visual Impairment Likely To Be Accompanied By Additional Disorders?

Most neurological vision impairments occur because of a global neurological insult, often perinatal hypoxia. This means the baby does not get adequate oxygen to their brain just before, during, or immediately following birth. This lack of oxygen affects much of the brain, leaving damage that affects many aspects of functioning. Therefore, though it is just one condition, neurological vision impairments are likely to be accompanied by additional disorders.

In fact, in one study, less than five out of every hundred children (4.7%) diagnosed with neurological vision impairment had vision impairment as their only diagnosed neurological condition.

Additional Disorders Can Make It Difficult to Diagnose and Treat Neurological Vision Impairments

Neurological vision impairments are variable, meaning these impairments affect every child in a somewhat different way. Some may have poor visual performance while others have much better visual acuity and performance but struggle with higher-level functioning or visual field deficits.

For this reason, therapy for neurological vision impairments is very individualized. This means it is imperative to get an accurate diagnosis and understand the child’s baseline abilities before building their therapy program and beginning treatment.

In many cases, diagnosing a neurological vision impairment and understanding a child’s visual concerns is made more difficult by their additional medical concerns, however. This may occur because:

Conditions that affect movement or speech may make it difficult to identify the condition and conduct testing
Cognitive deficits may make it difficult to diagnose and monitor children as they progress
Additional, treatable vision disorders give a false sense of impairment

In many of these cases, controlling or treating additional disorders or symptoms can help the baby or child’s therapy for their neurological vision impairment to be more effective. Stabilization of seizures, for example, can greatly improve the child’s quality of life and allow them to focus on and complete their daily neurological vision impairment therapy, as recommended.

It is also imperative that a pediatric ophthalmologist diagnoses and treats any additional problems that could affect the eyes or vision. This can greatly improve the outcome of therapy for children with neurological vision impairments.

Can Neurological Visual Impairments Progress Into Other Ailments Or Diseases?

Neurological visual impairments might not progress into other ailments or diseases, but they can sometimes co-occur with other ailments and diseases. If your child has been given a diagnosis of neurological visual impairments, they might also have stubborn seizures, cerebral palsy, and developmental delays. Your child’s eye examination may also show signs of a condition called strabismus that you might recognize as a lazy eye or crossed eyes. Another vision-related condition called nystagmus is less likely to occur, but still possible.

How Strabismus Affects Your Child’s Eyesight

Neurological visual impairments do not necessarily progress into other ailments or diseases, but eye exams do reveal other conditions. Strabismus is a medical condition that causes your child’s eyes to align incorrectly. When the six muscles that surround each of your child’s eyes fail to work in tandem, each eye looks in a different direction. One commonly seen form of strabismus is crossed eyes.

In the majority of children born with this disorder, the cause is unknown but is believed to be rooted in your child’s ability to control the eye muscle as opposed to the strength of the eye muscle. If your child is diagnosed with this disorder, they might have trouble reading or playing sports because their eyes may point in different directions.

How Nystagmus Affects Your Child’s Eyesight

Nystagmus is a medical condition that causes your child’s eye to make quick, uncontrollable movements. If your son or daughter has this condition, you may notice one or both of their eyes constantly darting up and down, from side to side, or in a circle.

Infantile nystagmus appears when your child is born and, like neurological visual impairments, is due to an issue with their brain, not their eyes. In addition to their vision, it can also impact their coordination and balance.

How Are Neurological Visual Impairments Diagnosed?

Doctors diagnose neurological visual impairments in children through an examination of your child’s eyes. When it is possible and feasible, your child’s visual abilities should also be clinically tested.

How Your Child’s Visual Exam Works

A visual acuity test is typically administered using a standardized letter chart. This is a recognizable test like the ones you may have seen in schools, doctor’s offices, or vision centers. Usually, each eye is tested individually with the results being recorded as a fraction. You can recognize it by numbers like 20/20 vision. Using large black and white stripes, visual acuity can also be tested in infants and children too young to know letters or numbers.

The doctor who examines your child might also assess and make note of your child’s visually guided responses and depending on the results, refer them to another doctor who specializes in children with a condition called low vision.

How Common Are Neurological Vision Impairment Diagnoses?

Brain injury and neurological damage is the leading cause of vision impairment in infants and young children in the United States and other Western countries. In a review of thousands of records from the British Journal of Ophthalmology, 2.4% of the children seen in the clinic over the last 15 years had neurological vision impairments. So, neurological vision impairments diagnoses could be assumed to be common.

These numbers could be higher in current patients and may continue to rise as medical advancements allow doctors to treat smaller and younger micro-preemies as well as newborns with severe hypoxic brain injuries. The increased rate of survival of these at-risk babies will likely mean more neurological concerns, including epilepsy, cerebral palsy, and neurological vision impairments.

Can Neurological Visual Impairments Be Misdiagnosed?

Learning that your child has a serious medical condition can be traumatizing. Finding out they were given the wrong diagnosis can add stress, frustration, and anger to an already difficult situation. Unfortunately, neurological visual impairments can be misdiagnosed as several other ailments and disorders that may have similar diagnostics. Your child’s doctor may notice signs and symptoms like adverse reactions to light, visual sensitivity, or poor visual acuity that can lead them to make a final and comprehensive diagnosis. An accurate diagnosis can allow your child’s medical team to create a reliable treatment plan for your son or daughter.

Neurological visual impairments can be misdiagnosed as delayed visual maturation, autism spectrum disorders, or several other medical ailments. A medical misdiagnosis can be more traumatizing than an accurate diagnosis because it temporarily leaves you looking in the wrong direction for the help your child needs.

What Tests Are Done To Diagnose A Neurological Visual Impairment?

If your child’s doctor is recommending tests to diagnose a neurological visual impairment, they might recommend a variety of tests that include one or more of the following:

MRI
Visual acuity
Crowding ratio
Visual field assessment
Ophthalmologic exam

Magnetic Resonance Imaging (MRI)

Among the tests to diagnose a neurological visual impairment is magnetic resonance imaging (MRI). An MRI exam can last up to an hour and will require your son or daughter to remain motionless. It uses computer-generated radio waves to create cross-sectioned, detailed pictures of your child’s organs and tissues.

An MRI is noninvasive and lets your child’s doctor see inside their body via high-resolution, 3D images. Your child’s doctor should discuss the results of the MRI with you and other members of their medical team.

Visual Acuity Tests to Diagnose a Neurological Visual Impairment

Assessments to diagnose neurological visual impairment will almost certainly include visual acuity tests, which are done to measure sight from specific distances. A visual acuity test is common– you might see the standardized eye charts used for older children and adults in schools, department stores, and at doctor’s offices. If your child is old enough to read, their eyes will be checked one at a time using letters or numbers. In infants and children too young to read, more age-appropriate tests are administered.

Visual acuity is measured in fractions, like 20/20, with the top number being distance and the bottom number being the average distance of a person with normal eyesight. Your child’s doctor should review their visual acuity and discuss their results in relation to their diagnosis of neurological visual impairment.

Visual Field Assessment

Visual field assessments are done to measure your child’s visual field. The visual field is the area of peripheral vision, or how far they can see out of the sides of their eyes when focused on an object in front of them.

Confrontation visual field exam is a quick assessment of your child’s visual field
Tangent screen test is an assessment of your child’s vision in relation to their brain and nerves
Goldmann Tests are an assessment of your child’s field of vision

Abnormal visual field assessments can indicate central nervous system disorders and/or too much pressure on certain parts of your child’s brain. Your child’s physician should discuss the results of this exam and their possible pattern of vision loss.

Ophthalmologic Exam

An ophthalmologist is a physician who specializes in assessing and treating eye disorders. They will assess your child’s symptoms and the appearance of their eyes and surrounding areas. An ophthalmologic exam might include measuring the way light enters your child’s eyes and measuring how their cranial nerves control the muscles that move their eyes.

Some common ophthalmological tests are:

Refraction testing to determine if your child is having trouble focusing their eyes
Visual field-testing to measure how your child sees out of each eye individually
The Amsler Grid determines your child’s central area of vision
Color vision testing measures how your child sees and perceives color

Ophthalmologists use an instrument called an ophthalmoscope–a handheld device that looks like a small flashlight–to examine your child’s cornea, lenses, retinas, and optic nerves.

An ophthalmologist might also use tools like a slit lamp to aim bright light into your child’s eyes and assess their eyes under extreme magnification. It gives the doctor a three-dimensional view of your child’s eye. The ophthalmologist will sometimes use eye drops to dilate our child’s pupils for this exam.

Finally, an ophthalmologist might use tonometry to measure the pressure in your child’s eye. Tonometry is often used to test for glaucoma using a portable, handheld device and numbing eye drops.

Are Neurological Visual Impairments The Result Of Existing Problems During A Pregnancy?

Even when you have regular prenatal care and take steps to ensure a healthy pregnancy, you can still have questions about your pregnancy and your newborn’s health. Neurological Visual Impairment can be the result of several factors. One of these factors includes perinatal asphyxia, a birth injury that occurs at the end of your pregnancy shortly before your child is born.

Neurological Visual Impairments that occur as the result of existing problems during pregnancy might include maternal drug use, pregnancy with twins, and maternal heart trouble. If you have concerns about your pregnancy as it advances, speak to your OBGYN or other health care provider. A thorough examination may help your child’s health care team uncover the exact cause of their diagnosis of Neurological Visual Impairment.

How Can Neurological Visual Impairments Affect A Newborn?

Neurological visual impairments can affect your newborn’s ability to learn, socialize with their peers, control their behavior, and relate to the world around them. As children grow and develop, vision usually comes before action, with most children developing a visual relationship with their environment before they begin to interact in it. In children, coordination, balance, and awareness of their own bodies are often reliant on good eyesight.

The ways neurological visual impairments affect a newborn will vary with each child.

Can Neurological Visual Impairments Be Corrected In Infants And Newborns?

Neurological visual impairments can be corrected in some infants and newborns, and some children might see some vision improvement. In some cases, children with this particular vision problem may be able to regain some of their eyesight. Some other ways they may show improvement in their eyesight include better sharpness of their vision, a better vision out of the sides of their eyes, and a better appreciation for faces.

Your child’s medical team can help you understand how their eyesight might improve or if there are treatments available for the underlying cause of their neurological visual impairments.

Treating Neurological Visual Impairments in Your Child

If your new baby’s vision is damaged, they may be suffering from neurological visual impairments—a condition caused by damage to their brain versus damage to their eyes. In other words, your child’s eyes work the way they are supposed to, but the nerve pathways to their brain were damaged in a way that does not allow their brain and eyes to communicate correctly.

A study published in the Indian Journal of Ophthalmology found that infants and children up to two years old can have improvement or correction of their eyesight with regular visual stimulation exercises. These exercises can help your child learn more effective ways of managing the vision they do have. Because employing visual stimulation on a daily basis is important for maximum results, your child’s vision should be stimulated and they should be encouraged to use their eyes as much as possible in clinical settings, at home, and in school.

Some forms of vision exercise your child might undergo include vision stimulation therapy and daily activities like learning to follow toys and faces with their eyes. Your child’s medical team will help you learn to work with your child at home in order to enhance the vision they do have as much as possible.

Helping Your Child Cope With Neurological Visual Impairments

The way a pediatrician or ophthalmic clinician might recognize the signs and symptoms of neurological visual impairments in your son or daughter is different from how you or their teachers or therapists might recognize them. You might first notice things like your child having an odd response to light—they might fixate on it or they might be unusually sensitive to it.

You might notice other odd behavior like your child reaching for things they see out of the sides of their eyes rather than for things that are right in front of them. While some treatments and therapies might allow your child to have some vision improvement, they might still need help learning to cope with limited vision. You might be encouraged to help your child maximize their vision in one or more of the following ways:

Provide head support as they play or during vision therapy sessions
Pay attention to how they position their head in relation to the object they are looking at
Keep visual tasks simple and easy to accomplish and adjust lighting until your child seems comfortable
Choose toys and faces that spark a positive reaction from your son or daughter

In many cases, children with Neurological Visual Impairments often maintain their ability to distinguish between colors, so choose toys with bright, vivid colors to encourage your child to interact with and reach for them. Your child’s eyesight is an important part of how they interact with the world around them. Their doctor should be able to find you ways to help them cope with and improve their vision as much as possible.

What Medical Or Surgical Options Are Available Following A Neurological Vision Impairment Diagnosis?

While medical or surgical options are available following a neurological vision impairment diagnosis, there is still no cure. This condition has no medical treatment or surgical option. However, early intervention and therapy can help.

Even without therapy, many children who suffer this type of brain injury and visual impairment show some level of gradual improvement. How to increase this visual recovery or the mechanism that causes it is not yet clear.

Developing a Personalized Therapy Plan Gives the Child the Best Chance at a Positive Outcome

With only limited medical and interventional treatments available for children with neurological vision impairment, it is imperative that families begin offering their child active visual stimulation therapies as soon as possible following their diagnosis.

This requires assessing the child’s visual abilities and determining the right strategy to address their needs. Often, this is made more difficult because of the child’s other neurological conditions. It is not unusual for a child with neurological vision impairment to also have epilepsy, cerebral palsy, or other medical concerns.

Once a pediatric ophthalmologist who sees these cases regularly has a good idea of your child’s needs, they can build a plan to address them. For example, therapy for an infant may include:

High-contrast, moving stimuli with lights
Using auditory and tactile cues to get the baby to look and maintain attention
Allowing extra time for the baby to respond to visual stimuli
Providing adequate support for the child’s body while working on visual therapies

Are The Effects Of Neurological Vision Impairments Temporary Or Permanent?

The condition we now know as neurological vision impairment used to be called “cortical blindness,” although this name is a misnomer. Babies and children with neurological vision impairments are not blind. They have some sight remaining, and there are reasons to believe that most can recover some additional vision with therapy.

Some babies and children may experience temporary blindness following a traumatic brain injury, but neurological vision impairments are different. They occur as a result of global brain injury, usually following a period when the brain did not receive adequate oxygen. The effects of neurological vision impairments are permanent, although they may improve significantly in some children.

Children Can Recover Some of Their Vision with Intervention

Even when severe vision impairment occurs, babies and children may be able to partially recover their sight with the right interventions. At the very least, the children and their families can learn ways to adapt to their special visual needs. For example, many children with neurological vision impairments cannot read pencil writing on paper. They can, however, read when a black marker prints letters on the same paper.

In general, babies and children who receive therapy and other interventions can make improvements in:

Visual acuity
Focusing on peripheral stimuli
Reaching for objects
Social gaze

A part of this process may also include identifying and treating other conditions that could make it difficult to focus or see. For example, effective seizure management can help children focus better and result in improved vision.

Most children who have a neurological vision impairment improve with therapy. One study published in the British Journal of Ophthalmology found that more than 60 percent of children with neurological vision impairments showed at least some improvement during follow-up visits. About a third remained the same, and two percent showed a decline in visual abilities.

Understanding Neurological Vision Impairment Therapy

There have been great strides in diagnosing neurological vision impairments over the last few years, even in children with other severe neurological conditions. However, there are still a few medical treatments for this condition.

Intervention and therapy show promise and many children improve when they undergo this type of rehabilitation. The therapy exercises, though, require specific active visual stimulations that the child must see dozens of times a day. These exercises address the issues the child faces because of their neurological vision impairment, including:

Light gazing
Fear and avoidance of light
Poor visual attention
Extreme preference for certain colors
Visual field abnormalities
Difficulty with visual complexity
Issues related to distance and space
Eccentric viewing
Atypical visual reflex behaviors
Problems with contrast

Some of these are characteristic behaviors of a child with a neurological vision impairment. With early interventional therapy and a care team that includes doctors and therapists familiar with neurological vision impairments, you can give your child the best opportunity to increase their visual abilities.

Can Neurological Visual Impairments Be Mitigated Or Reversed?

As a parent, one of your happiest moments is locking eyes with your newborn for the first time. Watching the light of recognition in your son or daughter’s eyes is one of the best feelings in the world. When your child receives a diagnosis of neurological visual impairments that delays this moment or makes it impossible, one of the first things you will want to know is whether the impairment can be mitigated or reversed.

Some neurological visual impairments can be mitigated or reversed, depending on your child’s condition. Some children might regain some eyesight even if their case of neurological visual impairment is severe. The recovery of sight they might experience is usually in areas like visual acuity and peripheral vision, or how they see out of the sides of their eyes. Children with some eyesight improvement might also begin to reach for objects or look at people. Additionally, successful treatment of seizures might also help enhance your child’s eyesight.

You May Have a Birth Injury Case if Your Doctor or Another Care Provider Caused Your Child to Suffer Injuries

There are several ways a newborn can suffer a traumatic brain injury between birth and leaving the hospital for the first time. This can include injuries from the improper use of forceps or a vacuum extractor, dropping the baby following delivery or later, and intentional harm from shaking or striking the child.

If you believe your child endured any of these and suffered a brain injury as a result, this could be the cause of their neurological vision impairment. You should contact a birth injury medical malpractice attorney in your state as soon as possible and request a free case review. If your lawyer agrees that you have a case against the doctor or hospital, you could recover compensation that includes:

Current and future medical care costs
Ongoing care costs
Equipment and tools necessary for mobility, in-home therapy, and care
Out-of-pocket expenses related to your child’s injuries and care
Pain and suffering damages

We encourage you to act quickly. Each state has its own statute of limitations that sets a deadline on how long you have to take legal action. Some states have rules that allow you to toll this deadline for birth injury cases, but not all do. Your attorney will be able to explain the time limits that apply in your state.

Schedule Your Free Neurological Visual Impairment Consultation Today

A diagnosed neurological visual impairment will affect more than your child’s eyesight. You, your family, your finances, and your child’s future will all be impacted by this visual impairment. A birth injury lawyer can help you obtain the financial compensation you are entitled to receive. For a free case review, call the Birth Injury Lawyers Group today at (800) 222-9529.

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