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Factors Associated With Lack of Vision Improvement in Children With Cortical Visual Impairment

Handa, Swati, FRCS, MCI; Saffari, Seyed E., PhD; Borchert, Mark, MD

doi: 10.1097/WNO.0000000000000610
Original Contribution

Background: Improvement in vision has been noted in children with cortical visual impairment (CVI), resulting from disparate types of brain injury. The purpose of our study was to determine the risk factors associated with poor recovery of vision in this group of patients.

Methods: Case records of children who were born before 2010 with at least 4 follow-up visits for CVI were reviewed for underlying etiologies of CVI, visual acuity (VA), and associated neurological and ophthalmological disorders. VA was assessed in 6 qualitative grades. Changes in VA were recorded as the difference between the grades of VA at presentation and the last follow-up visit. The outcome was calculated as a ratio of actual improvement to potential improvement in grades of qualitative VA. Multiple linear regression determined factors associated with lack of vision improvement in all children and based on etiology.

Results: Fifty-three children with CVI were identified. The median age at presentation was 13.6 months (range: 2.9–76.4 months) and the median follow-up was 5.8 years (1.1–16.3 years). CVI resulted from central nervous system (CNS) malformation (9.4%), hypoxic/inflammatory injury (15.1%), seizures (24.5%), and combined causes (51.0%). Vision improvement was noted in 83% of children. Lack of VA improvement was associated with older age at presentation in all children with CVI and within each etiological group except CNS malformation. None of the other investigated variables were associated with poor recovery of VA.

Conclusions: Most of the children with CVI showed improvement in vision. Older age at presentation, but not etiology of CVI, was associated with poor improvement in VA.

Pediatric Ophthalmology (SH), KK Women's and Children's Hospital, Singapore; Centre for Quantitative Medicine (SES), Duke-NUS Medical School, Singapore; and Children's Hospital Los Angeles and the Vision Center (MB), USC/Keck School of Medicine, Los Angeles, California.

Address correspondence to Swati Handa, FRCS, MCI, Pediatric Ophthalmology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899; E-mail:

The authors report no conflicts of interest.

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© 2018 by North American Neuro-Ophthalmology Society