Visual Problems
Ophthalmic ( Eye ) Problems in Children with Cerebral Palsy
A number of vision impairments are more common in people with cerebral palsy than in the general population
1)Retinopathy of prematurity
Retinopathy of prematurity (ROP) is an eye disease that affects prematurely-born babies. Both oxygen toxicity and relative hypoxia can contribute to the development of ROP. It is thought to be caused by disorganized growth of retinal blood vessels which may result in scarring and retinal detachment. ROP can be mild and may resolve spontaneously, but it may lead to blindness in serious cases. As such, all preterm babies are at risk for ROP, and very low birth weight is an additional risk factor. However, in preterm infants, the retina is often not fully vascularized. ROP occurs when the development of the retinal vasculature is arrested and then proceeds abnormally.
Patients with ROP are at greater risk for strabismus, glaucoma, cataracts and myopia later in life and should be examined yearly to help prevent and treat these conditions.
Retinal examination with pupillary dilatation and scleral depression is generally recommended for patients born before 30–32 weeks gestation, with birth weight 1500 grams or less by the the treating neonatologist. The initial examination is usually performed at 4–6 weeks of life, and then repeated every 1–3 weeks until vascularization is complete (or until disease progression mandates treatment). Treatment options include following depending upon the severity of disease
Laser photocoagulation
Cryotherapy
Scleral buckling and/or vitrectomy
Intravitreal injection of bevacizumab (Avastin)
2) Strabismus (Squint)
65-70 percent of children with cerebral palsy also have strabismus. Strabismus, a condition characterized by differences in the left and right eye muscles often causing the eyes to be misaligned or cross-eyed. Untreated, this can lead to very poor vision in one eye. Treatment includes eye patching, glasses, Botox A injections, prescription drugs, and/or eye exercises. Most children with cerebral palsy and strabismus will need to have some form of strabismus surgery. These surgeries can help in realigning the eyes of the child. The surgery usually consists of either weakening or strengthening the eye muscles, whichever is seen to be the best course of treatment.
3) Nystagmus
Nystagmus is defined as the rapid oscillating movement of the eye. This interferes with processing visual stimuli because the eye is not able to focus or fixate on its surrounding.
4) Cortical visual impairment
Cortical Visual Impairment (CVI) is common cause of permanent visual impairment in children with cerebral palsy . The diagnosis of CVI is indicated for children showing abnormal visual responses that cannot be attributed to the eyes themselves. Brain dysfunction must explain the abnormal visual responses. Fixation and following, even to intense stimulation, may be poor and the child does not respond normally to people’s faces. Visual regard and reaching (in the child with motor capabilities) toward objects is absent.
Rehabilitation and education
In all children with cerebral visual impairment, services of trained and experienced teachers are very important for the child’s development and education.
Referral of the child with CVI to state services for visually impaired children should be done promptly after diagnosis. Specific recommendations based upon the clinical measurement of visual abilities, such as visual acuity and visual fields, should be provided to parents, therapists and teachers. Teachers of visually impaired children should assess broader, “functional” visual behaviours and, often in conjunction with other therapists, devise interventions appropriate for the specific needs of the child. Appropriate additional support services for the school aged child, including for non-verbal learning disabilities, will be needed.
therapy, there is hope that the vision that he does have in the healthy
5) Hemianopia
Hemianopia is a condition marked by impaired vision or blindness in half of the visual field in one eye. If the impairment in the right or left half of the visual field is present in both eyes, the condition is called homonymous hemianopia. Put simply, this means that the child cannot see anything in the entire left or right visual field in both eyes. Because both eyes are affected more or less equally, the location of the problem must be at the optic chiasm (the part of the brain where the optic nerves partially cross) or further back along the visual pathways.
6) Refractive errors which included 50% cases with astigmatism, 25% with myopia and 25% with hypermetropia. Treatment includes prescription glasses.
7) Optic atrophy in 10%. Optic nerve atrophy is a permanent visual impairment caused by damage to the optic nerve