• Like
Presentation Handouts American Conference on Pediatric Cerebral Visual Impairment
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

Presentation Handouts American Conference on Pediatric Cerebral Visual Impairment

  • 845 views
Published

This is my presentation handout for the American Conference on Pediatric Cerebral Visual Impairment

This is my presentation handout for the American Conference on Pediatric Cerebral Visual Impairment

Published in Health & Medicine
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
845
On SlideShare
0
From Embeds
0
Number of Embeds
1

Actions

Shares
Downloads
11
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. A National Conference on Dominick M. Maino, O.D., M.Ed., F.A.A.O.The Evaluation and Treatment of Professor, Pediatrics/Binocular Vision ServicePediatric Cerebral Visual Impairment Illinois College of Optometry Illinois Eye InstituteThe Children’s Hospital and 3241 S. Michigan Ave. Chicago, Il. 60616Medical Center of Omaha, NE 312-949-7280 (Voice) 312-949-7358 (fax) dmaino@ico.edu www.ico.edu LyonsFamilyEyeCare.com MainosMemos.blogspot.com The Patient with Special NeedsThe Child with Special Needs A Brief Overview Individuals with Special Needs Pediatric Cerebral Visual ImpairmentCerebral Palsy Autism • 1. Defining Pediatric Cerebral Visual ImpairmentDown Syndrome Intellectual DisabilityFragile X Syndrome Brain Injury • Definition confusing, misunderstood and imprecise. • Pediatric Cerebral Visual Impairment (PCVI).Psychiatric Illness ….and…. • Pediatric Cortical Visual Impairment • Delayed Visual Development Pediatric Cerebral Visual Impairment 1
  • 2. Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual Impairment • North America • History of CVI • Brain injury 19th century •Cortical Visual Impairment with Phineas P. Gage • Elsewhere •Cerebral Visual Impairment Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual Impairment • World War I, wounded veterans with brain injury • Statokinetic dissociation (in children) • Displayed perceived • greater reduction in sensitivity to stationary visual motion in the “blind, non- stimuli relative to similar targets in motion seeing” visual field. • Riddoch phenomenon (adults) • Ability to sense movement even though blind • Ability to sense motion, • “See” moving objects…but not stationary ones lights, and colors • Blindsight • Conscious or • Ability to ‘sense’ objects in the way subconscious. Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual Impairment • Statokinetic dissociation (in children) • Statokinetic dissociation (in children)• Movement in the peripheral visual field may elicit a smile • For those children who understand language stating what is in the blind child with quadraplegia and profound being seen as the child reacts to it may enhance both visual intellectual disability. and language development.• Children who are fed with a spoon may intermittently open • Such children may rock to and fro. Whether this generates their mouths to receive food when the spoon is moved in an an image is difficult to know. arc from the peripheral visual fields, but not when it • Rarely, children with cerebral blindness who are mobile approaches the mouth from straight ahead. move slowly around obstacles. This phenomenon has been called travel vision. 2
  • 3. Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual Impairment • 1980’s adults with bilateral occipital cortex •Reduced visual acuity identifying insult (cortical blindness) feature. • Term applied to children. • Cortical visual impairment used in the •Many children damage to white 1980’s onward matter surrounding the ventricals • Definition of CVI includes injury lateral (perventricular leukomalacia PVL) geniculate nucleus/visual cortex •Cerebral Visual Impairment now used (especially in Europe) Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual Impairment• Cerebral visual impairment: inclusive term • Classification of CVI • Reduced visual acuity • Ocular visual impairment: Refractive state. Optics, Eye • Oculomotor anomalies health • Visual field loss • Cerebral visual impairment: Neuro-pathway problems, • Vision information processing problems cortical problems, oculomotor dysfunction, vision • Cognitive Visual Dysfunction (CVD) information processing (dorsal and ventral streaming • Used to identify visual perceptual anomalies processing mechanisms) • Used to identify vision information processing problems Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual ImpairmentThe ventral stream (also known as the "what pathway") • Delayed Visual Maturation (DVM)travels to the temporal lobe and is involved with object • DVM type I Visually impaired infants: improved visual abilities by the age of 6 months, oftenidentification. The dorsal stream (or, "where pathway") without treatment.terminates in the parietal lobe and process spatial locations. • DVM type II: attention problems, associated with neurological/learning abnormalities. Improvement takes longer • DVM III: children have nystagmus, albinism. Vision improves later, can improve to low-normal levels. • DVM IV: associated with retinal, optic nerve, macular anomalies 3
  • 4. Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual Impairment • Should we be concerned about how PVCI is defined?• Defining Other Disorders and PCVI Absolutely! • Variability with defining disorders not • American Association on Intellectual and uncommon Developmental Disabilities changed definition of • Autism rare anomaly mental retardation • Definition altered so that the number of • Decreasing IQ cut off point from to 80 to 70 those on the Spectrum is now considered • Added adaptive behavior qualifications epidemic • Result: instantly cured hundreds of thousands of • Legal, legislative, health care, those with mental retardation/intellectual disability overnight insurance issues Pediatric Cerebral Visual Impairment PCVI: References • Dutton GN, Bax M. (eds). Visual impairment in children due to damage to the brain. Clinics in Developmental Medicine. no 186. MacKieth Press. What we call a thing is very important London;2010. • Strategies for dealing with visual problems due to cerebral visual impairment: Gillian McDaid, Debbie Cockburn, Gordon N Dutton available from http://www.ssc.education.ed.ac.uk/courses/vi&multi/vjan08i.htmlTo name it is to have power over it • Alesterlund L, Maino D. That the blind may see: A review: Blindsight and its implications for optometrists. J Optom Vis Dev 1999;30(2):86-93 • Kran B. Mayer L. Vision impairment and brain damage. In Taub M, Bartuccio M, Maino D. (Eds) Visual Diagnosis and Care of the Patient with Special Needs. Lippincott Williams & Wilkins , NY, New York; 2012:135- 146. PCVI: References Pediatric Cerebral Visual Impairment • Colenbrander A. What’s in a name? Appropriate terminology Determining Vision Function and for CVI. J Vis Impair Blind. 2010:583-585 Functional Vision in Children with • Roman Lantzy CA, Lantzy A. Outcomes and opportunities: A study of children with cortical visual impairment. J Vis Impair Pediatric Cerebral Visual Impairment Blind. 2010:649-653. • http://www.aph.org/cvi/define.html • Cerebral Visual Impairment in Periventricular Leukomalacia: MR Correlation: Available from http://www.ajnr.org/content/17/5/979.full.pdf 4
  • 5. Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual ImpairmentDetermining Vision Function and Functional Vision in Children Determining Vision Function and Functional Vision in Children with Pediatric Cerebral Visual Impairment with Pediatric Cerebral Visual Impairment • Need to assess vision function and • Oculomotor ability (pursuits and saccades; functional vision convergence and divergence, strabismus) • Vision function •Clarity of vision (visual acuity, •Pursuits/Visual Tracking contrast sensitivity, refractive error, Amblyopia) •Saccades Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual ImpairmentDetermining Vision Function and Functional Vision in Children Determining Vision Function and Functional Vision in Children with Pediatric Cerebral Visual Impairment with Pediatric Cerebral Visual Impairment • Binocular Vision • Accommodation (focusing) • Convergence insufficiency/excess • Accommodative insufficiency • Divergence insufficiency/excess • Accommodative excess • Strabismus • Ill-sustained accommodation • Exotropia • Accommodative instability • Esotropia • Hypertropia Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual ImpairmentDetermining Vision Function and Functional Vision in Determining Vision Function and Functional Vision in Children Children with Pediatric Cerebral Visual Impairment with Pediatric Cerebral Visual Impairment • Depth perception (3D vision) • Eye health• Binocular vision (Stereoscopy) is the ability to align and focus both eyes • Cornea, lens, pupil, accurately on an object and then combine the visual images from each eye into • iris, vitreous, optic nerve, a single, clear, three dimensional perception. Difficulty seeing in 3D can arise when eye fatigue occurs, forcing the eyes to make adjustments to focus • retina• simultaneously on images that are near and far away. Symptoms indicating a potential problem viewing images in 3D can vary, • Visual Cortex but some common symptoms include headaches, blurred vision, nausea and dizziness. • Other areas of the brain (motor, • executive function) 5
  • 6. Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual ImpairmentDetermining Vision Function and Functional Vision in Children Vision Function of Children with Disability with Pediatric Cerebral Visual Impairment Down Syndrome: Visual Acuity, Refractive Error, Strabismus/Oculomotor, Accommodation, Ocular health, Vision• Special diagnostic tools Information Processing, Other • EOG (electrooculogram) Cerebral Palsy: Visual Acuity, Refractive Error, • ERG (electroretinogram) Strabismus/Oculomotor, Accommodation, Ocular Health, Vision • VER/VEP (visually evoked Information Processing, Other response visual evoked potential) Brain Injury: Visual Acuity, Refractive Error, Strabismus/Oculomotor, Accommodation, Ocular Health, Vision Information Processing, Other Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual Impairment Functional vision • Vision information processing (VIP)/Visual perceptual skills Functionally induced disability that overlays pathologically induced • Laterality/Directionality disability • Visual motor integration • Uncorrected refractive error • Non-motor perceptual skills • Amblyopia • Auditory perceptual/processing • On top of vision loss due • to cerebral impairment • Down Syndrome • Cerebral Palsy References References• Luek AH. Cortical or cerebral visual impairment in children: A brief overview. J Vis Impair Blind. 2010:585-592. • Ciuffreda K, Kapoor N. Acquired brain injury. In Taub M, Bartuccio M, Maino D. (Eds) Visual Diagnosis and Care of• Woodhouse JM, Maino DM. Down syndrome: In Taub M, Bartuccio M, Maino D. (Eds) Visual Diagnosis and Care of the Patient with Special Needs. the Patient with Special Needs. Lippincott Williams & Lippincott Williams & Wilkins , NY, New York; 2012:31-40. Wilkins , NY, New York; 2012:95-100.• Wesson M, Maino D. Oculo-visual findings in Down syndrome, cerebral palsy, • Roman-Lantzy, C. Cortical visual impairment: An and mental retardation with non-specific etiology. In Maino D (ed). Diagnosis and Management of Special Populations. Mosby-Yearbook, Inc. St. Louis, MO. approach to assessment and intervention. AFB Press, NY, 1995:17-54. New York; 2007.• Taub M, Reddell A. Cerebral Palsy. In Taub M, Bartuccio M, Maino D. (Eds) • http://www.3deyehealth.org/ Visual Diagnosis and Care of the Patient with Special Needs. Lippincott Williams & Wilkins , NY, New York; 2012:21-30. • http://www.MainosMemos.blogspot.com 6
  • 7. Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual Impairment • Treatment begins with the basics. Therapeutic Strategies for the •Vision function Treatment of •Refractive correction •Spectacles therapeuticPediatric Cerebral Visual Impairment •Eye health Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual Impairment• Treatment with spectacle/lenses • Treatment with spectacle/lenses • multi-focal prescription/bifocal • task specific glasses • prism • high “+” adds (magnification) • occlusion • Telescopes • Microscopes Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual Impairment• Vision Therapy • Vision Therapy • Oculomotor/hand- • Integration/Stabilization eye/accommodation • Visual stimulation & fusion • Vision information processing • Biocular • Vestibular/Vision • Binocular Apps 4 Vision Development http://www.sovoto.com/group/apps4VisionDevelopment 7
  • 8. Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual Impairment• Resources Thinking Outside the LightBox • Facebook (http://www.facebook.com/Thinkingoutsidet helightbox) • Pinterest http://pinterest.com/achampine0302/cortic al-visual-impairment-cvi-goodies/ • Blogs http://www.MainosMemos.blogspot.com Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual ImpairmentHow Do Environmental Factors, Medications For individuals with disability… and Non-Visual Handicaps Affect the • Medications: Prescribed many more medications Evaluation and Treatment of Pediatric • Higher affinity for adverse effects due to environmental/systemic factors Cerebral Visual Impairment? • Seldom complain of symptoms related to their disability, systemic anomalies, or medication side effects Pediatric Cerebral Visual Impairment Pediatric Cerebral Visual Impairment• Alternative and complementary medical therapies • Mental illnesses in childrenMaino D. Evidence based medicine and CAM: a review. Optom Vis Dev 2012;43(1):13-17 • Pediatric Bipolar disorderLemer P. Complementary and Alternative Approaches. In Taub M, Bartuccio M, Maino D.Visual Diagnosis and Care of Patients with Special Needs. Lippincott, Williams, Wilkins. 2012 • Pediatric depression• Traditional allopathic approaches 8
  • 9. Pediatric Cerebral Visual Impairment Medication Side Effects Antidepressants • Major environmental hazard: People Abdominal pain/constipation Blurred vision • do not know how to respond Abnormal dreams/thinking Increased risk of Glaucoma • make assumptions Abnormal ejaculation/orgasm Anxiety Visual Disturbances Photophobia • true for lay individuals, teacher, health care professionals• Other Medication Side Effects Medication Side EffectsAnticonvulsants Anti-Parkisons Memory problems/amnesia Blurred vision Abnormal dreams/insomnia Vision abnormalities Sedation Dimming of vision Increased muscle tone/weakness Blurred vision Insomnia Diplopia Involuntary movements Mydriasis Bronchitis Involuntary eye movements Hallucinations Decreased accommodation Fluid retention Dry eye Medication Side Effects Medication Side Effects Tranquilizers Anti-anxiety Breast development in men Risk of narrow angle GLC Anemia Decreased accommodation Breathing problems Cycloplegia/Mydriasis Seizures Nystagmus Insomnia Decreased vision Blood disorders Diplopia Tardive dyskinesia Capsular cataract Unusual excitement Mydriasis 9
  • 10. Dominick M. Maino, O.D., M.Ed., F.A.A.O. Professor, Pediatrics/Binocular Vision Service Illinois College of Optometry Illinois Eye Institute 3241 S. Michigan Ave. Chicago, Il. 60616 312-949-7280 (Voice) 312-949-7358 (fax) dmaino@ico.edu www.ico.edu LyonsFamilyEyeCare.com MainosMemos.blogspot.com 10