PDF of my presentation at the Children's Hospital in Omaha, NE

1. 4/9/2013
Diagnosis and Therapeutic Dominick M. Maino, OD, MEd, FAAO, FCOVD‐A
Intervention of Vision Function and
Functional Vision Anomalies in PCV Professor of Pediatrics/Binocular Vision
Illinois Eye Institute/Illinois College of Optometry
Lyons Family Eye Care
Chicago, Il
dmaino@ico.edu
ICO.edu
LyonsFamilyEyeCare.com
MainosMemos.com
Presenter Disclosures Vision Function and Functional Vision Anomalies in PCV
Consultant/ Expert Witness/Legal Consultant-Gilbert & Tobin, Sydney, Australia
American Optometric Association Spokes Person, Lecturer
Speakers bureaus American Academy of Optometry, Lecturer
College of Optometrists in Vision Development, Lecturer
Pacific University College of Optometry, Lecturer
Research funding “No Disclosures.”
Stock “No Disclosures.”
ownership/Corporate The American Conference on Pediatric Cortical Visual Impairment
boards-employment
brings together professionals in optometry, ophthalmology,
Off-label uses “No Disclosures.” occupational therapy and visual educational psychology to increase
Editor/Author Visual Diagnosis and Care of the Patient with Special Needs, Lippincott,
the understanding of the definition, diagnosis and management of
2012; American Optometric Association News cortical vision loss in children.
Vision Function and Functional Vision Anomalies in PCV Vision Function and Functional Vision Anomalies in PCV
1. Define pediatric cortical visual impairment (PCVI). 4. Demonstrate problem‐solving strategies when evaluating the new
2. Describe the diagnostic criteria utilized in occupational therapy, PCVI patient.
teachers of the visually impaired, optometry and ophthalmology. 5. Develop a multidisciplinary approach to the newly diagnosed
3. Discuss the management and treatment techniques utilized in PCVI patient.
occupational therapy, teachers of the visually impaired, optometry 6. Network with professionals in related medical and educational
and ophthalmology. disciplines who can serve as resources for improved vision care for
PCVI patients.
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Vision Function and Functional Vision Anomalies in PCV
7. Identify the causes of PCVI.
8. Discuss research topics which further the knowledge base of PCVI.
9. The use of social media and the internet to disseminate
information about PCVI.
Vision Function and Functional Vision Anomalies in PCV Vision Function and Functional Vision Anomalies in PCV
Pediatric Cerebral Visual Impairment (PCVI)
An Pediatric Cortical Visual Impairment
North America: Cortical Visual Impairment
Introduction Elsewhere: Cerebral Visual Impairment
Cerebral visual impairment: inclusive term
Ocular visual impairment: Refractive state, Optics, Eye health
1. Define pediatric cortical visual impairment (PCVI) Cerebral visual impairment: Neuro‐pathway problems,
cortical problems, oculomotor dysfunction, vision information
Definition confusing, misunderstood and imprecise. processing (dorsal and ventral streaming processing mechanisms)
Pediatric Cerebral Visual Impairment (PCVI).
Pediatric Cortical Visual Impairment For more in depth information please see: Maino D. Pediatric Cerebral Visual Impairment. Optom Vis Dev 2012:43(3):115‐120 (available
Delayed Visual Development from http://www.slideshare.net/DMAINO/maino‐cortical‐visual‐impairment)
Diagnosis and Therapeutic Intervention of Vision Function and Vision Function and Functional Vision Anomalies in PCV
Functional Vision Anomalies in PCV Diagnostic Approaches & Strategies
1.Case History
2.Visual Acuity
3.Refractive Error
4.Vision Function Assessment
Describe the diagnostic criteria utilized in ……
optometry and ophthalmology. 5.Ocular Health
6.Special Tools
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Vision Function and Functional Vision Anomalies in PCV Vision Function and Functional Vision Anomalies in PCV
Vision Function Vision Function:Eye health
Biomicroscopy, Tonometry
Clarity of vision (visual acuity, contrast Dilated Fundus Evaluation
sensitivity, refractive error) Special diagnostic tools
Oculomotor ability (pursuits and EOG (electrooculogram)
saccades; convergence and divergence) ERG (electroretinogram)
Accommodation (focusing) VER/VEP (visually evoked response
Depth perception (3D vision) visual evoked potential)
Vision Function and Functional Vision Anomalies in PCV Vision Function and Functional Vision Anomalies in PCV
Functional Vision Functional vision
Functionally induced disability that overlays Vision information processing (VIP)/
pathologically induced disability Visual perceptual skills
Uncorrected refractive error : Amblyopia laterality/directionality
Constant Strabismus: Amblyopia visual motor integration
Oculomotor dysfunction, Binocular vision non‐motor perceptual skills
dysfunction, Accommodative dysfunction: auditory perceptual/processing
Attention
Vision Function and Functional Vision Anomalies in PCV Vision Function and Functional Vision Anomalies in PCV
History Vision Function
All the usual questions AND Clarity of vision
General/Motor/Visual/Auditory
Development What is visual acuity?
Daily Living Skills What is contrast sensitivity?
Skills needed for Learning What is refractive error?
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Vision Function and Functional Vision Anomalies in PCV Vision Function and Functional Vision Anomalies in PCV
Vision Function: Clarity of vision Tests
What is visual acuity? of
Visual
The ability to see a certain Acuity
size object at a certain
distance . .
Vision Function and Functional Vision Anomalies in PCV Vision Function and Functional Vision Anomalies in PCV
Vision Function: Contrast sensitivity measures the ability to
see details at low contrast levels. Visual
Clarity of vision information at low contrast levels is
particularly important:
What is contrast sensitivity?
1. in communication, since the faint
shadows on our faces carry the visual
information related to facial
expressions.
Vision Function and Functional Vision Anomalies in PCV Vision Function and Functional Vision Anomalies in PCV
2. in orientation and mobility, where 3. in every day tasks, where there
we need to see such critical low‐contrast are numerous visual tasks at low
forms as the curb, faint shadows, and contrast, like cutting an onion on a
stairs when walking down. In traffic, the
light colored surface, pouring coffee
demanding situations are at low
contrast levels, for example, seeing in into a dark mug, checking the
dusk, rain, fog, snow fall, and at night. quality of ironing, etc.
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Vision Function and Functional Vision Anomalies in PCV Vision Function and Functional Vision Anomalies in PCV
4. in near vision tasks like reading
and writing, if the information is at
low contrast, as in poor quality copies
or in a fancy, barely readable
invitation, etc.
from http://www.lea‐
test.fi/en/vistests/instruct/contrast/csensiti/csensiti.html Regular Low
Contrast Contrast
Vision Function and Functional Vision Anomalies in PCV Vision Function and Functional Vision Anomalies in PCV
Regular Contrast Low Contrast
Vision Function and Functional Vision Anomalies in PCV Vision Function and Functional Vision Anomalies in PCV
Refractive Error
Myopia (Nearsightedness)
Hyperopia (Farsightedness)
Astigmatism
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Vision Function and Functional Vision Anomalies in PCV Vision Function and Functional Vision Anomalies in PCV
Refractive Error Refractive Error: Myopia (Nearsightedness)
Myopia (Nearsightedness)
Vision Function and Functional Vision Anomalies in PCV Vision Function and Functional Vision Anomalies in PCV
Refractive Error: Hyperopia (Farsightedness) Refractive Error: Astigmatism
Vision Function and Functional Vision Anomalies in PCV Vision Function and Functional Vision Anomalies in PCV
Refractive Error: Astigmatism Refractive Error: Assessment
Objective
Dry Retinoscopy
Cycloplegic Retinoscopy
Mohindra Dynamic Retinoscopy
Auto‐refraction
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Vision Function and Functional Vision Anomalies in PCV Vision Function and Functional Vision Anomalies in PCV
Refractive Error: Assessment Refractive Error: Assessment
Objective Objective
Dry Retinoscopy Mohindra Dynamic Retinoscopy
Mohindra Dynamic Retinoscopy Dark room
Cycloplegic Retinoscopy 50 cm
Neutralize main meridians
Algebraically add ‐1.25 to sph
Objective: Auto‐refraction Vision Function and Functional Vision Anomalies in PCV
Refractive Error:
Assessment
Subjective
Pediavision SPOT: See Maino D, Goodfellow G. Tomorrow’s Which is better 1 or 2?
Practice Today: SPOT On! AOANews 2013; March:29
URL http://www.spotvisionscreening.com/2013/
Oculomotor ability Oculomotor ability
basic extra‐ocular muscle assessment basic extra‐ocular muscle assessment
Pursuits
Saccades
Convergence
Divergence
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Oculomotor ability
Convergence Divergence
Accommodation
(focusing)
MEM Nott
Book Bell
Accommodation (focusing) Accommodation (focusing)
Monocular Estimate Method (MEM): you neutralize the
reflex while the patient accommodates to a target at
MEM
near (usually at 40cm) Room illumination should be dim but with
With motion: Lag of accommodation ‐‐‐ Add PLUS target illuminated
Against motion: Lead of accommodation ‐ Add MINUS Briefly insert lens into line of sight
Use patient’s correction for distance or near Measurements should be made within
TRUE measurement of lag/lead if measured 1 second per lens used to minimize the
with BVA dazzle of light and the effect of lens on
Place the target at their working distance
Adults: usually 40 cm Children: use Harmon’s
accommodation system
distance The lens that creates neutrality is the value
Accommodation (focusing) Accommodation (focusing)
Nott Method: clinician moves toward and Book Retinoscopy
away from the patient until neutrality is
seen (Dioptric difference between neutral and your Technique developed at the Gesell Institute
beginning distance is the lead/lag)
by Gerry Getman, OD working with Arnold
Against motion: move closer to the Gesell, MD.
patient
With motion: move further away
from patient
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Accommodation (focusing) Accommodation (focusing)
Book Book
1. Free and Easy reading level, reflex varied
from neutral to with motion with bright, 3. Frustration reading level (reading with
sharp edges and had a pinkish color. minimal comprehension) the reflex showed a
2. Instructional reading level (maintaining slow against motion with a dull brick red
the reading task with comprehension in spite color.
of being stressed) the reflex was a varying
fast against motion while the color was
bright, sharp, and very pink.
Accommodation (focusing)
Bell Retinoscopy
A small shiny bell dangling from a string is used
Binocularity
as a fixation target (now use a silver ball on the
Fusion
top of a stick). The ball is moved closer to and Stereopsis
farther from the patient along this midline. Depth Perception
The retinoscope is positioned slightly above
this line at a fixed distance of 50 cm. (20 (3D vision)
inches) from the patient. Watch what happens
to the reflex as you move the ball.
Binocularity Binocularity
Fusion Fusion
Stereopsis Stereopsis
Depth Perception Depth Perception
(3D vision) (3D vision)
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Testing Your Binocularity
Binocularity
Finger Test
Cover Test
Brock String
Circles
Color Vision Eye Health
Biomicroscopy
Dilated Fundus
Evaluation
Visual Fields
Eye Health Special diagnostic tools
EOG (electrooculogram)
ERG (electroretinogram)
VER/VEP (visually evoked
response visual evoked potential)
TOVA (Test of Variables Attention)
Visagraph/Computerized
Assessment of Eye Movements
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Special diagnostic tools Functional Vision Anomalies in PCV
ERG Amblyopia, Strabismus, Oculomotility Disorder, Accommodative
Disorders, Binocular Vision Disorders
VER/VEP Down Syndrome Review (see Woodhouse M. Maino D. Down
Syndrome. In Taub M, Bartuccio M, Maino D. (Eds) Visual Diagnosis
and Care of the Patient with Special Needs; Lippincott Williams &
Wilkins. New York, NY;2012:31‐40.)
TOVA
Cerebral Palsy Review (see Taub MB, Reddell AS. Cerebral Palsy. In
Taub M, Bartuccio M, Maino D. (Eds) Visual Diagnosis and Care of
Visagraph the Patient with Special Needs; Lippincott Williams & Wilkins. New
York, NY;2012:21‐30.)
Treatment of Functional Vision Anomalies in PCV Treatment of Functional Vision Anomalies in PCV
Treatment begins with the basics Treatment with spectacles
multi‐focal prescription/bifocal
Vision function prism
Refractive error & quality of life occlusion
Spectacles therapeutic task specific glasses
Eye health high “+” adds (magnification)
Low Vision Aids
Treatment of Functional Vision Anomalies in PCV Treatment of Functional Vision Anomalies in PCV
Treatment with spectacles Vision Therapy/Vision Rehabilitation/
Vision Stimulation
Use Principles of Neuroplasticity
“The medicine in my Use it or lose it
glasses has run out!” Use it and improve it
Specificity
Repetition matters
Intensity matters
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Treatment of Functional Vision Anomalies in PCV Treatment of Functional Vision Anomalies in PCV
Vision Therapy/Vision Rehabilitation/
Vision Stimulation Maino D, Donati R, Pange Y, Viola S, Vision Therapy/Vision Rehabilitation/
Barry S. Neuroplasticity. In Taub M,
Use Principles of
Bartuccio M, Maino DM. (eds) Visual Vision Stimulation
Diagnosis and Care of the Patient
with Special Needs. Lippincott 2012.
Neuroplasticity Use Principles of Neuroplasticity
Kleim JA, Jones TA. Principles of
Time matters experience‐dependent neural
plascitity: implications for Oculomotor/hand‐eye, Biocular, Binocular
Salience matters rehabilitation after brain damage. J
Speech Lang Hear Res. 2008;51;S225‐ Integration/Stabilization, Visual stimulation,
Age matters 39.
Vision information processing,
Transference Vestibular/Vision Computer applications
Interference
Treatment of Functional Vision Anomalies in PCV Treatment of Functional Vision Anomalies in PCV
Suggestions from members How To Modify your Home for Visual Stimulation
Rationale‐
Environment‐ directly impacts visual development and
brain cells
Lighting‐ to increase stimulation of brain cells
Open drapes‐ position child’s back to windows/doors
Use In‐direct lighting – floor or desks lamps are best and
reduce glare (direct light may damage retinal tissues);
compact fluorescent bulbs ‐16 or 22 Watt with warm color
Treatment of Functional Vision Anomalies in PCV Treatment of Functional Vision Anomalies in PCV
Increase contrast‐ Suggested Materials and Activities to try‐
Use electrical colored tape, stickers, decals to add to Mobiles‐ suspend colorful Mylar, CD’s, strings‐ provides movement
objects(bottles, cups) walls, cribs and shiny objects
Use plain colored sheets, poster board to hang on Screen savers‐ computer backgrounds are very stimulating and can
walls/corners to then attach objects, fabrics to make become a cause and effect activity
playspaces or rooms around the home more stimulating Household items‐ use soup cans, quacker oats containers, spoons,
Use patterned fabrics, carpet squares, cellophane, clear metal bowls, colorful cups
plastic‐ to add to walls, windows, play spaces Adhesives‐ wall decals, stickers; add to lower places on walls
Make a “stained glass” window or mobile‐ use cellophanes,
**Be aware of what you wear or what other sounds are in the environment; competing
CD’s, mylar wrapping papers stimuli make it harder to visually attend and focus
Use carpet squares on floor to mark areas; paint/tape on
floor moldings or door jams Barbara Halton‐Bailey, Education Coordinator Virginia Dept. f/t Blind
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Treatment of Functional Vision Anomalies in PCV Treatment of Functional Vision Anomalies in PCV
Show, Tell & Reach‐ Show, Tell & Reach‐
How to do‐
Develops understanding of objects and immediate Slow down the pace during activities
Routinely take 5 minutes or so; tell what object is and what is
world through hands on experience happening, allow extra time for baby to “study” with hands, ears,
Helps understand daily routines eyes and body
Develops better visual and/or motor responses Provide assistance with reaching
Babies may need to hold and “get to know” it by touching it before
Builds sound localization understanding and reaching for it away from the body
Increases active involvement Gradually put familiar toys a few inches away (after initially touching)
Lays the groundwork for crawling and walking and make a sound for baby to reach for the object
Barbara Halton‐Bailey, Education Coordinator Virginia Dept. f/t Blind
Treatment of Functional Vision Anomalies in PCV Treatment of Functional Vision Anomalies in PCV
Defined Spaces or Play spaces‐ Defined Spaces or Play spaces‐
Provides incentive for movement, exploration, and independent Keep objects predictable and highly meaningful to the child in each
interaction area
A life‐long organizational strategy to enhance efficiency of Be sure objects are easily accessible with the child’s current abilities
movement, independence and self‐esteem‐the use of defined spaces Return child to the play space frequently showing where 2 or 3 toys
expands and grows with the child are, throughout the day and allow the child to play independently
Use walls and furniture as reference points in each room of the
house Examples:
First place toys touching body as baby plays on tummy, back, side or Floor space‐ pallet with a border on 2‐3 sides created by walls,
seated on the play space. furniture
Move objects further away and make sounds with the object for Pull‐up space‐ arranged beside sofa, chairs, shelves, tables
baby to reach for Crib‐ use only if child enjoys waking periods in the crib
Treatment of Functional Vision Anomalies in PCV Treatment of Functional Vision Anomalies in PCV
Defined Spaces or Play spaces‐ I love … the use of shiny emergency blankets. They are like
Sittin’ Center‐ adapted seating with toys secured within reach beside, large sheets of reflective Mylar material that kids love to
in front, and above
wrap themselves in and look at the reflection of the light
Eatin’ place‐ High chair, tray table‐arrange cup and bowl
Kitchen space‐ special cabinet designated and marked, containing off of the wrinkles created in the sheets. ….reflective
child‐safe pots. Lids containers, spoons Christmas gift bags, water bottles filled with glitter, snap
Outer space‐ area in backyard defined by play equipment, furniture, and light up neon bracelets or necklaces, pompoms, shiny
garden fencing, wind chimes. Have predictable storage of outdoor reflective beaded necklaces, feather boas and the list goes
toys, wheeled vehicles, push carts, radio or music used as a sound on and on. Sometimes just using neon coloured duct tape
source to return to the door.
over a baby bottle or favorite toy works wonders.
Barbara Halton‐Bailey, TVI, NBCT Jody Whelan, Specialist, Early Intervention Early Childhood Vision
Education Coordinator, DBVI Consultant Northeast Blind Low Vision Early Intervention Program
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Treatment of Functional Vision Anomalies in PCV Medications and Alternative Therapies
Medications: Prescribed many more
medications
Higher affinity for adverse effects due to
systemic/environmental factors
Seldom complain of symptoms related
to their disability, systemic anomalies,
or medication side effects
Medications and Alternative Therapies Medications and Alternative Therapies
Alternative and complementary Major environmental hazard:
medical therapies People do not know how to
Traditional allopathic approaches respond, make assumptions
Mental illnesses in children true for lay individuals, teachers,
Pediatric Bipolar disorder health care professionals
Pediatric depression
Other Topics Case Reviews
4. Demonstrate problem‐solving strategies
Case Guided Workshop: The role of the Optometrist in the
when evaluating the new PCVI patient Management of the PCVI Patient
5. Develop a multidisciplinary approach to
the newly diagnosed PCVI patient Acknowledgements:
6. Network with professionals in related Dr. Tracy Matchinski: The Chicago Lighthouse for People who are
medical and educational disciplines who can Blind or Visually Impaired
serve as resources for improved vision care Dr. Mary Flynn‐Roberts: Illinois Eye Institute/Illinois College of
for PCVI patients Optometry Electrodiagnostic Service
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Case Reviews Case Reviews
Case #1 Case #1
Hx: 2 year 4 mo old, ischemic changes in the cortex Medications: Multiple medications
with both white and deep grey matter diffuse Participates in vision therapy, developmental tx,
abnormalities, CP spastic quad, DD, seizures since speech/OT/PT, PT pool,
birth (infantile spasms) VA 20/300 PL Teller Cards, 38 cm test dist. OU
Dx: CVI, Delayed visual maturation, exotropia. Horizontal tracking fine, vertical much more
Placental umbilical cord problems, lower heart rate, difficult
meconium aspiration, profound hearing loss Binocularity inadequate most of the time, IAXT 30‐
bilateral cochlear implants, encephalopathy 35PD
Case Reviews Case Reviews
Case #1 Case #1
VF using toys/OKN drum. Responded well in OD +2.50‐2.00X005 OS +2.50‐2.50X177
all visual fields. Old Rx Mohindra Ret +3.75‐2.50X180 OD
Contrast sensitivity at 10% level, moderately +3.50‐2,50X180
reduced for his age Near VA good, accommodation/interested in
Refraction hyperopia/astigmatism. near objects appears to function well.
Tolerates glasses well. No change from last Health of eyes: normal size, shape, clarity,
prescription. structure, pupils. DFE previously done
Case Reviews Case Reviews
Case #1 Case #2
Recommendations Hx: 2 y 5 mo female, picks up toys more,
High degree of vision function. increased facial expressions, still using g‐tube.
No change in mobility, feeding improving. Eye
Continue to work with health unremarkable
developmental therapist. Visual XT onset after head trauma, all milestones
search, scan, tracking vertically and delayed shaken baby syndrome, retinal signs
hand‐eye coordination therapy resolved, seizures, Prevacid, Topamax,
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Case Reviews Case Reviews
Case #2 Case #3
phenobarbital, ROS unremarkable except for 11 yr 6 m F. vision problems noted at 8mos of
what is noted above. Strong tracking all age, optic nerve hypoplasia, nystagmus
quadrants, + convergence, +OKN, pupil acc VEP all results delayed. Peak poorly formed
response, Teller 20/200 50cm, Cardif 20/253 but consistent with optic nerve hypoplasia,
at 20 cm, IET, IXT, nystagmus, cyclo +.50‐ nystagmus intermittent, gtube, seizures, poor
4.00X170 OD +.50‐4.00X010 OS handeye, Mobility rolls over
Dx CVI, strabismus, nystagmus
OT/PT/speech/developmental tx
Case Reviews Case Reviews
Case #3 Case #4
OD +.75‐3.00X170 OS +1.00‐4.00X010 cyclo 2 y/o HM, genetic mutation L1CAM that lead
OKN/Teller UTT, can separate head from eye to hydrocephalus and developmental delays,
movement, IAXT 10 with 5 R hyper, VF UTT, had VP shunt, in early intervention program,
contrast sensitivity UTT, ref +.50‐3.25X180 no self feeding, hearing ok, Lissencephaly,
OD, +.75‐3.75X015 OS, pupils OD 2mm OS ROS unremarkable, born c‐section because of
3mm RRL, ocular allergies large head, APGAR 9 and 9, no meds
Pataday Rx’d
Light stimulus therapy
Case Reviews 8. Discuss research topics which
Case #4 further the knowledge base of
Teller 20/180, Cardif 20/80, +tracking,
PCVI.
+OKN, + eyehand, FROM, Ta 26, 26 lids
held, +2.25 OD/OS IRET 10PD, PERRL –
apd Little research on pure PCVI
Dx: CVI, IAET, Hordeolum, hyperopia, eye
health unremarkable
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Rehabilitation of cortical visual impairment in children. Denise E Malkowicz, Optom Vis Sci. 2005 Sep;82(9):807‐16. Retrospective analysis of refractive errors
Ginette Myers, Gerry Leisman in The International journal of neuroscience in children with vision impairment. Du JW, Schmid KL, Bevan JD, Frater KM,
(2006) Ollett R, Hein B.
….We found that cortical or cerebral vision impairment (CVI) was the most
….Criteria were set to extract a fairly homogeneous group of common condition causing vision impairment, accounting for 27.6% of cases.
This was followed by albinism (10.6%), retinopathy of prematurity (ROP; 7.0%),
21 children with CVI due to perinatal HIE or postnatal anoxia optic atrophy (6.2%), and optic nerve hypoplasia (5.3%). Vision impairment was
who had extensive gray and white matter injury and multiple associated with ametropia; fewer than 25% of the children had refractive errors
neurological deficits; 20 of 21 (95%) had symptomatic < or = +/‐1 D. The refractive error frequency plots (for 0 to 2‐, 6 to 8‐, and 12 to
14‐year age bands) had a Gaussian distribution indicating that the
epilepsy as well. Subjects entered the study with responses emmetropization process was abnormal. The mean spherical equivalent
ranging from just a pupillary light reflex to rudimentary refractive error of the children (n = 813) was +0.78 +/‐ 6.00 D with 0.94 +/‐ 1.24
perception of outline. Each subject underwent an at‐home D of astigmatism and 0.92 +/‐ 2.15 D of anisometropia. Most conditions causing
vision impairment such as albinism were associated with low amounts of
treatment program. Twenty of 21 children (95%) manifested hyperopia. Moderate myopia was observed in children with ROP.
significant improvement after 4 to 13 months on the The relative frequency of ocular conditions causing vision impairment in
program. Results indicate that even in this challenging children has changed since the 1970s. Children with vision impairment often
group, there may be considerable neuroplasticity in visual have an associated ametropia
suggesting that the
systems leading to reintegration and visual recovery. emmetropization system is also impaired.
Cortical Visual Impairment Pediatric Visual Diagnosis Fact
9. The use of social media and Sheet http://www.aph.org/cvi/articles/bbf_1.html
the internet to disseminate
Cortical Visual Impairment
information about PCVI. http://www.aapos.org/terms/conditions/40
Blind Babies Foundation
Websites for information http://blindbabies.org/learn/diagnoses‐and‐strategies/
Perkins: Cortical/Cerebral Visual Impairment
http://www.perkins.org/assets/downloads/webinars/cvi
‐webinar‐session‐1.pdf
Social Media Social Media
Pinterest Blogs
http://pinterest.com/pediastaff/visual‐ http://adayinourshoes.com/tag/cortical‐visual‐
impairment/ impairment/
Facebook
Present Blindness American
https://www.facebook.com/preventblindness?fre
f=ts
Thinking Outside the Lightbox
https://www.facebook.com/Thinkingoutsidetheligh
tbox?ref=ts&fref=ts
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Resources: Resources
Dutton GN, Bax M (eds). Visual Impairment in Children due to Damage to the
Brain. Clinics in Developmental Medcine No. 186. Mac Keith Press, London, UK.
2010
Internet
Taub M, Bartuccio M, Maino D. (Eds) Visual Diagnosis and Care of the Patient http://drleahyvarinen.com/
with Special Needs; Lippincott Williams & Wilkins. New York, NY. 2012
Lantzy C. Cortical Visual Impairment: An Approach to Assessment and http://Mainosmemos.com
Intervention. AFB Press, NY, NY. 2007
Hyvarinen L, Jacob N. What and How does this Child See? Vistest, Ltd. Helsinki,
Finland. 2011
http://www.slideshare.net/DMAINO/
Brown, C. (2004). A guide for teachers and therapists working with my child.
Chapel Hill, NC: Early Intervention Training Center for Infants and Toddlers With https://www.facebook.com/Thinking
Visual Impairments, FPG Child Development Institute, UNC‐CH.
outsidethelightbox?ref=ts&fref=ts
Dominick M. Maino, OD, MEd, FAAO, FCOVD‐A
Professor of Pediatrics/Binocular Vision
Illinois Eye Institute/Illinois College of Optometry
Lyons Family Eye Care
Chicago, Il
dmaino@ico.edu
ICO.edu
LyonsFamilyEyeCare.com
MainosMemos.com
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