The previous two blogs in this series pointed out that history taking is important in children with visual difficulties. The presence of complications before, during or after birth, and any medical or developmental diagnoses are important elements in paediatric history taking, and can also highlight risk factors for CVI. If a child has visual difficulties, which cannot be explained by their eye condition, a CVI screening assessment is indicated. This can highlight if an in-depth assessment is recommended to identify specific visual difficulties and to offer appropriate adaptive strategies.

Down’s syndrome, cerebral palsy, general developmental delay, autism, ADHD and many more neuro-developmental conditions and behavioural diagnoses are associated with difficulties in seeing and interpreting the visual world, also known as cerebral vision impairment (CVI). Because of the high prevalence of CVI in children with additional support needs, it is particularly important to take any parental concerns about their child’s vision seriously, including when the sight test was normal. Optometrists have a unique opportunity to identify children at risk, and to refer those children for screening and/or a comprehensive CVI assessment.

In my last blog, I explained that visual function assessment is important in children as certain visual dysfunctions are more common in children with CVI. Whilst visual dysfunctions should alert a practitioner to the possibility of CVI, a significant proportion of children with CVI have normal eye test results.

When a child attends for an eye examination with visual difficulties, it is important to rule out ocular causes before these difficulties can be assigned to neurological or neurodevelopmental causes. In this blog, my focus is not the routine eye examination, but rather the elements of the sight test that deserve extra attention when CVI is suspected. Additionally, I will provide an overview of dysfunctions related to higher visual processing.

‘What is the leading cause of sight impairment in children in Western countries?’