Dr.Muralidhar Rajamani,
Abstract
Context:Parents are the main caregivers for children with cortical visual impairment (CVI) and it is important to assess their knowledge before planning any intervention programme
Aims:To assess the knowledge of parents of children with CVI through a questionnaire based survey
Settings and Design:Hospital based prospective study
Methods and Material:A 12 point questionnaire was administered to parents of children with CVI attending therapy clinic for the first time. Their responses were recorded in a Excel sheet.
Results:A total of 15 parents responded. Only three felt that CVI was due to
brain damage and the rest opined that it was due to damage to the brain, eye and opticnerve. All agreed that CVI can be treated only by vision training by a qualified therapist.10/15 felt that their children could be sent to a normal school. All parents felt that the childperformed better in a uncluttered environment. 12/15 recognized that their child hadproblems with orientation and motility. None of the parents were aware of the duration of therapy for CVI
Conclusions:Parents have fair knowledge of CVI and this can be used to the therapist’s advantage. There are however lacunae in their knowledge esp on the etiology and duration of treatment and this needs to be attended to
Introduction
Cortical visual impairment (CVI) in children is a disorder in which there is impairment in the visual acuity and functional vision including motor planning due to retrochiasmal visual tract disorder. CVI is a common cause of bilateral visual impairment during childhood in many developed countries. The AAPOS mentions cortical visual impairment as one of the leading cause of visual impairment in children. Data on the prevalence of CVI in India are scarce. Considering the high incidence of perinatal risk factors of CVI like perinatal hypoxia in India, the problem however is likely to be of equal or greater magnitude1
Treatment of cortical visual impairment hinges at early identification and intervention. Treatment involves multi-specialty coordination. The duration of therapy is long and requires commitment from all involved.2-4A recent study testing the knowledge of ophthalmologists attending a zonal ophthalmology conference showed that the respondents had limited diagnosis on the etiology, treatment and prognosis of CVI. The study stressed the need to improve the awareness of CVI among ophthalmologists.1 Parents are the immediate caregivers and play an equally important role in managing children with CVI. Our study aims to check the awareness of CVI among parents of affected children
Material and Methods:
A 12 point questionnaire was administered to parents of children attending the vision rehabilitation clinic of our hospital before attending therapy sessions. Only parents of children attending the clinic for the first time were included. Parents were asked to select yes/no for some questions and to select from the options given for the others. The responses were collated and analysed after removing all personally identifying information.
Results:
A total of 15 parents consented to participating in the study. Only 3/15 patients mentioned that CVI is due to brain damage. 3/15 felt that CVI was due to damage to the nerves of the eye. One parent said he did not know the cause for CVI and the rest opined that CVI was due to damage to all three (brain, eye, nerve of the eye). All parents agreed that CVI can be treated. All parents opined that CVI can only be treated by vision training and not by other means. 14/15 parents said that this involved a therapist with experience in vision training.
None of the parents knew the duration of treatment. 10/15 parents felt that their child could be sent to a normal school. All parents felt that their child had problems with clutter/distance and that their child performed best in a familiar uncluttered environment. 3/15 felt that their child did not have problems with orientation and mobility while the others reported that the child did have a problem. All parents acknowledged the child’s preference to look at movement/light/shiny paper. 13/15 parents said that their child had a colour preference toy. 13/15 parents reported that their child looks/reaches out by turning his/her head to one side.
Discussion
It is imperative for the vision therapist to assess the parent’s knowledge and to build the therapy sessions modelled on that. To the best of our knowledge there is no study that addresses the awareness of parents of children with CVI. The following key words were used “CVI, parents, questionnaire”.
Our study shows that parents have a fair level of knowledge on their child’s condition. Most parents were aware of the child’s problem with clutter/unfamiliar environments/mobility. Parents were also aware of the child’s colour preference for toys and shiny paper/movement/light. Most parents acknowledged the child’s problems with orientation and mobility. This can be stepping stones for a successful rehabilitation programme and the vision therapist can build on this.
Of concern is the fact that most parents had limited knowledge on the etiology of CVI. In a recently published paper Maitreya et al had highlighted that many ophthalmologists also had limited knowledge of CVI in children.1Thisis of concern for programmes aimed at reducing the incidence of CVI. None of the parents were aware of the duration of treatment. As therapy for CVI is likely to be prolonged, it is important for parents to have long term commitment.
The limitations of our study are the small number of respondents. The study was conducted in an urban centre and it is likely that parents had more access to information than what they would have had in a rural setting. Nevertheless our study highlights the fact that most parents had a good knowledge of CVI. Empowering them with further information on this subject would have a positive impact on intervention programmes.
References:
- Maitreya A, Rawat D, Pandey S. A pilot study regarding basic knowledge of “cortical visual impairment in children” among ophthalmologists.Indian J Ophthalmol.2018 Feb;66(2):279-284
- Lehman SS. Cortical visual impairment in children: identification, evaluation and diagnosis.CurrOpinOphthalmol 2012; 23:384‑7.
- Pawar N, Ravindran M, Ramakrishnan R, Maheshwari D. Pediatric cortical visual impairment: Etiology, associated findings, and prognosis in a tertiary eye care setting in South India . JCOR 2018; 6(2): 53-58
- Matsuba CA, Jan JE. Long-term outcome of children with cortical visual impairment. Dev Med Child Neurol. 2006 Jun;48(6):508-12.
| QUESTIONS |
| 1. What do you think is the cause of CVI?
(damage to the brain/eye/nerve of the eye/all of these)- tick the appropriate response |
| 2. Do you think CVI can be treated?- yes/no |
| 3. If yes, how? (medicines,surgery,vision training) – tick the appropriate response |
| 4. Do you think any physiotherapist can manage CVI? or do you think a specialized person with experience in vision training is needed? |
| 5. How long would treating CVI take? |
| 6. Do you think children with CVI can be sent to a normal school ? Yes/no |
| 7. Do you think children with CVI would perform better in a familiar uncluttered environment? |
| 8. Does your child have problem with clutter/ distance? |
| 9. Does your child have problems in orientation / mobility? |
| 10. Does your child have preference to look at movement/ light or shiny objects? |
| 11. Does your child look out and reaching by turning head to one side? |
| 12. Does your child have a color preference toy? |
Leave a Comment