Visual function in children with hemiplegia in the first years of life
Andrea GuzzettaBarbara FazziEugenio MercuriBarbara BertuccelliRaffaello CanapicchiJ. Van Hof-Van DuinGiovanni Cioni
47
Citation
24
Reference
10
Related Paper
Citation Trend
Abstract:
The aim of this study was to evaluate the incidence of visual function abnormalities in children with infantile hemiplegia, and the relation between visual abnormalities and type of lesion, as shown by brain MRI. Visual function was tested (grating acuity, visual field size, binocular optokinetic nystagmus [OKN], and ocular movements) in a group of 47 children with congenital or early acquired hemiplegic cerebral palsy (mean age 25 months, range 8 to 52 months). The cohort was subdivided into four groups according to MRI findings: brain malformations (n=5), abnormalities of the periventricular white matter (n=20), cortical-subcortical lesions (n=16), and non-progressive postnatal brain injuries (n=6). More than 80% of the children showed abnormal results in at least one visual test: acuity was the least impaired function, while visual field and OKN were abnormal in more than 50% of the cohort. No specific correlation could be identified between the type and timing of the lesions and visual function. Unlike adults with stroke, visual field defects were not always related to contralateral damage in the optic radiations or in the visual cortex. These results indicate that visual abnormalities are common in children with hemiplegia, and that they cannot always be predicted by MRI. All children with hemiplegia need a detailed assessment of visual function.Keywords:
Optokinetic reflex
Visual Impairment
Objective
To determine the extent of visual acuity and visual field impairment in patients with types 1 and 2 Usher syndrome.Methods
The records of 53 patients with type 1 and 120 patients with type 2 Usher syndrome were reviewed for visual acuity and visual field area at their most recent visit. Visual field areas were determined by planimetry of the II4e and V4e isopters obtained with a Goldmann perimeter. Both ordinary and logistic regression models were used to evaluate differences in visual acuity and visual field impairment between patients with type 1 and type 2 Usher syndrome.Results
The difference in visual acuity of the better eye between patients with type 1 and type 2 varied by patient age (P=.01, based on a multiple regression model). The maximum difference in visual acuity between the 2 groups occurred during the third and fourth decades of life (with the type 1 patients being more impaired), while more similar acuities were seen in both younger and older patients. Fifty-one percent (n=27) of the type 1 patients had a visual acuity of 20/40 or better in at least 1 eye compared with 72% (n=87) of the type 2 patients (age-adjusted odds ratio, 3.9). Visual field area to both the II4e (P=.001) and V4e (P<.001) targets was more impaired in the better eye of type 1 patients than type 2 patients. A concentric central visual field greater than 20° in at least 1 eye was present in 20 (59%) of the available 34 visual fields of type 1 patients compared with 70 (67%) of the available 104 visual fields of type 2 patients (age-adjusted odds ratio, 2.9) with the V4e target and in 6 (21%) of the available 29 visual fields of type 1 patients compared with 36 (38%) of the available 94 visual fields of type 2 patients (age-adjusted odds ratio, 4.9) with the II4e target. The fraction of patients who had a visual acuity of 20/40 or better and a concentric central visual field greater than 20° to the II4e target in at least 1 eye was 17% (n=5) in the type 1 patients and 35% (n=33) in the type 2 patients (age-adjusted odds ratio, 3.9).Conclusions
Visual acuity and visual field area were more impaired in patients with type 1 than type 2 Usher syndrome. Of note, 27 of 53 type 1 (51%) and 87 of 120 type 2 (72%) patients had a visual acuity of 20/40 or better in at least 1 eye. These data are useful for overall counseling of patients with Usher syndrome.Visual Impairment
Cite
Citations (56)
THE PROBLEM OF SURGICAL INDICATIONS FOR PITUITARY CHROMOPHOBE ADENOMA, WITH AN ANALYSIS OF 305 CASES
Three hundred and five consecutive cases of pituitary chromophobe adenoma that had been operated and verified pathologically during the period from November 1954 to March 1977, were analyzed in respect to their visual function before and after operation, to study retropeotivdly the validity of the operation. The main aim of operation was to relieve the compression of optic nerve and optic chiasma caused by the pituitary tumor. Postoperatively, the immediate results gave an improvement of visual acuity in 62.2% and improvement of visual field in 58.3%. Suggestion proposed that the recovery rate had a definite relationship to the degree of impairment of visual acuity and visual field, to the duration of compression to the optic nerve and to the degree of atrophy of the optic disc. In other words, the less impairment of visual acuity and visual field, immediately prior to the operation, the higher would be the postoperative recovery rate. This statement was further substantiated by the following facts: (1) In cases with severe impairment in visual acuity and in visual field preoperatively, the recovery, if it should occur at all after operation, would not eventually reach to a useful degree. (2) In cases with very severe impairment of visual acuity before operation, the least trauma imflicted during operation or pneumoencephalography might be enough to cause total loss of sight, (3) In all of the 6 eyes in which visual acuity was fully recovered and in all of the 13 eyes in which visual field was fully restored, the change of optic fundus was slight and the duration of compression to the optic nerve was relatively short before of operation.This illustrated that early diagnosis and early treatment were the key problems in order to expect a better result. The time of surgical interference of our cases might be too late according to our previous indications. We held that operation should be done as an elective one as soon as the diagnosis had been settled regardless how the visual acuity and how the visual field was.
Fundus (uterus)
Visual Impairment
Optic chiasma
Chromophobe cell
Cite
Citations (0)
Abstract Background The prevalence of visual impairments in people with severe and profound multiple disabilities (SPMD) is the subject of considerable debate and is difficult to assess. Methods In a typical Dutch care organization, all clients with SPMD ( n = 76) participated in the study and specific instruments adapted to these clients (requiring a minimum of cooperation) were used to measure visual acuity, the visual field, binocular vision, contrast sensitivity, refractive errors and visual functioning behaviour. Results We found an unexpected 92% of clients with SPMD to have visual impairments. Previously, only 30% were known to have visual problems. None of the persons observed had normal visual acuity. Subnormal visual acuity was the best result. The severity of the visual impairment was related to the severity of the intellectual disability. In addition to the problem of acuity, impairments in the visual field, impaired contrast sensibility and impaired binocular functioning were found, as well as impaired visual attention, fixation and following. In 22% of the _clients observed, refractive errors were found and glasses were advised. Conclusions Consequences for caregiving and for modifications of the environment were discussed.
Visual Impairment
SPMD
Cite
Citations (56)
Craniopharyngioma
Cite
Citations (53)
It's presented a midline meningioma of anterior level case which preoperative has an importance affectation of the visual acuity and visual field, and postoperative in dynamic is founded the important improvement of visual acuity and visual field. It's discussed visual field topography and atrophy optic pathophysiology. It's a neuro-ophthalmology case example, where the cooperation neurosurgery-ophthalmology permit medical solution and restored in social life of the patient.
Visual Impairment
Cite
Citations (0)
Visual Impairment
Etiology
Monocular
Hysteria
Visual Disturbance
Cite
Citations (39)
Dear Editor, The visual disability in an individual is determined by calculating the percentage of visual impairment as per the guidelines of the Department of Empowerment of Persons with Disabilities (Divyangjan) of the Ministry of Social Justice and Empowerment, Government of India.[1] The percentage of visual impairment is calculated either on the basis of visual acuity or visual field, but there is an ambiguity in calculating the percentage for persons having advance field loss with preserved visual acuity. This poses a difficulty for ophthalmologists assigned with the job of visual impairment calculation and certification. A major drawback is that the guidelines do not consider visual fields until and unless visual acuity is less than 6/18. What if a person's visual acuity is well preserved (>6/18) and their visual field is severely restricted to <20°? Secondly in a one-eyed person (VA<3/60 in worse eye) with good visual acuity (>6/18) in better eye, visual field is not considered for calculation of visual impairment how severely the field might be affected. Third, the matrix only considers visual field of one eye unlike visual acuity of both eyes when calculating the visual impairment. And lastly, it is only the percentage impairment that is used to decide visual disability, but how that visual impairment affects the quality of life (QOL) of an individual does not find any mention. The categorization of disability in current guidelines is adopted from definitions of visual impairment and blindness used in the International Classification of Diseases (ICD) which were in fact used to code and classify diseases for clinical purposes.[2] Contrarily, the purpose of visual impairment and disability certification is socio-economic integration of a person with disabilities.[3] Both visual acuity and visual field are important psychophysical parameters of visual functions and independently affect vision-related QOL of an individual.[4] Hence, I feel the following points should be considered in the guidelines: When does visual field receive precedence over visual acuity in calculating visual impairment? The visual field of both eyes should be complemented to calculate visual impairment. In a one-eyed individual, the visual field of the better eye should also be mapped. How the visual impairment affects the QOL should be taken into consideration. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Visual Impairment
Cite
Citations (1)
Abstract. During the period 1962–1986, 54 patients received the diagnosis hysterical visual impairment, i.e. 1 out of every 631 patients admitted to our department. Isolated visual acuity impairment was the most common symptom, followed by combined visual acuity impairment and visual field constriction, whereas isolated visual field constriction occurred most infrequently. The mean age of the patients in the first group was significantly lower than that of the patients in the latter group. A questionnaire sent to all patients in 1987 was answered by 41 patients. Twenty‐one of these (51%) felt that their visual function now was good, whereas 20 (49%) claimed that their visual function was still poor. Nine patients (22%) were disabled because of their visual problems. Twenty‐nine of the patients who answered the questionnaire were re‐examined. Sixteen of these (55%) still showed visual impairment at the follow‐up, while 13 (45%) showed complete disappearance of visual complaints. The younger patients appeared to have a better prognosis than the older ones.
Visual Impairment
Cite
Citations (40)
Abstract Use of The Visual System section of the AMA Guides to the Evaluation of Permanent Impairment ( AMA Guides ), Sixth Edition, requires knowledge and skills in ophthalmology and assessing impairment. Visual acuity usually is measured using symbols (letters, numbers, pictures, or other symbols) presented in a letter chart format. The Visual Acuity Scale (VAS) is a linear scale with fixed increments and provides a reasonable estimate of acuity-related visual abilities; the associated impairment rating is a reasonable estimate of acuity-related performance loss. This article shows how to perform visual acuity calculations and how to assess impairment of visual fields, including visual field test procedures and calculations. Additional factors can lead to a loss of functional vision and can limit the individual's ability to perform activities of daily living and include contrast sensitivity, glare sensitivity, color vision defects, and binocularity, stereopsis, suppression, and diplopia. If functional vision is affected and is not accounted for by visual acuity or visual field loss, the impairment rating of the visual system can be adjusted but should be limited to an increase of the impairment rating of the visual system by, at most, 15 points (ie, less severe than the total loss of one eye). The ability to rate visual impairment requires significant knowledge and education, and therefore a physician trained in ophthalmology should perform the visual examination and visual system impairment rating.
Visual Impairment
Cite
Citations (0)
Visual Impairment
Subjective refraction
Cite
Citations (213)