Cortical visual impairment is usually associated with developmental delay or disabilities. It can be noted in infants/ children due to various reasons like prematurity, brain damage associated with stormy prenatal or birth conditions, trauma, brain injury, cerebral palsy or genetic syndromes etc.
These children have to be recognised early and examined / assessed for early intervention. If not intervened early, the children may suffer from permanent disabilities and lifetime consequences and eventually exclusion from mainstream and society. This will further worsen their cognitive, emotional, physical condition etc.
Usually neurologists, paediatricians refer these children to ophthalmologists / optometrist / rehabilitation specialist for complete evaluation. The tests involve functional vision evaluation which requires extensive training and guidelines for the clinician. The professional will understand not only the visual potential but also the associated motor disability, cognitive impairment and poor attention which are usually the challenge.
Interdisciplinary approach and team of professionals:
Family counselling especially for the parents is important to help them understand the need for this intervention and how to cope with the situation psychologically and support the child.
An interdisciplinary approach is recommended as the caregivers include vision rehabilitation professional, vision therapist, rehabilitation counsellor, special educator, orientation and mobility instructor, optometrist, low vison care specialist, speech therapist & language therapists, occupational therapists, physiotherapists, social workers.
Vision rehabilitation professionals provide therapy with the aim to engage child‘s residual vision as a tool for learning and exploring the environment. In the absence of vision, systematic therapy to use tactile and hearing sense to understand the environment. Tailor made approach to intervention and protocols will be followed by rehabilitation specialists to address difficulties with cognitive ability, hearing, speech and vision of the child.
Continued therapy, support services of government / non-governmental organisations, individualised educational plan, referral to inclusive and special schools are important in helping these children and their families.
Challenges:
The major challenges in India for access to such care are
- Lack of awareness
- Non availability of trained professionals
- Limited resources
- Lack of access to care in low socio economic or rural population
Vision-Aid is aimed at addressing all the challenges and improving care and training of infants and children to improve visual processing skills.
References:
Jayaraman, D., Jacob, N., & Swaminathan, M. (2021). Visual function assessment, ocular examination, and intervention in children with developmental delay: A systematic approach – Part 2. Indian Journal of Ophthalmology, 69(8), 2012. https://doi.org/10.4103/IJO.IJO_2396_20
Swaminathan, M., Jayaraman, D., & Jacob, N. (2019). Visual function assessment, ocular examination, and intervention in children with developmental delay: A systematic approach. Part 1. Indian Journal of Ophthalmology, 67(2), 196. https://doi.org/10.4103/IJO.IJO_524_18