Cerebral Visual Impairment: which perceptive visual dysfunctions can be expected in children with brain damage? A systematic review

The current definition of Cerebral Visual Impairment (CVI) includes all visual dysfunctions caused by damage to, or malfunctioning of, the retrochiasmatic visual pathways in the absence of damage to the anterior visual pathways or any major ocular disease. CVI is diagnosed by exclusion and the existence of many different causes and symptoms make it an overall non-categorized group. To date, no discrimination is made within CVI based on types of perceptive visual dysfunctions. The aim of this review was to outline which perceptive visual dysfunctions are to be expected based on a number of etiologies of brain damage and brain development disorders with their onset in the pre-, peri- or postnatal period. For each period two etiologies were chosen as the main characteristic brain damage. For each etiology a main search was performed. The selection of the articles was based on the following criteria: age, etiology, imaging, central pathology and perceptive visual function test. The perceptive visual functions included for this review were object recognition, face recognition, visual memory, orientation, visual spatial perception, motion perception and simultaneous perception. Our search resulted in 11 key articles. A diversity of research history is performed for the selected etiologies and their relation to perceptive visual dysfunctions. Periventricular Leukomalacia (PVL) was most studied, whereas the main tested perceptive visual function was visual spatial perception. As a conclusion, the present status of research in the field of CVI does not allow to correlate between etiology, location and perceptive visual dysfunctions in children with brain damage or a brain development disorder. A limiting factor could be the small number of objective tests performed in children experiencing problems in visual processing. Based on recent insights in central visual information processing, we recommend an alternative approach for the definition of CVI that is based on functional visual processing, rather than anatomical landmarks. This could be of benefit in daily practice to diagnose CVI.