Medical Roadmap and Parental Expertise

The complete medical diagnosis and clinical evaluation process is of vital importance.

1. Neurological and Radiological Evaluation

CVI results from damage to the visual pathways or centers in the brain; therefore, the child should be followed by a pediatric neurologist.

• Neuroimaging (MRI or CT scan): Necessary to understand which regions of the brain are affected. However, it is important to remember that CVI can be present even if MRI results appear normal.

• EEG (Sleep and Awake): Requested to determine if treatable epileptic conditions (such as infantile spasms) are affecting vision.

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2. Comprehensive Eye Examination (Ophthalmological)

A pediatric ophthalmologist must examine the structure of the eye to identify "treatable" ocular problems.

• Refractive Errors and the Need for Glasses: Detection of conditions like myopia or hyperopia.

• Eye Movements and Alignment: Evaluation of conditions such as strabismus (eye misalignment) or nystagmus (involuntary eye movements).

• Ocular Structural Check: Examination of the cornea, lens (checking for cataracts), and retina to clarify whether vision loss stems solely from brain processing or from the eye itself.

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3. Functional Vision Assessment (FVA)

While clinical tests describe "how much the child sees," this assessment measures "how the child uses their vision in everyday life".

• Contrast Sensitivity: Testing whether the child can see low-contrast objects (e.g., rice on a white plate).

• Visual Field Tests: Determining from which angles (right, left, lower, upper) the child notices objects more effectively.

• Cognitive Vision Assessment: Through a process of structured history taking and systematic observation, the way a child interprets their visual world is identified. By determining how the brain’s different visual stations (the printer, the library, and the mapper) are functioning, this assessment ensures the selection of the most effective strategies to render the world 'visible' to the child

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4. Multidisciplinary Support Team

Because a child with CVI often has additional developmental needs, coordination with the following specialists should be established:

• Occupational Therapist (OT): For fine motor skills and eye-hand coordination.

• Physiotherapist (PT): For gross motor skills and the use of vision during movement.

• Speech and Language Therapist: To manage the impact of visual difficulties on communication.

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