Visual Impairments in Infants

One example of a maternity complication that has the potential to cause visual impairments is where the infant has been starved of oxygen at the time of delivery (hypoxic ischemic encephalopathy.)

It is common for these children to suffer with cerebral visual impairments (CVI), a brain based visual processing disorder.

What is CVI?

CVI is caused by damage to the visual cortex, the area of the brain responsible for sight, and by damage to the visual pathways within the brain (optic chiasm, optic tracts, lateral geniculate bodies, and optic radiations). It is typically seen in children who display abnormalities on an MRI scan within these areas of the brain.

There is currently no proven treatment to improve visual function in CVI. Children with CVI may require interventions such as environmental modifications to reduce clutter, and support from specialists such as occupational therapists, adaptive technology experts, and with orientation training.

If your child has suffered a brain injury as a result of clinical negligence, this is support that Forbes may be able to prove is required, and fund it through a claim for damages.

Effects on Children

CVI can have a massive impact on the child in day-to-day life. It may affect their ability to communicate, navigate, and perform day to day activities such as reading and writing, and their ability to learn and progress at school. It may prevent or make it more difficult for the child to pursue a particular career, and may impact on their ability to live independently. Additional care needs are often created as a result of this disorder. In extreme cases, it may lead to complete visual impairment.

The affects of CVI on visual function will depend on its severity, and the site of the brain damage.

Visual Field Defects: These can vary from hemianopia (loss of half the visual field) to inferior field defects. As a result, children with the condition may find it difficult to walk without tripping over.

Difficulty with Complex Visual Scenes: Children with CVI may find it difficult to interpret backgrounds with large quantities of objects and will find it easier to look at objects that are close up, as opposed to objects that are perceived at a distance.

Recognition Issues: Children with CVI may struggle to recognise familiar faces or objects. This makes it difficult for these children to interact with others. They may also struggle to adapt to their surroundings.

Impaired Depth and Motion Perception: As a result of this, day to day activities are challenging and require concentration over and above what is required from a neurotypical child. It may be difficult for children to engage in sports and exercise, as well as to do simple tasks such as walking down the stairs.

As a result of their visual impairments, children with CVI may often appear clumsy, find it difficult to engage, interact in social situations, and to navigate. They may struggle to recognise people that they have met previously.

Ocular Issues caused by CVI:

-          CVI typically causes visual field defects, which can include hemianopia (loss of half of the visual field), or inferior visual field defects, or inferior visual field neglect (leading to an inability to perceive objects in their lower visual field.)

-          Squint is common with children who have CVI. 50% of children with Cerebral Palsy are likely to suffer with a squint.

-          Nystagmus (where the eyes cannot focus and move rapidly backwards and forwards).

-          Amblyopia (where sight is reduced in one eye).

As the eye itself is not the cause of CVI, children with CVI will not demonstrate abnormality on an ocular examination. A such, in order to diagnose three criteria must be present:

-          History of birth injury causing injury to the brain

-          Evidence that the child struggles with functional difficulty in day-to-day life

-          Evidence of visual difficulties on examination

Other visual impairments that can be caused by Maternal Complications:

Retinopathy of Prematurity (ROP)

-          Premature infants or infants with very low birth weights are at risk of developing retinopathy. Doctors should ensure that they do all that they can to prevent a baby from being born premature, by ensuring that they monitor conditions associated with prematurity such as pre-eclampsia and diabetes.

-          ROP is common in premature babies, affecting about 65% of babies less than 1251 grams birthweight. The condition is usually very mild and settles on its own without treatment, but in some infants, ROP may need treatment if it does not resolve spontaneously. If untreated, severe ROP can seriously affect the infant’s sight and can cause blindness.

What are the risks?

-          The more premature the infant, the greater the risk of ROP.

How do you prevent it, spot it and treat it?

-          It is necessary to screen babies for ROP who are under 32 weeks gestation, and who weigh less than 3 pounds at birth.

-          During the screening an ophthalmologist will examine the infant’s retina.

-          If ROP is mild, there will need to be a follow-up examination 1 to 2 weeks later. If the follow-up examination shows it has not become worse, the ROP will settle on its own. More severe ROP will require an earlier re-examination, usually in a week. In a very few cases the ROP may be severe enough to require laser treatment, injections, scleral buckle surgery, or vitrectomy.

-          Retinopathy can also be caused by doctors exposing infants to too much oxygen during, or after, the birth. Medical professionals should ensure that the level of oxygen is controlled.

What can it cause?

-          Retinopathy can lead to visual impairments in infants such as retinal detachment, myopia, glaucoma, and blindness.

If you or anyone you know feels that they may have experienced any of the issues outlined in this article relating to birth injury and eye claims, and would like to discuss this, please contact the Clinical Negligence Department on 0800 0374625. A member of our team will be happy to assist.