Developmental Neurosciences Programme, UCL GOS Institute of Child Health University College London, London, UK.
Wolfson Neurodisability Service, Department of Neurosciences, Great Ormond Street Hospital For Children NHS Trust, London, UK.
Br J Ophthalmol. 2018 Apr;102(4):424-432. doi: 10.1136/bjophthalmol-2017-310694. Epub 2017 Nov 16.
The childhood condition of visual difficulties caused by brain damage, commonly termed cortical or cerebral visual impairment (CVI), is well established but has no internationally accepted definition. Clarification of its core features is required to advance research and clinical practice. This systematic review aimed to identify the definitions of childhood CVI in the original scientific literature to describe and critically appraise a consensual definition of the condition. MEDLINE, EMBASE, PsychINFO, CINAHL and AMED databases were searched in January 2017. Studies were included if they (1) were published original research, (2) contained a childhood CVI sample, (3) contained a definition of CVI and (4) described their CVI identification/diagnostic method. Thematic analysis identified concepts within definitions and narrative synthesis was conducted. Of 1150 articles, 51 met inclusion criteria. Definitions were subdivided according to detail (descriptive definition, description not reaching definition status and diagnostic/operationalising criteria). Three themes concerning visual deficits, eye health and brain integrity were identified (each containing subthemes) and analysed individually across definitions. The most common themes were visual impairment' (n=20), 'retrochiasmatic pathway damage'(n=13) and 'normal/near normal eye health' (n=15). The most consensual definition identified here may not be the best quality for advancing our understanding of CVI. We argue for the alternative definition: verifiable visual dysfunction which cannot be attributed to disorders of the anterior visual pathways or any potentially co-occurring ocular impairment. We propose reporting guidelines to permit comparison across studies and increase the evidence base for more reliable clinical assessment and diagnosis.
脑损伤引起的儿童视觉障碍的童年状况，通常称为皮质或大脑视觉障碍（CVI），已得到充分证实，但没有国际公认的定义。为了推进研究和临床实践，需要明确其核心特征。本系统评价旨在确定原始科学文献中儿童 CVI 的定义，以描述和批判性评估该疾病的共识定义。2017 年 1 月在 MEDLINE、EMBASE、PsychINFO、CINAHL 和 AMED 数据库中进行了搜索。如果研究符合以下标准，则将其纳入：（1）发表原始研究，（2）包含儿童 CVI 样本，（3）包含 CVI 定义，（4）描述其 CVI 识别/诊断方法。主题分析确定了定义中的概念，叙述性综合则进行了分析。在 1150 篇文章中，有 51 篇符合纳入标准。根据细节（描述性定义、未达到定义状态的描述和诊断/操作性标准）对定义进行了细分。在分析中确定了与视觉缺陷、眼睛健康和大脑完整性有关的三个主题（每个主题都包含子主题）。最常见的主题是“视力障碍”（n=20）、“视交叉后通路损伤”（n=13）和“眼睛健康正常/接近正常”（n=15）。这里确定的最常见定义可能不是推进我们对 CVI 理解的最佳质量。我们主张采用替代定义：可验证的视觉功能障碍，不能归因于前视通路障碍或任何潜在的并发眼部损伤。我们建议报告指南，以允许在研究之间进行比较，并增加证据基础，以便更可靠的临床评估和诊断。
