Galli Jessica, Loi Erika, Molinaro Anna, Calza Stefano, Franzoni Alessandra, Micheletti Serena, Rossi Andrea, Semeraro Francesco, Fazzi Elisa
Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy.
Front Hum Neurosci. 2022 Mar 2;16:750464. doi: 10.3389/fnhum.2022.750464. eCollection 2022.
Cerebral Visual Impairment (CVI) is a very common finding in children affected by Cerebral Palsy (CP). In this paper we studied the characteristics of CVI of a large group of children with CP and CVI, describing their neurovisual profiles according to three different age subgroups (subgroup 1: infants 6 months-2 years; subgroup 2: pre-school age 3-5 years; subgroup 3: school age ≥ 6 years).
We enrolled 180 subjects (104 males, mean age 66 ± 42.6 months; range 6-192 months) with CP and CVI for the study. We carried out a demographic and clinical data collection, neurological examination, developmental or cognitive assessment, and a video-recorded visual function assessment including an evaluation of ophthalmological characteristics, oculomotor functions, and basic visual functions. In school-aged children, we also performed an evaluation of their cognitive-visual profiles.
There were signs of CVI in all the three subgroups. Subgroup 1 (62 children) and subgroup 2 (50 children) were different for fixation ( = 0.02), visual acuity ( = 0.03) and contrast sensitivity ( < 0.01), being more frequently impaired in younger children. Comparing subgroup 2 with subgroup 3 (68 children), the older children presented more frequently myopia ( = 0.02) while the younger ones esotropia ( = 0.02) and alteration in smooth pursuit ( = 0.03) and saccades ( < 0.01). Furthermore, fixation, smooth pursuit, visual acuity, contrast sensitivity and visual filed ( < 0.01) were more frequently impaired in younger children (subgroup 1) compared to the older ones. Multiple correspondence analysis (MCA) confirmed the different neurovisual profiles according to age: younger children with CP showed more signs of CVI compared to the older ones. 34 out of 68 children belonging to subgroup 3 underwent the cognitive visual evaluation; an impairment of cognitive visual skills was detected in 21 subjects.
Younger children with CP showed more signs of CVI compared to the older ones, likely for the physiological maturation of visual system and mechanisms of neuroplasticity. In this direction, we suggest an early neurovisual evaluation to detect any weak visual functions.
脑性视觉障碍（CVI）在脑瘫（CP）患儿中非常常见。在本文中，我们研究了一大组患有CP和CVI的儿童的CVI特征，根据三个不同年龄亚组（亚组1：6个月至2岁婴儿；亚组2：3至5岁学龄前儿童；亚组3：≥6岁学龄儿童）描述了他们的神经视觉特征。
我们纳入了180名患有CP和CVI的受试者（104名男性，平均年龄66±42.6个月；范围6至192个月）进行研究。我们进行了人口统计学和临床数据收集、神经系统检查、发育或认知评估，以及视频记录的视觉功能评估，包括眼科特征、眼球运动功能和基本视觉功能的评估。在学龄儿童中，我们还对他们的认知视觉特征进行了评估。
所有三个亚组均有CVI体征。亚组1（62名儿童）和亚组2（50名儿童）在注视（P = 0.02）、视力（P = 0.03）和对比敏感度（P < 0.01）方面存在差异，年幼儿童更常出现受损。将亚组2与亚组3（68名儿童）进行比较，年龄较大的儿童近视更常见（P = 0.02），而年龄较小的儿童内斜视（P = 0.02）、平稳跟踪改变（P = 0.03）和扫视（P < 0.01）更常见。此外，与年龄较大的儿童相比，年龄较小的儿童（亚组1）在注视平稳跟踪、视力、对比敏感度和视野方面（P < 0.01）更常受损。多重对应分析（MCA）证实了根据年龄不同的神经视觉特征：与年龄较大的儿童相比，患有CP的年幼儿童CVI体征更多。亚组3的68名儿童中有34名接受了认知视觉评估；在21名受试者中检测到认知视觉技能受损。
与年龄较大的儿童相比，患有CP的年幼儿童CVI体征更多，这可能是由于视觉系统的生理成熟和神经可塑性机制所致。在此方向上，我们建议进行早期神经视觉评估以检测任何视觉功能薄弱情况。
