Functional vision assessment in children with Cerebral Visual Impairment

Update Nov. 2024



This project is conducted under the supervision of Dr Nienke Boonstra, Prof.Dr.N Jansonius, Prof. Dr. A Cillessen and Dr Bianca Huurneman at the Royal Dutch Visio, Nijmegen in collaboration with Radboud University and aims to streamline the diagnostic criteria for children with CVI in order to improve the available Dutch guidelines.

Personal Background and Interest:

A master’s graduate in optometry and vision science at the Elite school of optometry, India with clinical experience in low vision, binocular vision, neuro ophthalmology and pediatric ophthalmology. My main research area is multidisciplinary diagnosis and rehabilitation of children with CVI.

Aims of the project:

The objective of my project is to improve CVI diagnosis in children structural and functional vision investigations. The resulting objectives are to 1) understand the relationship between birth-related characteristics and VR-QoL in adults in the general population 2) classify childhood CVI based on functional and structural measures; 3) understand relationship between a CVI etiological classification and functional vision outcomes measures; and 4) investigate the structural and functional correlates of childhood CVI.

Current activities:

Birth-related Characteristics Predict Vision-Related Quality of Life in Adulthood: Results from the Lifelines Biobank

In this study, I used the Lifelines biobank to study the relationship between birth-characteristics and VR-QoL in a general population. I found that participants with birth defects directly related to abnormal eye or brain development was the most powerful predictor of poor VR-QoL in most visual function subscale. I also found that individuals born early preterm were related to general vision and vision-specific social functioning, people born with high birth weight contributed to general vision problems and individuals born by vacuum or forceps mode of delivery were associated with poor scores in activities in low luminance. We conclude that at the level of the general population, birth-related characteristics are related to VR-QoL. To elucidate the underlying mechanisms, future studies could add visual function to the questionnaire outcomes.

Classifying childhood Cerebral Visual Impairment: the added value of an extensive test battery versus a limited test battery 

In this study, I included 51 participants. This resulted in four CVI subtypes for the extensive test battery (subtle characteristics, higher-level visual function deficits, lower-level visual function deficits, and higher- and lower- level visual function deficits) and three CVI subtypes for the limited test battery (subtle characteristics, higher-level visual function deficits, and higher- and lower- level visual function deficits). This data-driven study has provided meaningful CVI subtype classifications based on the outcomes of various key functional and structural measures in CVI diagnosis. Comparison of the extensive test battery to the limited test battery revealed the added value of an extensive test battery in classifying CVI. The outcomes of this study, therefore, have provided a new direction in the area of CVI classification.

Optic nerve and retinal changes and their relationship to visual fields in children with cerebral visual impairment 

I used 85 CVI children and 47 controls in this study. Thus far, we have found that children with CVI had thinner pRNFL thickness compared to the control group in the superior, nasal, inferior and temporal sectors. We also found thinner GCL+IPL complex thickness in the temporal superior, superior, nasal superior, nasal inferior, inferior and temporal inferior sectors, in children with CVI compared to controls We did not find statistically significant between eyes differences in pRNFL and GCL+IPL thicknesses between both groups (q<0.05). The reduced pRNFL and GCL+IPL complex thickness in children with CVI is attributed to possible retrograde transsynaptic degenerative damage along with the influence of onset, severity and extent of damage. This could be a crucial parameter in diagnosing children with CVI clinically.

Future directions:

Next steps would include investigating the structure-function correlates in children with CVI. Also, studying in detail the relationship between etiological classification and functional vision outcome measures with a larger sample size.

My OptiVisT experience:

To have been a part of a diverse consortium has been a great learning experience.  Through OptiVisT, I have been able to network, build collaborations with researchers. This has been a rewarding opportunity to visit various universities, labs and clinical centers.