AP NEWS

CVI: The impairment affecting children whose eyes are fine

September 8, 2018

HATTIESBURG, Miss. (AP) — Tripp McCardle has had a tough go of it during his two years of life. When he was 8 months old, he contracted meningitis, starting a health journey on which he is still traveling.

One of the consequences he suffered from the disease was cortical vision impairment, or CVI. This occurs when the eyes are healthy and able to see, but the brain is not interpreting what is being visualized.

“He can see little slits of light, but it doesn’t have any meaning, any form,” said Martha McCardle, Tripp’s grandmother.

Fortunately for Tripp, he’s getting therapy from the only person in Mississippi to have undergone extensive training and experience working with children with CVI.

University of Southern Mississippi graduate Jillian Colon is the first official CVI Range Endorsee in the state. She sees children with the impairment at The Children’s Center for Communication and Development at Southern Miss.

“I knew she was really good,” McCardle said. “She worked with him so well on his eyes.

“I didn’t even know what CVI stood for, and she was very patient to explain it to me.”

When someone can’t see, the first inclination is to think there is a problem with the eyes. That impulse is not correct with CVI.

“CVI is when — due to some brain injury or damage, — the brain has difficulty processing visual information,” Colon said. “Kids (with CVI) will go to see if they need glasses and an exam will show their eyes are fine.”

In normal vision, the eye takes a picture of an object and sends the message to the brain via optic nerves. The brain recognizes the image and integrates it with other sensory messages such as hearing, touch, smell and taste.

In people with CVI, the eye takes a picture of the object and sends the message to the brain, but the message is not properly processed because of abnormal brain function. The condition is usually diagnosed by a neurologist or ophthalmologist.

Colon said certain habits of children with CVI may indicate they are experiencing the disorder.

“If the child likes to look out the window or look at the ceiling fan or is not making eye contact with you,” she said. “If you bring your hand to the child’s face, they may not blink.”

Children may also have distinct color preferences, preference for looking at lights, viewing objects up close and at odd angles, viewing moving objects and difficulty visualizing new surroundings or objects.

In Tripp’s case, he likes to look at lights and the colors red, yellow and hot pink. Colon uses this information to work with him. His grandmother has also used a red lollipop and a flashlight to stimulate him.

CVI is caused by anything that damages the visual parts of the brain. That can be a stroke, decreased oxygenation, decreased blood supply, increased pressure, seizure, metabolic disease, infection, head trauma or other neurologic disorders.

With so many causes of CVI, and an increasing number of premature babies surviving with brain injuries, Colon expects to be busy.

“There are a lot of kids who have these characteristics that haven’t been assessed or diagnosed,” she said. “I want to help as many kids as possible.

“I hope to meet these kids whose parents want help with their vision and meet with these therapists and provide knowledge about the subject.”

According to the National Institutes of Health, an estimated 10.5 percent of children with developmental disabilities have CVI. The condition is also prevalent in developing countries, where a large number of babies are born with oxygen deprivation.

Colon said some things can be done to help a child with CVI.

“At school or at their desk — give them a black background with a single object on it,” she said “Outline words in their favorite color.

“Reduce complexity in their environment — don’t have the child sit in front of a cluttered shelf. Turn them away from natural light.”

Vision can improve with CVI, but treatment of the underlying neurologic disease is essential. Then, as the brain matures, new connections can develop and the initial injury or deficit may be overcome.

For Tripp, who suffered several complications from his meningitis that could have caused CVI, little steps are meaningful.

“We’re extremely proud of him,” McCardle said. “Jillian is awesome with him.

“She had a silver salad bowl with dimples in it and the light would bounce off it. He responded to it. This might seem like small things to other people, but they’re major hurdles to us. We celebrate every one.”

Colon has hope that children like Tripp will improve with the right therapy.

“The children will always need some sort of adaptation little or big to use their vision the best they can,” she said. “We’re trying to get information about CVI out to more people so there is a better understanding of it, so children who are young and present the characteristics can get the interventions they need.

“The younger we start with these children, the better.”

At a glance

CVI: Cortical Vision Impairment is a decreased visual response caused by a neurological problem affecting the visual part of the brain.

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Information from: The Hattiesburg American, http://www.hattiesburgamerican.com

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