Neuro-ophthalmological disorders in cerebral palsy: ophthalmological, oculomotor, and visual aspects.

AIM Cerebral visual impairment (CVI) is a disorder caused by damage to the retrogeniculate visual
pathways. Cerebral palsy (CP) and CVI share a common origin: 60 to 70% of children with CP also
have CVI.We set out to describe visual dysfunction in children with CP. A further aim was to establish
whether different types of CP are associated with different patterns of visual involvement.
METHODS A total of 129 patients (54 females, 75males;mean age 4y 6mo, SD 3y 5mo; range
3mo???15y) with CP (51 with diplegia, 61 with tetraplegia, and 17 with hemiplegia; 62 [48%] of participants
were able to walk) and CVI enrolled at the Centre of Child Neuro-ophthalmology (at the
Department of Child Neurology and Psychiatry, IRCCS ???C. Mondino Institute of Neurology???, University
of Pavia) underwent an assessment protocol including neurological examination, developmental
and ??? or cognitive assessment, neuro-ophthalmological evaluation including
ophthalmological assessment, evaluation of visual acuity, contrast sensitivity, optokinetic nystagmus,
visual field and stereopsis, and neuroradiological investigations.
RESULTS Visual dysfunction in diplegia was characterizedmainly by refractive errors (75% of
patients), strabismus (90%), abnormal saccadic movements (86%), and reduced visual acuity
(82%). The participants with hemiplegia showed strabismus (71%) and refractive errors (88%);
oculomotor involvement was less frequent (59%). This group had the largest percentage of
patients with altered visual field (64%). Children with tetraplegia showed a severe neuroophthalmological
profile, characterized by ocular abnormalities (98%), oculomotor dysfunction
(100%), and reduced visual acuity (98%).
INTERPRETATION Neuro-ophthalmological disorders are one of themain symptoms in CP.
Each clinical type of CP is associated with a distinct neuro-ophthalmological profile. Early and
careful neuro-ophthalmological assessment of children with CP is essential for an accurate
diagnosis and for personalized rehabilitation.