Made of Gray

Cortical Vision Impairment

Holly D Gray7 Comments
We have been trying to get vision therapy for Caleigh for a couple of months now. ECI moves so slow and then we found out that VT (vision therapy) is only offered through our local school district. We finally got the evaluation 2 weeks ago, and last week the therapist (VT) and operations and mobility specialist (OMS) came to our house to talk about their findings.

I knew something was going on with Caleigh's vision and after lots of research and a trip to the eye doctor awhile back I self diagnosed her with CVI. Many and most children with PVL have some sort of cortical vision impairment. Our eye doctor didn't want to diagnose Caleigh yet, but I wanted therapy to start asap. So I went through our ECI coordinator to get the paper work from him. It took 2 months.After evaluating Caleigh for a little over an hour in our house, the VT and OMS returned last week to go over the assessment and talk about goals and plans. Caleigh does have CVI {not news to us} but they did break down the characteristics that she exhibited.

I've colored the characteristics that Caleigh has in red.

APPEARANCE

Does not look blind

Blank facial expression

Lack of visual communication skills

Eye movements smooth, but aimless

VISION FUNCTION

Visual function varies from day to day or hour to hour

Limited visual attention and lacks visual curiosity

Aware of distant objects, but not able to identify

Spontaneous visual activity has short duration

Visual learning tiring

Closes eyes while listening

Looks away from people and objects

Consistently look to either side when visual looking

When visually reaching looks with a slight downward gaze

Turns head to side when reaching, as if using peripheral fields

Uses touch to identify objects

MOBILITY SKILLS

Occasionally "sees" better traveling in a car

Difficulties with depth perception, inaccurate reach

Unable to estimate distances

Difficulties with spatial interpretation

Avoids obstacles, but unable to use vision for close work

IMPROVED VISUAL PERFORMANCE

When in familiar environments and when using familiar objects

When told "what" to look for and "where" to look

When objects are held close to eyes when viewing

When objects are widely spaced

When looking at one object verses a group of objects

When color is used to assist in identification of objects or shapes

When objects are against a plain background and paired with movement and sound

The ones not red are mainly because Caleigh is too young to assess.

Caleigh also has Esotropia. Esotropia is the most common form of strabismus in infants, a condition that refers to any misalignment of the eyes. In the case of esotropia, one eye deviates inward toward the nose while the other fixates normally. You can see it in the picture above. Basically, when the eyes aren't aligned the person usually sees double images. We have an eye doctor appointment the beginning of December. To fix esotropia usually the child wears a patch over their strong eye for a certain amount of time per day to strengthen the weaker eye. I had already asked about this in August, but was told we should wait. I'm going to insist this time around and if we don't get the answer we are looking for then we'll have to choose a new doc. Our vision therapist is scheduled to come twice a month.

Ok, so in a nut shell Caleigh responds to objects within about 18 inches. She glances at objects for only 1-2 seconds at a time then turns away. She can track toys on a horizontal access about 6-12 inches away. Although, her tracking is very slow and jerky. In a seated position Caleigh doesn't visually reach for toys. Laying down she feels for toys and grabs for them. She is very in tune audibly to what is going on and turns to noises quickly.

Caleigh's Cortical Vision Impairment, otherwise known as Neurological Vision Impairment, is from her brain injury. Caleigh's eyes themselves are fine. The problem lies within the brain. There is a scale that they measure CVI by. Using the above characteristics the scale goes from 10 being normal vision and 0 being blind. Caleigh was ranked at 2-3, which means that she displayed a significant number of visual behaviors consistent with CVI.

CVI is faceted in many ways. It is many times described like looking through a piece of swiss cheese. Some children can't see anything to the right of their nose. Some can only see a tunnel straight in front of them. Some down, some up, etc. Tunnel vision, which ever it may be, is a very common thing. Caleigh is always looking down. It looks like she is closing her eyes or is sleepy. People are always saying "oh, she's sleepy" or "oh, she's falling asleep." That drives me nuts because I feel like I have to explain, but most of the time I just agree. So NO, my baby is not sleepy all the time. We aren't sure how much and where Caleigh can see, but for now we think that her looking down is an indication. She also has photophobia, which is a dislike for bright lights. Many times kids with CVI gaze at lights, but Caleigh closes her eyes and ducks her head. It takes her a long time to get used to moving from one lighting situation to another. I've added links to more information in the Brain Food section, on the right hand sidebar of this blog.

Here's an example. In this photograph, Caleigh is actually looking at her hand. She is trying to get it to her mouth, but it looks like her eyes are closed.So, I know this is a lot of information. It is for us too. Talk of braille, tactile feeling, mobility specialists, patching, glasses, Texas State School for the Blind, special toys & books.....it's a lot. God has freed up our time away from TPN to work with Caleigh's cerebral palsy, and all it holds, head on. It is said that vision can be worked on and corrected until the age of 8. We have a long road of therapy ahead, but we already knew that.

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