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L. Tychsen, F.F. Ghasia, J.E. Brunstrom; Prevalence of Visual Disorders in Cerebral Palsy and Correlation With GMFCS Ratings . Invest. Ophthalmol. Vis. Sci. 2006;47(13):790.
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© ARVO (1962-2015); The Authors (2016-present)
The aim of this study was to evaluate the prevalence of visual function anomalies in children with cerebral palsy and determine a correlation between severity of motor impairment and visual anomalies
Afferent visual pathway anomalies and oculomotor anomalies were systematically studied in a group of 50 patients. Motor impairment was rated according to the Gross Motor Function Classification System (GMFCS) in five levels of severity.
Cortical Visual Impairment, Optic atrophy/hypoplasia, Retinopathy of Prematurity (treated/complicated), Visual field defects, Amblyopia were included in the afferent visual pathway anomalies. Strabismus, Nystagmus and Gaze palsies/paresis were studied under oculomotor anomalies. Only optic hypoplasia (p value: 0.021, Fischer exact two tailed test) and gaze palsies (p value: 0.0469, Fischer exact two tailed test) were statistically significantly higher in patients with more severe CP (GMFCS 4–5) compared to those with less severe CP (GMFCS1–3). Refractive errors in all groups of patients were quantified into three categories (mild:0–2, moderate: 2–4, severe 5–6). Severe myopia was significantly higher in patients with severe CP (GMFCS 4–5). However, one–way ANOVA was performed on means of refractive errors of all patients in each subgroup of GMFCS ratings and none were statistically significant. Also, no statistical significanct difference was observed in the prevalence of astigmatism and anisometropia. In addition, binocular vision was quantified and graded as 0= no binocular vision, 1= prism vergence, 2= fusion, 3= stereopsis. Degree of binocularity was not statistically significantly different in the five GMFCS subgroups. (One way ANOVA p value: 0.7190).
These results indicate that prevalence of most of the visual anomalies do not increase with increasing severity of cerebral palsy. Also, there is no correlation between degree of binocularity and severity of CP. Thus, children with severe CP should not be mislabeled as cortically blind. Instead all children with CP regardless of severity of motor impairment should be treated with the same protocol and there should be no difference in the long–term treatment outcome particularly in terms of restoration of binocular vision amongst different GMFCS groups.
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