Abstract
Purpose :
The purpose of this study was to determine physician prescribing and referral patterns in children with cerebral visual impairment (CVI). The secondary aim was to identify if visual acuity (VA), CVI severity or concurrent diagnoses affected glasses prescribing and visual rehabilitation referral patterns.
Methods :
A retrospective chart review was completed of all children with CVI examined at CCHMC from January 1, 2007 through March 1, 2018. Children with concurrent diagnosis of autism were excluded. The following data was collected: CVI diagnosis date, concurrent medical diagnoses, VA, refractive error, glasses prescription, visual rehabilitation referrals, and CVI range score 2. The CVI range was used as a surrogate to determine CVI severity.
Results :
199 patients were enrolled in the study. 95 (47.7%) had a refractive error that warranted a glasses prescription (group A). 92 (46.2%) did not have a refractive error that warranted correction and were not prescribed glasses (group B). 12 (6.0%) had a refractive error that warranted correction but were not prescribed glasses (group C). Visual acuity of group A (logMAR 0.79) and C (logMAR 0.96) were not statistically different (p-value=0.43). However, there is greater than one line difference between the groups: Snellen equivalents are 20/123 (A), and 20/184 (C). The mean CVI range score 2 were 5.8, 4.8, and 3.3 (p-value <0.03). Multiple logistic regression found only visual acuity had a significant impact on if a provider prescribed glasses (p-value=0.02). There was no difference in medical diagnosis of patients given glasses or a referral. 159 CVI range referrals were given at the initial CVI diagnosis, however, duplicate referrals were made. Physicians were more likely to give referrals at diagnosis visit.
Conclusions :
In our population 53.8% of CVI patients had refractive error that warranted correction. Less severe CVI patients were more likely to have refractive error and given glasses. Patients not prescribed warranted glasses had more severe CVI. In our practice children with very low visual functioning were not prescribed glasses as often, possibly limiting their visual rehabilitation. Changes should be implemented to ensure all CVI patients with refractive error are correctly being prescribed glasses to provide the best possible visual outcomes.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.