1/7/2025
Cerebral Visual Impairment Education: Training and Current Practice Patterns of Optometrists and Ophthalmologists
Rice, M.L., Harpster, K., Bulman, J., Shah, V., & Schwartz, T.L. (2024). Cerebral Visual Impairment Education: Training and Current Practice Patterns of Optometrists and Ophthalmologists. JVIB, 118(6), 383-394.
Cerebral Visual Impairment or CVI is now the number one cause of visual impairment in developed nations and is increasing in prevalence in developing countries. The authors of this article investigated the knowledge and training that optometrists and ophthalmologists have in diagnosing and prescribing treatment for CVI. They stated that there is a lack of consensus about diagnostic criteria, the heterogenous nature of brain pathology, and symptoms. Unfortunately, late diagnosis causes delays in development in children due to the lack of early intervention and educational services. This has led to frustration among parents who continue to seek a diagnosis and help for their children.
The researchers put together a survey that looked at four major points.
1) Explore the availability, nature, and extent of didactic education about CVI during optometry degree (OD) programs and ophthalmology (MD) residencies.
2) Examine the clinical education and hands-on experience in caring for children with CVI throughout the course of optometry training, including optional residencies and in ophthalmology training including residency and optional fellowship training.
3) Quantify familiarity with CVI.
4) Estimate frequency of diagnosing CVI in clinical practice and identify diagnostic testing and assessments used to confirm the diagnosis.
The survey that was designed included the following questions.
*Highest degree obtained;
*Familiarity with CVI;
*Number of class hours of formal
didactic CVI instruction if received;
*Clinical training in CVI;
*Frequency of diagnosing CVI in
Practice;
*Information used to diagnose;
*Referral practices for patients with
CVI;
*Follow-up frequency;
*Number of years practicing;
*Country of professional training and
current practice.
334 doctors completed the survey with 147 (44%) ophthalmologists and 187 (56%) optometrists. The doctors’ principal training and practice were in North American (with Canada and the U.S. being the primary countries), Europe, Oceania, and Asia. Most of the ophthalmologists had been in practice for 20-30 years and the optometrists for over 30 years.
59% of the participants were moderately to extremely familiar with CVI. 31% received formal classroom instruction on CVI during their training programs, but this included less than 1-2 hours of lecture time. 14% had over 10 hours of instructional time and 38% received some clinical training on CVI.
65% reported that they diagnosed CVI in their practices; however, the majority diagnosed CVI infrequently from once a month to once a year. 21% stated they diagnosed CVI on a weekly basis, and 3% of doctors diagnosed CVI daily.
Tools used to diagnose CVI included
*a complete eye exam (97%);
*medical history (96%);
*neuroimaging (63%);
*screening questionnaires (39%);
*tests of visual processing (29%).
Follow-up after the diagnosis varied with 67% of the doctors following up every 6 months; 21% on a yearly basis; and 5% “as needed”. If there were referrals made after the diagnosis, these included early intervention, education services, as well as the local association for individuals who are blind or have low vision.
Clinical directors of 48 optometry and ophthalmology programs were also surveyed. Less than half listed any training on CVI, with program directors stating that clinical training in CVI was rarely provided.
One of the results from the study was that ophthalmologists had more knowledge and experience with CVI than optometrists. No matter the current experience, CVI is extremely diverse in nature and difficult to convey in a 1-2 hour lecture. This study found that there is an incredible need to rectify the lack of training in CVI both in the classroom, and especially with follow-up clinical training. The need for doctors to form partnerships with an interdisciplinary team to help assess and decide on instructional strategies for the child is paramount. The researchers suggested that the team would include a pediatric ophthalmologist or optometrist, teacher of the visually impaired, occupational therapist and parents of the child. Other therapists and classroom teachers should be brought in to help meet specific needs and design the intervention plan.
Editor’s note: According to the statistics in this article, we still have a long way to go with doctors who have little experience with CVI. My best experiences with ophthalmologists and low vision optometrists who have diagnosed children with CVI, have been with those who work closely with TVIs. They are willing to exchange information on CVI and listen to the parents and the TVI about the child’s behavior in settings outside the doctor’s office. I remember a conversation years ago with Dr. Timothy Saunders (pediatric neuro-ophthalmologist with CEENTA for many years).
Me: Since he started walking with his walker, his vision has dramatically improved. Why would that be?
Dr. S: I was going to ask you the same thing?
We laughed and then discussed the nature of peripheral vision and movement. This was prior to specific CVI research concerning mobility, movement, and increased vision.
The one take away from this article besides the need for our docs to be better informed about CVI is –
get to know your eye doctors. Try to form a relationship of trust. It’s then that you can hopefully begin mutual discussions about students with CVI.
Braille Challenge
The Braille Challenge is coming. North Carolina is proud to host two regional competitions. More information from the national level can be found on the Braille Institutes Braille Challenge website. Below is information to get prepared for the North Carolina Challenges. Get Ready to Braille !!!
2025 Eastern North Carolina Braille Challenge
When: Monday, February 17, 2025
Time: 9:00am to 4:00pm
Location: Governor Morehead School
Address: 301 Ashe Avenue, Raleigh, NC 27606
Regional Coordinator: Joshua Berkov
Registration is open now through Tuesday, January 21, 2025
2025 Western North Carolina Braille Challenge
When: Thursday, February 27, 2025
Time: 8:30am to 2:30pm
Location: At Tracy’s Little Red Schoolhouse at IFB Solutions
Address: 7676 Phoenix Drive, Winston-Salem, NC 27106
Regional Coordinator: Kim Shoffner
Registration is open now through Tuesday, January 21, 2025
Crowd-Sourced Lesson Library
Looking for lessons to help spark interest with your students (as well as yourself)? Or do you want to share all the wonderful, creative ideas you have with your fellow TVIs and O&Ms? The Lesson Library with Paths to Technology may be what you need. Originally begun during COVID due to the need for digital/virtual lessons, The Lesson Library now contains lessons on about any topic you can imagine and may need to teach children with visual impairment or blindness. There are specific instructions for how you can submit your own lessons, as well.
Deaf/Blind Census 2025
By Yvonne Franz
Here are a few things to remember about the D/B census.
When: Now until Feb. 14, 2025
Who: Any VI student who also has a hearing impairment OR Central Auditory Processing Disorder.
(Note: Many of my MU students are on the D/B census due to the auditory processing part of their disability.)
Where: In ECATs under Deaf/Blind Census in the documents section of each student.
Why: An accurate count is important to generate federal money to help parents, students and staff attend workshops and get support at no cost.
Here’s the link to watch the information provided by DPI. The D/B part starts at 8:50 minutes into the video.
https://www.youtube.com/watch?v=qWxmJRs0UTI
