Characteristics of Patients Attending an Ophthalmic Outpatient Department at the Cerebral Palsy Association of Coimbra

Authors

  • Rosa Lomelino Pinheiro Integrated Responsibility Center for Ophthalmology, Hospital and University Center of Coimbra, Coimbra, Portugal
  • Liliana Cortez Integrated Responsibility Center for Ophthalmology, Hospital and University Center of Coimbra, Coimbra, Portugal
  • Catarina Paiva Integrated Responsibility Center for Ophthalmology, Hospital and University Center of Coimbra, Coimbra, Portugal; Coimbra Cerebral Palsy Association, Portugal;
  • Joaquim Neto Murta Integrated Responsibility Center for Ophthalmology, Hospital and University Center of Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, FMUC Academic Clinical Center of Coimbra, Portugal

DOI:

https://doi.org/10.48560/rspo.23784

Keywords:

Cerebral Palsy, Vision Disorders, Visually Impaired Persons

Abstract

Introduction: To assess visual impairment diagnosis, management, and consequences in patients with cerebral palsy at the Cerebral Palsy Association of Coimbra.

Methods:  This is a cross-sectional, descriptive study. A retrospective review of consecutive medical records was performed on 102 patients diagnosed with CP attending ophthalmology appointments between 2018 and 2019. The components of a detailed ophthalmologic evaluation, diagnostic tools, and methods to increase cooperation were recorded. We characterized cerebral palsy according to its etiology, type and resulting motor impairment. Visual function assessment included visual acuity, contrast sensitivity, stereopsis, and visual field. Ocular motility and anterior eye assessment with slit-lamp biomicroscopy results were also recorded. Performance on visual tasks such as eye hand coordination, visual spatial perception, and fix and follow were evaluated.

Results: The study included 102 patients aged from 10 months to 40 years. Regarding motor dysfunction classification, tetraplegia was the most prevalent type, followed by hemiplegia and diplegia. We found 60.8% of patients to have some degree of ocular disease. Visual field restrictions were found in 29.3% of patients, ranging from 30º to 100º, including restrictions superiorly and inferiorly. Contrast sensitivity mode was 1.25%. Saccadic and pursuit movement dysfunction was found in 13.7% and 15.6% of the cases. Eye-hand coordination was impaired in 16.6% of the patients.

Conclusion: Patients with cerebral palsy often present with visual disturbances. The ophthalmologist should be aware of the most frequent visual dysfunctions and how to diagnose them. Also, appropriate management to enhance visual performance can have a significant impact on social interaction, autonomy, and quality of life in these patients.

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References

Lew H, Lee HS, Lee JY, Song J, Min K, Kim M. Possible linkage between visual and motor development in children with cerebral palsy. Pediatr Neurol. 2015;52:338-343.e1. doi.org/10.1016/j.pediatrneurol.2014.11.009

Boyaci A, Aka A, Tutoglu A, Kandemir H, Koca I, Boyraz I, et al. Relationship among ocular diseases, developmental levels, and clinical characteristics of children with diplegic cerebral palsy. J Phys Ther Sci. 2014;26:1679–84.

Sewell MD, Eastwood DM, Wimalasundera N. Managing common symptoms of cerebral palsy in children. BMJ. 2014;349:g5474. doi: 10.1136/bmj.g5474.

Gulati S, Sondhi V. Cerebral Palsy: An Overview. Indian J Pediatr. 2018;85:1006-16. doi: 10.1007/s12098-017-2475-1.

Wimalasundera N, Stevenson VL. Cerebral palsy. Pract Neurol. 2016;16:184-94. doi: 10.1136/practneurol-2015-001184.

Saunders KJ, Mcclelland JF, Richardson PM, Stevenson M. Clinical judgement of near pupil responses provides a useful indicator of focusing ability in children with cerebral palsy. Dev Med Child Neurol. 2008;50:33–7.

Richards CL, Malouin F. Cerebral palsy: definition, assessment and rehabilitation. Handb Clin Neurol. 2013;111:183-95. doi: 10.1016/B978-0-444-52891-9.00018-X.

Ego A, Lidzba K, Brovedani P, Belmonti V, Gonzalez-Monge S, Boudia B, et al. Visual-perceptual impairment in children with cerebral palsy: A systematic review. Dev Med Child Neurol. 2015;57:46–51. doi: 10.1111/dmcn.12687.

Park MJ, Yoo YJ, Chung CY, Hwang JM. Ocular findings in patients with spastic type cerebral palsy. BMC Ophthalmol. 2016;16:1–6. doi:10.1186/s12886-016-0367-1

Saunders KJ, Little JA, Mcclelland JF, Jonathan Jackson A. Profile of refractive errors in cerebral palsy: Impact of severity of motor impairment (GMFCS) and CP subtype on refractive outcome. Investig Ophthalmol Vis Sci. 2010 51:2885–90.

Kozeis N, Panos GD, Zafeiriou DI, De Gottrau P, Gatzioufas Z. Comparative study of refractive errors, strabismus, microsaccades, and visual perception between preterm and full-term children with infantile cerebral palsy. J Child Neurol. 2015;30:972–5.

Lagunju I, Oluleye T. Ocular Abnormalities in Children With Cerebral Palsy. African J Med Heal Sci. 2007;36(1):71–5.

Sasmal N, Maiti P, Mandal R, Das D, Sarkar S, Sarkar P, et al. Ocular Manifestations in Children With Cerebral Palsy. J Indian Med Assoc. 2011;109:318-23.

Dufresne D, Dagenais L, Shevell MI. Spectrum of visual disorders in a population-based cerebral palsy cohort. Pediatr Neurol. 2014;50:324–8. doi.:10.1016/j.pediatrneurol.2013.11.022

Jacobson L, Rydberg A, Eliasson AC, Kits A, Flodmark O. Visual field function in school-aged children with spastic unilateral cerebral palsy related to different patterns of brain damage. Dev Med Child Neurol. 2010;52:2–5.

Jacobson L, Flodmark O, Martin L. Visual field defects in prematurely born patients with white matter damage of immaturity: A multiple-case study. Acta Ophthalmol Scand. 200684:357–62.

Mckillop E, Mbchb M, Dutton G. Impairment of vision in children due to damage to the brain:a practical approach. Br Ir Orthopt J. 2008;5:8-14.

Fonseca A. Neuroftalmologia Baseada na Evidência - “Neuropatias Ópticas Infecciosas.” . Lisboa: Sociedade Portuguesa de Oftalmologia; 2014.

Ego C, Orban de Xivry JJ, Nassogne MC, Yüksel D, Lefèvre P. Spontaneous improvement in oculomotor function of children with cerebral palsy. Res Dev Disabil. 2015;36:630–44.

Piña-Garza JE. Fenichel’s Clinical Pediatric Neurology.. 7th ed. Amsterdam: Elsevier; 2013.

Rafique SA, Northway N. Relationship of ocular accommodation and motor skills performance in developmental coordination disorder. Hum Mov Sci. 2015;42:1–14.

McClelland JF, Parkes J, Hill N, Jackson AJ, Saunders KJ. Accommodative dysfunction in children with cerebral palsy: A population-based study. Investig Ophthalmol Vis Sci. 2006;47:1824–30.

Avilés C, Páez JH, Rodríguez MT. Accommodation in children with cerebral palsy. J Am Assoc Pediatr Ophthalmol Strabismus. 2015;19:e35.

Pansell T, Hellgren K, Jacobson L, Brautaset R, Tedroff K. The accommodative process in children with cerebral palsy: Different strategies to obtain clear vision at short distance. Dev Med Child Neurol. 2014;56:171–7.

Ameri A, Mirmohammadsadeghi A, Makateb A, Bazvand F, Hosseini S. Clinical outcomes of botulinum toxin injection in patients with cerebral palsy and esotropia. Strabismus. 2015;23:8–13.

Jeon H, Jung JH, Yoon JA, Choi H. Strabismus Is Correlated with Gross Motor Function in Children with Spastic Cerebral Palsy. Curr Eye Res. 2019;44:1258–63.

Wainwright MS. Pediatric Neurologic Assessment and Monitoring. In: Zimmerman J, editor. Pediatric Critical Care. 5th ed. Amsterdam: Elsevier; 2011. p. 746–58.

Fazzi E, Signorini SG, La Piana R, Bertone C, Misefari W, Galli J, et al. Neuro-ophthalmological disorders in cerebral palsy: Ophthalmological, oculomotor, and visual aspects. Dev Med Child Neurol. 2012;54:730–6.

Ortibus EL, De Cock PP, Lagae LG. Visual perception in preterm children: What are we currently measuring? Pediatr Neurol; 2011;45:1–10.

Hellgren K, Jacobson L, Frumento P, Bolk J, Ådén U, Libertus ME, et al. Cerebral visual impairment captured with a structured history inventory in extremely preterm born children aged 6.5 years. J AAPOS. 2020 Feb 1;24(1):28.e1-28.e8.

Kozeis N, Anogeianaki A, Mitova DT, Anogianakis G, Mitov T, Klisarova A. Visual function and visual perception in cerebral palsied children. Ophthalmic Physiol Opt. 2007;27:44–53.

Duke R, Eyong K, Burton K, MacLeod D, Dutton GN, Gilbert C, et al. The effect of visual support strategies on the quality of life of children with cerebral palsy and cerebral visual impairment/perceptual visual dysfunction in Nigeria: Study protocol for a randomized controlled trial. Trials. 2019;20 :417. doi: 10.1186/s13063-019-3527-9.

Published

2021-06-30

How to Cite

Pinheiro, R. L., Cortez, L., Paiva, C., & Neto Murta, J. (2021). Characteristics of Patients Attending an Ophthalmic Outpatient Department at the Cerebral Palsy Association of Coimbra. Revista Sociedade Portuguesa De Oftalmologia, 45(2), 71–77. https://doi.org/10.48560/rspo.23784

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Original Article