Which one of the following does
not indicate visual problem in the
children
Answers
Answer:
where are the options ???.............
Children with disability are at a substantially higher risk of visual impairment (VI) (10.5% compared with 0.16%) but also of ocular disorders of all types, including refractive errors and strabismus. The aetiology of VI in children with disability reflects that of the general population and includes cerebral VI, optic atrophy, as well as primary visual disorders such as retinal dystrophies and structural eye anomalies. VI and other potentially correctable ocular disorders may not be recognised without careful assessment and are frequently unidentified in children with complex needs. Although assessment may be more challenging than in other children, identifying these potential additional barriers to learning and development may be critical. There is a need to develop clearer guidelines, referral pathways and closer working between all professionals involved in the care of children with disability and visual disorders to improve our focus on the assessment of vision and outcomes for children with disability.
Keywords: Neurodisability, Ophthalmology, Paediatric Practice
Introduction
Visual impairment (VI) is relatively rare among childhood disabilities, with a cumulative incidence of severe VI (SVI) in the general population of 6 per 10 000 by 16 years of age; in over 75% of children, visual loss occurs in the context of significant non-ophthalmic impairments or disorders.1 However, in children with complex or multiple disabilities, visual and indeed ocular problems are relatively common but may be overlooked as the focus may be on other aspects of health or management.2 3
The higher prevalence of visual disorders in children with developmental disabilities is accounted for by the many underlying causes of their disability with prenatal and perinatal factors and acquired injury all of relevance. Therefore, visual disorders are particularly increased in children born preterm, children who have suffered brain damaging events with subsequent learning difficulty and/or cerebral palsy (CP) and children who have congenital cerebral anomalies or other genetic syndromes that may predispose to ocular anomalies. Children who have primary visual disorders may also be at risk of later disability.4
An overview of the various disorders that may affect the visual system in children with a disability is presented, with a focus on those at particularly high risk. Visual assessment can be challenging in this group of children and a practical approach to assessment will be outlined.
Definitions of VI and other terms are given in online supplementary appendix 1.
Which children are at most risk of visual difficulty?
Children born preterm
Children born preterm are at risk of brain injury, with periventricular leukomalacia (PVL), the most common brain lesion. Those who avoid major motor impairment are well known to be at risk of adverse developmental outcomes, including, for example, cognitive difficulty of variable degree, impairments in attention and executive function5 6. It is less commonly recognised that they are also at risk of visual or ocular abnormalities. VI in children born preterm has been reported in between 1% and 3% with causes including cerebral VI and retinopathy of prematurity (ROP).7 Refractive errors have also been found to be four times more common in those born preterm (29.6%) than those born at term (7.8%)8 (table 1). These visual disorders result from both the ‘premature exteriorisation’ of the developing visual system and from the systemic complications of preterm
Comparison of visual impairments in children with disability (as reported in some key studies)
Although hypermetropia is the most common refractive error in childhood, myopia is more common in those born preterm, occurring both in those with and without previous ROP. In those with strabismus, esotropia and exotropia are equally common, in contrast to full-term children in whom esotropia is three times as common as exotropia.7
Difficulties with higher-order processing of visual information may also occur and some authors have particularly highlighted the occurrence of such difficulties in children with PVL. Hard et al16 reported poor visual perceptual skills in almost half of a group of 51 children born before 29 weeks’ gestation, only 6% of whom had PVL. Pagliano et al17 studied 24 children with spastic diplegia and PVL, 15 born prematurely and 9 at term. Those born preterm had poorer visual perceptual skills, suggesting that the PVL was not the key factor, but some other consequence of prematurity.
A higher incidence of visual difficulties is generally seen in those with more severe motor impairment.20–22 However, visual
Children with PVL have also been found to have visuoperceptual difficulties that were not explained by acuity or cognitive impairments.27 28 These included weakness in visual object recognition, visuospatial skills, visual memory and oculomotor control.
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