CVI Glasses Interventions

Linda Lawrence MD

All of the areas need more evidence -based information. All need further research.

  1. Glasses: “why are those thick little glasses prescribed for the babies?”

Is there a role for glasses?

  1. Lack of accommodation(focus) measured by dynamic retinoscopy; the difficulty with accommodation may occur because of inadequate neurological direction, lack of motivation or attention to near target by child, seizure medication or medication (hyocine) used to decrease salivation can paralyze pupil and affect accommodation, this means that hyperopia which is typical in a child may not be compensated for: no focusing at near, no compensation for hyperopia
  2. Significant refractive error, with evaluation not only according to published consensus standards for typically developing babies, but for this individual baby’s needs, this may include apahakia after lens removal as part of treatment for retinopathy of prematurity or congenital cataracts.If the vision is much lower that would be caused by the refractive error, may not help. I continue to be amazed at how refractive correction can improve function in developmentally delayed children.
  3. Correct strabismus (typically would be accommodative esotropia), may occur earlier in children with neurodevelopmental disabilities, these are typically hyperopic children (plus prescription, or “farsighted”)

The eyes may cross at near (esotropia)

  1. Prevent amblyopia from optical errors in eyes (very high myopia, high hyperopia, astigmatism that is significant or amblyogenic, anisometropia)
  2. Magnification for low vision. We do this in adults, why not in children ?
  3. What about the effect of the frame? Could this act like “blinders” and help center attentions better?
  4. Protection: all children’s glasses should be polycarbonate, to protect from additional injury, and if hit will not shatter. Children with low vision and blindness may be more prone to injury from flying objects, and many may not be able to get out of harm’s way.
  5. Others: prisms for visual field defects? Not for children

Questions

Do the education team and the caretakers/parents understand what the glasses are for?

1. What is the expected outcome for the child? This is a common parent question. (Ask the question: what can the child do since wearing glasses, that could not do before). Goal is improved use of residual vision, and to help in development of vision.

2. How do we access this outcome?(Parent and team report and reassessment)

3. Is the family placing glasses on the child at the appropriate times and for the appropriate reasons?

4. Do the glasses promote social, motor, communication or adaptive skill development?

5. What are the hardships for the family and child? How can we help them to overcome?

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