Cortical Visual Impairment: Another Piece of Morgan's Puzzle

Cortical Visual Impairment: Another Piece of Morgan's Puzzle

I love my Little Ball of Worry. That's my Morgan, my Little Ball of Worry.

I mentioned in my last post that Morgan has some vision issues. We discovered this a few months ago during her Physical Therapy. Julie, Morgan's Physical Therapist (PT), is amazing and noticed that Morgan was inconsistent in meeting her gaze. Sometimes Morgan would gaze right into her eyes and connect, and other times Morgan would look right through Julie as if she were not there. Morgan had been doing this with Danny and I as well as with objects. So Julie mentioned bringing in a Vision Specialist through Early Intervention Services to evaluate Morgan. I thought it was a good idea and certainly couldn't hurt to have her looked at by an expert. During Morgan's evaluation, the Vision Specialist, Sandra spotted some concerns.

So, we started Morgan's Vision Therapy.

This started the whole ball rolling on Morgan's sight. We scheduled an appointment with an ophthalmologist and our Pediatrician was made aware of it as well. While all this was set into motion, Morgan had her Brain MRI which had been scheduled during the first diagnoses if her Infantile Spasms.

The results of the Brain MRI were a little unusual. Her left hemisphere is a little bit smaller than her right, she has a little bit of fluid which isn't putting any pressure on her brain, and her optic nerves are little on the small side with a little bit of fluid around them. All this sounds a little scary, but honestly, I was a little relieved that it wasn't worse. Unusual is much better than something completely terrifying, and in my mind, this can be dealt with. Our Neurologist didn't seem overly concerned. We do know that there will be another Brain MRI in Morgan's future. The overall recommendation was to follow-up with the Ophthalmologist with the MRI results and ensure Morgan's vision was alright.

Our appointment with the Ophthalmologist went well and we found out that Morgan's optic nerves, while being on the small side, are alright. He reviewed her MRI and examined her. Although she is a little slow to react visually, her eyes are physically alright. But, he did diagnose her with possible Cortical Visual Impairment. That all we could do was continue her Vision Therapy and give it time. "Let's see what she can do."

After working with the Vision Specialist, reading everything I could on Cortical Visual Impairment (CVI) and closely observing Morgan, there is no doubt in my mind that Morgan has CVI.

Here is some information on what CVI is and some of the characteristics from littlebearsees.org. If you would like to read more then I've included here, please visit the website.

 http://www.littlebearsees.org/what-is-cvi/

What is Cortical Visual Impairment (CVI)?

Cortical visual impairment (CVI) is a term used to describe visual impairment that occurs due to brain injury.  CVI differs from other types of visual impairment which are due to physical problems with the eyes.  CVI is caused by damage to the visual centers of the brain, which interferes with communication between the brain and the eyes.  The eyes are able to see, but the brain is not interpreting what is being seen.

Cortical visual impairment (CVI) is often referred to by other terms including: cerebral visual impairment, neurological visual impairment, brain damage related visual impairment and so forth.    All of these terms refer to visual dysfunction resulting from injury to visual centers of the brain.  We will always refer to it as cortical visual impairment or CVI.

Typical Characteristics of CVI:

1.       Preference  for a specific color. You may have noticed that your child seems to prefer looking at a certain color. Bright red and yellow are often favorite colors, but some children prefer other bright colors such as blue, green, or pink.

2.       Need or preference for movement. Many children with CVI require movement in order to see an object. For example, it may be easier for them to look at a pinwheel or a swaying balloon.

3.       Delayed response when looking at objects (visual latency).  It may take time for a child with CVI to look at an object. Often they will look at an object and then look away. For this reason it is important to give your child enough time when presenting an object.

4.       Difficulty with visual complexity. Children with CVI need simplicity. First, it is important that the object presented is simple. For example, a single colored stuffed animal, like Elmo, is preferable to one with multiple colors. Likewise, it is important that the background and the environment are simple. For example, putting a solid black cloth behind a single colored toy helps to reduce visual clutter. Creating a simple environment is a matter of eliminating noise and anything else that might distract from the visual task.

5.       Light-gazing and non-purposeful gazing.  Often, children with CVI will stare at light. They may be seen gazing out the window or up at a ceiling light. They may also appear as if looking at things that are not there, or looking at things without intent.

6.       Visual field preferences.  Most children with CVI will prefer to look at objects in a particular direction. For example, they may see an object better when it is presented in their periphery, or may turn their head to see an object.

7.       Distance vision impaired.  Some children with CVI have trouble seeing far away. This is related to the preference for visual simplicity. Objects far away may be lost in visual clutter.

8.       Visual blink reflex is absent or impaired.  When an object comes too close to the eyes, or touches the bridge of the nose, many CVI children have an absent or delayed protective blink response.

9.       Preference for familiar objects.  Because it is difficult for CVI children to process the information that the eyes see, they often prefer familiar objects that the brain easily recognizes and has processed before.

10.   Impaired visually guided reach.  The ability to look at an object while reaching for it is impaired.  Often CVI children will look away from the object and then reach for it.

The good news is that with therapy and determination, Morgan's sight will get better and already has. We've seen some exciting developments in the last couple weeks.

Sandra and I have also noticed that Morgan has trouble with sensory integration. That a lot of the time, if there is a great deal of noise going on, e.g. Kyle, she disengages visual because she is concentrating on listening. The same for touch and taste. It's almost as if she can only use one of her five senses at a time. This has improved with therapy. She now can see and feel together and sometimes she will do alright if I add something with sound. But it's very inconsistent.

My Un-Scientific Theory

This is my theory on everything having to do with Morgan's vision up to this point. She was doing very well up until her seizures started. That is when we lost her. We lost her personality, all abilities she had gained, and her ability to see things consistently. She has made some progress with her sight during this battle with her seizures, but not much. It has been the last couple weeks that we've seen some amazing strides. She has now been seizure free for 12 days straight! She sees things that she couldn't before. I've also read that this kind of visual impairment can happen in infants with epilepsy. Her seizures seem to be the cause of her vision issues.

Morgan still has a long way to go, but I'm hopeful this will be another mountain we can scale. And the most hopeful sign of all, her laughter is back...