Cerebral palsy (CP) refers to a group of neurological disorders affecting movement, balance, and posture. This condition arises from abnormal brain development or damage, often occurring before, during, or shortly after birth. While CP is primarily recognized for its impact on motor skills, it frequently affects other functions, including a baby’s vision and eye control. Understanding these visual challenges is important for comprehensive care to infants with CP.
The Brain’s Role in Vision Control
The brain damage or developmental issues that cause cerebral palsy can affect the parts of the brain responsible for processing visual information. This includes the visual cortex, located at the back of the brain, which receives and interprets signals from the eyes. Areas controlling eye muscle movements and coordination can also be impacted, leading to difficulties in how the eyes work together.
Visual information travels from each eye along the optic nerve to various brain regions for processing. Signals from the left side of both eyes typically go to the right side of the brain, and vice versa. Difficulties with vision can arise if there is damage to these pathways or brain areas involved in visual processing.
Common Eye and Vision Problems in Infants with CP
Infants with cerebral palsy often experience various eye and vision problems, with approximately 70% of children with CP having a vision disorder.
Strabismus
One common issue is strabismus, a misalignment of the eyes. This can appear as crossed eyes, or eyes that turn outward or upward, affecting up to 50% of children with CP. Strabismus can lead to double vision, visual confusion, and reduced depth perception.
Nystagmus
Another condition is nystagmus, characterized by involuntary, repetitive eye movements like shaking or jerking. This constant movement can degrade vision clarity, making it difficult for a child to see clearly. Children with nystagmus sometimes tilt their head to find a “null point,” where eye movements are minimized for better focus.
Cortical Visual Impairment (CVI)
Cortical Visual Impairment (CVI) is a brain-based vision condition where the eyes may be healthy, but the brain struggles to process visual information. CVI can cause difficulties focusing on objects, blurred vision, and challenges recognizing familiar faces or navigating spaces. It is a leading cause of permanent vision loss in children, particularly those aged one to three years.
Refractive Errors
Refractive errors, such as nearsightedness (myopia), farsightedness (hyperopia), or astigmatism, are also common among infants with CP. These conditions cause blurred vision and can make it difficult for a child to focus on objects at various distances. The prevalence of refractive errors in children with CP can range widely, from about 33.3% to 86.5%.
The Diagnostic Process for Vision Issues
Early detection of vision problems in infants with cerebral palsy is important for improving developmental outcomes. Parents and caregivers play a role by observing behaviors that may indicate a visual impairment. These signs can include covering one eye, moving the head instead of the eyes when trying to focus, or squinting.
If concerns arise, a referral to a pediatric ophthalmologist, an eye doctor specializing in children’s vision, is recommended. A comprehensive eye exam for an infant with CP involves checking eye alignment, assessing the ability to track objects, and evaluating the health of the eye’s internal structures. Photoscreening, an instrument-based screening method, is also recommended for children 12 months and older who cannot reliably perform traditional eye chart tests.
Treatment and Management Strategies
Managing vision issues in infants with cerebral palsy often involves interventions tailored to the specific condition.
Corrective Lenses
Corrective lenses, such as eyeglasses, are commonly prescribed to address refractive errors like nearsightedness or farsightedness. These lenses help focus light onto the retina, improving visual clarity.
Amblyopia Treatment
For amblyopia, often called “lazy eye,” which can result from conditions like strabismus, patching therapy is a common treatment. This involves covering the stronger eye to encourage the weaker eye to develop better vision. Eye drops, such as atropine penalization, can also be used as an alternative to patching to blur vision in the stronger eye.
Surgical Options
Surgical options are available for conditions like strabismus to correct eye muscle alignment and improve binocular vision. Eye muscle surgery can also help quiet nystagmus, reducing involuntary eye movements and improving head posture. In some cases of severe refractive errors where glasses are impractical, refractive surgery options like LASIK may be considered to restore sharper vision.
Vision Therapy
Vision therapy, a non-surgical approach, can strengthen communication between the brain and eyes, improving coordination and visual processing skills.