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Visual impairment and perceptual visual disorders in children with cerebral palsy in Nigeria
  1. Roseline Ekanem Duke1,2,
  2. Justin Nwachukuw1,
  3. Chima Torty3,
  4. Uche Okorie1,
  5. Min J Kim4,
  6. Kathryn Burton5,
  7. Clare Gilbert6,
  8. Richard Bowman7
  1. 1Ophthalmology, Calabar Children’s Eye Centre, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
  2. 2Clinical Research Unit, ITD, International Centre for Eye Health, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, London, UK
  3. 3Pediatric Neurology, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
  4. 4Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, London, UK
  5. 5Community Paediatrics, Cambridgeshire Community Services NHS Trust, Saint Ives, Cambridgeshire, UK
  6. 6Clinical Research Unit, ITD, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, London, UK
  7. 7International Centre for Eye Health, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, London, UK
  1. Correspondence to Dr Roseline Ekanem Duke, Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria; dr.roselineduke{at}gmail.com

Abstract

Cerebral palsy (CP) is the most common cause of childhood physical disability globally. This study describes the spectrum of ocular morbidity and visual impairment in a community-based (recruited by key informants) sample of children with CP in Cross River State, Nigeria.

Methods A paediatric neurologist clinically confirmed CP and assessed systemic comorbidity. Ophthalmological assessment included developmental age appropriate acuity tests, objective refraction and objective and subjective tests of perceptual visual dysfunction (PVD).

Results 388 children aged 4–15 years with CP were identified. Visual problems were reported by carers in only 55 (14%) cases. Binocular visual acuity impairment was seen in 20/201 by Lea symbols test (10%) and 213/388 (55%) by the mirror test. Abnormal visual fields were seen in 58/388 (14.9%); strabismus in 183 (47%) abnormal contrast sensitivity in 178 (46%) and abnormal saccades in 84 (22%), spherical refractive errors in 223 (58%), significant astigmatism in 36 (12%), accommodative dysfunction in 41 (10.6%), optic atrophy in 198 (51%). Perceptual visual disorders were present in 22 (6%) subjectively and 177 (46%) objectively. The estimated frequency of cerebral visual impairment (CVI) in children ranged from 61 (16%) to 191 (49%) if children with optic atrophy were included.

Conclusion Children with CP have a wide spectrum of ocular morbidity and visual impairment, underestimated by carers. Children with CP require visual acuity assessments with a range of tests which account for associated comorbidities and oculomotor dysfunction. Functional vision assessments for PVD is important. CVI is common.

  • visual perception
  • epidemiology
  • child health (paediatrics)
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Footnotes

  • Contributors The different aspects of the research and the overall responsibility for the published work is accepted by the following: Conception or design of the work: RB, RED and KB. Data collection. RED, JN, CT and UO. Data analysis and interpretation. RED and MJK. Drafting the article. RED. Critical revision of the article. KB, CG and RB. Final approval of the version to be published and agreement to be accountable for all aspects of the work. RED, JN, CT, UO, MJK, KB, CG and RB.

  • Funding The Queen Elizabeth Diamond Jubilee Trust/Common Wealth Eye Health Consortium funded the research. Grant number (LSHTM ITCRZ6814).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was performed in accordance with the Declaration of Helsinki and approved by the ethics committees of Cross River State and the London School of Hygiene and Tropical Medicine. The study was explained to carers in their preferred language.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Deidentified participant data may be requested from the Investigator using their publishable contact and orchid identifier.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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