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
- child health (paediatrics)
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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.
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