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Cerebral Palsy for the Pediatric Eye Care Team—Part III: Diagnosis and Management of Associated Visual and Sensory Disorders

Correspondence: Requests for reprints should be addressed to: Kyle A. Arnoldi, C.O., C.O.M.T., Dept. of Ophthalmology, 3580 Sheridan Dr., Suite 140, Amherst, NY 14226. e-mail: kylea{at}buffalo.edu

Introduction: Cerebral palsy (CP) is a term used to describe a spectrum of deficits of muscle tone and posture resulting from damage to the developing nervous system. Though considered a motor disorder, CP can be associated with disorders of the sensory visual pathway. This paper, the final in a series of three articles, will present frequency, diagnosis, and management of the visual and binocular vision deficits associated with CP. Topics for discussion will include the prevalence and etiology of decreased acuity, the effect of CP on sensory and motor fusion, and the response to treatment for these sensory deficits.

Methods: A retrospective chart review of all cases of cerebral palsy referred to the St. Louis Children’s Hospital Eye Center was done. Detailed data on the sensory and motor deficits documented in these children was collected. Also recorded was the management strategy and response to treatment.

Results: Of the 131 cases reviewed (mean age 5.2 years at presentation), 46% had decreased vision in at least one eye due to amblyopia (24%), optic nerve abnormality (16%), cortical visual impairment (14%), or a combination. Forty-nine (37%) had significant refractive error. Sixty-four percent of those with significant refractive error responded to spectacle correction. Forty-three percent of those with amblyopia responded to conventional therapies. Of the nonstrabismic patients, 89% demonstrated sensory fusion, 90% had stereopsis, and 91% had motor fusion. No patient lacking fusion or stereopsis prior to strabismus surgery gained these abilities with realignment of the eyes.

Conclusion: While children with CP are capable of age-appropriate acuity and binocular vision, they are at increased risk for sensory visual deficits. These deficits are not the direct result of CP itself, but either share a common underlying cause, or occur as sequelae to the strabismus that is prevalent in CP. Most importantly, some sensory deficits may respond to standard treatment methods.

Key words: cerebral palsy, cortical visual impairment, fusion, amblyopia, visual acuity