■脑视力障碍（CVI）是西方国家视力障碍的重要原因。围产期缺氧缺血性损伤是CVI的最常见原因，但CVI也可能是遗传性疾病的结果。大多数患有CVI的儿童患有脑瘫和/或发育迟缓。早期诊断至关重要；然而，有必要就循证诊断工具和转诊标准达成共识.本研究的目的是根据分级方法制定CVI的诊断和转诊指南。
■我们根据GRADE方法5搜索CVI（儿童，发育年龄≤18岁)在Medline数据库中进行，Embase,和Psychinfo,每个人都有一个不同的主题。
■基于证据，选择了五个主题的文章：1.病史和CVI问卷23（共1,007）。2.眼科和正交评估37（出816）。3.神经心理学评估5（共716个）。4.神经放射学评估和磁共振成像（MRI）9（共723）。5.遗传评估5（458）。
■在病史记录中，早产低出生体重和APGAR(外观，脉搏,鬼脸,活动,呼吸)分数(<5)很重要。建议对3岁以下的儿童进行不同的问卷调查，年龄较大的儿童和特定风险人群（极度早产）。在眼科检查中，眼球运动,特别是扫视,住宿,拥挤,应评估对比敏感度和视野。OCT可以显示跨突触变性的客观迹象，并且可以通过眼动追踪来测量固定和扫视的异常。建议对视觉感知功能进行筛查，并可以指导进一步评估。CVI在脑性瘫痪中的MRI表现可以分为五组：脑发育不良，白质和灰质病变，出生后的病变和正常的MRI。在患有CVI和脑室周围白质软化症的儿童中，脑损伤严重程度与视觉功能障碍相关。可以在皮质和皮质下损伤以及相关的视觉功能损害之间进行区分。额外的评估（神经或遗传）可能是必要的，以完成CVI的诊断和/或揭示病因。
UNASSIGNED: Cerebral visual impairment (CVI) is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for
consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop
guidelines for diagnosis and referral in CVI according to the grade method.
UNASSIGNED: We developed the
guidelines according to the GRADE method 5 searches on CVI (children, developmental age ≤ 18 years) were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic.
UNASSIGNED: Based on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23 (out of 1,007). 2. Ophthalmological and orthoptic assessment 37 (out of 816). 3. Neuropsychological assessment 5 (out of 716). 4. Neuroradiological evaluation and magnetic resonance imaging (MRI) 9 (out of 723). 5. Genetic assessment 5 (out of 458).
UNASSIGNED: In medical history taking, prematurity low birth weight and APGAR (Appearance, Pulse, Grimace, Activity, Respiration) Scores (<5) are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups (extremely preterm). In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments (neurological or genetic) can be necessary to complete the diagnosis of CVI and/or to reveal the etiology.
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