Objective: To evaluate visual function in children with cerebral visual impairment (CVI) from various causes, examine its relationship with the severity of cerebral involvement using a semi-quantitative MRI scoring system (sqMRI), and compare the results with strabismic controls without visual impairment.
Methods: This retrospective study included children diagnosed with CVI and controls without CVI who were followed for strabismus. MRI data were compared using a modified 24-point sqMRI scale. Inter-rater agreement was excellent (ICC = 0.91; 95% CI: 0.79-0.96). Partial correlations controlling for gestational age were computed for primary MRI-BCVA relationships.
Results: Forty-two children with CVI and 40 strabismic controls were included. Hypoxic-ischemic encephalopathy was the most common cause (26.1%). Children with CVI had significantly lower gestational ages, birth weights, and best-corrected visual acuity (BCVA) (mean 0.28 ± 0.17 logMAR) compared to controls (0.05 ± 0.05 logMAR) (p < 0.001). The sqMRI scores showed significant correlation with BCVA, especially in the basal ganglia, thalamus, hemispheric, subcortical, and total MRI scores (p < 0.05). The total MRI-BCVA correlation remained strong after adjusting for gestational age (partial r = 0.78, p < 0.001).
Conclusion: A strong, prematurity-independent correlation was observed between sqMRI scores and visual impairment in a clinically diverse CVI population. These findings suggest that sqMRI scoring could be a useful additional tool for visual prognosis and early rehabilitation planning.
Keywords: Cerebral visual impairment; neuroimaging; semiquantitative MRI; visual function.