Survey reveals need for improvement in cerebral visual impairment education, training
Key takeaways:
- None of the training programs provided more than 2 hours of instruction on cerebral visual impairment.
- Most practitioners diagnosed cerebral visual impairment infrequently.
Current entry-level optometry and ophthalmology education and training programs do not adequately teach how to evaluate and manage cerebral visual impairment, according to a study published in Journal of Visual Impairment & Blindness.
The study researchers suggest the need for more comprehensive didactic and clinical training before and throughout practicing to encourage early diagnosis of cerebral visual impairment (CVI) in children, the delayed diagnosis of which impedes habilitation and education services as well as potential vision improvement through intervention and support.
Melissa L. Rice, OD, FAAO, of the division of ophthalmology at Abrahamson Pediatric Eye Institute at Cincinnati Children’s Hospital Medical Center and assistant professor in the department of ophthalmology at the University of Cincinnati College of Medicine, and colleagues performed a survey study to investigate the current CVI education and training optometrists and ophthalmologists receive — including didactic education, degree programs, residencies and fellowships — as well as current clinical practices regarding CVI.
They distributed the 5- to 10-minute online surveys to optometry and ophthalmology program directors as well as practicing clinicians via professional organization email lists, electronic discussion groups, the American Association for Pediatric Ophthalmology and Strabismus website and professional Facebook groups. The surveys utilized different type of questions, including multiple choice, open-ended and Likert scale questions, with data collected from May to August 2020.
Ultimately, 344 participants from North America, Europe, Oceania and Asia completed the surveys, including 147 (44%) practicing ophthalmologists and 187 (56%) practicing optometrists. Most (88%) of the respondents practiced in the U.S. and Canada.
The researchers found that more than half (59%) of the respondents scored moderately to extremely familiar with CVI on a 5-point Likert scale. However, only 31% received formal didactic or classroom CVI education during their training programs, and, of those, 37% received 1 to 2 hours of formal instruction, 19% had less than 1 hour, and 14% had more than 10 hours.
Further, 65% of optometrists and ophthalmologists reported diagnosing CVI in their practices. A majority of this group diagnosed it infrequently, either once a month (44%) or once per year (32%). The clinicians typically relied on a variety of tools to diagnose CVI, including complete eye exams (97%), medical history (96%), neuroimaging (63%), screening questionnaires (39%) and visual processing tests (29%). The most common combination of tools used was medical history and complete eye exam.
Additionally, 48 program directors completed the surveys. The researchers found that only 48% of programs offered formal CVI didactic education, which included lectures (96%), journal clubs (26%) and/or grand rounds (13%). Notably, 83% of programs provided only 1 to 2 hours of CVI education; the remaining programs provided less than 1 hour.
Most programs (92%) offered clinical instruction, but 81% of program directors reported that CVI clinical instruction was sometimes or rarely provided.
The researchers acknowledge several limitations to this study, including the potential for recall bias among the surveyed eye care practitioners.
“Having limited exposure to CVI during formal training is a missed opportunity with significant implications for the ability to recognize this condition,” the authors wrote.
“We recommend the trainee receive enough didactic and clinical experience to suspect a child may be at risk for CVI and to refer appropriately for diagnostic evaluation.”
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