A Quantitative Assessment Of Visual Function For Young And Medically Complex Children With Cerebral Visual Impairment: Development And Inter-Rater Reliability

BackgroundCerebral Visual Impairment (CVI) is the most common cause of low vision in children. Standardized, quantifiable measures of visual function are needed. ObjectiveThis study developed and evaluated a new method for quantifying visual function in young and medically complex children with CVI using remote videoconferencing. MethodsChildren diagnosed with CVI who had been unable to complete clinic-based recognition acuity tests were recruited from a low-vision rehabilitation clinic(n=22)Video-based Visual Function Assessment (VFA) was implemented using videoconference technology. Three low-vision rehabilitation clinicians independently scored recordings of each childs VFA. Interclass correlations for inter-rater reliability was analyzed using intraclass correlations (ICC). Correlations were estimated between the video-based VFA scores and both clinically obtained acuity measures and childrens cognitive age equivalence. ResultsInter-rater reliability was analyzed using intraclass correlations (ICC). Correlations were estimated between the VFA scores, clinically obtained acuity measures, and cognitive age equivalence. ICCs showed good agreement (ICC and 95% CI 0.835 (0.701-0.916)) on VFA scores across raters and agreement was comparable to that from previous, similar studies. VFA scores strongly correlated (r= -0.706, p=0.002) with clinically obtained acuity measures. VFA scores and the cognitive age equivalence were moderately correlated (r= 0.518, p=0.005), with notable variation in VFA scores for participants below a ten month cognitive age-equivalence. The variability in VFA scores among children with lowest cognitive age-equivalence may have been an artifact of the studys scoring method, or may represent existent variability in visual function for children with the lowest cognitive age-equivalence. ConclusionsOur new VFA is a reliable, quantitative measure of visual function for young and medically complex children with CVI. Future study of the VFA intrarater reliability and validity is warranted.