KNOWLEDGE, ATTITUDE AND PRACTICE OF CORTICAL VISUAL IMPAIRMENT AMONG OPTOMETRISTS IN INDIA
Main Article Content
Abstract
Background: Cerebral Visual Impairment (CVI) is the most common cause of visual impairment in children in the developed world and appears to be more prevalent in children with additional support needs. CVI is a brain-based visual dysfunction that may be missed when ocular findings are normal or minimal. Optometrists can contribute to early identification and referral, but evidence specific to Indian optometry is limited. The aim of the study is to assess knowledge, attitude and clinical practice related to CVI among optometrists in India.
Materials and Methods: A descriptive cross-sectional online KAP survey was conducted among 136 optometrists practicing in India between November 2024 to January 2025 using a structured online questionnaire circulated via social media. The questionnaire was face and content validated (S-CVI = 0.89). The questionnaire covered demographic details, knowledge, attitude and clinical practice of CVI scores of optometrists in India. Data were analysed using Jamovi version 2.3. Frequencies, percentages, mean, standard deviation, Cronbach’s alpha, Shapiro-Wilk test, Spearman’s rank correlation and multiple-response frequency analysis were used.
Results: Most respondents were aged 25-35 years (63.24%), female (68.38%) and Bachelor of Optometry qualified (66.18%); 95.59% was aware of CVI. Mean knowledge, attitude and practice scores were 6.20 ± 2.31, 10.81 ± 3.05, and 8.22 ± 10.61, respectively. Attitude correlated strongly with practice (r = 0.66) whereas, knowledge correlated weakly with practice (r = 0.24). Major barriers were a lack of awareness, training, diagnostic tools and optometry-specific guidelines.
Conclusion: Indian optometrists showed reasonable knowledge and positive attitude, but limited clinical implementation, highlighting the need for competency-based CVI training and clearer referral pathways.
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References
Boot, F. H., Pel, J. J. M., van der Steen, J., & Evenhuis, H. M. (2010). Cerebral visual impairment: Which perceptive visual dysfunctions can be expected in children with brain damage? A systematic review. Research in Developmental Disabilities, 31(6), 1149–1159. https://doi.org/10.1016/j.ridd.2010.08.001
Chang, M. Y., Merabet, L. B., & CVI Working Group. (2024). Special commentary: Cerebral/cortical visual impairment working definition: A report from the National Institutes of Health CVI Workshop. Ophthalmology, 131(12), 1359–1365. https://doi.org/10.1016/j.ophtha.2024.09.017
Chokron, S., Kovarski, K., Zalla, T., & Dutton, G. N. (2020). The inter-relationships between cerebral visual impairment, autism and intellectual disability. Neuroscience & Biobehavioral Reviews, 114, 201–210. https://doi.org/10.1016/j.neubiorev.2020.04.008
Gorrie, F., Goodall, K., Rush, R., & Ravenscroft, J. (2019). Towards population screening for cerebral visual impairment: Validity of the Five Questions and the CVI Questionnaire. PLOS ONE, 14(3), Article e0214290. https://doi.org/10.1371/journal.pone.0214290
Lama, A. J., Parajuli, R., Poudel, M., & Adhikari, S. (2022). Knowledge assessment on cortical visual impairment among ophthalmologists in Nepal. Nepal Journal of Ophthalmology, 14(1), 93–102. https://doi.org/10.3126/nepjoph.v14i1.38606
Lehman, S. S., Yin, L., Chang, M. Y., Section on Ophthalmology, Council on Children with Disabilities, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology, & American Association of Certified Orthoptists. (2024). Diagnosis and care of children with cerebral/cortical visual impairment: Clinical report. Pediatrics, 154(6), Article e2024068465. https://doi.org/10.1542/peds.2024-068465
Maitreya, A., Rawat, D., & Pandey, S. (2018). A pilot study regarding basic knowledge of cortical visual impairment in children among ophthalmologists. Indian Journal of Ophthalmology, 66(2), 279–284. https://doi.org/10.4103/ijo.IJO_425_17
Mazel, E. C., Bailin, E. S., Tietjen, M. W., & Palmer, P. A. (2019). A questionnaire assessing what teachers of the visually impaired know about cortical/cerebral visual impairment. Seminars in Pediatric Neurology, 31, 41–47. https://doi.org/10.1016/j.spen.2019.05.007
McConnell, E. L., Saunders, K. J., & Little, J. A. (2021). What assessments are currently used to investigate and diagnose cerebral visual impairment (CVI) in children? A systematic review. Ophthalmic and Physiological Optics, 41(2), 224–244. https://doi.org/10.1111/opo.12776
Pehere, N. K., Narasaiah, A., & Dutton, G. N. (2019). Cerebral visual impairment is a major cause of profound visual impairment in children aged less than 3 years: A study from tertiary eye care center in South India. Indian Journal of Ophthalmology, 67(10), 1544–1547. https://doi.org/10.4103/ijo.IJO_1850_18
Philip, S. S., & Dutton, G. N. (2014). Identifying and characterising cerebral visual impairment in children: A review. Clinical and Experimental Optometry, 97(3), 196–208. https://doi.org/10.1111/cxo.12155
Pilling, R. F., Allen, L., Bowman, R., Ravenscroft, J., Saunders, K. J., & Williams, C. (2023). Clinical assessment, investigation, diagnosis and initial management of cerebral visual impairment: A consensus practice guide. Eye, 37(10), 1958–1965. https://doi.org/10.1038/s41433-022-02261-6
Sakki, H. E. A., Dale, N. J., Sargent, J., Perez-Roche, T., & Bowman, R. (2018). Is there consensus in defining childhood cerebral visual impairment? A systematic review of terminology and definitions. British Journal of Ophthalmology, 102(4), 424–432. https://doi.org/10.1136/bjophthalmol-2017-310694
Smitha, K. S., Prabhu, M., & Veenish, S. (2023). Cerebral visual impairment awareness: Is our postgraduate curriculum missing the bus? Indian Journal of Ophthalmology, 71(5), 2310. https://doi.org/10.4103/IJO.IJO_2864_22
Tooth, C., Pilling, R. F., & Woodhouse, J. M. (2025). Raising awareness of cerebral visual impairment (CVI) through the use of educational videos: One size does not fit all. British Journal of Visual Impairment, 43(1), 239–252. https://doi.org/10.1177/02646196231225081
Williams, C., Pease, A., Warnes, P., Harrison, S., Pilon, F., Hyvarinen, L., West, S., Self, J., Ferris, J., & CVI Prevalence Study Group. (2021). Cerebral visual impairment-related vision problems in primary school children: A cross-sectional survey. Developmental Medicine & Child Neurology, 63(6), 683–689. https://doi.org/10.1111/dmcn.14819