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Terminology for Brain Injury–Related Vision Loss: The Debate Continues

Gordon N. Dutton The most common cause of visual impairment in children in the United States and Europe is damage to the brain. This subject is developing rapidly in both knowledge and complexity, and, internationally, a range of terminologies has developed. Clinical presentations are wide ranging, including children with little or no vision, those with significantly reduced visual acuities (with or without limited visual fields and with or without perceptual visual dysfunction), and those with disabling perceptual visual problems (with or without more minor disorders of acuity and visual fields). The range of visual perceptual dysfunctions not due to brain pathology does not, however, warrant inclusion, but a subject of contention is where the boundary needs to be drawn. The challenge is how to optimally classify and manage these disorders in such a way that no child is disadvantaged. Current descriptive terminologies for brain injury–related vision loss include those founded upon neuropathology (in those who do not survive their brain injuries), pathogenesis and timing, neurophysiology, radiology and anatomy, resultant visual behaviours, and resultant needs; and all will continue to be applied by the wide range of professional groups involved. James E. Jan (2011), in the February issue of this journal, provided cogent reasons why the term cerebral visual impairment should not be used as a replacement for cortical visual impairment. However, the world literature argues in favour of both terms having their place. Cerebral visual impairment is internationally regarded as an umbrella term, a concept with which Dr. Jan takes issue. However, it can usefully encompass and define a discrete range of childhood visual impairments due to damage to the brain. To quote Elisa Fazzi and her colleagues from Italy (2009):