Open Access Highly Accessed Open Badges Research article

Low vision due to cerebral visual impairment: differentiating between acquired and genetic causes

Daniëlle GM Bosch1234, F Nienke Boonstra14, Michèl AAP Willemsen45, Frans PM Cremers23 and Bert BA de Vries24*

Author Affiliations

1 Bartiméus, Institute for the Visually Impaired, Zeist, The Netherlands

2 Department of Human Genetics, Radboud University Medical Center, P.O. Box 9101, Nijmegen, HB 6500, The Netherlands

3 Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

4 Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands

5 Department of Pediatric Neurology, Radboud University Medical Center, Nijmegen, The Netherlands

For all author emails, please log on.

BMC Ophthalmology 2014, 14:59  doi:10.1186/1471-2415-14-59

Published: 1 May 2014



To gain more insight into genetic causes of cerebral visual impairment (CVI) in children and to compare ophthalmological findings between genetic and acquired forms of CVI.


The clinical data of 309 individuals (mainly children) with CVI, and a visual acuity ≤0.3 were analyzed for etiology and ocular variables. A differentiation was made between acquired and genetic causes. However, in persons with West syndrome or hydrocephalus, it might be impossible to unravel whether CVI is caused by the seizure disorder or increased intracranial pressure or by the underlying disorder (that in itself can be acquired or genetic). In two subgroups, individuals with ‘purely’ acquired CVI and with ‘purely’ genetic CVI, the ocular variables (such as strabismus, pale optic disc and visual field defects) were compared.


It was possible to identify a putative cause for CVI in 60% (184/309) of the cohort. In the remaining 40% the etiology could not be determined. A ‘purely’ acquired cause was identified in 80 of the patients (26%). West syndrome and/or hydrocephalus was identified in 21 patients (7%), and in 17 patients (6%) both an acquired cause and West and/or hydrocephalus was present. In 66 patients (21%) a genetic diagnosis was obtained, of which 38 (12%) had other possible risk factor (acquired, preterm birth, West syndrome or hydrocephalus), making differentiation between acquired and genetic not possible. In the remaining 28 patients (9%) a ‘purely’ genetic cause was identified.

CVI was identified for the first time in several genetic syndromes, such as ATR-X, Mowat-Wilson, and Pitt Hopkins syndrome. In the subgroup with ‘purely’ acquired causes (N = 80) strabismus (88% versus 64%), pale optic discs (65% versus 27%) and visual field defects (72% versus 30%) could be observed more frequent than in the subgroup with ‘purely’ genetic disorders (N = 28).


We conclude that CVI can be part of a genetic syndrome and that abnormal ocular findings are present more frequently in acquired forms of CVI.

Acquired; Cerebral visual impairment; Genetic diseases; Visually impaired children