Abstract
Welcome to the Journal
Welcome to the Septembr 2017 issue of the British Journal of Visual Impairment where in this issue I have tried to compile a broad a range of issues as possible. So therefore we see papers regarding nutrition advice in age-related macular degeneration, to a paper on the effect of cane length and swing arc with the long cane. There is also an interesting paper on teenagers with visual impairment and new media which I expect over the next coming issues to see more research about new media and visual impairment (VI) such as the paper on supporting leisure and communication in People with Visual and Intellectual Disabilities via a Smartphone-based Program. It is good to see a paper on Braille coming through however the results of the research gave me some course for concern in that the “current use of contracted French braille in Quebec indicates that it is not often used in the life of blind individuals. However, the faith of our participants
in the relevance of the contracted code is still very strong….” and I totally agree with the comment that we must strive to “find the proper balance between the uses of French braille versus other technologies such as text-to-speech”. (Laroche, et al 2017 – this issue). We also see in this issue another interesting paper which looks at the feelings of patients with thyroid associated orbitopathy. Following on from the successful special issue on Physical Activity and VI I have included a small but nevertheless interesting case study on physical activity for individuals who are blind. And for those who are engineering minded there is a small paper looking at the cost effective ultrasonic module for people with visual impairment using a headphone jack. Finally there is a paper which reviews the rehabilitation and habilitation strategies for children and young people with homonymous visual field loss caused by cerebral vision impairment which brings me to my main topic of the editorial.
Cerebral Visual Impairment V Cerebral Visual Disorders
I have just returned from two very interesting international conferences the first of these was the Vision 2017, the 12th International Conference by the International Society for Low Vision Research and Rehabilitation (ISLRR) in The Hague, Netherlands, and the second was the 9th ICEVI Europe 2017, Bruges, Belgium. At both of these conferences were papers around and specifically on the topic of cerebral visual impairment. However, what I did notice in almost every paper (not all but nearly all including my own!), no one defined exactly what cerebral visual impairment is. Some papers went into quite specific medical examinations of patients with CVI whilst other papers were about developing screening or assessments of people with CVI. All of which I found very interesting but I could not but help in thinking that how can we develop assessments of CVI if we cannot define CVI?
We need most urgently to have a unified global definition for cerebral visual impairment. We need it to be precise, exact and above all to be agreed upon. I was discussing this problem with our colleague Lea Hyvärinen and she reminded me that originally CVI was a name used in education to cover a cohort of severely disabled children that could have normal looking eyes but quite apparently did not have visual and many other functions at the level of their age. CVI was and is a name to describe atypical functioning of children due to brain damage related vision loss and other disorders. (Hyvärinen, 2017, Personal Communication).
As Lea pointed out, I have written in several editorials that impairment does not equate with disease and as such this is why we do not see CVI in the International Classification of Diseases (ICD) but Cortical Visual Impairment is mentioned in the American ICD-9 and ICD-10 as a disorder of optic nerve and visual pathways > other disorders of optic nerve and visual pathways …and visual pathways (IDC 10- 2017 ICD-10-CM Diagnosis Code H47.619 US Version), however not of the visual brain. So there is the acceptance as a disorder in the US IDC 10. Cerebral Visual Disorders might then be an acceptable name for the ICD-11 for use in medicine. It would be the umbrella term for the many visual processing disorders. We could use CVI in the International Classification of Functioning, Disability and Health (ICF) because it is a definition of a certain group of visual functional problems (b210-b229 + b156 ICF 2017).
I believe however that some work is ongoing to actually try and define CVI so that it can be included in the latest revision of IDC 11. If this is the case then I await this definition. But if a single definition cannot be obtained which I have been told is the latest stumbling block for inclusion, could we not broaden the concept and perhaps think about, as Lea does, not in terms of Cerebral Visual Impairment but as Cerebral Visual Disorders (CVD). This would give us the ”logical umbrella” name needed for IDC 11 whilst not narrowing it down to a undefinable sentence. CVD would allow for us to ensure as Amanda Lueck notes (Vision 2017 conference paper) that there are at least three subgroups of people with CVI, those with profound visual impairment due to CVI, those that have functionally useful vision and cognitive challenges, and those who have functionally useful vision and who work at or near the expected level for their age group are included in such a definition.
I know that I have written about the problem of defining CVI before and that this is a recurring editorial theme of mine. Perhaps we are getting a little closer to some agreement on what CVI means - although perhaps we first need to decide whether CVI is a term for impaired visual functioning in education and CVD covers the numerous visual processing disorders in medicine and both CVI and CVD need to be defined as umbrella terms.
I hope you enjoy this issue.
Professor John Ravenscroft
Editor in Chief
British Journal of Visual Impairment.
Special thank you to Lea Hyvärinen for putting up with my questions and her support.