Behavioural Features of Cerebral Visual Impairment Are Common in Children With Down Syndrome

Gemma J. Wilton, Rhodri Woodhouse, Valldeflors Vinuela-navarro, Rachel England, J. Margaret Woodhouse

Research output: Contribution to journalArticlepeer-review


It is widely recognised that children with Down syndrome have a broad range and a high prevalence of visual deficits and it has been suggested that those with Down syndrome are more likely to exhibit visual perception deficits indicative of cerebral visual impairment. This exploratory study aims to determine the prevalence of behavioural features suggestive of cerebral visual impairment (CVI) occurring with Down syndrome and whether the visual problems can be ascribed to optometric factors. A cohort of 226 families of children with Down syndrome (trisomy 21), aged 4–17, were invited to participate in a validated question inventory, to recognise visual perception issues. The clinical records of the participants were then reviewed retrospectively. A five-question screening instrument was used to indicate suspected CVI. The majority of the 81 families who responded to the questionnaire reported some level of visual perceptual difficulty in their child. Among this cohort, the prevalence of suspected CVI as indicated by the screening questionnaire was 38%. Only ametropia was found to have a significant association with suspected CVI, although this increased the correct prediction of suspected CVI outcome by only a small amount. Results suggest that children with Down syndrome are more likely to experience problems consistent with cerebral visual impairment, and that these may originate from a similar brain dysfunction to that which contributes to high levels of ametropia and failure to emmetropise. It is important that behavioural features of CVI are recognised in children with Down syndrome, further investigations initiated and appropriate management applied.
Original languageEnglish
Article number673342
JournalFrontiers in Human Neuroscience
Publication statusPublished - 14 Jun 2021

Bibliographical note

Copyright © 2021 Wilton, Woodhouse, Vinuela-Navarro, England and Woodhouse. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Funding: VV-N and RE were funded by Action Medical Research and Garfield Weston Foundation (GN2338).


  • Down syndrome
  • cerebral visual impairment
  • CVI
  • visual perception
  • refractive error
  • dorsal stream
  • ventral stream


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