Preverbal visual assessment for screening cerebral visual impairment: Diagnostic accuracy and clinical utility.

Aim: To evaluate the relationship between Preverbal Visual Assessment (PreViAs) results and cerebral visual impairment (CVI) diagnosis.

Method: This single-center retrospective chart review included children who completed a CVI interdisciplinary clinic or occupational therapy vision evaluation between May 2018 and May 2023 and had a completed PreViAs. Data were extracted from the electronic medical record. Data analysis included sensitivity, specificity, area under the curve, and Fisher's exact test.

Results: Of the 205 charts screened, 98 met study criteria (81 with CVI, 17 without); ages ranged from 3 to 50 months. The mean age of children with CVI was 15.41 months (SD = 8.93) and without was 13.24 months (SD = 5.98). Among the PreViAs domains, visual processing showed the highest frequency of concern (CVI = 94%; non-CVI = 76%), while visual attention had the lowest (CVI = 72%; non-CVI = 41%). Visual processing demonstrated the highest sensitivity (93.8%), whereas visual attention showed the best balance of sensitivity (71.6%) and specificity (58.8%). Area under the curve ranged from 0.59 to 0.66. All domains demonstrated significant differences between children with and without CVI (Fisher's exact test, p < 0.05).

Interpretation: Effective screening tools are critical for detection of CVI. The PreViAs is a sensitive screening tool in children at high risk for CVI. Children with concerns on the PreViAs should be referred for an interdisciplinary CVI evaluation.