legal blindness

[lem]

Our 4 year old grandson was born 3 months premature.  This is some of the information from a letter from his eye doctor.

  Bilateral optic atrophy secondary to cerebral palsy, interventricular hemorrhage and a history of hydrocephalus.  Right homonomous hemianopsia due to a left retrochiasmal injury to the visual pathway.  this may be occipital lobe but may also be optic tract or optic radiations.  

  His intake diagnosis includes optic atrophy bilaterally, hypotropia of the left eye and estimated visual acuity at 20/800. He showed no response to an oculokinetic stimulus. He shows no nystagmus. The pupil exam and anterior segment exam were normal. The ocular motility was full, and the alignment varied from orthophoria to 15 prisms of exotropia.  Funduscopic exam shows atrophy of each optic nerve.  the vessels are moderately attenuated, and the macula is normal in each eye. Peripheral retinal scars are visable from his retinopathy of prematurity treatment. Dilated retinoscopy shows mild hyperopia which does not require spectacles.

  My questions is:  Is there any new medical information that has come out in the last four years that would be of some help to our grandson in correcting his eye sight problems?  Also , would you please explain some of this diagnois to us?

  Thankyou for any help you can give us.

[lem]

Thank you for responding to my question and thank you for putting the eye doctor's letter into plain english.  We were told that the brain takes years to heal, so we still have hope that someday he'll be able to do more.  It does seems like he looks at us at times.  Do you have any idea what he would be able to see with 20/800 eyesight?  And is there no hope to repair these damaged nerves?   Thank you again.

[CCF-Neuro-M.D.-JT]

Very sorry to hear about your grandson. His vision problems are quite complex and from your description sounds rather severe. As of now there hasn't been anything reported in the medical literature that would be of benefit to someone with your grandson's signs/symptoms. What I can do is attempt to explain what the ophtho said.

Sounds like the eyeball itself is normal. It can move normally, although they sound a bit misaligned from the descriptions of hypotropia (displaced downwards) and exotropia (displaced outwards). But then the nerve that connects the eyeball to the rest of the brain (optic nerve) has been severely damaged on both sides where it is attached to the eyeball. This is optic atrophy. The nerve is again damaged further back on its way to the part of the brain that processes vision (occipital lobe)on the left side which means even if he could see, he would completely miss half of his right visual field in both eyes. This is the right homonymous hemianopsia. And the optokinetic stimulus helps to confirm his inability to see. Hope that helps.