Opthamologist Reports

This is Dr. Schmitt's letter to Dr. Damron on November 18th, only ten days before Paisley's MRI. We went in thinking she might just need some baby glasses, never imagining what we were going to face.
I had the pleasure of seeing Paisley in clinic on November 17, 2011. This six-month-old girl was brought in by her parents due to concerns that she does not see well. They have noticed that Paisley does not appear to fixate on anything. They have not seen any shaking of the eyes. They also note that Paisley has other developmental delays and is not pulling or reaching for objects.
On examination I cannot demonstrate any fixation or following behavior. I am able to elicit opticokinetic nystagmus with both the right eye and in the left. Pupils are slightly irregular but equally reactive. Motility is full. There is no strabismus. There is no nystagmus. Anterior segment is remarkable for punctate polar cataracts. Dilated funduscopic exam shows normal optic nerve, macula, vesseks and periphery, Cycloplegic retinoscopy shows moderate hyperopia.
I discussed with Paisley's parents that I agree that her vision is significantly behind what we would be expecting for her age. There are punctate cataracts which are not visually significant at this point, and, aside from this, the eye exam appears normal. Of note, the optic nerves areof normal size and I do not find any abnormality of the retina. With this in mind, it is likely that the decreased visual function is due to cortical visual impairment. I have recommended an MRI to evaluate the brain and orbits, and we will be setting this up in the near future. I did discuss with Paisley's mother and father that given her developmental delays it is possible that she will also need referral to pediatric neurology. I will follow up with you on the results of the scan.


Short report from follow up visit by Dr. Schmitt, on January 17, 2012.
8 month old female with CVI, polymicrogyria. seen by Gammeltoft. EEG nl, then developed infantile spasms ~ 8 per day. Mom sees eyes shaking now ~ 1 month ago.
Exam: No F and F (?), no reaction to light
Ant Seg: punctate cataracts
A/P 1. cortical visual impairment, infantile spasms, 2. cataracts polar punctate
Follow up in 6 months.

Basically, nothing as changed. At least it's not worse. She told us that her vision will improve once her neurological condition does. As far as Gammeltoft is concerned, it's not. I am so excited for PT and OT tomorrow morning. Let's get going, prove 'em wrong!!