V. Soundarya Dharshini, B. Optom
Paediatric Optometrist, Sankara Nethralaya, Chennai, India
Prosopagnosia is a condition in which an individual is unable to recognise faces. (1) Visual agnosia is an impairment in recognising visually presented objects. (2)Cerebral Visual Impairment (CVI) is the leading cause of childhood vision impairment in developed countries. The prevalence of CVI in these regions ranges from 10 to 22 cases per 10,000 births in children under 16 years. In developing countries, the prevalence is about 10 per 10,000 births.(3)
Case details
An 8-year-old girl was accompanied by her mother, who reported complaints of poor eye contact and difficulty in recognising faces and objects. The mother gave a history that the child is a known case of Acute Necrotizing Encephalopathy. She also had a history of seizures and had undergone tracheostomy. Optometric evaluation revealed reduced visual acuity, wandering eye movements, chin-down posture, and reliance on auditory cues, suggesting visual agnosia. Assessment for visual agnosia confirmed impaired shape and object recognition with intact colour perception. A low vision assessment recommended vision stimulation therapy and a trial of glasses, and the mode of schooling was also discussed with her mother.
Discussion
Prosopagnosia is an overlooked feature of cerebral visual impairment, particularly when the ventral visual stream is affected. (4) Unlike visual acuity loss, which can be detected easily with standardised eye charts, prosopagnosia often requires a variety of ancillary tests to confirm.(5)A child may read letters; however, they may still find it difficult to recognise their own mother by sight. This gap in detection means that many children remain undiagnosed, with their challenges misinterpreted as inattention, memory issues, or social disinterest.
The occipital regions of the brain are important for interpreting visual signals, and the fusiform gyrus is important for facial recognition. (4) Any lesions in these regions cause prosopagnosia and visual agnosia. (2)Traditional clinical assessments are rarely designed to detect face recognition deficits. Standard vision tests measure detail clarity; however, they overlook facial recognition ability, making functional vision assessments in real-life contexts essential.
Figure 1: This image depicts various shapes that may confuse individuals with visual agnosia.
Image Courtesy: https://images.pexels.com/photos/11200121/pexels-photo-11200121.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=2
Multidisciplinary approach and management
Accurate diagnosis benefits from a multidisciplinary approach involving low vision optometrists, neuro-ophthalmologists, occupational therapists, and special educators. (5,6) Management focuses on compensatory strategies, teaching children to use consistent non-visual cues like voice. Since visual function extends beyond acuity, educational planning should involve parents. When needed can consider a specialised learning environment. Research has largely centered on adults, leaving gaps in paediatric evidence and rehabilitation strategies. Increasing awareness among professionals and families enables earlier detection, better support, and improved social, emotional, and quality-of-life outcomes for children.
Conclusion
Understanding the ophthalmic and neurological manifestations, along with their causes, can assist the multidisciplinary team in assessing the visual impairment affecting a child with CVI in formulating appropriate rehabilitation strategies.(6)
References
- Corrow SL, Dalrymple KA, Barton JJS. Prosopagnosia: current perspectives. Eye and Brain. 2016;8:165–175. doi:10.2147/EB.S92838.
- Kumar A, Wroten M. Agnosia. In: StatPearls. StatPearls Publishing; 2023.
- Patial Y, Swaminathan M. Cerebral visual impairment. TNOA Journal of Ophthalmic Science and Research. 2018;56(4):244. doi:10.4103/tjosr.tjosr_108_18.
- Josephs KA, Josephs KA Jr. Prosopagnosia: face blindness and its association with neurological disorders. Brain Communications. 2024;6(1):fcae002.
- Lindquist B, Westerberg C. Closing in on a Consensus in Identifying, Assessing and Diagnosing Children With Cerebral Visual Impairment. Acta Paediatrica. 2025;114(10):2490–2498.
- Delay A, Rice M, Bush E, Harpster K. Interventions for children with cerebral visual impairment: A scoping review. Developmental Medicine & Child Neurology. 2023;65(4):469–478.
About the Author
V. Soundarya Dharshini
Paediatric Optometrist
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