Explaining cortical visual impairment and environmental adaptation — OSCE

Candidate instructions (8-minute station)

You are the paediatric registrar in the neurodisability clinic. A 10-month-old girl born at 26 weeks gestation, who has spastic diplegia, does not reliably fix and follow or reach for toys held in front of her. She turns toward the window light but ignores faces held close. Her external eye exam, red reflexes and dilated fundus are normal, with clear media and a healthy retina. ^[6]

Your tasks are: ^[1]

1. Explain the diagnosis of cortical visual impairment in plain language, including why the baby sees poorly despite a healthy eye. ^[2]
2. Describe the paradoxical behaviours the parent may have noticed, and what they mean. ^[2]
3. Explain the habilitative approach — why there is no drug or surgery for the cortex, the hope of improvement through the brain rewiring, and the practical environmental adaptations at home. ^[11]
4. Outline the team that will support the family and the plan ahead. ^[7]

You are not expected to order new investigations in this station or to discuss urgent imaging — the eye is normal and the diagnosis is being explained. ^[1]