“How we learn to see” is the title of the workshop that Dr. Daniela Ricci, pediatric neurologist of the National Center on low vision and vision rehabilitation, and her team will hold in Rome on 14-15 February 2020. The event will be an opportunity to illustrate a whole sector of vision rehabilitation: low vision in childhood, its causes, and the chances of recovery offered by spontaneous or induced brain plasticity in the first months of life.
“Eyesight plays a pivotal role in child development from birth, both for motor and interpersonal skills”, Dr. Ricci explains. “Early diagnosis of any vision problem is therefore crucial for timely treatment so that a child may develop their full potential”. The National Center for Vision Rehabilitation, where Dr. Ricci works as a pediatric neurologist, treats approximately 800 visually impaired children every year.
Many of these children have a surprising recovery ability, even in the case of severe brain damage, because around the end of pregnancy, brain plasticity in newborns is higher. “This means,” Dr. Ricci clarifies “that when damage occurs during the neonatal period, the adjacent areas of the brain, which are still intact, perform the functions that are recognized as essential. This spontaneous plastic ability is at its peak in early infancy, although recent studies have shown that ‘induced’ plasticity during rehabilitation can improve vision performance at all ages”.
“Vision problems can stem from very different causes, some severe, others less so. However none of them should be ignored and the assessment of visual skills must be conducted from the first days of life, when risks may be present. In the case of eye diseases, vision problems may not be immediately evident, however, orthoptic and ophthalmological examinations can be performed from the first months of life. On the contrary, in some brain pathologies, vision problems may be the first sign to emerge, in the form of poor attention or poor ability to fixate or follow a toy. In both cases, a possible vision problem should be taken into consideration and its cause should be investigated. The earlier the diagnosis is made – and the earlier the intervention is performed – the greater the recovery of the child and the development of their potential”.
This is the scope of the workshop “HOW WE LEARN TO SEE – Early neuro-visual assessment and rehabilitation”, which will be held in Rome on 14-15 February 2020.
“The event caters to different healthcare professional categories”, explains Dr. Ricci, who is the organizer. “The aim is to summarize the most important information on how to detect visual problems, which exams must be performed in the early stages and what kinds of intervention should be carried out to promote the development of a child’s visual and psychomotor skills”.
Dr. Ricci, what is the incidence of low vision in children, and what are the causes?
“Unfortunately, we don’t have reliable data regarding children in Italy. According to the ISTAT report “Health conditions and use of health services in Italy and the European Union”, one third of elderly people suffer from at least moderate visual limitations, which amounts to 4.5 million people. Two out of a hundred people aged 15 and over, suffer from severe visual limitations, a percentage that rises to 5.4 among the over 65, and to 8.6 among the over 75. There is no reliable data for subjects under the age of 15. However, we can say that since 70 percent of children with a motor problem, which is the consequence of brain lesions, can be affected by an associated vision deficit, at least two children out of 1000, who are born alive every year, are at a high risk of developing a visual impairment. Children with eye pathologies must be added to that figure”.
What does the rehabilitation path consist of?
“Play is always the basic underlying activity. Our core task is to help children use their sight and find it interesting, so that exercises and efforts, combined with the brain’s ability to replace damaged neurons with intact ones from adjacent areas, encourage the development of visual skills to their full potential. Since we have assessment protocols, that are standardized and easy to perform, which help us identify a vision issue from the neonatal period, we can start our observations also in the neonatal intensive care unit. The initial intervention, especially in the neonatal period, is often more centered on the parents. As soon as a diagnosis is made, parents can feel powerless and don’t know how they can help their little ones. Our task is to support parents in the early stages and help them understand that simple things – such as arranging indoor lighting, feeding, play and cuddling (by showing their faces in high-contrast, so that children may look at them) – help children become competent. In this way, we reinforce the child-parent relationship, which is always at risk in the presence of a sensory deficit, and help parents become more confident in their role as educators and more at ease with their children. Recovery possibilities at that age are very good, but interventions must be early and timely”.
More than 1.4 billion people in the world are short-sighted and their numbers seem destined to increase: half of the world’s population is likely to become short-sighted by 2050 
The authors of the article – all Americans [[medical researchers working in California (Eye Monitoring Center), in Boston (Harvard Medical School and Department of Ophthalmology) and in Maryland (National Eye Institute)]] – write that the risks of major complications incurred by people with high myopia, range from retinal detachment to glaucoma, and include cataracts, choroidal neovascularization, optic neuritis, staphyloma and myopic macular degeneration.
If you have not already done so, arrange an eye examination as soon as possible because you are still entitled to it. You can make a free appointment at one of the many specialists participating in the campaign that was launched on the occasion of World Sight Day, on 11th October, 2018 (
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Consider a disease such as Stargardt’s maculopathy. People who suffer from it have great difficulties in reading, are dazzled by sunlight and their visual abilities progressively weaken in their youth and over their working life, in particular, at the centre of the visual field. What can be done? Today, there is no known cure, as Stargardt’s maculopathy is a genetically transmitted retinal dystrophy, but patients can learn to make the most of their residual visual skills, regain self confidence and improve their quality of life. All this thanks to visual rehabilitation.
Severe visual limitations affect, on average, 2.1% of the European Union population aged 15 years old and upwards, while from 65 years of age, the figure climbs to 5.6%, rising even further to 8.7% for those aged 75 and over. In Italy over one third of the elderly suffer from at least moderate visual limitations, equating to approximately 4.5 million people. This is stated in the Annual Report of the Italian Ministry of Health, which cites the latest ISTAT publication on “Health Conditions and recourse to health services in Italy and in the European Union.”
(as usual, the situation is better in the Centre-North of Italy). Approximately 60,000 people underwent a first visit without being rehabilitated (2016 data). The problem is not only the excessively high cancellation rate, but often rehabilitation centres are underfunded. Ideally they should be staffed with various professional figures – such as an ophthalmologist, an orthoptist, a psychologist and an instructor of orientation and mobility -, but too frequently this is not the case.
Myopia is on the rise among Chinese children: in a group of 4741 school children, the incidence of this refractive error was found to be between 20% to 30%. Even though myopia is rising worldwide, this growth has been particularly significant in China.
Guangzhou.
From 9-11 October, people in Rome had the opportunity to undergo free eye examinations on board Mobile Ophthalmology Units. These are hi-tech camper vans, equipped for eye examinations. This initiative was promoted by the International Agency for the Prevention of Blindness-IAPB Italy. 
