Unveiling Potential of Early Intervention and Vision Therapy in Developmental Delay and Visual Impairment: A Case Report

A 3-year 8-month-old boy was referred to the clinic for unusual visual behavior, including poor fixation and not looking down while walking. Birth history revealed full-term cesarean delivery, perinatal tachypnea, and NICU admission. Developmental delays were evident across motor, speech, and social domains. Ophthalmic evaluation showed visual acuity of 1 cpcm at 28 cm, mild refractive error, and accommodation lag. Visual functional assessment using LEA tools revealed deficits in shape and size perception, spatial orientation, and eye-hand coordination. Nystagmus was noted, alongside optic nerve pallor and vessel attenuation. SD-OCT demonstrated neurosensory retinal thinning, shallow foveal dip, and attenuated ellipsoid zone. MRI identified peritrigonal hyperintensities – consistent with cortical visual impairment (CVI). Diagnosed with CVI and global developmental delay (GDD), the child underwent intensive vision therapy. Over 6 years period, visual acuity improved to 6/9, contrast sensitivity to 1.20 log CS, and perceptual-motor skills markedly progressed. Although expressive language delays persisted, fine and gross motor skills improved, and social engagement was enhanced. This case illustrates the neuroplastic potential of early, multidisciplinary interventions, including vision therapy, in mitigating functional deficits associated with CVI and GDD. Targeted therapy facilitated meaningful gains in visual function, mobility, and adaptive function, underscoring its role in preventing disability and promoting rehabilitation.