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Gordon Dutton’s Blog (33) Making A Diagnosis

Making a diagnosis

Much has been written about what is needed to make a diagnosis of cerebral visual impairment.

Emphasis has been given to the need for brain scans, the tests that should be used, or the sub-specialty or status of the clinician making the diagnosis.

Yet less emphasis appears to be placed upon what is really needed, prior knowledge and the requisite diagnostic skills.

Sir Arthur Conan Doyle trained as an ophthalmologist. He wrote fondly of his undergraduate training in Edinburgh where he drew inspiration for the character of Sherlock Holmes from a remarkably skilled diagnostician, the surgeon Joseph Bell FRCSE (1837-1911). He wrote of Mr Bell:

I had ample chance of studying his methods and of noticing that he often learned more of the patient by a few quick glances than I had done by all my questions.

Sir Arthur Conan Doyle

It was Bell's extensive knowledge combined with his capacity for detailed observation, deduction, and skilled diagnosis that Conan Doyle admired, and employed to great advantage in his detective stories.

Cerebral visual impairment has been defined by the catch-all description of it being ...

"a verifiable visual dysfunction which cannot be attributed to disorders of the anterior visual pathways or any potentially co-occurring ocular impairment" *

... but diagnosis entails recognition, and characterisation of its many variants that can be seen in people from birth to old age.

From my perspective, the answer to the question, "What is needed to make a diagnosis of cerebral visual impairment?', does not concern brain scans, nor a doctor with a specific specialism.

It relates to the clinician with the requisite resources, experience, knowledge and diagnostic skills, to recognise, differentiate and identify each and every manifestation of the condition, as well as the ability to make the diagnosis and to characterise it.

Accurate diagnosis and detailed characterisation of the unique pattern of each individual's cerebral visual impairments, combined with skilled communication of the findings in ways that all can understand, are the first steps towards ensuring optimal education and care.


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