Blindness and visual impairment feature in many of the claims that we pursue for our seriously injured clients at Boyes Turner. Whilst this devastating form of disability is sometimes the result of damage to the eye, blindness and eyesight problems can also arise from damage to the brain. When errors in maternity, neonatal, medical/surgical or ophthalmic care result in blindness or sight loss, the injured person may be entitled to make a claim. We understand that compensation can’t reverse the injury or cure the condition, but it can provide our clients with much-needed care and support, rehabilitation, specialist technology and other physical, psychological and financial assistance. With this help, our clients can and do improve their independence, mobility, communication and quality of life. Cortical visual impairment (CVI) or cortical blindness Cortical visual impairment, sometimes known as cortical blindness, is a condition which happens within the brain. The eyes can see but the brain cannot interpret what the eyes see. Children who suffer from CVI usually have other serious neurological problems, such as cerebral palsy. This is because CVI is usually caused by damage to the brain. According to a study reported in the British Journal of Ophthalmology, the four most common causes of CVI are: perinatal hypoxia – oxygen deprivation around the time of birth, such as HIE; cerebral vascular accident – a stroke, where the blood supply to the brain is disrupted from a blood clot or ruptured artery; meningitis – an infection of the protective lining of the brain; acquired hypoxia – oxygen deprivation from other causes, such as cardiac arrest. At Boyes Turner, most commonly, our clients with cortical blindness have suffered hypoxic brain damage and severe neurological disability, such as cerebral palsy, as a result of mistakes in maternity or neonatal care. Errors, such as inadequate fetal heart monitoring, delays in delivery or inadequate resuscitation, which severely deprive the baby of oxygen can damage the brainstem or the visual cortex which processes visual information. Jaundice and kernicterus Kernicterus is another type of brain damage that causes visual impairment along with severe neurological disability. Kernicterus is the name given to the pattern of damage to the brain that occurs when a baby has too much bilirubin in their blood (hyperbilirubinaemia). Bilirubin is a natural, yellow pigment that is released into the bloodstream during the body’s normal process of breaking down old red blood cells. Bilirubin is processed in the liver and then stored in the bile duct and gallbladder, so that it can help the body digest fats in the small intestine (as bile). Once it has done its job, it is passed out of the body with the rest of the body’s waste. If the newborn baby’s liver is unable to process all the bilirubin, any remaining unprocessed and highly toxic bilirubin becomes very dangerous because it can penetrate the blood-brain barrier, causing severe damage to the brain and spinal cord. This damage causes severe disability, including cerebral palsy, intellectual impairment, hearing loss and visual impairment. The first warning sign of bilirubin toxicity is jaundice. The excess, unprocessed bilirubin causes the yellow discolouration of skin and eyes that is known as jaundice and is commonly seen in newborn (particularly breastfed) babies. Neonatal jaundice is often transient and harmless but must be carefully monitored to ensure that, if needed, the baby has phototherapy or exchange transfusion treatment before their bilirubin reaches dangerous levels. Kernicterus is totally preventable and should not happen with correct monitoring and treatment. Visual impairment and other severe disability from kernicterus in babies usually only occurs where there has been substandard neonatal care. Hypoglycaemia Neonatal hypoglycaemia (low blood glucose or sugar) is a metabolic condition that is common in newborn babies. Babies with low birthweight, growth restriction (IUGR), diabetic mothers or feeding difficulties are at increased risk of hypoglycaemia. In the first few days of life, babies who have not yet settled into a regular feeding pattern may be unable to maintain safe blood sugar levels. Hypoglycaemia becomes dangerous when the newborn’s blood sugar drops below a safe level. Without correct monitoring and treatment, a baby with hypoglycaemia can suffer permanent brain damage and disability. Severe neurological injury from hypoglycaemia sometimes includes cortical blindness or visual impairment. Unlike hypoxic (oxygen deprivation) causes of birth and neonatal brain injury, neurodevelopmental disability from hypoglycaemia often isn’t obvious to the parents in the early stages of the child’s life. The effects of injury from untreated neonatal hypoglycaemia might be mistaken for other things, such as behavioural problems or developmental learning challenges until the true extent of the child’s disability is revealed by problems at school. Retinopathy of prematurity (ROP) ROP is a condition which affects the eyesight of very premature babies who are born before their retina have fully developed. After premature birth, the baby’s retinal blood vessels develop abnormally leading to detachment of the retina and, ultimately, blindness. Premature babies who have very low birth weight or who have needed oxygen therapy to help them breathe, owing to under-development of their lungs, are thought to be at increased risk of ROP. Premature babies are known to be at risk of ROP and must be carefully monitored so that treatment can take place at the correct time. Failure to monitor or, where necessary, to provide timely treatment for ROP can lead to permanent loss of vision. Acquired brain injury leading to visual impairment Visual impairment can also be caused by other types of acquired injury to the areas of the brain that control sight. These include infection, traumatic injury, strokes and tumours. Infections, such as meningitis or encephalitis, which cause inflammation within or around the brain can cause damage to the optic nerve, leading to impaired vision. Optic nerve damage can result in partial or complete sight loss in one or both eyes. Cortical visual blindness can also be caused by serious infection. Meningitis and viral encephalitis are medical emergencies which need urgent hospital admission and prompt treatment. Delays in diagnosis and treatment can lead to death or severe disability. Brain tumours can permanently impair the sufferer’s sight if allowed to put pressure on the optic nerve. Strokes, brain haemorrhages and brain damage following cardiac arrest can also result in permanent loss of vision. How Boyes Turner help clients after blindness and visual impairment from medical negligence Blindness and visual impairment are devastating and cause life-changing disability. Learning to adapt to live with blindness takes time, resources, care and support, and rehabilitation. Where the injury was caused or significantly worsened by medical negligence, we can help visually impaired clients rebuild their lives and provide financial security by recovering substantial, individually tailored compensation. Depending on the severity of the client’s injury, their disability and personal circumstances, we can help recover compensation for: pain, suffering and disability arising from the injury care and domestic assistance case management rehabilitation and therapies specialist equipment adapted accommodation special educational needs vocational retraining and support transport financial losses, such as loss of earnings medical costs Recent cases include: a £480,000 settlement for a child whose inevitable sight-loss from a rare, benign brain tumour, was made worse by a six-month delay in diagnosis by an optician; $23 million damages settlement for a boy who suffered kernicterus brain damage, including visual impairment, after community midwives failed to recognise and act on his signs of jaundice; a £150,000 settlement from a GP in a disputed case arising from the GP’s failure to refer our client urgently to a stroke/TIA clinic for treatment of ‘amaurosis fugax’ ( episodes of temporary loss of vision from lack of blood flow to the retina), resulting in loss of central vision in one eye. liability judgment (with damages to be assessed) and an immediate interim payment of £250,000 for a child with cerebral palsy, severe visual impairment and learning difficulties, caused by maternity mistakes during a water birth labour. If you or a member of your family have suffered severe neurological disability as a result of medical negligence and you would like to find out more about making a claim, contact us by email on firstname.lastname@example.org.