In the developed world the face of childhood blindness has changed dramatically in the past two to three decades. Improved medical and ophthalmological care since the late 1950s can be credited with the decrease in the prevalence of congenital and acquired ocular blindness.1 2 For example, the prevalence of congenital cataracts has been reduced dramatically as the result of rubella immunisation programmes.3 Moreover, a thorough understanding of the importance of early surgery coupled with significant improvements in surgical techniques has resulted in vastly improved visual outcomes in children with congenital and developmental cataracts.3 4

Regrettably, the reduction in ocular blindness has been more than offset by an increasing rate of neurological visual impairment.5 This change can be attributed to the improvement in rates of survival of very premature infants and critically ill children. For those who provide care for visually impaired children this epidemic of neurological visual impairment has brought with it a myriad of new diagnostic and rehabilitation problems.6 These children are usually multidisabled visually impaired whose needs are not limited to visual rehabilitation and assistance. In addition, quite often, their multiple disabilities compound the problems of clinical visual assessment as well as rehabilitation strategies.7

The term cortical blindness refers to the loss of vision, secondary to injuries or maldevelopment involving the geniculostriate pathways. Clinically, it is manifested as the absence of vision and optokinetic nystagmus in the presence of a normal ocular examination and intact pupillary light responses.8 It most commonly occurs in children following hypoxic insults,9 10 but may also arise as a sequela …