Vision-MDT

Consensus Statement on the Multidisciplinary Model of Pediatric Neurovisual Rehabilitation

Building an Integrated Service Framework for Children with Neurovisual Dysfunction

Tianjin Consensus 2026 (Discussion Draft)

Preamble

Visual development in childhood extends far beyond the ability to see.

Vision plays a fundamental role in cognitive development, learning, motor control, behavioral regulation, social interaction, and participation in everyday life.

Contemporary neuroscience has demonstrated that vision represents one of the most important channels of information acquisition during childhood development. Visual dysfunction may arise not only from ocular pathology but also from abnormalities of visual network development, neurological injury, or impairments in visual information processing.

For many children, the primary challenge is not reduced visual acuity but impaired processing and utilization of visual information, leading to significant limitations in developmental performance and functional participation.

In recent years, neurovisual conditions—particularly Cerebral Visual Impairment (CVI)—have gained increasing international attention. Emerging evidence and international consensus documents emphasize that neurovisual disorders frequently span multiple domains, including ophthalmology, neurology, rehabilitation medicine, psychology, and education. Consequently, multidisciplinary collaboration has become an essential component of effective assessment and intervention.

At the same time, the growing prevalence of neurodevelopmental disorders, cerebral palsy, acquired brain injury, autism spectrum disorder, attention-deficit/hyperactivity disorder, learning disabilities, and other complex developmental conditions has created an urgent need for coordinated interdisciplinary care.

In response to these challenges, the Vision-MDT Expert Group proposes the Vision-Based Multidisciplinary Team (Vision-MDT) model, a collaborative framework that places neurovisual function at the center of assessment, decision-making, intervention, and long-term management.

This document serves as the pediatric specialty consensus within the broader Vision-MDT Consensus Framework and should be considered complementary to the Vision-MDT Consensus Statement on Neurovisual Medicine (2026).

1. Core Concepts and Definitions

1.1 Neurovisual Medicine

Neurovisual Medicine is an emerging interdisciplinary field that investigates the relationships among visual systems, brain function, behavior, and participation.

The field recognizes vision not merely as a sensory input process but as an integral component of higher-order functions including cognition, motor performance, learning, and social participation.

1.2 Neurovisual Dysfunction (NVD)

This consensus proposes Neurovisual Dysfunction (NVD) as an overarching functional framework.

NVD refers to limitations in the acquisition, processing, integration, or functional utilization of visual information resulting from dysfunction at any level of the visual system.

Examples include, but are not limited to:

Cerebral Visual Impairment (CVI)
Visual attention disorders
Visual-spatial dysfunction
Visual cognitive dysfunction
Visual executive dysfunction
Neurodevelopmental disorder–related visual dysfunction

NVD should be viewed as a functional continuum rather than a single diagnostic category.

Within the Vision-MDT framework, NVD serves as a common construct for screening, assessment, intervention planning, and outcome evaluation.

1.3 Vision-MDT

Vision-MDT is a multidisciplinary model of care in which neurovisual function serves as the central organizing framework for assessment, clinical decision-making, intervention, and follow-up.

2. Target Population

Vision-MDT primarily serves three broad groups of children.

Group A: Children with Neurovisual Dysfunction or High Neurovisual Risk

Including:

Cerebral Visual Impairment (CVI)
Hypoxic-Ischemic Encephalopathy
Acquired Brain Injury
Cerebral Palsy
Neurological sequelae
Epileptic encephalopathies

Group B: Children with Neurodevelopmental Disorders

Including:

Autism Spectrum Disorder (ASD)
Attention-Deficit/Hyperactivity Disorder (ADHD)
Global Developmental Delay (GDD)
Developmental Coordination Disorder (DCD)
Learning Disorders
Developmental Language Disorders

Group C: Children with Complex Functional Disabilities

Including:

Genetic syndromes
Rare diseases
Multiple disabilities
Long-term functional limitations

These categories are based on neurovisual risk and rehabilitation needs rather than disease classification. Overlap between categories is expected.

3. Fundamental Principles

Consensus Statement 1

The primary goal of pediatric neurovisual rehabilitation is to optimize overall development and participation, rather than merely improving visual metrics.

Consensus Statement 2

Assessment of visual function should extend beyond visual acuity and encompass ocular, neurovisual processing, and participation-related domains.

Consensus Statement 3

Neurovisual dysfunction is inherently multidimensional and multisystemic; multidisciplinary collaboration should therefore be considered the standard model of care.

Consensus Statement 4

Assessment and management should be guided by functional outcomes and participation needs.

4. The Vision-MDT Conceptual Framework

The Expert Group recommends a Three-Level Neurovisual Function Model as the core conceptual framework for pediatric neurovisual rehabilitation.

Level 1: Visual Organ Level

Focuses on:

Ocular structures
Refractive status
Retina
Optic nerve
Visual pathways

Key Question:
Can visual information be effectively acquired?

Level 2: Neurovisual Processing Level

Focuses on:

Visual attention
Visual search
Visual-spatial abilities
Visual cognition
Visual memory
Visual executive functions
Sensorimotor integration

Key Question:
How does the brain interpret and use visual information?

Level 3: Functional Participation Level

Focuses on:

Learning performance
Reading and writing
Motor performance
Behavioral regulation
Play participation
Social interaction
Activities of daily living
Home and school adaptation

Key Question:
How does visual function translate into real-life performance?

The three levels interact dynamically and bidirectionally.

Functional limitations may arise through both bottom-up and top-down mechanisms.

5. Vision-MDT Organizational Structure

Consensus Statement 5

Vision-MDT should adopt a Core Team + Extended Team model.

Core Team

Ophthalmologists
Pediatricians
Pediatric Neurologists
Rehabilitation Physicians
Occupational Therapists (OT)
Physical Therapists (PT)
Speech-Language Therapists (SLT)
Low Vision Rehabilitation Specialists
Neurovisual Rehabilitation Specialists

Extended Team

As needed:

Optometrists with neurovisual training
Psychologists
Special Educators
School Teachers
Social Workers
Nurses
Neuroradiologists
Parents and Caregivers

Consensus Statement 6

Parents should be recognized as essential members of the Vision-MDT team.

Because neurovisual rehabilitation largely occurs within home, school, and community environments, parents function not only as supporters but also as active rehabilitation partners.

Their roles include:

Information providers
Goal-setting partners
Home-based intervention facilitators
Outcome evaluators

Families should receive appropriate education, training, and psychosocial support.

6. Standard Vision-MDT Clinical Pathway

Consensus Statement 7

A six-step pathway is recommended:

Risk Screening → Multidimensional Assessment → MDT Decision-Making → Individualized Intervention → Environmental Adaptation → Long-Term Follow-Up and Management

Step 1: Risk Screening

Target populations include:

Premature infants
Children with cerebral palsy
Children with developmental disorders
Children with brain injury
Children with learning difficulties
Children with high-risk neurological conditions

Step 2: Multidimensional Assessment

Assessment should be structured according to the Three-Level Neurovisual Function Model.

Step 3: MDT Integrated Decision-Making

An MDT report should include:

Functional diagnosis
Problem list
Rehabilitation goals
Individualized intervention plan
Follow-up plan

Step 4: Individualized Intervention

May include:

Medical treatment
Neurovisual rehabilitation
OT/PT/SLT services
Cognitive and behavioral interventions
Educational support

Step 5: Environmental Intervention

May include:

Home modifications
School accommodations
Assistive and accessibility technologies
Learning environment optimization
Community resource linkage

Step 6: Long-Term Follow-Up

Longitudinal monitoring should be established to track developmental trajectories and adjust goals according to changing needs.

7. Outcome Evaluation

Consensus Statement 8

Outcome evaluation should be guided by the WHO International Classification of Functioning, Disability and Health (ICF).

Assessment should not rely solely on visual acuity outcomes.

Recommended domains include:

Body Functions

Visual attention
Visual search
Binocular vision
Visual cognition

Activities

Reading
Writing
Learning
Mobility
Activities of Daily Living (ADL)

Participation

School participation
Family participation
Social interaction
Play participation

Individualized Goal Achievement

Goal Attainment Scaling (GAS)

Family Outcomes

Parent satisfaction
Caregiver burden

8. Workforce Development and Quality Assurance

Consensus Statement 9

Pediatric neurovisual rehabilitation requires a structured workforce development framework.

The Expert Group recommends four training pathways:

A. Screening Program

For pediatric, rehabilitation, and ophthalmic clinicians.

B. Discipline-Based Training

For specialty professionals participating in Vision-MDT services.

C. Neurovisual Rehabilitation Fellowship

Advanced subspecialty training in neurovisual assessment, diagnosis, rehabilitation planning, MDT leadership, teaching, and research.

D. Vision-MDT Coordinator Program

Training in:

MDT coordination
Case management
Family support
Resource integration
Quality management

Consensus Statement 10

A unified quality management framework should include:

Standardized assessment systems
Standardized reporting systems
MDT governance structures
Follow-up databases
Quality indicators
Adverse-event monitoring

9. Building the Vision-MDT Collaborative Network

Consensus Statement 11

Regional, national, and international collaborative networks should be developed.

Priority areas include:

Teleconsultation services
Remote assessment support
Standardized databases
Online training systems
Multicenter research platforms
International collaboration networks

The Tianjin Initiative (2026)

We call upon clinicians, researchers, educators, rehabilitation professionals, families, and policymakers to:

Recognize vision as a fundamental organizing system in child development rather than merely a sensory function;
Transform neurovisual rehabilitation from a discipline-specific service into a multidisciplinary model of care;
Place functional improvement and participation at the center of clinical decision-making;
Build integrated neurovisual health systems that connect healthcare, rehabilitation, education, families, and community support services.

Vision-MDT Core Philosophy

Seeing is not the destination.
Understanding vision is where development begins.

Vision provides a window into child development.

Collaboration creates pathways toward a better future for children.

Selected References

Sakki HEA, et al. Visual function and visual perception in children with neurodevelopmental disorders: A systematic review. Dev Med Child Neurol. 2022;64(7):812–823.
Philip SS, Dutton GN. Cerebral visual impairment in children: a practical approach. Lancet Child Adolesc Health. 2021;5(7):521–531.
Williams C, et al. Assessment and management of cerebral visual impairment in children: a multidisciplinary approach. European Paediatric Neurology Society Guideline Summary. 2022.