What is Cortical Visual Impairment?
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Cortical Visual Impairment (CVI) is an
acquired bilateral visual acuity loss caused
by brain damage to the occipital lobes
and/or damage to the posterior
(geniculostriate) visual pathway located
behind the macula. A child’s eye
movements, pupil reactions and eye
examinations may appear to be normal, yet
the child is unable to see normally because
the brain damage produces disturbed and
inefficient visual processing and visual
sense.
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CVI is caused by any event that produces
damage to the visual parts of the brain,
including stroke, hydrocephalus (increased
brain pressure), seizures, decreases in blood
flow or oxygen to the brain, infection
(meningitis or encephalitis), or head
trauma. Head trauma, accidental or
intentional (as in the case of Shaken Baby
Syndrome), is the leading cause of CVI in
children in the United States.
What visual behaviors and
characteristics will I see in students
with CVI?
There are many characteristics associated with
CVI. Children may experience the following
visually:
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Decreased visual fields (areas in which
an object can be seen) that fluctuate
Decreased and fluctuating visual acuity
(sharpness of vision) with close viewing
Better use of peripheral (side) rather
than central vision with head turning,
tilting or looking away noted to access
peripheral view
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Good color vision with preferences of
colors noted, such as red and yellow
Poor depth perception – overreaching
for objects, problems with mobility
Light gazing or non-purposeful gaze
Slow visual responses which appear to
improve when an object is moving or
pointed out to the child first
Poor attention to visual stimuli, most
likely due to “crowding” or “clutter”
which occur when the visual
environment is overstimulating or too
busy. Overstimulation can also cause
the child to have a short visual
attention span.
Preference for gazing at familiar objects
or surroundings, rather than showing
curiosity by observing and exploring
new places and things.
Can Cortical Visual Impairment be
treated and does it improve?
Treatments for CVI focus primarily on
treating underlying neurological (brain)
disease or dysfunction. Many children with
CVI are on medication to decrease seizures
or to address disturbed sleep, a common
side effect. Children may experience
problems with eating because chewing and
swallowing are partially visually learned
skills. Proper positioning and muscle
movement becomes an issue for children
with orthopedic problems. Many children
with CVI also experience severe
developmental delays based on the level of
trauma experienced and the types of
underlying neurological and physiological
conditions the child has. These all can
improve with medical, educational and
therapeutic intervention.
What can I do in the classroom or
home setting?
Early intervention is necessary to stimulate
visual development as improvement in
acuity does take place over time. The
following recommendations will assist your
student:
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Provide time to process things
visually. Frequent “vision breaks”
help, as well as refraining from
primarily visual tasks when a child is
hungry, tired or ill.
Try to pair touch or sound/verbal
descriptions with visual tasks to
attract the child’s attention and to
activate other senses.
Use movement and bright, shiny
colors to activate visual attention
and capitalize on varying visual fields
and use of peripheral vision.
Presenting items from the side first,
then moving them towards the
center, can often help a child
respond visually.
Avoid clutter and overstimulation.
Present items one at a time on a
dark background. Select books with
one large picture per page or a solid
color ball or blocks. Keep it simple
and increase visual complexity
slowly over time.
Repetition and use of familiar,
concrete and preferred objects
helps. Develop a routine way to
present items/complete tasks to be
used by all caregivers.
Positioning can make a huge impact
on response. Try presenting things
on an inclined surface or when the
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child is in an upright seated or
standing position. Supported head
control is very important.
Something to remember is that
when a child with CVI needs to
control his head, use vision and do a
motor task this can be compared to
asking an adult to learn to knit while
walking on a tightrope.
Look at how a child responds in
different levels of light or when light
is positioned differently. Find the
one that seems to work the best and
try to use this whenever working on
academic tasks.
References
Brown, C. (n.d.). Assessing and facilitating the
use of functional vision in young children who
are visually impaired. Retrieved 6-16-2014 from
www.infantva.org/documents/pr-itcvafunctionalvision.pdf
Good, W., Jan, J., Burden, S., Skoczenski, A.
Rowan, A. (2001). Recent advances in cortical
visual impairment. Developmental Medicine &
Child Neurology 43: 56 – 60.
Cortical Visual Impairment (2014). Retrieved
from www.aapos.org/terms/conditions/40
Cortical Visual Impairment Pediatric Visual
Diagnosis Fact Sheet (Fall 1998). Retrieved from
www.tsbvi.edu/seehear/falll98/cortical.htm
What is CVI? (2012). Retrieved from
www.aph.org/cvi/define.html
Developed by Lucy Davis