You have noticed something about how your child sees the world. They seem to look past objects rather than at them. They reach for the red toy but ignore the blue one. Bright lights fascinate them, but a busy playroom overwhelms them. Their eye exam came back normal, and yet something is clearly different. What you may be seeing is cortical visual impairment, and understanding it can change everything about how you support your child.
What Is Cortical Visual Impairment (CVI)?
Cortical visual impairment is a brain-based visual disorder in which the eyes are structurally normal and capable of receiving visual information, but the brain has difficulty processing, interpreting, and making sense of what the eyes see. It is caused by damage to the visual processing areas of the brain (primarily the occipital lobes and visual pathways), the same type of injury that causes cerebral palsy.
CVI is the leading cause of visual impairment in children in developed countries, surpassing all eye-based conditions combined. Studies estimate that 60 to 70% of children with CP have some degree of visual impairment, with CVI being the most common type.
The 10 Characteristics of CVI
Dr. Christine Roman-Lantzy identified 10 characteristic behaviors that help clinicians and parents recognize CVI and distinguish it from eye-based vision problems:
| # | Characteristic | What It Looks Like |
|---|---|---|
| 1 | Color preference | Child responds more to specific colors (often red or yellow) than others |
| 2 | Need for movement | Child notices moving objects more easily than stationary ones |
| 3 | Visual latency | Delayed response when looking at objects; may take several seconds to “see” |
| 4 | Visual field preferences | Child consistently uses one area of their visual field better than others |
| 5 | Difficulty with distance | Child sees objects close up better than far away |
| 6 | Visual complexity issues | Overwhelmed by busy patterns, cluttered backgrounds, or crowded environments |
| 7 | Light-gazing or light aversion | Drawn to lights compulsively or avoids bright environments |
| 8 | Difficulty with novelty | Responds better to familiar objects than new ones; needs repeated exposure |
| 9 | Absence of visually guided reach | Does not look at objects while reaching for them (looks, then reaches, or reaches without looking) |
| 10 | Fluctuating visual function | Vision appears to change based on fatigue, illness, environment, and complexity |
If brain injury during delivery caused both CP and CVI, a case review can help you understand what happened.
How CVI Is Diagnosed
CVI diagnosis requires two things: a normal or near-normal eye exam (confirming the eyes are not the primary problem) and a functional vision assessment by a teacher of the visually impaired (TVI) using the CVI Range assessment tool. The CVI Range, developed by Roman-Lantzy, scores the severity of each characteristic on a scale from Phase I (most impaired) to Phase III (most resolved), guiding intervention priorities.
Many children with CP have CVI that goes undiagnosed because their eye exam is normal and clinicians do not screen for brain-based vision problems. If your child shows any of the 10 characteristics above, request a CVI evaluation.
Supporting Your Child at Home
Environmental adaptations
- Reduce visual clutter. Present objects against a plain, dark (ideally black) background. Clear the visual field of distracting patterns and competing objects.
- Use your child’s preferred color. Wrap toys or utensils in red or yellow tape. Use colored bowls and cups that stand out against the table.
- Add movement. Shiny or reflective objects that catch light, mobiles, and gently moving toys may be easier for your child to see.
- Allow extra time. Visual latency means your child needs more time to process what they see. Wait 10 to 15 seconds after presenting an object before assuming they have not seen it.
- Control lighting. Backlighting (placing a light source behind an object) and reducing ambient glare can improve visual attention.
Structured visual programs
A TVI trained in CVI will develop a systematic intervention program that gradually increases visual complexity as your child’s brain learns to process more information. This might include transitioning from single-color objects to multi-color, from simple to patterned backgrounds, from stationary to competing visual stimuli, and from near to distance viewing.
If a birth injury caused your child’s CP and CVI, our team can help identify resources and compensation.
CVI and Education
Children with CVI have the right to vision-related services under IDEA. This includes access to a TVI, materials adapted for their visual needs, and classroom accommodations (simplified visual displays, high-contrast materials, preferred seating, reduced visual clutter). Request a functional vision assessment and CVI evaluation as part of your child’s IEP or IFSP process.
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