Cortical Visual Impairment
I recently attended a conference so I could educate myself on Cortical Visual Impairment, one of the diagnoses my son has. It was so enlightening and revolutionary, and add in a big heap of mom guilt. When you have a child with multiple disabilities, it can be tough to decide which one to prioritize or focus on. After this conference and digesting what I learned there, I am definitely moving CVI to the top of the list.
Author’s note: Since this post is over 6 years old, I can comment on progress. I can tell you that it was life-changing (duh!) to make CVI accommodations a priority. I am so glad that I went to hear Dr. Lantzy. I was overwhelmed at first with all the changes, but once you get into that pattern of thinking, it’s much easier. Now, most everything we buy for Kevin (feeding utensils, plates, anything really) we think about what it is going to look like for him.
The following information is from Dr. Christine Roman-Lantzy, one of the leading researchers and specialists in CVI. I’m not a doctor, nor do I play one on the Internet. Please consult your child’s medical team with specific concerns.
What is Cortical Visual Impairment (CVI)?
There are two types of visual impairments. Those that eye based (a problem with the actual eye) and those that are brain-based (a problem with the brain). CVI is brain-based. There is damage or atypical structures in the visual pathways. Visual processing is compromised to varying degrees. The eyes get the image and the brain perceives it, however, it cannot categorize the information or sort the information. The brain cannot label it or put meaning to it. This is why glasses do not fix the problem. Children may look at objects, frequently. Looking at an item does NOT mean that they are able to interpret it.
Causes of Cortical Visual Impairment
Including, but not limited to:
- hypoxia (a lack of sufficient oxygen in the body’s blood cells)
- ischemia (not enough blood supply to the brain), all of which may occur during the birth process
- developmental brain defects
- head injury
- hydrocephalus (when the cerebrospinal fluid does not circulate properly around the brain, and collects in the head, putting pressure on the brain)
- infections of the central nervous system, such as meningitis and encephalitis
- neurological conditions such as chromosome disorders
- Traumatic Brain Injury (TBI)
Is this the same as cortical blindness? It is now widely accepted that “cortical blindness” is not an appropriate diagnostic term for children with early, acquired visual impairment due to non-ocular causes.
Characteristics of CVI
• A preference for color, predominantly red and yellow, but can be any color. Children are drawn to rich, highly saturated colors. Color is a visual anchor for them.
• Need for movement, especially rapid movements. May fixate on fans or other similar objects. Older children (in the classroom) may not be able to “not look” when visually distracted by a ceiling decoration, movement in the hallway or outside the classroom window. This includes shiny things, mylar and similar items that will draw their attention.
• Visual latency, meaning the patient’s visual responses are slow and often delayed. They need wait time in order to respond. With proper interventions, the latent times can greatly improve.
• Visual field preference—the patient sees better in one area, i.e. right peripheral.
• A difficulty with visual complexity, meaning not seeing an object when other stimuli, such as sounds, are present. If an environment is sensory complex, they have to choose which sense they are going to attend to. This includes the ability to the analyze faces, which are very visually complex. This means that the kids will often avoid looking into unfamiliar faces.
• Light-gazing and non-purposeful gaze. Since they cannot sort and categorize what they are seeing, if they cannot find something meaningful (to them) to look at, the child will have a non-purposeful gaze.
• A difficulty with distance viewing (often mistaken for nearsightedness). This is due to what could be a visually complex environment. In these instances, the child will use memory to override their vision skills, which then makes it appear as if they can see–because they will be able to navigate familiar environments based on memory.
• Atypical visual reflexes, such as not blinking when you tap bridge of the nose or visually threaten the child with fingers (ie, act as if you are going to poke in the eye, judge response.)
• A difficulty with visual novelty, meaning the patient prefers looking at familiar objects. Often confused with a hyper-interest in something, since they will fixate and show a preference for the familiar. Prefer objects that they already know, therefore the brain doesn’t have to “sort out” the information. They have to be taught from the perspective of building a visual schema to work from, as they have none. They have no previous visual experiences or knowledge to draw from, it has to be taught.
• An absence of visually guided reach. “Look, look away, reach.”
The next step is to find someone (specialist) that can do an assessment on your child for CVI range. This is a range scale that goes from 1-10 and has three separate phases and will help determine strategies to help your child improve.
I don’t like the word ‘treatment’ because that implies a fix or a cure. Eg: Do some type of therapy for X number of months and bingo! No more CVI! It doesn’t really work that way. Ask your child’s doctor.
Your child may need vision services and/or orientation and mobility services. Try to find providers that are familiar with the latest information on CVI. Note: a CVI range assessment exam IS NOT the same as a Functional Visual Assessment (FVA). I recommend getting both for your child.
Shared Behaviors DOES NOT mean Shared Diagnosis
Here are some behaviors that kids with CVI exhibit:
- lack facial regard/eye contact
- delayed play skills
- delayed speech/language skills
- perseveration on familiar objects
- delayed social skills
Sound like anything else you know? When assessing your child, make sure you explore ALL the options, as many physicians are still unfamiliar with CVI. Make sure your IEP team is aware of this diagnosis and that strategies are implemented to help your child visually access his/her education. Ask if your school district or county has TVIs (teachers of the visually impaired) and determine if this will help your child.
From Boston Children’s Hospital-Confusing diagnostic entities include:
- delayed visual maturation
- autism spectrum disorders
- severe bilateral central scotomata (with eccentric fixation)
- dyskinetic eye movement disorders
- profound mental retardation
CVI and your IEP
It all begins with the evals! So make sure you request a functional vision assessment (FVA) and an Orientation and Mobility (O&M) assessment. From there, the team should decide if the child needs direct teaching or just accommodations.
We did several years of direct teaching of both vision and O&M. Kevin moved up several numbers in the scale, and now he just gets accommodations and consults. The accommodations that you need on the IEP should come from someone like Dr. Roman or your child’s doctor. The CVI accommodations are pretty standard now and many schools are using them.
Myths and Misconceptions about CVI
“The child’s vision will vary from day to day, hour to hour.” FALSE. The child’s visual abilities do not change, the environment may change.
And unlike many ocular (eye-based) problems, CVI patients can improve their vision. Improved vision feeds cognition and builds those neuropathways. This means actual learning and improvement in skills can take place, rather than just an improvement in coping skills.
CVI: websites, resources, Pinterest boards
- LightBox & other ideas that glow
- Fun activities for kids who are blind or visually impaired
- Apps & accessibility board for kids with disabilities
- APH CVI website– information on assessments, strategies, interventions, and so on.
- CVI Resources-Dr. Roman’s site from West Penn Hospital
- AFB-The American Foundation for the Blind’s statement on CVI. Once you’ve read that, you can just click their icon up top to return to the home page and browse around at their other resources and information.
- Resource and scientific papers from National Deaf/Blind Association
- Little Bear Sees-website for and by parents of a child with CVI
- Wonderbaby-great resource site for children with visual impairments
- A vision teacher with a blog about vision and CVI
This post was originally written in 2012 but was recently updated to fix links and formatting.