Cerebral/cortical visual impairment (CVI) is a brain-based visual impairment caused by damage or interruption to the visual processing areas of the brain. With CVI, the brain has difficulty recognizing and making sense of the visual world. CVI impacts every aspect of life. The CVI visual behaviors are a framework for understanding the impact of CVI on access and is rooted in current CVI research.
CVI is the leading cause of childhood blindness and low vision, but it is alarmingly underdiagnosed. Less than 20% of kids in the US have a CVI diagnosis. CVI often co-occurs with neurological, neurodevelopmental, or genetic conditions. Those with healthy eyes and without other conditions can still have CVI.
How might CVI impact the work of a teacher of students with visual impairments (TVI)?
CVI is the leading cause of pediatric blindness and low vision, so the majority of TVIs (if not nearly all) will work with students with CVI.
TVIs build a deep understanding of CVI, how to evaluate functional vision in students with CVI, and implement accessible instruction, materials, and programming matched to the specific ways CVI impacts access for each student.
TVIs develop and implement strategies that address the unique challenges of CVI, and incorporate their knowledge of building compensatory skills and strategies. All students with CVI use compensatory skills. Some rely on visual strategies, like color-coding, while others use non-visual strategies, such as tactile, auditory, or kinesthetic methods—and many use a combination of these approaches.
Additionally, a TVI collaborates closely with other educators, therapists, and the child’s family to create an individualized approach that supports the student’s learning and overall development. This involves ongoing assessment, creativity, and flexibility in teaching methods to meet the specific needs of students with CVI.
When might you suspect a student has CVI within your work as a TVI?
CVI has diverse manifestations, and no two individuals with CVI are exactly alike. Here some examples of indicators and observations that might lead to suspecting CVI.
Medical history review has any red flags for CVI
Interacts with materials using their tactile or auditory sense before using their vision
Hard time recognizing pictures and images
Difficulty making eye contact and may mistake people who have similar attributes (hair, glasses, gait)
Difficulty with stairs, curbs, and thresholds in the environment
Has trouble looking at and orienting to something pointed out at a distance
Notices something only when it moves or only seems interested in objects that move
Is overly attentive to light sources (lamps, overhead lights, windows)
Gets close to objects, learning materials, or an item in their environment in order to see it
Misses things in certain visual fields (right, left, lower, upper)
Gets overwhelmed, upset, or has meltdowns in new, loud, or busy places
Appears to have a short attention span or is disinterested in learning tasks; struggles with reading or math
What strategies and interventions might be helpful when working with students with CVI?
Each individual with CVI will need specific strategies and interventions that are informed by assessment. No two children with CVI learn the same way. Many general strategies may help support a student including a quiet, simple environment with reduced clutter and minimal distractions, appropriate physical positioning, visual breaks, and access to multisensory instructional strategies, such as incorporating tactile and auditory into learning.
Instructional adaptations
Use a multisensory approach to instruction, using visual an non-visual sensory channels to support learning and concept development.
Use the most accessible learning media. What type of learning material is most accessible to the individual student? Is it images? Print? Enlarged print? Tactile symbols? Braille? Auditory? A combination?
Reduce visual clutter and crowding. Simultaneous visual information may disrupt visual recognition. If the learning task includes the use of vision, make sure items are presented either one at a time or with the number of items that is the assessed threshold for the student. Block non-essential visual information from your student’s view (i.e. light, motion, clutter). Increase the spacing between items to enhance visual access and support optimal visual attention and visual-motor skills.
Leverage color and contrast. Color coding is a strong support and compensatory strategy for visual recognition. Use materials that contrast in color with the background (e.g. a brightly saturated color against a simple, dark surface).
Intentional use of light. Use backlit devices or task lighting to support visual attention and recognition. Remember, some with CVI have light sensitivity, so too much light can be uncomfortable and fatiguing.
Provide wait time. Allow time (based on assessment results and task demand) for the student to establish visual attention, to visually recognize, and to physically or verbally respond. Even after looking, processing what is seen may require more time.
Consider the impact of motion. Sometimes, slow methodical movement of an object can support visual attention and recognition. For some, slow movement of an image on a tablet can help them process and recognize it. For others, self-movement can help provide a sense of seeing and support processing visual input.
Present materials in accessible visual fields. Learning materials should be positioned in the most accessible visual field (right, left, upper, lower)—use assistive items (i.e., slant board, book stand, tablet stand).
Environmental adaptations
Reduce clutter: Simplify the visual environment by removing unnecessary items that could distract or overwhelm the student.
Reduce noise and distracting light (overhead, from windows) and movement (high traffic areas, peers passing by, or working in a group nearby).
Layout: Keep floor surfaces clear and classroom materials and resources in consistent locations to help students with CVI become familiar with their surroundings.
Positioning: Position your student in learning spaces that limit movement in their peripheral vision to reduce visual and auditory distractions, helping them focus visually. For example, seating them facing two walls can block out excess movement. The student should also be fully physically supported for learning tasks and activities.
Maintain a predictable and organized environment. Having a well-organized learning space supports environmental mapping and consistency.
Use bright, bold colors to support visual attention and recognition of landmarks in the environment. The incorporation of color should be strategic as adding too much color to the environment can increase the impact of crowding. Make sure color is used to support increased contrast to help the target pop and stand out.
TVIs collaborate with all team members and can provide needed expertise and an understanding of student’s access needs with SLPs, PTs, classroom teachers, BCBAs, OTs, special educators, ATs, and teaching assistants.
A TVI can observe their student with multiple related service providers and collaborate to better understand the needs of the student. For example, an TVI and an Occupational Therapist (OT) can work together to help a child with CVI develop eating skills. The TVI may suggest using high-contrast, non-slip placemats and brightly colored utensils, making them easier to see, while the OT focuses on fine motor skills like grasping and bringing food to the mouth. This combined approach enhances independence during mealtime by supporting both visual access and motor coordination.
TVIs bring specialized expertise in adapting learning materials and environments to accommodate the unique visual challenges of their students. A TVI can provide strategies for adapting the environment and individualized teaching methods to ensure the student can access and engage with the curriculum. Additionally, a TVI can work closely with the educational team to create and implement Individualized Education Plans (IEPs) that address the specific challenges related to CVI, helping the student achieve their full potential in the classroom.
Note to readers: This article is meant as an overview and brief introduction to CVI, a deep and complex condition with diverse manifestions. It is important to remember that all children with CVI have different needs. The recommendations and suggestions are ideas for a starting point. There is not one size fits all approach for CVI, and interventions and strategies must be match to the student’s individualized needs and comprehensive assessment results.
Lacey is a CVI Parent Community Manager for the CVI Center at Perkins School for the Blind. Lacey has worked closely with young children with visual impairments, multiple disabilities, rare diseases, and dual sensory loss, providing consultation and support to the students, families, and their teams. Lacey has a Bachelor’s in General Studies with a Concentration in Early Childhood Education from the University of Kansas, a Master’s in Education as a Teacher of Students with Visual Impairments (TVI) from UMass Boston, and a Graduate Certificate in Cortical/Cerebral Visual Impairment (CVI) also achieved at UMass Boston. Lacey’s interest was inspired by her 13-year-old daughter’s diagnosis of CVI and she continually strives to learn more and support families with all she has learned along her own journey.