Article
What is CVI?
CVI is a brain-based visual impairment caused by damage to the visual pathways or visual processing areas of the brain.
What is CVI?
Cerebral/Cortical Visual Impairment (CVI) is the leading cause of childhood blindness and low vision. It’s a brain-based visual impairment caused by damage or interruption to the brain’s visual pathways. CVI can occur at any stage of life, congenital or due to injury, from many causes, and has diverse presentations. It affects how individuals process and interpret visual information. People with both healthy eyes and eye conditions can have CVI, since the issue is with the brain’s interpretation, not the eyes themselves. They have trouble processing what those eyes can see.
Individuals with CVI may have difficulty with visual attention (being able to look at something) and visual recognition (being able to recognize what you are looking at), which can result in a lack of access to the visual world. Some people with CVI may see the world as distorted and unrecognizable. Others can focus but might struggle to understand what they see. A crowded setting, a hot day, or fatigue has the potential to make vision use nearly impossible.
Jump to a section
With CVI, the brain has difficulty converting the raw data from the eye into a reliable, meaningful image of the world that can be interpreted and acted upon.
Matt Tietjen, CTVI and leader in the field
What causes CVI?
Current research shows that CVI has many causes and associated conditions. This is not an exhaustive list. CVI is common in neurodevelopmental conditions, and complications from premature birth, lack of oxygen, pediatric stroke, and genetic conditions are common causes of CVI. As more people with CVI and their families share their stores and as the science of CVI evolves, we’ll continue to learn more.
There are several common causes of CVI, including:
- Complications from premature birth
- Epilepsy and seizure disorders
- Genetic conditions
- Lack of oxygen at birth
- Pediatric and perinatal stroke
- Traumatic brain injuries
What are associated conditions with CVI?
Many conditions co-occur with CVI, including:
- Cerebral palsy
- Developmental delays
- Down syndrome
- Autism
- Williams syndrome
- Rett syndrome
- Many rare genetic conditions
- Learn more and find more details about how CVI is diagnosed.
How prevalent is CVI?
CVI is extremely common, yet remains widely underdiagnosed.
- Less than 20% of likely U.S. cases are diagnosed. For every diagnosed child with CVI, there are four more likely cases of CVI.
- One study shows that up to 1 in 30 kids may have CVI-related visual difficulties.
- Several studies show that up to 70% of kids with Cerebral Palsy have CVI. According to CVI prevalence data from the CVI Center using medical claims data and advanced analytics from McKinsey & Company, 64% of kids with CVI have epilepsy, 72% have developmental delay, 23% have autism, and 20% have genetic anomalies.
Common CVI behaviors
CVI manifests differently in each person, but there are common visual behaviors and traits. These may include:
- Difficulty with visual attention and recognition
- Trouble using vision in cluttered, crowded, loud places
- Difficulty with hand, foot, and eye coordination
- Struggle to perceive motion, such as moving cars, a swing, or a ball
- Trouble with facial recognition and understanding facial experiences
- Experience visual fatigue and overwhelm often
- Difficulty interpreting pictures, words, symbols and other two dimensional materials
- Trouble integrating vision with other senses
- Hard time finding things at a distance
- Difficulty navigating from place to place
- Visual field loss
People with CVI often develop unique compensatory skills (nonvisual and metacogntive skills) to access their learning, community, and daily activities. Support for CVI needs to be sustained and lifelong.
CVI is sometimes misdiagnosed as an emotional or psychological disorder. Common misdiagnoses include ADHD, autism spectrum disorder, delayed visual maturation or learning disabilities. CVI is often one piece of a child’s complex diagnosis.
If you’ve met one child with CVI, you’ve met one child with CVI.
Dr. Gordon Dutton
CVI’s impact
Individuals with CVI, their families, and current research share how CVI impacts many aspects of life, development, and mental and physical health. These include:
- Daily living skills
- Socialization
- Communication
- Motor skills
- Academic skills (literacy, math, etc)
- Health-related quality of life outcomes
- Mental health
Centering the lived experiences of those living with CVI is paramount to understanding how deeply CVI affects an individual’s daily life, the complex and diverse ways CVI manifests, the varied compensatory skills and techniques used for access, and why targeted interventions and access must be unique to how an individual experiences the world.
Information is landing on your eyes, but you can’t make sense of it. You can’t wrap your head around things you’re seeing. You can’t tell where one object ends and the next begins. You are looking at things, but you don’t know what you are looking at.
-Nai, adult with CVI and author of The CVI Perspective
How to diagnose CVI
There’s no standard diagnostic test for CVI, which makes it hard to identify.
However, this is changing: The National Eye Institute and National Institutes of Health have now identified CVI as a research priority. They also released a detailed working definition of CVI to support diagnosis, so clinicians can better recognize kids suspected to have CVI. The American Association of Pediatrics also published guidance for pediatricians on the diagnosis and care of children with CVI.
A pediatric ophthalmologist, neurologist, neuro-ophthalmologist, optometrist, or clinical low vision specialist typically makes a CVI diagnosis.
Important CVI resources
If your child is diagnosed with CVI, you might be worried and overwhelmed. CVI research and treatment are continually growing and improving. We offer detailed, science-backed knowledge, guidance, and tools for:
- Understanding CVI and the brain
- Education and access
- Early intervention and Individualized Education Programs (IEPs)
- Parenting advocacy and support
- CVI stories
Where to find your CVI community
CVI Now offers so many ways to connect, including:
- 1:1 Parent Support Sessions
- Parent/Caregiver Facebook Group
- Monthly CVI Now Newsletter
- Educator Hub
Lean in. We’ve got you.
Every person with CVI has a right to life-changing access.
Every person with CVI has a right to early diagnosis, effective vision services, and an accessible education — no matter their zip code and no matter how their CVI manifests.
With CVI, it’s about access to learning. Visual skills are not a prerequisite for learning and access. With comprehensive (and integrated) assessment and accessible educational programming, individuals with CVI can learn to access their world in the way that works best for them. Some use visual skills, some use compensatory strategies, and many use both.
Foundations of access:
- Adopt a comprehensive whole-child CVI assessment to evaluate the CVI visual behaviors and how each child uses compensatory skills. The goal is to integrate these findings into the whole picture of the child’s educational needs. Families, educators, and medical professionals must collaborate to provide effective care, services, and opportunities.
- Center autonomy, agency, and advocacy by believing the person with CVI, providing choices for access, understanding that behavior is communication, and implementing systems that allow each person with CVI to make their own choices.
- Make school accessible with an instructional approach that uses adapted materials, tasks, and environments to meet the unique needs of each child. This will help reduce visual fatigue, a common CVI symptom, and increase access to learning.
- Use a multisensory approach to learning that leverages each child’s sensory strengths (auditory, tactile, visual, movement). All sensory inputs support brain development.
- Implement intentional and systematic instruction with scenarios that are deliberate, consistent, and predictable. Direct instruction supports concept development and incidental learning (receiving information through observation). People with CVI also require direct instruction in the Expanded Core Curriculum (ECC), which teaches foundational skills needed for daily life, independent living, and the workplace.
- Create visually simple, quiet environments for learning by eliminating visual clutter, noise, and other sensory information. This kind of overwhelm can make it extremely difficult to visually access objects and environments, and acquire new learning.
References:
- Barclay, L. A. (2015). Assessments linked to interventions: Literacy and math. In A. H. Lueck & G. N. Dutton (Eds.), Vision and the brain: Understanding cerebral visual impairment in children (pp. 411–434). AFB Press American Foundation for the Blind.
- Bennett RG, Tibaudo ME, Mazel EC and Y. N (2025) Implications of cerebral/cortical visual impairment on life and learning: insights and strategies from lived experiences. Front. Hum. Neurosci. 18:1496153. doi: 10.3389/fnhum.2024.1496153
- Chokron S, Kovarski K and Dutton GN (2021) Cortical Visual Impairments and Learning Disabilities. Front. Hum. Neurosci. 15:713316. doi: 10.3389/fnhum.2021.713316
- Dutton, G. & Lueck, A. (2015). Vision and the Brain: Understanding Cerebral Visual Impairment in Children. New York, New York: American Foundation for the Blind Press.
- Manley, CE, Walter, K., Micheletti, S., Tietjen, M., Cantillon, E., Fazzi, E., Bex, P., Merabet, L (2023). Object identification in cerebral visual impairment characterized by gaze behavior and image saliency analysis. Brain Dev (2023).
- McDowell, N. (2024). One Size Does Not Fit All: The Lived Experiences of Children and Adults Who Have CVI. Journal of Visual Impairment & Blindness, 118(6), 448-453.
- Monteiro, S., Esch, P., Hipp, G., & Ugen, S. (2025). How do children with Cerebral Visual Impairment (CVI)-related visual difficulties perform on key academic domains in grade 1? Child Neuropsychology, 1–21. https://doi.org/10.1080/09297049.2025.2454450
- Nguyen, R., O’Neil, S. H., Borchert, M. S., & Chang, M. Y. (2025). Adaptive functioning and relationship to visual behavior in children with cerebral/cortical visual impairment. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 104107. Advance online publication. https://doi.org/10.1016/j.jaapos.2025.104107
- Philip, S. S., & Dutton, G. N. (2014, May 1). Identifying and characterising cerebral visual impairment in children: A review. Clinical and Experimental Optometry, 97(3), 196–208. https://doi.org/10.1111/cxo.12155
- Pilling, R. F., Allen, L., Bowman, R., Ravenscroft, J., Saunders, K. J., & Williams, C. (2023). Clinical assessment, investigation, diagnosis and initial management of cerebral visual impairment: a consensus practice guide. Eye (London, England), 37(10), 1958–1965. https://doi.org/10.1038/s41433-022-02261-6
- Roman-Lantzy, C. (2018). Cortical Visual Impairment: An Approach to Assessment and Intervention. 2nd ed., New York, NY: AFB Press.
- Teach CVI (2017). Tools for educators and health care providers. Retrieved from: https://www.teachcvi.net
- Tietjen, M. (2019). The “What’s the Complexity?” Framework. In Roman-Lantzy, Christine. (2019) Cortical Visual Impairment: Advanced Principles (pp. 92-150). Louisville, KY: APH Press
- Van Hove, C., Damiano, C., & Ben Itzhak, N. (2025). The relation between clutter and visual fatigue in children with cerebral visual impairment. Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 45(2), 514–541. https://doi.org/10.1111/opo.13447
- Wilton, G. J., Woodhouse, R., Vinuela-Navarro, V., England, R., & Woodhouse, J. M. (2021). Behavioural Features of Cerebral Visual Impairment Are Common in Children With Down Syndrome. Frontiers in human neuroscience, 15, 673342. https://doi.org/10.3389/fnhum.2021.673342
- Williams, C., Pease, A., Warnes, P., Harrison, S., Pilon, F., Hyvarinen, L., West, S., Self, J., & Ferris, J. (2021, June). Cerebral visual impairment-related vision problems in primary school children: A cross-sectional survey. Developmental Medicine & Child Neurology, 63(6), 683–689. https://doi.org/10.1111/dmcn.14819
