When to suspect CVI

If your child experiences visual difficulties or displays unexplained behaviors, it’s important to consider Cerebral/Cortical Visual Impairment, or CVI.

Boy wearing glasses looks toward their teacher while engaging with learning materials

If your child experiences visual difficulties or displays unexplained behaviors, it’s important to consider Cerebral/Cortical Visual Impairment, or CVI.  

It’s also important to remember that you’re not alone. CVI is the leading cause of childhood blindness and low vision. One study shows that up to 1 in 30 kids have CVI-related visual difficulties. 

However, CVI is alarmingly underdiagnosed. Less than 20% of likely cases in the United States are diagnosed. For every child who is diagnosed with CVI, four more likely cases go unaddressed. 

Currently, diagnosing CVI can be a complex process, and the medical community is working to develop clear diagnostic criteria for CVI. There are no clinical tests to “see” CVI. Plus, some symptoms of CVI are similar to other conditions. 

But some medical providers do know how to evaluate for CVI. (See our doctor directory here.) Use this guide to empower yourself as a parent or caregiver, spread awareness, and advocate for your child.

In this 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. CVI is based in your child’s brain, rather than their eyes—but it affects how your child processes and interprets visual information.

Who’s at risk?

CVI is common in neurodevelopmental conditions, and it often co-occurs with cerebral palsy, epilepsy, and developmental delay. Emerging research also shows CVI prevalence in Down syndrome, autism, and rare diseases. Complications from premature birth, lack of oxygen, pediatric stroke, and genetic conditions are common causes of CVI, too. 

 CVI can also occur with healthy eyes, without any other conditions. 

Learn more about CVI prevalence by the numbers.

What are common vision development milestones?

Understanding visual milestones can help alert you when something doesn’t seem quite right with how your child is or isn’t using their vision. Individuals with CVI are diagnosed at all ages, and we hope that more children with CVI are diagnosed early. Below are some common visual milestones up to age 4 to help provide context for when and why you should suspect visual difficulties.

At birth, babies haven’t yet developed the ability to easily tell the difference between two targets or move their eyes between the two images. Their primary focus is on objects 8 to 10 inches from their face or the distance to a parent’s face.

Eye-hand coordination begins to develop as a baby starts tracking moving objects with their eyes, and then reaching for them. 

Color vision sharpens, and babies will begin to show preferences for certain colors.

By three months, babies should begin to follow moving objects with their eyes and reach for things.

At this stage, control of eye movements and eye-body coordination skills continue to improve. A baby will turn their head to see an object.

Depth perception (the ability to judge if objects are nearer or farther away than others) starts to develop. For example, a baby might begin to play peek-a-boo.

Color vision sharpens, and babies will begin to show preferences for certain colors.

As babies begin to crawl, eye-hand-foot-body coordination improves.

At around 9 months, babies begin to pull themselves up to standing.

By 10 months, a baby should be able to grasp objects with thumb and forefinger.

By twelve months, most babies will be crawling and trying to walk. Babies can judge distances fairly well and throw things with precision.

By this age, a child’s vision is nearing 20/20.

Kids at this age can usually copy shapes and name colors.

Kids at this age are ready to begin reading. 

They recognize and recite the alphabet.

They have complete depth perception.

They can name coins and money.

For more information on visual milestones, visit Stanford Medicine and the American Optometric Association.

We hope every child gets diagnosed with CVI as early as possible. But many kids are diagnosed with CVI in elementary school and beyond. Learn more about how CVI is assessed and diagnosed

Girl sits at a desk smiling and looking at her laptop

Could my child have CVI?

Every child develops differently, and no two kids are exactly alike. For your child to be diagnosed with CVI, symptoms must not be explainable by other eye-health conditions or vision problems related to their eyes. 

You know your child best: If something seems unusual to you, trust your instinct. If your child is missing the common visual milestones above, and it’s not attributable to eye conditions, consider CVI. 

Often, many children with CVI who don’t meet visual milestones in their first year are diagnosed with “delayed visual maturation.” However, this diagnosis isn’t appropriate after 12 months. 

Remember: It’s never too late to be diagnosed. Here are some behaviors to consider that could be caused by CVI.

How is your child looking?

Individuals with CVI may:

Can your child recognize and find things?

Individuals with CVI may:

How does your child interact with others?

Individuals with CVI may:

Does your child appear tired or get easily overwhelmed?

Individuals with CVI may:

What happens at mealtime?

Individuals with CVI may:

How do they get around?

The CVI population includes all kinds of movers, mobility experiences, and the use of mobility aids (wheelchairs, walkers, gait trainers, white canes). The items below apply to all with CVI, no matter how they move through an environment.  

Individuals with CVI may:

How does your child navigate changes in depth?

Individuals with CVI may:

How does your child engage at school?

Individuals with CVI may:

You also might hear people talk about the CVI Visual Behaviors commonly evaluated and recognized by major theorists.  Although everyone experiences CVI differently, these broader key traits commonly manifest in people with CVI. Learn more about the CVI Visual Behaviors.

Two boys building towers with light up blocks

If you suspect CVI: What to do next

Are these behaviors familiar? It’s time to take action, and Perkins is here to help.

If your child is diagnosed with CVI, talk to your medical provider about: 

How to take action

While waiting for a clinical appointment, you can still request educational assessments to evaluate how your child is (and isn’t) using their vision to access learning materials and their environment. Kids with CVI can and do learn—and the earlier they can access their environment, the better.

Jack kneels to pose with his guide dog, a yellow lab named Laredo.

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