If your child experiences visual difficulties or displays unexplained behaviors, it’s important to consider Cerebral/Cortical Visual Impairment, or CVI.
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.
What is CVI? Read about which children are most as risk and learn the common vision development milestones.
Could my child have CVI? Learn the questions to ask and ways to observe your child so you can get answers.
If you suspect CVI: What to do next. Download our 1 pager and discover how to take action.
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.
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.
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.
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:
Have trouble looking at and orienting to something pointed out at a distance
Notice something only when it moves or only seems interested in objects that move
Be overly attentive to light sources (lamps, overhead lights, windows)
Bring objects close to their eyes
Tilt their head or move their body in a certain position when looking at something
Have trouble finding a switch on a toy or item to turn it on
Only notice or pay attention to objects close by or in front of them
Not shift visual attention between the pages of a book or between two objects
Not seem interested in new toys or objects
Appear to touch or listen first before looking
Play with their hands or another item to create motion in front of their eyes
Struggle to look in the mirror
Appear to have inconsistent vision
Can your child recognize and find things?
Individuals with CVI may:
Lose objects that they drop on the ground
Have trouble finding things that aren’t in a predictable place
Have trouble finding an item on a cluttered surface or in a bin with other items
Use touch to search for objects instead of their eyes
Bang on a table to make items move
Bat or swing their arms to find a toy, food, or bottle
Pick up a similar object of the same color, shape, or size when trying to find a certain item
Miss things in certain visual fields (right, left, lower, upper)
Need verbal directions and cues to find something
Have a hard time recognizing pictures and images
Not notice new items or toys and have trouble recognizing common objects
How does your child interact with others?
Individuals with CVI may:
Mistake someone unknown for a parent or family member, or approach strangers thinking they’re a parent
Mistake people who have similar attributes (hair, glasses, gait)
Only recognize someone when they speak
Have trouble recognizing themselves or familiar people in photos
Not return a social smile
Miss gestures like a high five or a handshake
Appear to “look through” you
Have difficulty making eye contact
Have difficulty finding someone in a group of people
Does your child appear tired or get easily overwhelmed?
Individuals with CVI may:
Get tired after using their vision for certain amounts of time
Rub their eyes often
Put their head down
Get easily overwhelmed when there are too many things to look at
Appear overly tired at the end of a school day
Seem like vision is hard to use or turned off when tired
Get upset, irritable, anxious, overly quiet, or nonresponsive with too many visual demands
Have wildly different responses to the exact same stimuli depending on mood, time of day, fatigue, illness, or other factors
Get overwhelmed, upset, or have meltdowns in new, loud, or busy places
What happens at mealtime?
Individuals with CVI may:
Miss food on a certain part of their plate
Have trouble using and visually guiding utensils
Not look at their food when eating, preferring to touch it
Eat for a short period of time (or not at all) in noisy environments
Resist reaching for cups, utensils, or food items in front of them
Over- or under-reach for their cup or spoon
Touch a surface first before putting their cup down
Wait until they feel the bottom of a cup hit the table before they let go of it
Not open their mouth until it’s in close range or when they feel the spoon or food touch their mouth
Only eat foods that are visually familiar and look away or are uninterested in new foods
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:
Look down only when in busy or new places
Show surprise or get upset with sudden sounds, loud noises, or people talking around them
Use the soles of their feet versus vision to navigate stairs, curbs, and new surfaces
Hold onto a trusted adult
Ask to leave an environment
Touch everything in close range
Go to the perimeter of the room or space to be away from commotion or clutter
Stop, sit down, or fall to the ground when moving in an environment
Fall over clearly visible objects or obstacles
Bump into furniture, doorways, or people
Have trouble when furniture is rearranged
Pause or sit down when a floor surface changes, such as from carpet to wood
Have a hard time moving through a crowded hallway and knowing where to go
Not know the route to and from a familiar place
Use hearing, touch, and memory of certain landmarks to support getting around
How does your child navigate changes in depth?
Individuals with CVI may:
Have trouble stepping off a curb or going down steps
Miss a drop-off, uneven ground, or a hole in the ground
Over- or under-step when depth changes
Need to hold the railing on steps
Drag the back of their heel when going down steps
Toe tap at the end of stairs or at a change in floor pattern
Pause at the top of the ramp or drop off
Not look down at steps when going up or down
How does your child engage at school?
Individuals with CVI may:
Appear to have a short attention span or are disinterested in learning tasks
Have trouble copying words or drawings
Stay at the perimeter of a playground or sides of the classroom to be away from commotion, clutter, and unpredictable movement
Have difficulty joining a group
Struggle with independent play
Struggle with reading and/or math
Miss the beginning or end of words
Have a hard time finding the next word and/or moving to the next line when reading
Have trouble writing on the line or in a given space
Have a hard time with one-to-one counting and using objects or 2D images
Struggle to recognize common pictures or images
Not like or make progress with worksheet learning
Have safety concerns with PE or during recess
Needs assistance finding their cubby or hook
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.
Capture videos of your child in everyday routines and different environments to show signs of visual difficulties. Share the videos during the appointment.
Use the TeachCVI screening tools to capture more information about your child, and bring it to your appointment.
The medical provider will check for eye conditions (many with CVI also have eye conditions). To be diagnosed with CVI, symptoms must not solely be explainable by vision problems related to the eye.
If your child is diagnosed with CVI, talk to your medical provider about:
Referring your child for vision services, such as state blind programs and services (such as MA Commission for the Blind). Remember that each state has its own definition of eligibility based on visual acuity, visual field deficits, or other criteria
Documenting medical necessity for vision services in early intervention (0-3), school system (3+), college (18+), or adult rehab and vocational programs (18+).
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.
For babies and toddlers: Reach out to early intervention services in your area and request a functional vision evaluation and CVI assessment. Learn more in our CVI Early Intervention series.
For school-aged children and up: Reach out to your school team to request a functional vision evaluation and CVI assessment, learning media assessment, and orientation and mobility assessment. Learn more about CVI assessments and dive into our CVI Now IEP Guide.