By: Ryan R. House, MD, FAAP & Sharon S. Lehman, MD, FAAP
Cerebral/cortical visual impairment (CVI) is a condition caused by damage to parts of the brain responsible for seeing. It leads to vision problems that are not caused by problems in the eyes. Even though it's the eyes that gather images of the world around us, vision is based in the brain. In children with CVI, the brain has trouble processing the signals sent from the eyes.
CVI is one of the most common causes of vision loss in children in the United States. Getting a diagnosis and vision services as early as possible can maximize a child's development and learning experience.
How do I know if my child has CVI?
Children with CVI struggle with activities that rely on vision. While CVI affects everyone differently, here are some common issues that may affect a child with CVI:
Poor visual attention, especially in cluttered, busy settings. Your child may seem to have trouble noticing something they are looking for in a toy bin or recognize a familiar face in a crowd.
Delays in recognizing or responding to something they see. Taking longer to complete visual tasks like copying words or pictures.
Preference for certain colors. They may be more drawn to rich, more intense colors, for example, rather than paler shades.
Paying more attention to objects that are moving rather than still. Your child may not seem to notice a toy until you shake it, for example. However, children with CVI may also hve trouble keeping track of fast-moving objects.
Clumsiness with stairs, changing surfaces or tripping over curbs.
What causes CVI?
Certain conditions or injuries that affect the brain may be linked with CVI. These include:
If your child has a history of a brain-related condition or injury and is having challenges with their vision, talk with your pediatrician. They may suggest seeing a pediatric ophthalmologist (pediatric eye specialist) to assess your child's vision further.
How is CVI diagnosed?
In addition to going over a child's medical history, a pediatric ophthalmologist will ask about certain behaviors you may have noticed. They will also do a complete eye exam to make sure no other problems are causing the low vision. Certain
eye problems are more common in children with CVI and require treatment to get the most possible out of the vision they have.
In addition, testing for brain function with a neurologist (brain specialist) may be needed if it hasn't already been done.
What happens after a CVI diagnosis?
If your child is diagnosed with CVI, they will receive a referral for vision services evaluation. These services vary based on location and your child's age. Vision services are usually provided through an early intervention program (for children birth to 3 years old) or through the school.
A specially trained educator, called a teacher of the visually impaired, will do several evaluations. Their goal is to determine what services are needed to help the child learn. These exams include how the child is able to use their vision, how they use other senses to access materials, and what technology can best help the child.
Treatment for CVI
There are no specific treatments to cure CVI, but steps can be taken to maximize a child's vision. Appropriate eye treatment will be prescribed by the eye doctor. Your child's visual function may improve over time.
Your pediatrician, and likely a pediatric neurologist, will work together to make sure any underlying problems in the brain are treated as best as possible. The pediatric ophthalmologist will treat any eye problems so that the child is able to maximize the vision they have.
Low vision services can help a child with CVI learn to interact at home, school and out in the world to reach their full potential.
Remember
It is vitally important to identify and diagnose CVI as early as possible. This allows your child to be set up with resources that will allow them to maximize the vision they have.
If your child has a history of a neurologic problem and you have concerns about vision, speak with your pediatrician and request a referral to a pediatric ophthalmologist.
More information
About Dr. House
 Ryan R. House, MD, FAAP, a member of the American Academy of Pediatrics Section on Ophthalmology, is a pediatric ophthalmologist at a private practice in Queens, New York. He currently serves as a member of the Pediatric Low Vision and Rehabilitation Committee for the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Dr. House is also a member of the American Academy of Ophthalmology and a diplomate of the American Board of Ophthalmology.
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About Dr. Lehman
 Sharon S. Lehman, MD, FAAP, is an attending pediatric ophthalmologist at Wills Eye Hospital in Philadelphia, Pennsylvania. She is Emeritus Chief of Ophthalmology at Nemours Children's Health System in Wilmington, Delaware. Her other appointments include Clinical Professor of Ophthalmology and Pediatrics and Assistant Dean of Faculty Affairs for Nemours at Sidney Kimmel Medical College. Dr. Lehman is a past chair of the Executive Committee of the American Academy of Pediatrics Section on Ophthalmology. Dr. Lehman has special interest in cerebral/cortical visual impairment/brain-based visual impairment and has published and lectured nationally and internationally on this topic. She advocates for children with cortical visual impairment on a national level by participating in education, scholarship and policy.
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