Children who have Cortical Visual Impairment due to brain injury, infection, etc., have a visual impairment related to dysfunction of the brain rather than the eyes. In other words, the eyes work fine but the brain cannot process what it is seeing. When I found out my daughter had CVI, I was devastated, but motivated to learn that the brain can be trained to see due to “neuroplasticity.”
I was first introduced to The 10 Characteristics of CVI by my daughter’s CVI Range Endorsed vision consultant, Tara Tompai. At the time, my daughter was just a few months old and she seemed not to look at anything in particular. Tara showed my daughter an array of objects in a variety of colors. Some were shiny, some were complex, she sometimes used a flashlight and dimmed the lights. This was unlike any assessment the previous medical professionals had performed. They’d wave objects back and forth, up and down. Instead, Tara held the objects in place giving my daughter plenty of time to notice. She experimented with distance and location. Following the assessment of my daughter and an in-person interview, Tara felt that my daughter presented the characteristics that are associated with Cortical Visual Impairment (CVI).
Throughout the session, I had noticed my daughter briefly glance at certain objects, look away, and repeat. Was that her looking? I’d never seen anything like it. But yes, Tara assured me that under the right conditions, my daughter would look at certain objects, and with the right interventions in place, she would begin to look at even more.
I was intrigued by what took place during my daughter’s assessment. Why was it so different from previous medical assessments? I started reading Dr. Christine Roman-Lantzy’s book “Cortical Visual Impairment: An Approach to Assessment and Intervention” and finally began to understand.
CVI Interventions Must Be Personalized
Kids with CVI are impacted to some degree by The 10 Characteristics of CVI. Every child is unique and there are significant differences from individual to individual as to how The 10 Characteristics of CVI impact visual functioning. There is the expectation that the vision of a child with CVI will improve, but only with facilitated adaptations and interventions that are personalized for the child’s current level of visual function.
If your child has a preference for shiny red objects, you can tie shiny red helium balloons or pom poms in their view. If your child sees best when an object is in their right field of vision, it’s better not to place the object in their left peripheral field. As you meet your child’s current visual needs and help them to build visual behavior, they can begin to resolve these characteristics. With rigorous persistence, they will look at more and more, expanding their visual horizons, so to speak.
Understanding how your child is impacted by The 10 Characteristics of CVI is critical to knowing your child’s current level of visual function. This is best done by having a CVI Range Endorsed vision consultant assess your child.
In the meantime, it’s time to get familiar with The 10 Characteristics of CVI.
The 10 Characteristics of CVI
Below is a list of The 10 Characteristics of CVI with a description for each characteristic.
- Color preference
- Need for movement
- Need for light
- Visual latency
- Visual field preferences
- Difficulty with complexity
- Difficulty with distance viewing
- Difficulty with visual novelty
- Absence of visually guided reach
- Atypical visual reflex responses
#1 Color Preference
A child with CVI is likely to have a strong preference for a specific color. Red or yellow are often a safe bet, but every child is different. Using objects and toys in the child’s favorite color can help maintain the child’s attention. Rather than using black and white contrast objects, very bright and vibrant colors are recommended. My daughter’s color preferences are red, yellow and orange.
#2 Need for Movement
Shiny or reflective toys and objects that give off the illusion of movement are recommended for attracting the visual attention of a child with CVI. Currently, my daughter is in Phase 1 which means we are building visual behavior. We present shiny red things throughout her daily routine to get her in the habit of looking. I also attach reflective paper to things like her bright yellow spoon that we use for every meal. It signals to the brain that there is something to look at.
#3 Need for Light
Dimming the lights and shining a light on an object (or using a light table) can help facilitate a child’s ability to more easily look at the object. When my daughter’s CVI Range Endorsed vision consultant first recommended this, I was alarmed that this may be the only way my daughter would forever see things. To my relief, she assured me that the need for light would begin to resolve as my daughter’s vision improved.
#4 Visual Latency
It’s critical to give your child plenty of time to look at an object without moving it around (or talking)! When I first started holding toys for my daughter to look at, it would take her upwards of an entire minute. The length of time for familiar objects has shortened but she often takes longer when I introduce new toys or objects. Even when she does look, I hold the object in place because she tends to look, look away, look back, look away, and so on. Her vision consultant informed us that each time she looks, she is taking in more and more of the object’s appearance.
#5 Visual Field Preferences
Kids with CVI may have preferred visual field preferences and can have difficulty with their lower visual field, thus requiring a white cane when mobile to avoid tripping. My daughter’s preferred visual field preference seems to be close to center on her right side. When I want to show her something, I ensure I place the toy or object where I know she can see it best.
#6 Difficulty with Complexity
When referring to complexity, there are four kinds that children with CVI may have difficulty with: complexity of object’s appearance, complexity of array, complexity of sensory environment and complexity of the human face. When complexity is present, the child can display lack of visual attention. When complexity is reduced, the child can better maintain visual attention.
Complexity of object’s appearance:
When a child is in the early stages of CVI (Phase 1), it is recommended to only introduce toys and objects of a single color so that he or she can more easily perceive it as a single object. When objects and toys are more than one color or patterned, it is recommended to adapt them so that they are visually accessible. For example, wrapping a multi-colored toothbrush with shiny red material and presenting it against a solid colored background.
Complexity of visual array:
Kids with CVI can have difficulty visually identifying even simple objects that are in a pile, overlapping, in close proximity or on a patterned surface (e.g., showing your child a toy while wearing a patterned shirt). Spacing objects apart and teaching salient features can help improve their ability to differentiate objects. When a child is in Phase 1, it is best to show just one single-colored object at a time against a single-colored background. Even glossy backgrounds that catch light can affect a child’s visual function so it’s best to use matte backgrounds.
Complexity of sensory environment:
The sensory environment plays a major role in affecting how well a child with CVI can use his or her vision at any given time. This includes sounds in the environment, speaking to the child while showing them an object, touching the child, tactile stimulation, etc. For this reason, learning in typical classrooms can be a big challenge for kids with CVI. My daughter is in Phase 1 and she must be in a highly controlled environment with no sensory competition when it’s time for her to look at an object, such as when I am feeding her with her yellow spoon. It’s necessary to ensure she’s in a comfortable position and that the room is silent. As her vision improves, we expect that she will be able to tolerate more sensory competition in the environment when she is using her vision.
Complexity of human face:
The human face is the most difficult thing to visually process because it is always changing. For this reason, children with CVI have difficulty making eye contact or remembering faces. They may be able to recognize highly familiar faces such as primary caregivers but this is not always the case. When I went to the Perkins CVI Symposium in Boston in June 2019, I met parents whose children could not recognize their classmates’ faces, and so they created specific activities to assist recognition in other ways (e.g., observation of hairstyle, voice, color of clothing, etc.). My daughter occasionally makes eye contact with me but it is fleeting and only happens when my face is very close to hers. While eye contact is very important for a newborn to bond with the mother, my daughter and I have bonded in other ways (lots of cuddles and kisses!). If I don’t let her know I’m leaving or entering the room, she has no idea. I regularly tip-toe into her room and lean over her crib—she never realizes I’m there! It’s recommended to identify yourself to a child with CVI when approaching them, and to name people who are in the room so they are not left in the dark.
#7 Difficulty with Distance Viewing
Children with CVI have difficulty discriminating objects in the distance due to the complexity of all the visual elements in their view that must be processed. My daughter is in Phase 1 and I must hold objects within a few inches of her face in order for her to look at them. As a child’s vision improves, they may become better at recognizing objects that are farther away. Difficulty with distance viewing is one reason why children with CVI do not benefit from incidental learning until their vision has greatly improved.
#8 Difficulty with Novelty
Many times I’ve heard that a child with CVI views the world as a swirling kaleidoscope of colors. The child’s brain must be trained to identify objects, in the beginning, one at a time. The child must become highly familiar with a very limited number of objects and toys at first, so that they can begin to recognize them and discriminate them from the background. Once a child becomes familiar with an object, for example, a red cup, you can then introduce a slightly different cup (e.g., the same cup but in the color yellow) so that the brain can begin to understand that cups can be different.
#9 Absence of Visually Guided Reach
A child with CVI may experience difficulty reaching to touch an object while simultaneously making eye contact with it. Once a child has built visual behavior using specific adaptations (Phase 1) and has progressed to Phase 2 on The CVI Range, it is recommended to develop visually guided reach using methods such as light table activities. My daughter tends to look at an object and only when it is very familiar (her yellow spoon) does she look away and then reach to touch it. She often ends up patting down the surface with her hand to locate it.
#10 Atypical Visual Reflex Responses
Humans have two innate reflexes called the visual blink reflex and the visual threat response. Their purpose is to protect the eyes. In children with CVI, one or both of these reflexes may be absent or delayed. For example, my daughter blinks when I touch her on the bridge of her nose in between her eyes but does not blink when I quickly bring my hand very close to her eyes.
Learn more about The 10 Characteristics of CVI in Dr. Christine Roman-Lantzy’s video
This Perkins video by Dr. Christine Roman-Lantzy helped me greatly. You may benefit from it too if you are unfamiliar with The 10 Characteristics of CVI. Click the button below to visit Perkins eLearning and watch the video.
Cindy has a deep interest in Cortical Visual Impairment (CVI) and is currently studying Early Childhood Education. She focuses most of her time on her energetic daughter: playing, cuddling and helping to make her world visually accessible. Cindy holds a degree in Marketing and has worked in the not-for-profit sector for many years.