Cortical Visual Impairment (CVI)

Cortical visual impairment (CVI) happens when your child has vision issues due to damage to parts of their brain that process vision. So, it’s about their brain, not their eyes. Healthcare providers also call it cerebral visual impairment.

Cortical visual impairment is the leading cause of vision loss in children. CVI most often affects babies and young children, but it can continue into adulthood. Any damage to your brain’s visual processing areas can cause CVI.

Vision is different for everyone because what you see feels “normal” to you. The same goes for children. They might not be able to tell you they’re having vision problems. But you may notice unusual behaviors tied to how they see and learn. This might include trouble recognizing or reaching for objects. Talk to their healthcare provider if you notice this. The sooner they get help, the less CVI may affect their development, learning and social skills.

How does CVI affect vision?

This condition can cause issues with:

• Figuring out where something is
• Seeing what’s directly in front of you
• Seeing what’s on the outside of your central vision
• Noticing movement
• Visually guiding your own movement
• Gaze control
• Visual attention
• Visual analysis and recognition
• Visual memory

Signs and symptoms of cortical visual impairment

As your child might not be able to tell you what they’re experiencing, you may notice the following signs:

• Difficulty recognizing faces, places or objects
• Having more trouble seeing an object on a pattern rather than a solid background
• Looking away from an object while reaching for it
• Not responding as you’d expect to what they see
• Not understanding what they’re looking at
• Reacting slowly to hand gestures, facial expressions or other cues
• Looking at moving objects more than still ones
• Using side vision instead of looking straight at an object
• Needing to look at things close up to see them
• Staring at bright lights or being sensitive to light
• Trouble focusing or following things with their eyes

Cortical visual impairment causes

Damage to parts of your child’s brain that process vision causes CVI. This includes your child’s:

• Occipital lobe. This is in the back of your brain. It processes what you see.
• Parietal lobe. This is near the top and sides of your brain. It helps you understand where things are and how they move.
• Temporal lobe. This is near your temples (before your ears). It helps you recognize what you see (like faces and objects).

Most of the time, this damage happens before, during or shortly after birth. A lack of oxygen to your child’s brain at birth (called hypoxic-ischemic encephalopathy) is the most common cause.

Other causes include:

• Seizures that damage their brain (like infantile spasms)
• Brain differences or malformations (like holoprosencephaly, schizencephaly or lissencephaly)
• Fluid buildup in their brain
• Infections (like meningitis and encephalitis)
• Infections during pregnancy (like Zika virus and TORCH infections)
• Head injuries
• Bleeding in or around their brain
• Metabolic conditions (like frequent low blood sugar)
• Brain diseases that get worse over time (like Fabry disease and Leigh syndrome)

Babies who are born preterm are more likely to develop this condition.

Co-occurring conditions

Kids with this condition often have other brain-related diagnoses, like:

• Autism spectrum disorder
• Cerebral palsy
• Developmental delays and learning disabilities
• Epilepsy
• Sleep disorders

How doctors diagnose cortical visual impairment

If you think your child has trouble seeing, the first step is to get an eye exam. This will check for any problems with their eyes. If the exam doesn’t find any vision problems, the issue may be in their brain.

Your child should then see an eye doctor (ophthalmologist). They may also need to see other doctors, like a pediatric brain doctor (neurologist) or a neuro-ophthalmologist. Their doctor will check your child, ask about their health history and any concerns you have about their vision. They may order brain scans, like an MRI.

Getting a CVI diagnosis can take time. But it’s important to stick with it so your child gets the right diagnosis and the help they need.

How is cortical visual impairment treated?

There’s no cure for CVI. Your child’s healthcare provider might recommend different ways to help them manage their symptoms. This could include making changes at home and school to help them see and learn.

Examples include:

• Avoiding too much visual clutter (like not using patterned rugs or dishes)
• Avoiding vision tasks (like reading and looking at pictures) when your child is hungry, tired or upset
• Having teachers or family wear the same bright item (like a scarf) each time to help your child recognize them
• Lowering room lights and using screens that light up from behind
• Using big, colorful, high-contrast or moving objects for learning
• Using text with more space between lines and blocking extra text to help with reading
• Using touch or sound to get your child’s attention

Every child learns in their own way. Once you know what works best for them, you can adjust and make changes to support them as they grow.

When should my child see their healthcare provider?

Your child will likely need regular visits with a neurologist or eye specialist to monitor their symptoms. As they get older, their environment and learning needs will change. Their providers may adjust treatments to better support them over time.

What can I expect if my child has CVI?

It’s important to remember that no two children with CVI experience it the same way. Your child’s healthcare providers and specialists can help you understand what to expect.

Most children with CVI see some improvement in their vision as they grow. But for some, vision challenges stay the same or get worse.

If your child has CVI, advocating for their care is key to making sure they get the support they need. Speaking up for their healthcare and school accommodations can help them achieve the best possible quality of life. Early intervention can reduce the impact on their development, education, social skills and mental health.

Consider joining a support group for families living with CVI. You can connect with others and learn practical tips from others who share a similar experience.

Can adults get CVI?

Brain damage from a stroke or traumatic brain injury can cause vision problems. Healthcare providers may call this acquired CVI. But it’s different from the type of CVI that affects babies and children. It often comes with different symptoms.

If you notice any vision changes in adulthood, especially after a head injury or brain condition, see a provider right away.