The impact of visual impairment on a child can be difficult to understand, especially when it is caused by a neurological disorder rather than a medical condition affecting the eye itself. Cerebral visual impairment (CVI) is one of the leading causes of vision impairment in children and can be especially challenging to understand and support.

Parents of children with CVI may feel overwhelmed, but there are many ways to help their child live with this condition. We’ll explore CVI with tips for parents to help their child lead a fulfilling life.

What is CVI?

Cerebral vision impairment is an umbrella term for a variety of brain-related visual and perceptual difficulties that affect the way a person sees the world around them. It has been recognised as the most common cause of childhood visual impairment in developed countries.

 It can be caused by damage to areas of the brain that process vision, or by other developmental differences that interfere with these areas.

How does CVI impact children?

According to new research investigating CVI at the University of Bristol [1], brain-related visual impairments may affect 1 in every 30 children.

Children with CVI may have difficulty recognising or interpreting shapes, colours, moving objects, and patterns. They may also have difficulty with depth perception and reading.

CVI may also have an impact on a child’s behaviour and development. Some children may be more sensitive to light or sound, making it difficult to focus on visual tasks. They may also become easily overwhelmed in busy environments or situations where there is a lot of visual and other sensory information.

It’s also worth mentioning that some children with CVI can do well at typical vision assessments in the clinic.

Tips for Parents

There are many ways to help your child learn and grow. It’s essential to be patient and understanding, as learning can take more time for those with CVI. Here are some tips for helping your child develop visually:

Create a safe environment

Children with Cerebral Visual Impairment need a secure, safe, and structured environment to explore and learn. All potential hazards should be removed from the environment in order to prevent any harm or confusion.

Make sure all furniture is placed in an organised manner and clutter is kept to a minimum. It’s also important to adjust all lighting, so there are no shadows or bright spots that could be distracting.

Use familiar objects to teach new concepts

If your child is having difficulty understanding a concept or learning something new, it can be helpful to use familiar objects to explain. For example, you can use a toy like a ball or a box to demonstrate different shapes.

You can also use favourite toys and activities to teach your child about colours (if colour can be seen), sizes, patterns and other concepts. For example, you could ask your child to sort pieces of clothing by texture, or draw patterns in sand with a stick.

Read aloud to your child

Reading to your child helps them focus on sounds and words, which can support their visual processing. For example, when you read a story and point out different words and objects and explain what they mean.

When reading aloud to your child, it is important to be very descriptive in order to help them visualise the story. Describe the characters, their actions and facial expressions, and any other details about the environment or story. This will help your child build a mental image of what is happening in the book.

It is also important to make sure you are speaking clearly and at a comfortable pace for your child. Taking breaks between paragraphs or sentences can also help your child focus and process what you are saying.

Provide ample visual stimulation

Visual stimulation is an essential part of helping a child with CVI develop their vision. This can be anything that stimulates their vision, such as shapes, colours (if colour can be seen), patterns and movement. This can be done through activities such as playing with toys, looking at books or photographs, or watching television.

When providing visual stimulation to a child with CVI, ensure environments are not overly stimulating with distractions as this can be too overwhelming. It is best to start with shorter periods of time and gradually increase it as your child becomes more comfortable.

Be patient and understanding

Always remember that children with CVI may take longer to learn new concepts and process visual information. As a parent, it is essential to be patient and understanding when supporting your child.

Be sure to provide positive reinforcement and praise when your child succeeds at a task. This will help build their confidence and encourage them to keep trying.

Create a routine

Every child is different and therefore it is important to create a routine tailored to your child’s individual needs. This helps them feel more secure and increases the chances of success by providing structure.

Make sure that the routine is consistent and include activities such as playing, reading, and visual stimulation. Creating a consistent and structured environment can help your child feel safe and secure as they navigate their world.

Having designated times for different activities, such as meals, playtime, learning time or bedtime can create a comfortable environment of predictability,

Remember, every child with cerebral visual impairment is unique and has their own strengths and challenges. With patience, love, and support, you can help your child reach their full potential.

How to adapt your home/school

People with CVI can face a range of difficulties in their daily life.

InFocus’s Research Scientist, Dr Jonathan Waddington, has collected some ideas for simple adaptations in the home or school environment that can help these young people overcome barriers to independence.

Reducing background clutter and noise

Too much visual information can be overwhelming for someone with a cerebral visual impairment so background clutter and decorations should be kept to a minimum. In some cases, a plain coloured tent or “CVI Den” surrounding the individual can be used as an easy way to block visual clutter.

Household items or classroom equipment can be kept out of sight when not in use. Here at InFocus we try and keep rooms clear by keeping objects in clearly labelled storage or behind plain curtains.

If you can make changes to the room itself then you might consider using plain colour rather than patterns when planning flooring, wall coverings, and fabric coverings. Keep room layouts clear, minimise furniture to maximise space available for movement, and inform individuals with visual impairment if furniture has to be moved.

Background noise can also make processing visual information more difficult when learning to build visual behaviour so creating a quiet and calming environment is usually preferred.

Lighting, contrast and positioning

Reduced clarity of vision, reduced contrast sensitivity, and reduced visual fields are common symptoms of cerebral visual impairment. This means you should carefully consider the use of lighting, contrast, and positioning in the home or school environment.

Natural light has many beneficial features but is not easy to control. It is important to have good, even illumination when attempting tasks that require functional vision.

Try using a combination of dimmable lighting and task lighting to tailor the levels of artificial light. You might want to consider the individual’s needs, the activities being undertaken, and also how much natural light is available in the room.

One of the downsides of lighting is glare, and high-gloss areas should be avoided. Focal light sources can be diffused with lamp shades for light fittings or vertical blinds for windows, which can help prevent any involuntary light gazing behaviour.

How can contrast help someone with a cerebral visual impairment?

Contrasts in colour and brightness allow us to see where one object ends and another begins. It can be used to raise awareness of obstacles, landmarks, important information, or small usable objects such as switches.

Examples of this might include painting skirting boards and door frames in a colour that contrasts the neighbouring walls and floor. This will help boundaries to stand out, aiding orientation around the environment.

This list is just a starting point, as no one person is going to have all the actions for creating accessible environments for people with cerebral visual impairments.

We recommend a collaborative approach involving teachers, parents, low vision specialists, and the individuals themselves to come up with ideas that might really help them to overcome environmental barriers to independence.

CVI tools

Due to the vast spectrum of difficulties associated with the condition and the many features of CVI that overlap with other conditions, a variety of tools have been developed to assess the functional impact that CVI has on an individual.

One of these tools is the CVI Range, designed by Christine Roman-Lantzy as a framework for assessment and intervention. Research studies have shown that the CVI Range assessment results in a consistent and reliable measure of functional vision.

CVI Range assessment at InFocus

Since 2015, InFocus has run a CVI Range program within the school and college, after piloting the framework with individual students in previous years.

We offer ‘CVI Range’ assessments to families, local authorities or other agencies who want to gain a better understanding of a young person’s functional vision. Through this, we can make some positive suggestions and strategies for making the most effective use of that vision.

Assessments are conducted by InFocus staff who are experienced in the education and habilitation of young people with a visual impairment.

The assessment process involves;

• Interviews with parents/carers – parents and carers are key to gaining a better understanding of a child’s functional vision
• Direct face to face assessment – a structured vision assessment is conducted to confirm some basic visual abilities
• Informal observations – unstructured functional vision assessment in an appropriate multi-sensory environment

From the measure of lowest functional vision to the measure of highest functional vision, the CVI Range scores are:- 0-1, 1-2, … , 9-10.

The aim of the assessment is to identify the presence of typical characteristics of CVI in an individual child and to evaluate the impact each of the characteristics has on a young person’s learning and living.

The combination of these elements of the assessment identifies where on the ‘CVI Range’ a young person is and indicates what interventions and adaptations could be employed to help the young person to make sense of and best use the functional vision they have.

The impact on our students

We were able to measure robust improvements in functional vision each year for our students as a group. Baseline assessment scores were 5-6 on average but ranged from 1-2 to 7-8.

Scores increased by one rank per year on average for the first two years and improvements began to plateau in the third year. Only the time enrolled on the program was associated with improvements on the CVI Range scores. Neither age nor baseline scores appeared to influence improvements.

There was even indication of improvements in quality of life for some students, associated with the improvements in functional vision.

We recently presented these results at the European Society for Low Vision Research and Rehabilitation (ESLRR) and were awarded the prize for the best poster presentation.

If you would like more information on the CVI Range assessment including costs please email or call 01392 454200.

[1] University of Bristol (2021) Brain-related visual problems may affect one in 30 primary school children, February: CVI study | https://www.bristol.ac.uk/news/2021/february/cvi-study.html