1. Becoming a Team to Build Understanding of CVI
Burju Sari, M.Ed., CTVI
Ellen Cadigan Mazel, M.Ed., CTVI
Omer Sari, RCK

2. *Omer’s Birth History 31 weeks of gestational age 6 weeks of NICU stay
First ultrasound showed brain bleeding
Second ultrasound showed that bleeding stopped
At 1 month- IVH- stage III-IV

3. *Visual History Not looking at faces Slow visual processing
Down gazing
Frequent naps (rests)
Gazing at lights
Diagnoses of strabismus and prescription glasses

4. *“I know something is wrong”
Video of “#1 Crib Complexity”
Video of stroller: “#2 Twins”

5. *Misdiagnosis Autism (EI)
Cognitively impaired (Infant-toddler follow up)

6. *Perkins Infant Toddler
At 6 months- Ellen’s first visit for FVA
CVI training
Infant toddler group on campus & parent group
Support
Sharing experience
Learning more

7. Omer’s visual skills: 6 Months Score 1-1.25
Color: Looking at red, solid colored items. Locating red faster and sustaining longer
Movement: Like shiny things. Movement gains a brief look. If items don’t move, he doesn’t glance at all. Hates places with many people moving around.
Latency: Difficult to gain visual attention. Brief when it occurs.

8. Omer’s visual skills
Visual field: Left visual field is stronger. Looks down to the left.
Light: Consistent lightgazing.
Visual novelty: Limited number of items are visually regarded
Complexity/Latency: Napping or “playing possum”.

9. Video: “#3 Lights”

10. Omer’s visual skills Complexity: Fussy in busy places.
Complexity: Only quick glances towards faces. Looks quickly away when voice is introduced.
Visual Motor: Less movement of hands.
Visual Reflexes: No blink to touch or visual threat.

11. Adaptations: Color: Movement: Use red as highlighting color
Feeding: bottle and spoon are color highlighted
Movement:
Reduce access to distracting environmental movement
Use movement to draw visual attention

12. Adaptations: Latency: Visual Fields:
Slow down and give him time to locate items
Visual Fields:
Present items in peripheral, left visual field.
Present familiar, lighted and moving items in weaker right visual field.

13. *Adaptations: Complexity Use single colored items
Use books with storyboxes
Provide plain backgrounds
Reduce other sensory inputs (sounds, touch, vibration) while looking
Provide multisensory learning with one sense challenged at a time.

14. *Adaptations: Lightgazing Distance Eliminate distracting light sources
Use light to draw visual attention to meaningful items
Distance
Provide consistent items at 12”-18” to play with.
Narrate distance events.

15. Adaptations: Novelty Visual Motor Standardized presentations
Familiar toys
Familiar routines
Visual Motor
Active learning

16. Reaching: Video: “#4 No VM”
Video “#5 VM to sound”

17. Improvements 9 months: Score 3.75-4
Looks at mom (important for a mom)
Expanded his toy selections
Breaks away from light sources to look at toys
Looks at more novel materials is they match color, light, shape.
Red still favorite but expanding color interest.

18. Improvements 9 months: Score 3.75-4
More visual interest and visual curiosity
Looking at 2-3 feet if something is moving.
More social
More reaching to items in his environment: Very dependent on sound
More visual stamina.

19. Omer: age 3 Looks at all colors and multicolored items.
Sustains gaze on materials
Looks at faces but “look through you”
quality. Very social. Smiles at everyone.
Only looks at light if he is tiring to walk in
his walker
Looks at stable items around him at 3-4 feet.
Looks at distance movements.

20. Clearly on Task Cognitively
Video “#6 ABC”

21. Omer: age 3 Likes to look at books
Looks immediately on presentation of materials
Blink reflex present
Can look at noisy toys.

22. Video “#7 Complex sticks”.
Video “#8 sticks black”
Video “#9 walking outside”

23. Scoring wrong: Age 3 Scoring Too High
Looking is not understanding
Using CVI Range statements as the only basis for understanding CVI
Characteristic can disappear from the CVI Range statements but that visual characteristic still impacts learning.
Visual characteristics all remain important for visual understanding and function.

24. Thinking Characteristics are Resolved
Looks at all colors and multicolored items.
Looks quickly
Looks at faces
Looks at distance at times

25. “I see the impact of his CVI everyday”
Color: Still Important
He asks for red clothes.
He has a red bike.
Playing a board game he automatically picks red
color side of the game or symbol.

26. Color: Still Important
He picked red glasses frames.
Going to a party or somewhere busy, he asks mom to wear red or orange.
Likes other colors too like blue.
Brother in red bumper cars.
Picked Mario as a Halloween costume with lots of red and blue.

27. Color: Still Important

28. *Movement: Still an Issue
Movement helps location against complexity
Movement helps him find things at distance
Movement distracts him in peripheral visual fields.

29. Latency: Still an Issue
How we know
Visual fatigue
Longer time to find against complexity
Longer time with novel items
Longer time at distance
Longer time for facial recognition.

30. Reasons for collaboration:
*Transition to School
Reasons for collaboration:
IEP: nonsense words (Police car)
Classroom teacher taking classes: preschool
Needed services

31. *Misconceptions about high Phase II and III
Social emotional challenges
Cognitive impairment
Cognitively fatigued
Distractible

32. ”I see the impact of CVI everyday.”
*What is left over now?
”I see the impact of CVI everyday.”
Color supports understanding: Likes and picks “red” color
Latency: Visual fatigue and for understanding new things
Complexity: Just realized our dog has a face

33. *What is left over now? Novelty: His brother’s bike is different
Novelty, Complexity: Cutting nails
Distance viewing: Can’t see the kite
Complexity: Facial recognition is still difficult

34. Video “#10 Complexity Cheerios
Video “#11 Not looking crowd”

35. *What happens in new places
Gets quiet
Gets fatigue easily
Head down
Hates field trips
Difficulty recognizing people from different nations

36. The more you learn about CVI the harder it is to explain.

37. *Self Advocacy Understanding His CVI
(Video: Omer explaining his own CVI)

38. *Self Advocacy: Building his advocacy skills: Less complex/busy
Ask to be closer to targets
Description of distance events/situation
Frequent breaks

39. What expanded learning for team around CVI?
Matt Tietjen’s “What’s the Complexity” framework
CVI Scotland website
Perkins CVI Hub
Perkins Elearning
Christine Roman Lantzy: Cortical Visual Impairment: An Approach to Assessment and Interventions 2018
Dr. Gordon Dutton: Vision and the Brain

40. Becoming a Team to Build Understanding of CVI
The End
Burju Sari, M.Ed., CTVI
Ellen Cadigan Mazel, M.Ed., CTVI