1. Cortical Visual Impairment
Sandy Newcomb, PhD
Connections Beyond Sight and Sound
University of Maryland

2. Based on work of:
Roman-Lantzy, Christine. (2007). Cortical visual impairment: An approach to assessment and intervention. New York: AFB Press.

3. Overview of presentation
Introduction to CVI
Characteristics of children with CVI
Assessment - functional vision assessment

4. What is Cortical Visual Impairment?
Vision loss due to damage or malformation in the brain that interferes with the child’s ability to understand vision information coming from the eyes
Leading cause of VI in young children

5. CVI is suspected when:
Normal eye exam or eye condition cannot explain level of visual impairment
History of brain injury or malformation
Presence of unique visual characteristics

6. Medical history significant for CVI
Asphyxia/Hypoxic-ischemic encephalopathy (HIE)
CVA/stroke
Intraventricular hemorrhage (IVH)
Periventricular leukomalacia (PVL)
Infection
Structural anomalies
Trauma
Prematurity
Metabolic disorders

7. Unique visual characteristics
Color
Movement
Latency
Visual fields
Complexity - array, sensory environment, object
Light gazing
Distance
Reflexes
Novelty
Visual motor

8. Severity of CVI
Children with CVI can function from almost no vision to almost typical vision
The 10 characteristics interfere with visual functioning to varying degrees depending on the severity of CVI

9. COLOR Color vision is usually preserved in children with CVI
Children often have a favorite color or will only look at certain colors
Children with typical vision or ocular problems will look at any color

10. MOVEMENT Movement attracts visual attention
Children with CVI may only look at something that moves or has movement quality (shiny)
Often helps children with CVI with mobility

11. Latency
Latency is the length of time between when a visual stimulus is presented and when a child looks at or orients towards the stimulus

12. Visual fields
Children often have field losses or field preferences

13. COMPLEXITY

14. Light gazing non-purposeful gaze
60 % of children with CVI often compulsively gaze at lights
Most have periods of non-purposeful gaze when they are not looking at anything in particular

15. Distance viewing
Children with CVI can often only look at things close to them
Distance is a function of complexity

16. Visual reflexes Reflexes often absent, or inconsistent
Blink to touch between eye brows
Blink to threat

17. Visual novelty
Children with CVI often look at familiar things better than novel
Novel environments can be challenging
Familiarity is easier because CVI is about learning. The child has learned to look at what is familiar.

18. Visual motor
Children with CVI often have trouble using eyes and hands together
Often look, look away and reach
Some children cannot look at what they are holding
Some children need to touch something to look at it

19. Progression of Resolution
Early Resolution
Light gazing, blink reflex
Mid Resolution
color, latency, visual threat, movement
Later Resolution
Field, visual motor, complexity, novelty, distance viewing

20. Severity of CVI CVI can be severe, moderate, or mild
Severity of CVI is described in three phases

21. Major goal of each phase
Phase 1 : building stable visual function
Phase 2: integrating vision with function
Phase 3: visual curiosity, visual learning