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Common Visual Impairments of Students who are Blind or Visually Impaired

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Cortical Visual Impairments

By: Carmen Willings
teachingvisuallyimpaired.com
​Updated March 11, 2018

Christine Roman-Lantzy has done much research in the area of Cortical Visual Impairment. In her book, "Cortical Visual Impairment: An Approach to Assessment and Intervention", she identifies the cause of CVI can generally be thought of as conditions that affect the visual pathways or visual processing centers of the brain. It is a condition in which children have reduced visual acuity as a result of damage to posterior visual pathways. In most cases, the eyes of such children are structurally normal, yet they have diminished visual capacity. She indicates that the most common conditions associated with a diagnosis of CVI are asphyxia, perinatal hypoxic-ischemic encephalopathy, intraventricular hemorrhage, periventricular leukomalacia, cerebral vascular accident, central nervous system infection, structural abnormalities, and trauma.

She further states that the occipital lobes of the cerebral cortex at the back of the brain are primarily concerned with vision; the visual messages from the eye traveling along the optic nerve pathway in the form of electrical signals are routed to this location. The child may have an abnormal MRI or CAT scan that shows damage to parts of the brain such as the visual cortex or optic radiations. When attempting to determine the cause of a child’s visual disability, CVI should be considered when the child has:

  1. A normal or near normal eye exam that cannot explain the child's impaired vision.
  2. A history or presence of neurological problems.
  3. The presence of behavioral responses to visual stimuli that are unique to CVI.
 
If you discover that the student has a history of seizures, be very cautious in using any flashing lights as this may trigger a seizure.

CVI is frequently seen in children who were born prematurely, have neurological disorders, or have acquired brain injury. When CVI is suspected, a review of medical and other records is needed. The presence of CVI is indicated when these three criteria are met. Dr. Roman-Lantzy has identified the following characteristics of CVI:

  1. strong color preference, especially for red or yellow
  2. need for movement to elicit or sustain visual attention; either the viewer or the object viewed needs to be moving to maximize the viewer's ability to view the object
  3. visual latency - delayed responses in looking at objects
  4. visual field preferences - the presence of unusual field locations in addition to loss of visual field.
  5. difficulties with visual complexity - difficulty when an object itself presents a complex display when an object is viewed within an environment that presents a complex display, or when an object is viewed at the same time that other sensory input is competing for the viewer's attention and ability to manage sensory stimuli.
  6. light-gazing and non-purposeful gaze
  7. difficulty with distance viewing
  8. absent or atypical visual reflexes - the reflex to blink in response to an approaching object is impaired
  9. difficulty with visual novelty - a preference for viewing familiar objects is shown
  10. absence of visually guided reach - the ability to look at and touch an object at the same time is not displayed, and these two actions are performed separately.

Overall, children who exhibit any of these characteristics or visual behaviors are usually unable to use their vision consistently in what might be thought of as a “normal” way.  In general, the greater the severity of CVI, the greater the number of CVI characteristics present.  However, these characteristics may change or improve. For more information on CVI and strategies from Christine Roman, visit the APH.

CVI Book Resources

book cover
Roman-Lantz, Christine. Cortical Visual Impairment: An Approach to Assessment and Intervention. American Foundation for the Blind, 2007. This resource book includes the unique assessment tool developed by Christine Roman-Lantzy and systematic, targeted principles to help students with cortical visual impairment. Includes a framework with which to understand working with CVI and concrete strategies in working with these students.

Picture
Roman-Lantz, Christine. Cortical Visual Impairment: An Approach to Assessment and Intervention, 2nd edition. American Foundation for the Blind, 2018. The new and revised content in this second edition brings the book up-to-date with new research and insights into CVI, its development and progression, and the best approaches to assessment and intervention with children affected by this condition. As in the previous edition, assessment forms, including the CVI Range and CVI Progress Chart, provide a comprehensive method for evaluating the functional vision status of, and program planning for, children with CVI.

Cover of Vision and the Brain
Lueck, Amanda Hall. Vision and the Brain: Understanding Cerebral Visual Impairment in Children. American Foundation for the Blind, 2015. Cerebral visual impairment, also known as cortical visual impairment, or CVI, has become the most common cause of visual impairment in children in the United States and the developed world. Vision and the Brain is a unique and comprehensive sourcebook of current knowledge about CVI and best practices for working with children. Expert contributors from many countries illuminate the complexities of vision loss related to brain injury and neurological causes and provide readers with approaches to assessment and intervention.

Picture
Sheline, Diane. Strategy to See. VeriNova LLC, 2016. Strategy To See is a resource book for parents/caretakers, educators and medical personnel (including but not limited to TVIs, COMS, PTs, OTs, Speech Therapists, Music Therapists, ophthalmologists, optometrists, low vision specialists and Special Education Teachers) of students from birth to 22 years who have a diagnosis of Cerebral/Cortical Visual Impairment or C/CVI. It offers specific strategies and discusses topics including brain plasticity, the importance of early intervention, the use of the CVI Skills, development of IEP Goals and Objectives and several printable handouts are provided.

Online CVI Resources

Link to CVI website
The American Printing House for the Blind has a great CVI website with information on Cortical Visual Impairment. Information includes articles, videos, stories, as well as supports, strategies and resources.

AFB logo
The American Foundation for the Blind provides useful articles on Cortical/Cerebral Visual Impairment:
  • Who receives intervention for CVI
  • Cortical Visual Impairment, Traumatic Brain Injury, and Neurological Vision Loss
  • Statement on Cortical Visual Impairment​

Picture
CVI Scotland is devoted to helping people understand cerebral visual impairments, and together work towards developing the understanding of this complex condition. They have created a free reading tool named "Look," a reading tool, with multiple functions and settings, designed to make reading easier for people with CVI.  

Picture
The Texas School for the Blind has a comprehensive article on Cortical Visual Impairment that was featured in their See Hear Newsletter.

Perkins School for the Blind Logo
Perkins offers a CVI hub that includes custom CVI training, tailored for your district’s needs. They also promote the Perkins-Roman CVI Endorsement. The endorsement recognizes those who master the techniques of the CVI Range©, the assessment tool created by Christine Roman, to evaluate a child’s use of vision and track progress.
Picture
Little Bear Sees is a website dedicated to raising awareness about cortical visual impairments. It is designed to provide the information and tools necessary for helping children with CVI learn how to see.

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    • Developing SMARTER Goals
    • Selecting the Right AT
    • Tips for Being a "Physically Fit" TVI
    • The Art of Teaching the ECC
    • Activities to Teach the ECC
    • Determining Service Intensity Using the VISSIT
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      • Simulation Activities
    • Professional Publications >
      • General VI Resource Books
      • CVI & MD Resource Books
      • Braille Resource Books
      • O&M Resource Books
      • Early Intervention Resource Books
      • Journal Resources
  • Foundations of VI
    • History of Visual Impairments >
      • Timeline of VI
      • Biblical Passages Concerning Blindness
      • Notable People
      • Helen Keller
      • APH Museum
      • Leaders & Legends
      • History of Braillewriters
      • Legislation
    • Visual Impairments >
      • Structure & Function of the Eye
      • Vision Classifications
      • Common Vocabulary
      • Common Visual Impairments
      • Cortical Visual Impairments
      • Convergence Insufficiency (CI)
      • Deaf-Blind
    • VI Resources >
      • VI Organizations
      • US Government Agencies
      • Support Networks
      • Deaf-Blind Resources
      • Georgia Vision Resources
      • Online Parent Resources
    • V.I. Book Resources >
      • Children's Books
      • Young Reader Books
      • Books about Dog Guides
      • Teen & Young Adult Books
      • Non-Fiction Books
      • Helen Keller Books
      • Parent Resource Books
      • Grief & Suffering Books
    • Impact on Development & Learning
    • Psychological Impact
    • Social Etiquette
    • Financial Assistance
  • VI Service
    • Educational Programming >
      • National Agenda
      • The Expanded Core Curriculum
      • IDEA and Vision
      • Federal Quota Funds
      • Deaf-Blind Child Count
      • State SpEd Agencies
      • Schools for the Blind
    • Referrals >
      • Vision Concerns
      • Referral Process
      • Eligibility Guidelines
      • Vision Therapy Controversy
      • When Student Doesn't Qualify
    • Medical Vision Exams >
      • Medical Professionals
      • Vision Tests & Tools
      • Visual Acuity
      • Lenses
      • Visual Fields
    • FVLMA >
      • What is the FVE
      • Interpret the Eye Report
      • Environmental Observations
      • FVLMA Observations
      • Interviews
      • Assessment Kit Materials
      • Oculomotor Skills
      • Near Visual Acuities
      • Print Comparisons
      • Distance Acuity
      • Test Visual Fields
      • Vision Skills
      • Learning Media Assessment
      • Reading Rates
      • Writing the FVE Report
    • Service Planning >
      • ECC Annual Needs
      • Service Delivery Models
      • Least Restrictive Environment
      • Early Intervention Services
      • Students with Multiple Disabilities
      • Student Led IEPs
      • 504 Plans
      • Transition Plans
    • Writing Goals >
      • Writing SMART Goals
      • Blooms Taxonomy
      • Independent Living Goals
      • Compensatory Goals
      • Sensory Efficiency Goals
      • Assistive Technology Goals
      • Social Skills Goals
      • Recreation & Leisure Goals
      • Self Determination Goals
      • Career & Vocational Goals
    • Low Vision Eval
    • O&M Evaluation
    • Educational Assessments
  • Adaptations
    • Unique Visual Needs
    • Accommodations & Modifications
    • Home Adaptations >
      • General Home Safety
      • Kitchen Adaptations
      • Bathroom Adaptations
      • Medication Adaptations
      • Clothing Management Adaptations
    • Curriculum Adaptations >
      • Numbers & Counting
      • Algebra
      • Geometry & Spatial Sense
      • Measurement & Data
      • Early Literacy Experiences
      • Create Tactile Books
      • Reading Instruction
      • Reading Efficiency
      • Science Adaptations
      • Social Studies Adaptations
    • Material Adaptations >
      • Accessible Educational Materials
      • Large Print
      • Braille Code
      • Photocopying
      • Font Legibility
      • Increase Contrast
      • Pictures and Worksheets
      • Tactile Graphics Guidelines
      • Creating Tactile Graphics
      • Teacher Made Materials for Students with MD
    • Instructional Adaptations >
      • Individual Schedules & Communication Cards
      • Movies & Assemblies
      • Lectures & Instruction
      • Board Work (Chalk, Interactive, White)
    • Environmental Adaptations >
      • School Campus Adaptations
      • Classroom Design Tips
      • Labeling System
      • Adjust Lighting
      • Playground Adaptations
      • Sensory Areas & Rooms
    • Early Childhood Adaptations >
      • Daily Schedule
      • Morning Meeting
      • Weather Check
      • Dramatic Play
      • Blocks
    • Adaptations to the Arts >
      • Art Adaptations
      • Art Materials
      • Music
      • Music & Movement
      • Dance
    • Recreation & Leisure Adaptations >
      • Recreation Adaptations
      • VI Sports Associations
      • Recreation Resources
      • Camps for VI
      • Card and Board Game Adaptations
      • Transcribe Playing Cards
  • VI AT
    • Overview of Assistive Technology
    • VI Assistive Technology >
      • Non-Optical Low Vision Devices
      • Low/Medium Tech Devices for Tactual Learners
      • Optical Devices for Near
      • Optical Devices for Distance
      • Video Magnifiers
      • Screen Magnification & Readers
      • Braille Technology
      • Tactile Graphics Technology
      • Auditory Access Devices
      • Braillewriter Repair
    • Apps for VI >
      • Note Taking Apps
      • Apps for Accessing Books
      • Identification Apps
      • Navigation & Location Apps
      • Braille Apps
      • Magnifier Apps
      • Sound Making Apps
      • Cause & Effect Apps
      • Vision Skills Apps
      • Apps for Early Learning
      • Read to Me Story Apps
      • Apps for Communication
      • Android Apps for VI
    • AT Instruction >
      • Video Magnifier Instruction
      • Notetaker Instruction
      • Accessing Audio Books
      • Navigate Computer without a Mouse
      • Word Processing and Shortcuts
      • Keyboarding Instruction
    • iOS for VI >
      • iPads as Instructional Tools
      • Making the iOS Device Accessible
      • iOS Accessibility Resources
      • VoiceOver
    • Assistive Technology Assessment
    • VI AT Resources
    • Vendors
  • Instruction
    • Virtual Instruction
    • Instructional Strategies >
      • Development of ECC Resources
      • Teaching in Thematic Units
      • Teaching the ECC
      • Summer Reading (braille)
      • Summer Outdoor Activities
      • Rainy Day Activities
    • Compensatory >
      • Guiding Principles of Concept Development
      • Functional Skills
      • Community Based Experiences
      • Concepts to Teach
      • Organization & Study Skills
      • Cranmer Abacus Instruction
      • Time Management
    • Communication Modes >
      • Language Development
      • Braille Instruction
      • Braille Instruction Materials
      • Writing Braille
      • Signature & Handwriting Instruction
      • Nemeth Braille Code
      • Tactile Graphics Instruction
    • Sensory Efficiency >
      • Sensory Input
      • Encourage Use of Vision in Students with MD
      • Lightbox Use
      • Sensory Activities for Students with MD
      • Sensory Table
      • Visual Efficiency Skills
      • Visual Attend and Scan Activities
      • Visual Tracking Activities
      • Visual Discrimination Activities
      • Visual Motor Activities
      • Optical Device Use
      • Tactual Readiness
      • Developing Skillful Hands
      • Auditory Readiness
      • Listening Skills Instruction
    • Independent Living >
      • Responsibility & Independence
      • Mealtime Independence
      • Eating Adaptations
      • Food Preparation
      • Recipe Activities
      • Hygiene & Grooming
      • Dressing & Clothing Management
      • Money
      • Housekeeping Instruction
    • Orientation & Mobility >
      • Transition Between Activities
      • Proper Guide Techniques
      • Orienting Student to Environment
      • Mobility Skills
      • Travel
      • Dog Guides
    • Social Skills >
      • Non-Verbal Communication
      • Social Interactions
      • Self Concept
      • Icebreakers & Mixers
    • Career Education >
      • Classroom Jobs
      • Career & Vocational
      • Prepare for College & Career
    • Recreation & Leisure >
      • Learn to Play
    • Self Determination