What is Cerebral Visual Impairment (CVI)?

Damage to the areas of the brain that are responsible for processing vision can lead to a condition known as cerebral visual impairment (CVI).

Under normal circumstances, the eyes transmit electrical impulses to the brain, and the brain will then process those signals into the images you see. If you have CVI, your brain will have difficulty processing and comprehending the signals being sent to it.

CVI is most prevalent in infants and young children, but the condition can persist into adulthood as well.

What causes CVI?

CVI is caused by a brain injury. In most cases, these injuries develop before, during, or shortly after birth. Common causes of CVI in newborns and young children include

• Hydrocephalus (when fluid builds up in the brain)
• Traumatic brain injuries (e.g. shaken baby syndrome and accidental head injuries)
• Certain genetic conditions
• Lack of oxygen or blood supply to the brain, usually resulting from a stroke
• Neonatal hypoglycemia, infections (e.g. viral meningitis)
• Periventricular leukomalacia (PVL), a brain injury which primarily affects premature newborns and results in the damaging of brain tissue

CVI is also more likely to affect prematurely born infants.

What are the symptoms of CVI?

CVI can result in a spectrum of vision difficulties, from minor to severe. Children with CVI may have difficulty:

• Recognising faces and objects
• Understanding what they are observing
• Responding to what they observe
• Identifying objects or images in crowded spaces or busy backgrounds
• Seeing certain parts of things in front of them, like busy moving scenes
• Reaching for something while staring at it

Furthermore, parents whose children have CVI may observe the following symptoms:

• The child’s preference to focus his attention on one area of their field of vision, such as their side or peripheral vision
• The child is slow to respond to visual signals (visual latency)
• The child looks more interested in things that are in motion (e.g.: ceiling fan)
• The child often fixates on bright objects
• The child has absent or impaired visual blink reflex

How is CVI diagnosed?

Abnormal visual behaviours that cannot be explained with a clinical eye test constitute a CVI diagnosis. Usually, a paediatric ophthalmologist and neurologist who is familiar with CVI-related visual behaviour can make the diagnosis during a routine office visit. An optometrist will perform additional testing on the child and an occupational therapist will administer the necessary care.

Method of assessment & processes

1. Interviews
   • Interviews with parents/guardians that include complete medical, birth, developmental, and educational background information.
2. Observation
   • The child is observed throughout the evaluator's time with the child, beginning with initial interaction.
   • The doctor will look out for numerous "visual behaviours" displayed by children with CVI - examined through various settings and situations.
3. Direct evaluation of children
   • The evaluation consists of systematically presenting visual stimuli known to elicit behavioural responses suggestive of CVI, and then observing and recording the child’s reaction.

What is the treatment for CVI?

There is currently no cure for CVI. However, early intervention and evaluation can help address your child's visual concerns sooner.

The results of the assessment will be used to design learning environments and instructional materials that will assist your child in building visual attention and help identify the world around them.

Our occupational therapist at REHABCENTRIC will also design personalised educational and recreational activities for your child to participate in.

At REHABCENTRIC based in Ara Damansara Medical Centre (ADMC), our healthcare professionals will help you choose the best solution for your child’s needs. You and your child will be well-guided and cared for by professionals who have years of expertise in making the process as smooth as possible.