By Jennifer Smith TEIS Teacher of Students with Visual Impairments

How can my child have a visual impairment if the doctor says her eyes are perfect?  On the surface, that seems to be a contradictory statement; a person with a visual impairment and perfect eyes, but vision happens when multiple body systems are coordinated.  Your child’s perfect eyes may be collecting visual information without difficulty, but her brain may be processing that information ineffectively.  Visual impairments that happen in the brain are called Neurological or Cortical Visual Impairment or CVI.  CVI is becoming more commonly recognized as a component of many other brain injuries, related to premature birth or related to traumatic head injury.  Fortunately, if early and informed intervention to support visual development occurs, children affected by CVI can attain near typical visual abilities.

Caregivers of children with congenital or traumatic brain-based disabilities such as Cerebral Palsy, Periventricular Leukomalacia, or shaken baby syndrome (among others) might consider the possibility of vision being impacted by these neurological conditions.  In the Pittsburgh area, we are fortunate to have one of the foremost experts in the field of CVI, Dr. Christine Roman-Lantzy, providing CVI evaluations, in addition to the Western Pennsylvania School for Blind Children’s Outreach Director and CVI Project leader, Beth Ramella, providing evaluations and information.  While a neurologist’s evaluation is required for a medical diagnosis, these two providers can produce a thorough evaluation and suggestions for your child’s visual education.  In addition, most Teachers of Students with Visual Impairments (TSVIs) are well educated in the effects of CVI and how to treat this visual disorder, and can make excellent recommendations for next steps if you suspect CVI may be affecting your child.

CVI can affect ten areas of visual abilities, and within this group of abilities, some areas may be more or less affected than others.  Ask yourself the following questions while considering your child’s behavior:

1. Is your child strongly attracted to light sources like brightly lit windows, lamps, or glare from shiny or metallic surfaces?
2. Does your child enjoy looking at ceiling fans or other moving or spinning objects?
3. Does your child strongly prefer one color, to the exclusion of items of other colors?
4. Does there seem to be a time lag between the time a toy is presented in front of your child, and your child noticing it?
5. Does your child seem to look at a toy, look away from the toy, and then reach for it while not looking?
6. Do you notice your child having difficulty locating a desired toy in the midst of other toys, finding a requested picture with a larger image, or locating Elmo on a red blanket?
7. Does your child seem to have difficulty noticing familiar people and items at distances greater than 5 feet from his body?
8. Does your child tend to look at toys to her left or right, but ignore those right in front of her, held above her, or held close to her chest?
9. If you flick your fingers toward your child’s face, or touch him on the bridge of his nose, does he blink?
10. Does your child consistently play with the same toys, ignoring or becoming upset when new toys are presented?

If you have concerns or questions about CVI and your child, please speak with  your pediatrician and consult an eye care professional familiar with CVI, such as a pediatric ophthalmologist or pediatric neurologist.  Early intervention is crucial in CVI, because unlike many optic-based visual impairments, visual skills can be improved through education, training and support.  Research has shown that treatment by TSVIs with knowledge of CVI can improve the visual outcomes of children dramatically.  If your child receives a diagnosis of CVI, she will be placed on a range from 1-10, with 1 being the lowest level of visual functioning, and 10 being near typical visual functioning.  With experiences and opportunities crafted together with your doctor, the CVI evaluator, the TSVI, and you – your baby’s first teacher, your child can make enormous growth in visual skills during the early years.

Notes:

Christine Roman-Lantzy works through Allegheny Health Network, West Penn Hospital

Beth Ramella at Western Pennsylvania School for Blind Children, call (412) 621-0100 x 379

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