Cortical Visual Impairment (CVI) is the leading cause of congenital blindness in children, but it’s still widely under-recognized. As pediatric therapists, we often spot concerns before a formal diagnosis is made, yet CVI signs can be mistaken for behavior or sensory issues. This post highlights 5 common signs of CVI, how we can help in our treatment sessions, and how to determine when to refer a child for evaluation.
What is CVI?
CVI is a brain-based visual impairment. It doesn’t stem from damage to the eyes, but from the brain’s difficulty processing visual information. In most cases, the child’s eye exam appears normal, which can delay identification.
1 – Strong Color Preference
Children with CVI often visually attend only to one specific color. In the past, red or yellow were the most noted, but research shows it can be any color. If a child consistently engages with toys or items of a single color, it’s worth noting.
Clinical Takeaways:
- Use colored overlays, high-contrast materials, or colored light filters in therapy
- Ask caregivers what toys, cups, or clothing seem to catch the child’s eye
- Introduce new skills using items in the child’s preferred color, then slowly vary colors over time
2 – Absence of Visually Guided Reach
This is one of the hallmark signs of CVI. A child may briefly look at an object, then look away before reaching. Unlike typical reaching behaviors, these children do not maintain visual contact while reaching. If you observe this look-look away-reach pattern, CVI should be considered.
Clinical Takeaways:
- Reduce background clutter to help the object “pop” visually
- Allow the child time to locate the item visually before introducing movement
- Use lighted objects or movement-based prompts to enhance visual targeting
3 – Delayed Visual Response (Visual Latency)
Children with CVI may take 30 seconds or more to visually respond to an object. This delay is often misinterpreted as a lack of interest or inattention.
Reduce all other sensory input and allow extended wait time before expecting a response. Avoid repeating commands, as it resets the child’s processing.
Clinical Takeaways:
- Present one object at a time
- Pause and wait silently before adding verbal prompts
- Avoid stacking instructions (e.g., “Look! Grab it! Touch the ball!”) which can overload processing
4 – Light Gazing or Non-Purposeful Gaze
Some children appear visually drawn to lights, reflections, or bright windows — but show little interest in people or toys. This is known as light gazing and is a classic behavior associated with CVI.
Clinical Takeaways:
- Dim overhead lights if possible and reduce glare in therapy spaces
- Use backlit or illuminated objects to attract visual attention intentionally
- Pair movement with light to redirect focus toward functional tasks
5 – Inconsistent Visual Engagement
These children may notice some things but miss others in the same space. Vision may fluctuate depending on fatigue, stimulation, or health. This variability is a key red flag for CVI.
Clinical Takeaways:
- Note when and where vision is most functional (e.g., at home in a quiet room vs. in a crowded clinic)
- Limit competing stimuli in the visual field (toys, print, movement)
- Document patterns and share with families and specialists to guide accommodations
When to Refer for a CVI Evaluation
Referral should be made to a pediatric ophthalmologist, neurologist, or teacher of the visually impaired familiar with CVI assessment.
Refer if you observe multiple signs, especially:
- Absence of visually guided reach
- Long visual response times
- Light-seeking behaviors
- Difficulty using vision in busy environments
- Inconsistent visual behaviors despite a normal eye exam
CVI is the only visual impairment that can improve with therapy. Early identification and intervention can significantly change outcomes.
This blog is based on training presented by Rhiannon Thomas, OTR, MOT, a pediatric occupational therapist with advanced expertise in Cortical Visual Impairment.
Rhiannon is a continuing education instructor for Knowledge Is Now where she teaches evidence-based strategies to support functional vision in therapy.
