Supporting a child with cerebral/cortical visual impairment (CVI) means many things: getting them the right assessments, accommodations, and assistive technology, as well as doing things at home and in the community. But how do we as parents ask for the right assessments, accommodations, and services for our children? And how do we support them at home, outside of the school setting, to make sure that they are also accessing all of the world around them?
For insights into these questions and more, we’ve spoken to Melinda Chang, MD, neuro-ophthalmologist at Children’s Hospital Los Angeles; Rachel G. Bennett, MEd, CCVI, director of CVI Now at the CVI Center at Perkins School for the Blind; Sonja Biggs, PhD, TVI, co-founder and president at Sonja Biggs Educational Services; Sarah Chatfield, TVI, CEO at Sonja Biggs Educational Services; and Rebecca Hommer, EdD, an educator and education and technical assistance specialist for the University of Maryland program Connections Beyond Sight and Sound.
Note that the word “impairment” is part of the diagnostic official language; we at Undivided typically use "low vision, partially sighted, blind, or CVI" for visual impairment.
In the first part of our CVI series, we explored CVI in depth, including signs and symptoms, public benefits, and more. When your child starts going to school, if they have any type of low vision, including CVI, the school is required by California law to provide certain assessments:
One important thing to remember when asking for and advocating for CVI services in an IEP: “Services should be determined by the assessment because that's where you develop your IEP goals from. The team looks at the recommendations and they see what has been recommended. That is how the team determines the goals. The process is: assessment, IEP goals, and services determined by the recommendations,” Dr. Biggs explains.
The assessment is crucial because there is no one-size-fits-all package of related services, accommodations, and modifications for all children with CVI. While there are many common things to ask for and consider, every child is going to have different needs and strengths.
Parent tip: as you’re trying to go through the diagnosis journey, remember that you can still request educational assessments under the law. Even if a formal diagnosis hasn’t been made yet, CVI might already be impacting your child’s ability to access the general curriculum, so don’t hesitate to ask for those assessments.
So first things first: the functional vision assessment, including a specific CVI assessment.
There are a few assessments that are CVI-specific, including the Perkins CVI Protocol that was just released in 2024. Bennett tells us that it’s free and available to everybody and is really comprehensive — it looks at all the different CVI visual behaviors and how a child is using their vision, but also how they’re using their compensatory skills — or those nonvisual skills that our kids use as workarounds for everyday things — which are so important to understand.
There are other assessments specific to CVI, which you can explore here, including Christine Roman-Lantzy’s CVI Range, but as Chatfield explains, brain research is evolving so quickly that more effective tools are coming out in response to the research that is coming out, such as Perkins CVI Protocol.
Here are some key points to remember:
What are the 16 CVI visual behaviors?
As Bennett explains, Perkins has created a framework of 16 CVI visual behaviors that is based on research and leading theorists, and can be used during a CVI diagnosis and assessment. ”That’s a whole framework we can use to understand the complexity of CVI. But even within each of those visual behaviors, they might have diverse manifestations. That’s why comprehensive assessment is the first thing we need to do to help us understand how to teach our kids,” Bennett adds. So what exactly do these visual behaviors consist of? Here’s the full list:
Let’s take a moment to touch on those compensatory skills. Children with CVI often develop compensatory skills, which are strategies that help them use their strengths to work around challenges. These skills help them access their schoolwork and navigate the world. Compensatory skills might include things like using auditory cues, tactile exploration, or color coding. Some children with CVI use their vision when it’s helpful, while others rely more on these strategies, and many use a combination of both. Their experiences help shape how these skills develop and how they use them every day.
The functional vision and CVI assessments can help assess how your child uses compensatory skills, which, along with the assessment of visual behaviors, can help teachers of the visually impaired create a robust and personalized CVI evaluation report, which includes specific recommendations to support your child’s learning and needs.
The next step is the learning media assessment. This assessment helps identify the different sensory channels your child uses to access information, such as vision, hearing, or touch. It provides valuable insights into how materials should be presented to best support your child’s learning. As Dr. Biggs explains, “The learning media assessment is also really important because it’s going to determine which media is going to work best, what assistive technology (AT) and AT assessment provision is important, because it’s going to determine what AT is going to help the student the best given their different challenges with their vision. The learning media is going to tell you whether the child needs braille, whether the child learns best through audio means, or whether the child learns best using tactile means, or all of them, or large print. It could be all of those put together that the child needs. So the learning media assessment is going to determine which media the child’s going to use.”
The AT assessment is also very important because AT helps them access their learning. Maybe it’s a CCTV if they’re using a communication device, in which case they should be working in conjunction with their speech language therapist, or different computer programs, adapted keyboards — there’s a lot of technology tools that can help children with CVI.
This is another biggie completed by an orientation mobility specialist, and it looks at how the child is navigating in the school and the community and their safety in their environment as well. More on this later!
Question: who conducts these assessments?
Answer: Dr. Biggs explains that a teacher of the blind and visually impaired (TVI) typically completes the functional vision and CVI assessments. An orientation mobility assessment is done by someone who is trained in orientation and mobility. Sometimes, if a child has multiple disabilities, the AT assessment can be done by an AT specialist there at the school to determine whether the student needs a special stand for a wheelchair or that kind of thing. “But a TVI needs to be working with that AT specialist, if it’s not the TVI doing the AT assessment themselves,” Dr. Biggs says. TVIs are trained to do AT for students with CVI and low vision.
Team collaboration is key
When it comes to services and your child’s team, it’s crucial to make sure the right professionals are involved. Your child should have a TVI, an O&M specialist, and someone for assistive technology on their team. Depending on your child’s needs, other specialists might be needed as well. The key is collaboration. For example, the TVI and speech therapist need to work together to assess how vision might be impacting communication skills or the use of an augmentative and alternative communication (AAC) device. Similarly, the occupational therapist and physical therapist need to work closely with the TVI to make daily routines more accessible and address any mobility challenges. This is especially important for tasks such as stepping over a threshold, where color or tactile cues might be needed. CVI affects many areas of development, so it’s important that these professionals collaborate closely to ensure all aspects of your child’s needs are met. If the team is not working together, key assessments, such as assistive technology evaluations, won’t be as effective. And as Dr. Biggs reminds parents, don’t exclude the TVI from any of the assessments!
After assessments come goals, services, and supports. But first, let’s address three big questions parents might have.
Does a child need an official CVI diagnosis or eye report to get services at school?
While having a medical diagnosis can be helpful and is good practice, you don’t need one to do assessments and get services. This is because, as Dr. Biggs explains, “We’re looking at the functional vision of the student in the classroom and how it’s affecting their success in the classroom . . . I like to look at all the previous reports — medical, PT, OT, speech and language — to see how, in the past, that student’s been evaluated, so that I can get a feel for that student.”
As Chatfield adds, “I’ve seen families really struggle to get what they suspect is a CVI diagnosis. So you can go to an eye doctor and get a really good eye report that says the way your ocular health is suggests you shouldn’t have a visual impairment. And yet, that family comes back and says, ‘They do not act like they like to look at things’ or ‘They struggle in certain environments.’ And so that’s why the field has moved away from requiring an eye report. Or you can have a ‘perfect eye report,’ and it still necessitates eligibility for vision services because the functional [assessment] is going to say, ‘Okay, the ocular health of this eye, according to this report, is good, and they also struggle in these ways in the classroom to use their vision, and that’s affecting their ability to access free, appropriate public education (FAPE), and so these are the things that need to be in place for that student.”
Would a child with CVI automatically qualify for low vision services?
Not necessarily. Remember, everything is based on assessment; the assessment determines eligibility for services. Chatfield adds that, “You could even see that a kiddo might have eligibility, met criteria, then the team in a team environment says, ‘You know, at this point, because of the medical fragility of the student, or because of three other things that are reasons that might be true for the student, we’re going to do some smaller version of services, or maybe a consult model.’” While direct services are recommended for children with CVI, note that some districts do try to put children on consult. If you want direct services for your child, make sure to voice that during the IEP meeting.
What if the school says, “They’re not blind, their eyes are fine, they don’t need vision services or accommodations?”
Dr. Biggs explains that if a school says this, parents can request an assessment. It’s important to insist on an assessment before any decision is made. A trained professional, like a TVI or O&M specialist, needs to assess the child. Someone who isn’t trained in CVI can’t legally determine a student’s needs based solely on what they think the student can or can’t see. So, asking for that assessment is the key step in advocating for your child.
The Expanded Core Curriculum, in a nutshell, “is a nine-area curriculum to help bridge the gap between a standard school curriculum and what an individual who is blind or visually impaired would miss due to lack of visual access — to instruction, the environment, activities, social interactions, and incidental learning.” The ECC is a set of essential skills designed for children with vision challenges, including those with CVI. It covers more than just academics like reading and math; it also focuses on daily living skills, orientation and mobility, social interactions, and technology use. The nine areas of the ECC include compensatory and functional academic skills; learning strategies to make up for vision loss, such as braille; assistive technology; and alternative reading and writing methods. You can find a more in-depth explanation of each area here.
Dr. Biggs explains more about the ECC, including the ECC assessment:
As Perkins explains, “Individuals with CVI need explicit instruction in each ECC area. Without access to incidental learning, concepts that are learned through observation by sighted peers must be directly taught to individuals with CVI.” It’s important to note that during the IEP process, the student should undergo an ECC screening and evaluation, alongside all the other assessments we explained previously. The ECC screening helps identify the student’s strengths and areas that need focus, while considering their specific CVI needs. Keep in mind, not all areas will be addressed every year, as the focus might shift based on the student’s development.
The ECC and the IEP
Chatfield explains that from all the assessments, the IEP team can identify areas where the student might need extra support, like social interaction. Then, during the IEP meeting, the team decides what areas are most critical to focus on in the upcoming year. This involves input from the teacher, parents, and ideally the student themself. From that input, critical items from the ECC will be used as goals, which might include braille or other skills from the ECC. The ECC addresses not only practical skills like orientation and mobility but also things like self-advocacy and learning how to navigate new environments. While all aspects of the ECC are important, the team focuses on the most critical goals for the student each year and builds upon them over time.
When it comes to CVI, each area of the ECC is interconnected. They build on one another to create a strong foundation for learning and independent living skills. As Chatfield adds, incorporating ECC is a matter of focusing on the main skills that a student needs to be working on. “All of the ECC is important,” she says, “but can we take all of that time out of that student’s day to focus on the ECC? Typically, we have the things that we consider the most important for the next 12 months, and we focus on that, and then we build from year to year.”
Chatfield shares that her son is pole vaulting this year, and it ties into the recreation and leisure aspect of the ECC. He works with his coach to communicate the specific supports he needs to succeed in pole vaulting, while also developing important social skills by interacting with peers and being part of a team. “And the ECC captures those skills,“ she says. “Not just the orientation and mobility of moving on a cross country [course], but also, do you know how to advocate for yourself when you go to a new field within a new environment so that you have a fair shot of completing the track in a way that makes the most of what your learning medium is?”
The ECC aims to build these skills, ensuring that students have a solid foundation for high school development and whatever comes next, with TVIs helping them prepare for a successful future. And visual and compensatory skills should be integrated into every goal and objective of the IEP.
Under IDEA, orientation and mobility services are listed as related services in the IEP. If your child has CVI, it’s important they take a CVI-specific assessment in addition to their O&M assessment. That way, their education team can fully understand the best ways to help them learn orientation and mobility while accounting for any special circumstances CVI might cause. For example, some kids with CVI have trouble using more than one sensory input at a time. That could influence an O&M goal involving using a white cane to step-walk while also listening for oncoming traffic and stopping when traffic is heard. Part of understanding CVI is understanding the different levels of sight a child might experience with the diagnosis. Each level, or phase, needs different accommodation and services.
What would an orientation mobility specialist work on?
Bennett explains that they could work on safe navigation skills in the school building and in the environment. They could help teach your child about proprioception and the body, orienting them themselves in space, and all the different ways that we move our body through space. They could also help your child understand mobility issues and all the different strategies for safe navigation. “It’s such a critical piece,” she says. “And also it’s not just for walkers. Wheelchair users need orientation and mobility instruction. Every person who is moving through space, no matter how or what, and who has CVI or visual impairment, needs an orientation and mobility specialist to help give them the strategies they need for safe navigation.”
Dr. Hommer explains more about O&M for kids with CVI:
It’s important to work with educators and specialists to craft specific IEP goals that incorporate all the information from CVI and O&M assessments to increase the learning opportunities and strategy efficiency for each child.
It’s also important to assess every environment the child is in, not just school. Parent interviews are really important because, as Dr. Biggs says, “In going and observing the child in different environments — like I observed a student in his home environment, in the community, at school — I was able to make a determination that yes, O&M was appropriate for this student, and a cane was appropriate for this student, based on all of those observations that I did. In those different environments, he had a problem with stairs, he had a problem with shadows on the ground, he had a problem with crowded environments and too much noise. And so in order to give him confidence to be able to travel independently, the cane was his tool, and he loves it — even still to this day, he loves it.”
To learn more about O&M, head to our article Orientation and Mobility (O&M) 101.
O&M aides, such as white canes and guide dogs, can play an important role in the life of a child with CVI. White canes can be acquired for free from your school district or from the National Federation of the Blind. As Bennett explains, white canes are not just for people who are legally blind: “If you are not able to walk safely around and see where people are and see moving cars, that’s a form of low vision and blindness, right? If you can’t read many paragraphs because of clutter, if you can’t recognize words, all of that. So yes, anybody who has some form of low vision or blindness has a right to use whatever tools are necessary for access,” she says, and that includes kids with CVI.
Why might a child benefit from using a white cane? Dr. Biggs explains that a cane is particularly helpful for children who struggle with their lower visual field. It helps them detect steps, curbs, and shadows, as well as navigate tricky terrain. For example, if they encounter a dark shadow on the ground, the cane helps them distinguish whether it’s a hole or just a shadow. In noisy, crowded environments, their vision might not provide enough clarity, making it difficult to feel confident.
Dr. Biggs shares the story of a young boy who would freeze up every time he went to Costco with his mom. After learning to use a cane, he gained confidence and could walk with ease beside her. Though there was some debate about whether he should use a cane, it significantly helped him feel more secure in complex, busy environments.
A child with CVI can and should be included in everything, with accommodations, academically and socially. Dr. Biggs explains that your local school district can serve your child if the right team is in place, all of which we’ve discussed previously. “There’s a big team of people that have to work together to make that a successful academic experience for the student, in order to make it work in a school district,” she says.
Should children with CVI go to a school for the blind?
While a school for the blind is an option for children with CVI, there are a few key things to remember. Schools for the blind have their own process: most have an assessment protocol to decide whether a student will be accepted. And not all schools accept all students: some schools might not be equipped to serve students with multiple disabilities.
Something to note is that every school for the blind is different in their culture and what their “traditional student” looks like. “The traditional student at the Utah School for the Blind looks very different from the traditional student at the California School for the Blind,” Chatfield says. “So families that are considering whether or not that placement might be the most appropriate for their child would do well to tour and see what the average classroom looks like, because an average classroom might be more set up or geared towards the student with an ocular impairment who’s highly independent, versus a student with very complex access needs. And each student in that classroom has their own kind of microcosm of classroom adaptations happening.”
One benefit of having your child attend a school for the blind is that every teacher there is going to be aware of the ECC skills. But, it’s a very personal choice. Chatfield explains that some families choose to keep their child in a local school because they’re thinking ahead — college, work, and everyday life will likely be in environments with mostly sighted people. Being in a local school can give their child the chance to practice the social and independence skills they’ll need in those settings, starting early.
For more information on inclusion, head to our Low Vision and Blindness 101 article.
Tackling subjects like reading and math is a challenge for children with CVI, especially if they have co-occurring disabilities. As our experts tell us, the learning media assessment is going to be huge here. Bennett tells us that when it comes to CVI, we have to think about access on several levels. There are some foundational concepts and general supports for somebody with CVI, but these are things to try as you assess them and really get an individualized, targeted approach. Some tips include reducing clutter in the environment, reducing clutter on the learning task, and using a multisensory approach. For example, with reading, if you know they prefer their tactile sense, braille concepts can be taught early on to see just how they respond to it. For kids who prefer the auditory process, audiobooks can be a great tool for reading. Here are some more tips.
When it comes to literacy, Bennett explains that the learning media assessment plays a key role in understanding the different sensory channels your child uses. There are many reading curriculums available, but they must be accessible for your child. Some children with CVI may also have dyslexia, so it’s important to understand how their brain processes and understands words. Even if they can read print, it might be so fatiguing that they can’t fully capture the meaning, affecting their comprehension. There are many factors to consider when addressing literacy for kids with CVI.
Some kids with CVI may also have central auditory processing disorder, Bennett says, which is a brain-based hearing issue — “CVI of the hearing world. So they have a hard time processing sounds, words, hearing things being said in the cluttered sound environment. It’s important to understand that there may be auditory processing issues going on too, as well.”
While worksheets are some of the most widely used learning tools, research has shown black-and-white abstract worksheets and drawings are not accessible for many with CVI. But we can adapt worksheets for CVI, for example by using digital tools, having one equation on the worksheet instead of 20, color coding, etc. it's different for every child. Children with CVI also do better with real 3D objects and representations. “Even thinking about geometry, for example. In a 2D form you can represent a 3D shape, and that takes a lot of visual spatial and visualization skills that can be difficult for somebody with CVI. So get the real models in, get real objects. It’s such a critical piece,” Bennett says.
A key part of helping kids with CVI learn is giving them a chance to preview new concepts before they dive in, Bennett explains. Since they might not be able to naturally take in all the visual information around them, they need extra time to get familiar with new ideas. For example, if they’re learning about airplanes, they might not have ever seen or understood that things can fly in the sky. So, it’s really important to help bridge what they already know to the new things they’re being taught, especially when it comes to subjects like science or social studies. This extra previewing helps them connect the dots and better understand the material.
When it comes to making learning accessible, it’s important to understand what visual field works best for your child. Is it at eye level or to the right? Knowing where to present materials can make a big difference. Also, think about how they’re sitting — if they’re not physically supported, it can drain energy and make it harder to focus on their learning task. So, ensure they’re sitting in a way that offers good support, as this can help them use their vision and other sensory channels more effectively, Bennett advises.
When thinking about using color for kids with CVI, it’s important to focus on creating a “pop-out” effect. Color can be a strength, so using it strategically can help. For example, you can use color to highlight changes in depth or color-code reading materials. For some children, color-coding every other word or marking the beginning and end of a sentence can help them understand where to start and finish.
Intentional use of lighting can be very helpful for children with CVI. Task lighting, such as shining a light on the object you want them to focus on, or adjusting the lighting on a tablet, can help them attend to and recognize important items more easily.
“Clutter is public enemy number one for CVI, so it’s really difficult to process simultaneous visual information at once. Those of us who have average visual processing abilities can walk into a room and instantly take in the scene and get all the information we need to make decisions. For people with CVI, they may only be able to process one thing at a time. A hot day or feeling tired, or pre- and post-seizure can impact visual access a lot,” Bennett explains.
Movement can also be really distracting, but it can also be a support — so that slow movement of an object to help that visual attention, using noise and other audio to help alert and understand, can be helpful, but too much background noise can be really fatiguing. Here’s a breakdown of what to know about visual clutter:
But there are fixes. For example:
Bennett tells us that the areas in the brain that visually process math are also the areas in the brain where CVI is. That’s why some kids with CVI struggle with math, especially with tasks that require visual processing. For example, one-to-one counting can be tough. Visualizing a number line is another challenge. Math involves a lot of visual and spatial skills, and many children with CVI struggle with these aspects. Since math is something we encounter daily, it’s harder for kids with CVI to learn it naturally like others might. This is a growing area of concern, and while there are resources available, it’s clear that CVI significantly impacts math learning. But again, people with CVI can do much more with the right support.
Bennett explains that it's essential to remember that when it comes to CVI, it's about access to learning as CVI impacts every area of learning and skill development. “This means that visual and compensatory skill access needs to be considered across all goal areas. Goals must be assessment driven and based on present level data. Goals should focus on skill building and should be written to reflect what the student will do and not the service provided,” she shares.
Dr. Biggs explains that IEP goals are determined by the recommendations on the assessments. “Goals would entail specialized training needed to use recommended AT, or learning to read using specific accommodations for reading, such as extra spacing or enlarged black words on a yellow background. Not every child [with CVI] is going to require the same IEP goals,” she says.
How does this work? Bennett tells us that sometimes parents ask questions about how they use the results of the CVI image assessment, for example, to create a goal for their child. The image assessment shows that the child can't access black and white drawings and can only access familiar realistic color photographs. This assessment informs the need for accommodations and adaptations that need to be in place for the child to access instruction and learning.
“Goals and objectives are valuable real estate in the IEP,” Bennett adds. “And so it's incredibly important that they reflect the skills that your child needs to work on to progress in academic areas, with daily living skills, communication skills, or social and independence skills. And in the objectives, this is where we can provide given statements that incorporate specific CVI supports and the conditions that need to be in place. For example, for a reading comprehension goal, objectives might include a statement like, ‘Given previewing of new content, direct instruction in new concepts, real objects, and text-to-speech, Student A will…’”
Here are two sample goals Dr. Biggs shares with us. Note that these are just samples. Goals will be different for each child and each situation.
Bennet explains that the CVI population is “incredibly heterogeneous and diverse, so each student with CVI can receive services from an array of providers.” For example, students with CVI receive services from TVIs, O&Ms, OTs, PTs, SLPs, BCBAs, and so on. It can also be important for assistive technology specialists to work with students at CVI.
Bennet adds that it’s essential that every provider and educator on the team understands how CVI uniquely manifests in the student along with all the other whole-child needs. “This is why collaboration is so critical for the school team, to ensure that all the right accommodations, adaptations, environmental supports are in place for a student to be able to access OT instruction and a session, for example, or build an accessible total communication approach. An OT and a TVI might do a joint session for students who're learning how to use a brailler. A TVI and a BCBA will do a joint observation to really understand the antecedents of a student's behavior and try to understand how CVI and the barriers to access its causing might be a function of the behavior.”
Dr. Biggs explains that OT would be to develop fine motor skills (using scissors, typing on a keyboard, holding a pencil, using a spoon, etc.). PT would be to develop gross motor skills (walking, standing, reaching, using a wheelchair, etc)
OT can play a key role in helping kids with CVI by working on sensory integration, improving fine motor skills, and providing strategies for tasks like writing, hand-eye coordination, and daily living activities. OT can also help children develop adaptive strategies to manage visual and environmental challenges, ensuring they can access their learning and function independently. OT, for example, can help with visual motor skills, which help us coordinate what our eyes see with our hands, legs, and other movements.
A child with CVI who struggles with visual attention and spatial environmental awareness can benefit from OT. “Individuals with CVI benefit from treatment focused on establishing and restoring visual skills; over time, interventions, strategies, and adaptations can increase their perception of the visual world around them,” this article from WashU Medicine explains. One area can be the development of pre-braille skills, such as tactile discrimination and finger isolation, and environmental modifications to increase a child’s visual access to their environment.
Dr. Biggs and Bennet both share that it will depend on the child's needs. Bennet explains that CVI is a heterogeneous and diverse population of students and some with CVI do have a 1:1 aide for their own individualized needs and reasons. “Some need nursing support. Some need a 1:1 specifically during transition or when out in the community. Some have a dedicated paraeducator who adapts all their materials. Some might need one to one instruction for core content. Some might need a 1:1 for behavior and safety. There are truly so many options and scenarios that should be available for students at CVI to be able to fully access their educational program. When it comes to services and placement it must be student centered assessment driven and meet the individual needs of the student,” Bennet says.
Dr. Biggs adds that, “Districts usually have a process using a rubric for determining the need for a 1:1 aide. It can be recommended in the recommendations of the functional vision evaluation if the TVI feels it is necessary. Some children may need a 1:1 aide. Yes, it can be an option. However, it is best to keep in mind the role of an aide is to foster independence and not do it for the child.”
Socializing and making friends is hard for anyone growing up, but having CVI can create additional barriers. This may be due to challenges with facial recognition and crowds and cluttered spaces. “The impact of clutter, crowding, and noise only increases the difficulties of finding people and accessing conversation and social cues,” this study shares.
Bennett tells us that, “Socialization is a huge challenge for students with CVI, and this can really impact quality of life outcomes for our students.” She shares some tips:
Children with CVI often use compensatory skills to engage with peers and family members. They may use tactile cues and exploration, context cues, color coding strategies, memory, and prediction skills. They can try recognizing people by their hair color or distinct features, such as glasses, a beard, or a familiar perfume. Here are some other tips from Dr. Biggs:
In general, you can start by exploring these accommodations and supports:
When it comes to accessibility, is it best practice to have everything on a computer or tablet since those devices offer more built-in options, or does it really depend on the individual student and how they access information best? As Dr. Biggs explains, if the assessments say that a student needs all their materials on the computer, then the school needs to provide access to a computer that has the audiobooks or the enlarged books on the computer or iPad. “Whatever is in the IEP has to be provided by the district, but typically iPads are used with students with CVI,” she says.
One factor of using tablets or computers is the social impact of “fitting in.” As Chatfield shares, “If you have an enlarged print, that can be something that some kids don’t want to be called out on, right? And so if you have the device in front of you, and you can manipulate the font to make it the most comfortable for your eyes, if the software platform should allow for that, that makes you look more typical. And I think especially for middle school and high school kiddos, they get that piece of self-awareness.”
Another benefit is for reading and sitting for longer periods of time. As Chatfield says, “When it comes to reading, one of the great things that an iPad or other digital device can do is allow you to manipulate the size of the font really easily. Put it up in center field so you’re not hunching over, so you’re avoiding long-term back and spine issues, and it allows you to control the contrast lighting too. So when the kiddos are younger, we like those tactile manipulatives. And coloring might be appropriate or might not be, depending on who that kiddo is, but as they get older, that assistive tech is so great for the kids with CVI.”
Another important thing with CVI is that children’s most comfortable field of vision is having a tablet or laptop up in front of them and in their center field of vision, and backlit by the light of the iPad. “That typically helps with eye fatigue,” Chatfield says, “because we do see some lower field neglect, which is somewhat common for kiddos with CVI, which goes back to that necessity for orientation and mobility. Sometimes you’ll see a kiddo who’s really great up here, but when it comes to below and looking below, you’ll see them full head tilted down to do stairs because they want that in their center field.”
Bennett tells us that for some children, digital access is wonderful because you can remove the visual clutter and you can add some color-coding to worksheets or add different accessibility design tools on a tablet. Key word: accessibility. For others, it’s the opposite. “My son has mild photophobia,” Bennett says. “So looking at a tablet is actually fatiguing for him. So he really just needs real objects. He needs that worksheet to be totally thrown away. And there needs to be another way. Or, for example, if it’s a math equation sheet that has a million equations on it, just do one at a time. There’s so many different ways that you can set up an equation with 3D numbers and symbols on a slant board and just be able to manipulate it. You’re still using vision, but you can use other senses to buttress the vision.”
The real question around accessibility isn’t whether to use a computer or a worksheet. As Bennett explains, it’s about thinking more broadly: “There’s not one size fits all, of course, but just thinking, fundamentally, if the worksheet is not accessible, what are other ways to teach this concept?”
This can help some with CVI but Bennett explains that before jumping to a tool like a magnifier, we first need to ask: Can the child actually access 2D materials, like pictures or text on a page? If the answer isn’t clear, that’s where assessment comes in. Even if a magnifier or a tool like a CCTV (a screen that enlarges print) might help, it doesn’t mean it’s automatically the right fit. Children with CVI need a customized, thoughtful approach — using tools and strategies that are based on how they see and interact with the world. It’s not just about handing them a magnifier or blocking off distractions, it’s about building an intentional, targeted plan that supports how they learn best.
Dr. Biggs explains that whether a child needs to use braille is based on how much CVI is affecting the student's functional vision, and the outcome of the learning media assessment. “If the learning media assessment shows yes, this child is a candidate for braille, then that’s what’s recommended for that student. Not all children with CVI need braille. Some just need some tweaks to print in order to be able to access print. But some students with CVI are candidates for braille. It depends on how much is CVI affecting that functional vision.”
Before a team can determine whether a child is eligible for braille, there are many things to consider in the learning media assessment. For example, does the child need specific accommodations to access print? Maybe they need larger text, more spacing between words, or print outlined in their preferred color. Some students might benefit from reading on colored paper — like yellow instead of white — or need specific lighting conditions to help them see better. All of these factors are part of understanding how a child best accesses written information.
Chatfield adds another big piece of the braille question: the ability to have gross motor control and fine motor control. “Your fingers have to be sensitive enough and accepting of the texture of braille well enough, and you have to be able to do the sweeping motion, even if you have modified braille,” she says. “So those kiddos with complex access needs who may have very, very low vision — and some of that very, very low vision may be due to CVI — they may be traditionally considered for braille. But there’s not just the piece with the ocular piece. With those kiddos, you have a lot of other things that go into it: are they accepting of the texture piece or do they have the motor control required?”
Participating in sports teams or PE class might be challenging for a child with CVI. While adaptive PE might be a great option, an O&M specialist can help identify what supports your child needs to safely and confidently navigate physical spaces — including during play or sports. Dr. Biggs shares some accommodations that might help: A ball with a jingle helps a child locate it by sound. Bright-colored pinnies (like yellow or red) can help them tell who’s on their team when it’s hard to see faces during fast movement or noisy play. Poles or out-of-bounds lines can be marked with bright yellow tape or paint to make them easier to see.
Find more accommodations for CVI in this article by Perkins.
Assistive technology, along with other accommodations, is a biggie for children with CVI. As Dr. Biggs explains, a learning media and AT assessment is key — they help determine which AT tools will be the best fit. Every tool should be selected based on an assessment of your child’s unique needs. These tools and strategies should be written into your child’s IEP. If assistive tech is to be funded (often using low-incidence funds), schools will usually require assessment results, recommendations, and IEP goals tied to the technology.
As Chatfield explains, your child’s assistive technology should align with what’s learned in the learning media assessment — that means how your child best takes in information (through touch, sound, or vision). Here are a few examples:
Here are a few examples of what AT for CVI might entail:
High-tech tools, such as:
Low-tech tools, such as:
For more information, head to our article Tech, Equipment, Apps, and More for Low Vision and Blindness.
Although CVI presents so differently in children, and one day can be different from the next, here are a couple challenges your child might face and some information to help.
It’s important to understand that a child with CVI might be able to read a passage one day and struggle to read it the next. This inconsistency is a hallmark of CVI, Bennet tells us, — their ability to process visual information can be impacted by outside and internal factors. For example, visual difficulties might be more pronounced when they’re tired, stressed, or in a busy environment, but less noticeable when they’re calm or in a familiar setting. Without recognizing CVI, these fluctuations can be mistaken for behavior issues or lack of effort. Fatigue can have a big effect on processing visual information, making it essential to understand and support their unique visual needs.
Bennett wants us to know that CVI impacts much more than vision. For example, it can affect communication, daily routines, social skills, and academics. CVI can affect health and well-being, too. Studies show that kids with CVI are at higher risk for reduced quality of life if they don’t get the support they need. That’s hard to hear, but it also highlights how important it is to get early help and advocate for your child.
Most kids learn so much just by watching the world around them (called incidental learning). But for kids with CVI, that visual learning doesn’t happen the same way — and that’s not their fault. It just means they need more direct, intentional ways to learn. Bennett gives an example of a child with full visual access who might see one picture of a giraffe and recognize it in any form — real, cartoon, or toy. But a child with CVI might only recognize a giraffe they’ve seen many times in a familiar context. If the color or background changes, it might not register as the same thing.
“This doesn’t mean our kids can’t learn. It just means they need a whole different approach of targeted, direct instruction, and understanding how that’s going to impact reading skills, reading comprehension, math skills, and listening comprehension — and the foundational skills for all of these are often learned through incidental learning,” Bennett says.
Often, kids with CVI are labeled as having “behavior issues,” maybe called noncompliant or inattentive, but Bennett says, “I think of CVI as the intersection between blindness and low vision and neurodiversity because the CVI brain is a different way of processing the world. [For children with CVI], this is the only vision [they] know. So what we may think as something salient or important may not even register with a CVI brain. So you have to understand what their experiences are exactly.”
As a parent, it’s natural to have concerns and questions about the tools and supports your child might need, especially when it comes to something like a white cane. One common misconception is that someone who uses a white cane must be completely blind. That’s not the case! For some children with CVI, it can be used, alongside other supports, to help them feel more independent. So who can use a white cane? Bennett says anyone who needs access.
“We have to dispel the myths about what blindness is,” Bennett says. “For those who are not able to fully, reliably rely on their vision 24/7, [this] means you have some form of low vision or blindness. And that’s CVI — if you are not able to walk safely around and see where people are and see moving cars, that’s a form of low vision and blindness, right? If you can’t read many paragraphs because of clutter, if you can’t recognize words. So yes, anybody who has some form of low vision or blindness has a right to use whatever tools are necessary for access.”
She shares an example of her son Henry, who uses his white cane, and how it actually helps him use his vision more. With the cane, he doesn’t have to worry about what’s happening with the ground or his feet, which gives him more confidence and a greater sense of agency. It makes him feel safe and comfortable as he navigates his surroundings. He’s also learning braille, which suits his tactile nature, while still working on print. While print can be tiring for him, braille is becoming his preferred method as he gets older.
“Give our kids the tools and options, the whole toolbox. You never know what’s going to be their choice, and our kids have every right to choose what works best for them,” Bennett says.
Safety is something on all parents’ minds, but especially if your child has a disability. “CVI has a really big impact on safety, and I know that’s a huge one for us parents when we’re advocating for our kids, that’s what’s helped me get the most support for my son,” Bennett says. For many kids with CVI, the way their brain processes motion (or doesn’t) can create real risks. Fast-moving things — like a swing at the playground or a passing car — might not register in time. People can seem to appear out of nowhere. Bennett describes it as feeling like her son is walking through a haunted house, because so much pops into view unexpectedly. “And if we don’t have that type of visual access, safety is a huge, huge concern,” she adds. That’s why understanding CVI is so important for creating a safe and supportive world for our kids. Some tips for parents:
Did you know that there are a ton of myths about CVI? Bennett clears up the top three myths:
And she sets the record straight. Keep this info handy for when you come across these misconceptions!
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