Paediatric
Cerebral (Cortical) Visual Impairment
Also known as: CVI, cerebral visual impairment, cortical visual impairment, brain-based vision loss, functional vision child, visual processing disorder child, light gazing, eccentric viewing child
Filed as: Soon
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Visual impairment arising from the brain rather than the eye, and the leading cause of paediatric visual impairment in developed countries. The defining feature is a mismatch: the child's visual FUNCTION is worse than the ocular findings can explain. Reported prevalence is 26-83% in cerebral palsy and 21-47% in preterm infants. Critically, routine vision screening may not identify it — a normal eye examination and a passed acuity screen do not exclude CVI.
Recognition
Symptoms: what patients report
- Visual performance that VARIES — better at home than in a busy classroom, worse when tired, worse in cluttered environments.
- Difficulty recognising objects or faces despite measurable acuity.
- Light gazing, or conversely marked light aversion.
- Delayed visual response — a latency between a target appearing and the child responding.
- Eccentric viewing, or looking away from a target while reaching for it.
- Parents and teachers often describe the child as 'not looking' rather than 'not seeing'.
Signs: what the examination shows
- Ocular examination that is normal, or abnormal to a degree insufficient to explain the functional deficit.
- Variable and inconsistent acuity between tests and between visits.
- Preserved acuity with impaired visual function — the child may read a chart yet be unable to find a toy on a patterned rug.
- Frequently coexisting strabismus, refractive error and accommodative dysfunction, all of which are separately treatable.
- Associated neurological history: cerebral palsy, hypoxic-ischaemic encephalopathy, seizure disorders (particularly infantile spasms), intraventricular haemorrhage, periventricular leukomalacia, prematurity.
What OptoGuide™ covers for cerebral (cortical) visual impairment
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Diagnosis and Care of Children with Cerebral / Cortical Visual Impairment — AAO/AAP clinical statement (2024, United States)
- RANZCO — Paediatric Referral Guidelines (April 2025)
- Special Commentary: Cerebral/Cortical Visual Impairment Working Definition: A Report From the National Institutes of Health CVI Workshop. Chang MY, Merabet LB, CVI Working Group. Ophthalmology. 2024;131(12):1359-1365.
- Cerebral Visual Impairment in Children: Causes and Associated Ophthalmological Problems. Pehere N, Chougule P, Dutton GN. Indian Journal of Ophthalmology. 2018;66(6):812-815.
- Vision Rehabilitation Preferred Practice Pattern®. Jackson ML, Virgili G, Shepherd JD, et al. Ophthalmology. 2023;130(3):P271-P335.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual.