A child reaches for a toy, hesitates, then turns away — not because their eyes cannot see it, but because their brain cannot make sense of what they are seeing. Cortical or Cerebral Visual Impairment (CVI) is one of the most common yet misunderstood causes of vision difficulties in children today. Unlike traditional eye disorders, CVI stems from damage to the brain’s visual processing centres, leaving many children with outwardly normal eyes but profound challenges in using vision meaningfully. As survival rates of high-risk infants improve, CVI is emerging as a critical and often overlooked child health concern.
“This is what makes CVI so confusing for families. In CVI, the eyes themselves may be completely healthy. The issue lies in how the brain processes what the eyes see. The child may technically ‘see,’ but the brain struggles to make sense of that visual information,” explains Dr Jagadeesh Reddy Bandi, HOD–Ophthalmology, Arete Hospitals.
Children with CVI do not simply experience reduced vision; they experience vision differently. The brain’s difficulty in interpreting visual input can make shapes appear fragmented, movement overwhelming, and recognition of faces — even familiar ones — extremely challenging. Busy environments, crowded patterns, or rapidly changing scenes often lead to visual fatigue or distress.
“Many children with CVI prefer moving objects or bright colours. They may avoid visually busy environments altogether. Some turn their head to one side to look, while others rely more on touch and sound than vision,” explains Dr Jagadeesh.
This inconsistent visual behaviour is often one of the earliest clues. Parents may notice that their child responds to objects on some days but appears to ignore them on others. He further emphasises, “Poor eye contact does not always mean a social delay. It can simply be a sign that visual processing itself is difficult.”
Meanwhile, Dr Tarang K Vora, consultant paediatric neurosurgeon, Apollo Hospitals, Jubilee Hills adds that static or cluttered surroundings often remain visually inaccessible to children with CVI. He states, “Many children rely on movement or strong colour contrast to notice objects underscoring how different visual strategies may emerge as coping mechanisms.”
One of the biggest challenges with CVI is that it is invisible. Standard eye examinations frequently appear normal, which can delay diagnosis and lead to misunderstanding.
Dr Jagadeesh Reddy notes, “Eye checks alone do not tell us how the brain is handling visual information. That’s where CVI gets missed.”
In many cases, children are initially labelled with developmental delay, behavioural concerns, or even autism before CVI is considered. Dr Tarang points out that the inconsistency of visual responses often adds to the confusion. “A child may recognise an object one day and fail to do so the next, which leads to misplaced expectations from parents and educators,” he says.
This lack of awareness can be emotionally taxing. Families may sense that something is wrong but struggle to get clear answers, while teachers may misinterpret visual difficulties as lack of attention or learning ability.
Vision plays a central role in a child’s learning, movement, and independence. Children with CVI may struggle with reading, recognising faces, navigating spaces, or judging depth. They may appear clumsy, hesitant, or slow to move through unfamiliar environments.
“Daily activities like eating, dressing, or playing can take longer because visual information is overwhelming or unclear,” points Dr Jagadeesh.
In classrooms, these challenges can significantly affect participation and academic progress unless educators understand the child’s visual needs. Dr Tarang stresses that without appropriate support, delayed intervention can widen developmental gaps that become harder to bridge over time.
Despite these challenges, both doctors emphasise that CVI is not a dead end. Early identification and intervention can make a meaningful difference. “The young brain has remarkable plasticity. With timely support, children with CVI can learn to use their vision more effectively,” notes Dr Jagadeesh.
Diagnosis and management require a multidisciplinary approach. Ophthalmologists help rule out eye-related causes, neurologists identify underlying brain injury, therapists address visual, motor, and sensory integration, and educators adapt learning strategies accordingly.
Simple, thoughtful adaptations can dramatically improve visual access for children with CVI. Reducing visual clutter, maintaining predictable routines, using high-contrast colours, and allowing extra time for tasks all play a crucial role. Dr Jagadeesh concludes, “Children with CVI do better when their surroundings are simple and structured. Too much visual clutter can overwhelm them.”