Our Mission

Vision-Aid provides comprehensive support and resources for children with Cerebral / Cortical Visual Impairment (CVI) and their families.  

Our mission is to create an inclusive environment where every child can thrive and reach their full potential. We achieve this through partnerships with hospitals, offering early intervention services and multidisciplinary approaches to treating CVI. 

To empower children with CVI through personalized habilitation programs, fostering independence, and enhancing quality of life. 

What is CVI?

Cerebral / Cortical Visual Impairment (CVI) is a disorder caused by damage to the parts of the brain responsible for processing visual information. It is the most common type of vision disorder in infants and young children, which can progress to adulthood if early intervention is not done at the appropriate time. Children with CVI have vision problems caused by the brain which a problem of their eye cannot explain. In normal eyes, an electrical signal is sent to the brain and the brain converts the signal to images. In the case of CVI, the brain has trouble processing and understanding these signals. 

Definition of CVI

Cerebral visual impairment (CVI, also called cortical visual impairment) is a brain-based visual condition that affects pathways involved in processing incoming visual information via neural networks throughout the brain (Lueck et al., 2019)

Prevalence of CVI

In terms of epidemiology, CVI has become the main cause of childhood vision impairment in high-income countries and is on the rise in low-income countries. 

A recent Indian study from South India noted that CVI was the cause of visual impairment in 33% of cases, and CVI in combination with other ocular conditions was seen in another 11% of cases (Pehere NK et.al 2019). About 33-58% of children with visual impairments have CVI worldwide. 

How CVI is identified:

It is commonly thought earlier as a diagnosis of exclusion and is often missed. But now the understanding has changed for the better. The suspicion of CVI needs justification on careful examination. If the vision or visual acuity does not correlate with the anomaly the child has, then CVI is suspected Otherwise, if the child has visual difficulty in major domains like recognizing or navigating or if there is a visually guided search for reaching or walking and a learning disability which the actual eye examination does not correlate to the CVI is suspected and diagnosed. These are the domains of visual capabilities that are being investigated. So functional vision examination is mandatory, if a functional vision examination (not just the ability to see i.e. Visual acuity). If the child shows difficulty in this examination across visual domains, then CVI is diagnosed. Even if the MRI is not supportive and comes back as normal, still the diagnosis of CVI can be made. This approach likely allows for more accurate identification and support for children with CVI, ensuring they receive appropriate interventions. 

Causes of CVI

CVI can affect both children and adults. In children, common causes include: 

  • Traumatic brain injury to the occipital lobe 
  • Congenital abnormalities of the occipital lobe 
  • Perinatal ischemia 
  • Neonatal hypoglycemia 
  • Infections 
  • Epilepsy 
  • Metabolic disorders 
  • Neurologic disorders 
  • Decreased blood supply and oxygenation 

Symptoms of CVI

Symptoms of CVI can vary and may include, 

  • Difficulty responding to visual stimuli 
  • Recognizing faces and objects 
  • Navigating cluttered spaces 
  • Reaching for objects while looking at them 
  • Delayed visual response 
  • Preference for looking at moving objects 
  • Sensitivity to light or staring at bright lights 
  • The child prefers to look at moving objects.  
  • Prefers to look at things in a certain part of their vision (peripheral side vision) 
  • Some kids with CVI have sensitivity to light while some stare at bright light. 

These symptoms are usually picked by parents/paediatricians. 

Clinical Tests for CVI

Clinical tests for evaluating CVI involve a combination of assessments by vision and neurological specialists, including: 

  • Functional vision tests in addition to best possible Visual acuity, Visual field and colour perception tests 
  • Visually Evoked Potential (VEP) 
  • Neuroimaging techniques like MRI and CT scans 

Functional Vision Evaluation:

Clinical tests for evaluating CVI involve a combination of assessments by healthcare professionals specializing in vision and neurological function. These assessments include detailed birth, systemic, and ocular history, followed by observation and behavioral assessment of the individual’s visual behavior and responses to various visual stimuli, including preferred stimuli and responses to environmental changes. 

Individuals with CVI may exhibit an abnormal light response, such as light gazing or photophobia. They often show a blunted or avoidant social gaze, avoiding eye contact or not engaging visually with others. Brief fixation and intermittent following are also common, indicating challenges in maintaining steady visual attention. Poor visual acuity, where vision clarity is significantly reduced, is another concern. Additionally, CVI can lead to visual field defects, resulting in a loss of vision in certain areas of the visual field. 

The clinical test includes visual acuity testing. Although traditional visual acuity testing does not accurately reflect the visual disabilities associated with CVI, more specific tests like preferential-looking tests and recognition cards can provide more information regarding visual status. Other tests include visual field testing, which involves assessing the visual field to identify any defects caused by damage to specific areas of the brain. Color vision testing gives insight into the color perception abilities of patients with CVI, while contrast sensitivity testing provides information regarding the ability to distinguish between the target and the background. Visually Evoked Potential (VEP) is an electrophysiological technique that provides information about the occipital response to visual stimuli. VEP is particularly helpful in determining visual acuity in non-verbal children or those unable to xcommunicate. Neuroimaging techniques like Magnetic Resonance Imaging (MRI) and Computer Tomography (CT) are used to identify structural abnormalities or areas of damage within the brain associated with CVI. 

Multi-disciplinary approach

CVI treatment involves a multidisciplinary approach to management, including: 

  • Educational interventions 
  • Based on the degree of impairment, individuals with CVI can benefit from educational interventions customized to their specific needs. This can include specialized teaching methods or materials designed to enhance visual perception and processing skills. 
  • Environmental modifications 
  • This can help their day-to-day activities of life easier by adjusting lighting, reducing visual clutter, using high contrast materials, and providing visual support such as visual schedules or labels. 
  • Visual skills training 
  • This involves improving skills such as visual scanning, tracking, visual attention, and activities involved in visual skills training includes tracking objects, locating objects in cluttered spaces, and practicing visual search tasks. 
  • Sensory integration 
  • This includes integrating sensory modalities such as touch and auditory inputs to support visual processing and overall perception. 
  • Adaptive technology 
  • Introducing assistive devices and technology to facilitate access to visual information. This includes magnifiers, electronic devices with customizable contrast setting, screen readers and tactile graphs. 
  • Parent and caregiver training 
  • Providing appropriate education and training to parents, educators and care givers on how to support an individual with CVI in various environments. 
  • Collaborative approach:  
  • Collaborating among multiple disciplinary teams of professionals which includes Ophthalmologists, Optometrist, and vision specialist with Occupational therapist, Neurologist, physical therapist, educators, to address individual needs comprehensively. 
  • Long-term support and monitoring 
  • Ongoing support and monitoring to address changes in the individual visual functioning over time and to adjust rehabilitation strategies as needed. 

Our Programs for CVI have the following focus areas:

  1. Early Intervention 

    Early diagnosis and intervention are crucial for children with CVI. Our early intervention programs, provided in partnership with hospitals, focus on developing visual and cognitive skills through play-based activities, sensory integration, and family education. 

  2. Individualized approach 

    Each child with CVI has unique strengths and challenges. We work closely with families, educators, and hospitals to develop personalized approaches that address specific needs and goals, ensuring that every child receives the support they need to succeed academically and socially. 

  3. Therapy Services 

    Our team of Vision-Aid resource centers provides a range of services specifically focussed on vision therapy, and also other additional therapies of occupational therapy, physical therapy, and speech therapy. These therapies, are designed to enhance visual processing skills, eye-hand coordination, motor skills, communication abilities, etc. 

  4. Parent and Family Support & Community Integration 

    Families play a crucial role in the development of children with CVI. Education and counseling help parents and caregivers understand CVI, navigate challenges, and advocate for their children. We also believe in the importance of community and social inclusion. Our programs Vision-Aid resource centers include recreational activities and social skills training to help children with CVI build confidence and form meaningful connections. 

  5. Innovative approaches to CVI care: 

    By incorporating peer interaction, the Vision-Aid team at Aravind Eye Care, Madurai, enhances therapy acceptance and socialization, fostering an energetic and inclusive learning environment. This innovative strategy ensures personalized and effective care for each child, promoting holistic development. 

    To read more on this, click the link https://visionaid.org/news/fostering-inclusive-growth-vision-aids-collaborative-approach-to-vision-rehabilitation-at-aravind-eye-care-madurai/  

Future road map

a) Workshops and Conferences: 

We advocate best practices for CVI through specialized workshops and conferences, sharing the latest research and strategies to foster a community of learning and excellence. 

b) Professional Training Programs: 

Our comprehensive training programs equip healthcare professionals, educators, and therapists with the skills needed for quality CVI care, covering early intervention, adaptive technologies, and holistic approaches. 

c) Resource Development: 

We create and disseminate resources such as guides, toolkits, and online courses to ensure professionals have access to the latest information and practical tools for continuous improvement in CVI care. 

Success Stories

Read inspiring stories from families who have benefited from our programs. See how our holistic approach, in partnership with hospitals, has made a difference in the lives of children with CVI. 

Master Lohith

Master Lohith is a 2.5 years old child with Cerebral visual impairment (CVI) and Global Developmental delay, who was referred from the Paediatric Ophthalmology department of Sankara Nethralaya Vision-Aid resource centre. The very first day to the Clinic, he was brought by his mother and grandmother. Their poor family status also contributed to their depression level which was observed during their first visit. His functional vision was assessed along with other developmental areas which were severely impaired because of encephalopathy, a neurological and seizure disorder. 

Understanding the need for immediate early intervention along with multi-therapeutic intervention, the team counselled the mother for accepting the condition of the child, to undergo the recommended therapies and to provide sustained cooperation. Then the child was referred to a paediatric physiotherapist to work on his gross motor development. The child is given visual developmental therapy, sensory integration therapy, fine motor stimulation, and speech stimulation regularly, the family’s cooperation and support are remarkable in terms of attendance and involvement. Initially the child did not fixate or follows any lights, no babbling or articulation and inadequate neck control. But now after 6 months of intensive therapies, he is briskly fixating and following lights, started to babble, articulate sounds and 75 % neck control achieved. He has been supported in availing Government benefits as well as part of the rehabilitation program. His mother says that she is overwhelmed at this family-oriented support services at the centre.

Toddler with Microcephaly

Toddler, a 2-year-old child diagnosed with Microcephaly and developmental delay, was referred from the Vision-Aid resource center, and the child was accompanied by the parents. The functional vision of the toddler was meticulously assessed, and positive responses were observed during various evaluations. 

In a controlled room setting, the child followed bright-colored, illuminated toys of more than 2 inches in size at a distance of 40 cm. Additionally, they responded to bright, glittering toys and targets positioned at 20 cm under normal room illumination, displaying a preference for sound-making toys. Recognizing the urgency of early intervention and visual perception therapy, the team provided counseling to the parents, emphasizing the importance of accepting the child’s condition and maintaining sustained cooperation with the recommended therapies. 

The child received regular sessions of visual developmental therapy, focusing on visual perception skills, eye-hand coordination, and physiotherapy at the center. The family’s exceptional cooperation and support were evident through consistent attendance and active involvement. The parents expressed a keen interest in continuing therapy, highlighting their commitment to the child’s developmental progress. 

The child underwent a comprehensive eye examination, revealing improvements in their vision. Their response progressed from light fixation to distinguishing Lea paddles at 0.5 cycles per centimeter (@50 cm). Visual skills training included tasks such as picking up toys, dropping rings into a ring stand, removing shape pegs from a peg board, and using their right hand to drop a ball into a hammer case. The child’s cooperation significantly improved, and they demonstrated a preference for using their right hand throughout activities. Notably, the kid correctly identified the trainer, offered social smiles, and made efforts to maintain eye contact during various activities. 

In physiotherapy, the child achieved milestones by sitting in a kneeling position, folding their legs for more than half an hour during therapy, and taking steps while holding one hand of the examiner and grasping a rail with the other hand. 

The parents expressed their gratitude, noting that they had never encountered such family-oriented support services before coming to the center, further emphasizing the impactful role of the clinic in the child’s developmental journey. 

Child with Microcephaly and squint

A 4-year-old child diagnosed with Microcephaly and squint, was referred from the Pediatric Ophthalmology department to the Vision-Aid Resource Centre.  

Microcephaly is a condition in which a baby’s head is smaller than expected for its age and body size. This can associated with developmental issues and intellectual disabilities. In terms of fine motor skills and visual perception, the child demonstrated capabilities by searching and accurately picking up pale-tinted fancy beads, each measuring less than half an inch at a distance of 25 cm from a high-contrast background and 20 cm from a low-contrast background, even with the assistance of extra illumination.  

Recognizing the immediate need for Visual Developmental Therapy, the team counseled the parents to accept their child’s condition and undergo the recommended therapies, emphasizing the importance of sustained cooperation. The kid received visual developmental therapy, focusing on visual perception skills and eye-hand coordination.  

The baby made substantial progress after management, successfully engaging in concept-teaching activities, recognizing shapes, colors, and sizes, and even showing improvement in eye contact after the management was done in the resource center.  

Upon inquiry about pre-writing skills, they were regularly referred to Occupational Therapy at the center. The family’s remarkable cooperation and support were evident through consistent attendance and active involvement. 

In Occupational Therapy, the kid’s pre-writing skills and coloring activities have shown notable improvement since the first visit. The parents expressed their gratitude, noting that they had never encountered such family-oriented support services before coming to the Vision-Aid Resource Centre. They remain highly interested in continuing to avail services at the center.

References

  1. Lueck, A. H., Dutton, G. N., & Chokron, S. (2019). Profiling Children With Cerebral Visual Impairment Using Multiple Methods of Assessment to Aid in Differential Diagnosis. Seminars in Pediatric Neurology, 31, 5–14. https://doi.org/https://doi.org/10.1016/j.spen.2019.05.003 

  2. Pehere NK, Narasaiah A, Dutton GN. Cerebral visual impairment is a major cause of profound visual impairment in children aged less than 3 years: A study from tertiary eye care center in South India. Indian J Ophthalmol. 2019 Oct;67(10):1544-1547