Is improving vision enough for a child with CVI?

No.  Of course not.  Please don’t get me wrong, improving functional vision is really quite important.  I talk about it all the time.  I think it is critical.  In fact, every provider who works with children who have CVI should have an expectation of improving vision.  Not a wish or a hope or a notion, but an expectation of improving functional vision.

For a number of years, I described improving vision into high Phase III as the endpoint.  I would emphasize the need for CVI Range scores to continually improve until every child with CVI ultimately attains Phase III CVI status.  A lofty goal, yes, but one that I believed raised the expectation for educators including me.  Then, somehow I began to realize that individuals with CVI who reached Phase III had some special abilities.  They were able to not just look but to understand what they were looking at.   Sometimes, children who were in or approaching Phase III could associate a word with an associated target. I noticed that they could compare a new concept with one that they already knew. They weren’t just looking, they were understanding what they saw.  It was at that point that I realized that seeing, language, and cognition have a synergistic relationship.

So, my next steps were to analyze the key factors that helped an individual with CVI begin to actually understand what they were looking at.   Clearly, adaptations to materials were the first step. If a child with CVI does not first have access to visual materials, environments & interactions, then the rest is lost.  I rely on scores derived from The CVI Range to guide the process of the necessary adaptations for each child.  Then, I must help the child with CVI begin to disassemble the visual “kaleidoscope” using specific teaching methods.  I have to help that individual learn to identify the defining features of a visual target and pair these salient features with language that is succinct and consistent.  In other words, it is not enough to merely look at an image or object that is “cat”; it is mandatory that the child have a way to look at the novel image, recognize critical details, and confirm that, for example, the presence of triangle-shaped ears & whiskers likely indicates that the image or object is a cat.

Competence in integrating the use of vision with learning becomes pretty clear when reading IEP goals written for students with CVI. In fact, the words in the vision portions of the IEP tend to either make my heart light or filled with dread.  For example, when I read that that a child with CVI is expected to “learn to visually track an object 180 degrees”…dread.  When I read that a child with CVI is expected to “learn to look at themselves in a mirror”…dread.  When I read that a child with CVI is expected to “learn to look at complex pictures”…dread.  When I read that a child with CVI is expected to “look at high contrast, novel materials”…dread.  On the up-side,  these goals at least indicate that the child has some degree of direct vision service.

Competence in working with children who have CVI may be far more complex than the children themselves.  The skill set requires the teacher to have a deep understanding of the characteristics of CVI through all three Phases.  It requires knowledge of how children learn, birth through young adulthod.  It requires the ability to know about the skills necessary for competence in reading, math, communication, positioning, & social development.  It requires the ability to engage in the environment, understand the environment, and whenever possible, move independently and safely through it. It requires an understanding of nutrition and anti seizure medicines.  It requires the ability to know about and believe in neuroplasticity.  It requires the ability to read the cues of a child who cannot tell adults when they are fatigued, frustrated, or hungry.  It requires a master teacher and a champion.

So, improvements in functional vision are always a goal.  But this goal must be reflected in the skills the child has obtained because of the integration of learning with vision resulting in greater inclusion in their world.  It is not a job for sissies but when embraced with knowledge and dedication, the rewards are stupendous.