Using the Wrong Kinds of Functional Visual Assessment

If the visual professional conducts the wrong kind of functional visual assessment; an ocular assessment for a child affected by CVI, they would be focusing on the eye based visual functioning problems.  The ocular assessment answers such questions as:

  • Does the child’s eyes have an unusual appearance? The child with CVI often has eyes that look typical. They might have exotropia or esotropia caused be eye-teaming difficulties. This is not a muscle based (eye based) problem.
  • Are visual fields affected by the eye-based loss? Here in the ocular assessment there is a focus on the permanent loss of vision in upper and lower visual field, temporal hemianopia or left and right sides, scotomas (loss of portions of central vision), or loss of vision on one side of both eyes.
  • Are the child’s eye’s aligned? An ocular consideration might lead to surgery to correct a muscle imbalance rather than the brain based eye teaming coordination problem prevalent in CVI.
  • Do the child’s eyes converge and diverge? This question is rarely relevant to the child with CVI who is not able to visually locate, sustain or understand what is seen.
  • Does your child track objects?  This question is rarely relevant to the child with CVI who is not able to visually locate, sustain or understand what is seen.
  • Does the child shift gaze or scan? These questions do not consider a child’s ability to locate, sustain and understand what is seen.  The number of items can affect the ability to shift gaze from one familiar item to a newer item or from a preferred colored item to a less preferred colored item.  Simply the number of displayed items can overwhelm the child with CVI and affect the ability to shift and scan.
  • Does your child see the range of colors? In ocular terms, this is an inability to see color differences. In CVI the child might have a preference for looking and sustaining on certain colors.
  • Does this child have depth perception: This ocular information assesses the child’s ability to understand depth due to limitations in use of both eyes or field loss.  In CVI, we are concerned about depth related to distance, visual field and complexity of the environment.
  • Is the child sensitive to light? This ocular question leads to strategies to avoid light.  The child with CVI might favor light as a visual target due to the easy and relative lack of complexity.  Light can be reduced but also used as a strategy to promote looking.
  • Does the child need increased contrast? This question asks whether the supports of increased contrast will help a child with an ocular impairment to see objects better.  For the child with CVI, we are concerned with the reduced complexity of the background.
  • What is the child’s best viewing distance? For the child with an ocular impairment, this information tells us the best distance to place materials due to the visual acuity of the eyes.  For children with CVI, we think about distance as a function of complexity.  The further away an item appears, the greater complexity interferes with visual functioning.

Given the erroneous focus of the assessment topics, the functional visual information is of no use for the brain based visual impairment, CVI. The focus of the assessment areas would have no relationship to the functional areas that are the hallmarks of CVI: color, movement, latency, visual field preferences, visual motor skills, visual novelty, visual reflexes, complexity (auditory, positional, tactile, increased array, faces, and complexity of objects).(Roman-Lantzy)

With this poor assessment, characteristics of the child’s functional vision would remain unidentified.  If assessment areas are unidentified, they cannot appear in the child’s statement of functional visual skills or in goals and objectives. Environmental considerations would not appear in the child’s accommodations and modifications. Cognitive skills might be masked by the inability to understand what is seen.  Communication systems might be inaccessible for children. Social skills would not be addressed appropriately.  (The face is inaccessible for a child with CVI due to visual skills not social engagement). Since all learning involves visual skills, poor assessment would make other skills and goals areas inaccessible.

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4 comments

  1. Thank you for posting such a concise explanation of the limitations of the ocular based assessment. I find however that I am called to assess without a diagnosis of CVI and not being a medical person cannot suggest that diagnosis myself. I do describe the behaviors in a way that a medical person should be able to use it towards a diagnosis. All the more important to obtain a medical report prior to assessment- but our regulations do not permit this here in NY.

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  2. Thank you so much! After 18 years of the wrong assessments snd 3 surgeries, we have finally had our assessment with Dr. Roman and yep it’s CVI. The last surgery was December 2014 and her eye is already in about tge same place. I am hoping the brain based eye training will help. Is it too late to help her? She was a 7 but her seeking, fine motor, close schoolwork and field vision are greatly affected. She has a memory deficit thst is huge but I am thinking she possibly isn’t seeing so isn’t processing because she doesn’t have the vision part. Is any of this possible?

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    1. I am so glad you have the diagnosis! The brain has great plasticity all through life so continue to provide her with the supports she needs to understand her environment. Just vision sessions will not make changes. Everyone on her team needs to understand CVI and how it effects your daughter. That way the material will be presented for learning the exact way she requires.The environment must be adapted to meet those needs as well.
      Children with perfect vision have consistent, repeated exposure to create memories and solid concepts. Their vision helps them connect sound, smell, and touch to all that understanding. Improved vision is a great gift for learning

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