A Review of CVI Interventions

Interventions for children with cerebral visual impairment: A scoping review

Authors

Ariana DeLay, Melissa Rice, Elsie Bush, Karen Harpster

Main Research Question: For children from birth to age 18 diagnosed with CVI, what kinds of interventions have been used?

Cortical or Cerebral Visual Impairment (CVI) happens when the eyes are working, but the brain’s visual “wiring” is damaged or not processing correctly. Imagine the eyes as high-quality cameras—but the cable connecting them to the computer (the brain) has a problem.

In the United States, CVI is now the leading cause of vision loss in young children, especially those born prematurely or with conditions like cerebral palsy or brain injury. CVI affects how children learn, move, and take part in daily life. Many children are evaluated and treated by many clinicians, including eye doctors, neurologists, occupational therapists, and teachers of students with visual impairment, to help them use their vision as fully as possible.

Experts agree that the earlier the support begins, the better. However, this can be difficult because there is little clear guidance on what therapies actually work for children with CVI. Most research has focused on diagnosing the condition, not on testing treatments. This review looks at the research on CVI interventions—what’s been tried, what seems promising, and where the big gaps remain.

How the Review Was Done

The research team searched four major scientific databases for any studies on CVI treatments in children. They:

• Included only peer-reviewed research with participants aged 0-18 years who had CVI or CVI-like visual challenges.
• Excluded conference abstracts and textbooks, and studies with acute CVI (not congenital).
• Screened 895 studies—only 23 met the criteria.
• Pulled out information regarding the type of intervention, the age of the children, and the measures used. Additionally, the strength of the evidence was evaluated.

The team rated each study’s quality using respected scoring systems. No limits were set on study design so the review could capture the full range of published studies.

Image Description: A clinician in a lab coat sits on a mat facing a young girl who is pointing to a simple red object on a tablet. Photo courtesy of Vision Nanny: Community Programme by LV Prasad Eye Institute, India, to illustrate this article. The program was not part of this scoping review.

What the Researchers Found: Six main types of CVI interventions

1 Visual stimulation programs – Using bright colors, high-contrast patterns, or lights to attract visual attention and interest.

2 Vision skills training – Exercises for tracking, focusing, eye movement control, and using vision for purposeful actions.

3 Task/environment changes – Modifying the child’s surroundings or activities to make visual processing easier (less clutter, better lighting, colored backgrounds).

4 Stem cell transplantation – Experimental treatments aimed at repairing brain pathways linked to vision.

5 Acupuncture – Tongue, body, or scalp acupuncture, sometimes paired with visual exercises.

6 Transcranial electrical stimulation – Applying gentle electrical currents to the brain along with vision therapy.

Who Participated?

• Children ranged from 1 month to 17.5 years old.
• Study sizes varied hugely—from one child in a case study to 388 children in a large trial.
• All children had congenital CVI, though the exact cause or severity wasn’t always explained.

Study Quality

• Only three studies were high-quality studies, randomized controlled trials (RCTs).
  
• Most were small sample sizes or case studies—good for generating ideas, but not for proving effectiveness.
• Many relied on subjective observations instead of standardized tests, making results harder to trust or repeat.

What Was Measured?

• Standard eye tests (visual acuity, contrast sensitivity).
• Functional vision skills (following movement, looking at objects, using vision for communication).
• Everyday skills (self-care, moving around safely, school activities).
• Brain activity scans (fMRI, PET, VEP). 

Because each study measured success differently, the results from the studies cannot be directly compared across interventions.

Highlights By CVI Intervention Type

Visual stimulation programs

• Often done at home by parents, sometimes daily for months.
• Showed improvements in visual attention and curiosity, but these were mostly based on caregiver or therapist observations.

Vision skills training

• Included exercises, technology like eye-gaze communication devices, and combined motor + vision programs.
• Gains reported in visual tracking, fixation, and functional skills (like reaching for objects).
• Mostly very small studies.

Task/environment changes

• In one RCT, giving caregivers visual strategies boosted children’s communication scores.
• Decluttering classrooms and using colored tents or backdrops improved attention for some students.
• Adjusting lighting and contrast helped children engage more visually.

Stem cell transplantation

• A few studies showed better visual acuity and brain scan results, especially in children without severe eye damage.
• Still very experimental—not something used in routine care.

Acupuncture

• One RCT found greater improvements in visual acuity and brain responses when acupuncture was combined with visual stimulation.
• Another small study saw some brain metabolism changes.

Transcranial electrical stimulation

• One case study reported dramatic improvements in visual acuity and brain activity.
• Too early to know if it works for more children.

Why This Matters for CVI

Right now, we’re still in the “early exploration” stage for CVI therapies. A few approaches—especially environmental adaptations, some training programs, and certain medical techniques—look promising. But without consistent ways of measuring success and without larger, well-controlled trials, it’s hard to say which methods truly help most children.

For families and educators, this means decision-making often relies on trial and error, professional judgment, and what’s practical for the child—rather than clear-cut evidence. However, with any intervention, an outcome measure should be used to measure if the intervention is effective for the child being treated. 

Conclusions About CVI Interventions

• No single CVI intervention currently has strong, high-quality evidence backing it.
• Many children in these studies improved, especially in attention, acuity, or functional use of vision—but results are too limited and varied to form solid guidelines.
• There’s an urgent need for:
  • Larger, controlled trials.
  • Standardized, objective tools to measure functional vision (how vision works in daily life, not just on an eye chart).
  • Research that considers differences in CVI severity, cause, and other health factors.

With CVI cases rising, building a stronger evidence base for effective therapies is essential.

Key Takeaways for Parents and Educators

1 CVI is brain-based—the eyes may be fine, but the brain’s visual processing is disrupted.

2 Therapies tried so far range from light/color activities and skill training to environment adaptations, acupuncture, and experimental brain treatments.

3 The research is still young—most studies are small and inconsistent, so there’s no clear “best” intervention yet.

4 Many reported gains focus on functional vision—helping a child use whatever vision they have more effectively in daily life.

Families and educators should work closely with a multidisciplinary team and be open to adapting strategies as the child’s needs and responses change.

Delay, A., Rice, M., Bush, E., & Harpster, K. (2023). Interventions for children with cerebral visual impairment: A scoping review. Developmental Medicine & Child Neurology, 65(4), 469-478. DOI: 10.1111/dmcn.15431