The Relation Between Clutter and Visual Fatigue in Children With Cerebral Visual Impairment (CVI)
Authors
C. Van Hove, C. Damiano, N. Ben Itzhak
Main Research Question: How individuals with Cortical/Cerebral Visual Impairment (CVI) experience visual fatigue when confronted with visual clutter
Individuals with CVI often struggle with visual recognition, navigating complex scenes, and maintaining visual attention, especially in environments filled with competing visual stimuli. These difficulties can be exacerbated by what is often referred to as visual clutter—visual environments that contain a high density of overlapping or distracting elements.
The central research question posed by Van Hove and her team is: How does visual clutter contribute to visual fatigue in individuals with CVI, and how do individual differences shape this experience? To answer this, researchers observed individuals with CVI while they played games as part of a larger study (iVision study). Researchers graded visual fatigue based on behaviors such as resting their head in their hands and closing their eyes often. They scored clutter by three methods 1) subjective observations by researchers, who graded visual, auditory, and additional clutter; 2) subjective observations by anonymous individuals who agreed to grade photographs of CVI participants for a nominal fee (these graders were recruited through a crowdsourcing site, Prolific), and 3) objective clutter algorithms applied to the same photographs via Matlab and Rstudio scripts.
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Percent of children with CVI who showed at least one visual fatigue sign
Key Findings
The main hypothesis was that visual clutter would be associated with visual fatigue. The authors found that at least one visual fatigue sign was seen in 94% of children with CVI. Researchers’ visual and additional clutter scores were significantly associated with visual fatigue scores, with small to moderate effect sizes (correlation coefficients 0.32 and 0.25, p=0.006 and p=0.03, respectively). The factors most strongly associated with visual fatigue were the amount of furniture, disturbing light sources, and people interacting with the child. None of the other measures of clutter (subjective observations via crowdsourcing and objective algorithms) were associated with visual fatigue scores. However, the crowdsourced observations of clutter and objective clutter algorithms were significantly associated with researchers’ scoring of visual clutter.
One interesting result of the study is the degree of individual variability observed among the participants with CVI. While nearly all participants with CVI showed some level of increased fatigue, the manifestations of visual fatigue varied widely.
Image Description: A student sits at a desk with his head resting in one hand and his eyes closed. The classroom scene behind him is cluttered with colorful books and learning tools.
Limitations
It is important to note that the behaviors that were considered indicative of fatigue are non-specific, such as touching eyes/glasses or yelling.
Another limitation of the study is that the crowdsourcing and objective algorithm methods of measuring visual clutter only evaluated a subset of the participants (55 of 72), because the researchers did not obtain ethical approval to take photographs of the participants until later in the study. Additionally, two of the seven researchers who rated visual clutter and visual fatigue were unmasked to the study questions, although they only rated three participants.
Significance of the Study
In terms of broader significance, the study contributes to a growing body of literature emphasizing the importance of environmental design in supporting individuals with visual processing challenges. Classrooms, public spaces, and even digital interfaces often contain high levels of visual clutter that can be overwhelming for individuals with CVI. Understanding the role of clutter in triggering visual fatigue can help guide the creation of more accessible environments. For example, minimizing unnecessary visual details and simplifying visual scenes can make a substantial difference in reducing fatigue and improving functionality.
Main Conclusions: Individuals With CVI Experience Challenges With Clutter and Environment Matters
In summary, this study by Van Hove et al. offers evidence to support anecdotal observations that individuals with CVI experience challenges in cluttered environments. Additionally, the study’s findings suggest that objective algorithms using photographs are insufficient to assess all sources of clutter that can contribute to visual fatigue in children with CVI. An experienced clinician remains critical to making observations and modifications that can optimize the visual environment for children with CVI., , . The relation between clutter and visual fatigue in children with cerebral visual impairment. Ophthalmic Physiol Opt. 2025; 45: 514–541. https://doi.org/10.1111/opo.13447