Cerebral/Cortical Visual Impairment (CVI): The Responsibility of Practitioners in the Field of Visual Impairment in a Changing Landscape

Over the past 20 to 30 years, various groups have worked hard to understand CVI (cerebral/ cortical visual impairment). Their work has raised challenging questions, and some exciting discoveries have been made. Although our knowledge of CVI feels like it is changing rapidly, study of the topic is truly in its infancy. With this ever-changing landscape, practitioners who work with people who are visually impaired (that is, those who are blind or have low vision) strive to propel our field into the next phase of understanding and application. Achievement of such a goal will require collaborative thinking and a plan of action. What follows as a result of these new discoveries are challenges to professionals who work with individuals with visual impairments. Each challenge is founded in a question of responsibility in light of the changing landscape born of our growing understanding of CVI: 1. Who are we responsible for serving? 2. How do we serve them? 3. How are we building professional knowledge and skills to accomplish that important task? Although change can be difficult, it also provides an opportunity for our profession to grow. In doing so, we have an opportunity to better serve the children, their families, and the educational team. DETERMINING WHO WE SERVE As educators of students with visual impairments, we serve children under IDEA, the Individuals with Disabilities Education Act. Section 300.8 of the Act defines the eligible criteria for special education services. Visual impairment is described within that list: "Visual impairment including blindness means an impairment in vision that, even with correction, adversely affects a child's educational performance. The term includes both partial sight and blindness" (IDEA, [section]300.8). As a field, we have agreed that CVI is included under this eligibility criterion. In fact, in reference to eligibility for federal quota funds, American Printing House for the Blind (APH) has added a statement to its eligibility criteria, "functions at the definition of blindness" (FDB), which is defined as visual performance reduced by brain injury or dysfunction when visual function meets the definition of blindness as determined by an eye care specialist or neurologist" (APH, n.d.). A working definition of CVI was provided in a commentary published in the Journal of Visual Impairment & Blindness (JVIB) and authored by the CVI advisory group from APH (Roman et al., 2010). In that comment, cortical visual impairment "is defined as impaired vision that is due to bilateral dysfunction of the optic radiations or visual cortex or both. It can coexist with ocular and ocular motor disorders and can be the result of perinatal brain dysfunction or be caused by trauma" (Roman et al., 2010, p. 69). Each definition of CVI through the years has become more specific regarding eligibility for special education services and brain-related visual impairment. Recent comments have urged the field of visual impairment to consider a broader definition in light of current understanding of the interconnectedness of the visual system throughout the cerebral cortex. The term cerebral visual impairment is generally accepted to include cortical visual impairment in addition to brain-related dysfunction of the visual system beyond the occipital cortex; for example, to include dysfunction in the temporal, parietal, or frontal lobes of the brain. Although terminology is important and warrants discussion, the practical application of that discussion is the determination of exactly whom practitioners in our field should be serving. We must carefully consider whether a definitive definition of CVI would be beneficial, given that the medical field is still wresting with its understanding of the visual brain. However, if IDEA calls us to serve those with adverse educational effects based on visual impairment (IDEA, [section]300. …