When 20/20 vision hides a diagnosis: Understanding cerebral visual impairment

Cerebral visual impairment (CVI) has emerged as the leading cause of pediatric visual impairment in developed countries, but for years, eye care professionals lacked the understanding needed to recognize it, a gap that has made distinguishing CVI from ocular disease an increasingly urgent part of routine eye care. CVI is a condition in which the visual pathways of the brain fail to process visual information typically despite normal or near-normal ocular findings. It is now formally defined as visual impairment caused by an underlying brain abnormality that disrupts visual processing pathway development, producing deficits in visual function and functional vision, whether through lower-order issues like reduced acuity, higher-order issues like difficulty interpreting complex scenes, or both, that exceed what any co-occurring eye condition would explain.¹ Historically, the diagnostic label attached to this profile was cortical blindness, terminology drawn almost entirely from adult neurology and applied to patients who acquired vision loss following stroke or traumatic head injury. That framework left little room for a pediatric population whose visual systems never developed typical cortical processing to begin with, and as a result, children presenting with this profile were, for years, diagnostically overlooked or misclassified under behavioral or developmental labels instead, a gap in consensus terminology that persisted in the literature for decades.