For over three decades, the founder and director of Pediatric VIEW at The Children’s Home of Pittsburgh, Dr. Christine Roman-Lantzy, has studied cortical visual impairment (CVI) in children.
This clinical work and research led to Dr. Roman-Lantzy to develop The CVI Range® Assessment, a tool aimed at providing eye care professionals with a systematic way of understanding a child’s functional vision in relation to CVI.
In light of the assessment achieving official recognition in a recently published peer-reviewed Ophthalmology Science study, The Ophthalmologist sat down with Dr. Roman-Lantzy to discuss her pioneering work in the pediatric ophthalmology space.
What does the publication of the Ophthalmology Science study mean to you?
It means a great deal to me. The CVI Range was created to help the many families with children whose visual behaviors were not being understood. These families knew their children were responding to the visual world differently, and traditional eye examinations could not fully explain the behaviors they were seeing at home.
Over the years, we've learned that this population is much larger than many people once realized – CVI is now known to be the leading cause of pediatric visual impairment in developed countries. Because CVI is so prevalent, every ophthalmologist who cares for children is likely seeing children with CVI in their practice today. The concern is that many of these children can still be missed if clinicians rely on traditional measures of vision.
The Children’s Home of Pittsburgh’s Pediatric VIEW Program uses The CVI Range to help educators, therapists, families, and clinicians precisely describe those visual behaviors and use that information to make daily life and learning more accessible and meaningful.
This study gives clinicians stronger evidence that functional vision can be measured systematically and should be part of the conversation when evaluating children with suspected CVI. But a score is only valuable if it helps us better understand a child's functional vision and identify the supports and opportunities that can help them use vision more effectively.
What does The CVI Range assess that conventional visual acuity tests do not?
Many children with CVI have normal or near-normal eye exams. But a visual acuity test tells us about a particular size print and the distance at which the print can be seen; it does not fully capture functional vision.
A normal eye examination does not necessarily rule out a significant visual disability. When families describe visual behaviors that seem inconsistent with examination findings, those observations should prompt a broader assessment of how the child uses vision in daily activities, particularly when neurological risk factors are present.
Ophthalmologists should have CVI on their radar whenever a child has a history of a significant neurological condition and families report visual concerns that are not fully explained by the eye examination. Children born prematurely or those with conditions such as cerebral palsy, stroke, seizures, hydrocephalus, traumatic brain injury, developmental disabilities, or certain genetic conditions are at increased risk. Warning signs may include difficulty finding objects in busy or cluttered environments, inconsistent responses to visual information, trouble recognizing faces, challenges navigating unfamiliar spaces, visual fatigue, or difficulty reaching accurately for objects.
CVI also frequently coexists with other neurological, developmental, and medical diagnoses, which can make the impact to function easily overlooked. The CVI Range assesses a child’s visual function by systematically assessing the ten unique visual and behavioral characteristics. The process is conducted through interviews with people who know the child, observation, and direct assessment.
Is there specific training required to administer and interpret The CVI Range?
Training educators, therapists, and other specialist professionals to accurately administer and interpret The CVI Range is a key part of the Children’s Home of Pittsburgh’s Pediatric VIEW Program. The CVI Range Proficiency is a method for professionals to demonstrate competence in conducting The CVI Range.
We offer two training tracks: CVI Range Assessment Proficiency (CVIR-AP) for professionals who administer the assessment, and CVI Range Service Proficiency (CVIR-SP) for those who incorporate its findings into their practice. Professionals demonstrate proficiency through a portfolio review process that evaluates their ability to administer, interpret, and apply The CVI Range.
What work is Pediatric VIEW doing to expand access to CVI assessment and professional training?
The Children’s Home of Pittsburgh works to fill gaps in services for children with medical complexities and their families. Within that mission, Pediatric VIEW works directly with children and families, but we recognize that assessment is only the beginning.
We are expanding foundational and advanced learning opportunities so professionals can build competence over time. Because children with CVI are heterogeneous, training must prepare professionals to assess each individual child rather than apply the same strategies to everyone.
Our work includes school observations, team consultation, and training in areas such as literacy, communication, assistive technology, orientation and mobility, and week-long CVI intensive programs.
Our professional development opportunities also include an upcoming eight-week webinar series which will run from October 1 through November 19, 2026 and feature Pediatric VIEW practitioners and guest speakers, with specialty-focused content, practical strategies, and tools for supporting individuals with CVI.
How could the validation change the way ophthalmologists, neurologists, pediatricians, and other clinicians approach CVI?
The study gives clinicians evidence that functional vision can be measured in a structured and reliable way. It also helps guide the development of interventions and measures changes in functional vision over time. Parents and caregivers are often the first to recognize that a child's visual behavior does not match what would be expected, even when clinical findings appear reassuring. Their observations can provide important clues that may not be evident during a brief office visit. A conventional eye examination may identify an ocular condition, but the ocular findings may not fully account for the child’s visual behavior – and CVI and ocular visual impairment may coexist.
For ophthalmologists, that may mean looking beyond visual acuity and ocular findings to consider how the child functions visually in everyday environments. When those concerns are present, clinicians should consider CVI and ensure the child is referred for appropriate functional-vision assessment.
The challenge is not identifying CVI once it is suspected. The challenge is suspecting it in the first place, particularly when the results of the eye examination alone do not provide the answer. Sometimes the simple act of recognizing CVI and making the right referral can change a child's trajectory.
How can the CVI Range become more widely adopted within hospitals and healthcare systems?
This study is an important step toward wider adoption of the CVI Range by hospitals and health systems. But health systems need to recognize functional vision as an important clinical and developmental outcome. We need to understand more than what a child can see on an eye chart; we need to understand how they use vision in everyday life.
Adoption also requires appropriate training, interdisciplinary collaboration, and clear referral pathways. Ophthalmologists, neurologists, neuropsychologists, educators, therapists, and families each bring essential perspectives. Everyone who works with a child has a role in recognizing when visual behavior does not match what would be expected.
For ophthalmologists specifically, that role may begin with a simple shift in thinking: asking not only "How well do this child's eyes function?" but also "How well does this child use vision in everyday life?" That simple question may help identify children who might otherwise be overlooked.
What further research would you like to see following this study?
I would like to see larger studies that include the full diversity of children with CVI. I'd also like to see more intervention research. We need carefully designed studies examining whether individualized, assessment-based interventions change functional vision and whether those changes improve meaningful outcomes in communication, literacy, social development, and daily living.
I would also like to see longitudinal research beginning in infancy to better understand developmental trajectories and the influence of neurological stability, medical factors, environmental access, and intervention intensity. Earlier identification could help families and professionals address visual needs during critical periods of development.
Screening for CVI should become more systematic. Research should identify sensitive screening questions that prompt appropriate referral without treating screening as diagnosis, particularly for children with relevant neurological histories, unexplained visual behaviors, developmental disabilities, cerebral palsy, complex communication needs, or apparent social and attentional differences. This could include studying how CVI-informed questions might be incorporated into developmental and behavioral assessments and when findings from an eye examination should prompt further evaluation of functional vision.
Given the prevalence of CVI and the frequency with which it coexists with other developmental and neurological diagnoses, we need practical screening approaches that help frontline clinicians recognize when functional vision may be contributing to a child's challenges.
I am particularly interested in research examining how unrecognized CVI may influence clinical developmental and behavioral assessments. A child who has difficulty recognizing faces, showing curiosity in new places, interpreting complex scenes, or looking while listening may perform in ways that are attributed solely to autism, attention, cognition, or motivation. Too often, diagnosticians may believe they are observing behaviors that remind them of autism or attention difficulties, when in fact they may be seeing signs of brain-based visual impairment. Finally, families must be included as research partners. Their knowledge is not incidental data, it is essential.
Is there anything further you would like to add?
I am extremely grateful to Dr. Melinda Chang, Dr. Mark Borchert, and the research team for their expertise, dedication, and partnership in bringing this important study to fruition.
I am equally grateful to the children and families who participated. Families have always been the true north of my work. Long before many professionals had language for these visual behaviors, parents were describing what their children could and could not do – how their vision changed with familiarity, movement, sound, fatigue, complexity, and distance. Our responsibility is to listen carefully and respond with the same seriousness families bring to their observations.
If there's one message I'd leave with clinicians, it is when a child's visual behavior doesn't match examination findings, ask more questions. Listen carefully to families and consider functional vision.
