Natural history of cerebral visual impairment in children with cerebral palsy

What Does the Research Say?

Children with cerebral palsy (CP) often also have cerebral visual impairment (CVI).  This study shows that while CVI remains present over time, many specific visual skills can improve as children grow.

1) What did the researchers study?  

The research from a Neuro-opthalmological care center followed 51 children who had both CP and CVI from infancy into school age to see how their vision changed over time.

They wanted to know which early visual signs (especially eye movement problems) predicted later “cognitive visual” difficulties, such as trouble recognizing objects or finding things in space.

2) What were the important findings?  

• CVI did not go away, but many individual visual functions (how steadily a child looks, how their eyes track, how clearly they see, and how wide their visual field is) improved, and some children reached normal levels by preschool or school age.
• Problems with eye movements (like jerky tracking or slow, inaccurate eye jumps) in infancy and preschool were linked with later cognitive visual difficulties at school age.
• Eye alignment problems (strabismus, especially exotropia) and changes in the back of the eye (optic nerve appearance) became more common as children got older.
• Children born at term and those with milder motor difficulties tended to show more improvement in basic visual functions.

3) How did they conduct this research?  

Children were examined three times: as infants (6–35 months), in preschool (3–5 years), and again at or after age 6.

At each visit, doctors checked:  
  - Eye health (front of the eye, optic nerve) and need for glasses  
  - Eye movements (fixation, tracking moving targets, quick eye jumps, eye alignment, nystagmus)  
  - Basic vision (sharpness/acuity, contrast sensitivity, visual fields)

At school age, children who could participate also had testing of visual motor skills (like using vision to guide the hands) and visual perception (recognizing and understanding what they see). 

4) What does this mean for families?  

CVI in CP is “permanent but not unchanging”. This means the brain injury is lasting, but a child’s vision is not fixed at one level and many aspects can improve over time, especially through the preschool and early school years.

Seeing early eye movement problems (for example: difficulty fixing gaze, jerky tracking, or slow eye movements) should prompt close follow‑up, because these can signal a higher risk of later cognitive visual challenges.

Even when scans show white matter injury or when CP is more severe, improvement is still possible, and ongoing visual assessment can help target supports where a child has the most potential to gain.

5) What can families do to best advocate for their needs?  

• Ask for regular, detailed neuro‑ophthalmology or pediatric eye evaluations that look beyond “can my child see the eye chart?” to include eye movements, visual fields, and contrast sensitivity.
• Request early referral to low‑vision and CVI‑experienced teams (orthoptists, vision therapists, occupational therapists, early intervention) to build visual skills and adapt the environment (such as adjust lighting, clear clutter, high contrast, positioning).
• If your child had early eye movement problems, advocate for cognitive visual assessments at school age (such as visual perception and visual motor testing), especially if learning, reading, or navigation seem harder than expected.
• In CP clinic, IEP/504 meetings, and therapy planning, highlight that research shows vision in CP and CVI can improve and that targeted support for vision is just as important as support for movement or speech.
• For children born preterm or with white matter injury, emphasize the known higher risk of visual issues and ask that visual development be monitored as closely as motor and cognitive development.

Galli J, Loi E, Calza S, Micheletti S, Molinaro A, Franzoni A, Rossi A, Semeraro F, Merabet LB, Fazzi E. Natural history of cerebral visual impairment in children with cerebral palsy. Dev Med Child Neurol. 2025 Apr;67(4):486-495. doi: 10.1111/dmcn.16096. Epub 2024 Sep 24. PMID: 39316724; PMCID: PMC11875525.