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Navigating the Evolving Landscape of CVI Assessment: Comparing Tools, Identifying Strengths, and Building Comprehensive Evaluations

Saaron Putnam-Almaguer, M.S., TVI, COMS

Perkins-Roman Endorsed, CVI Certificate-UMass

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Objectives

Develop a deeper understanding of existing CVI assessments: their strengths, limitations, and practical applications.
We will discuss:

What each tool does well
What it misses
Time commitment
Training requirements
Family friendliness
Progress monitoring value

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Multidimensional FVLMA

Ocular information (visual functions)
Medical history & medication information
Interviews & history taking
Observations in multiple environments
CVI assessments: CVI Range, Dutton’s Inventories, CVI PIMD, TEACH CVI, etc.
Near and distance functional vision assessment
Learning Media Assessment: Sensory balance, SLK, Tietjen’s 2D assessment, etc.
Review Evaluations from all other specialties: PT, OT, SLP, AAC, etc.

Ocular information (visual functions)

Medical history & medication information

Interviews & history taking

Observations in multiple environments

CVI Assessments: The CVI Range, Dutton's Inventories, CVI Protocol, TEACH CVI, etc.

Near and distance functional vision assessment

Learning Media Assessment: Sensory Balance, SLK, Tietjen's 2D Assessment, AAC/CVI Matrix, etc.

Review Evaluations from all other specialties: PT, OT, SLP, AAC, etc.

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Current CVI Assessment Landscape

Where we started:

CVI Range-Roman-Lantzy (2007)
Visual Skills Inventory- McCulloch/Dutton (2007)

Where we are now:

Approximately 18 CVI-related assessments, inventories, questionnaires, and screening tools

Important distinction:

These tools do not all answer the same question

More tools ≠ an easier decision

The challenge is choosing the right tool-or combination of tools-for the question we are trying to answer

Current CVI Assessment Landscape

Where we started:�For many years, the CVI Range was the primary educational tool commonly used by TVIs to describe CVI characteristics and guide intervention planning.

Where we are now:�The field has expanded significantly. There are now approximately 18 CVI-related assessments, inventories, questionnaires, and screening tools available or in active use internationally, including tools developed in the United States, United Kingdom, Scotland, Europe, and Australia.

Important distinction:�These tools do not all answer the same question. Some are:

comprehensive educational assessments,
caregiver questionnaires,
screening tools,
performance-based assessments,
higher visual function inventories,
or targeted tools for specific populations.

And that count still does not include emerging CVI-specific O&M tools and mobility-focused assessment frameworks, such as the developing Brain-Based Orientation and Mobility Assessment (BBOMA).

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Time to reflect

Consider which CVI assessments you are using.

Why are you using them?
What information was it designed to provide?
What information does it miss?
What population was it trialed on?
Is it research-based, and if so, has the whole assessment been studied or parts of it?

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CVI Assessments

CVI-I 51 Question Inventory – Dutton/MacIntyre-Beon/Chanda

CVI Range – Roman-Lantzy

Perkins CVI Protocol

Visual Assessment Scale – CVI-PIMD (VAS)

TEACH CVI Screening 1-3

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Dutton’s 51-Question CVI Inventory (CVI-I) �(2010, 2021)

Purpose

Gather a structured history of everyday behaviors
Identifies patterns suggestive of higher visual function difficulties
Helps determine areas needing further observation, direct assessment, and intervention

Population & Cultural Considerations

School-age children (ages 5+).
Consider developmental, motor, and cognitive abilities when determining whether individual questions are applicable

How Information is Gathered

Structured history-taking rather than direct performance testing
Completed through caregiver report (51 questions describing everyday vision-dependent behaviors)
Responses use a frequency scale (never, rarely, sometimes, often, always, with newer trial version including NA)

Information Gained

Structured profile of reported higher visual function difficulties and patterns associated with dorsal/ventral stream processing
Information about everyday visual functioning
Identification of areas warranting further direct assessment
Information useful for intervention and environmental adaptations

Research Evidence

Research was originally conducted primarily with Scottish children and excluded children with autism, dyspraxia, poor reading skills, and other developmental/behavioral difficulties
Later research by Dutton includes children with neurological/developmental conditions
Published reliability research with strong test-retest/repeatability evidence (Macintyre-Beon et al., 2012)
HVFQI-51 is currently being studied across additional populations and is available in English, Korean, and traditional Chinese (Chandna et al., 2021)

https://pmc.ncbi.nlm.nih.gov/articles/PMC8636735/?

Structured caregiver history/questionnaire focused on higher visual function

2012: Macintyre-Beon et al. published the peer-reviewed reliability study of the 51-question inventory in Eye. That study included 36 children with CVI and 156 controls.

2021: Chandna and colleagues adapted the CVI-I and renamed it the HVFQI-51 to make clear that it identifies higher visual function difficulties rather than diagnosing CVI. 2024: The HVFQI was further expanded with seven additional questions in research on higher visual functions.

The later HVFQI work explicitly states that the name was changed from CVI-I to Higher Visual Function Question Inventory to avoid implying that questionnaire results diagnose CVI.

The inventory has subsequently been used with populations with other neurodevelopmental conditions. For example, later research has used the inventory with children with Down syndrome, and published reviews report use in populations including autism, cerebral palsy, epilepsy, and mild intellectual disability.

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Dutton’s 51-Question CVI Inventory (CVI-I)�(2010) cont.

Training

Administration is relatively straightforward
Questions can be completed by caregivers
Responses should be treated as an indicator to investigate, rather than proof of a specific neurological visual-processing deficit
Requires knowledge of higher visual functions and dorsal/ventral stream processing to meaningfully interpret results
CVI Scotland has training videos and modules covering higher visual functions

Availability & Cost

Question inventory published in Vision and the Brain: Understanding Cerebral Visual Impairment in Children (Lueck and Dutton, 2015)

O&M Relevance (High)

Major education strengths
visual search, environmental complexity, navigation, lower visual field awareness, motion perception, spatial processing, visually guided movement, orientation in unfamiliar environments

Visual Behaviors/Areas Assessed

Visual fields/localized visual attention

Perception of movement

Visual search

Visually guided movement

Visual attention

Complexity/crowded scenes

Visual recognition

Navigation/orientation

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CVI-I: Education Use and Considerations

Family-Friendliness

Parent/caregiver perspective is central
Frequency response format is straightforward, but higher-level visual-function terminology can become technical
Can uncover visual behaviors that don’t occur during formal assessments with its use of everyday examples
Some questions may not be culturally/environmentally relevant

Time (Moderate)

Completion of inventory
Analyzing and synthesizing information
Report-writing time

Progress Monitoring

Strength: same questions can be repeated, and frequency ratings can document changes. Useful for following specific higher visual-function concerns over time. Can help evaluate whether supports/interventions remain appropriate
Limitations: Was not developed as an educational progress-monitoring measure. Changes in results should be interpreted alongside direct observations and functional performance

Its strength is higher visual processing
Identifies concerns that may be missed by a child with good VA but significant visual processing difficulties
Strong focus on real-life functional behaviors
Useful for understanding dorsal- and ventral-stream difficulties
Substantial caregiver input
Useful for investigating complexity, recognition, navigation, visual search, and visually guided movement

What it does well

Does not diagnose CVI independently
Does not replace a thorough FVA/LMA
Some questions may not be developmentally applicable to every child

What it was not designed to answer

What everyday behaviors suggest that higher visual processing difficulties may be affecting this child’s functioning?

Best question this tool answers

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CVI Range - Roman-Lantzy (2007, 2018)

Purpose

Identify how CVI characteristics affect functional vision
Describes current level of visual functioning through a descriptive indicator used for intervention planning and progress monitoring
Guide intervention, accommodations, and environmental supports

Population & Cultural Considerations

Children and youth with a diagnosis or suspected CVI (6mos-21yrs).
Can be used across a wide range of developmental abilities
Published demographic info for the original CVI Range is limited
Published materials are English only, with educational resources available in other languages, including Spanish
CVI Range-CR validation includes racially/ethnically diverse children with significant developmental, neurological, and ocular comorbidities

How Information is Gathered

Parent/caregiver interview
Observation
Direct assessment
Information across environments and activities

Information Gained

Profile across the 10 CVI characteristics
0–10 continuum score and placement within Phase I, II, or III
Intervention priorities

Research/Validation

The original CVI Range had reliability
CVI Range-CR’s most recent research (Chang et al., 2026) shows:

strong internal consistency,
good intra-rater reliability,
good inter-rater reliability,
sensitivity to change over time

Criterion-referenced functional CVI assessment/intervention framework

The CVI Range is criterion-referenced, not norm-referenced.

That means the assessment does not compare a student to same-age peers or generate percentile rankings. Instead, it evaluates the presence and impact of specific CVI characteristics and measures how a student uses vision across environments and activities. The results are used to identify strengths, areas of need, appropriate interventions, and progress over time.

Best with multi-impaired/complex bodies

Population/cultural considerations:

That matters because translating an assessment isn't as simple as translating its words. Questions such as those in the parent interview have to retain the same construct and meaning across languages and cultures. Ideally, a translated assessment goes through forward translation, back-translation, cultural review, pilot testing, and reliability/validity testing before we can assume scores are comparable.

When interviews are conducted through interpreters or translated materials, evaluators should consider how language and cultural differences may influence interpretation of caregiver responses.

Clinical Research: validation study published in 2026. That study included 40 children with CVI, with a mean age of 4.3 years. The sample was racially/ethnically diverse: 40% White, 30% Hispanic/Latino, 13% Asian/Pacific Islander, 5% Black/African American, and 13% other/declined.

It included children with substantial disability and medical complexity. All participants had developmental delay; 53% had cerebral palsy, 90% had seizures, 38% had a genetic/metabolic disorder, 35% had hypoxic-ischemic encephalopathy, and many had ocular comorbidities such as strabismus, optic atrophy, nystagmus, and refractive error. The average CVI Range-CR score was in early Phase II, so this was not simply a sample of higher-functioning children with CVI.

It moves the conversation beyond “Does this assessment have reliability?” to the equally important question:

Who was this assessment developed and tested with—and how similar are they to the student sitting in front of me?

That is exactly where cultural and linguistic responsiveness matters. A caregiver interview can be statistically reliable in its development population and still require thoughtful adaptation when you're interviewing a recently immigrated family, using an interpreter, working across different cultural understandings of disability, or asking questions about behaviors that may be interpreted differently across cultures.

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CVI Range - Roman-Lantzy (2007, 2018) cont.

Training/Knowledge Needed

Requires a strong understanding of the CVI characteristics and how those characteristics can manifest differently across students, environments, and activities
Requires a strong knowledge of scoring guidelines to maintain fidelity
Conducted by TVI or others with training

Availability & Cost

Assessment Forms available in Cortical Visual Impairment: An Approach to Assessment and Intervention (2018)

Family-Friendliness

Parent interview is central
Questions focus on observable behaviors
Family input contributes significantly to assessment
Scoring language, characteristics, and phases require explanation to prevent families from interpreting the number as a standardized developmental score
Language/cultural interpretation of interview questions should be considered

10 CVI Characteristics

Color preference

Need for movement

Visual latency

Visual field preferences

Visual complexity

Light-gazing / nonpurposeful gaze

Difficulty with distance viewing

Atypical visual reflexes

Difficulty with visual novelty

Absence of visually guided reach

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CVI Range: Education Use and Considerations

Time (High)

Time varies considerably depending on: Familiarity with the student, number of observations, interviews, direct assessment, scoring, and interpreting scores
Evaluator experience
Report-writing time

Progress Monitoring

Baseline for reassessment/progress monitoring using the same 10 characteristics
Descriptive indicators (0-10) provide a longitudinal framework
Phase changes can be documented
Recent CVI Range- research supports sensitivity to change
Designed to be repeated yearly

O&M Relevance

Useful information regarding fields, movement, complexity, distance, latency, visually guided reach, environmental access

Gives a structured CVI profile
Connects assessment directly to intervention
Helps identify conditions that improve/support visual access
Allows repeated assessment over time
Familiar to many U.S. TVIs and educational teams

What it does well

Does not replace a thorough FVA/LMA
Faces/people, sensory integration, lower-limb guidance, and recognition are not separated into distinct categories to the extent they are in newer frameworks
The numerical score should not be interpreted like a standardized developmental score

What it was not designed to answer

How are CVI Characteristics affecting this student's current visual functioning and what should we target next?

Best question this tool answers

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Perkins CVI Protocol (2024)

Purpose

Designed to understand how CVI affects an individual’s ability to access people, objects/materials, communication, environments, movement, and learning
Places emphasis on identifying both visual behaviors and compensatory skills
Connect assessment findings to educational access
Individualized accommodations, recommendations, and IEP supports

Population & Cultural Considerations

Students with diagnosed or suspected CVI (0-21yrs).
Can be used across a wide range of developmental, motor, communication, and visual abilities
Published demographic information regarding race/ethnicity, language, and disability distribution of trial students is limited

How Information is Gathered

File/medical review
Parent/caregiver interview
Educational team interview
Observations across environments
Individualized direct assessment
Assessment of compensatory skills
Trailing strategies/accommodations during assessment

Information Gained

Individual profile across the 16 CVI visual behaviors
Identification of compensatory strategies
Functional description of visual access
Detailed educational eval report
Individualized recommendations & accommodations to support IEP programming

Research/Validation

84% reliability for the parent interview component (Zatta & Willems, 2024)
Published psychometric evidence for the complete protocol remains emerging

https://www.perkins.org/our-work/cvi/the-perkins-cvi-protocol/

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Perkins CVI Protocol �(2024) cont.

Training

Requires a strong understanding of the 16 visual behaviors and how they may manifest differently across students, environments, and activities (CVI Lens)
Understand how compensatory skills and other disabilities/sensory demands influence visual functioning
Requires a strong understanding of how and what to test to get the information that you seek.
Optional self-paced course through Perkins

Availability & Cost

Free and available through Perkins CVI Now
Optional trainings through Perkins Academy; costs vary by training

Family-Friendliness

Parent/caregiver interview is built into the process
Focuses on access tools, strengths, and interests rather than deficits

Visual Behaviors

Ocular/Eye Function

Appearance of Eyes
Movement of Eyes

Visual Awareness & Looking

Visual Attention
Response Interval
Visual Field Abilities
Visual Curiosity
Impact of Light
Impact of Motion
Impact of Color

Recognition & Visual Processing

Visual Recognition
Form Accessibility
Access to People
Clutter/Crowding/Spacing
Sensory Integration & Impact on Vision

Interaction/Visual-Motor

Visual Guidance of Upper Limbs
Visual Guidance of Lower Limbs

Protocol is intended for use by a TVI, ideally with CVI knowledge. The workbook contains foundational information to support users who have less CVI experience. Perkins offers optional self-paced courses and workshops in visual behaviors, assessment, report writing, and assessment-to-intervention. No certification or endorsement is identified as a requirement for using the Protocol.

The training emphasis differs somewhat from the Range:

Range → fidelity in interpretation/scoring

Protocol → developing a comprehensive “CVI lens” and investigative assessment process

I

t's a free, downloadable, customizable, and science-based tool that assesses students' visual behaviors and compensatory skills to provide tailored recommendations

Perkins currently organizes the behaviors conceptually into ocular impacts, visual awareness/looking, recognition/processing, and interacting, while emphasizing that the behaviors are interconnected rather than isolated skills.

https://www.perkins.org/understanding-cvi-visual-behaviors/

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Protocol: Education Use and Considerations

Time (High)

Thorough file review: educational and medical
Observations across environments
Parent & team interviews, including building a student profile
Individualized direct assessment
Identification of compensatory skills
Trailing strategies/accommodations during assessment
Report-writing time

Progress Monitoring Value

Strength: 16 behaviors can be revisited over time; changes in access and compensatory strategies can be documented; & useful for determining if accommodations continue to work as demands/environments change
Limitation: progress is documented behavior-by-behavior and functionally; repeated at 3-year re-eval

O&M Relevance

Useful information regarding lower-limb guidance, fields, visual curiosity, motion, clutter/crowding, recognition, response interval, sensory integration, environmental access

Broad coverage of lower- and higher-order visual functioning
Considers compensatory strategies as strengths/access tools
Encourages assessment across environments
Explicitly adds more categories (attention/recognition, faces, etc.)
Directly connects findings to educational recommendations
Provides a report-writing framework for TVIs

What it does well

Does not diagnose CVI
Does not replace a thorough FVA/LMA
Requires the evaluator to synthesize qualitative information rather that rely on a numerical score

What it was not designed to answer

How does CVI affect this child’s access to people, materials, environments, and learning – and what supports improve that access?

Best question this tool answers

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Visual Assessment Scale for CVI in Persons with Profound Intellectual and Multiple Disabilities (VAS CVI-PIMD)(2018)

Purpose

Structured assessment of functional visual behavior and describes the individual’s Level of Visual Functioning
Identifies behaviors/characteristics associated with CVI
Combines formal visual-function findings, multidisciplinary observations, and caregiver information
Records the results of the observations by a multidisciplinary team after the ophthalmological examination and the formal assessment of visual functions.

Population & Cultural Considerations

Designed specifically for individuals whose cognitive, motor, and communication disabilities make traditional visual assessment difficult
There is limited information regarding other demographics outside of the Dutch educational/healthcare context

How information is gathered

Review of visual/medical information
Formal assessment of visual functions
Structured multidisciplinary observation/collaboration
Visual Assessment Scale Form
Parent/caregiver questionnaire

Information gained

Six-level profile of functional vision
Profile of functional visual skills/behaviors (looks at strengths, areas of difficulty, and conditions influencing visual performance
Information to guide intervention
Multidisciplinary picture of visual functioning

Research/Validation

Researched on children/adolescents with PIMD
Agreement between evaluators regarding the individual's Level of Visual Functioning was substantially stronger
Agreement regarding the number/presence of individual CVI characteristics was considerably weaker

In the Netherlands such a team consists of at least an orthoptist, a psychologist and a therapist (occupational therapist, itinerant worker). This may be different in countries where service for visually impaired children is education-based.

CVI PIMD fills a gap the first three tools don't: it was designed specifically for people with Profound Intellectual and Multiple Disabilities (PIMD) who may be nonverbal and unable to participate in conventional vision testing. It was developed by Marjolein Wallroth and Marieke Steendam at Royal Dutch Visio in the Netherlands and published as a manual/forms package in 2018

How information is gathered

Available for free at https://www.visio.org/vas-cvi-pimd
Here’s a link to the VAS webinar

Level of Visual Functioning — places observed visual functioning within a six-level hierarchy, providing a picture of the individual's current functional use of vision.
Profile of functional visual skills — information about visual awareness, attention, fixation, tracking, gaze shifting, visual exploration, and increasingly complex use of vision.
Identification of CVI characteristics — documents which CVI-related characteristics are observed and how they may affect visual functioning.

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VAS CVI-PIMD (2018) cont.

Training/Knowledge Needed

Designed for use by professionals experienced in visual assessment and PIMD within a multidisciplinary team
Requires an understanding of functional visual development and CVI and knowledge of how motor limitations influence visual responses
Requires careful observation and interpretation of subtle visual behaviors
Manual provides detailed scoring guidance
Optional training videos

Availability & cost

Free and publicly available through Royal Dutch Visio

O&M Relevance (Moderate)

Provides visual awareness, visual fields, visually guided movement, environmental attention, response to movement, visual exploration, and functional use of vision.

Visual Behaviors/CVI Characteristics

Visual awareness/

attention

Fixation

Following/

tracking

Shifting gaze

Visual exploration

Recognition

Visually guided movement

Complexity/

environmental demands

Light

Movement

Latency/

response

Functional use of vision

The VAS examines functional visual development through observable behaviors rather than requiring conventional responses.

Areas include:

Basic Visual Responses

Awareness of visual stimuli
Orientation toward visual targets
Visual response to environmental stimuli

Visual Attention

Establishing visual attention
Maintaining attention
Fixation

Eye Movement / Visual Exploration

Following/tracking
Shifting gaze
Scanning
Active visual exploration

Recognition / Functional Vision

Recognition of familiar visual information
Increasingly purposeful use of vision
Functional use of vision during activities

CVI-Related Characteristics

The VAS additionally examines CVI-related behaviors involving areas such as:

visual fields,
complexity,
movement,
light,
response time/latency,
visually guided movement,
and environmental influences on visual performance.

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VAS CVI-PIMD: Education Use and �Considerations

Family-friendliness

Dedicated parent/caregiver questionnaire
Focuses on observable everyday behaviors and doesn’t require an understanding of neurological terminology to report what is seen

Time (Moderate)

Completion of parent questionnaire
Collaborative observations
VAS form completion
Report-writing time

Progress Monitoring

Strength:

Six-level hierarchy provides a consistent framework for documenting change. Same observational items can be revisited. Functional behaviors can be compared over time.

Limitations:

Inter-rater agreement was stronger for the Levels of Visual Functioning than for identifying individual CVI characteristics. Therefore, interpret changes in specific CVI characteristics cautiously and support them with observation and multidisciplinary information.

Specifically designed for persons with PIMD (doesn’t require verbal responses or assume typical motor abilities)
Focuses on observable behaviors
Multidisciplinary by design
Provides hierarchy of functional visual ability

What it does well

Does not replace ophthalmological examination, formal assessment of visual functions, or the broader multidisciplinary process used to determine CVI
Does not replace a thorough FVA/LMA
Developed specifically for PIMD, not the best choice for a student with stronger cognitive, communication or motor abilities

What it was not designed to answer

How is this individual with significant multiple disabilities functionally using vision, and what CVI characteristics may be affecting that visual functioning?

Best question this tool answers

More comprehensive isn't always better. Population fit matters.

The Royal Dutch Visio manual says the VAS was developed to answer whether, and to what degree, CVI can be identified in children and adults with PIMD. It also states that CVI determination should consider three pieces together: the person's eye examination does not fully explain visual functioning, there is neurological history/presence, and CVI-related behavioral/visual responses are present.

Importantly, the VAS is intended to sit after ophthalmological examination and formal assessment of visual functions within a multidisciplinary assessment process. The manual describes the final result as part of an integrated multidisciplinary report.

The VAS CVI-PIMD can contribute evidence toward determining the presence and severity of CVI in individuals with PIMD; however, it is intended to be used as part of a comprehensive, multidisciplinary visual assessment and not in isolation.

The Perkins Protocol explicitly positions itself as an educational assessment, whereas the VAS emerged from a Dutch multidisciplinary clinical/rehabilitation model and was intentionally designed to contribute to determining whether CVI is present in people with PIMD. That's an important difference in purpose and professional context.

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TEACH CVI Screening Tool (2017)

Purpose

Identify behaviors that may be associated with CVI
Identify children who may need further CVI evaluation
Provide educators and healthcare providers with a common framework for discussing functional visual concerns
Help identify areas of visual functioning that warrant deeper investigation

Population & Cultural Considerations

Three versions were intentionally developed to accommodate different developmental and mobility profiles
Developed in Iceland; includes Icelandic screeners
Recent research includes children with NVI, CVI, ocular comorbidities with various acuities, field loss, and varying developmental/motor profiles

How information is gathered

Birth, medical history, and eye information
Behavioral questionnaire/screening list
Screening score

Information gained

Structured CVI screening result
Identification of CVI-related red flags
Profile of functional behaviors that warrant further investigation
Information to guide referral and for communication with ophthalmology/medical providers

Research/Validation

2024 Rasch Analysis found it is a psychometrically valid instrument that is well-targeted to a sample of CVI patients and capable of measuring functional vision independently of visual acuity (Martin et al., 2024)
93% of the range of visual ability represented in the sample and provided evidence that the questionnaire measures an underlying construct related to the impact of CVI on functional visual ability
2024 Diagnostic study found that TEACH 1 has high sensitivity but low specificity, meaning it had a significant number of false positives for CVI

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TEACH CVI (2017) cont.

Training/Knowledge Needed

Manual provides detailed scoring guidance; greater knowledge of CVI is needed for interpretation of results
Selection of the correct form requires understanding the child’s developmental/motor functioning

Availability & cost

Free and publicly available through the TEACH CVI website

O&M Relevance

Levels 2 and 3 contain numerous questions directly relevant to O&M
Identifies possible mobility-related concerns such as walking into visible objects, looking downward while walking, stairs, floor color/depth/texture changes, fields, clutter, unfamiliar environments, motion perception, passing people/cars/cyclists, spatial positioning, speed/direction/distance of movement
Does not directly assess O&M performance

Visual Behaviors/CVI Characteristics

Overlaps with many of the Perkins 16 Visual Behaviors, particularly:

Visual Attention & Awareness: attention, visual fields, light, fatigue
Visual Recognition & Processing: objects, faces, color, visual complexity, and 2D images
Motion & Visual-Motor: movement perception, visually guided reaching and mobility
Sensory & Environmental Access: competing sensory input, unfamiliar environments, and visual distractions

Additional Functional Areas Highlighted

Academic access: reading, writing, clocks, charts, and visual representations
O&M-related concerns: stairs, obstacles, environmental navigation, and judging speed/distance
Emotional/behavioral responses: anxiety or distress associated with visual and sensory demands

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TEACH CVI (2017)

Family-friendliness

Questions describe recognizable everyday behaviors and doesn’t require understanding neurological terminology.
Relatively straightforward response format.
Three versions help avoid asking families large numbers of developmentally inappropriate questions.
Can help families describe concerns that may otherwise be difficult to communicate what is seen

Time (Low)

Completion of one screening form (Level 1, 2, or 3)
Scoring and interpreting data
Report-writing time

Progress Monitoring

Developed as a screening tool, not a progress monitoring instrument
No established developmental continuum

Quick and accessible and doesn’t require specialized assessment materials
Covers a broad range of visual behaviors between all three versions
Starting points for additional FVA/CVI assessment
Functional information from everyday environments
Strong connection between education and healthcare by providing concrete behaviors for referral conversations
Includes substantial O&M relevant content

What it does well

It is not meant to be diagnostic but can lead to diagnosis in the context of greater information. A positive screen tells you to investigate further
Does not replace a thorough FVA/LMA

What it was not designed to answer

Are there enough CVI-related behaviors present that this child should receive further CVI assessment or diagnostic evaluation?

Best question this tool answers

More comprehensive isn't always better. Population fit matters.

The Royal Dutch Visio manual says the VAS was developed to answer whether, and to what degree, CVI can be identified in children and adults with PIMD. It also states that CVI determination should consider three pieces together: the person's eye examination does not fully explain visual functioning, there is neurological history/presence, and CVI-related behavioral/visual responses are present.

Importantly, the VAS is intended to sit after ophthalmological examination and formal assessment of visual functions within a multidisciplinary assessment process. The manual describes the final result as part of an integrated multidisciplinary report.

The VAS CVI-PIMD can contribute evidence toward determining the presence and severity of CVI in individuals with PIMD; however, it is intended to be used as part of a comprehensive, multidisciplinary visual assessment and not in isolation.

The Perkins Protocol explicitly positions itself as an educational assessment, whereas the VAS emerged from a Dutch multidisciplinary clinical/rehabilitation model and was intentionally designed to contribute to determining whether CVI is present in people with PIMD. That's an important difference in purpose and professional context.

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CVI Assessment Tools: At-a-Glance Summary

No single assessment answers every question. The goal is to select the tool—or combination of tools—that best matches your student's abilities, the concerns being investigated, and the educational decisions we need to make.

CVI Range

How do the 10 CVI characteristics affect this student's functional vision, and what interventions should we prioritize?

Perkins CVI Protocol

How does CVI affect this student's access to people, materials, environments, and learning, and what supports improve access?

Dutton CVI-I / HVFQI

What higher visual-processing difficulties are showing up in everyday activities, and what should we investigate further?

VAS CVI-PIMD

How does an individual with profound intellectual and multiple disabilities use vision, and what CVI characteristics may be affecting their functioning?

TEACH CVI

Are there behaviors that suggest possible CVI and indicate a need for further evaluation?

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Using AI to Support CVI Assessment & Report Writing

How AI Can Help TVIs

Organize assessment responses into the 16 Perkins CVI Visual Behaviors.
Identify documented strengths, difficulties, and areas needing further assessment.
Cross-reference findings from multiple assessment tools.
Draft clear, objective FVA/LMA narratives.
Reduce time spent organizing information and writing reports

Important Considerations

Protect student privacy: Use only district-approved AI tools and follow student-data/FERPA policies.
Verify accuracy: Review all AI-generated statements against original assessment data.
Avoid assumptions: Do not allow AI to invent observations or infer causes of behaviors.
Stay within our professional role: TVIs document functional visual behaviors and educational impact; we do not medically diagnose CVI.

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Final Thoughts

Our goal is not simply to complete an assessment. It's to understand the student well enough to make a difference in their educational experience.

Know the Student

Strengths, abilities, experiences, and needs

Know the Tools

Purpose, strengths, limitations, and evidence

Build the Full Picture

Combine findings to guide meaningful educational access

I'd like to end with a saying commonly attributed to Dr. Gordon Dutton: "If you've met one child with CVI, you've met one child with CVI."

Throughout this presentation, we've explored how much the CVI assessment landscape has grown. We have more tools available to us than ever before, but more tools don't necessarily mean easier decisions.

Each assessment brings something different to the table. Some help us identify possible CVI, others explore higher visual processing, and others provide a comprehensive understanding of functional vision and educational access.

As TVIs, our responsibility is to thoughtfully select tools based on the individual student's strengths, abilities, developmental profile, and needs. We also need to consider the research behind each tool, its limitations, and the perspectives of families and educational teams.

Ultimately, no single assessment tells the whole story. It's how we bring together information from multiple sources that allows us to develop meaningful recommendations and improve access to learning.

Our goal is not simply to complete an assessment. It's to understand the student well enough to make a difference in their educational experience.

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References

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