A child who repeatedly looks away from a busy worksheet may appear distracted. Another may stare toward bright lights, struggle to recognize familiar faces, or avoid picture books even though a routine eye examination does not reveal an obvious explanation.
For children with cerebral/cortical visual impairment, or CVI, behaviors like these can reflect the way the brain processes visual information rather than a lack of attention or interest. The eyes may be capable of seeing, but the brain can have difficulty interpreting, organizing, or making useful sense of what reaches it.
That distinction has shaped more than five decades of work by Pittsburgh-based educator and researcher Christine Roman-Lantzy. Her career has focused on children whose visual abilities were difficult to understand through conventional approaches, and on giving families and educators practical ways to recognize what those children can see and how they use vision.
Her work has become increasingly relevant as awareness of CVI grows. The National Institutes of Health has described cerebral visual impairment as an emerging leading cause of childhood visual impairment and has warned that limited awareness contributes to children being missed or misdiagnosed.
Vision Involves More Than the Eyes
CVI challenges one of the most familiar ways of thinking about vision.
A child can have an eye examination that appears relatively normal and still experience significant difficulty using vision in everyday situations. CVI involves the brain and visual pathways, which means the problem can become more obvious in the way a child responds to people, objects, movement, visual clutter, or unfamiliar environments than on a standard acuity chart alone.
The effects can vary considerably from one child to another. Some children may struggle to recognize faces or objects. Others may have difficulty finding something in a visually crowded scene, understanding complex movement, orienting themselves in space, or attending to several visual elements at once.
That variability is part of what makes CVI easy to overlook. The resulting behaviors may be interpreted as behavioral problems, learning difficulties, lack of attention, or characteristics of another developmental condition.
The Pittsburgh Post-Gazette article describing Roman-Lantzy’s work illustrates how easily this can happen. One family reported that their son’s visual difficulties had been documented as misconduct because he looked away or appeared not to be paying attention. His assessment told a different story.
A Child Who Stared at Lights Changed the Direction of a Career
Roman-Lantzy began working with children with visual impairment in the 1970s. One young girl stood apart from the other children she was teaching because she had been considered blind yet spent long periods staring toward lights.
The child’s eye examination was normal, leaving Roman-Lantzy without an obvious explanation for the behavior. Years later, she came to understand that bright light and strong contrast can provide visual information that is easier for some children with CVI to process.
That early experience became part of a much longer effort to understand functional vision in children whose responses did not fit traditional expectations.
Roman-Lantzy later developed the CVI Range assessment, an approach intended to evaluate characteristic visual behaviors and help identify how a child uses vision. According to the Post-Gazette, peer-reviewed research confirming the reliability and validity of the assessment was published in 2026, marking an important point in the development of a tool she first introduced nearly two decades earlier.
Harvard Medical School ophthalmology professor Lotfi B. Merabet told the Post-Gazette that validation represented an important step for a field where physician awareness remains limited. The broader problem is that CVI cannot be approached simply as blurry eyesight that can be corrected with a pair of glasses.
Christine Roman-Lantzy works with her client, Alex Arbutiski, during a play activity adapted for his cortical visual impairment at the Children’s Home of Pittsburgh. Roman-Lantzy has spent decades researching CVI and developing ways to help children better access and interpret visual information.
Visual Clutter Can Change What a Child Can Find
The experience of Samuel, a third-grade student described in the Post-Gazette article, shows how functional vision difficulties can appear in everyday tasks.
Samuel was born prematurely, has cerebral palsy, and had experienced a stroke. His parents traveled from Oklahoma to Pittsburgh seeking answers because he continued to struggle with reading and was receiving little support for his visual needs.
During his assessment, Roman-Lantzy asked him to locate Cheerios placed against backgrounds that became increasingly visually complex. He initially found them without difficulty. As the surrounding patterns became more crowded, however, he became less certain.
The task demonstrated something that can be difficult to capture through a conventional eye examination. A child may be able to see an object when it is isolated but struggle to locate or recognize the same object when competing visual information surrounds it.
That distinction has direct implications for classrooms. Worksheets filled with images, crowded pages, visually complex learning materials, and busy environments may create barriers for a child who otherwise appears capable of seeing.
Roman-Lantzy’s response to Samuel centered on access rather than ability.
“I can’t think what he couldn’t learn. What he has experienced is a complete lack of access. I think he can learn anything. There are just so many kids who need their shot.”
— Christine Roman-Lantzy, Director of Pediatric VIEW, Children’s Home of Pittsburgh
That perspective reframes behaviors that might otherwise be treated as inattention or noncompliance. Understanding how a child processes visual information can change the question from whether the child is willing or able to learn to whether the environment is allowing the child to access what is being taught.
CVI Can Overlap With Other Developmental Conditions
CVI can be particularly difficult to recognize because children may already have neurological or developmental diagnoses.
The NIH notes that cerebral palsy commonly occurs alongside CVI and that characteristics of autism and dyslexia can overlap with CVI-related visual difficulties. CVI itself is not primarily a disorder of language, learning, or social communication, but those similarities can contribute to underdiagnosis or misdiagnosis.
A child who does not recognize a familiar face may appear socially disengaged. Difficulty locating an object among visual clutter may look like poor attention. Avoidance of complicated pictures can be interpreted as a lack of interest.
Those behaviors can have very different implications when a visual processing problem is contributing to them.
This does not mean CVI should replace other diagnoses or that every unusual visual behavior points to cerebral visual impairment. It means functional vision deserves consideration when a child’s everyday visual abilities seem inconsistent with what a standard eye examination would predict.
Assessment Can Lead to More Useful Environments
Identifying CVI is not simply about attaching a name to a set of behaviors. The practical value comes from understanding what helps an individual child access visual information.
At the Children’s Home of Pittsburgh, where Roman-Lantzy directs Pediatric VIEW, assessments can take hours and result in individualized recommendations that address communication, classroom access, mobility, adaptive technologies, and other aspects of daily life.
Those recommendations may involve adjusting visual complexity, changing how objects or learning materials are presented, using stronger contrast, or choosing strategies that match the child’s particular visual responses.
The goal is not to make every environment visually simple. It is to understand which characteristics interfere with a particular child’s visual access and which changes help that child participate more successfully.
This is also why functional assessment matters alongside conventional eye care. Visual acuity remains important, but it cannot describe every aspect of how a child uses vision to recognize people, find objects, move through space, or learn from visually presented information.
Access to CVI Assessment Remains Uneven
Recognition is only one barrier. Families may also have difficulty finding professionals with specific CVI expertise or paying for assessment.
The Post-Gazette reported that health insurance does not cover the specialized testing provided through Roman-Lantzy’s program. Families may face costs between $400 and $700 for assessments that can last several hours, while grants and charitable support help provide scholarships for some families.
That creates an uncomfortable gap. Greater awareness can lead families to seek answers, but access to professionals who understand CVI remains uneven.
The terminology itself has also evolved. Cerebral visual impairment and cortical visual impairment have both been widely used, which is why the combined term cerebral/cortical visual impairment sometimes appears. NIH-led experts have worked to establish clearer elements for identifying the condition and improving consistency among clinicians.
Greater agreement cannot solve every access problem, but a shared understanding can make it easier for clinicians, educators, therapists, and families to recognize when further assessment may be appropriate.
Children Need Their Visual Behaviors to Be Taken Seriously
One of the most important lessons from Roman-Lantzy’s work is that a child’s behavior can provide information about vision.
Looking away, staring toward light, struggling with crowded images, failing to recognize someone, or needing more time to visually locate an object may all be meaningful. They should not automatically be treated as evidence that a child is uncooperative or incapable.
CVI is complex, and no single behavior identifies it. A comprehensive evaluation still matters, particularly because children may have ocular conditions, neurological diagnoses, and other developmental needs alongside cerebral visual impairment.
Greater awareness gives professionals another possibility to consider when a child’s visual behavior does not make sense based on the eye examination alone.
For children such as Samuel, that change in perspective can be profound. Recognizing that difficulty accessing a crowded page is a visual problem rather than misconduct opens the door to different materials, different teaching strategies, and a more accurate understanding of what the child is capable of learning.
CVI reminds us that seeing is not only about whether the eyes detect an image. Children also need the brain to organize and interpret that image in a way they can use.
When that process works differently, the answer may not be asking a child to try harder. It may begin with understanding how that child sees.
Sources
Pittsburgh Post-Gazette. A little girl who ‘stares at the lights all day,’ and a Pittsburgh researcher's quest to find out why. August 8, 2026.
https://www.post-gazette.com/news/health/2026/08/08/pittsburgh-vision-impairment-cvi-christine-roman-lantzy-suicide/stories/202607310044
National Institutes of Health. NIH-led scientific team defines elements of brain-based visual impairment in children.
https://www.nih.gov/news-events/news-releases/nih-led-scientific-team-defines-elements-brain-based-visual-impairment-children
