• Profile video | Profile transcript
• 17 years old
• Traumatic Brain Injury at age 11.
• Orthopedic ally Impaired–CP
• Eye Exam indicates that there is no ocular visual impairment; CVI is the main cause.

CVI Parent Interview Questions: (teacher and mother filled in answers together)
(p. 34, Roman-Lantzy, 2007)

Parent Interview video | Interview transcript

1. Tell me what you do with a toy to get your child interested in it?  Definitely interested in any kind of basketball, balls of any size (size doesn’t matter).  Doesn’t take much to get him interested in something. Before it may have needed movement or be a red color but they are past that. 
2. When you show your child something, how do you know he or she sees it? I ask him to tell me about it.  That is where we have gotten to pictures.  Describe it for me and he does.  Especially objects in space.  In pictures we question and wonder if he is guessing. 
3. Does your child have a favorite side or a favorite head position? He tilts to the right.  When we have worked on visual things especially with picture cards/ etc.  We always do them up or eye level.  (Such as on a white erase board more on the right then on the left).   He has a harder time attending to things that are down in front of him. 
4. Does your child usually find objects by look or by feeling for them? Most of the time by looking.  Sometimes when things are on the table I catch him feeling for items.  They had a big keys keyboard and he could tell you all the letters that were yellow.  Using his hands and using his eyes at the same time was difficult.  
5. Do you have concerns about the way your child sees? Yes, it is not something that is constant and you can have days that are different.  We will start understanding what he is seeing more and more.  The other part is that I am concerned about his vision in the way of reading and him being completely independent.  Three or four years ago they worked on sensitivity in his fingers for Braille.
6. Where do you usually hold objects for your child to look at?  At eye level (best).  Ian can see objects pretty much on any plane.  It is the 2D that is trickier.
7. What are your child’s favorite things in your house?  Basketball, mixer, monkey (named Dexter), anything with the Lakers, Air Hockey table and his Wii.  His CD’s– he learned through repetition. 
8. What, if anything, have doctors told you about your child’s eyes?  That they are 20/20.  There is nothing wrong with his eyes– it is all in the brain. 
9. When does your child usually like to look at things?  When he is awake and alert.  When he gets really tired it is hard to see.  It takes a lot of conscious effort to see things– low contrast.
10. What color are the things your child likes to look at most?  If we are on the highway, he always points out yellow cars.  Also things that are red.  Bright colors.  He is not dependent on color to see like he used to be.  Contrast definitely helps him see better/ he misses a lot of detail.
11. What does your child do when he or she is near very shiny or mirrored objects?  This is not as applicable now– but early on it would get his attention.
12. Describe how your child behaves around lamps or ceiling fans.  Doesn’t stammer on them.  He is normal around them. 
13. Are you usually able to identify what your child is looking at?  Sometimes it is difficult.  Mom has been told that his peripheral vision in his brain is stronger than his straight on focus. 
14. Does your child usually first notice things that move or things that don’t move? When he first started getting into objects it required movement.  He probably attends to things better if they move.  He does not require it anymore.
15. How does your child position his or her head when you think he or she is looking at something?  I don’t know.  (Maybe down towards the left, teacher thinks.)
16. Do you think your child has a “favorite” color?  Purple/Gold (Lakers).  As far as visually yellow or red.
17. Does your child seem to notice things more at home or more in new places?  If it is objects or when driving to San Antonio he can point out where they are.  In some unfamiliar situations it may be harder. 
18. Describe how your child positions his or her head when swatting or reaching toward something.  He reaches with his left and guessing that his head is cocked to the right (guessing to the right/teacher sees to the Left).
19. How does your child react when you give him or her new things to look at?  Both the language retrieval and vision are when he has a difficult time with new things.  He knows what they are.  If you give him multiple choice he can retrieve it. 
20. Do you position your child in a certain way to help him or her see things?  When they would do cards they did it at eye level.  He was not as successful when things were on the table.  There cannot be a lot of stuff competing with what he is trying to see.  He can point to the details of an object on a picture card and then he would be able to put those cards together and label the object.
21. Have you ever been concerned about the way your child’s eyes move? No
22. What does your child do when there are many objects in front of him or her to look at?  That is overload.  He may try but then it is just too much.
23. Tell me about the faces your child prefers to look at.  Pretty girl faces.  Calendar of pretty girls he would rather look at that! That is one of the suggestions one center had made about retraining Ian’s brain that there should be pictures of pretty girls and have Ian describe what they are doing differently in the pictures.
24. If your child had his or her own object to look at and a new object, which object would he or she prefer?  Depends on what the other object is. 
25. Tell me what your child’s favorite objects or toys look like.  Pictures of girls, basketball, etc.  Can be anything and any size. Flat and does not have the dimension that is the problem– it is not going to help just making it bigger. 

Answer Key for Ian's CVI Resolution Chart (Cheat Sheet)

INTERVIEW: (* on chart) (+ positive for CVI, – negative for CVI, ? inconclusive)

1. + Targets movement (2) and fields (4).  Positive for CVI because it used to require movement, but don’t mark on chart for current functioning.  Actually addresses color: Mark on chart in row 1, range 9–10.
2. + Targets visual attention/non–purposeful gaze (6).  Answer refers to complexity (5), and places him in the 8–9 range.  He looks at pictures but may be guessing as to their meaning, and sees 3–d better (“objects in space”).  Mark on chart in row 5 on line between range 7–8 and 8–9.  Positive for CVI but not for what question asks.
3. + Asks about field preference (4) and additional disabilities.  Answer seems to be positive for fields– “more on the right” & “harder to attend to things down in front”.  Mark this on resolution chart in row 4, range 3–4.
4. + Asks about visually guided reach (10) or visual complexity (5).  Answer positive for visually guided reach because of “using hands and eyes together at the same time was difficult”.  Mark this on row 10, in range 5–6.  Make note on chart that highlighting with yellow is helpful.
5. + Is asking about appearance of the eye/eye exam.  Positive for CVI because of comments on how visual function changes.  Not necessary to mark anywhere on chart.
6. + Asks about visual field preferences (4) and visual complexity (5).  Answers give positive answers for fields “can see objects pretty much on any plane”  (4) and complexity “”2D is trickier” (5).  Record range 9–10 in row 4.   Answer is inconclusive as far as range for complexity so no markings necessary.
7. ? This question targets light–gazing/non–purposeful gaze (6), movement (2), and visual novelty (9).  The answer does not give clear information to mark on chart–just that he’s a teen! 
8. + Asks about eye exam.  Positive for CVI.  20/20 vision in eyes, but vision is still impaired.  Make note under distance, row 7, that eyes are 20/20, FYI.
9. + Asks about visual novelty (9) and complexity (5).  Answer is positive for latency (3).  Mark on chart in row 3, range 5–6.
10. +Asks about color preference (1) and novelty (9).  Answer is positive for color preference, but not specific enough to mark on chart (1).   Make note that yellow and red highlighting help draw visual attention under row 1.
11. + Asks about light gazing (6), movement (2), and color preference (1).  Answer is positive for CVI in that he used to light–gaze, but it is now resolved.  Mark in row 6 under range 5–6.
12. + Asks about non–purposeful gaze/light–gazing (6).  Answer is same as 11.  Mark in row 6 under range 5–6.
13. ? Asks about non–purposeful gaze (6).  Answer addresses fields but is inconclusive.
14. + Asks about movement (2) and fields (4).  Answer is positive CVI for movement because it used to be needed but is no longer needed but still helps with attention.  Record on chart in row 2 range 7–8.
15. ? Targets fields (4).  Answer is inconclusive.
16. +Asks about color preference(1).  Answer is positive for CVI.  Mark on row 1, range 7–8, continues to prefer red and yellow.
17. + Targets complexity of array (5) and non–purposeful gaze (6) and novelty (9).  Answer addresses complexity but answer is not on chart–he is able to look in a very complex situation–while driving in car looking out window.  Answer also addresses novelty because he can point out objects on familiar drive.  Mark in row 9 under range 7–8.
18. ? Targets visual motor (10) and field preferences (4).  Answer is inconclusive because some of the way he moves/turns his body has to do with motor impairment.
19. + Targets novelty (9) and complexity (5).  Answer is positive for novelty–in that giving multiple choice may serve as warm–up time.  Mark in row 9 under range 7–8.
20. + Asks about fields (4) and complexity (5).  Answer addresses complexity in that “there cannot be a lot of stuff competing with what he’s trying to see”.  This refers to visual clutter, not auditory.  It may be marked in row 5, range 7–8 by process of elimination.  (5–6 too low, 9–10 too high for this).
21. ? Asks about eyes.  Targets those kids who do not already have CVI diagnosis.  Answer is inconclusive.
22. + Targets complexity (5) and novelty (9).  Answer is positive for complexity (5).  “That is overload–he may try but then it is just too much.”  Mark in row 5, range 7–8, same reason as question 20.
23. ? Targets novelty (9) and complexity(5).  Inconclusive–it does not say what Ian does in response to the pictures of pretty girls.
24. ? Asks about novelty (9) and complexity(5).  Answer is inconclusive.
25. ? Asks about novelty (9) and complexity(5).  Answer is inconclusive

         17 positives, 0 negatives, 8 inconclusives.

OBSERVATION: (• on chart)

Observation video | Observation transcript

1. Accurate reach while looking at van door to close it.  Visually guided reach–mark row 10 under range 9–10.
2. Recognized “fruit” from 5 ft.  Mark row 5 (complexity), range 9–10 and row 7 (distance), range 5–6.
3. Color–first looked at red, Lisa asked to identify, touched to gain more information. (pepper)  Supports continued attraction to things that are red and that Ian continues to need tactual information to check/verify visual information.  Also, has trouble differentiating red and orange: identified red apple as an orange.  Good information, but not for chart.
4. When asked if it’s a lemon or a lime, he leaned in to narrow field and decrease complexity. Mark on chart, row 5 (complexity), range 9–10.
5. Hard to tell the color of the lime when it was over complex, multi–colored background.  Easier when over black and white background.  Mark under complexity, row 5, range 9–10.
6. Identifies orange correctly, quickly while touching and holding over plain background. Mark under complexity, row 5, range 9–10.
7. When asked to pick something from a complex array that did not include red, Ian picked a yellow squash.  Make note, yellow still draws visual attention.
8. Is able to visually function with background noise. (Music, Lisa talking, etc.)  Use milk/eggs as example.  Mark on chart under complexity, row 5, range 7–8.
9. Gum shelf shows fatigue–looking away and not looking close, like when really looking for visual information.  This began after about 10 minutes of looking in new environment.  Mark in latency, row 3, range 5–6.
10. Doesn’t look at cashier at all, even though he’s pretty social–fatigue. Mark in latency, row 3, range 5–6.
11. Finds van from 20 feet (or more) in unfamiliar environment!  Distance–mark in row 7 under range 9–10.

DIRECT ASSESSMENT (^ on chart):

Session 1:

Direct Assessment #1 video | Assessment #1 transcript

1. When asked to pick up skittles off table, picks up red first, then yellow, then other colors.  Finds in many fields. Mark in row 4 (field preferences), range 9–10.
2. Notices object in left, right, and upper peripheral fields quickly, minutely faster response when object moving. Mark in row 4 (field preferences), range 9–10.
3. Pictures: After viewing pictures section, mark in row 5 (complexity) range 7–8.
   • Color outline or white not necessary to help Ian look at picture.
   • Single colored items are most easily identified in pictures, such as the van (identified as a car–large expanse of white) and the pool (large expanse of blue).  This might be a helpful strategy.
   • Outlining pictures in a particular may be used for categorization, such as person, place, object, (provides a hint–visual categorizing is something CR recommends for students at this phase, too), but don’t use red and orange.  Ian can’t tell them apart well enough.
   • Ian uses strategy of moving close, moving and turning picture but it does not seem to help. 
4. Cluttered background with with 4 previously recognized pics, gets close but can’t find pool (picks van instead–blotch of white when blue pool probably blended into background.)  Mark in complexity, row 5, under range 7–8.
5. Blocks–picked an orange block when asked for red.  When asked to pick any block and say the color picked yellow. Harder to find green, but accurately picked it.  Has trouble with red and orange, but better if they’re next to each other for comparison(?).  Also–obviously getting tired.  Ian has been intensely using his vision for about 10 minutes (mark in row 3 (latency) range 5–6.

Session 2:

Direct Assessment #2 video | Assessment #2 transcript

6. Faces: recognized familiar people in context.  When they were out of context he had more trouble.  Mark in complexity, row 5, range 7–8.
7. Moving and handling is a strategy Ian uses–it seems to work better with objects than pictures.  He gets information from tactile and auditory senses over and above vision–might be interfering with vision. Mark in complexity, row 5, range 7–8. 
8. Visually guided reach together or in rapid sequence.  Mark in row 10, box 7–8.
9. Blink to threat, blink to touch–Mark in Row 8, range 9–10.

CVI Resolution Chart

From Cortical Visual Impairment: An Approach to Assessment and Intervention, by Christine Roman-Lantzy, copyright © 2007, AFB Press, New York. All rights reserved. These forms have been modified to enhance accessibility.

Date:                                       Student’s Name:      Ian                                 Evaluator: Lynne & Sara
Use the following chart to help develop areas of needs for development of IEP goals and objectives.

There are three phase categories which group the ranges as follows: Phase I (Range 1–2 to the midpoint of Range 3–4) Building Visual Behavior, Level I Environmental Considerations; Phase II (midpoint of Range 3–4 to midpoint of Range 7–8) Integrating Vision with Function, Level II Environmental Considerations; and Phase III (midpoint of Range 7–8 to Range 9–10) Resolution of CVI characteristics, Level III Environmental Considerations.

Key:

• Draw an X though boxes that represent resolved visual behaviors
• Use highlighter to outline boxes describing current visual functioning
• Draw an O in boxes describing visual skills that may never resolve because of coexisting ocular conditions

From Cortical Visual Impairment: An Approach to Assessment and Intervention, by Christine Roman-Lantzy, copyright © 2007, AFB Press, New York. All rights reserved. These forms have been modified to enhance accessibility.

Essential Forms
The CVI Range

Recording the CVI Range video | Recording the CVI Range transcript

From Cortical Visual Impairment: An Approach to Assessment and Intervention, by Christine Roman-Lantzy, copyright © 2007, AFB Press, New York. All rights reserved. These forms have been modified to enhance accessibility.

Student/child’s name:  Ian                                      Age:  17
Evaluator(s):  Lynne and Sara                                          Evaluation Date:  ___00/00___
This assessment protocol is intended for multiple evaluations over a period of time.  Suggested scoring (no less than three times per school year):

• Initial assessment (red)
• Second assessment (blue)
• Third assessment (green) Further assessments will require a new form.

First evaluation on 00/00 shows range of CVI to be 7.75 to 9.

Figure1: Line graph from 1 to 10, 1 representing no functional vision and 10 representing typical or near–typical visual functioning.

From Cortical Visual Impairment: An Approach to Assessment and Intervention, by Christine Roman-Lantzy, copyright © 2007, AFB Press, New York. All rights reserved. These forms have been modified to enhance accessibility.

The CVI Range:  Across – CVI Characteristics Assessment Method

From Cortical Visual Impairment: An Approach to Assessment and Intervention, by Christine Roman-Lantzy, copyright © 2007, AFB Press, New York. All rights reserved. These forms have been modified to enhance accessibility.

Rating I

Rate the following statements as related to the student/child’s visual behaviors by marking the appropriate column to indicate the methods used to support the scores:

• O = information obtained through observation of the child/student
• I   = information obtained through interview regarding the child/student
• D  = information obtained through direct contact with the child/student

In the remaining columns, indicate the assessed degree of the CVI characteristic:

• R    = The statement represents a revised visual behavior
• +    = Describes current functioning of student/child
• +/–  = Partially describes student/child
• –    = Does not apply to student/child

From Cortical Visual Impairment: An Approach to Assessment and Intervention, by Christine Roman-Lantzy, copyright © 2007, AFB Press, New York. All rights reserved. These forms have been modified to enhance accessibility.

The CVI Range:  Within – CVI Characteristics Assessment Method

From Cortical Visual Impairment: An Approach to Assessment and Intervention, by Christine Roman-Lantzy, copyright © 2007, AFB Press, New York. All rights reserved. These forms have been modified to enhance accessibility.

Rating II

Determine the level of CVI present or resolved in the 10 categories below and add to obtain total score. Rate the following CVI categories as related to the student/child’s visual behaviors by circling (marked with parenthesis on the chart below) the appropriate number (the CVI Resolution Chart may be useful as a scoring guide):

• 0    Not resolved; usually or always a factor affecting visual functioning
• .25    Resolving
• .5    Resolving; sometimes a factor affecting visual functioning
• .75    Resolving
• 1     Resolved; not a factor affecting visual functioning

Total of CVI characteristics present (numbers in parenthesis) = 7.75

From Cortical Visual Impairment: An Approach to Assessment and Intervention, by Christine Roman-Lantzy, copyright © 2007, AFB Press, New York. All rights reserved. These forms have been modified to enhance accessibility.

Cortical Visual Impairment (CVI) Assessment

Recommendations video | Recommendations transcript

Student: Ian
Assessors: Lynne McAlister, TVI; Sara Kitchen, TVI
Date: 00–00– 00

Ian was assessed using the Roman–Lantzy (2007) CVI resolution assessment tool. At today’s evaluation date, he is 17 years old. The primary goal of this assessment is to determine functional vision abilities and to identify potential characteristics of CVI that may be interfering with Ian’s functional performance.

Ian’s medical history is consistent with the neurological disorders often associated with CVI. His primary handicapping condition is traumatic brain injury. Ian does not wear corrective lenses and his eye exam indicates CVI as the reason for his visual impairment. The evaluation consisted of analyzing videotapes of Ian in several environments as well as information from his parents and the staff members who work with him. Ian demonstrated characteristics of CVI. This report will be organized according to these characteristics.

Color preference:

Some people with CVI seem to respond more quickly to objects of a particular color. Ian hovers between total resolution of color vision and still preferring certain colors. While he looks at objects of any color, he seems to gravitate toward shades of red and yellow. Ian’s mother states that in the past he may have needed an object to be red or yellow but he is beyond that now. However, he usually picks out red and yellow cars when asked to point them out on the highway. When presented with an array of multicolored skittles, he picked up a red one first, then a yellow. Red shades seem to be the most easily seen color, but when asked to pick up a red block from a colored array he chose an orange block and told me it was red. When asked in the same situation to pick up any block and tell me it’s color, he chose and accurately named the yellow. After picking up a red block, he studied it for some time before correctly identifying it. At a grocery store, he was asked to pick one fruit/vegetable from the array on the shelf. Ian chose a red pepper and named the color orange. He identified a red onion and red apple as orange. When asked to pick another fruit from an array that did not have any red objects in it, he chose a yellow squash. He correctly identified a drawing of a red stop sign saying, “Red, it’s a stop sign.” He identified a drawing of a yield sign as, “a yellow sign.” When asked to identify several multicolored objects, he would invariably pick them up first and then look at them. When asked to identify the object only visually, he looked at it and picked it up. After handling the objects, he correctly identified most of them. He did not identify a brown action figure, but did say that it was orange. While not recognizing a picture of the outside of the campus natatorium (he identifies it as a “building”), when shown a picture of the inside he said, “blue…it’s the pool. I can see it better because it’s blue”. He could not identify a photo of a familiar campus location that was black and white, only identifying the pavilion as being outside. These reactions seem to indicate that color acts as a visual magnet for Ian. He seems to see objects that are in the red/orange spectrum as well as yellow more easily than others. This visual behavior in students with CVI has been corroborated in the literature. 

Need for Movement:

Many people with CVI respond best visually to targets that move in space or have reflective properties. Ian’s mother says while he probably attends to things better if they move, he does not require it anymore. When presented with shiny, moving objects in his peripheral fields, Ian seemed to see the objects a second before he saw them when they were not moving, but it was not a noticeable difference. Ian looks at objects that are neither moving, shiny, nor reflective. This CVI characteristic seems to have been resolved.

Visual Latency:

 This characteristic manifests itself with a delayed response between the time a target is presented and the time when an individual sees it. Ian showed little or no delay in directing his vision to a target. However, he did show delays in correctly identifying a target, such as photos and objects. He took some time to study these items, sometimes moving the item around as an aid in recognizing it. Physically handling objects seemed to directly affect his ability to identify them. Ian displays a visually guided reach, meaning he is able to look at an object and use that information to touch it.

Visual Field Preferences:

Many students with CVI have strong visual field preferences. These field differences are typically not due to damage to the retina or other structures of the eye, they are caused by damage to the visual pathways of the brain. Ian was able to pick up skittles placed in all of his visual fields. He recognized objects coming from behind him without restriction in his right, left, upper, and lower fields. He used his central visual fields to look at objects. These behaviors indicate that this characteristic has been resolved. However, Ian’s mother reports that he tilts his head to the right when viewing objects, and he seems to have a harder time attending to things that are in his lower visual fields. This may be from a difficulty controlling the movements of his head and eyelids, or may indicate a continuing visual difficulty with visual fields.

Visual Complexity:

Difficulties with visual complexity can mean difficulty with the complexity of the surface of the object, of the viewing array, or of the sensory environment. Along with color, this seemed to be the most challenging aspect of Ian’s vision. His mother states that his vision is compromised when there are a lot of things competing with what he is trying to see. When there are too many objects in his visual field it is overload. He may try but then he gives up. Ian was able to identify salient features in two and three–dimensional materials with backgrounds of low complexity. To look at these materials, he often would either bring the object 8 to 12 inches from his eyes, or lower his head the same distance. This succeeds in blocking out background clutter, and is not necessarily an indicator of impaired acuity. However, it is important to refer to an eye specialist when there is a question of visual acuity impairment. Ian’s eye doctor has given him acuity of 20/20. Ian’s mother was also unsure of his ability to interpret two–dimensional pictures, stating that he may be guessing.  Ian was able to identify photos of a van, a person (“it’s a girl”), and the school cafeteria full of people. When presented with a Meyer–Johnson picture of a round smiling face, he asked if it told time. After four pictures he had correctly identified were placed on a very colorful patterned background and asked to find the pool picture, he bent his head four inches from the array and studied it for approximately 45 seconds. He then chose the picture of the white van. After being given a lime at the grocery store, Ian could not name identify it or state it’s color while holding it over the array of the other fruit and vegetables. When asked to turn so that he was holding over the brown floor, he stated it was “greenish”. He was also able to identify an orange when he held it over the uncluttered floor. When asked to identify unspeaking people sitting next to him, Ian accurately named his teacher and TA. When asked to identify a job coach, Ian initially identified him as his RI, and then correctly named him. Faces present a very complex visual array, and the inability to recognize them is very common among people with CVI. This characteristic seems to be resolving in Ian.

Light Gazing and Non Purposeful Gaze:

Some people with CVI have abnormal responses to light, either staring at light, or photophobia. Ian displays none of these behaviors.

Difficulty with Distance Viewing:

Ian recognized a van at a distance of 20 feet. However, distance vision is greatly affected by difficulties with visual complexity, as the further you look the more things that are in the visual field.

Atypical Visual Reflexes:

Ian blinked when a hand approached his face. This is a typical response of the eye to a visual threat.

Difficulty with Visual Novelty:

Many individuals with CVI tend to visually attend to objects or targets seen previously, but may ignore visually novel or new things. Ian’s mother states that in unfamiliar situations it may be more difficult for him to process visual input. She reports that he learns through repetition. When he gets tired it is harder for him to see. Ian seemed to be able to see all the objects I presented, but it took him several seconds of study before he could name an unfamiliar object or picture. This delay was most pronounced in very complex visual environments. Ian told his teacher that if he studied flash cards with sight words on them he would be able to read them better. When Ian’s job coach sat down next to Ian silently within the context of a routine that did not normally include the job coach, it took Ian at least a minute to name him correctly, first labeling him a RI. Ian’s mother states that he has a difficult time with language retrieval paired with visually novel objects

Absence of Visually Guided Reach:

This characteristic may be thought of as hand–eye coordination. Ian’s mother reports that using his hands and eyes together is difficult for him. Ian is able to look at something and pick it up simultaneously. However, once he is holding an object he may not look at it as he tactually manipulates it to aid in recognizing it. In one session with us, Ian insisted on picking up the novel objects we showed him, even though we asked him to just look at them. Tactual input seems to assist him with object recognition.

Lynne McAlister, CTVI, and Sara Kitchen, CTVI

Recommendations

• Color should be used to anchor Ian’s vision to the objects he needs to look at. The colors red, orange, and yellow should have dominance, then the other colors in the spectrum. This may be done by using color photos of people and places to organize his calendar or some other familiar sequence, the current event highlighted with a red or yellow cardboard frame that can be moved from picture to picture.  Highlight visual targets with red/orange spectrum colors to draw Ian’s visual attention.  Use labeled color photographs (of items, places, etc., that contain color) as symbolic representations in Ian’s daily schedule/activities. Drawn pictures may also be useful as an organizational tool within lessons, especially if he is involved in the drawing and labeling process. These labeled pictures may take the place of written notes. Perhaps experiment with bold print on a red or yellow background to see if this aids in his sight word recognition. The goal is to allow Ian access to a learning media that does not depend on another person to deliver it. Ian may not be able to recognize either the picture or the word at first, but through consistent exposure he may be able to more easily process the information to the point of the picture no longer being necessary.
• Present visual targets on a plain background.  Allow Ian to bring items close to his face in visually cluttered environments. Always be aware of the visual environment behind the object he is looking at. Simplifying the background of an object or person may allow him to recognize it.
• Allow Ian tactual access to objects to assist in recognition.  Also, encourage exploration of objects to increase Ian’s knowledge of the tactual properties of objects as they relate to the visual aspects. Encourage Ian to look and manipulate objects at the same time.
• Use some sort of occluder to block out excess detail on a page of images or symbols. For example, block out all but the individual word that is being read.
• Experiment with spacing between letters in words to see if it is easier for Ian to recognize the letters when they are farther apart.
• Highlight environmental landmarks as necessary.
• Consider the use of a cane, which may help Ian remain anchored to the environment in the presence of a high degree of environmental complexity.
• Allow Ian time to study a novel object/word before requiring a response. Perhaps he could be given the opportunity to examine materials for an upcoming lesson without adult intervention so that he has some degree of visual recognition of the task.
• Be aware that Ian experiences visual fatigue after approximately 10 minutes of consistent uninterrupted viewing. This is especially apparent with novel items. Upon reaching this point, Ian stops looking. Build in frequent breaks when asking Ian to use his vision, allowing him to also respond auditorially.
• While movement may aid Ian’s use of vision, when he is upright and walking he is also concentrating very hard on those motor skills. This divided attention may detract from his ability to process visual input. It will be easier for Ian to perform complex visual tasks when his body is stable and seated.
• Christine Roman states that instruction for a student with a high resolution of CVI characteristics, such as Ian, has two main themes: teaching sorting skills with reference to the concepts of alike and different, and disembedding salient features from a background. Learning how to compare and contrast the visual properties of objects supports the ability to analyze novel information and visual complexity. Learning to differentiate a feature or object from a background supports the development of the ability to differentiate details and make fine visual discriminations.
• As with any student with CVI, Ian’s functional vision may be affected by factors such as stress, over–stimulation, fatigue, or too much visual novelty.