Research

Citation

Van Hove, C., Damiano, C., & Ben Itzhak, N. (2025). The relation between clutter and visual fatigue in children with cerebral visual impairment. Ophthalmic & Physiological Optics, 45(2), 514–541. https://doi.org/10.1111/opo.13447

Summary

This peer-reviewed study examined the relationship between visual clutter and visual fatigue in children with cerebral/cortical visual impairment (CVI). 

The researchers found a clear association between higher levels of visual clutter and increased signs of visual fatigue. Over 90% of participating children demonstrated observable indicators of visual fatigue, particularly in cluttered environments. The study also highlighted that visual fatigue is influenced not only by visual clutter, but by interacting factors such as lighting, movement, auditory input, and social activity within a space.

Why this matters for the CVI Book Nook

CVI Book Nook materials are designed with careful attention to background simplicity, salient features, reduced clutter and predictable layouts. The findings reinforce the understanding that visually complex environments and materials can increase visual fatigue and reduce a child’s ability to engage, attend, and learn. This study supports the need for materials that prioritize visual access and meaningful interaction for children with CVI.

Related Resource

Perkins School for the Blind. (2025). Research confirms what families know: Clutter causes fatigue in kids with CVI. CVI Now.

This companion article translates the research findings into family- and educator-friendly language and highlights how lived experiences within the CVI community helped shape and inform this study.

Citation

Bennett, R. G., Tibaudo, M. E., Mazel, E. C., & Nai, Y. (2025). Implications of cerebral/cortical visual impairment on life and learning: Insights and strategies from lived experiences. Frontiers in Human Neuroscience, 18, Article 1496153. https://doi.org/10.3389/fnhum.2024.1496153

Summary

This peer-reviewed article examines how cerebral/cortical visual impairment (CVI) impacts learning, navigation, socialization, and overall quality of life through an analysis of lived experiences shared by individuals with CVI. 

The article highlights that visual access for individuals with CVI is often inconsistent and unreliable, particularly in visually complex, cluttered, noisy, or fatiguing environments. Participants described significant challenges with incidental learning, reading, recognizing objects and people, navigating environments, and interpreting social cues. Many individuals reported that using vision requires substantial cognitive effort, often leading to visual fatigue and the need to rely on compensatory sensory strategies.

The authors also describe CVI as a “full-body experience,” emphasizing the impact of CVI on mental and physical health, including anxiety, stress, fatigue, and reduced quality of life. The article underscores the importance of early identification, comprehensive assessment, and individualized, multisensory supports to improve access, participation, and long-term outcomes for individuals with CVI.

Why this matters for the CVI Book Nook

This article directly supports the CVI Book Nook’s emphasis on individual access, reduced visual complexity, and multisensory learning experiences. It reinforces that many foundational concepts typically learned incidentally through vision must be intentionally taught for children with CVI due to fluctuating visual access, fatigue, and environmental demands.

CVI Book Nook materials are designed to reduce visual clutter, support predictable layouts, and pair visual information with meaningful sensory experiences. This research validates the need for materials that prioritize access and participation.

Citation

Manley, C. E., Walter, K., Micheletti, S., Tietjen, M., Cantillon, E., Fazzi, E. M., Bex, P. J., & Merabet, L. B. (2023). Object identification in cerebral visual impairment characterized by gaze behavior and image saliency analysis. Vision Research, 213, 108228. https://doi.org/10.1016/j.visres.2023.108228 

Summary

This peer-reviewed study investigated how individuals with cerebral/cortical visual impairment (CVI) identify common objects presented in different visual formats, including abstract line drawings, realistic line drawings, and color photographs. The researchers compared object identification accuracy, reaction time, and visual gaze behavior in 50 individuals with CVI and 50 neurotypical controls using eye-tracking technology.

The study found that individuals with CVI demonstrated lower success rates and longer reaction times when identifying objects, particularly when images were abstract or presented in black and white. Object identification improved as images became more realistic and included color, with performance approaching that of neurotypical controls when color photographs were used. These findings highlight the importance of object form, contours, and color as critical visual cues for recognition in individuals with CVI.

Eye-tracking data revealed that participants with CVI showed larger visual search areas and a greater number of fixations, indicating increased visual effort during object identification. Gaze patterns in the CVI group were also less aligned with the most visually salient features of the images. When objects were incorrectly identified, participants required even more time and visual effort, further illustrating the cognitive and perceptual demands of visual processing in CVI.

The authors conclude that image design plays a significant role in visual accessibility. Abstract, symbolic, or simplified images—commonly used in educational materials—may pose substantial barriers for individuals with CVI, while realistic, color-rich images can better support recognition and reduce visual effort.

Why this matters for the CVI Book Nook

This research directly supports the CVI Book Nook’s emphasis on intentional image selection, realistic visuals, and reduced visual complexity. The findings reinforce that commonly used abstract or symbolic images may not be visually accessible for many learners with CVI, even when those images are designed to be “simple.”

CVI Book Nook materials prioritize realistic images, salient features, meaningful color, and predictable presentation to support object recognition and reduce visual effort. This study provides empirical evidence that thoughtful image design can improve access, support incidental learning, and reduce visual fatigue for individuals with CVI.

Citation
Stockall, N., Villar Cole, C., & Contreras-Vanegas, A. (2020). Behavioral signs of cerebral visual impairment in very low birth weight infants. Journal of Occupational Therapy, Schools, & Early Intervention. https://doi.org/10.1080/19411243.2020.1822258

Summary
This peer-reviewed article examines early behavioral signs of cerebral/cortical visual impairment (CVI) in infants and young children. The authors explain that CVI is frequently under-identified because many children demonstrate typical visual acuity on eye exams, while still experiencing significant challenges with visual processing, attention, movement, and interpreting visual information.

They describe how CVI often shows up through subtle, adaptive behaviors that are frequently misinterpreted as motor delays, sensory differences, anxiety, or behavioral concerns. Examples include avoiding visual clutter, difficulty with stairs or uneven surfaces, reliance on movement or touch to explore space, preference for slower visual input, difficulty recognizing faces, and challenges making sense of complex visual scenes.

The article explains that dorsal stream impairments may affect visual attention, motion processing, depth perception, and navigation, while ventral stream impairments may impact object recognition, facial recognition, and visual memory. Together, these differences can significantly influence motor development, communication, cognition, and social interaction, especially when children have limited opportunities to visually explore their environment.

The authors stress that many behaviors seen in children with CVI are intentional compensatory strategies used to manage visual overload and fatigue. When these behaviors are misunderstood, children may miss out on appropriate supports during critical periods of brain development. To support access and learning, the authors recommend interventions grounded in Universal Design, Universal Design for Learning (UDL), multisensory instruction, and differentiated instruction, with a focus on reducing visual complexity, supporting predictable routines, honoring individual pacing, and adapting environments and materials to align with how children with CVI use vision.

Why this matters for the CVI Book Nook

This article reinforces that many behaviors seen in children with CVI are adaptive responses to visual overload, not lack of interest or ability. It supports the CVI Book Nook’s focus on simple visuals, reduced clutter, predictable layouts, and intentional pacing to support access and reduce visual fatigue. Most importantly, it validates the need for early, visually respectful learning experiences so children’s strengths are recognized and supported from the start.

Citation
Roman-Lantzy, C. (2019). An approach to literacy for children with CVI. Pediatric Cortical Visual Impairment Society.
https://pcvis.vision/educators-and-therapists/cvi-and-literacy/

Summary
This article outlines a CVI-specific, developmentally sequenced approach to literacy that differs from traditional literacy instruction used with children who have ocular visual impairments. Literacy learning for children with CVI begins with real objects presented in isolation, paired with intentional language that highlights salient visual features. Instruction progresses from objects to images and then to symbols and words, with careful attention to visual complexity, consistency, and repetition.

The article emphasizes that visual discrimination develops before visual recognition and identification, and that words are more accessible when taught as whole visual shapes rather than as strings of individual letters.

Why this matters for the CVI Book Nook
The CVI Book Nook is grounded in this exact framework. Books are intentionally designed to reduce visual complexity, highlight salient features, and support object-to-image-to-symbol learning. Predictable layouts, realistic images, minimal text, and repetition help support visual access, emerging literacy, and shared reading experiences for learners with CVI.

Citation

Chokron, S., & Dutton, G. N. (2016). Impact of cerebral visual impairments on motor skills: Implications for developmental coordination disorders. Frontiers in Psychology, 7, Article 1471. https://doi.org/10.3389/fpsyg.2016.01471

Summary

This peer-reviewed review article examines how cerebral/cortical visual impairment (CVI) affects motor development, coordination, learning, and functional participation in children. The authors explain that vision is foundational to early development, as visual perception precedes and guides action, movement, and interaction with the environment.

The article describes CVI as a brain-based visual impairment that can disrupt visual recognition, attention, spatial organization, visual search, and visuomotor coordination—even when visual acuity appears normal. Damage to dorsal and ventral visual processing pathways can result in difficulties with object and face recognition, navigating space, interpreting complex scenes, guiding movement, and coordinating hand–eye actions. These challenges often become more apparent in visually complex or cluttered environments.

Chokron and Dutton also explore the frequent overlap between CVI and developmental coordination disorder (DCD), noting that motor difficulties observed in children with CVI are often misattributed to primary motor or behavioral conditions. The authors emphasize that unrecognized CVI can limit learning, reduce motivation to explore, restrict incidental learning opportunities, and negatively impact academic performance, social interaction, and independence.

The article underscores the importance of early identification, comprehensive visual assessment, and careful differential diagnosis to ensure that visual impairments are recognized and addressed before children are mislabeled or provided with inappropriate interventions.

Why this matters for the CVI Book Nook

This article reinforces the CVI Book Nook’s emphasis on intentional visual access, reduced visual complexity, and thoughtful material design. The authors clearly demonstrate that vision supports not only recognition and reading, but also movement, exploration, and engagement with the environment—areas that are often disrupted for children with CVI.

CVI Book Nook materials are intentionally designed to minimize clutter, highlight salient features, and reduce unnecessary visual demands so that children can use vision more efficiently and comfortably. This research supports the need for predictable layouts, simplified visual scenes, and multisensory supports to reduce visual fatigue, support incidental learning, and promote meaningful participation across learning and daily routines.

Citation
Hatton, D. D., Ivy, S. E., & Boyer, C. (2013). Severe visual impairments in infants and toddlers in the United States. Journal of Visual Impairment & Blindness, 107(5), 325–336.

Summary
This large-scale study examined data from nearly 6,000 infants and toddlers with severe visual impairments across the United States. The findings identified cerebral visual impairment (CVI) as the most prevalent cause of severe visual impairment in young children. The study also found that a majority of these children have additional disabilities and that there is often a significant delay between diagnosis and referral to specialized early intervention services.

The authors highlight the importance of early identification, early intervention, and the need for developmentally appropriate materials that support learning from a very young age.

Why this matters for the CVI Book Nook
This research reinforces the need for accessible, inclusive learning materials designed for children with CVI and complex needs. CVI Book Nook resources are created with the understanding that many children with CVI have multiple disabilities and may experience delays in accessing appropriate services. Providing visually accessible books early helps support concept development, communication, and shared learning experiences during critical developmental periods.