Uncovering Hidden Visual Challenges in Down Syndrome

Published July 11, 2025 · Frontiers in Human Neuroscience

Cortical visual impairment (CVI)—a neurological condition affecting how the brain processes visual information—is now recognized as the most common cause of childhood visual impairment in the U.S. Yet its occurrence alongside Down syndrome (DS) remains underdiagnosed.

A new case series in Frontiers in Human Neuroscience explores how CVI can compound the visual and developmental challenges already present in individuals with DS. The study closely examines three adolescents (ages 15–19) with DS, aiming to distinguish behaviors resulting from CVI from those tied to DS or other common neurodevelopmental conditions like ASD and ADHD.

🎯 What the Cases Reveal

Shared Visual Impairments
All three participants showed:

Reduced visual acuity and constricted visual fields
Difficulties with eye coordination and motion tracking
Challenges in both recognition (ventral stream) and navigation/judgment (dorsal stream)
Sensory overload when processing visual, auditory, and tactile input simultaneously

Functional Vision Insights
Through parent-led inventories and functional vision assessments, the study highlighted how clutter, color, and movement significantly affect visual attention and task completion. A common strategy employed was reliance on color coding and multisensory cues (verbal, auditory, tactile) to aid in object recognition and learning.

Behavioral Adaptations
These teens often exhibited protective behaviors like slow, cautious walking, trailing hands along walls, or avoiding busy visual environments. Some also showed physical signs of visual overwhelm, such as fainting or migraine-like symptom.

Why It Matters

Misdiagnosis & Diagnostic Overshadowing
CVI symptoms are easily mistaken as general DS traits or attributed to coexisting conditions like ASD—often delaying identification and support.
Impact on Development
With vision central to how individuals with DS engage with the world—especially as visual learners—undetected CVI can hinder educational, social, and life-skill development.

Taking Action: Screening & Accommodations

Assessment Tools:
The team used validated questionnaires like the “Top‑11 CVI Screener” and HVFQI-51 along with functional vision assessments to formally identify CVI traits.

Effective Accommodations:
For those identified with CVI, tailored supports made a measurable difference:

Clutter reduction and high-contrast visuals: Clear, simplified visual spaces aid attention
Color coding & visual schedules: Bright cues support recognition and memory
Multisensory learning: Combining verbal, tactile, and auditory reinforcement helps when visual processing is overloaded

Looking Ahead

The study highlights an urgent need to integrate CVI screening into routine care for individuals with DS. Researchers call for:

Epidemiological studies to track how widespread CVI is in the DS population.
Standardized screening protocols embedded in clinical practice.

What You Can Do

If you’re a clinician, caregiver, or educator supporting someone with DS, consider these steps:

Be alert to signs like difficulty finding objects in clutter, brief gazes at faces, overwhelming responses to motion or noise.
Use standardized tools (e.g., Top‑11 Screener, HVFQI-51) to assess CVI-related behaviors.
Introduce simple modifications: declutter spaces, add color-coded cues, streamline visual elements.
Collaborate with visual specialists, OTs, and multisensory learning experts.

Final Thoughts

This study shines light on a critical—but often hidden—aspect of visual health in Down syndrome. Better screening, targeted supports, and early intervention could dramatically improve quality of life, learning, and independence for individuals living with DS + CVI.

Reference
Vietzman, S., Chandna, A., & Heidary, G. (2025). Cerebral/Cortical visual impairment (CVI) in Down syndrome: a case series. Front. Hum. Neurosci. 19:1563420. DOI: 10.3389/fnhum.2025.1563420.