Towards Designing Digital Learning Tools for Students with Cortical/Cerebral Visual Impairments: Leveraging Insights from Teachers of the Visually Impaired
Adele Smolansky, Miranda Yang, Shiri Azenkot · 2024 · Proceedings of the 26th International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS '24) · doi:10.1145/3663548.3675636
Summary
This paper investigates how digital learning tools should be designed to support students with cortical/cerebral visual impairment (CVI), a neurological condition that affects the brain's ability to process visual information rather than the eyes themselves. CVI is now the most common cause of visual impairment in children in the developed world, yet digital tools are overwhelmingly designed for ocular visual impairments such as blindness or low vision, which have fundamentally different characteristics. The researchers interviewed 20 U.S.-based Teachers of the Visually Impaired (TVIs) who specialised in working with students with CVI. These TVIs described a highly individualised, labour-intensive process of assessing each student's visual profile — encompassing their specific CVI characteristics, preferred colours, tolerance for visual complexity, visual field preferences, and environmental sensitivities — and then manually adapting academic materials to match. CVI is characterised by a set of ten visual and behavioural traits identified by Christine Roman-Lantzy, including difficulty with visual complexity, preference for familiar objects, challenges with distance viewing, visual field preferences, difficulty with visually guided reach, need for movement to attract visual attention, problems with visual novelty, absence of visually guided reflexes, difficulty with crowded visual environments, and light-gazing or light aversion. Each student presents a unique combination of these characteristics at varying severities, making one-size-fits-all solutions inadequate.
Key findings
TVIs reported spending enormous amounts of time manually creating accommodations — enlarging images, reducing visual clutter, adding colour highlights ("bubbling" letters), isolating content on pages, and sourcing real-world photographs instead of abstract clip art. Most existing digital learning tools were described as unusable for CVI students because they featured cluttered interfaces, small text with insufficient spacing, complex backgrounds, abstract or cartoonish imagery, and auto-advancing content that did not allow enough processing time. Participants identified several critical design requirements: tools must allow customisation of visual complexity (reducing elements on screen), support individual colour preferences (not just high contrast), use real photographs rather than illustrations, provide ample spacing between elements, allow content to remain static until the student is ready to advance, and avoid visual clutter in navigation and interface chrome. TVIs strongly desired tools that could automate the adaptation process — for example, automatically simplifying a worksheet based on a student's visual profile. The study also revealed that CVI students are often inappropriately served by tools designed for blind users (such as screen readers), even though their needs are visual rather than auditory. Several participants noted that CVI awareness among general education teachers and even some vision professionals remains low, creating additional barriers.
Relevance
This paper fills an important gap in accessibility research by focusing on a population whose needs are poorly understood and rarely addressed in digital design. For web and application developers, the findings highlight that standard accessibility practices — designed primarily for blind or low-vision users — do not serve people with CVI. The design considerations offered are directly actionable: reduce visual complexity, support customisable colour schemes beyond simple high contrast, use real photographs over illustrations, allow user-controlled pacing, and provide generous spacing. The concept of a student visual profile that drives automatic adaptations suggests a promising direction for personalised accessibility settings. For accessibility practitioners, this paper is a reminder that visual impairment is not monolithic — neurological visual impairments require fundamentally different accommodations than ocular ones. The study's limitation is that it captures teacher perspectives rather than direct input from students with CVI, though the authors acknowledge this and note the ethical complexities of research with children who have complex needs.
Tags: cortical visual impairment · education · digital learning tools · visual impairment · assistive technology · children