Understanding the Connection Between HIE and Cortical Vision Impairment in Children
When a baby experiences a lack of oxygen to their brain—before, during, or after birth—it can lead to a condition called hypoxic ischemic encephalopathy (HIE). HIE is a type of brain injury that affects how different areas of the brain function, including the parts that process vision.
One of the most common vision-related impacts of HIE is something called cortical visual impairment (CVI), also known as cerebral visual impairment. CVI is now the leading cause of permanent visual impairment in children in the world.
CVI is different from problems with the eyes themselves. Instead, it happens when the brain has trouble understanding or processing the information it receives from the eyes. In children with HIE, the areas of the brain that were injured often include those responsible for visual processing, such as the occipital lobe or pathways connecting different brain regions.
Children with CVI may have trouble:
These challenges can vary greatly from child to child.
While estimates vary, studies suggest that 30% to 70% of children with HIE may develop some form of visual processing difficulty, including CVI. The risk is higher in children who had more severe brain injuries or needed intensive care like cooling therapy in the NICU.
Pediatric-acquired HIE—brain injury from lack of oxygen after the newborn period—also carries a risk for CVI, especially if the injury affects the back parts of the brain.
CVI can be hard to diagnose early on because infants and young children are still developing their vision. Parents are often the first to notice something seems different—such as their baby not making eye contact, seeming uninterested in faces or toys, or reacting unpredictably to movement or lights.
While CVI can be suspected in infancy, it is most commonly diagnosed between ages 1 and 3, once visual behaviors and brain development become easier to observe and assess.
There is no single test to diagnose CVI. Instead, doctors use a combination of:
Early and accurate assessment is important for planning support.
The good news is that vision can often improve over time with the right support. Interventions may include:
Families play a vital role in helping tailor strategies that work best for their child.
Recent studies are showing that early screening for CVI in babies with HIE is critical. There is growing evidence that the brain has more “neuroplasticity” (the ability to rewire and adapt) in early childhood, making early intervention especially important.
Promising research areas include:
Institutions like the NICHD Neonatal Research Network and patient advocacy organizations such as Hope for HIE and CVI Now are helping push forward this research and awareness.
If your child had HIE or a brain injury and you notice visual differences, ask your doctor for a referral to a pediatric ophthalmologist and/or a teacher of the visually impaired. You can also:
Every child with CVI is unique. With the right tools, understanding, and support, children with HIE and CVI can thrive.
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