Who should get a Functional Vision Assessment?
"It feels like they can see... but they don't always use their vision."
I hear this from families all the time. Maybe your child's eye test came back fine, but something still doesn't quite add up. Maybe they see brilliantly one moment and seem to miss things the next.
A functional vision assessment looks at how someone actually uses their vision in everyday life, not just how clearly they can read an eye chart. It's for children and adults, and it doesn't rely on someone being able to read letters or tell you what they see.
Why the brain matters
Seeing begins in the brain. The eyes take in light, but it's the brain that makes sense of it.
For many people with neurological or developmental differences, the brain pathways that interpret what we see develop and work differently. This includes people with cerebral (cortical) visual impairment, or CVI, and many people who are autistic, were born early, or have had a brain injury or stroke.
When the brain processes vision differently, it can change how someone recognises objects and faces, judges depth, finds things in a busy space, moves around, and copes with clutter or movement.
And it's easy to miss. Looking away, wandering off or not joining in can be mistaken for not paying attention, anxiety or not trying, when really their visual brain is working incredibly hard.
Who should get assessed?
Anyone with a neurological or neurodevelopmental difference should consider a functional vision assessment.
Brain injury and neurological differences
| Around the time of birth
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Neurodevelopmental differences
| Genetic and rare conditions
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This isn't a complete list. If your child or loved one doesn't fit neatly into any of these, but you've noticed some of the signs below, it's still worth a chat.
When the brain processes vision differently, it can change how someone recognises objects and faces, judges depth, finds things in a busy space and moves around. It can also change how comfortable they feel with clutter or movement.
And it's easy to miss. Looking away, wandering off or not joining in can be mistaken for not paying attention, anxiety or not trying, when really their visual brain is working incredibly hard.
The teddy bear test
"Can you pass me the teddy bear?"
A child hands it to you. Job done! But did they look for it?
They might have reached into the toy box and felt around for something soft and squishy with ears. It's just like how you might feel around in your bag for your phone, instead of tipping everything out to look.
The outcome is the same, whether vision was used or not. That's why functional vision can be so easy to overlook.
Things you might notice
Every person is different, but families often tell me their child or loved one:
finds it hard to spot toys, utensils or equipment in a busy or cluttered space
recognises familiar objects only when they're in their usual spot
looks away during conversation (sometimes this makes listening easier), or picks up less from facial expressions
finds visually busy tasks like Lego, drawing or reading tiring
trips over things, or hesitates where the flooring changes
is confident going UP stairs, but much less sure coming DOWN
tilts or turns their head in some situations
has great days and much harder days, depending on tiredness, noise or how busy things are
None of these mean something is "wrong". They're clues that someone may process vision differently, and that understanding how could really help.
It can also help
people with complex communication needs, or who communicate without speech
families who have been told "the eyes are fine" but still feel something isn't adding up
What happens in an assessment?
Because functional vision is about real life, I assess it in real places, like home, the park or the library. We start by talking through your child's story and what you've noticed. Then it mostly looks like play.
We might go looking for ducks at the park, find a small duck and then a bigger one, or see how their eyes follow their favourite toy as I walk away. I watch how clutter, lighting, contrast and colour affect them, how noise and other senses change what they can see, and when they start to tire. If something feels new, we try it on Mum, a sibling or the teddy bear first.
When a person is comfortable with it, I also use formal tests. But every small detail helps paint the bigger picture.
What you'll receive
At the end, you'll have a visual profile: a clear picture of how that person uses their vision, what makes seeing easier, what makes it harder, and when their brain is working hardest.
I share that profile with you and, with your permission, with the people who support your child or loved one, like their speech pathologist, occupational therapist or orientation and mobility specialist. Each of them is the expert in their own area. The profile simply means everyone is working from the full picture.
Looking beyond the eye chart
Vision is more than 20/20. It's:
How we connect with people.
How we learn.
How we move safely through the world.
How we make sense of everything around us.
When we understand functional vision, we stop asking "Why aren't they trying?" and start asking "How are they seeing their world?"
Not sure if it's right for you?
That's completely okay. If something here sounds familiar, or you simply have a feeling there's more to the story, I'm happy to chat it through, point you toward helpful resources, and help you work out your next steps.
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