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Texas Senseabilities Newsletter

Submitted by Cindy Bachofer, PhD, CLVT       

(with thanks to Maribeth Betton & Cristi Fleming for the invitation to their classroom)

Abstract: The author discusses ways to teach students with visual impairment about anatomy and functions of the eye, visual impairment, and eye examinations. She lends her personal perspective as a teacher and consultant with visual impairment herself.

Keywords: eye anatomy, self-determination, science and technology

“What’s wrong with your eyes?” or “Why can’t you see that?” are questions that students with visual impairment, both those who are blind or have low vision, are likely to hear throughout their lives. These questions, ranging from curious to insensitive to supportive, may come from peers, from neighbors, or from someone in a store. Students may feel especially sensitive or self-conscious about their eyes as this is one trait that makes them different from peers and family. Having the ability to respond to such questions in a confident way whether to engage, delay, or end the conversation is an important part of self-determination.  It is an empowering feeling to be able to direct the interaction and, if they choose, to describe this unique feature of themselves with poise and accuracy.

Explicit instruction at both the elementary and secondary level is needed for students to increase their understanding of the visual process and to explain these concepts in their own words. This article describes benefits of learning about the eye, including the visual system, and individual eye conditions and application of this topic in both the general curriculum and the Expanded Core Curriculum (ECC). The article also summarizes a set of lessons and activities developed over a number of years to learn about eye anatomy and functioning. This initial topic gives a natural lead-in for students to recognize the implications of their visual impairment and to describe tools and strategies they use to manage tasks independently.  These activities came together in a semester-long unit for use with a class of 5 students in the Experiences in Transition (EXIT) program for young adults at Texas School for the Blind and Visually Impaired (TSBVI).  An emphasis of this program is career readiness, including students’ development of skills to put potential employers and co-workers at ease concerning their visual impairment and their ability to meet the demands of the job.

Information about their eye condition may come from different sources such as their parent, eye doctor, or the teacher of students with visual impairments (TVI). Instruction in this topic is a recognized part of the TVI role and chapters on the visual system and eye conditions are a standard inclusion in textbooks within the field of visual impairments. Few studies (Guerette, Lewis, & Mattingly, 2011; Sacks & Corn, 1996) are available to document students’ knowledge of their eye condition and the area warrants further investigation.  When asked, 85 of 89 students (Sacks & Corn, 1996) or 96% responded in a survey that they had questions about their visual impairment while only 42 of the participants (48%) reported that they brought this up with their parents. Students vary in how much they want to know about their eye condition and for some the most basic facts (e.g., name, part of the eye affected) are sufficient.  Two studies across a 15-year span report similar and very limited understanding by students of their visual impairment.  In the earlier study (Corn & Sacks, 1996), 34% (N=30) of participants could name their eye condition and only 13% (N=11) could name the part of the visual system that was affected.  Researchers in the more recent study (Guerette, Lewis, & Mattingly, 2011), reported that 31 of 51 participants (62%) said that a parent, teacher, or doctor had told them the name of their eye condition. Of this group, only 16.3% could actually state the name and explain what it meant and 35.5% could only give the name. The majority of students in these studies seemed to remember that they’d heard about the impairment but had not retained enough information to respond accurately to more specific questions. What responses would our students give to an interviewer today?

Learning about the eye can have additional benefits for students beyond gaining factual knowledge about how the eye works. This includes self-awareness, application to academic work, and practice in areas of the ECC (e.g., assistive technology, self-determination). The development of positive self-identity for a young person who is visually impaired begins with having accurate information about his or her eye condition and being able to communicate this information to others in school, community, and work settings (Guerette, Lewis, & Mattingly, 2011; Sacks, 2010; Sacks & Corn, 1996). A critical part of healthy self-identity and positive self-esteem is recognition that the visual impairment is only one aspect of the person who is made up of many different interests and goals.

Talking about the eye can spark curiosity and open up communication for students who may have barriers about identifying as someone with a visual impairment or are struggling with a sense of low self-worth. I have often been surprised how students with a guarded demeanor have let their guard down when they pick up a 3-D model of the eye. They especially take ownership in these lessons when they get to guide the direction of exploration and when they discover that the resources for learning about the human eye go beyond a book. This information may be emotionally charged for some students and it is advisable to talk with parents before beginning instruction.

This topic can be applied in a student’s academic setting in a number of ways. The study of optics and the properties of light fit into the science curriculum as a branch of physics and have relevance throughout our day with use of items such as eye glasses and camera lenses. Learning the names of the parts of the eye (e.g., cornea, vitreous) and eye conditions (e.g. hypoplasia, oculocutaneous albinism) fulfills language arts objectives of word construction and vocabulary building. Taking apart and rebuilding these multi-syllabic words can have high appeal for students with poor literacy skills and provide a bridge to related language arts objectives. Learning about the eye and the uniqueness of eye conditions also presents ideal topics for personal essays and research papers at any age level. Students may also be interested in independent study projects in classes such as journalism, public speaking, or art. Numerous benefits exist for studying this topic at both the elementary and secondary level.

Learning about the eye presents opportunities for practicing ECC skills. Instruction directly supports practice in assistive technology, self-determination, and sensory efficiency skills. Related areas include career education and social skills. The remainder of this article describes activities used with students to increase their understanding of anatomy and physiology of the eye and their eye condition. These lessons can be as brief as 10 minutes or last an hour and can be a motivating reward for completing other work. Most can be adapted to various grades and functioning levels and can be used for a single student or a class. A necessary component of each lesson is providing time for students to discuss what was learned as well as allowing the student to role play or practice communicating about their vision with an array of individuals (peers, teachers, doctors). This gives them the opportunity to test their own explanations and be prepared to respond when someone asks, “What’s wrong with your eyes?”

Life-sized Eye (group activity)

Students participate in staging a super-sized eyeball from everyday items.  Each student receives an object that represents a part of the visual system and a card with the part in bold letters or in braille as needed.  The members of the cast have rehearsed a brief definition of their term such as “I’m the cornea and, like a windshield, I protect the eye and stop things from getting in it.” “I’m the retina or the back wall of the eye where all of the nerves take the image and send it to the brain.” Short definitions such as these capture the basic purpose and position in the eye.  Depending on the group size, the cast can be as small as 5 or up to 20 with two life-sized eyes. 

The Life-sized Eyeball lesson travels easily.  My eyeball-in-a-bag kit typically includes seven eye parts: a large clear plastic serving bowl for the cornea, a brightly colored flexible 7” cloth ring pool toy for the iris, a clear plastic bowl-shaped planter insert for the lens, a thick balloon filled with a gel substance or a squishy, smooth ball for the vitreous, a shag carpet square or bath matt with thick pile representing cells and blood vessels as the retina, exercise bands for two cast members are the muscles of the eye, and finally, the brain is a textured rubber ball with bumps or nubs.  To expand the list, additional parts such as a foam tube, from a craft or hardware store, can be used as the optic nerve and a round plastic leak-proof pouch for holding toiletries can serve as the aqueous.  Additional factoids can be shared such as the aqueous is 99% water, the word base of retina in Latin means net, and eye muscles are the fastest reacting muscles in the whole body.  The interactive nature of this activity appeals across school grades from kindergarten to senior year. Even hard to impress young adults have asked for a repeat session with the Life-sized Eyeball.

3-D Eye Model

Taking apart and re-assembling the 3-D eye model gives students time for a close-up inspection of the eye. A number of affordable models for purchase are available through the internet. The eye doctor or the science (human anatomy) teacher is another good resource.  It is important that the model be an accurate representation of the eye and has removable parts so the student can understand their shapes and location within the eye structure. This lesson also gives a chance to practice definitions and review how the parts work together.

Eye Diagram in Color

A colorful, clearly labeled diagram of the eye is a great take-home page for students to keep. A copy on cardstock holds up better for long-term use.  Study of this cross-section view of the eye gives practice time for naming the parts and knowing the position of each.  Once this page is familiar, students can receive an un-labeled outline of the same diagram, or a tactile outline, to color and label.  This activity lets them begin the process of finding their own words for describing their eye condition and its effect on functioning. A student may explain her light sensitivity when working on the computer and accessibility options that increase comfort. Several practice sessions are needed to help the student gain confidence to do this independently in conversation with others.

Eye Words Match-up

Correct spelling and pronunciation of parts of the eye is essential for students to feel confident in their communication.  These words, such as sclera, conjunctiva, and vitreous, have an intriguing or exotic sound and this feature helps to capture student attention. Talking about the eye model has already provided exposure to this distinct vocabulary.  Taking the words apart, either in print or braille, and re-matching them into pairs (e.g., cor-nea, ret-ina) is more engaging than spelling drills.  Students can follow a word list at first in the matching exercise and then challenge themselves to timed contests in the matching.

Animal Eyes Research

Having a comparison to our human eyes is helpful in making distinctions of how our vision works versus other creatures in the animal world. Through resources such as children’s books and short YouTube videos, this lesson reinforces the function of eye parts such as the pupil and photoreceptors. Younger children have a particular fascination for learning about animals and these brief activities lead to more in-depth understanding. Stephane Frattini’s wordless book Who’s Looking at You is filled with close-up pictures of animal eyes.  YouTube videos also have stunning photography and present related information such as side-by-side comparisons of vision. For example, snakes can see heat signatures at night, birds and fish have ultraviolet photoreceptors, and a rat can move each eye independently.  More than just great trivia, these activities can help a student become more receptive to discussing differences in eyesight and appreciating visual abilities.

Magnifier and Mirror Close Up

Examining the eye close up can be a fascinating experience.  It is advisable to preface the activity with a little discussion to confirm each student’s comfort level.  Students can examine and admire their own eye with a 10x mirror, available in a variety of discount store cosmetic aisles. Shakespeare’s line “The eyes are the window to the soul” may suggest why this close-up activity is a very personal one for some students. One student commented with an anti-climactic tone after observing his nystagmus, “So that’s what they keep talking about?” Other eye conditions affecting the front view of the eye such as coloboma or aniridia can also be viewed. With permission, students may find a partner and agree to look at the eye of a peer or a family member through a stronger handheld magnifier of 6x or 8x power. Our eyes are as individual as our fingerprints and this activity proves that fact.   

Clinical Low Vision Exam

Preparing for a low vision examination presents new topics for learning about the eye. Another visit to the eye doctor can raise anxiety and it is helpful for students to understand how this doctor visit is different. What is contrast sensitivity, field of view, or stereopsis? How are these characteristics measured and how does each impact functioning? A primary goal of the clinical low vision exam is to measure factors of visual functioning (e.g., acuity, adaptation to light) and to increase visual functioning (e.g., scanning to maximize field of view).  Students and teachers can prepare for this exam by learning about the different tools used and recording questions for the doctor. The student becomes an active participant by bringing these questions to the appointment and becomes more invested in the information shared. Pictures of a contrast sensitivity test or a near vision test help students become familiar with these items ahead of time.  For example, arranging the discs in the D-15 color test may confuse some students and they can practice by arranging a large pack of color markers in a similar manner.  Having a chance to explore a range of optical devices before or after the appointment if a display area is available is another valuable aspect of the exam. To develop their awareness as an informed consumer of devices, it is essential for students to recognize that these tools vary in design and features such as power or field of view. As a concluding task, the student and teacher can take time to read the low vision report sent by the doctor following the exam.  An alternative when an appointment is not scheduled is to arrange for a brief 15-minute phone interview or Skype call with a low vision specialist to cover a student’s specific questions

Edible Eyeballs

Food is motivating for every age level.  This activity provides one more representation of the eye and focuses on the exterior layer.  A variety of recipes are online.  Campfire-sized marshmallows give students a large surface area for creating their eye (or pair of eyes). This also invites discussion of the sclera, the visible white part of the eye.  Students can choose their favorite iris color from Gummy lifesavers with the lifesaver hole being the pupil.  After discussion of the pupil, students may prefer to add a big chocolate chip or an M&M to mark the empty spot.  A flexible candy retina such as Rips® licorice squares sit on the back of the marshmallow. Students can use a plastic knife tip to make the opening in the marshmallow eye and the candy retina for the licorice vine candy optic nerve.  Icing as glue is helpful for holding the parts together and adding to the popular dessert factor.  This provides one more activity for students to practice talking about the eye and gain a conversational ease with eye anatomy. (Thanks to TVI Kathi Garza and her students in the TSBVI elementary summer enrichment program).

Technology Tools

The computer or iPad are ideal research tools for bringing together assistive tech skills and further study on the eye.  Our reliance on vision as a primary sense leads to universal curiosity on how the eye works and disorders of the eye.  A student may choose to explore topics such as instruments used in an eye exam (ophthalmoscope, auto-refractor), consumer organizations established for individual eye conditions (NOAH for albinism), or medical advances in vision (such as electronic retinal implants). Beginning tech users can read a simple teacher-prepared document that describes the process of seeing or search for student-oriented sites for learning about the eye (e.g., Kids’ Health at http://kidshealth.org/kid/htbw/eyes.html).  Being able to share specialized knowledge on an engaging topic can provide an important boost to student self-esteem.

Student Presentation

The telescoping chrome presentation pointer was appealing enough to lessen stage fright as each speaker considered the eye poster at the front of the room. Students in the Texas School for the Blind and Visually Impaired EXIT class took turns acting as presenter and describing the structure of the eye, their eye condition, and its implications on functioning.  Activities through the semester prepared them for this assignment and, after a rehearsal, their delivery was impressive.  Then, they wanted to do it again!  Students could choose to record their presentation to show to teachers or they could expand this assignment to creating additional products such as a Powerpoint presentation or a pamphlet that becomes part of the portfolio that introduces them. This request affirmed that the unit had met its objectives of increasing self-awareness and confidence as a person with low vision and taking ownership in this feature that made each of them unique.

As an elementary student I can remember reciting the syllables of my eye condition, re-tro-lent-al fi-bro-pla-sia (now known as retinopthy of prematurity) the longest word I knew as a 9 year old. I was especially drawn to pictures of the eye in the encyclopedia.  Talking about this out loud did not occur until I was an adult.  Use of instructional time for students to retain the necessary knowledge of their eye condition and to gain confidence in expressing the information is warranted. This topic has multiple benefits for students in the general curriculum, areas of the expanded core curriculum, and psychosocial development.  Lessons created for this topic can have great flexibility in terms of time commitment and student individual needs.  From creating life-sized eyeballs to learning from YouTube videos, it’s time for eye time.

References

Guerette, A., Lewis, S., & Mattingly, C. (2011).Students with low vision describe their visual impairments and visual functioning. Journal of Visual Impairment and Blindness, 105, 287–298.

Sacks, S.Z.,& Corn, A.L. (1996).Student with visual impairments: Do they understand their disability? Journal of Visual Impairment and Blindness, 90,412–422.

Sacks, S.Z. Psychological and social implications of low vision. (2010).  In A.L. Corn & J.N. Erin (Eds.) Foundations of Low Vision: Clinical and functional perspectives. (pp. 67-96). New York: American Foundation for the Blind.