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Texas SenseAbilities - a free newsletter provided by TSBVI and DARS-Division of Blind Services provides articles from parents, individuals with visual impairment and deafblindness, programming information and strategies, updates on resources and training in English, Spanish, braille and large print as well as electronic formats.

Deaf-Blind Perspectives - Deaf-Blind Perspectives is a free publication with articles, essays, and announcements about topics related to people who are deaf-blind. Published two times a year (Spring and Fall) by The Teaching Research Institute of Western Oregon University, its purpose is to provide information and serve as a forum for discussion and sharing ideas. The intended audience includes deaf-blind individuals, family members, teachers, and other service providers and professionals.

 

Eye ConditionEffects On VisionEducational Considerations

Achromotopsia (color deficiency, colorblindness, achromacy, or rod achromacy)

Cone malformation, macular deficiency, and partial or total absence of cones.

  • Limited or no color vision
  • Colors may be seen as shades of gray
  • Loss of detail
  • Decreased acuity
  • Central field scotomas
  • Normal peripheral fields
  • Associated with nystagmus and Photophobia
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Support of eccentric viewing
  • High contrast materials
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Reduced or diffused lighting
  • Supplement vision with auditory and tactile information
Eye ConditionEffects On VisionEducational Considerations

Achromotopsia (color deficiency, colorblindness, achromacy, or rod achromacy)

Cone malformation, macular deficiency, and partial or total absence of cones.

  • Limited or no color vision
  • Colors may be seen as shades of gray
  • Loss of detail
  • Decreased acuity
  • Central field scotomas
  • Normal peripheral fields
  • Associated with nystagmus and Photophobia
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Support of eccentric viewing
  • High contrast materials
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Reduced or diffused lighting
  • Supplement vision with auditory and tactile information

Albinism

Total or partial absence of pigment, causing abnormal optic nerve development

Lenses and tinted lenses may be prescribed.

  • Decreased acuity
  • Photophobia
  • Increased sensitivity to glare
  • High refractive error
  • Astigmatism
  • Central scotomas
  • Nystagmus
  • Muscle imbalance
  • Eye fatigue with close or detailed work
  • Reduced depth perception
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Close viewing
  • High contrast materials
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Lighting from behind
  • Reduced glare
  • Line markers and templates - placeholders
  • Frequent breaks

Amblyopia (was Anopsia, called “lazy eye”) See strabismus

Reduced visual functioning in one eye, which causes the person to use one eye instead of both.

With young children, eye exercises, oclusion or patching of one eye or surgery may help.

  • Monocular vision
  • Reduced visual field
  • Reduced depth perception
  • May develop blindness in one eye
  • Reduced visual-motor abilities
  • Eye fatigue with close or detailed work
  • Frequent breaks
  • Seating should favor functional eye.
  • Familiarization with new environments
  • Time to adjust in new situations
  • May need adaptations for activities requiring visual-motor coordination

Achromotopsia (color deficiency, colorblindness, achromacy, or rod achromacy)

Cone malformation, macular deficiency, and partial or total absence of cones.

  • Limited or no color vision
  • Colors may be seen as shades of gray
  • Loss of detail
  • Decreased acuity
  • Central field scotomas
  • Normal peripheral fields
  • Associated with nystagmus and Photophobia
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Support of eccentric viewing
  • High contrast materials
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Reduced or diffused lighting
  • Supplement vision with auditory and tactile information

Albinism

Total or partial absence of pigment, causing abnormal optic nerve development

Lenses and tinted lenses may be prescribed.

  • Decreased acuity
  • Photophobia
  • Increased sensitivity to glare
  • High refractive error
  • Astigmatism
  • Central scotomas
  • Nystagmus
  • Muscle imbalance
  • Eye fatigue with close or detailed work
  • Reduced depth perception
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Close viewing
  • High contrast materials
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Lighting from behind
  • Reduced glare
  • Line markers and templates - placeholders
  • Frequent breaks

Amblyopia (was Anopsia, called “lazy eye”) See strabismus

Reduced visual functioning in one eye, which causes the person to use one eye instead of both.

With young children, eye exercises, oclusion or patching of one eye or surgery may help.

  • Monocular vision
  • Reduced visual field
  • Reduced depth perception
  • May develop blindness in one eye
  • Reduced visual-motor abilities
  • Eye fatigue with close or detailed work
  • Frequent breaks
  • Seating should favor functional eye.
  • Familiarization with new environments
  • Time to adjust in new situations
  • May need adaptations for activities requiring visual-motor coordination

Achromotopsia (color deficiency, colorblindness, achromacy, or rod achromacy)

Cone malformation, macular deficiency, and partial or total absence of cones.

  • Limited or no color vision
  • Colors may be seen as shades of gray
  • Loss of detail
  • Decreased acuity
  • Central field scotomas
  • Normal peripheral fields
  • Associated with  nystagmus  and Photophobia
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Support of eccentric viewing
  • High contrast materials
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Reduced or diffused lighting
  • Supplement vision with auditory and tactile information

Albinism

Total or partial absence of pigment, causing abnormal optic nerve development

Lenses and tinted lenses may be prescribed.

  • Decreased acuity
  • Photophobia
  • Increased sensitivity to glare
  • High refractive error
  • Astigmatism
  • Central scotomas
  • Nystagmus
  • Muscle imbalance
  • Eye fatigue with close or detailed work
  • Reduced depth perception
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Close viewing
  • High contrast materials
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Lighting from behind
  • Reduced glare
  • Line markers and templates - placeholders
  • Frequent breaks

Amblyopia (was Anopsia, called “lazy eye”) See strabismus

Reduced visual functioning in one eye, which causes the person to use one eye instead of both.

With young children, eye exercises, oclusion or patching of one eye or surgery may help.

  • Monocular vision
  • Reduced visual field
  • Reduced depth perception
  • May develop blindness in one eye
  • Reduced visual-motor abilities
  • Eye fatigue with close or detailed work
  • Frequent breaks
  • Seating should favor functional eye.
  • Familiarization with new environments
  • Time to adjust in new situations
  • May need adaptations for activities requiring visual-motor coordination

Achromotopsia (color deficiency, colorblindness, achromacy, or rod achromacy)

Cone malformation, macular deficiency, and partial or total absence of cones.

  • Limited or no color vision
  • Colors may be seen as shades of gray
  • Loss of detail
  • Decreased acuity
  • Central field scotomas
  • Normal peripheral fields
  • Associated with nystagmus and Photophobia
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Support of eccentric viewing
  • High contrast materials
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Reduced or diffused lighting
  • Supplement vision with auditory and tactile information

Albinism

Total or partial absence of pigment, causing abnormal optic nerve development

Lenses and tinted lenses may be prescribed.

  • Decreased acuity
  • Photophobia
  • Increased sensitivity to glare
  • High refractive error
  • Astigmatism
  • Central scotomas
  • Nystagmus
  • Muscle imbalance
  • Eye fatigue with close or detailed work
  • Reduced depth perception
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Close viewing
  • High contrast materials
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Lighting from behind
  • Reduced glare
  • Line markers and templates - placeholders
  • Frequent breaks

Amblyopia (was Anopsia, called “lazy eye”) See strabismus

Reduced visual functioning in one eye, which causes the person to use one eye instead of both.

With young children, eye exercises, oclusion or patching of one eye or surgery may help.

  • Monocular vision
  • Reduced visual field
  • Reduced depth perception
  • May develop blindness in one eye
  • Reduced visual-motor abilities
  • Eye fatigue with close or detailed work
  • Frequent breaks
  • Seating should favor functional eye.
  • Familiarization with new environments
  • Time to adjust in new situations
  • May need adaptations for activities requiring visual-motor coordination

 

Achromotopsia (color deficiency, colorblindness, achromacy, or rod achromacy)

Cone malformation, macular deficiency, and partial or total absence of cones.

  • Limited or no color vision
  • Colors may be seen as shades of gray
  • Loss of detail
  • Decreased acuity
  • Central field scotomas
  • Normal peripheral fields
  • Associated with  nystagmus  and Photophobia
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Support of eccentric viewing
  • High contrast materials
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Reduced or diffused lighting
  • Supplement vision with auditory and tactile information

Albinism

Total or partial absence of pigment, causing abnormal optic nerve development

Lenses and tinted lenses may be prescribed.

  • Decreased acuity
  • Photophobia
  • Increased sensitivity to glare
  • High refractive error
  • Astigmatism
  • Central scotomas
  • Nystagmus
  • Muscle imbalance
  • Eye fatigue with close or detailed work
  • Reduced depth perception
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Close viewing
  • High contrast materials
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Lighting from behind
  • Reduced glare
  • Line markers and templates - placeholders
  • Frequent breaks

Amblyopia (was Anopsia, called “lazy eye”) See strabismus

Reduced visual functioning in one eye, which causes the person to use one eye instead of both.

With young children, eye exercises, oclusion or patching of one eye or surgery may help.

  • Monocular vision
  • Reduced visual field
  • Reduced depth perception
  • May develop blindness in one eye
  • Reduced visual-motor abilities
  • Eye fatigue with close or detailed work
  • Frequent breaks
  • Seating should favor functional eye.
  • Familiarization with new environments
  • Time to adjust in new situations
  • May need adaptations for activities requiring visual-motor coordination

Aniridia

A rare genetic disorder that causes absence of all or part of the iris, usually affecting both eyes

It also causes the cornea to lose clarity over time by inhibiting the stem cells that “refresh” it with new, clear epithelial cells. Aniridia is often associated with amblyopia, cataracts, the development of closed angle glaucoma, and sometimes, displaced lens, under-developed retina, and nystagmus. Contact lenses with an artificial iris, tinted spectacles, or bioptic glasses may be prescribed. iris and stem cell implant surgeries are now possible.

Hereditary aniridia is associated with Gillespie syndrome. Sporatic Aniridia may cause nephroblastoma (Wilm’s tumor), and it is associated with WAGR syndrome

  • Decreased acuity
  • Photophobia
  • Large pupil that may be misshapen
  • Generally, respond very well to use of low vision devices
  • Corneal involvement: Scattered light, increased glare, blurred vision, and further reduction of  acuity
  • If cataracts develop: further reduction of visual acuity, blurred vision, and decreased color vision
  • Fovial involvement: loss of detailed (fine) vision
  • If glaucoma develops: fluctuating visual functioning, field loss, poor night vision, and decreased sensitivity to contrast

 

  • Vision stimulation for infants to maximally develop the visual cortex
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Allow time for adjustment to lighting changes
  • Provide seating in the front of the classroom with back to windows
  • Reduced glare
  • Provide lighting from behind
  • Reduced or diffused lighting
  • Lamps with rheostats and adjustable arms
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Use of a black chalkboard and bold chalk
  • If white board is used, bold black markers are recommended over other colors
  • Felt-tipped pens and tinted paper with bold lines
  • Place paper/worksheets on a dark/black background (e.g., blotter, construction or butcher paper, posterboard, etc.)
  • Provide copies of materials presented on the board.
  • Use black backgrounds and white san serif fonts in slide presentations

Anophthalmia

Absence of one or both eyeballs

Causes can be heredity, injury, or secondary to disease. Prosthetic eyes are prescribed to preserve the health of the eyelids and surrounding tissues.

  • Monocular vision:
  • Reduced fields
  • Reduced depth perception
  • Blindness
  • May need visual efficiency training to develop scanning skills
  • Seating and presentation of materials should favor functional eye
  • May need tactile and auditory learning media

Aphakia

Absence of the lens

Although it can be caused by injury, aphakia is usually a result of cataract surgery. Treatments include lens implants, contact lenses, and/or glasses.

  • Inability to accommodate to varying focal distance
  • Inability to accommodate to lighting changes
  • Reduced depth perception
  • May have peripheral field distortions
  • Support wearing of any prescribed lenses
  • High contrast materials
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Enlarged printed materials
  • Close viewing
  • Adequate lighting (e.g., lights with rheostats and adjustable arms)
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Allow time for adjustment to lighting changes

Astigmatism

Irregularity in the curvature of the cornea and/or lens, which prevents light rays from being properly focused on a single point on the retina

Astigmatism commonly occurs with myopia and hyperopia. It also can be associated with albinism and keratoconus. Corrective lenses may be prescribed.

  • Blurred vision at any distance (uncorrected)
  • Distorted vision
  • Tendency to squint to create a pinhole effect
  • Visual fatigue associated with close work
  • High contrast materials
  • Adequate lighting (e.g., lamps with rheostats and adjustable arms)
  • Frequent breaks from close/detailed work

Buphthalmos (Infantile glaucoma)

Enlarged eyeballs

Caused by congenital glaucoma; hereditary; onset from birth to three years; can cause enlargement and increased depth of the anterior chamber, damage to the optic disc, and/or increased diameter and thinning of the cornea; requires surgery, and blindness occurs if left untreated.

  • Photophobia
  • Reduced central acuity
  • Corneal opacity
  • Excessive tearing
  • Refractive error
  • Eye pain

 

  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Reduced or diffused lighting from behind
  • Sunglasses, visors or hats may be worn indoors
  • Allow time for adjustment to lighting changes
  • High contrast materials
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Enlarged printed materials
  • Close viewing

Cataracts

Opacity or cloudiness of the lens, which restricts passage of light to the retina; usually bilateral

Opacity increases over time until “mature” cataracts can obscure the fundus and the pupil may appear white. Mature cataracts are usually removed surgically, requiring lens implants or contact lenses.

  • Reduced visual acuity
  • Blurred vision
  • Reduced color discrimination
  • Photophobia
  • Associated with nystagmus
  • Visual ability fluctuates according to light
  • If cataracts are centrally located, near vision will be reduced
  • Increased sensitivity to glare

 

  • Support of the wearing of any prescribed lenses
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Enlarged printed materials
  • Close viewing
  • Support of eccentric viewing
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • May need reduced or diffused lighting
  • Lighting from behind
  • May need lamps with rheostats and adjustable arms
  • Reduced glare

Chorioretinitis

Posterior uveitis, or an inflamation of the choroid that spreads to the retina

This can be caused by tuberculosis, histoplasmosis, or toxoplasmosis.

  • Blurred vision
  • Photophobia
  • Distorted images
  • Central scotomas
  • Support of eccentric viewing
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Enlarged printed materials
  • Close viewing
  • Diffused, less intense light to enlarge the pupil
  • Telescope
  • May need to use tinted lenses, sunglasses, visors, or hats outdoors and indoors as well
  • High contrast line markers or templates for reading, finding math problems, or locating other information

Coats’ Disease  (Exudative Retinitis or retinitis telangiectasia)

A congenital, nonhereditary, and progressive disorder that is characterized by abnormal development of the blood vessels behind the retina

Coats’ occurs mostly in males. Symptoms typically appear in children around six to eight years old but they can appear in infancy. Coats' usually affects only one eye. Severity depends on the size and number of affected blood vessels. Leakage of blood and fluids cause retinal swelling and detachment. Cryotherapy and laser photo-coagulation sometimes are used to stop the progression of blood vessel growth and leakage. 

  • Decreased central acuity
  • Loss of detail
  • Progressive central field loss
  • Reduced night vision
  • Loss of color vision
  • May develop strabysmus
  • May have iritis
  • May have glaucoma
  • May develop cataracts
  • May be blind in one eye
  • Peripheral fields can be affected
  • Avoid contact sports and other high risk activities to prevent retinal detachment
  • Seating and presentation of work should favor more functional eye
  • Visual efficiency training to develop scanning skills

 

Coloboma

Hereditary birth defect that causes a notch or cleft in the pupil, iris, ciliary body, lens, retina, choroid, or optic nerve

A “Keyhole” pupil often occurs. It can be associated with refractive error, cataracts, nystagmus, strabismus, and glaucoma (later in life).

  • Decreased acuity
  • Photophobia
  • Muscle imbalance
  • Restricted fields (if retina is affected)
  • Reduced depth perception

 

  • High contrast materials
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Average to bright light
  • Reduced glare
  • May need to use sunglasses, visors, or hats outdoors and indoors as well (if iris is affected)
  • High contrast line markers and templates may be helpful for reading, finding math problems, or locating other information

Color deficiency (colorblindness) 

See Achromotopsia

 

 

Cone Monochromacy

See Achromotopsia

 

 

Corneal Ulcers, Corneal Opacities, Corneal Scarring, Keratitis, and Interstitial Keratitis

An open sore or scarring on any part of the cornea

It can be caused by bacteria, viruses (herpes), fungi, vitamin deficiency, injury, a hypersensitive reaction, diabetes, or severe dry eye. Superficial ulcers (called abrasions) usually heal quickly and completely, but deep ulcers cause growth of scar tissue or new blood vessels that impair vision. Corneal ulcers are usually quite painful, and other symptoms may include vision loss, squinting, and tearing (watering). Early diagnosis and treatment are crucial. With extensive scarring, a corneal transplant may be necessary. There are promising results with use of artificial corneas, which seem to be less likely to be rejected.

  • Photophobia
  • Fracturing of light (like looking through broken glass)
  • Increased glare
  • Blurred vision
  • Reduced acuity
  • Blindness

 

  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Reduced or diffused lighting
  • Sunglasses, visors or hats may be worn indoors
  • Seating in front of room with back toward windows
  • Reduced glare
  • High contrast materials
  • Diffused lighting from behind
  • Lights with rheostats and adjustable arms are helpful for close work.
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Enlarged printed materials
  • Frequent breaks from visual tasks
  • Support of eccentric viewing
  • May need auditory materials for longer reading assignments

Cortical Visual Impairment (CVI)

A neurological visual disorder resulting from damage to the optic nerve and/or parts of the brain that process and interpret visual information (i.e., visual cortex)

CVI is characterized by:

  • Specific color preference, especially for red and/or yellow
  • Attraction to movement
  • Visual field preference, especially for peripheral fields
  • Visual latency: delayed visual processing - in directing gaze, identification, recognition, and/or discrimination
  • Difficulties with discrimination and interpretation of complex visual information
  • Poor visual attention
  • Atypical visual responses (e.g., looking at something while appearing not to look)
  • May not look at an object and reach for it simultaneously (look first, then look away while reaching)
  • Better visual performance with familiar objects/settings
  • Unique visual features (i.e., light gazing and non-purposeful gaze)
  • Fluctuation in visual functioning
  • Reduced visual fields
  • Photophobia
  • Fatigue has a negative impact on visual performance
  • Use of movement to increase visual attention
  • Use of preferred color to increase visual attention
  • Present visual information in preferred visual field
  • Present visual information on a solid background (e.g., black or white cloth)
  • Use of bright, high contrast materials
  • Increase line spacing and white space on a page of text and/or images to reduce visual clutter and complexity
  • Use high contrast templates to reduce the amount of information seen at one time
  • Close viewing
  • Vision efficiency training
  • Frequent breaks from visual tasks
  • High illumination from behind
  • Sunglasses, visors or hats may be worn indoors
  • Support use of one sense at a time
  • Reduce visual, auditory, and tactile distractions
  • Extra time to respond
  • Extra time to adjust to new environments
  • Use of consistent language
  • Use of color coding as visual cues for recognition
  • Use of consistent visual cues across settings

Diabetic Retinopathy

Changes in the blood vessels of the retina, causing hemorrhaging in the retina and vitreous

It is caused by juvenile or type 2 diabetes. It may lead to retinal detachment and blindness.

  • Increased sensitivity to glare
  • Lack of accommodation
  • Floating obstructions in the vitreous
  • Fluctuating acuity
  • Diminished color vision
  • Reduced visual fields
  • Double vision
  • Blindness
  • Adequate high quality lighting (e.g., lamps with rheostats and adjustable arms)
  • High contrast materials
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Large button/key technology may be helpful
  • Training in use of auditory materials may be needed due to loss of vision and tactile sensitivity
  • Training in use of speech recognition input software may be helpful
  • Precautions related to decreased sensitivity in hands and feet (e.g., burns, cuts, falls)

Diplopia

Muscular defect that restricts the ability of the eyes to work together

It causes double vision, as the image from one eye is imposed on the image from the other eye. Left untreated, this condition can develop into amblyopia. Corrective lenses may be prescribed.

  • Visual confusion
  • Double vision
  • Dizziness
  • Suppression of the image from one eye, causing monocular vision
  • Eye fatigue
  • Blurring of print
  • Headache
  • Loss of place in visual tasks
  • High contrast materials
  • Reduced glare
  • Extended time to adjust to new situations
  • Frequent breaks from visual tasks
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Familiarization with new environments

Dislocated Lens

The lens is not in its natural position.

It is sometimes associated with coloboma, Marfan’s syndrome, or Marchesani’s syndrome. Also, it may be associated with diplopia or cataracts.

  • Blurred vision
  • Double Vision
  • Visual fatigue during close or detailed visual tasks

 

  • Frequent breaks from visual tasks
  • High contrast materials
  • Adequate lighting (e.g., lamps with rheostats and adjustable arms)
  • Reduced or diffused lighting
  • High contrast line markers or templates for reading, finding math problems, or locating other information

Enucleation

The anterior chamber or the entire eyeball is surgically removed from the orbit (eye socket).

Prosthetic eyes or scleral shells are usually recommended.

  • If one eye is removed, there is no depth perception.
  • Monocular vision
  • Reduced visual field
  • Effects of any eye condition(s) of the remaining eye
  • Blindness
  • Effects visual-motor skills, especially reach and negotiation of steps and drop-offs
  • Training in care of prostheses
  • Vision efficiency training (i.e., scanning)
  • Considerations related to the visual impairment of the remaining eye
  • Considerations related to possible changes in learning media

Esophoria, Esotropia, Exophoria, and Exotropia   See strabismus

 

 

Glaucoma

An eye disease which causes increased pressure in the eye because of blockage in the normal flow of the fluid in the aqueous humor

Causes include changes in the lens or uveal tract, trauma, reaction to a medication, surgical procedures, and heredity. Eye pain and headaches are associated with glaucoma. Prescription eye drops to reduce pressure must be used regularly, and surgery may be necessary. Untreated, glaucoma can lead to degeneration of the optic disk and blindness.

  • Fluctuating visual functioning
  • Field loss
  • Poor night vision
  • Photophobia
  • Difficulty reading
  • Difficulty seeing large objects presented at close range
  • Decreased sensitivity to contrast
  • Eye redness
  • Hazy cornea
  • Wide open pupil
  • Stress and fatigue have a negative affect on visual performance

 

  • Support use of sunglasses, visors, or hats in bright sunlight and bright lighting indoors
  • Allow time for adjustment to lighting changes
  • Reduced glare
  • Adequate lighting (e.g., lamps with rheostats and adjustable arms)
  • High contrast materials
  • May benefit from magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • May need visual efficiency training to develop scanning skills
  • Frequent breaks from visual tasks
  • May need instruction in tactile learning and braille
  • Teachers must be alert to signs of pain and increased ocular pressure.

Hemianopia (hemianopsia)

Blindness or impaired vision in one half of the visual field in one or both eyes

If both eyes are affected, vision loss may occur on the same side in both nasal fields, or in both temporal fields. Visual acuity in the unaffected field(s) remains unchanged. Hemianopia can be caused by stroke, other brain trauma, tumors, infection, or surgery.

  • Field loss
  • May be unaware of missing visual information
  • Visual efficiency training to develop scanning skills
  • Use markers at the beginning and/or ending of each line of text to facilitate reading the entire line

Histoplasmosis (Presumed Histoplasmosis Syndrome - POHS)

This is a syndrome affecting the choroid and retina, which is characterized by peripheral atrophic chorioretinal scars, maculopathy, and atrophy or scarring adjacent to the optic disc. Vision loss is secondary to macular and choroidal neovascularization (CNV).

POHS is most likely caused by a fungal infection acquired through exposure to spores in bird droppings and bat guano. Treatments include steroids to treat the initial infection, laser, anti-vascular endothelial growth factors, and photodynamic therapy. Prism lenses may be prescribed.

  • Distorted vision
  • Blind spots
  • Macular damage or central scotomas cause “patchy” fields, central vision loss, and reduced color vision.
  • Peripheral damage causes loss of night vision
  • Lamps with rheostats and adjustable arms
  • High contrast line markers or templates for reading, finding math problems, or locating other information.

Central damage:

  • Eccentric viewing
  • Magnification to enlarge an image beyond the scotoma
  • Enlarged printed materials
  • Close viewing
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Diffused, less intense light to enlarge the pupil so that more area can be viewed
  • CCTV with reversable foreground and background (white on black)

Peripheral damage:

  • High illumnation
  • NOIR lenses or overlay filters may be helpful
  • CCTV for maximum contrast
  •  Night vision devices (e.g., Streamlight flashlights, Third Generation® Night Vision Devices, etc)
  • Visual efficiency training in organized search (grid) patterns
  • May need to be seated farther away from the front to see more of the viewing area (e.g., board, screen, chart, etc)

Hyperopia (Farsightedness)

A refractive error in which the focal point for light rays is behind the retina

It is caused by the eyeball being too short from front to back. Corrective lenses are usually prescribed.

  • Distance acuity is better than near acuity
  • Uncorrected, close visual tasks may cause headache, nausea, dizziness, and eye rubbing

 

  • Support use of prescription lenses for close visual tasks
  • Magnification for near tasks (e.g., hand-held magnifier, electronic magnifier, screen enlargement software)
  • Frequent breaks from close visual tasks
  • Alternate near and distance visual tasks

Hyperphoria, Hypertropia, Hypophoria, Hypotropia    See strabismus

 

 

Hypoplasia  See Optic Atrophy

 

 

Keratitis See Corneal Ulcer

 

 

Keratoconus (KC)

Degenerative disorder in which the cornea thins and takes on a conical shape

Keratoconus is often bilateral but not symmetrical, so vision may be significantly better in one eye than the other. Vision deteriorates at varying rates (sometimes quite rapidly), and plateaus of stable vision can occur. Although it seems to be hereditary, keratoconus is typically diagnosed in adolescence. It is sometimes associated with retinitis pigmentosa, Down’s syndrome, Marfan’s syndrome, and aniridia.  Treatments include prescription lenses and various surgeries: intrastromal corneal ring segments, cross-linking, mini asymmetrical radial keratotomy, and corneal transplants. There are promising results in transplants with use of artificial corneas, which seem to be less likely to be rejected.

  • Slightly blurred vision in early stages, increasing as KC progresses
  • Distortion of entire visual field, which worsens in low light
  • Decreased visual acuity especially distance vision
  • Irregular astigmatism (parts of the field are in focus, and parts are out of focus)
  • Increased sensitivity to glare
  • Decreased night vision
  • Multiple images
  • Flaring of images
  • Streaking
  • Stationary objects/lights may appear to move
  • May develop photophobia
  • Cornea can rupture
  • Can lead to blindness
  • Avoid activities that could cause corneal damage, such as  contact sports and swimming in heavily chlorinated water
  • Reduced glare
  • Diffused lighting
  • Lamps with rheostats and adjustable arms
  • High contrast materials
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)

Leber’s Congenital Amaurosis (LCA, Leber’s Congenital Amaurosis)

A rare hereditary disorder that leads to degeneration of the macula

LCA becomes evident within the first few months of life. Progressive central field loss can occur, although vision is generally stable. LCA is a subset of retinitis pigmentosa with at least thirteen described types that are distinguished by genetic cause, patterns of vision loss, and associated eye conditions. Nystagmus, keratoconus, photophobia, extreme hyperopia, and sluggish (or absent) pupilary response to light are often present with LCA. Excessive rubbing of eyes (also poking or pressing) is a characteristic behavior. 

 

  • Decreased acuity
  • Reduced night vision
  • Progressive central field loss
  • Loss of color vision
  • Loss of detail
  • Peripheral fields can be affected
  • May need visual efficiency training to develop scanning skills
  • Support of eccentric viewing
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • High contrast materials
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Enlarged printed materials
  • Close viewing
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Lamps with rheostats and adjustable arms
  • Support use of sunglasses, visors, or hats in bright sunlight
  • Seat in the front of the room with windows behind back
  • May need frequent breaks from visual tasks
  • May need instruction in use of auditory materials
  • May need instruction in tactile learning and braille

Leber’s Hereditary Optic Neuropathy (LHON, Leber’s Optic Atrophy)

It is a rare hereditary disease caused by a mitochondrial mutation and passed on by the mother. It is characterized by rapidly progressive and severe optic nerve degeneration (atrophy).

It occurs in young men and, rarely, young women. Onset is usually in young adulthood. Most often, there is acute vision loss in one eye and then, a few weeks or months later, in the other eye, but vision loss sometimes occurs in both eyes simultaneously. It can include other types of central nervous system involvement.

  • Reduced central acuity
  • Vision may be blurred
  • Fluctuating visual performance
  • Color vision may be impaired
  • Visual perception may be impaired

 

  • High illumination
  • High contrast
  • Enlarged printed materials
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Avoid visual clutter:
  • Present visual information in isolation
  • Avoid busy backgrounds
  • Avoid wearing patterned clothing when presenting visual information

Macular Degeneration (Macular Disease, Congenital Macular Disease, and Age-Related Macular Degeneration)

Progressive (degenerating) damage to the central part of the retinal cones

The dry form involves yellow deposits (celluar debris) on the macula and eventually, thinning of cells in the macula, which leads to tissue death. In the wet form, there is abnormal growth of blood vessels in the choroid underneath the macula. These blood vessels leak blood and fluid into the retina, causing distortion, blind spots, loss of central vision, retinal scarring, and risk of retinal detachment. Macular degeneration is the leading cause of blindness in people over sixty, but it also can occur in children below age seven. Factors contributing to the development of the disease include heredity, diabetes, head injury, nutritional deficits, high cholesterol, smoking, and exposure to sunlight without eye protection. There is no cure, but treatment can slow progress of the disease. Treatments include nutritional supplements, laser therapy, and medication. 

  • Reduced central acuity
  • Peripheral vision is not affected
  • Central scotomas
  • Distorted vision
  • Blurred vision
  • Decreased color vision
  • Slow recovery from changes in light
  • Loss of contrast sensitivity
  • Visual fatigue
  • Support of eccentric viewing
  • Support use of sunglasses, hats, or visors in bright sunlight
  • Allow time for adjustment to lighting changes
  • Adequate lighting (e.g., lamps with rheostats and adjustable arms)
  • Diffused lighting may allow the pupil to enlarge so that more area can be viewed
  • Close viewing
  • Magnification (e.g., hand-held magnifier, electronic magnifier with light text on dark background, screen enlargement software, telescope for distance viewing etc.)
  • Reduced glare
  • High contrast materials
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Seating in front with back to window
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Frequent breaks from visual tasks
  • Avoid standing in front of a light source when speaking to the student

Microphthalmia (Microphthalmos, nanophthalmia, nanophthalmos)

A hereditary, developmental disorder that causes one or both eyes to be abnormally small

It may occur with other congenital abnormalities such as club foot, additional fingers or toes, webbed digits, polycystic kidneys, and cystic liver. This disorder can be associated with Patau Syndrome, Triploid Syndrome, or Wolf-Hirschhorn Syndrome. It may result in  cataracts, glaucoma, aniridia, and coloboma.

  • Decreased visual acuity
  • Photophobia
  • May have fluctuating visual abilities

 

  • High contrast
  • Reduced glare
  • Average to bright light
  • May need magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Expectations may need to be adjusted due to the frustration related to fluctuating visual abilities
  • Frequent breaks from visual tasks
  • Instruction in strategies for stress reduction and dealing with frustration related to fluctuating visual abilities

Muscle Imbalance See Strabismus and Amblyopia

 

 

Myopia (Simple and Degenerative Myopia, nearsightedness)

A refractive error in which the image of a distant object is formed in front of the retina and cannot be seen distinctly; eyeball is elongated from front to back

Degenerative myopia is progressive, causing increasingly severe nearsightedness, so that visual acuity often cannot be corrected to normal with lenses. It can lead to retinal detachment, choroidal hemorrhages, reduced central vision, opacities in the vitreous, macular swelling, and cataracts. Treatments include corrective lenses and LASIC surgery.

  • Reduced distance acuity
  • Near vision is better than distance vision
  • May squint and frown when trying to see at a distance

 

  • High illumination
  • Reduced glare
  • May need to be seated closer to the front in order to see written information, videos, and demonstrations
  • If myopia is progressive, take precautions to protect the retina

Nystagmus

Involuntary eye movements, which can be horizontal, vertical, circular, or mixed

Causes can be heredity, neurological disorders, toxicity, pharmaceutical drugs, alcohol, inner ear disturbance, or unknown. Nystagmus can be increased by stress, spinning, and rhythmic movements. 

  • Inability to maintain steady fixation
  • Reduced visual acuity
  • Visual fatigue
  • Vertigo (rare)
  • Stripes and other patterns may increase the rate of the nystagmus
  • Shifting gaze or tilting the head may help to find the null point at which the nystagmus slows.
  • Frequent breaks from close visual tasks
  • Vary visual tasks
  • Adequate lighting
  • Good contrast
  • Line markers, rulers, typoscopes, and other templates may be helpful for keeping the place on a page
  • Instruction in stress reduction strategies

Optic Atrophy (Optic Nerve Atrophy)

Hereditary or acquired damage to the optic nerve that limits or stops transmission of visual information from the eye to the brain

It is evidenced by a pale optic disc and reduced pupilary response. Acquired optic atrophy can be caused by disease, pressure on the optic nerve, trauma, glaucoma, or toxicity. Type 1 optic atrophy is progressive.

 

  • Fluctuating visual performance
  • Color vision may be reduced
  • Night vision may be reduced
  • Visual perception may be impaired
  • May have photophobia
  • Visual stimulation in infancy and early childhood.
  • Low vision training in early childhood to help the child interpret visual information
  • Supplement visual information with tactile and auditory information
  • High illumination
  • If photophobia is present:
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Provide adequate lighting through use of lamps with rheostats and adjustable arms)
  • High contrast
  • Enlarged print
  • May need magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Avoid visual clutter:
  • Present visual information in isolation
  • Avoid busy backgrounds
  • Avoid wearing patterned clothing when presenting visual information
  • May need adapted color dependent activities
  • May need alternate methods for matching clothing
  • May need instruction in tactile learning and braille

Optic Nerve Hypoplasia (ONH)

ONH and Septo-Optic Dysplasia (SOD) are related disorders of early brain development. ONH is a congenital, nonprogressive condition in which the optic nerve is under-developed and small.

It may affect one or both eyes, and when both are affected, side-to-side nystagmus is frequently present. During the first few years of life, vision may improve as the brain continues to develop. The incidence of strabismus is increased with ONH. It is one of the three defining characteristics of Septo-Optic Dysplasia, which is also called DeMorsier’s Syndrome. Learning disability, autism, cerebral palsy, and intellectual developmental delays can occur with ONH and SOD. Possible causes include young maternal age, genetic mutation, fetal alcohol syndrome, trauma, and viral infection.

  • May have decreased visual acuity
  • May have better acuity In one eye than in the other
  • May have nystagmus
  • May have strabismus
  • May have variable field restrictions
  • Visual perception may be impaired
  • High illumination
  • High contrast
  • Enlarged printed materials
  • May need magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Avoid visual clutter:
  • Present visual information in isolation
  • Avoid busy backgrounds
  • Avoid wearing patterned clothing when presenting visual information
  • Provide opportunities to confirm or clarify visual information through tactile exploration
  • May benefit from verbal descriptions to help make sense of visual information.
  • May need adapted color dependent activities
  • May need alternate methods for matching clothing
  • May need instruction in tactile learning and braille

Peter’s Anomaly

A congenital, genetic disorder that involves clouding (opacity) and thinning of the cornea

It is caused by abnormal development of the front third of the eye (anterior segment), and central opacities are most common. The iris may or may not be attached to the cornea (Type 1), and cataracts and other lens abnormalities may be present (Type 2). It is very common for amblyopia and glaucoma to develop. This condition can be associated with peters plus syndrome.

  • Blurred vision
  • Decreased central acuity
  • May have scotomas in peripheral fields
  • Photophobia
  • Increased sensitivity to glare
  • Reduced color discrimination
  • Visual ability fluctuates according to lighting
  • May have reduced near vision

 

  • Support of eccentric viewing
  • May need visual efficiency training to develop scanning skills
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Adequate lighting from behind using lamps with rheostats and adjustable arms
  • Reduced glare
  • Seat with back to windows
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Enlarged printed materials
  • High contrast materials
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Close viewing
  • May need adapted color-dependent activities
  • May need alternate methods for matching clothing
  • Frequent breaks from visual tasks

Photophobia

Abnormal sensitivity to light (any type)

It is usually associated with an eye disease or disorder (e.g., iritis, ocular albinism, aphakia, aniridia, dislocated lens, cataracts, glaucoma, etc.). However, many people experience mild photophobia that is unrelated to another eye condition. Other causes include corneal inflammation, some medications, and eye injuries. Severe photophobia can be quite painful, even in relatively dim light. 

  • Squinting
  • Closing the eyes
  • Eye pain
  • Headaches
  • Eye fatigue
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Reduced or diffused lighting
  • Provide lighting from behind
  • Use of shielded lamps with rheostats and adjustable arms)
  • Reduced glare
  • May benefit from use of NOIR sunglasses and/or filters (colored overlays) when reading
  • May need breaks from visual tasks or rest periods in a darkened area

Phthisis bulbi

Abnormally low intraocular pressure, which can cause shrinkage of the eye

It may occur as a complication of eye surgery, or it can be caused by eye diseases, serious and long-term inflammation, or injury. Low pressure damages the macula. The tissues inside the eye deteriorate, become disorganized, and scar tissue is formed. In some cases, the eye can become completely nonfunctional. Sometimes a scleral shell prosthesis is prescribed for proper lid function, eyelash direction, healthy tearing, protection of the cornea, and aesthetics. 

  • Reduced central acuity
  • Reduced color vision
  • Blindness
  • Average or bright light
  • Reduced glare
  • May need high contrast
  • May need magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • May benefit from use of high contrast line markers or templates for reading, finding math problems, or locating other information
  • May need some materials presented auditorily
  • May need instruction in tactile learning and braille

Presbyopia

The gradual loss of flexibility of the lens that occurs with age

It results in inability of the eye to focus at near distance. Presbyopia generally begins to noticeably affect visual functioning around age 40, and people often need prescription lenses by age 45. Options for prescription lenses include glasses for near-distance tasks, bifocals, transition lenses, and monovision contact lenses. Vision also can be corrected by reshaping the cornea using lasers (LASIK), radio waves (conductive keratoplasty - CK), or gas bubbles (IntraCor). Other surgical treatments include artificial lens implants, corneal inlays, and corneal overlays.

  • Blurred vision at normal reading distance
  • Headaches from doing close visual tasks
  • Further compromises the vision of aging adults who have existing visual impairments

 

  • Adequate lighting
  • High contrast
  • Frequent breaks from near-distance visual tasks

Ptosis

Drooping (sagging) of the eyelid

It may affect upper and/or lower lids and one or both eyes. Ptosis is usually due to weakness of the muscles that control the eyelids, damage to the nerves that control these muscles, or very loose skin of the upper eyelids.  Commonly associated with the aging process, ptosis also can be congenital and hereditary, or caused by injury or disease. A ptosis crutch may be prescribed to elevate the eyelid. Medications may be prescribed for those who have myasthenias gravis. Children with severe ptosis need eyelid lift surgery early in life to insure normal visual development and to prevent amblyopia.

  • Severe ptosis obscures the upper visual field
  • Long-term reduction of visual field can cause amblyopia

 

  • May need visual efficiency training to develop scanning skills
  • Ensure access to information that is elevated (bulletin boards, black/white boards, video screens, etc.)

Retinal Detachment

An emergency situation in which parts of the retina pull away from the underlying tissue that nourishes it and from the supporting structure of the eye

Detachments can be repaired if treated within 24-72 hours, but detached parts deteriorate rapidly. Any detachment endangers the entire retina. Detachments are caused by retinal tears, fluid under it, or shrinkage of the vitreous. These conditions may be due to injury, inflammatory eye disorders, advanced diabetes, degenerative myopia, and other retinal disorders.  

  • Field loss
  • Blind spots (scotomas)
  • Blurred vision
  • Possible loss of central vision
  • May develop myopia and/or strabismus
  • Avoid contact sports and other high risk physical activity to prevent retinal detachment
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • May need visual efficiency training to develop scanning skills
  • Support of eccentric viewing
  • High illumination
  • Reduced glare
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Seating in front with back to window
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Frequent breaks from visual tasks

Retinal Dysplasia

A rare, hereditary disorder resulting in abnormal development or growth of the retina and characterized by retinal folds, overgrowth of cells, and rosettes of retinal tissue

It can be associated with Meckel syndrome. 

  • Field loss
  • Blind spots (scotomas)
  • Blurred vision
  • Possible loss of central vision
  • Reduced visual functioning at night or in dimly lit places
  • Nighttime orientation and mobility evaluation
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Visual efficiency training to develop scanning skills
  • Support of eccentric viewing
  • Lamps with rheostats and adjustable arms
  • Reduced glare
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Frequent breaks from visual tasks

Retinitis Pigmentosa (RP)

A group of hereditary disorders causing degeneration of the retina

It is characterized by progressive loss of vision and reduction of visual fields, usually from the periphery inward. However, in some cases, central vision is affected first. RP may be associated with Usher’s syndrome, Leber congenital amaurosis, Laurence-Moon Biedl, and Bassen-Kornzweig syndrome. 

 

  • Loss of peripheral vision
  • Night blindness
  • Tunnel vision
  • Decreased acuity
  • Decreased depth perception
  • Blind spots (scotomas due to retinal scarring
  • Photophobia
  • May develop cataracts
  • May become totally blind
  • May be associated with myopia, vitreous opacities, cataracts, and keratoconus
  • Avoid contact sports and other high risk physical activity to prevent retinal detachment
  • High illumination
  • Reduced glare
  • NOIR lenses or overlay filters may be helpful
  • Video magnifier for maximum contrast
  • Night vision devices (e.g., Streamlight flashlights, Third Generation® Night Vision Devices, etc.)
  • Visual efficiency training in organized search (grid) patterns
  • Orientation and mobility evaluation at night and in dimly lit places
  • For central vision loss: magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • For peripheral field loss: increase viewing distance to see more area.

Retinoblastoma

A rare type of cancer in which malignant cells grow in the retina

It usually develops in early childhood. The majority of children who develop this cancer have mutations only in eye cells (non-germinal). They will not pass on the mutation, and usually, retinoblastoma develops only in one eye. When the mutation occurs in all body cells (germinal retinoblastoma), the disease is hereditary. These children are more likely to develop retinoblastoma in both eyes, pineal brain tumors (trilateral retinoblastoma), and other forms of cancer anywhere in the body. Current treatments include surgery, radiation, and chemotherapy. Retinoblastoma can become life threatening if the tumor extends beyond the eye, so enucleation is frequently necessary.

  • Strabismus is one of the first signs of retinoblastoma.
  • Restricted fields due to removal of tumors
  • Blind spots (scotomas) due to removal of small tumors
  • With monocular vision, there is no depth perception and visual field is restricted.
  • Blindness
  • Medications can negatively affect residual vision.

 

  • Avoid contact sports and other high risk physical activity to prevent retinal detachment
  • Orientation and mobility evaluation at night and in dimly lit places recommended
  • May need visual efficiency training to develop scanning skills
  • Support of eccentric viewing
  • May need magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • May benefit from access to auditory materials
  • May require instruction in tactile learning and braille

Retinopathy of Prematurity (ROP, retrolental Fibroplasia)

Incomplete development of the blood vessels of the retina

It occurs in premature infants. The vessels also may grow abnormally from the retina into the back of the eye. They may bleed into the eye, scar tissue may develop, and retinal detachment may occur. The major risk factors are degree of prematurity and low birth weight. There are five stages of ROP, ranging from mildly abnormal blood vessel growth in stage one to retinal detachment in stage five. ROP may be associated with other issues caused by incomplete development. Lasers or freezing (photocoagulation and cryotherapy) may be used to stop the abnormal blood vessels from continuing to grow. Also, surgery may be done to re-attach the retina. 

  • Retinal scarring
  • Decreased visual acuity
  • Severe myopia
  • Field loss
  • Partial or complete retinal detachment
  • Blind spots (scotomas)
  • Strabismus
  • Total blindness
  • May develop glaucoma

 

  • Early intervention and sensory stimulation
  • Avoid contact sports and other high risk physical activity to prevent retinal detachment
  • Nighttime orientation and mobility evaluation
  •  May need visual efficiency training to develop scanning skills
  • Visual efficiency training in organized search (grid) patterns
  • Adequate to high illumination (e.g., lamps with rheostats and adjustable arms)
  • Reduced glare
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Frequent breaks from visual tasks
  • May benefit from access to auditory materials
  • May need instruction in tactile learning and braille
  • May benefit from magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Reduced glare
  • Night vision devices (e.g., Streamlight flashlights, Third Generation® Night Vision Devices, etc.)
  • Balance need for a larger viewing area with the need for magnification
  • Balance need for close viewing against the need for increased distance and a larger portion of the text/pictures
  • Adapted color-dependent activities
  • Alternate methods for matching clothing
  • Support of eccentric viewing

Retinoschisis

A degenerative disorder in which the retina splits into two separate layers, resulting in progressive loss of vision, beginning in the fields that correspond to the areas where the retina splits

The hereditary form (juvenile X-linked retinoschisis) affects mostly boys and young men. The more common form can affect both men and women, and it usually is acquired in middle age or older (senile retinoschisis). Both forms may be associated with cysts (sack-like blisters) that form a spoke-like pattern in the retina. Retinal detachments can occur, and if detected early, they sometimes can be repaired with surgery. Prismatic glasses may be prescribed to increase field of vision.

  • Strabismus
  • Nystagmus
  • Central field loss
  • Peripheral field loss
  • Reduced visual acuity
  • Reduced color discrimination
  • Blind spots (scotomas)
  • Blindness

 

  • Avoid contact sports and other high risk physical activity to prevent retinal detachment
  • May need visual efficiency training to develop scanning skills
  • May need visual efficiency training in organized search (grid) patterns
  • Adequate lighting (e.g., lamps with rheostats and adjustable arms)
  • Reduced glare
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • Frequent breaks from visual tasks
  • May benefit from access to auditory materials
  • May need instruction in tactile learning and braille

For central vision loss:

  • Nighttime orientation and mobility evaluation
  • Magnification (e.g., hand-held lighted magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • High illumination
  • Night vision devices (e.g., Streamlight flashlights, Third Generation® Night Vision Devices, etc.)
  • Adapted color-dependent activities
  • Alternate methods for matching clothing

For peripheral field loss:

  • Increase viewing distance to see more area
  • Support of eccentric viewing
  • Balance need for a larger viewing area with the need for magnification

Rod Achromacy     See Achromotopsia

 

 

Scotoma (pl. scotomata, scotomas)

A portion of the visual field that is blind or partially blind and surrounded by relatively normal vision, depending on the presence of other eye conditions

Scotomas can occur in any part of the visual field. They can be caused by retinal disorders, tumors, stroke, or traumatic brain injury. 

  • May affect central or peripheral fields
  • Reduced acuity
  • May cause loss of detail
  • May cause photophobia
  • May cause reduced color vision
  • Visual efficiency training to develop scanning skills
  • Support of eccentric viewing
  • Seating and presentation of work should favor more functional eye
  • May need to use sunglasses, visors, or hats outdoors and indoors as well
  • Reduced glare
  • May need lighting from behind using adjustable lamps with rheostats and adjustable arms
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • May benefit from enlarged printed materials
  • May benefit from close viewing
  • High contrast materials
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • May need adapted color-dependent activities
  • May need alternate methods for matching clothing

Septo-Optic Dysplasia See Optic Nerve Hypoplasia and "Syndromes"

 

 

Strabismus (muscle imbalance

Abnormal alignment of the eyes; an inability to look at the same point in space with both eyes at the same time

It can be caused by a defect in the extra-ocular muscles or in the part of the brain that controls eye movement. It can be hereditary, and it may be associated with brain tumors, cerebral palsy, Down syndrome, extreme farsightedness, cataracts, or having much better vision in one eye than in the other. Strabismus includes:

  • “phorias”– muscle imbalances that are controlled by the brain's efforts toward binocular vision. Not always present, they tend to manifest when the person is tired.
  • “tropias” - observable deviations that the brain cannot resolve. They are always present.
  • Eso – turned inward/nasal (esophoria and esotropia)
  • Exo – turned outward/temporal (exophoria and exotropia)
  • Hyper – turned upward (hyperphoria and hypertropia)
  • Hypo – turned downward (hypophoria and hypotropia)

Treatments can be effective for young children: eye exercises, occlusion of the better eye, medications, and surgery. Prismatic glasses may be prescribed to increase field of vision.

  • Impaired ability to achieve binocular vision
  • Decreased depth perception
  • Affects eye-hand coordination
  • Difficulty fixating
  • May have difficulty scanning, tracking, and tracing
  • Difficulty following fast-moving objects
  • Difficulty making eye contact

 

  • Orientation and mobility evaluation recommended, specifically for negotiation of drop-offs and stairs in unfamiliar places
  • Vision efficiency training in scanning, tracking, and tracing

 

Toxoplasmosis

Congenital or acquired inflammation of the retina and choroid (retinochoroiditis), which can cause retinal scarring

Toxoplasmosis is caused by infection with the toxoplasma parasite found in animal feces and unpasteurized milk. Unborn babies are most vulnerable to the infection, and it can cause damage to the brain, eyes, or other organs. Treatments include anti-inflammatory medications, photocoagulation (laser) therapy, and cryotherapy (freezing).

  • Scotomas
  • Peripheral field loss
  • Central field loss
  • Loss of visual acuity
  • Decreased color vision
  • Photophobia
  • Increased sensitivity to glare
  • Visual efficiency training to develop scanning and eccentric viewing skills
  • Reduced glare
  • May need lighting from behind using adjustable lamps with rheostats and adjustable arms
  • Magnification (e.g., microscopic lenses, electronic magnifier, screen enlargement software, telescope, etc.)
  • May benefit from enlarged printed materials
  • May benefit from close viewing
  • High contrast materials
  • High contrast line markers or templates for reading, finding math problems, or locating other information
  • May need adapted color-dependent activities
  • May need alternate methods for matching clothing

Trachoma

A contagious bacterial infection of the eyes and eyelids, causing scarring and buckling of the eyelids

This causes the eyelashes to turn under, which leads to corneal scarring. Repeated and prolonged infection causes permanent visual impairment and blindness. Trachoma is spread through direct contact with secretions from the eyes, eyelids, or nose of an infected person. It is the leading cause of preventable blindness worldwide.

  • Photophobia
  • Fracturing or scattering of light (as in looking through a broken windshield
  • Increased glare
  • Blurred vision
  • Reduced acuity
  •  
  • Sunglasses, visors or hats outdoors, and indoors as well
  • Reduced or diffused lighting from behind (e.g., lamps with rheostats and adjustable arms)
  • Front row seating with back toward windows
  • Reduced glare
  • High contrast materials
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Enlarged printed materials
  • Frequent breaks from visual tasks
  • Support of eccentric viewing
  • Auditory materials for long reading assignments
  • May need instruction in tactile learning and braille

Uveitis

Inflammation of the uveal tract (middle layer of the eye), which consists of the iris, choroid, and ciliary body

The most common form affects the iris, and it may be called anterior uveitis or iritis. The cause may be unknown. Known causes include autoimmune disorders, infection, toxoplasmosis, tuberculosis, and histoplasmosis. Complications can cause glaucoma and damage to the retina or cornea, leading to permanent vision loss.

  • Photophobia
  • Blurred vision
  • Floaters
  • Decreased acuity
  • Glaucoma
  • Retinal scarring
  • Corneal damage

 

  • High contrast materials
  • Reduced glare
  • Allow additional time for adjustment to new visual conditions
  • Use of lamps with rheostats and adjustable arms
  • May need visual efficiency training to develop scanning and eccentric viewing skills

Wilm’s Tumor (nephroblastoma)

Rare abnormalities of the eye, especially aniridia, related to a malignancy of the kidneys

Although the cause is sometimes unknown, this form of cancer can be caused by genetic changes, which also can be hereditary. Pinhole contact lenses and sunglasses may be prescribed.

See “Syndromes" for associated conditions.

  • Decreased acuity, further reduced by other conditions
  • Photophobia
  • Large pupil (misshapen)
  • With corneal involvement: Fractured light, increased glare, blurred vision
  • With cataracts: blurred vision, and decreased color vision
  • Fovial involvement: loss of detail vision
  • With glaucoma: fluctuating visual functioning, field loss, poor night vision, and decreased sensitivity to contrast
  • May have nystagmus
  • May have ptosis
  • Vision stimulation for infants to develop the visual cortex
  • Sunglasses, tinted contact lenses, visors or hats in bright light outdoors and indoors
  • Allow time for adjustment to lighting changes
  • Front row seating with back to windows
  • Reduced glare
  • Provide reduced or diffused lighting from behind
  • Lamps with rheostats and adjustable arms
  • Magnification (e.g., hand-held magnifier, electronic magnifier, screen enlargement software, telescope, etc.)
  • Use a blackboard and bold chalk
  • Use of bold, black markers on a white board
  • Felt-tipped pens and tinted paper with bold lines
  • Use of dark/black background
  • Provide copies of materials presented on the board.

Boston College 

School of Education
120 Campion Hall
Chestnut Hill, MA 02167
Dr. Susan Bruce
Assistant Professor  

PHONE: 617-552-4239
EMAIL:
FAX: 617-552-1840
TTY:
WEBSITE: 

Boston College has a long history in preparing teachers at the master's level to work with learners who are deafblind.  Although many graduates remain career teachers, others have become researchers, consultants, college professors, program administrators, and state deafblind coordinators.  Many international students have returned to their home countries to take leadership positions in the field of deafblindness.  Varied educational practicum settings are available and out-of-state as well as local practicum experiences are encouraged.  Federal grant money may also be available.

Cochlear Implants And Children On-line Course

Cochlear Implant Education Center at the Laurent Clerc National Deaf Education Center at Gallaudet University 
Debra Nussbaum

WEBSITE: http://clerccenter.gallaudet.edu/

The Cochlear Implant Education Center at the Laurent Clerc National Deaf Education Center at Gallaudet University is continuing to work on many initiatives related to children with cochlear implants. (with primary focus on children, families and educational programs that also use sign language) An on-line course is offered entitled Cochlear Implants and Children: Considerations for Implantation and Educational Planning.  An overview of the technical aspects of the device, surgical procedures, issues involved in determining candidacy, extent of benefit from the implant, and considerations for family support and educational planning.  Information related to effectiveness of cochlear implants will be highlighted in the context of age of implantation, psychological adjustment considerations and deaf culture issues. Contact Debra Nussbaum for information on the next sceduled class.

HOPE Online Courses

Free one-hour educational seminars are given by internationally known experts on a range of topics relating to the (re)habilitation and educational needs of children, teens, and adults who use cochlear implants or the Baha System. Continuing education credits (CEUs) are available from the American Academy of Audiology and the American Speech-Language-Hearing Association. Many courses are offered for CE Credit from the AG Bell Academy for Listening and Spoken Language for the LSLS Certification. CEUs are administered by Audiology Online. Cochlear Americas offers a free Certificate of Participation for those who have completed courses and returned a Feedback Form via the designated mechani

Northern Illinois University - Certificate Training In Deafblindness

Department of Communicative Disorders
Northern Illinois University
Rehabilitation Counseling
DeKalb, IL 60115
Jennifer L. Gregory Project Coordinator  

WEBSITE: http://www.chhs.niu.edu/

Northern Illinois University's Department of Communicative Disorders, housed within the College of Health and Human Sciences, offers a unique program designed to provide quality continuing education to the rehabilitation professional who wishes to enhance his or her skills in providing quality services to persons who are deaf-blind. This program is funded by the U.S. Department of Education, Rehabilitation Services Administration. Participants may earn 15 semester hours of academic credit at either the undergraduate or graduate level. Training begins with an intensive three-week institute on the Northern Illinois University campus, located 65 miles west of Chicago. Students then enroll in a distance-learning component of the course that is completed during the second semester of study. The goal of the program is to impact significantly the delivery of rehabilitation services to persons who are deaf-blind by assisting rehabilitation professionals to be knowledgeable concerning the unique considerations of providing quality and accessible services to this population.

OHOA Intervener Learning Modules

The  Open Hands Open Access (OHOA) Intervener Learning Modules are a national resource designed to increase awareness, knowledge, and skills related to intervention for students who are deaf-blind and are being served in educational settings (ages 3 through 21). The development of the modules is in response to Recommendation 3 of the Recommendations to Improve Intervener Services (NCDB, 2012).  Recommendation 3 is one of a set of recommendations intended to establish a strong national foundation for intervener training and workplace supports. 

The module content was created by a diverse group of experts in the field of deaf-blindness including state and national deaf-blind project staff, parents of children who are deaf-blind, higher education faculty, teachers, educational interpreters, and interveners.  Each includes a variety of accessible videos, photographs, slide presentations, and learning activities.  The modules have been guided by an advisory committee, and reviewed by a variety of experts in deaf-blindness and the process of intervention, experts in module design, and field-test participants.

Cortical Visual Impairment Online Course [CVI]

Jim Deremeik
Lions Vision Research and Rehabilitation Center  

This course is a re-creation of a workshop on CVI conducted by Dr. Gordon Dutton, a pediatric ophthalmologist from Glasgow, Scotland, at the 2006 AER International Conference. The workshop entitled CVI - Damage to the Brain: A Common Cause of Visual Impairment in Children, is an online course broken into nine sections. The course provides participants an overview of the visual system and how it works, disorders of vision due to damage to the brain, and approaches to helping students with vision problems due to damage to the brain. Dr. Dutton provides participants theory and practical application from his expertise as a clinician working with children and their families having been diagnosed with CVI. The course is broken into eight learning modules. The ninth and last section is a question and answer forum for those who attended the Salt Lake City workshop. The intended audience for this course is any care provider working with a child diagnosed or suspected of having cortical (cerebral) visual impairment.

East Carolina University Graduate Certificate In Deafblindness

The Deaf-blindness Certificate is an on-line program to prepare educators in the area of deaf-blindness based on nationally recognized competencies, reviewed by ECU faculty, and the National Consortium of Deaf-blindness.

Hunter College Of The City University Of New York

Hunter College School of Education
Department of Special Education
695 Park Avenue
New York, NY 10021
Rosanne K. Silberman, Ed.D.

EMAIL:
PHONE: (212) 772-4740
FAX: (212) 650-3542

Hunter College offers a Master of Science in Childhood Special Education with a specialization in Severe/Multiple Disabilities Including Deafblindness.  The program is designed to prepare teachers to provide instruction to learners with severe disabilities including those with deafblindness in specialized and inclusive settings.  Emphasis is on collaboration betweem special education and general education to prepare students to improve the quality of learning and increase educational opportunities and standards for all learners. Graduates will be prepared to teach in diverse settings that include early intervention centers, specialized programs in public and private schools, private agencies, hospitals and clinics.  They will be able to serve in such roles as specialized teachers of learners with severe disabilities including deafblindness, inclusion support providers, and as collaborative team teachers with general education teachers. Tuition waivers and stipends may be available for full and part-time study.

George Brown College

George Brown College
P.O. Box 1015 Station B
Toronto M5T 2T9
Toronto, Ontario Canada M5T 2T9
Betty-Jean Reid

The Intervenor for Deafblind Persons program provides an opportunity for students to learn how to work with people who have a combined loss of vision and hearing. Over the span of two years, students have the opportunity to learn how to guide, use assistive devices, and deal with the medical fragility that clients often present. The Intervenor for Deafblind Persons program is unique in Canada.

San Francisco State University

The Master of Arts in Special Education is an individually designed professional degree in an area of emphasis with deafblindness being one of the areas of emphasis. This degree provides advanced knowledge in Special Education and emphasizes research and leadership skills within a selected program of study. Programs within the department provide students with an opportunity to learn and participate in scholarly research, demonstration, training, and clinical projects with faculty. Coursework completed prior to, or concurrently with, Education Specialist or Clinical Rehabilitative Services credentials may be applied to the degree emphasis (Special Education and Related Studies components), with approval of graduate program advisor.

Graduate study requires application and admission to the department and university. A minimum grade point average of 3.0 is required for admission to the master’s degree. Refer to the department application for additional application requirements.

Texas Tech University College Of Education Virginia Murray Sowell Center For Research And Education In Visual Impairment

Texas Tech University offers distance education classes as well as traditional on campus classes for teachers interested in special education masters or doctoral programs with emphasis on a choice of orientation and mobility, visual impairment, or deafblind studies.  Some programs offer state and/or national certification upon completion.

Utah State University Online Preservice Training in Deafblindness

Specially trained to aid the deafblind, interveners have the potential to make a huge difference in the life of a child. Interveners help deafblind children acquire communication, personal development and relationship building skills in order to promote social and emotional well-being.

Versión Español de este artículo (Spanish Version)

by Gigi Newton, Teacher Trainer, TSBVI, Texas Deafblind Outreach

Originally published in the Fall 2000 edition of See/Hear

Editor's note: In 1992, Gigi Newton, Teacher Trainer with Texas Deafblind Outreach, began to share information with our team about the benefits of massage therapy with children who are deafblind. During this time, Evelyn Guyer, a certified infant massage therapist, had begun to train individuals in the use of Bonding And Relaxation Therapy (BART) and had received a grant to train parents and others to use these techniques with deafblind children. Gigi wrote an article about some of the work being done by Evelyn and others that was published in the July 1992 edition of P.S. News (the Deafblind Outreach newsletter before SEE/HEAR).

Also in 1992, through Gigi and Stacy Shafer, Early Childhood Specialist with Visually Impaired Outreach, we learned about Active Learning theory from Dr. Lilli Nielsen of Denmark. Active Learning focused on providing the child with blindness opportunities to be an active participant in interactions with the environment. This approach benefits children with visual impairments by assisting in the development of body awareness and motor skills, cognitive skills such as comparing and contrasting qualities (heavy, light, soft, hard, smooth, rough, noisy, quiet, vibrating, still, etc.), and choice-making.

In 1997, I attended a session at the National Deafblind Conference in Washington, D.C. titled "Hands: Tools, Sense Organs, Voice", presented by Barbara Miles. Her session focused on the functions of hands in cognitive, linguistic and emotional development for children with deafblindness. In May of 1999, DB-LINK published Barbara's article, "Talking the Language of Hands to Hands." This article (which is available on the DB-LINK website at http://www.tr.wou.edu/dblink/) looks at the role of hands in early development for children with blindness, deafness, and deafblindness, and suggests strategies for facilitating hand development in children with deafblindness.

For the past several years, the Texas Deafblind Outreach team has been discussing the importance of these theories and approaches in the education of children with deafblindness. Developing the tactual sense, body awareness, the use of hands, and establishing bonds of trust between the child and caregiver or instructor are key components in the child's ability to benefit from instruction. This is especially true when the child is severely visually and auditorially impaired, but is also true to some degree for any child with sensory impairments. Many early literacy and learning skills require the development of the tactual sense, the awareness and use of hands and fingers, the child's willingness to trust an instructor who guides his/her hands to explore objects and people in the environment.

In the summer or early fall of 2001, Texas Deafblind Outreach plans to offer a workshop for parents and members of their children's' educational teams that emphasizes these approaches. Future editions of SEE/HEAR will also feature articles on these topics to help you decide if this workshop might be beneficial for you. Here we are reprinting Gigi's 1992 article about infant massage and the importance of touch in parent-infant bonding. Touch is a powerful way to communicate.

Touch from another human being can be a nourishing medicine or a damaging poison. Without words, we can show affection by giving a hug or by stroking a child's arm, or we can show disapproval by using our hands to restrain a child's hand. The importance of touch for a child with deafblindness is apparent. The child will use this sense extensively to develop communication skills, to help orient in different environments, and most importantly to connect socially with others. This article focuses on the power of gentle touching and suggests ways in which touch can make a positive change in your life and the life of your child.

What does caring and loving touch do for infants? It is a necessary part of developing attachment between the child and parents. It is the beginning of communication between you and your child. Because you make him feel secure, the child learns to trust you and develops an emotional tie to you. The child's response to those feelings of security deepens your feelings of love and protectiveness towards him. It is what Dr. T. Barry Brazelton refers to as the parent and child "falling in love" with each other.

The most important thing parents can do to help develop this attachment is to first become careful observers of their child and learn how to interpret his needs. A newborn communicates his needs or feelings to his parents primarily through crying. When a baby's cry is responded to quickly and warmly, the child begins to develop a bond or attachment to the caregiver.

When a child is not responded to he does not feel safe. As a result his sleeping, eating, and social interactions can all be affected. According to research findings, if a baby knows a caregiver will respond, the baby begins to reserve crying for more specialized needs. This finding disputes the belief that babies are spoiled by parents who respond every time to their child's crying.

Talking to a baby while responding to his cry lets him know that the caregiver understands his feelings. Over time he begins to be comforted by the voice and to understand that words are a way of communicating. This situation changes somewhat with children with deafblindness.

Babies with deafblindness will need to have more input through other senses such as touch, smell, etc. because of the information that is lost to them through their decreased vision and hearing. Try cuddling the child against your chest while you are speaking or holding his hand or foot against your cheek or chest to let him feel the vibrations of your voice. Use a consistent signal, like soft pats on the back or stroking his forehead to communicate your empathy.

The crying behaviors of infants with hearing, vision, and /or neurological problems may be different from an infant without disabilities. It may take more observation to understand what their cry means and how to respond to them. Parents might try to list times when the baby cries and note any patterns in the baby's environment that might be causing him distress. If all the child's basic needs (i.e., food, dry diapers, companionship, etc.) have been met and the child continues to cry, the parent may need to look for signs of over-stimulation. Some of these signs are: turning the body, face or eyes away; closing his eyes; arching the back; spitting up; rapid shallow breathing; changing color; hiccupping.

It the child is over-stimulated you may need to try some inventive approaches to consoling your baby. Preventively, you can try to keep your baby's daily schedule as consistent as possible. You can make the environment calming by dimming the lights, dropping the noise level, and reducing social stimulation. You may also try things like placing him in his travel chair on the washing machine so he is lulled by the vibrations. Taking rides in the car, running a vacuum cleaner, anything that produces a steady vibrating motion or monotonous sound, can also help him to relax or calm. You will have to be creative in finding the type of calming actions that work best for your child.

Moms and dads also bond with their babies by kissing, cuddling, and making eye contact. Babies with vision, hearing, or motor impairments may not receive as much feedback from this type of physical contact because of their impairment. Ask your Vision Teacher to help you decide how your baby uses his vision and how to adjust the lighting in his environment to maximize the use of his vision. For example, the baby might see your face better if the light came from behind him so he does not have to look into a glaring light when he turns to you. To keep from startling a baby who may not hear your voice, a "signature" scent (hand lotion or perfume) may provide a cue that you are near.

Infants with seizure disorders or motor impairments may not respond well to touching and holding. Certain types of touch may actually trigger a seizure in some children with seizure disorders because it is stressful. Some children are tactilely defensive or they have abnormal muscle tone. When a baby does not show a typical response to a parent's attention the parent may interpret the baby's response as rejection. The parents may begin to hold the child less often. However, the child's atypical response to touch may relate to muscle tone rather than to feelings about his parents. With these children, it is critical for the parents to learn to touch their child in a way that is acceptable and pleasurable to the child.

Physical therapists and occupational therapists can help parents discover what types of physical touch their child can tolerate and learn to enjoy. They can also make suggestions about textures (for clothing, bedding, etc.) that may be more pleasing to the child. Parents may want to start with a few minutes of touching, and increase the time gradually as the child can tolerate it. Often children prefer firm pressure on their arms and legs as opposed to light stroking. When using light strokes move in the direction of the hair growth, not against it. Avoid applying pressure on the spine. As the child becomes comfortable with being touched he will become more comfortable touching things and people in his environment. If a child does not enjoy touching, he will have a difficult time learning to explore his surroundings.

In Touching by Montagu we learn that holding and rocking a baby has physiological and emotional benefits. Touching increases the baby's cardiac output, promotes respiration that in turn discourages lung congestion and helps the baby's gastrointestinal function. The movement of rocking often helps in digestion and absorption of food.

During normal home activities such as diapering, bathing and bedtime, incorporate a few minutes of gentle touching. Rubbing on baby lotion, cuddling before bedtime or massaging arms and legs during a bath can add an extra measure of caring to ordinary events. Sometimes these caring touches can even make a bothersome event pleasurable.

One special technique of touching that is being used to increase bonding is infant massage. Infant massage is a more structured way of touching. Many hospitals use infant massage with premature infants. Current studies seem to suggest infant massage may enhance a premature baby's physical growth and development. Infant massage is something you do with your baby as opposed to something that is done to your baby. It is a way for parents to connect with their child on a special level. Massage can help parents learn the way their baby's body looks and feels when he is tensed or relaxed; the look and feel of a gassy stomach; the difference between pain and tension.

Resources and References

If you want information about infant massage training contact: The International Association of Infant Massage Instructors, E. Micki Riddle, R.N., Ph.D., Executive Director, 1891 Goodyear Avenue, Suite 622, Ventura, CA 93008 or phone (805) 644-8524. There is also a website; go to http://www.iaim-us.com/. The following books can be ordered through the website, by calling toll-free (888) 448-9489 or by e-mailing 

  • Baby Massage: Parent-Child Bonding Through Touch, Amelia D. Auckett, Harper Collins, 1989.
  • From the Hand to the Heart (book and video tape), Evelyn Guyer. This is a book for parents and caregivers who care for disabled individuals.
  • Infant Massage: A Handbook for Loving Parents, Vimala Schneider McClure, Bantam Books, 2000.
  • Touching, Montagu, A., Harper Collins, 1986.
  • Another booklet that may be useful to parents is available from the Blind Children's Center, P.O. Box 29159, Los Angeles, CA 90029 or from their website at http://www.blindcntr.org/
  • Move With Me: A Parents' Guide to Movement Development for Visually Impaired Babies, Blind Children's Center (also available in Spanish).

 

7/99

_____ Annual ARID within last year (to include VI ARD/IEP or IFSP Supplement)

_____VI IEP

_____*Parent's Explanation of Safeguards

_____*Parent's Release of Confidential Information

_____ Parent's Resource Sheet each year

_____*Parent's Permission to Test

_____ Parent's Release for information to Texas Education Agency, etc.

_____*Notice of ARID

______Ophthalmologist Report (with CIA Eligibility Report, Part A attached)

    1. indication of no vision or serious vision loss
    2. visual field
    3. visual acuity
    4. prognosis

_____ Functional Vision and Learning Media Assessment (with CIA Eligibility Report, Part B: Functional Vision Report attached)

    1. an evaluation of performance of tasks in variety of environments using near and far vision
    2. recommendation concerning low vision evaluation
    3. recommendation concerning need of O & M evaluation

_____Learning Media includes:

    1. appropriate learning media
    2. statement of need for ongoing assessment to determine learning media
    3. determination if student is "functionally blind"
    4. if student is "functionally blind", documentation of strengths/ weaknesses in braille skills.

_____ARD summary addresses (when appropriate)

    1. low vision evaluation (every 3 years)
    2. orientation and mobility evaluation (every 3 years)
    3. assistive technology

_____*Modification sheet/ coordinate with IEP

______Orientation and Mobility Report (if applicable)

    1. learning competencies which identify the need for the related service
    2. documentation that the service will enable the student to benefit from instruction
    3. a recommendation for the specific service(s) to be offered

_____"Statement of Need for Transition Services" (on or before age 14)

_____*'Individual Transition Plan (16 years or older)

_____*Vocational Testing (14 years or older)

_____*Graduation Plan

* = General District Requirements (not VI specific)

For Further Clarification: Visual Impairment

  • On the eye report if exact measures could be not be obtained, an eye specialist must so state and give best estimates.
  • On the eye report "Prognosis when possible" refers to the doctor's ability to determine a prognosis. If the doctor is unable to report a prognosis then that inability should be noted. No information about the prognosis constitutes a discrepancy.
  • Documentation should ensure that the functional vision evaluation reflects visual functioning in the environments in which the student functions. These may include, but not be limited to, the classroom, cafeteria, gym, hallway, school grounds, job site, and home. Although the FVE should include data from the medical reports, that information alone is not sufficient. The FVE should include information which can be used as the basis for educational decisions.

    There should be a variety of recommendations including modifications to the environment, supplemental aids and equipment, adaptive technology, teaching strategies, physical education, vision related services, assessment strategies, testing strategies, and areas of needed instruction in compensatory skills areas. (These recommendations can be combined with those from the Learning Media Assessment.)

    An FVE which (a) does not clearly indicate the student's visual functioning in a variety of environments, or (b) is a restatement of the medical information, or (c) otherwise does not include information designed to assist in educational decisions is out of compliance.

     

    If a clinical low vision evaluation and/or an orientation and mobility (O&M) evaluation was recommended, there should be documentation that the evaluation occurred within a reasonable time frame. Reports should be included in the student's eligibility folder.

  • In the LIVIA, a statement of need for ongoing assessment to determine appropriate learning media is necessary in this report only if the evaluator is unable to determine a learning media. Typically this occurs when evaluating a very young child, a child with severe and profound disabilities, or when there is a borderline vision determination.
  • A learning media assessment evaluates:
    • the efficiency with which the student gathers information through the use o vision, touch, and hearing.
    • the appropriate learning media and the variety of methods and materials the student uses to accomplish learning tasks
    • the primary literacy medium the students will use for reading and writing (such as print, large print, Braille, and/or auditory tapes.)

    There should be a variety of recommendations including what the learning media should be, modification to the environment, supplemental aids and equipment, adaptive technology, teaching strategies, physical education, vision related services, assessment strategies, testing strategies, and areas of needed instruction in compensatory skill areas.

    The LMA may be combined with the functional vision. evaluation. However, the LMA should be labeled as such. Only a teacher holding a valid certificate to teach students with a visual impairment is qualified to perform a learning media assessment.

  • For Functionally Blind, "Braille skills" include pre-Braille and/or Braille readiness activities which develop the skills required for Braille reading and writing. These skills may include tactual exploration and discrimination, fine motor coordination, and hand strength. Pre-Braille and/or Braille readiness activities may be appropriate for:
    • infants and preschoolers
    • students with multiple disabilities
    • students who are blind and in the primary grades
    • older students who are learning Braille due to trauma, deteriorating vision, and/or severely limited visual efficiency.

Elaine Kitchel, M.Ed.

American Printing House for the Blind

Why should we care about blue light?

For years now, professionals in the fields of light energy and vision have known about the hazards ultraviolet (UV) light presents to ocular health. We are gradually having longer and more intense exposures to blue light; much of the world of commercial display and industry is lit with cool white fluorescent tubes which emit a strong spike of light in the blue range. Indeed many homes and offices are lit with cool white fluorescent tubes. No one doubts more people are spending time in front of video display terminals (VDTs) which produce blue light. While some people find blue light irritates their eyes or causes headache, most are able to ignore it. Scientists only now are beginning to investigate its long‑term effects and offer some solutions for maintaining ocular health in the presence of blue light.

What is blue light?

Experts differ as to the exact wavelength of UV light waves, but generally speaking, UV light is defined as that part of the invisible spectrum which ranges from 380nm to 200nm. (Nm stands for nanometer which is one billionth of a meter.) This part of the spectrum is divided into UV‑A, (380nm to 315nm), UV‑B, (314nm to 280nm,) and UV‑C (279 to 200nm.)

UV‑C, the shortest wavelength for purposes of this report,  is virtually absent from ordinary lamps, blacklight and sunlight within the earth's atmosphere. It is largely germicidal in nature and is used by dentists and in industry for sterilization purposes. One of the primary benefits of the ozone layer is that it filters out virtually all of UV‑C. However, UV‑B and UV‑A do manage to enter our atmosphere where UV‑B and to some degree UV‑A, have been implicated in the formation of skin cancers and cataracts and in the degeneration of retinal tissue. (Van der Leun and Gruijl, 1993). UV‑A is particularly plentiful in the light emitted from black light bulbs, so popular in "sensory stimulation" activities. However, until recently, little was said about near UV, or "blue light" and its effects upon the eye. Blue light is that light with wavelengths in the 500nm to 381nm range. Both blue light and UV‑A are sometimes referred to as "near UV," but for purposes of this report, "near UV" refers to blue light.

What about "black light?"

Of special concern is the blue light given off by "black light" tubes and bulbs. These are glass tubes/bulbs coated with special phosphors on the inside surface. When the gas in the tube is excited by an electrical current, it glows; when the light passes through the coated glass, only the wavelengths in the UV‑A and blue light range are emitted. When viewed under black light, many objects fluoresce. This fluorescence is deemed desirable by party‑goers, artists and even educators.

In 1980 the team of Poland and Doebler used black light to test eye‑contact training with children who had cerebral palsy. They found  their subjects performed better under black light than under ordinary room light. In 1983 these findings were again supported by Potenski in a similar experiment with multiply handicapped, deaf‑blind children. The conclusion was that severely brain‑damaged children seemed better able to use their vision when only the task was highlighted and the rest of the environment lay in darkness. Neither study remarked about any safeguards employed to protect the practitioner or the students from the effects of UV‑A or blue light emitted by the black‑light tube. Further, neither study employed a control group which performed the same tasks in a dark room under an ordinary spot lamp, for comparison.

Review of Literature

Retinal Damage

In an early study conducted by Ham, Ruffolo, Mueller and Guerry, (1980) rhesus monkeys were exposed to high‑intensity blue light at 441nm for a duration of 1000 seconds. Two days later lesions were formed in the retinal pigmented epithelium (RPE.) These lesions consisted of an "inflammatory reaction accompanied with clumping of melanosomes and some macrophage invasion with engulfment of melanosomes which produce hypopigmentation of the RPE" (Ham et al., 1980, p.1110). Since melanin, a common pigment component present in the RPE, strongly absorbs blue light, there is reason to be concerned that the retina is subject to actinic injury from blue light. However, the lens strongly absorbs blue light as well but runs a high risk of possible opacification.

Human studies have not been conducted due to the obvious ethical problems involved in deliberately subjecting humans to potentially hazardous conditions. However, Taylor et al., found an association between cataract formation and exposure to UV-B when he studied 838 watermen who worked on Chesapeake Bay. He was not, however looking for a link between near UV and retinal or lens cell anomaly. The closest studies available are ones which use animals. Among researchers and scientists who have studied blue light, many are of the opinion that blue light might be a hazard and precautions would be wise. Some researchers are more certain: Ham et al., after conducting studies on animals, suggested "long term, chronic exposure to short wavelength light is a strong contributing factor to senile macular degeneration" (p. 1110).

In 1992, Chen, a researcher at St. Erik's Eye Hospital in Sweden, sought to explore the basis to explain why blue light reactions cause retinal degeneration. Drawing on the research of E. L. Paulter, Morika and Beenley (1989), who found that a chemical chemical called cytochrome oxidase is a key enzyme in the respiration of the retina in higher mammals, Chen decided to investigate this phenomenon in rats. Cytochrome oxidase is found in the RPE and in the inner segment of the photoreceptors. Paulter's in vitro studies of bovine REP tissue showed that blue‑light exposure destroyed cytochrome oxidase and inhibited cellular respiration. This inhibition was followed by retinal degeneration. Chen then performed a similar experiment upon rats in which he exposed them to 15 minutes of 404nm blue light which was not strong enough to cause thermal damage. He then killed some rats immediately, and one for each of the next three days. Upon examining their retinas, he found the blue light exposure had indeed inhibited the production of cytochrome oxidase. This was evident in his observation of the photoreceptor cells which had been destroyed. He concluded inhibition of cytochrome oxidase by blue‑light exposure and the consequent  suppression of the cellular metabolism is a potential cause of retinal degenation (1993, p. 422).

One might argue that results in laboratory rats are not necessarily indicative of human results. For this reason, primate research often follows other mammalian research. In 1980 the group of Sperling, Johnson and Harwerth irradiated the retinas of baboons and rhesus monkeys with blue light. The eye tissues of these primates are very similar to those of humans. In addition to color blindness in the blue‑to‑green range, Sperling et al. found extensive damage in the RPE resulting from absorption of energy  by the melanin granules. It should be pointed out that the damage seen . . . including macrophagic activity, disrupted cells and plaque formation, is characteristic of that seen by Ham et al. (1978), and others in what he calls the photochemical lesion.

In light of findings like these, ophthalmologists are beginning to filter the blue light emitted from their ophthalmoscopes through a yellow lens. A study by Bradnam, Montgomery, Moseley and Dutton concluded: "This study has shown that the use of a yellow lens is very effective at reducing the blue‑light hazard and extends the safe operating period by a factor of approximately 20x. . . In the interests of patient safety, it is recommended that yellow lenses are considered for use for routine indirect ophthalmoscopy" (1994, p. 799).

Lens Damage      

After some yellowing, by the age of 20, the lens becomes a natural, though imperfect, absorber of wavelengths between 400 and 320nm. It helps protect the retina from damage by near UV radiation. The lens also provides partial but imperfect protection to  the retina from blue light. In early studies it was thought that UV‑B was the only wavelength band responsible for cataracts. However

Most authorities now believe that the near UV radiation absorbed  throughout life by the lens is a contributing factor to aging and senile cataract. Thus, by protecting the retina from near UV radiation, the lens may become cataractous. My own personal opinion is that both the retina and the lens should be protected throughout life from both blue light and near UV radiation. This would delay the onset of senescence in both lens and retina (senile cataract and senile macular degeneration.) (Ham, 1983, p. 101).

Youths under the age of 20, and especially very young children, have little or no yellowing of the lens. Therefore any UV or blue light which enters the eye is unfiltered and strikes the retina at full‑strength exposing not only the retina, but the lens to damage.

Nancy Quinn, a registered nurse and an expert on blue light emissions from VDTs wrote:
Blue light wavelengths and part of the blue spectrum are focused in front of the retina, while green and yellow are focused on the retina, and some red spectrum is focused behind. Thus blue light contributes little to visual acuity and visual perception loses sharpness as the blue light component adds significantly to the eye's energy expenditure for focusing, and if reduced can greatly reduce eyestrain without loss of acuity.

There is mounting medical evidence that prolonged exposure to blue light  may permanently damage the eyes, contribute to the formation of cataracts and to the destruction of cells in the center of the retina (n.d.).

What can be done?

Ham et al. (1980) and Gorgels and van Norren (1995) pointed out that actinic, or photochemical damage to retinal tissue, is more a function of wavelength than either intensity or duration. Gorgels and van Norren, after examining rat retinas damaged by blue light, wrote "duration had no influence on damage threshold dose, nor on morphology. We conclude that wavelength (and neither irradiance nor duration) is the factor responsible for the encountered morphological differences"(p.859).

These studies suggest neither the human cornea nor lens provides sufficient protection from blue light for our modern environment. Our ancestors did not have to deal with many hours under cool white fluorescent light, nor did they spend any time looking at video display terminals at close range. Our eyes' natural filters do not provide sufficient protection from the sunlight, let alone blue light emitted by these devices nor from the blue light emitted from black‑light tubes.

As a feature of their molecular structure, many plastics have the ability to filter out UV‑A and UV‑B light. Clear polycarbonate spectacles are now available which are labeled "filters 100% UV." Clear plastic, however, will not filter out blue light. In order to accomplish this, the filter must be tinted. Yellow is the preferred color because it allows  the best contrast for the most people while still offering UV and blue light protection. Bradnam, et.al. (1994) showed the yellow lens to be very effective in protecting the retinas of their patients who were being exposed to blue light during ophthalmoscopy. In the case of black light activities, yellow is the only color which gives adequate blue light and UV protection, under which fluorescent materials will still appear to fluoresce. Both Solar Shield and NoIR produce a yellow lens which filters out 100% UV and 100% blue light. Filters should always be between the light source and the eyes. For this reason, visors or spectacles work best. Acetate sheets, which are often used, offer little or no protection from blue light.

The blue light factor should be of maximum importance to persons working with young children and with individuals who may have albinism, aphakia, achromatopsia, coloboma, sub-luxated lenses and other conditions in which the light reaching the retina is unfiltered, or causes extreme light sensitivity. Professionals in the field of vision would profit by, at the very least, employing proper filtering precautions and limits of exposure to both subject and practitioner, when using black light and other sources of blue light during sensory stimulation, and visual training activities.

Practical Suggestions

  1. Student and practitioner should always wear yellow-tinted lenses or visors which offer 95-100% UV and blue light protection during the use of black light.
  2. Black light usage should be very limited. Recent studies suggest that the old guidelines of 2-3 times per week per child with sessions less than 15 minutes each (Moore, 1986) may be too much. Efforts should be made to wean the student from black light into dim light and then into daylight vision development activities.
  3. UV screen filters which fit over the display terminal, or UV filtering spectacles should be worn during the use of a video display terminal (computer screen.)
  4. If possible, limit the use of cool white fluorescent tubes or mercury lights in the environment. Substitute warm white tubes or incandescent lamps if possible.
  5. Students or practitioners with albinism, aphakia, coloboma, sub-luxated lenses or achromatopsia should wear UV/blue filtering lenses or visors outdoors and also indoors if under cool white fluorescent or mercury lights.
  6. lways make sure the source of blue light is below waist level, or behind the student. Blue light sources should not be near eye level.

These few simple precautions may help to preserve the ocular health and comfort of students, rehabilitation clients, and the professionals and paraprofessionals who serve them.

This research synthesis has been published in the Journal of Visual Impairment and Blindness, June (2000). NY: AFB Press

References and Resources

Bergmanson, J. P. (1993).  Ultraviolet radiation damage to the corneal endothelium?  Ophthalmology, 100(4), 442-443.

Bradnam, M.S., Montgomery, D. M., Moseley, H., & Dutton, G. N. (1995).  Quantitative assessment of the blue-light hazard during indirect ophthalmoscopy and the increase in the Asafe@ operating period achieved using a yellow lens.  Opthamology, 102(5), 799-804.

Chen, E.  (1993).  Inhibition of cytochrome oxidase and blue-light damage in rat retina.  Graefe's Archive for Clinical and Experimental Ophthalmology, 231(7), 416-423.

Chou, B. R. (n.d.). Ocular health and the atmospheric environment.  Ontario, Canada: University of Waterloo, School of Optometry.

Creech, L. L., & Mayer, J. A. (1997).  Ultraviolet radiation exposure in children: a review of measurement strategies.  Ann­­als of Behavioral Medicine, 19(4), 399-407.

Fedorovich, I. B., Zak, P. P., & Ostrovskii, M. A. (1994).  Enhanced transmission of UV light by human eye lens in early childhood and age-related yellowing of the lens.  Doklady Biological Sciences, 336(1), 204-206.

Gorgels, T. G., & van Norren, D.  (1995).  Ultraviolet and green light cause different types of damage in rat retina.  Investigative Ophthalmology & Visual Science, 36(5), 851-863.

Ham, W. T., Jr. (1983).  Ocular hazards of light sources: review of current knowledge.  Journal of Occupational Medicine, 25(2), 101-103.

Ham, W. T., Jr., Ruffolo, J. J., Jr., Mueller, H. A., & Guerry, D., III.  (1980).  The nature of retinal radiation damage: dependence on wavelength, power level and exposure time; the quantitative dimensions of intense light damage as obtained from animal studies, Section II.  Applied Research, 20, 1005-1111.

Hao, W., & Fong, H. K. (1996).  Blue and ultraviolet light-absorbing opsin from the retinal pigment epithelium.  Biochemistry, 35, 6251-6256.

Hightower, K. R. (1995).  The role of the lens epithelium in development of UV cataract.  Current Eye Research, 14, 71-78.

Organisciak, D. T., Darrow, R. M., Barsalou, L., Darrow, R. A., Kutty, R. K., Kutty, G., & Wiggert, B. (1998).  Light history and age-related changes in retinal light damage.  Investigative Ophthalmology & Visual Science, 39(7), 1107-1116.

Pautler, E. L., Morita, M., & Beezley, D. (1989).  Reversible and irreversible blue light damage to the isolated, mammalian pigment epithelium. Proceedings of the International Symposium on Retinal Degeneration (pp. 555-567).  New York: Liss.

Poland, D. J., & Doebler, L. K. (1980).  Effects of a blacklight visual field on eye-contact training of spastic cerebral palsied children.  Perceptual and Motor Skills, 51, 335-338.

Potenski, D. H. (1983).  Use of black light in training retarded, multiply handicapped, deaf-blind children.  Journal of Visual Impairment & Blindness, 77(7). 347-348.

Quinn, N. (n.d.).  Resume and research into the effects of video display terminals use and office environmental lighting.  Miami, FL: Brain Power International LTD.

Rapp, L. M. & Smith, S. C. (1992).  Morphologic comparisons between rhodopsin-mediated and short-wavelength classes of retinal light damage.  Investigative Ophthalmology & Visual Science, 33, 3367-3377.

Sperling, H. G. (n.d.).  Position paper for workshop on long-term visual health risks of optical radiation.  Houston: University of Texas, Health Science Center.

Sperling, H. G., Johnson, C., & Harwerth, R. S.  (1980). Differential spectral photic damage to primate cones.  Vision Research, 20, 1117-1125.

Taylor, H. R., West, S. K., Rosenthal, F. S., Munoz, B., Newland, H. S., Abbey, H., & Emmett, E. A. (1998).  Effect of ultraviolet radiation on cataract formation.  The New England Journal of Medicine, 319(22), 1429-1433.

Tezel, T. H., & Kaplan, H. J. (1998).  Harvest and storage of adult human photoreceptor cells: the vibratome compared to the excimer laser.  Current Eye Research, 17, 748-756.

Yegorova, E. V., Babizhayev, M. A., Ivanina, T. A., Zuyeva, M. V., & Ioshin, I. E.  (1988). Spectral characteristics of intraocluar lenses and damage to the retina by visible light.  Biophysics, 33(6), 1108-1114.

Statewide Resources

Texas Interagency Task Force on Deafblindness

Other State Deafblind Projects

National Deafblind Resources

International Resources

General Resources

Elaine Kitchel, M.Ed., Research Scientist

The American Printing House for the Blind

For years it has been known that persons with visual impairments need three times as much light, in general, to do the same task as a person with normal vision.  Some research was done between 1923 and 1965 by the United States Post Office to document that difference.  Since that time many new types of lighting have been developed for private and commercial use. Some of those new developments have fortunate applications for persons with low vision.

First, one ought to know how much light is needed by the visually-impaired individual.  There are a few exceptions but as a general rule, where a 50 watt bulb will do for a person with normal vision, a person with low-vision will need 150 watts.  That rule of thumb can generally be applied to all except persons suffering from retinitis pigmentosa, albinism, achromatopsia and photophobia.

Old research studied light in footcandles.  A footcandle is the amount of light at one foot from a one candela lamp.  This is equal to one lumen/foot of light today.  Light today is spoken about in lumens.  A lumen is the amount of light energy per second radiated from a one candela source and falling on a one foot square area at a distance of one foot from the source. You can probably see why it is easier to talk about light in terms of wattages.

In layman's terms, a person with normal vision can function quite nicely in a 12 x l2 foot room lit by 2, 40-watt fluorescent tubes. It is quite a different story for a person with low vision.  According to the formula, this person would need 6, 40-watt fluorescent tubes to light the same area.  However it is not that easy.  Persons with eye pathology are especially sensitive to the type of light emitted by regular cool-white fluorescent tubes. 

Blue light wavelengths and part of the blue spectrum are focused in front of the retina, while green and yellow are focused on the retina, and some red spectrum is focused behind.  Thus blue light contributes little to visual acuity and visual perception loses sharpness as the blue light component adds significantly to the eye's energy expenditure for focusing, and in reduced can greatly reduce eyestrain without loss of acuity.

There is mounting medical evidence that prolonged exposure to blue light may permanently damage the eyes, contribute to the formation of cataracts and to the destruction of cells in the center of the retina." (Quinn, 1998)

In spite of the problems with blue light, this is the type of tube most commonly found in schools, stores and nearly all public places.  For many persons with low vision, this is problematic. Not only do they need brighter light, they need a different kind of light.  Fortunately special tubes which do not emit the ultraviolet and blue end-spectrum light which is so plentiful in cool white tubes, are available to replace regular cool white fluorescent tubes use by so many businesses and public places. These are called SPX30 (General Electric)  or SP30 (Sylvania and Phillips) tubes.  These can make a significant difference for those persons with low vision by reducing photostress and discomfort.

For persons with low vision then, brightness and type of light are important.  Additionally, the directionality and the diffusion of the light are also important. These can be regulated by dimmers, diffusers and light filters. The peracube, a silver egg-crate type of grid which replaced the acrylic lenses on many fluorescent tubes, has made a positive difference for many persons with visual impairment.

 Much must be taken into account when designing a room or workspace for use by persons who are light sensitive. (Migraine sufferers, persons with multiple sclerosis, lupus and epilepsy often fall into this category as well as persons with ocular conditions.) For example, access to natural light is a consideration. Persons with macular degeneration often benefit from strong natural light, while those with retinitis pigmentosa perform better in a dim environment with the only light falling on the task at hand.

 The color and reflecting qualities of the walls are another important consideration.  Many institutions like to paint walls a glossy white or blue.  But studies show that most persons who are sensitive see their best when they have walls with a non-reflective finish of a warm, pinkish hue. This is because light from the blue end of the spectrum, also called short wavelength light, becomes focused in front of the retina instead of upon it.  This causes the eye to work much harder. 

For persons with normal vision and optimal ocular health, a hard-working eye is not a problem.  But for people whose eyes are already compromised by disease or injury, whenever their eyes are worked hard as they do under the short wavelength blue light, such as that emitted by cool white tubes, the eyes cannot carry away the products of photoreception fast enough to keep up.  This build-up of waste products in the eye is often interpreted by the brain as glare, pain, or light blindness.

Care then, should always be taken, whenever possible, to promote optimum visual performance in the person with low vision, by providing lighting without ultraviolet and blue wavelengths, and a visual environment which has been carefully selected to meet his needs.

References

Creech, L. L., & Mayer, J. A. (1997).  Ultraviolet radiation exposure in children: a review of measurement strategies.  Annals of Behavioral Medicine, 19(4), 399-407.

Fedorovich, I. B., Zak, P. P., & Ostrovskii, M. A. (1994).  Enhanced transmission of UV light by human eye lens in early childhood and age-related yellowing of the lens.  Doklady Biological Sciences, 336(1), 204-206

Gorgels, T. G., & van Norren, D.  (1995).  Ultraviolet and green light cause different types of damage in rat retina.  Investigative ophthalmology & visual science, 36(5), 851-863.

Hall-Lueck, A. (1986, May).  Facts and fads: what works and what doesn't.  Paper presented at the National Forum on Critical Issues in Infant and Preschool  Education of Blind and Visually Impaired Children, American Foundation for the Blind.

Ham, W. T., Jr. (1983).  Ocular hazards of light sources: review of current knowledge.  Journal of Occupational Medicine, 25(2), 101-103.

Ham, W. T., Jr., Ruffolo, J. J., Jr., Mueller, H. A., & Guerry, D., III.  (1980).  The nature of retinal radiation damage: dependence on wavelength, power level and exposure time; the quantitative dimensions of intense light damage as obtained from animal studies, Section II.  Applied Research, 20, 1005-1111.

Kitchel, E., (2000) The effects of blue light on ocular health. Journal of Visual Impairment and Blindness, 94(6) 399-403.

Quinn, N., (1998) Research  into the effects of video display terminals use and office environmental (fluorescent/neon) lighting. The computer filter.

Anne Corn
Professor of Special Education
Vanderbilt University

The use of blindfolds in the teaching and training of all legally blind students has become a topic of discussion in the past few years. At a recent conference, Anne Corn and Phil Hatlen were invited to present their positions and opinions on education of legally blind students with remaining vision. They were members of a panel that took the position that many legally blind students will benefit most by utilizing remaining vision as their primary avenue of learning. Another panel took the position that every legally blind person needs to learn the skills of blindness, and should learn them while blindfolded.

When I was 18 a counselor told me I was denying my blindness because I refused to use a white cane. He was adamant that if I was legally blind I should use blindness methods for my academic, daily living, and mobility skills. I remember feeling inadequate at the time – trying to explain to this very nice man who was blind - why I did not need or want to use a cane. I felt comfortable with using combined visual and auditory methods for getting through heavy amounts of reading assignments, but simply put, I was not blind. I had no other way to rationalize my personal decision or convince him of my visual abilities to function in an efficient, safe, and comfortable manner.

More than thirty years later, I find myself, once again, trying to explain why someone who has low vision and who meets the legal criteria for blindness may not need or want to be blindfolded or employ the methods of blindness during the rehabilitative process or in daily life unless they are unequivocally more efficient and comfortable methods. Still, people with low vision, who are legally blind, based on individual needs, benefit from special education and rehabilitative services if they are to become efficient users of their low vision, learn non-visual methods when more efficient or comfortable, and become employed with jobs that allow for reasonable accommodations.

Let me begin with five premises that are at the heart of my personal convictions about blindfolding. First, a person who has low vision is not a blind person with just a little bit of vision. Second, a person with low vision is not a person trying to deny his or her blindness. Third, a large segment of the population includes persons who have stable conditions or will not lose all of their vision. Fourth, non-visual approaches may be taught with or without a blindfold in circumstances where vision is not an efficient modality. And fifth, a person with low vision is a person with low vision; they are neither blind nor are they fully sighted and should not be coerced into functioning in one way or another. I will speak to these premises and then raise questions about the scientific merits of using a blindfold during the rehabilitative processes.

I find that people who are functionally or totally blind, and those who have not developed visual efficiency for reading or for orienting and way-finding, often think that if people with low vision would only function more as people who are blind, their problems would go away. In effect, they are saying “you are blind” and your little bit of vision is just getting in the way. I believe they find it difficult to understand that people with low vision, especially those who have stable conditions, in the higher levels of legal blindness can and do see a great deal. Vision is, and always will be, the best gatherer of information beyond arm’s reach. Once a blindfold comes off, vision appears to become the dominant sense. To ask people with low vision to function as if they have no vision asks them to not use something that is precious and that will be present and available in their daily lives. I have never seen evidence that having low vision is a detriment in learning about the world by using vision or other senses. I have never seen evidence that people with low vision who have been blindfolded do function differently (better or worse) or have different levels of confidence (higher or lower) than they would if they did not undergo blindfolding for extensive periods of time.

It was in 1934 when the American Medical Association established the visual acuity and visual field criteria for legal blindness. This was before a time when a body of knowledge was developed about the functional use of low vision and before optical devices were available to enhance the use of low vision. At that time, blindness methods were probably appropriate for a vast majority of people who met the criteria for blindness set forth in the 1935 Social Security Act. Today, however, those who receive optical devices, appropriate instruction, and emotional support may obtain competitive levels of print or print and Braille literacy and employment; they function without blindness methods or they know how and when to use non-visual approaches as complementary or secondary methods. The same may be said of those who are functionally or totally blind who receive appropriate devices and technology, appropriate instruction and emotional support – they, too, reach competitive literacy levels and are employed. However, the visually efficient people with low vision are not the ones who are giving testimony about how a lack of Braille skills or blindness skills in their educational programs have held them back academically or emotionally.

While a person with 20/200 visual acuity may not be able to see print without a magnifier with or without glasses, he can see at great distances, using central, mid- and far periphery to complete tasks, sometimes using optical devices, and sometimes using special techniques to enhance visual efficiency. If I ask people who are congenitally totally blind and those who are congenitally sighted the distance at which they think those with 20/200 or 20/400 acuity can see objects, they are often surprised to learn that one may not see details but can see snowcaps on distant mountains or detect objects as small as 3/4 inches at 27 feet from the person or identify a coin on the ground at 7 feet. Why then, would they want to rely on auditory cues and a cane touching the ground only a few steps in front of their bodies, even if this may be a safe way to travel for those who do not use vision? Of course environmental conditions, level of vision, and prior experience in learning to use vision may have an impact on what is seen and how it is interpreted but these levels of vision are often far more efficient than non-visual methods. Also, even when there are fluctuations in vision, I believe people with low vision learn when to use and when not to rely on visual methods, and this may be taught without blindfolding. It is not as if the lights go out, new or different methods are employed based on different environmental conditions, and with vision when appropriate.

Young children with low vision often do “test” to see what it means to be “more blind” or “more sighted”. The world may look “normal” to them and they wonder why others speak about their poor vision. Gradually, they piece together what it means to have low vision and they learn that others are reading small print and identifying objects at much farther distances than they can. As they have no comparison, children with congenital low visual acuity do not see the world as “blurry” or “foggy”. Those with other types of low vision e.g., field restrictions, also put the pieces of the puzzle together and begin to understand how they see differently.

It is heart wrenching when we hear from people who, as children, should have learned Braille or other non-visual methods as primary or complementary methods along with their sight. I am pleased that educational services for students with visual impairments has moved forward in its thinking. With functional vision assessments, learning media assessments, and clinical low vision evaluations, Braille, print, or a dual media approach are appropriately available. Today, the challenge may not be so much as whether a child should learn Braille, print, or a combined approach but how many hours of instruction are delivered by a qualified teacher. Braille can be taught without blindfolding the person learning to read by touch.

Professionals sometimes marvel at the tasks people with low vision can accomplish and then say but the people coming to me have such poor vision that blindfolding is the only approach that makes sense. I wonder, if people weren’t blindfolded whether these same people might reach higher levels of visual efficiency, if this is their choice. Might the opposite approach, teaching enhancement of low vision throughout the day, show significant results.

Only after a functional vision assessment, a clinical low vision assessment, and an orientation and mobility assessment, can projections be made as to the extent to which a child or adult can learn to use their vision for literacy and for orientation and mobility, the extent to which they may become efficient, safe, comfortable, and confident. Without these assessments it is inappropriate to say that everyone needs any specific treatment to become rehabilitated. Blindfolding shouldn’t be the response when people receive no or poor quality low vision services.

Can we draw upon the experiences of people from other disability areas? We don’t place earmuffs on children who are hard of hearing to ask them to learn to sign and read lips. Although some people who are deaf may suggest holding back amplification, this is more of a cultural issue than one of teaching children with hearing impairments to improve their communication skills with the population that hears. The vast majority of professionals in hearing impairments, I believe consider the use of hearing aids and cochlear implants a positive approach rather than one that robs a child of his deafness.

I cannot fully understand the experience of blindness just as I do not believe someone who is blind and who has never seen or who has not become visually efficient can fully understand what the experience of low vision is all about. I would not presume to be the spokesperson to tell what is “best” for people who are blind and I hope that those who are functionally or totally blind would not assume they fully understand what is “best” for children or adults who have the potential to use their vision well. Fully sighted people also cannot fully understand people with low vision just as they cannot fully understand those who are blind. However, there are fully sighted people and blind people who through their professional and personal experiences with those with low vision who are highly respected and who bring much wisdom to this discussion.

Blindness methods work well and can surely be trusted by those who are functionally or totally blind. Educators have for many years believed that multi-sensory approaches work best in teaching skills such as reading. Why then should we assume that removing a sense results in better functioning with that sense?

Some people may say that results are sufficient. Anecdotal responses tell us that people who have been blindfolded are pleased and feel they have benefited from the experience. We know that a portion of people taking placebo drugs also believe they have benefited from taking them. We also have a self-selected sample of the visually impaired population, those who are willing to be blindfolded. This sample may not be able to speak to the benefits or adverse effects that may be derived from blindfolding. We also know that people respond positively to caring treatment. Can you imagine being thrust into blackness (not blindness since they see the inside of their sleep shades) and then have caring people give positive strokes because you have learned skills? I think satisfaction here would be high – but are the results effective?

To date, I know of no empirical research that speaks to whether there are benefits in the development of skills or self-confidence with the blindfold experience. Some research questions may include:

  1. Are there significant differences in outcomes for the two treatment options (with and without blindfolds) when people have:
    1. stable vs. progressive conditions?
    2. Higher or lower levels of visual functioning
    3. Low visual acuity and/or significant visual field restrictions
    4. Congenital vs. adventitious low vision
    5. Use blindfolds for different periods of time, e.g., 8 hours/day, 16 hours/day, or specific to task learning
    6. Total immersion or gradually add more time and/or more physical movements under blindfolds?
  2. Do people who have had blindfold experience use their low vision more or less efficiently with their other senses when they remove the blindfold than those who have received quality low vision services?
  3. Are there specific personality characteristics that should contraindicate use of sleep shades for rehabilitative processes?

I consider it irresponsible to blindfold for several hours at a time unless we know that there are no adverse effects, e.g., increased fears, or that the adverse effects are minimal or impact a very low percentage of the population. I also consider it irresponsible to blindfold without evidence that there are advantages to use of the blindfold that significantly outweigh receiving rehabilitative services without the blindfold.

I believe when any controversial methodology is used, as blindfolding is today, that clients must receive information about the best scientific knowledge to date along with professionals’ experience with clients with similar eye conditions. One without the other is not acceptable.? Saying, “I believe it works”, or “I hear from others that it has helped them” is simply not providing responsible information to clients. If I were to look into the effectiveness of blindfolding at my university, I would be required to have my methods undergo a review by our human subjects committee. If I were to use any “innovative treatment” at a Vanderbilt facility to aid a person, I would need an informed consent. This consent would need to include any potential adverse effects that are known. Without a method for documenting adverse effects, one cannot assure people undergoing that treatment that none exist.

Furthermore, adults learn to make good choices and problem solve when given opportunities to do so. To require a blindfold experience in order to receive rehabilitation services is taking away one of the most important decisions a person with low vision can make. It also placed them in a difficult position not faced by those who are blind. To accept the blindfold says I am blind and I should do as I am told – to refuse it makes one feel like an imposter, accepting services from a “commission for the blind” where only truly blind people should be recipients. If I were trying to make such a decision, two questions I might ask are, Will I receive visual efficiency training following the use of the blindfold or are you suggesting I just learn not to use my vision at all? How will I understand when my vision is and is not useful to me if I don’t have a chance to receive such feedback during rehabilitation? With research, it may show that the population of people who currently refuse services because of the practice of blindfolding may re-consider and accept services once there is hard data.

Another argument I’ve heard for blindfolding is that people with low vision have low self-esteem. I can assure you it is not because they have vision that they have low self-esteem. I believe some of the problems may be due to the fact that they are being pushed in two directions, to be more like those who are blind and then they feel like the imposter, or to be more like those who are sighted and then they are less capable. I hope to see the time when professionals consider it acceptable for people to just have low vision.

Are there circumstances under which I could envision blindfolding as an effective method? Yes, but I want to know more about the effects before I recommend this to adults who are undergoing rehabilitation. I could envision several appropriate uses for a blindfold including but not limited to: people for whom vision is so low that it is confusing to them under certain circumstances, people who experience night blindness, people who have low levels of vision with progressive conditions and when under the care of a psychologist or psychiatrist a person has such fears of blindness that under controlled circumstances, periods of blindfolding are recommended. I am not saying that low vision or blindness creates in and of themselves a need for mental health care. Rather, I am saying that there are people for whom the adjusting processes are so stressful that counseling should be a part of their rehabilitative services. When some of these conditions are evident and there is scientific evidence to the benefits, then a recommendation may be made that a client consider blindfolding.?

Finally, while our field has traditionally stayed away from the medical model, I see blindfolding as a treatment that can have benefits as well as detrimental effects when not used responsibly. Are we going to continue to carry these personal convictions without scientific review? Are you ready to take your pill – I hear it is good for you.