Visual Impairment By Marla Leland, Roberta Grubman, and Susan Barry

What defines visual impairment? Visual Impairment Including Blindness: a visual impairment, that even with correction, adversely affects a child’s educational performance. This term includes both partial sight and blindness. (idea.ed.gov)

Legal Definition of Legal Blindness A visual acuity of 20/200 or less in the better eye even with correction, or when peripheral (side) vision is narrowed to 20 degrees or less, also known as "tunnel vision.” Low vision is defined as no better than 20/70 but better than 20/200 in the better eye with correction.

Vision impairment is not very common among children 1 out of every 20 pre-school aged children will have a vision problem that affects their ability to learn (Prevent Blindness America, 2010) The federal government classifies.05% of children ranging from 6-17 as visually impaired. Less than 1%. Nearly two-thirds of children with vision impairment also have at least one other developmental disability, such as intellectual disabilities, cerebral palsy, hearing loss, or epilepsy.( Prevalence of Visual Impairment In Children:

Vision Challenges Seen Everyday: nearsightness, myopia light rays focus in front of rather than on retina farsightedness – hyperopia – light rays focus in back, behind the retina astigmatism – if cornea or lens is irregular rays are blurred or distorted

The three leading causes of blindness in children are: Cortical Visual Impairment, (CVI) Retinopathy of Prematurity ( ROP) O ptic N erve H ypoplasia (OHN)

Cortical Visual Impairm ent (Cerebral Blindness) Approximately 30-40% of children with visual impairments have CVI Caused by damage to the parts of the brain (trauma, stroke, seizure, ‘shaken baby’ etc.) Abnormal light response, light gazing Blunt or avoid social gaze Brief fixations Poor visual acuity Visual field loss Fatigue from visual tasks Peripheral vision dominates when reaching Visual attention for moving stimuli is better than for static stimuli Difficulty seeing object or image in a crowded or busy background

Retinopathy of Prematurity (ROP) Abnormal growth of blood vessels in the eye which causes the retina to detach Excessive concentrations of oxygen often cause ROP, which can lead to blindness. Oxygen is often administered to premature babies to prevent brain damage, Premature babies, especially those born at less than 3 pounds, and/or less than 28 weeks are at risk for ROP. It is occasionally seen in full-term babies, and those who receive oxygen therapy Visual accuracy varies, to blindness Various visual defects usually found in the central field of visions, 5 stage classifications vision from a thin, flat line, to a mass, to detachment of retina (Yanoff & Duker: Ophthalmology, 2009)

Optic Nerve Hydroplasia (ONH) the underdevelopment of the optic nerve. It might exist independently or in association with other disabilities or defects. There is some evidence to suggest that this disorder is related to alcohol or drug use by mothers during their pregnancies, but in many cases the cause is unknown. (National Foundation for the Blind) Children Experience: blurred sight color vision problems, reduced contrast vision, poor peripheral vision, and sometimes Nystagmus (uncontrollable shaking of the eyes).

Amblyopia When the proper nerve pathways are not developed fewer signals are sent to the brain. Left untreated pathways may weaken and be permanently damaged.

Retinitus Pismentosa Nystagmus Albinism Pediatric Glaucoma Cataracts Additional Visual Impairments

Characteristics of Children with Visual Impairments : 1. Some physical stereotypical behaviors of visually impaired people: a. repetitive movements such as rocking b. tilting the head combined with rocking c. repetitive hand or finger movements d. grimacing. 2. Intellectual ability is not usually affected by visual impairment alone, it doesn’t affect what a child can learn, but rather how a child learns. 3. Lack of vision does not affect ability to understand and use language. 4. Cognitively there may sometimes be early delays but they don’t last long. 5. Socially it can be challenging.

ASSESSMENT/ EVALUATION

General Testing Guidelines Test all students on school entry and every third year after through eighth grade  Test for visual acuity using optotype (Big E)/ generally snellen test Use Pseudoishromatic plates for testing color vision teachers observations of students’ appearance and behavior that may indicate vision difficulties Notify the parents/guardians of students Assist parents/guardians, when necessary, in a follow-up program  Record on health record

Snellen Chart

CDE & Marin County BOE Vision Impairment definition (Same as IDEA definition but add) The term visually impaired includes for educational purposes: Functionally blind students who because of the severity of their visual impairment rely basically on senses other than vision as their major channels for learning. Low vision students who use vision as a major channel for learning A visual impairment does not include visual perceptual (how brain understands what eye sees) or visual motor (use of hands and vision to perform a task) dysfunction resulting solely from a learning disability.( ie – dyslexia, etc.)

Assessment Definition : Federal Code for Assessment: The Code of Federal Regulations (34 CFR), sec : Assessment/Low Vision Assessment and Evaluation states that state and local educational agencies shall ensure that, at a minimum, tests and other evaluation materials must be validated and tailored to assess specific areas of educational need for individual students with visual impairments. Students must be assessed in all areas related to the suspected disability. In addition the expanded Core Curriculum for Blind and Visual Impaired Children: a body of knowledge and skills that are needed by students with visual impairments due to their unique disability-specific needs. They need core curriculum as well as expanded. The ECC is used as a framework for assessing, planning individual goals and providing instruction.

Procedures for Special Education Assessment of Visually Impaired students: Every child is required to have a vision and hearing assessment prior to the first IEP (Education Code Section 56320). eye report from an ophthalmologist or optometrist. A teacher of the visually impaired, the orientation-and-mobility specialist, and the child’s family conduct a functional vision assessment.

Functional Assessment Details DEFINITION: observing students interacting in different environments (classroom, outdoors at a store) under different lighting conditions to see how well the student can identify objects and perform tasks. Includes extended Core Curriculum assessments

COMPONENTS of Functional Assessment Vision Assessment Near & Distance Acuity Peripheral visual Field Reading Levels & Speed Current Print Functioning Examples of near & distance functioning Light Sensitivity Visual Efficiency Life / Learning skills Assessment Compensatory Skills Orientation & Mobility Social Interaction Independent Living Sills Recreation & Leisure Skills Self Determination skills (older Students)

Other Technology Assessments Media Assessments Assistive Technology Assessment Clinical Low Vision Evaluations

Teaching Children Who Are Visually Impaired

Other Differences in Learning for Visually Impaired Students

Learning Environment for Visually Impaired Students

Do’s: Use words: look, see, watch Use students name when calling him/her Read out loud what you write on the board Encourage independence Avoid saying “here” or “there” because that might not be enough information Provide extra time for reading Braille Provide extra storage for equipment Encourage devices

Don’ts: Be afraid to touch but tell child first – respect students personal preference Over protect Worry about awkwardness – a child is a child Be afraid to require student’s best work Be afraid to require good behavior Hesitate to ask what something looks like to a child Tolerate bad behavior

Teachers Assess Students: In a Curriculum Based Measurement (CBM) More time for Braille and Nemeth Code for Math

Educational Placement

Methods of Orientation and Mobility

California Department of Education In 2005, the Legislature required the State Board to adopt Braille Reading and Braille Mathematic Standards by 2006.

WHY BRAILLE?

VOTE: Who is this room feels, that with all the technology today, Braille is becoming obsolete?

In 1965, 50% of all visually impaired students read Braille In 2011, 10% of all visually impaired students read Braille

“Regarding employment among individuals who are blind reveals that braille use has a high correlation with employment.” (Ryles) “Most disciplines accept that the primary indicators of socioeconomic status in the society are employment and education leading to self-sufficiency.” (NFB)

Truth About Braille Blind people who know the Braille code and use it regularly find success, independence and productivity. Braille is correlated with a higher educational level, a higher likelihood of employment and a higher income level. There is a crisis in Braille literacy

Consider this: A good education it the key to success every American deserves an equal opportunity to receive a good education. Inherent to being educated is being literate. The ability to read and write means access to information that in turn, leads to understanding and knowledge. Knowledge is power. The power to achieve, function in the family, thrive in the community, succeed in a job and contribute to society.”(NFB)

Nearly 90% of America’s blind children are not learning to read and write because they are not being taught Braille or given access to it.

What does this mean for teachers?

Other Factors

Teaching Braille to Students Who Are Visually Impaired

IDEA mandates that all blind children should be taught Braille unless it is determined to be inappropriate.

The Good News!

Video:

Perkins Expanded Core Curriculum

“Students must learn through doing rather than being told how to perform an activity…students need safe chances to practice and fail and to then try again and be successful”(Dorinda Rife)

IMPORTANT RESOURCES - American Foundation for the Blind - The Braille Institute -National Federation of the Blind / Advocacy Special Note for Northern California – Preschool Children: - Blind Babies