VISUAL IMPAIRMENT

(Including Blindness)

1. DEFINITION

“Visual impairment including blindness” means impairment in vision that, even with correction, adversely affects a child’s educational performance. The term includes both partial sight and blindness. This impairment refers to abnormality of the eyes, the optic nerve or the visual center for the brain resulting in decreased visual acuity.

About 90% of people who are visually impaired live in the developing world. Age-related macular degeneration, glaucoma, and diabetic retinopathy are the leading causes of blindness in the developed world.

Most of us are familiar with visual impairments such as near-sightedness and far-sightedness. Less familiar visual impairments include:

  • strabismus, where the eyes look in different directions and do not focus simultaneously on a single point;
  • congenital cataracts, where the lens of the eye is cloudy;
  • Retinopathy of prematurity, which may occur in premature babies when the light-sensitive retina hasn’t developed sufficiently before birth;
  • Retinitis pigmentosa, a rare inherited disease that slowly destroys the retina;
  • optic nerve hypoplasia, which is caused by underdeveloped fibers in the optic nerve and which affects depth perception, sensitivity to light, and acuity of vision; and
  • Cortical visual impairment(CVI), which is caused by damage to the part of the brain related to vision, not to the eyes themselves.

Signs and Symptoms of Possible Vision Problems

If you experience any of the following eye changes, schedule an appointment with your ophthalmologist or optometrist immediately, even if you’ve been to your eye doctor recently:

  • Severe, sudden eye pain
  • Recurrent pain in or around the eye
  • Hazy, blurred, or double vision
  • Seeing flashes of light or sudden bright floating spots
  • Seeing rainbows or halos around lights
  • Seeing floating “spider webs”
  • Seeing a “curtain coming down” over one eye
  • Sensing a “cup filling up with ink” in one eye
  • Unusual, even painful, sensitivity to light or glare
  • Swollen, red eyes
  • Changes in the color of the iris
  • White areas in the pupilof the eye
  • Sudden development of persistent floaters
  • Itching, burning, or a heavy discharge in the eyes
  • Any sudden change in vision

 

Other Indicators of Possible Vision Problems

Other indications of possible vision problems in children may include problems with the following daily living activities:

Moving Around

  • Having difficulty walking on irregular or bumpy surfaces
  • Walking or stepping hesitantly
  • Going up and down stairs slowly and cautiously
  • Shuffling the feet
  • Brushing against walls while walking
  • Missing objects by under-reaching or over-reaching

Everyday Activities

  • Discontinuing or doing certain activities differently such as reading, watching television, driving, walking, or engaging in hobbies.
  • Squinting or tilting the head to the side to focus on an object
  • Having difficulty identifying faces or objects
  • Having trouble locating personal objects, even in a familiar environment
  • Reaching out for objects in an uncertain manner
  • Having trouble identifying colors
  • Selecting clothing in unusual combinations of colors or patterns

Eating and Drinking

  • Having problems getting food onto a fork
  • Having difficulty cutting foodor serving from a serving dish
  • Spilling food off the plate while eating
  • Pouring liquidsover the top of a cup or drinking glass
  • Knocking over glasseswhile reaching across the table for another item

Reading and Writing

 

Instructional Strategies for Students who are Blind or Visually Impaired

  • Determine what medium is best for an individual child through the Learning Media Assessment.  This may be braille, print, dual media, auditory strategies, objects, symbols, or some combination.
  • Provide books and literacy tools in a format that is accessible to the child.
  • Read aloud using stories and books that are interesting and appropriate for the child.
  • Create a literacy-rich environment, in which the child knows that others are reading and writing.

There are a variety of methods that students with visual impairments use to read. Often a single student will use different strategies in particular settings or for specific materials or content.  The first step in determining what approach will be most effective for an individual student is, a Learning Media Assessment.  The Learning Media Assessment (LMA) offers a framework for selecting appropriate literacy media for a student who is visually impaired.  This includes braille, print, auditory strategies, and dual media.

Reading Strategies for Students with Visual Impairments

  1. Paper strategies, including print, magnification and braille;
  2. E-text strategies,including tracking, auditory support and refreshable braille;
  3. Auditory strategies,including readers and auditory books.

Instructional Adaptations

Adaptation Explanation and Examples
Hands-on experiences Real-life examples of pictures or actual objects are used in instruction, for example, real coins are provided when pictures of coins are shown in a book.
Models Models of objects that are primarily visual are used, such as objects rather than pictures to represent the planets in the solar system.
More easily readable visual aids Your child receives his or her own copy of information that will be displayed on an overhead or whiteboard or chalkboard.
Clear directions Explicit language is used when giving directions; such as “Pass your papers to the right,” rather than “over here.”
Peer (classmate) note taker A classmate takes notes of material written on the board and provides a copy to the student with visual impairments.
Extra time for responses in class Your child may require extra time to respond to class discussions because he or she needs more time to read an assignment.
Oral description or narration Oral descriptions are provided of visual display material; for example, an exhibition of fine art would be described, or portions of a video or film would be narrated during times when there is no dialog.
Experiential learning Your child has the opportunity to experience concepts directly that others may view in pictures or from a distance; for example, if the class is learning about farm animals, your child might visit a farm.
Verbalization of writing Information that is being presented on a whiteboard or in an overhead is spoken aloud as it is being written.

 

Adaptations of Instructional Materials

Adaptation Explanation and Examples
Braille Textbooks, worksheets, and all materials used in instruction are provided in braille.
Tactile graphics Printed maps, diagrams, and illustrations are provided in a tactile format.
Audiotape materials Books and other print materials are provided on tape.
Electronic access Materials are provided in an electronic format to be accessed with a computer or electronic notetaker, for example, your child uses an online encyclopedia to do research for a term paper or reads a textbook in digital format.
Print book for parents If your child reads in braille, he receives a print copy of a textbook for your use.
Highlighting Markers and highlighting tape are used to enhance the important parts of text.
Large print Large-print books are used for instruction or portions of books, such as a map, are enlarged as needed.
Manipulatives Physical items (such as small toys, buttons, or beads) are used to demonstrate mathematical concepts or used in art classes to complete a tactile drawing.

 

Accommodations for Assignments

Adaptation Explanation and Examples
Extra time for completion Your child may need extra time because of his or her reading or writing speed or the kind of tools required for reading or writing.
Descriptive response Your child may provide a written description of a project instead of a visual representation. For example, the class assignment might be to make a drawing of a cell viewed through a microscope. The student who is blind instead provides a written description of the cell rather than a drawing.
Use of models Your child provides a model for an assignment rather than a two-dimensional representation.
Reduction of copy work If an assignment requires copying text or problems, a worksheet is provided so your child can write answers directly on the worksheet and does not need to re-copy the assignment. For example, the teacher might write ten mathematics problems on the board for the students to copy and solve in their notebooks, but the visually impaired student works on a worksheet instead.

 

Adaptations in Classroom Testing

Adaptation Explanation and Examples
Extended time Your child may need extra time because he or she reads or writes slowly, or because of the tools he or she uses for reading or writing.
Use of manipulative Your child may use manipulative to demonstrate understanding, rather than responding in writing to a question, for example, a first-grade student demonstrates an understanding of time by using a braille model of a clock to show the answers on a test.
Spelling tests for braille readers A student who uses contracted braille (which uses a number of contractions and shortened forms to write words) should also take spelling tests using uncontracted braille to make sure they can also read and write in standard English.
Dictation of responses to a scribe The student verbally reports an answer, and a sighted person records the answer on the answer sheet.
Screen access to tests administered on a computer Depending on your child’s need to read in print or braille, appropriate screen access to text may be needed through enlarged text, refreshable braille, or a copy of the test in hardcopy braille.

 

Adaptations in Assistive Technology

Adaptation Explanation and Examples
Low vision devices (near) Magnification devices for viewing or completing near vision tasks.
Low vision devices (distance) Telescopes for viewing or completing distance vision tasks.
Braillewriter A mechanical tool resembling a typewriter that is used for writing or “embossing” braille.
Slate and stylus A portable tool for writing braille made up of two flat pieces of metal or plastic that are used to hold paper and a pointed piece of metal used to punch or emboss braille dots.
Electronic braillewriter An electronic device for writing braille, incorporating a braille keyboard, which frequently has additional features, such as a calculator.
Personal digital assistant (PDA) An electronic device for organizing and managing data, often integrated with an electronic note taker.
Notetaker (braille) A portable device for reading and writing in class, with braille output, often integrated with the features of a PDA.
Notetaker (speech) A portable device for reading and writing in class with speech output, often integrated with the features of a PDA.
Computer A tool for literacy and learning activities and access to information, especially when equipped with specialized software and hardware.
Refreshable braille A device that is connected to (or integrated into) a computer or note taker and that represents braille text by means of pins that can be raised or lowered to form braille cells.
Speech access software Computer software that enables a computer to “speak” the text on the screen through the use of synthetic speech that announces what is displayed on screen.
Braille translation software Computer software that translates print into braille and braille into print.
Large monitor for computer A monitor that, by virtue of its size, provides larger images for students with low vision.
Scanner A device that copies print material and uses software to translate it into an electronic format so that it can be converted into a preferred reading medium.
Magnification software Software that enlarges text displayed on a computer or other screen.
Braille embosser A printer that embosses (prints) braille.
Print printer A regular printer to provide print text for sighted teachers and classmates.
Tactile graphics maker A tool that makes print images into tactile format that can be “read” through the fingers.
Word processor A computer software program for writing and manipulating text.
Electronic mail (e-mail) Electronic mail sent through computers and other devices that is a communication medium for students to receive and return classroom assignments.
Talking calculator A device that provides speech access to a calculator.
Large-print calculator A calculator with large numbers on the keys to provide access for students with low vision.
Talking dictionary An electronic device that provides a dictionary with speech access.
Tape recorders A device for recording auditory information and listening to materials provided auditorily on tape.
Digital players A portable device to access digitally recorded audio books and materials.
Alternative computer access A number of methods that allow a person with physical disabilities to use a computer, such as adapted keyboards and voice recognition technology.
Augmentative and alternative communication devices Special communication devices for students who may have hearing disabilities or other limitations in communication. For example, some of these devices play prerecorded messages at the push of a button.
Adapted devices for daily living A wide variety of devices adapted for use by people who are visually impaired, including measuring devices, kitchen utensils, games and toys, and writing aids.

 

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