Students with low vision have unique learning needs; that is, each student has his or her own needs. This course explores various topics related to school-age children with low vision and the U.S. educational system. The many adaptations and strategies presented in this course can help these students develop skills and learn. The information is for parents, classroom teachers, paraeducators, and medical professionals such as family doctors and optometrists who work with children with low vision. Although this course is U.S.-based, the information is helpful for everyone. The goal of this course is to present information that specifically helps students with low vision to be successful in school.
The course consists of seven lessons, beginning with Lesson 1’s question, “What is low vision?”. Lesson 2 explores the common causes of low vision in children, such as cortical visual impairment and retinopathy of prematurity. Lesson 3 describes what to expect in typical vision assessments. Lesson 4 identifies environmental and material accommodations that can be used to ensure the student with low vision is comfortable and able to access learning material. Lesson 5 discusses various low vision devices such as magnifiers and monoculars, and assistive technology such as CCTVs, as well as how to motivate students to use them. Lesson 6 explores the psychosocial aspects of low vision, such as how students feel about their condition and how adults working with these students can provide support. Finally, Lesson 7 outlines the significance of the Expanded Core Curriculum (ECC) and a student’s Individualized Education Plan (IEP). Some lessons include videos to enhance the learning material. The Resources supplement offers links to relevant articles and information for your own further research and enrichment.
Each lesson includes section reviews, which are for your personal development only. Complete the section reviews before going on to a new section of the course. Students who routinely do the section reviews perform significantly better on assignments. Do not send your responses to your Hadley instructor. Rather, check your comprehension by comparing your answers with those provided.
To complete the course, you are required to submit seven assignments, one at the end of each lesson. These assignments enable your instructor to measure your understanding of the material presented in the lessons. Refer to the Getting Started instructions for information about submitting assignments.
The Hadley School for the Blind wishes to express appreciation to Sharon Zell Sacks, Ph.D., and Francey Liefert, low vision specialist, of the California School for the Blind, who wrote the original version of this course for Utah State University.
If you are ready to begin learning about the school-age student with low vision, begin Lesson 1: What Is Low Vision?
Lesson 1: What Is Low Vision?
Defining low vision is not simple. Teachers, family members, medical professionals, and even the child with low vision can find the concept confusing and frustrating. A useful definition of low vision clarifies how having low vision differs from being sighted or being blind. It also clarifies how children with low vision are not all alike.
This lesson first explores perceptions and definitions regarding low vision. Then it describes Corn's model of visual functioning to show the many factors that affect how a person sees. It will become clear that each child with low vision is unique. Familiarizing yourself with this information will help you determine what your child or student needs to be successful in school.
After completing this lesson, you will be able to
a. discuss perceptions and definitions related to low vision
b. explain the factors involved with functional vision, according to Corn's model
Perceptions and Definitions
Low vision is easily misunderstood. Many sighted people do not realize a person can have a visual condition that is neither full sightedness nor full blindness. It is often difficult for them to realize that corrective lenses such as glasses and contact lenses do not restore full sight to those with low vision. This section identifies common misconceptions, explains why families might struggle to understand low vision, defines terms associated with low vision, and establishes a working definition of low vision for this course.
Misconceptions of Low Vision
Sighted people may think they can easily tell apart those who are sighted and those who are blind. In fact, many people commonly think there are only two categories of visual functioning: sighted or blind. The category of sighted people, of course, includes those who have full sight with the help of glasses or contact lenses.
When a person with low vision appears to have sight, people often expect that person to function as a sighted person. Common misconceptions include:
If a person can't see well, glasses or contact lenses should restore full vision.
If a person is wearing glasses, it does not make sense that he or she still needs to get up close to view an object, read text, or view signs on a board.
If a person has vision, he or she should not need help with reading signs or menus.
If a child is wearing glasses, why is he or she using braille to accomplish tasks?
Likewise, other common misconceptions lead to the treatment of a person with low vision as someone who is blind. For example:
If a person is using a long white cane, guide dog, or braille, that person must be fully blind.
If a person makes little eye contact or has wandering eye movements, that person must be blind.
If a person is labeled as "legally blind," that person must be fully blind.
All of the preceding perceptions are NOT accurate, of course. Visual impairments come in many varieties. Some individuals may have just enough vision to recognize faces and distinguish many environmental cues, even though their eyes wander. Others may have enough vision to see things up close, but need assistive devices and aids to travel around. Still others may use glasses but not have full vision. In fact, some children with low vision may take off their glasses because they do not seem to help anyway. Consider the following case study about Susan, who has low vision and is misunderstood by her peers.
Susan is 10 years old and was born with an eye condition that affected her vision. She holds textbook material 2 inches from her face in class. Often she uses a magnifying glass or eyeglasses to enlarge reading material. Susan cannot read the whiteboard in class unless she is about 3 feet from the board and a dark marker is used. Susan locates her friends on the playground at recess by remembering the color of their clothing and their body shape.
Many of Susan's friends cannot figure out why she has trouble seeing from a distance. They think she is sighted; after all, Susan seems to locate her friends on the playground easily.
Notice how Susan's friends are confused about Susan's vision. Because she appears to be able to see, they expect her to see as a fully sighted person. This case study is an example of how low vision may come in many varieties and is easily misunderstood.
A first step to understanding low vision is to realize that having low vision is different from being fully sighted and from being fully blind.
Diagnosis of Low Vision
Families, too, may first think about the diagnosis of low vision in terms of either sightedness or blindness. Culture and values can play a large role in how families perceive low vision. In fact, some parents may consider the low vision as a punishment, a curse, or God's will. Reactions range from overprotectiveness to indifference. The following are two common attitudes families may have; neither helps the child:
The family believes the child with low vision cannot independently perform daily tasks. The family feels they need to specially care for the child, at the expense of fostering independence and self-reliance.
The child with low vision appears sighted and seems to function visually, so the child is expected to perform visual tasks with few or no adaptations. Families may become angry with the child when he or she appears to see one thing but not another.
Understandably, families of children with low vision often have difficulty defining their child's low vision. Many infants and young children with low vision are initially diagnosed as blind because they appear to function as if they are blind:
They may not react typically to visual stimuli such as toys or mobiles.
They may not be able to look at family members without verbal and tactile cues.
They may be unwilling to explore or move around their environment without prompting from others.
Further complicating the issue, some medical professionals often identify children with low vision at birth as legally blind. Upon hearing this label, families might focus only on the word blind. The term legally blind needs to be explained, or families may not realize that the term indicates qualification for certain services, but not the actual visual ability of the child. This term will be further explained later in this lesson.
In addition, some medical professionals tell these families that their child would be best served by a school for the blind rather than by a local school program. Again, hearing the word blind can further emphasize the false idea that the child cannot see. If the child's actual visual ability is not clarified, the misconception can carry forward even to the point where the child may come to think he or she is actually blind.
Even after coming to terms with a diagnosis of low vision, families often find it hard to understand how their child can see or function when performing visual tasks. The families may have many questions, such as:
How does my child see?
What adaptations and accommodations need to be made to help my child see better?
How will my child's vision change in the future? Will my child eventually become completely blind?
These important questions form the starting point for understanding a child's low vision. The answers to these questions will vary from child to child. No two children with low vision see alike; two children can function very differently even with the same eye condition.
Terminology Related to Low Vision
Familiarity with a few terms commonly associated with low vision is helpful. Keep in mind, however, that these terms are defined differently from country to country. This course focuses on definitions used in the United States.
Parents often hear the term legally blind when their child is first diagnosed with low vision. This term designates whether a person qualifies for certain services and equipment, and can affect privileges such as driving. Legal blindness does NOT measure how a person actually sees, because it takes into account only visual acuity and visual field.
Individuals who are legally blind have been clinically diagnosed with:
a visual acuity of 20/200 or less with best correction in the better eye
Visual acuity measures how well a person can see distances. Individuals who are fully sighted have a visual acuity of 20/20. Therefore, the visual acuity of 20/200 for a person who is legally blind means the person must be 20 feet or closer to an object to recognize the details that a person who is fully sighted can see from 200 feet away.
Visual field refers to the amount of space a person can see in front and at the sides while looking straight ahead. The normal entire visual field is about 180 degrees from side to side, as shown in the diagram, and 60 degrees up and down. The visual fields of each eye normally overlap about 60 degrees, creating a single field of vision known as binocular vision. A visual field of 20 degrees in the better eye, therefore, is very narrow.
The term legally partially sighted refers to individuals who have a visual acuity between 20/70 and 20/200. This designation is another term used to qualify a child for services and equipment in school.
In school settings, students with visual impairments qualify for specialized services based on how their vision impacts their learning. Parents may encounter the terms functionally blind and functionally low vision:
Students who are functionally blind may use auditory and tactile modes, such as braille, for most of their learning needs. These individuals may need audio versions of novels or instruction in braille reading and writing for their learning needs.
Students who are functionally low vision use a combination of visual, auditory, and tactile modes to acquire information. That is, a student who is functionally low vision may use large print, audio, and braille for school assignments.
Consider the following case study about Jonathan who is functionally low vision.