Low Vision in Children

I went to a seminar on August 15th, 2008 hosted by the Hamilton Eye Clinic, called “The Children's Vision Rehabilitation Project: A MultiDisciplinary Approach to Low Vision in Children” with visiting professors Terry Schwartz, MD, and Rebecca Coakley, MEd, from the West VA Eye Clinic.  The seminar was for ophthalmologists, OTs, vision rehab professionals, educators, and more. One of my good friends Orli is a low vision occupational therapist at Hamilton Eye plus I always want to learn more about everything, so it was a very interesting day. I've intended to write this post for over a YEAR now. Finally got around to it. I should have written it the next day as my notes were not great so I'm missing 95% of it I feel. But I'll share what I did get out of it – note this is my own one year later understanding, so take it with grain of salt. 🙂
Low vision equipment: Many times expensive items are recommended to people but then sit unused for whatever reason – its too ugly or inconvenient or too hard to use or whatever. So ideally a clinic will set something up where for example you use something 30 days as a loan then buy from them as used equipment if you like it – win/win for all.
Starting low vision training: The younger the better. Even a 3 year old can get in some good training. For example let a child explore looking out an empty toilet paper roll. If you start young enough the child will see their low vision aid as practically an appendage because it becomes so integral to their quality of life. I thought it was interesting that it was pointed out that kids who are deaf tend to be more socially adept than blind kids, because of all the nonverbal social cues I guess. Also interesting that young children have an egocentric location thing going on – if you give a child that empty toilet paper roll they may put it between their eyes on their forehead, not on their eye as you would expect. 
Technology: It's now pretty cool to have technology so some of the odder looking devices that people use, are actually seen as impressive or neat, rather than negative. 
Large print: There is frequently at least a 4 month delay for reproduction of books into large print. Audiobooks, Braille, or other options may be better.  Many doctors and therapists assume large print is the answer to everything when in fact it can make things worse depending on the type of vision problem. For example if a person has a constricted vision field, large print just makes it HARDER to see as even less is now within their vision field at any one time.

Canes: Sometimes the person with low vision is not quite at the level at really needing the white cane, but use it anyway because it warns other people to be careful/aware around them.

Reading: Many people with low vision can read, however the difficulty may be in sustaining it due to distance from print, nystagmus, general ocular control, etc.

Nystagmus: Sometimes a head tilt/turn helps quiet the jumping of the eyes and maintain optimal sight.

Here are some things I wrote down that I no longer have any idea what I was referring since it's been like three years 😡 If anyone wants to clarify any of this, go right ahead.

Fans – shadows
Grating acuities, teller acuities, etc, “Facile”
Stable or progressive vision issues

“achromats” = not people first language. 

Sensory channels most used – Learning Media Assessment.
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Braille: A lot of kids actually read Braille with their eyes! If a kid has visual sensory preferences (even with low vision), it may mean Braille is not a great choice. A tactile child will benefit from Braille more.
Alright, I'm headed out to a store, so I need to stop writing this post – so it's unfinished from this point down – I'll try to come back and edit it later today. 

all might have same diagnosis but want different choices .

Some kids can see letters but not read due to saccade issues.
Visual function, with rehab, can lead to functional vision
Albinos – 1/2 fibers dessicate at optic chiasm. problems with stereoopsis? Need orientation and mobility – problems iwth depth perception
Nyctalopia – in to out, transitions – ie bright playground to normal classroom
Try and maximize remaining visision

Brain fools us – we think we see all around us but not raeally

Sighted kids rely on visually impaired kids for freeze frame data – complete change from before!

Desire to drive is often incentive. 

timid kids that bruise and fall a lot – key that maybe field loss is problem.
Optical positions for visition, 
visual function plus rehab = functional vision
Learning Media Assessment – which sensory channels?
Kid may feel butons on your shirt or put head on table. Puppet in hand. Good clue as o visual or tactile. Visual – no Braille. Many kids just read the Braille. 
Each kid in fam may have same VA diagnosis but diff choices on which to use. 
Penlight and toy on penlight like a little monster. 
Tactile buttons or giant diagrams of microwave, dryer, etc. 
Contrast and lighting are two huge ones. 
safety pins on clothing or rubber bands around items
liquid level indicators
commercially available products like giant remote, magnifying glasses, etc
marroon blanket over beige couch
yellow towel over white tub

Jul 19, 2011 | Category: Occupational Therapy | Comments: none

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