Common Visual Impairments

Teaching Students with Visual Impairments

COMMON VISUAL IMPAIRMENTS

By: Carmen Willings
teachingvisuallyimpaired.com

A visual impairment is the loss of vision that cannot be corrected by refraction (glasses). There are a number of eye disorders that can lead to visual impairments. Visual impairment can also be caused by trauma and brain and nerve disorders. Visual impairments affect people differently. It is important to understand each student's visual impairment in order to understand the potential impact on the student's vision and prognosis.

A visual diagnosis will not affect two people in the same way. Each student is unique and will have individual characteristics based on intellectual ability, developmental rate, social competence as well as other factors including educational opportunities. Even when students have identical acuities and visual diagnosis, their use of vision can be very different. Eye specialists use a variety of diagnostic procedures and tests to assess the integrity, health and function of the eye. As part of the evaluation process, the doctor will use a combination of the child's history as well as the evaluation of the eye in determining the type and extent of visual impairments. It is common for eye reports to change from year to year in the report of the visual diagnosis. Doctors may drop diagnosis or change their impressions of the visual diagnosis. For this reason, it is best to retain copies of previous reports as it will help paint a picture of the child and understand current and previous therapies and recommendations.

Amblyopia

(am-blee-OH-pee-uh) Amblyopia is sometimes called “Lazy eye.” It is a functional defect characterized by decreased vision in one or both eyes without detectable anatomic damage to the retina or visual pathways. If the eyes are not straight (strabismus), the student may suppress the vision in the turning eye to avoid seeing double. In all cases of amblyopia, the brain "shuts off" one eye to favor the eye with better vision. Amblyopia may be treated by patching the good eye, by surgery or with corrective lenses.

“Crossed eyes”, a patch over an eye or high refractive corrective lenses may cause social adjustment problems.
Depth perception may be affected. Students may need familiarization to help anticipate distances and heights.

Aniridia

(an-uh-RID-ee-uh) Aniridia is a congenital anomaly. It is characterized by the incomplete formation of the iris. Associated with glaucoma, nystagmus, sensitivity to light, and poor vision. Normal reactions (adaptations and responses) are impossible.

Corrective lenses may be prescribed, usually tinted to help reduce photophobia.
The student will typically have problems relating to illumination and glare.
The student may function best in reduced lighting.
The student may experience eye fatigue when reading for extended periods of time.

Anophthalmos

Anophthalmos or Anophthalmia is the absence of a true eyeball. The student may have a prosthetic eye.

Students may have problems associated with wearing a prosthesis. Teachers and/or attending adults become involved in this care and routine. Frequently cleansing and placing the prosthesis, and care of the orbit are part of the training required during the school day.

Aphakia

The absence of the lens of the eye usually is due to surgery for cataract. In rare cases it is a part of the abnormally small eye (microphthalmos). Convex lenses are worn to provide refractive power lost because of the absence of the lens. Plus lenses of high power make the eyes look larger when worn in spectacles.

Achromatopsia

(ay-kroh-muh-TAHP-see-uh) Achromatopsia is a congenital defect. It is characterized by the rare inability to distinguish colors due to cone malformation and partial or total absence of cones). It is a hereditary condition that is non-progressive. People with achromatopsia also commonly experience some vision loss, especially in bright light, to which they are extremely sensitive. The severity of achromatopsia varies.

Bright light and glare should be avoided. Some students may be so negatively impacted that they will need to be instructed in cane skills in order to travel independently on bright days or when there is a lot of glare.
Student's typically prefer reduced illumination when reading. The student may benefit from task lighting from behind directed on the book/paper so long as the light does not reflect off of a high sheen surface.
Student's may need high contrast, tinted lenses, and/or sunglasses both indoors and outdoors.
The student may not be able to discriminate colors (may need to teach the student alternative techniques for identifying colors. For example the position of the red and green lights in a traffic signal, using color identification tags on clothing).

Albinism

(AL-bin-izm) Albinism is a congenital defect. It is characterized by a lack of pigment in eyes, hair and skin. Usually associated with decreased visual acuity, nystagmus (rhythmic side-to-side eye movements) and photophobia (light sensitivity). It is non-progressive.

Ocular albinism: lack of pigment in iris and choroids; results in reddish pupils and iris (from choroidal vessels seen through overlying retina). Usually accompanied by poor vision, light sensitivity (photophobia), and involuntary oscillating eye movements (nystagmus). Complete-Glare is more troublesome than illumination. Tinted lenses may be prescribed.

The student may function best in reduced illumination but glare is the critical concern. The student may be adventitiously blinded throughout the day depending upon lighting and glare conditions. Adjust illumination to conditions and individual (i.e., control glare via seating and/or tinted lenses; use sunglasses and/or hat with visor outdoors).
There may be concern over personal appearance. The student may be more resistive to using any accommodations because they may not want to stand out more.
Classroom seating should be appropriate to the corrected refractive error and photophobia.
The student may benefit from high contrast line markers for reading.

Astigmatism

(uh-STIG-muh-tiz-um) Astigmatism is a refractive error characterized by the inability of an eye to focus sharply (at any distance), usually resulting from a spoon-like (toric) shape of the normally spherical corneal surface. Instead of being uniformly refracted by all corneal meridians, light rays entering the eye are bent unequally, which prevents formation of a sharp focus on the retina. Slight uncorrected astigmatism may not cause symptoms, but a large amount may result in significant blurring. Corrected by a cylindrical (toric) eyeglass or contact lens, or refractive surgery.

Cataract

(KAT-uh-rakt) Cataracts are a pathologic condition. It is characterized by opacity or cloudiness of the crystalline lens, which may prevent a clear image from forming on the retina. Surgical removal of the lens may be necessary if visual loss becomes significant. A cataract may be congenital or caused by trauma, disease, or age.

Glare should be avoided.
Restriction of physical contact sports may be necessary if there is a danger of retinal detachment.
Social and emotional problems may result if the lens are noticeably opaque or if the glasses lenses are very thick.

Coloboma

(kah-luh-BOH-muh) Colobomas are a congenital anomaly. It is characterized by a cleft or defect in normal continuity of a part of the eye, e.g., absence of lower segment of optic nerve head, choroids, ciliary body, iris, lens or eyelid. It is caused by improper fusion of fetal fissure during gestation. It may be associated with other abnormalities, including a small eye (microphthalmia).

Educational needs and lighting requirements and other accommodations are dependent upon the severity of the condition and the part of the eye affected.

Color Blindness

If the student is color blind, they may encounter difficulty with tasks involving color discrimination

The student may not be able to discriminate colors (may need to teach the student alternative techniques for identifying colors. For example the position of the red and green lights in a traffic signal, using color identification tags on clothing).

Glaucoma

(glaw-KOH-muh) Glaucoma is a pathologic condition characterized by increased intraocular pressure resulting in damage to the optic nerve and retinal nerve fibers. Characterized by typical visual field defects and increased size of optic cup. A common cause of preventable vision loss. May be treated by prescription drugs or surgery.

Generally, high levels of illumination are needed with control of glare even though the student may be sensitive to light.
Difficulty in adapting to various changes of light may be present.
Physical activities as well may be curtailed. Peripheral field loss may restrict mobility and sports activities.
Large print materials are generally not recommended due to peripheral field loss. If there is only a reduction of vision, large print may be used but the number of words seen will be reduced.

Hemianopsia

Hemianopsia (half vision) is a result of a malfunction along the optic pathway sometimes as a result of pressure from a tumor. The result will be related to the amount of pressure and location. Field loss can be the same in both eyes or opposite, involving half fields or quadrants or affect the uppor or lower fields.

Hyperopia (Farsightedness)

(hi-pur-OH-pee-uh) Hyperopia is a refractive error sometimes called farsightedness. It is a focusing defect created by an underpowered eye, one that is too short for its optical power. Light rays from a distant object enter the eye and strike the retina before they are fully focused (true focus would be“behind the retina”). Farsighted people can see clearly in the distance but only if they use more focusing effort (accommodation) than those who have normally powered eyes; close-up vision may be blurred because it requires even more focusing effort. Corrected with additional optical power, supplied by a plus lens (spectacle or contact) or refractive surgery.

Lebers Congenital Amaurosis

(am-uh-ROH-sis) Lebers is a congenital defect. It typically involves blindness or near-blindness in both eyes. There is typically marked reduction in retinal function seen on an electroretinogram.

Macular Degeneration

Macular Degeneration is a pathologic condition. It is characterized by deterioration of the macula, resulting in loss of sharp central vision. Loss of central vision affects acuity, color vision, and may also cause light sensitivity.. There are two types: juvenile or senile. The most common form of inherited macular degeneration in Stargardt's Disease.

Student may need average or dim lighting
Student may need high contrast line markers for reading

Myopia (Nearsightedness)

(mi-OH-pee-uh) Myopia is a refractive error sometimes called nearsightedness. It is a focusing defect created by an overpowered eye, one that has too much optical power for its length. Light rays coming from a distant object are brought to a focus before reaching the retina. Nearsighted people see close-up objects clearly but distance vision is blurry. Corrected with a minus lens (spectacle or contact) or refractive surgery to “weaken” the eye optically and permit clear distance vision. For students with simple myopia, usually corrective lenses will correct the visual disorder mechanically. Headaches from eye strain are common for uncorrected myopia. Further, corrective lenses are able to mechanically restore distance vision such that images are not blurred. Degenerative myopia is different in that it usually can not be corrected with corrective lenses. The high refraction required will mechanically reduce the peripheral fields.

Children with Myopia will frequently hold their reading material very close to the eyes which is acceptable since it tends to increase the visual size of the print nor will it hurt their eyes.
The severe myopic student may develop an interest in activities requiring close visual work as opposed to those activities requiring distance vision such as sports.
Restrictions may be placed on physical activities due to the possibility of retinal detachment.

Nystagmus

(ni-STAG-mus) Nystagmus is a functional defect characterized by involuntary, rhythmic side-to-side or up and down (oscillating) eye movements that are faster in one direction than the other. The inability to maintain a steady visual fixation causes low visual acuity.

Optic Nerve Atrophy (ONA)

Optic Nerve Atrophy is a dysfunction of the optic nerve resulting in the inability to conduct electrical impulses to the brain causing loss of vision. The optic disc becomes pale and there is a loss of pupillary reaction.

The needs of the student will be dependent upon the characteristics of the disease and the involvement.
Since blind spots can be central or in the peripheral areas, the type of reading material will be determined by the particular characteristics of the disease.
High levels of illumination are usually needed.

Optic Nerve Hypoplasia (ONH)

(hi-poh-PLAY-zhuh) Optic Nerve Hypoplasia is a congenital, non-progressive, abnormality characterized by small optic disc; sometimes surrounded by a double ring (scleral halo) and often a pigment epithelium halo.

Presbyopia

Presbyopia is when the lens becomes less flexible and less able than previously to accommodate for near viewing. Presbyopia occurs as a natural part of aging and typically around the age of 40 so school age students will not be affected by this, however, this could compound the student's vision when they get older.

Retinal Detachment

Retinal detachment is a pathological condition. It is characterized by separation of the retina from the underlying pigment epithelium. It is almost always caused by a leaking retinal tear, which allows fluid to pass from the vitreous into the sub-retinal space. It disrupts visual cell structure and thus markedly disturbs vision; often requires immediate surgical repair. The foremost recommendation is that a student with a detached retina or a student with conditions associated with retinal detachments such as high myopia, be restricted for physical activities. Even a mild blow to the head can result in a detachment.

Retinitis Pigmentosa

Retinitis Pigmentosa is a pathologic, hereditary condition that is characterized by progressive retinal degeneration in both eyes. Students experience night blindness, that may be followed by loss of peripheral vision (initially as ring-shaped defect), progressing over many years to tunnel vision and finally blindness.

Students typically need high illumination.
Students may experience visual fatigue.

Retinoblastoma

(ret-in-noh-blas-TOH-muh). Retinoblastoma is a pathologic, hereiditary condition. It is characterized by a malignant intraocular tumor that develops from retinal visual cells. If untreated, seedling nodules produce secondary tumors that gradually fill the eye and extend along the optic nerve to the brain, ending in death. It is the most common childhood ocular malignancy.

Retinopathy of Prematurity

(ret-in-AHP-uh-thee) Retinopathy of Prematurity is a pathologic condition. It is characterized by a series of destructive retinal changes that may develop after prolonged life-sustaining oxygen therapy is given to premature infants. Sometimes it regresses but other times a peripheral fibrous scar forms that detaches the retina, resulting in vision loss or blindness. Other possible complications include glaucoma, cataracts, myopia (nearsightedness), sunken eyes, eye misalignment.

Due to the possibility of retinal detachment, physical activities may need to be restricted.
Services and accommodations will be dictated by the limitations and severity of the visual loss.

Strabismus

(struh-BIZ-mus) Functional defect. Strabismus is a defect of the eye-muscle system. Eye misalignment or eyes that do not move normally, caused by extraocular muscle imbalance. One fovea is not directed at the same object as the other. Strabismus causes either "tropias" or "phorias." Tropias deviations that can't be controlled as the one eye is turned when trying to look at an object which makes binocular vision impossible.

Esotropia is the turning of one or both eyes toward the nose;
Exotropia is the turning of one or both eyes away from the nose (toward the temploral side of the face);
Hypertropia is the deviation of the eye upward; and
Hypotropia is the deviation of the eye downward.

Other Causes of Visual Impairments

Infections

An infection is a pathologic condition. Invasion of disease-producing microorganisms, resulting in localized cell injury, toxin secretion, or antigen-antibody reaction. Several infections may affect the visual system. There are several infections that may be contracted in utero or during birth. They are often known by the acronym TORCH, for toxoplasmosis, rubella, cytomegalovirus, and herpes.

Trauma

Trauma may be incurred by amniocentesis (rarely) or by forceps delivery. Globe perforation can occur from amniocentesis, leading to corneal scarring, possible cataract, retinal detachment, and retinal or vitreous hemorrhage. Maternal drug abuse is another cause of trauma.

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TVI’s Guide to Teaching the ECC: An Activities Based Curriculum for Teaching Students who are Blind or Visually Impaired
The TVI’s Guide to Teaching the ECC is a digital pdf available for download. It is designed specifically for fellow itinerant Teachers of Students with Visual Impairments (TVI’s), and consists of over 400 activities and topic areas of discussion for instructing students in the Expanded Core Curriculum. The activities are age-neutral and multi-sensory and therefore can meet the needs of the broad range of students served on an itinerant caseload serving. The activities can be individualized to the students various learning modalities and scaffold in order to challenge students but ensure success. Select those activities that align with the student’s learning objects based on the student’s unique visual needs and academic and developmental level. In addition to the core activity areas, each of the 32 Thematic Units incorporates additional unique ECC concepts and skills providing you with a years’ worth of activities. These units are cyclical and can be used repeatedly to help students build on prior knowledge and develop a deeper understanding of concepts. Each unit includes suggestions for activity adaptation associated with the unit. These include lists of objects, possible community-based experiences, environmental print, poems, children & young reader books, children's songs, pop culture songs, movies, and websites.

In addition to the book, the following two supplements are included:
·      TVI’s Guide to the ECC Concept Checklist
·      TVI’s Guide to the ECC Activities Checklist

For complete product details and additional images, visit the TVI's Guide product page.

TVI's Guide to the ECC Product details
·      Digital pdf download: 346 pages (11 pt font)
·      Publisher: Teaching Students with Visual Impairments
·      Author: Carmen Willings
·      Language: English

Visual Efficiency & Near Magnifier Fluency Worksheets: TVI's Guide to the ECC Grab and Go Supplements
The Near Magnifier Fluency Worksheets is a Grab and Go supplement to the TVI's Guide to Teaching the ECC. This workbook is a pdf download that can be printed on demand for use with students. It contains five different types of worksheets for developing visual motor skills and near magnifier fluency skills particularly with the use of a video magnifier. As a companion to the TVI’s Guide to the ECC, the worksheets correspond to each of the 32 ECC Thematic units. The worksheets, along with a list of environmental print for each thematic unit, are designed to help students refine their visual motor skills while reinforcing ECC concepts presented in the thematic units.

For complete product details and additional images, visit the Visual Efficiency & Near Magnifier Product Page.

Visual Efficiency & Near Magnifier Fluency Worksheet Details:
·      Digital pdf download: 210 pages
·      Publisher: Teaching Students with Visual Impairments
·      Author: Carmen Willings
·      Language: English

Thematic Keyboarding & Braille Fluency and Maintenance Worksheets: A TVI’s Guide to Teaching the ECC Grab & go Supplement
The Thematic Keyboarding & Braille Fluency and Maintenance Grab and Go ECC worksheet packet is a print on demand workbook that contains worksheets in print and simulated braille to use for data collection. Present the student with a hard braille copy and use the worksheets to document accuracy and fluency in reading braille. As a companion to the TVI’s Guide to the ECC, the worksheets correspond to the ECC Thematic activities presented in the curriculum guide. These word lists and sentences will help the student refine their keyboarding or braille reading skills while bridging ECC concepts presented in the thematic units. Although the lists and passages can be produced using a manual braillewriter, you may also copy and paste the passages into any braille translation software for quick production on an embosser. They may also be entered into a typing program such as APH’s Talking Typer to build keyboarding fluency.

For complete product details and additional images, visit the Thematic Keyboarding & Braille Fluency & Maintenance Product Page

Thematic Keyboarding & Braille Fluency Worksheet Details:
·      Digital pdf download: 338-page print and simulated braille worksheets
·      Publisher: Teaching Students with Visual Impairments
·      Author: Carmen Willings
·      Language: English

Thematic Vocabulary Cards and Checklists: Grab & Go ECC Supplement
The Thematic Vocabulary Cards and Checklists Grab and Go ECC supplement is a 446 page pdf downloadable print on demand workbook that includes 2940 vocabulary card on 3 1/2" x 2" templates divided by each of the 32 Thematic Units along with a checklist of each unit words in print and simulated braille. As a companion to the TVI's Guide to the ECC, the vocabulary cards correspond to the ECC Thematic activities presented in the curriculum guide.

Additional Use:
Teachers of Students with Visual Impairments can have a extremely varied caseloads. It is possible to go several years without having a student on your caseload who requires braille instruction. Like other skills, if you do not practice your braille regularly, it is easy to lose those skills. Use these checklists and cards to maintain your braille skills. Fold the checklist along the line dividing the print from the braille. Choose to either read the print and produce the word in braille using a braillewriter or read the simulated braille and decode it. Finally, these vocabulary cards and checklists may be used with family members or peers who are interested in learning and practicing the braille code.

For complete product details and additional images, visit the Thematic Vocabulary Cards & Checklists Product Page

Thematic Vocabulary Cards and Checklists Details:
·      Digital pdf download: 446-page print on demand resource
·      Publisher: Teaching Students with Visual Impairments
·      Author: Carmen Willings
·      Language: English

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Lotto Cards
The LOTTO Cards Grab and Go Supplement includes 37 theme related unit cards along with activity suggestions that support activities within the TVI's Guide to Teaching the ECC.

On My Way File Folder Cards
Print and use these cards to represent locations the student may visit that are related to the current thematic unit. Use these with the On My Way File Folder Game outlined in the TVI's Guide to Teaching the ECC p. 27.

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TSBVI has a wonderful chart that lists the most common visual impairments, the effects on vision and the educational considerations. I highly recommend referencing this free online chart! Additionally, it was reprinted with permission and can be found in Keys to Educational Success.

Virginia Bishop put together this handbook on Selected Anomalies and Diseases of the Eye in 1986. I continue to use this resource as it has great information about a wide range of visual impairments including possible classroom implications and recommendations.

Support Networks

This page contains a list of support networks and organizations whose mission is to provide information, research and support to persons with specific visual impairments and diseases.