Referral Process

By Carmen Willings
teachingvisuallyimpaired.com
Updated June 13, 2025

Having taught students with visual impairments in North Carolina, Ohio, and Georgia, I am aware that it is important to keep in mind that each state and/or agency may have different eligibility guidelines or criteria. The following is the typical sequence to follow when a student is going through the initial referral process. 

STEP 1: Identify Concerns

The referral process begins when concerns about a student’s vision are raised by a parent/caregiver, teacher, therapist, or school nurse. In some cases, the student may report having difficulty seeing. Regardless of the source, recognizing and documenting these concerns is the essential first step. 

STEP 2: Obtain a Current Eye Report

To determine eligibility for vision services, the school or agency must receive a comprehensive eye report from a licensed optometrist or ophthalmologist. The report must be dated within one year. A school vision screening is not sufficient for eligibility determination. If an eye report is not yet available, the parents or caregivers must schedule an appointment for a complete eye exam. Vision can change over time, especially in developing children, so up-to-date medical information is critical.

Note: For students with Cortical Visual Impairment (CVI), a diagnosis from a neurologist is also acceptable for initiating the referral process.

STEP 3: Review by the (TVI)

Once the eye report is received, the TVI reviews the document to gather information about:
  • Visual acuity
  • Visual field loss (if applicable)
  • Medical diagnosis
  • Prognosis
The eye report is one component of eligibility determination, but helps guide the TVI's educational assessment and understanding of how the student's diagnosis may impact learning.
After high school graduation or aging out of K–12 services, students may become eligible for services through Vocational Rehabilitation or programs for older adults, which rely more heavily on medical documentation. 

STEP 4: Conduct the FVLMA

The TVI conducts a Functional Vision and Learning Media Assessment, which includes:
  • Observations of the student’s use of vision in classroom and school settings
  • An evaluation of how vision impacts educational performance
  • A Learning Media Assessment to determine the student’s primary mode of learning (e.g., print, braille, auditory)
  • Recommendations for strategies, accommodations, and supports
This step helps identify whether the student needs braille instruction, vision services, or other vision-specific evaluations. If a negative educational impact is identified, the referral process continues. ​​

STEP 5: Additional Assessments Based on Age and Needs

  • For infants, toddlers, and preschoolers: The team assesses both the child’s developmental strengths and needs, as well as the family’s priorities and support needs (optional). Identified services and support are used to create measurable child and family outcomes.
  • For school-aged students with low vision: A Clinical Low Vision Evaluation may be recommended. This specialized exam, conducted by a certified low vision specialist, evaluates the student’s ability to utilize prescribed low vision devices for both near and distance tasks.
Note: TVIs cannot prescribe low vision devices. Since appointments may take weeks or months, the evaluation process typically continues, and IEPs can be amended later to reflect the results. 

STEP 6: Determine Service Eligibility and Plan Support

  • For children ages birth to 2:
    An Individualized Family Service Plan (IFSP) meeting is held. The IFSP outlines:
    • Family and child goals
    • Services and supports to meet those goals
    • Timelines and progress indicators
  • For students ages 3 to 21:
    If the student’s visual impairment has an educational impact, the team determines whether the student:
    • Requires accommodations only (supported under a 504 Plan)
    • Needs specialized instruction in areas of the Expanded Core Curriculum (ECC), in which case an Individualized Education Program (IEP) is developed.
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