By Carmen Willings
teachingvisuallyimpaired.com
Updated October 4, 2017

The process of referring a student with a suspected visual impairment for school based vision services begins when there are concerns about a child's vision or the lack thereof. If you have a concern about a child's vision, the first step is to take the student to an optometrist or ophthalmologist.
For younger children in particular, it is important to find a doctor who specializes in working with children. If the child has additional disabilities, it is particularly important to locate a doctor who specializes or is experienced in working with students with multiple disabilities. The ophthalmologist or optometrist will need to determine the cause, receive a visual diagnosis, approximated visual acuity, and determine if the student needs to be referred for school based vision services (or early intervention for children birth through age 2). The following is a list of the ABC'S of vision problems. Some of these concerns may be related to other medical conditions or medications. It is always best to address any concerns with the student's pediatrician as well.

Appearance

  • One or both eyes turn inward or outward, or one is slightly higher or lower than the other eye.
  • Crusty or red eyelids or red eyes.
  • Eyes that are in constant, rapid motion.
  • Drooping eyelids(s)
  • Pupils of different sizes, or different reactions to light and accommodations.
  • Glands that are enlarged, inflamed, or otherwise infected.
  • Excessive tearing, light sensitivity, lid spasms.

Behavior

  • Lack of or reduced eye contact.
  • Shows poor eye muscle coordination.
  • Covers or closes one eye for critical seeing.
  • Thrusts head forward to see distant objects.
  • Tilts head to one side for critical seeing.
  • Tries to "brush away" a blur.
  • Rubs eyes often or blinks often while reading or looking at books.
  • Frowns or squints when looking at or trying to see distant objects.
  • Stumbles often over objects, is awkward
  • Holds book, toy, or picture too close or too far away.

Complaints

  • Sensitivity to light.
  • Burning or itching of eyes or eyelids.
  • Seeing double, or blurred vision.
  • Headaches, usually after a critical visual task.
  • Nausea or dizziness.
  • Eyestrain, fatigue.

School Related

  • Difficulty copying from the board.
  • Difficulty with handwriting.
  • Confuses similar words.
  • Needs more light to read than expected.
  • Reading comprehension deteriorates with time.
  • Doesn't read to the end of a sentence before going to the next.
  • Head moves instead of eyes when reading or looking at pictures.
  • Loses place when reading and skips lines.
  • Needs to use finger as a line marker.
  • Difficulty solving maze puzzles and word searches.
  • Math errors due to misalignment of numbers.
Vision Concerns Checklist
This checklist, available free for download on the Printables page, can be used to help those outside the vision field identify vision concerns and know when to make a referral for vision services.

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