Enabling Children and Adults with Low Vision to Extend ... - Certec

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Enabling Children and Adults with Low Vision to Extend ... - Certec

Enabling Children and Adults withLow Vision to Extend their VisualReachAnne L. CornProfessor, Department of SpecialEducation, Ophthalmologyand Visual SciencesVanderbilt UniversityIntroduction• My experiences – my concerns– Age 6 – chalkboards– Age 7 – circus, plays– Age 8 – script writing– Age 9 – books– Age 12 – stamina– Age 14 – scientific equipment– Age 17 - drivingIntroduction• Over the years there were:– New philosophies– New devices– New techniques– New expectationsExpectations• Meet John– Age 20– Oculocutaneous albinism– O.U. 20/200– Mild photophobia– Efficient user of optical devices– Average intelligenceExpectations• Do you believe John is able to:– Read a standard newspaper article?– Read a street sign from across a street?– Read a paperback book?– Drive a car?Expectations• Expectations for Visual Functioning (EVF)– 20-item likelihood scale of daily tasks– A tool for assessing teachers’ expectationsfor visual functioning of hypotheticalindividuals– A tool for assessing whether students,parents, and teachers have similarexpectations for students’ future visualfunctioning


Definitions• Visual efficiency• Visual reach• Extension of visualreachPremises• For tasks and experiences usuallyperformed with vision, the use of visionis the most efficient and preferredsense for those with functional vision.• Those with low vision who extend theirvisual reach will become better able tolearn through vision and will requirefewer accommodations in school, work,and home environments.Premises• It is the responsibility and obligation ofschool/rehabilitation personnel toensure that all children and with lowvision are provided with appropriateopportunities to extend their visualreach.Premises• All of the above are tempered by thelevel of comfort and efficiency that achild’s vision affords; non-visual andcombined visual and non-visualapproaches may be more efficientand/or preferred in students withsevere low vision.Extending Visual Reach• Child or adult:– Alters body position– Uses optical devices– Uses non-opticaldevices– Modifies environment– Uses visualtechniques– Uses combinations ofthe aboveExtending Visual Reach• Process– Concept – new levelof visual functionexists– Capability - Newlevel within extendedreach– Motivation to see– Skills needed to see– Acts on desire


Extending Visual Reach• Psycho-socialAspects– Identity as a personwith usable vision– Confidence in visualskills– Comfort with othersseeing effortsExtending Visual Reach• Includes:– Near, intermediate,and distance vision– Central, mid- and farperiphery– Short, medium, andextended durationtasks– Explorations andincidental visualinformationExtending Visual Reach – Not Just forReading• Includes:– Literacy– Orientation &Mobility– Recreation– Living Skills– Career Education– Appreciation ofbeautyExtending Visual Reach• Assessments– Ophthalmology– Clinical low vision– Functional vision– Learning media– Literacy– Orientation andmobilityExtending Visual Reach• Setting goals– For visual use– For extended use– For integration ofvisual skills intogeneral educationand expanded corecurricula– For use in daily livingWhat is needed?• Realistic and high expectations• Provision of optical devices• Instruction in visual efficiency andextending visual reach• Coordinated instruction in literacy• Emotional support


Instruction in Optical Devices• Pre-requisite Visual Skills• Pre-requisite Visual Concepts• Mechanics of Devices• Mechanics of Eye, Head, Lens, Object• Mechanics of Device Movements,Distance from ObjectInstruction in Optical Devices• Interpretation of Images• Speed• Generalization• Routine UseResearchCorn et. al. 2001• Barraga 1963• Sykes 1971• Corn, Wall, Bell,Wilcox, Jose, &Perez 2001• Corn & Koenig 2002Providing Access to the VisualEnvironment (PAVE)• Components:– Clinical low vision evaluations– Ophthalmology consultation– Provision of optical devices– Instruction for visual efficiency– Instruction in the use of optical devicesProviding Access to the VisualEnvironment (PAVE)• Components:– Consultation about low vision to parentsand school personnel– Monitoring of students skills– Research


Providing Access to the VisualEnvironment (PAVE)• Procedures– Notification to schools– Enrollment of students– Review of all visual information• Ophthalmology report• Functional vision assessment• Other reportsProviding Access to the VisualEnvironment (PAVE)• Procedures– Intake at clinic– Clinical low vision evaluation– Multidisciplinary team review– Order prescribed devices– Follow-up appointments, oph., contact lens– Review of reports– Provide instructionProviding Access to the VisualEnvironment (PAVE)• Procedures– Return to students until student is:• Efficient user of optical devices• Using devices in daily routines• Gains control over visual environment to extentpossible• Integrates use of vision within classes• Integrates use of vision with other non-visualapproaches as appropriateProviding Access to the VisualEnvironment (PAVE)• Procedures– Re-evaluation• Refinement of optical device prescription• New visual demands in the classroom• New visual demand in community• New school placement• Change in visual functioning• Change in visual conditionProviding Access to the VisualEnvironment (PAVE)• Devices– Hand held near and distance devices– Spectacle mounted near, intermediate, anddistance devices– Light absorptive lenses, therapeutic contactlenses– New glasses as appropriate, e.g.,cosmesis, open fields, change in refractionProviding Access to the VisualEnvironment (PAVE)• Devices– Duplicate devices for children 3-6 years– Repairs and replacement during first yearin program– Ancillary non-optical devices, e.g., lamps– Do not include closed circuit television,enlarging software, but will provideconsultation and resource referrals


Providing Access to the VisualEnvironment (PAVE)• Premises– Optical devices are educational tools– Optical devices belong to the students– Large print books are not removed– A comprehensive educational low visionprogram requires the work of amultidisciplinary team including parents– Psycho-social considerations must beaddressed in prescription and instructionProviding Access to the VisualEnvironment (PAVE)• Premises– Students with visual-only and with multipledisabilities may benefit from educationallow vision services– TVIs and COMS receive continuingeducation for teaching use of opticaldevices– TVIs and COMS incorporate visualefficiency and optical devices into theirprogramsSelected Differences with TypicalClinic Programs for Adults• Mounting system selected by clinician• Older adults primarily receive nearvision devices• Patients expected to transfer skills toother environments• Instructional sequences not delineated• Evaluations by self report rather thanvisual performanceClosing• Ann Sullivan Macy(1924)– “You may be asenthusiastic as youwish on my behalf inendorsing thetelescopic lenses. Inever knew therewas so much in theworld to see.”

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