In this article we will consider visual impairment along with accessing information and life more generally.

Both are developed extensively in my books to include managing the above in functional everyday terms; for example, when travelling for ‘a’ to ‘b’ or boiling an egg safely.

More specifically we will cover,

• Indications of a visual impairment
• Signs of a visual impairment impacting on tasks
• Behavioural observations to determine functional vision

Face book

Posted regularly on my face book page will be a series of common eye conditions and how to manage them to include,

• Myopia (shortsightedness)
• Hypermetropia (longsightedness)
• Hypermetropia (longsightedness)
• Astigmatism
• Cone dystrophy or Achromatropia
• Albinism
• Aniridia
• Cataracts
• Coloboma
• Glaucoma
• Hemianopia
• Keratoconus
• Macular degeneration
• Nystagmus
• Optic atrophy (OA)
• Optic nerve hypoplasia (ONH)
• Retinitis pigmentosa (RP)
• Squint
• Retinopathy of Prematurity (R of P)
• Squint

After these we will then briefly consider additional syndromes and conditions such as,

• Cortical visual impairment (CVI) In an earlier blog I spoke about this one in more detail
• Down’s syndrome
• Marfan’s syndrome
• Retinoblastoma
• Rubella (German measles)
• Usher’s syndrome

Indications of a visual impairment

Observations which might suggest a visual impairment can include,

• Movement of head rather than eye(s) when reading
• An unusually short or long working distance
• Poor posture at the desk; for example, sitting awkwardly or in a bent or twisted position
• An unusual sideways gaze when concentrating on a visual task
• Frowning or facial grimacing
• Complaints of dizziness, headaches or general eye discomfort
• Clumsy movements to include for example, bumping into objects positioned at the side or stumbling over objects which should be clear visually
• Moving down steps in a very cautious manner
• Fear of heights
• Poor balance
• Reluctance to join in activities; for example, take part in fast moving games
• Answering questions or commands without being addressed by name – often mistaken for rude or uncooperative behaviour
• Turning head to use one eye only or covering one eye
• Tensing the body when reading or when viewing a distant object

Signs of a visual impairment impacting on tasks

• Inconsistent quality or variations in the amount of work completed
• Unusual levels of fatigue during or after completing a visual task
• Deterioration in reading after a lengthy period
• Poor attention or concentration span especially when activities are being demonstrated across the room
• Fumbling over fine hand eye coordination activities
• Wanting to be very close to a TV or computer screen
• Errors when reading and writing especially reversals and omissions
• Difficulties when reading long words
• Confusion when reading certain letters; for example, ‘cl’ for ‘d’, ‘in’ for ‘n’
• Writing and spacing letters or words in an unusual manner
• Tiny, slanting writing with little awareness of lines
• Partly formed letters or letters drawn in the wrong sequence
• Problems with reading back own hand writing
• Difficulty copying correctly from for example a blackboard or text book or other sources of information
• An increasing gap between comprehension and reading rate along with accuracy scores on a standardised test
• Very slow reading rates, using a finger to keep her or his place and guide the eyes
• Consistently losing her or his place when reading
• Difficulty when searching for information on a page; for example, when using a dictionary or interpreting a graph
• Restlessness and/or lack of interest in activities requiring prolonged close work
• Difficulties when reading poor quality worksheets or in processing information which is not presented in a linear manner
• Written work which does not reflect oral ability

Behavioural observations to determine functional vision

Two people with the same level of sight may function in different ways. One learner may be keen to use her or his vision and display good movement, mobility and orientation skills for example where as another may not. Factors which affect how well a person can see and recognise objects may include,

• Whether objects are familiar or strange
• Distance from an object
• Size of an object
• Detail or simplicity of object
• Amount of light on the object
• Contrast an object presents against a background
• Colour of an object
• Whether objects are still or moving
• How easy the object is to find
• Position of the object
• Time available for looking

Visual functioning is primarily developmental. The more visual experience someone has the more pathways to the brain are stimulated and the greater the accumulation of various visual images and memories. Vision can therefore be improved with visual training when a greater number of images is placed in the memory.

Things to consider when assessing someone’s functional vision include,

• Preferred lighting
• Preferred position for viewing; for example one and two in relation to watching TV, accessing demonstrations and/or using a computer
• Access to information on a notice board, black or white board
• Independent travel in familiar or unfamiliar place
• Ability to adapt to changing light conditions
• Preferred print size and its contrast against a back ground
• Ability to cope in practical activities; for example, when cooking or cleaning the home
• Ability to cope in activities such as ball games and does s/he take a full and active part in team events
• Speed of working – the amount of unfinished work is a useful indicator here
• Ability and willingness to use any prescribed low vision aids

Other observations may include,

• Level of independence
• Social integration in and out of a familiar environment
• In addition the child should be observed and assessed in a range of visual perception skills which may include
• Locating and fixating on an object long enough to recognise if
• Tracking moving objects, scanning with the eyes, and moving the gaze from one object to another
• Discriminating objects e.g. recognising an object from its online shape
• Identifying patterns e.g. recognising symmetrical and non-symmetrical patterns or matching identical features such as numbers or letters
• Hand-eye coordination e.g. completing a tracing activity such as a maze
• Identifying facial expressions and body gestures

An observations and resulting profile should take account of the social, cognitive and intellectual development. It should also contain information about the her or his working environment, recommendations about adaptations which are needed and any training in special curricula areas such as mobility and orientation or keyboard skills which will facilitate access to the mainstream.

The report will also suggest specific activities which will help to improve any visual perceptual skills found to be underdeveloped.