Focus On Low Vision
Caring for Kids
By Erinn Morgan

There is a real need today for practitioners willing to treat children with low vision. In fact, data from the 1994 National Health Interview Survey indicates that 609,000 children under the age of 18 are visually impaired (defined as blindness in one or both eyes, or any other trouble seeing even when wearing glasses).

Still, many eyecare professionals are remiss to put forth efforts in this arena. Those who do, however, often say it's the most rewarding part of their practice.

About 30 to 40 percent of the patients seen at Nittany Eye Associates in State College, Pa., have low vision, and of these, 40 percent are children, says Marla Moon, OD, one of five ECPs on staff. "Most other patients take 30 minutes for an exam. These patients take 60 to 90 minutes, and they usually come back several times. Your heart has to be in it."

Today there are more support services, early intervention programs, and low vision devices geared to kids than ever before. By tapping these resources, the job of a children's low vision practitioner is easier and more profitable.

The first step to developing a focus on children's low vision services is to set up a referral network.

Referrals come from a variety of places for the New York City-based Lighthouse International's children's program. "New York state has an early intervention program that sends us a number of younger kids," says Michael Fischer, OD, director of Low Vision Services for New York City, Lighthouse International. "Older children are referred from the state commission for the Blind and Physically Handicapped. We also get a lot from pediatric ophthalmologists, other intervention programs, and parents just calling in."

Becoming familiar with the local and state intervention programs and local pediatric ophthalmologists is a good start. The next step is to make these places aware of your low vision services.

It is also important to determine which age groups you would like to treat. Some practitioners, such as Fischer, focus on young children under the age of five. Others treat older children and pre-teens, while a few cover the full spectrum.

There is some debate about what age is appropriate to begin treating children. Some believe it is best to wait until the child is developed enough to understand the learning process and devices. A more prevalent school of thought is to start as early as possible to help the child get used to using devices and assistance. "I see very young children all the way down to two months of age," says Fischer.

THE EVALUATION PROCESS

Once the child is in your office, an exam is the first order of business. Some say the evaluation should be tailored to age groups. "When they are referred by an early intervention program from birth to age three, they get a series of evaluations," explains Fischer. "We do an educational and psycho-social assessment. I do a visual function assessment and usually dilate them for an ocular health assessment. They may also get seen by one of the vision teachers. Then we have a team meeting with early intervention counselors to assess where they need to go next. They may recommend things like occupational therapy or speech therapy."

Fischer observes that older kids have a different process. "When they are over age five, the commission for the Blind and Visually Handicapped does an assessment on what they need, and they also want a low vision assessment from one of our doctors."

THE DEVICES

There have never been so many devices available for small patients before. Still, there is an age debate about how early a child should start with them.

"There are still some eye doctors who believe kids aren't ready until fifth grade, but I believe this is not true," says Nittany Eye Associates' Moon. "The earlier you can begin to develop skills, the better user they will be."

Another positive direction with devices is to educate the kids and their parents how to integrate them into daily life. "I teach kids how to integrate them into their lives by using them at day-to-day events. This is preparing them for real life--not just the classroom," says Moon.

New technology is also making life easier for kids in the classroom. Electronic magnification devices are coming on strong and availability is helping lower prices to make this option more viable. John Palmer, owner of the Magnifying Center, with locations in Florida, says with kids he uses a mounted camera on an arm that magnifies images onto a monitor. The system includes a computer, flat screen monitor, speech system, and video camera all in one. Sometimes school systems or local agencies will help cover the cost.

THE FINE POINTS

Working with kids, it helps to keep several points in mind.

Be flexible. "What works for one kid in a situation is usually different than for another kid in the same situation," says Moon. "You may need to bring in the family and have counseling. Sometimes we bring in a child psychologist."

Acknowledge peer pressure. While some kids love the technology behind something like a head-borne device, peer pressure can cause other kids to reject anything that draws attention to them. "Pocket magnifiers are good for kids because they can keep them in their pocket and pull them out when needed, and not advertise their disability," Fischer says.

Go to school. Moon recommends extending in-office services to the classroom. "I will go into the classroom with the case worker and the vision teacher. We bring in the devices the child will be using, so everybody else in the class and the teacher see how Johnny sees and works with the devices. It's kind of show-and-tell and takes away the mystery."

Be positive. "Don't just hit the parents with the fact that their child is legally blind," says Moon. "It is better to say, 'Let's look at what we can do to maximize the vision they have. We have things that we can do to help.'"