Focus On Low Vision
Teamwork The Key to Pediatric Care
By Karlen McLean, ABOM, NCLC

Teamwork. Whether you're talking about eyecare professionals or caregivers, teamwork is what is what pediatric low vision care is all about.

At the ECP level, most pediatric low vision settings include a team consisting of an optometrist, ophthalmologist, low vision specialist, low vision technician, and optician. In terms of pediatric patient management, there's also a team--one that can consist of program directors for state and local organizations, other medical care providers, parents, and other outside-the-scope- of-vision providers who are involved in the care of a visually challenged child.

Pediatric low vision care entails several steps and cooperation between many professionals PHOTO COURTESY MARK WILKINSON, OD

One reason that teamwork on the part of both ECPs and caregivers is so important is that children's needs change as they mature. That requires both flexibility and coordination of efforts.

To find out how they do it, we asked several low vision specialists to detail what they see as the most important points in caring for these special kids.

Comprehensive care. Rebecca Coakley, a pediatric low vision specialist at the West Virginia University Department of Ophthalmology in Morgantown, W.Va., says, "You need to get a comprehensive picture of a low vision patient. Often low vision patients are otherwise challenged, such as with mobility issues and learning disabilities."

Flexible programs. It's important to keep the pediatric low vision program you have in place fluid.

"We reinvent our Children's Vision Rehabilitation Project (CVRP) every year based on the needs of the kids," says Coakley. "For example, we do a lot of educating the educators, focusing on the low vision patient's parents and teachers," she adds.

	Training for low vision tools should cover school work and beyond PHOTO COURTESY MARK WILKINSON, OD

Multiple steps. The CVRP, which conducts 12 to 15 clinics a year, is one example of how complex the chain of care can be.

The program encompasses seven steps: Vision evaluation; medical examination; prescription of a low vision device; education on how to use the device; occupational therapy; orientation and mobility; and assistive technology such as closed circuit televisions (CCTV).

The sequence. In the case of CVRP, evaluators get referrals from vision teachers, medical personnel or doctors. Then the clinic puts together the components, including forms, patient history, medical history, home, and education information. After all that is compiled, the child is evaluated, usually with a teacher or parent present.

Broad training. Once the evaluation is complete, the team decides on the appropriate low vision device, then trains not just the child, but also the parent and educator on its use.

Technical support. Technical support is important, says Jennifer Bell, low vision specialist and teacher with the Providing Access to the Visual Environment (PAVE) program at Peabody College, Nashville, Tenn. Thanks to a low vision grant from the state, about 100 school-age children per year are seen at the three annual low vision clinics held there. Doctors and low vision specialists provide training for teachers and parents, and help integrate devices into the school setting.

A doctor evaluates a young patient at West Virginia University

Acclimation. It's important that low vision training go beyond the school setting. "PAVE also takes kids to grocery stores, libraries, and other public venues for acclimation," Bell says.

Follow-up care. Follow-up at the schools is key. "We get the doctor's report, then prescribe the device, order it, and dispense it at the child's school with lots of training," adds Bell. "We'll see a child one to two times every month at the start."

Re-evaluation. Educators stress it's important to understand that needs change. Ongoing support includes services that evolve with the child's development, including re-evaluation every one to two years and supplying of other devices. Typically, a young school-age child will start with a 2.8X magnifier for reading and near-vision work, then move up to a 4X or 6X when they are ready.

Follow-up is crucial through a child's development. "A visually challenged child's visual needs change as they mature," says Mark E. Wilkinson, OD, associate professor, clinical, and director, low vision rehabilitation service, Department of Ophthalmology and Visual Sciences, University of Iowa in Iowa City.

So, what is the ultimate goal of pediatric low vision care? "Our goal is to create a fully functioning adult," says Wilkinson. "Independence, the ability to drive if possible, and functionality in college and the workplace as the student matures are all important goals."