Hands On - Focus On Low Vision
A Growth Process
by Randy Jose, OD

The pediatric low vision case can be challenging and usually means a long-term relationship between practitioner and patient. With awareness of what kids are going through physiologically and psychologically, the result can be a better quality of life and increased independence for growing patients.

Following is an outline of key concerns and actions for managing each of six important stages of pediatric low vision.

Teens want to blend in and low vision tools aren't always used PHOTOS COURTESY: MARK WILKINSON, OD

1 Birth to age three. The low vision examination must concentrate on the needs and concerns of the parents more than the child at this stage. The clinician must determine the appropriate level of visual functioning and try to demonstrate the vision loss--or visual potential--to the parents.

Parents should be provided with information on support programs for them, educational needs for their child when school starts, and comfort that their child can function independently even with a severe vision loss. A low vision specialist can coordinate services with the pediatric optometrist between the medical and optometric needs of the child.

2 Preschool and kindergarten to second grade. For this age group, it's important to provide refractive error corrections and ensure on-going pediatric medical/optometric care as needed.

The clinician must be aware of all educational services available in the local area to be able to direct parents in the use of these services. A good partnership between the school and parents is very important to the child's long-term goals for independence. Optically, learning activities often involve symbol recognition and simple magnifiers.

Most kids have enough accommodation to see small objects clearly by bringing things close to investigate details. And don't forget that education is more than just reading print: Seeing a spider's eight legs is just as much a part of learning as the letter "E."

3 Third grade through grade school. Clinicians need to address reading skills, comprehension, and fatigue. A vision exam must check for refractive errors, assess accommodative demands, look at binocular issues for reading, check on contrast sensitivity, and conduct a thorough evaluation of peripheral fields. The results will ascertain the need for mobility instruction or explain observed mobility challenges in school.

A child must learn to navigate independently in school and at home. Reading issues are addressed with optical systems that start to use more eye movement. As much as possible, large print should not be considered. Instead, the student should be encouraged to use magnifiers and regular print whenever feasible.

	With grade-school aged kids, consider tools over large-print materials

4 High school. Clinically, doctors would love using bioptic telescopes for expanding the student's world beyond the five-to-10 feet that conventional eyewear typically provides. It would be ideal to have each visually challenged student use microscopic lenses for reading, as they provide the largest field of view and allow access to far more materials.

However, another name for high school students is "teenagers," and relatively few teenagers will wear anything obvious at school. The biggest challenge for a low vision clinician at this stage is with a child's perception of looking different. The clinician must figure out how to get the student to use optical systems for visual functionality, yet still protect the delicate self-confidence of a teen.

Using special eyewear at home is better than not at all. A friendly classroom setting with a supportive teacher can be the best route. Sometimes, you have to back off for a year or two.

5 Teen driving. Driving can serve as the stimulus for a student to wear telescopic lenses. Some states allow the use of these devices for driving, and some don't. Therefore, the clinician must be certain of the state laws.

A responsible clinician will make sure the proper bioptic system fits, and the student must demonstrate that they will wear the bioptic in public. Students often learn that there are other school and recreational uses for the bioptic, which is additionally beneficial in case the state's Department of Public Safety in the end does not license the student.

6 College. Most college students are willing to do anything they can to improve their access to information. For example, many low vision college-age students will use auditory note taking, closed circuit television (CCTV) for studying, microscopes for library work, and hand magnifiers when at the store. Some use Braille for recreational reading.

Any device or tool properly used can increase a visually challenged college student's success rate.

According to the National Center on Birth Defects and Developmental Delays, nearly two-thirds of children with vision impairment also have one or more other developmental disabilities, such as mental retardation, cerebral palsy, hearing loss, or epilepsy. Children with more severe vision impairment are more likely to have additional disabilities than are children who have a milder vision impairment.