Developing Your Child’s Vision:

A Guide for Parents of Infants and Young Children with Vision Impairment

By Bill Takeshita, O.D., F.A.A.O., F.C.O.V.D. Director of Children’s Services, The Center for the Partially Sighted

Overview

Signs and Symptoms of Vision Problems

This checklist can help you identify eye problems in your child:

Appearance

Behavior

Children’s Program at The Center for the Partially Sighted

The Children’s Program at The Center for the Partially Sighted is devoted exclusively to helping children who are partially sighted maximize their remaining sight, even if they are legally blind. We help these children use their sight to function successfully... in the home, in the classroom and on the playground. The Center provides information, treatment and support to the families, teachers and therapists of children who are visually impaired.

Services include:

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Early Intervention

The purpose of this article is to provide parents, teachers and therapists with critical information to help the child who has a vision impairment. Children born with impaired sight do not know how they are supposed to see the world. Those who develop vision problems as young children may not have the language to communicate information that could help detect these problems. Early professional intervention can make a major difference in your child’s development.

Vision is More than 20/20 Eye Sight

Having 20/20 eye sight is not necessarily perfect vision. The standard eye chart used in the offices of doctors and school nurses measures how well a child can recognize a black letter from a distance of twenty feet with one eye. But this test detects less than 20% of children’s vision problems. It does not evaluate how well a child performs on reading distance, eye-hand coordination, tracking skills (following movement), eye teaming skills (how well both eyes work together) and visual processing skills.

Vision is the ability to take in, process and understand visual information. It includes eyesight, eye movement skills, eye teaming, focusing, depth perception, color vision, peripheral vision, visual perception and processing, and the ability to integrate all of this information with our other senses.

Vision is a Learned and Developed Skill

Your child’s vision is a learned and developed skill that requires stimulation and experience. Like learning to walk and talk, children must learn how to use their vision. The visual system involves much more than the eyes. The visual system interacts with the muscles of the body to develop reaching, crawling, grabbing and walking. In fact, two thirds of the functions of the brain are associated with vision.

Patterned targets are required to allow the visual cells of the brain to develop. Without patterned stimulation, these areas of the brain do not develop the ability to process visual information.

Because vision requires stimulation, problems that occur in the eye or in the visual areas of the brain can affect your child’s vision. Examples of these problems include: eye diseases, such as congenital cataracts, retinopathy of prematurity, ocular albinism, optic nerve and retinal disease; and neurological abnormalities to the visual pathways and visual centers of the brain.

Vision Affects the Development of Children

Research has taught us that vision affects how children develop. Studies suggest that up to 75% of what children learn during the early years of life is processed through their vision.

Children with vision problems may not be able to use their vision to make eye contact, socially bond with family members, and also may have difficulty developing the sense of day versus night. Because vision also serves as a learning sense, children with visual impairment may not learn to perform many tasks as quickly as a child with full vision because they cannot learn by mimicking the behaviors of others. A child with impaired sight may be delayed in sitting, crawling, walking, talking, or learning to read and write. For these reasons, it is critical that you help to develop your child’s vision.

The Team Approach to Vision Care

Children with vision impairment benefit from a team of vision care professionals — ophthalmologists and optometrists. Each specializes in different areas of vision and has specific training that is unique to each profession. Children who are partially sighted should receive regular eye health examinations from their ophthalmologist to insure that their condition is stable and that they are not at risk for other vision problems.

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The functional vision assessment performed by a low vision optometrist evaluates how children use their remaining sight and determines if there are devices to help children reach their full visual potential. These two eye care professionals work together to insure that the child has the best care possible.

Ophthalmologists are physicians who specialize in the medical and surgical treatment of eye diseases. When a child has an eye disease that requires surgery or a combination of surgery and medical treatment, an ophthalmologist is needed.

Optometrists specialize in the functional implications of vision problems and the non-surgical treatment of these problems. They have extensive training in the use of glasses, contact lenses, prisms, filters, and low vision aids. In California and 41 other states, optometrists prescribe medications and drugs for eye conditions. Both ophthalmologists and optometrists are required by law to diagnose eye diseases and vision problems.

Vision Stimulation

Vision stimulation activities can help children use their remaining vision more effectively. The theory is that by performing these activities, the visual areas of the brain are stimulated to maximize the development of vision. They are not exercises that strengthen eye muscles, or cure eye diseases or abnormalities to the brain. The activities presented in this brochure are to help stimulate the development of your child’s vision.

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Recommendations For the First Year

Things To Remember

Things To Do

Have a complete ophthalmological assessment so that your child will receive any medical treatments that may be necessary. If needed, glasses should be prescribed by a pediatric or low vision optometrist.

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One to Two Years

Things to Remember

Things to Do

Schedule your child’s second year ophthalmological assessment.

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Three to Five Years

Things to Remember

Children develop pre-reading and pre-writing skills at the age of 4. This is a period to develop visual skills that can be used for reading and writing. One of the most important skills for reading is tracking from left to right.

Language skills are also developed during this period.

Things to Do

Schedule your vision assessment with a low vision specialist to determine the level of functional vision before the child starts preschool or kindergarten.

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Five to Eight Years

Things To Remember

This is an important period with respect to schooling. You will need help from your low vision specialist and other professionals who work with your child to carry out many of the following suggestions.

Children should be assessed to determine whether they will require specialized text or books to learn to read. In some cases, a child may require large print books, while in other cases, Braille would be a more efficient method of reading. A developmental low vision optometrist can determine whether the child has the visual skills necessary to read while an educator can assess the mental skills needed for reading.

Things To Do

It is important to have another functional vision assessment before the third grade. During the third grade, your child reads to learn.

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Functional Vision Assessment

A functional vision assessment is performed by a low vision specialist to determine the extent of your child’s sight and how well the child is using that sight. A functional vision assessment should check central and peripheral sight, scanning techniques, visual processing, glare and contrast sensitivity, as well as a range of other visual skills. The following is a example of a report by the Center’s Pediatric Developmental Optometrist to use as a guide when your child is evaluated.

Jaymie T. is a four-year-old girl, diagnosed with retinopathy of prematurity by her ophthalmologist. She weighed one pound and thirteen ounces at birth, 26 weeks into gestation. Jaymie also has cerebral palsy and receives speech, physical and occupational therapies. She takes Tegritol to control seizures and has not had a seizure in over two years. Her mother wanted to learn how well Jaymie uses her vision and whether she has the vision necessary for reading, writing and performing other academic tasks in her preschool.

Functional Vision

My examination confirmed the diagnosis of retinopathy of prematurity, a condition affecting the retina, the tissue inside the eye that collects visual information and sends it to the brain. The retina is not fully developed until 32 weeks of gestation but Jaymie was born prior to this period.

Jaymie, however, has a very high degree of functional vision. She uses her vision to locate toys in our office and to find her way from one room to another. Jaymie did not use her hands to feel her way through the Center. She makes excellent eye contact and uses her vision to observe the behaviors of people around her.

Distance Clarity of Sight

Like many children with her condition, Jaymie has a high degree of nearsightedness which affects her ability to see distant objects clearly. At the present time, Jaymie’s distance sight measures 20/400 in each eye without glasses. This suggests that she can identify a symbol 7 inches high from a distance of twenty feet. I have prescribed glasses for Jaymie to wear for all distance activities, including walking, watching television, and playing outdoors. With the new prescription, her sight improves to 20/200, suggesting she can identify a letter 3.5 inches from a distance of twenty feet.

Recommendations:

Reading Clarity of Sight

Jaymie has excellent sight at distances closer than five feet. She can identify symbols as small as 10 point type size without glasses. I do not recommend glasses for Jaymie when she performs near work, such as reading, writing, crafts, or working on the computer.

Recommendations:

Peripheral Vision

Jaymie has some difficulty seeing objects in her upper field of vision. This may affect her ability to see objects like cabinets or branches that are at a level higher than her head. She may also have difficulty seeing her teacher when sitting on the floor during "circle time."

Recommendations:

Eye Movement Skills

Jaymie is able to move her eyes fully in all fields of gaze. However, her left eye crosses or turns inward when she reads with her distance glasses, a condition called esotropia. Without her glasses, her eye does not cross.

Jaymie has an eye teaming problem that can affect her ability to track as she learns to read. It causes her to see double. I do not recommend surgery for Jaymie at this time. She is able to control her eye teaming problem very well when she does not wear her glasses. In the future, bifocal spectacles may be considered as her academic demands require more precise sight to copy from the chalkboard to her paper. At the present time, I am concerned that bifocals may affect her balance and mobility.

Color Vision and Sensitivity to Glare

Jaymie has a color deficiency that affects her ability to discriminate colors of similar hue, such as red from orange or pink. She is also sensitive to glare and bright light.

Recommendations:

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Visual Perception Screening

Jaymie’s visual perception skills are developing very well. She was able to accurately solve the Form Board Test, placing the geometric shapes in the appropriate location. She has some difficulty with visual motor integration skills which affect her ability to copy geometric shapes. I do not believe that Jaymie has the visual motor skills necessary for printing or handwriting at this time.

Summary

Because her distance clarity of sight measures 20/200 with her glasses, Jaymie is legally blind and eligible for those services and benefits for the legally blind. However, her level of functional vision is very high. Jaymie’s vision condition primarily affects her ability to see distant objects clearly. Her near vision is excellent and I believe she has the visual skills necessary to be able to read and write. She is an excellent candidate for optometric low vision aids. When she is five years old, specialized glasses to enhance her distance sight will help prepare her for the academic activities of the first grade.

It is important that Jaymie have yearly ophthalmological examinations to assure her eyes remain as healthy as possible. I have noticed some difficulty with her balance and eye-hand/eye-foot coordination that I do not feel are related to her vision and believe that she would benefit from continued physical and occupational therapies. I would like to re-examine Jaymie in one year. If you have any questions or concerns, please feel free to call me.

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Modification of the Classroom for the Child with Vision Problems

Last Updated: Thursday, December 31st, 2009 at 06:28:24

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