Vision impairment is a disability of access. DR SUE SILVEIRA explains how orthoptists help children overcome these barriers to participate within most areas of the curriculum.
Children with low vision and blindness are a unique and diverse group of learners. Given the significant impact that vision impairment can have on general childhood development and learning, early detection and management of vision impairment is essential.
Because Australia has committed to services that provide vision surveillance from birth and early vision screening, most children suspected with vision impairment have access to timely diagnostic services. Early diagnosis of vision impairment segues into essential early intervention and preparation for learning, with the child and their family being central to all planning and decisions.
Education of children with low vision and blindness in Australia aims to prepare children for the life challenges they will face, but also the life opportunities they will be offered.
As the standard national curriculum doesn’t capture the diverse skills needed by these children, an approach called the Expanded Core Curriculum (ECC) is recommended. The ECC embraces nine essential skill areas including compensatory, sensory efficiency, orientation and mobility, assistive technology, social interaction, self- determination, recreation, and leisure and career skills. An understanding of the child’s visual ability and needs informs their participation and success in each ECC skill area. Details of the child’s visual ability can be found in reporting from a low vision assessment.
Low vision assessment plays an essential role in translating the child’s lived visual experience, by reporting both visual function – or what a child can see, and functional vision – or how the child prefers to use their vision in their everyday life. Reporting must be available to everyone that has contact with the child including their family, educators, orientation and mobility instructors, access technology consultants, allied health and other professionals. Reporting must also be meaningful for older children so they can build essential self-determination and self-advocacy skills, by understanding their eye condition and speaking up about their access needs.
Fundamental differences exist when clinical and low vision assessments are compared. Clinical assessment is generally performed in environments that are optimised for visual performance, to reveal the child’s visual threshold. Low vision assessments often aim to mimic the actual environment where the child uses their vision, where dynamic factors such as changes in lighting, background information and other distractions occur.
Importantly, the child’s visual performance in their actual environment can reveal the presence and impact of significant factors such as glare and visual fatigue which will not necessarily be apparent in clinical environments.
The format of low vision assessments will vary according to the child’s age and co-morbidities, and the aim of the assessment. Typically, the diagnosis will be explained, with essential information such as the stability and fragility of the eye and/or vision condition, flagging the likelihood of future changes to the child’s visual function. Visual acuity will be included in reporting, with additional details such as binocular near and distance visual acuity, and changes in visual acuity when low vision devices are used.
Other strategies that maximise the child’s access to literacy such as font type and size, and adaptations to the reading position will be described. When available, information on visual fields is included, to inform on the child’s peripheral visual ability, particularly for orientation and mobility planning.
Vision impairment is a disability of access and when these barriers are overcome, children can participate in most areas within their learning curriculum. Information in the low vision assessment can be used to guide decisions around access such as recommending that a child becomes a braille user, and how access technology and low vision aids can enhance learning.
To maximise the child’s educational experience, information from the low vision assessment is used when setting up classrooms and considered when planning for the child’s general school participation. For example, significant factors that routinely impact on children with vision impairment such as glare can be identified in the low vision assessment, and then minimised in the school environment.
The low vision assessment acts as a conduit to the sighted world to reveal the nuances of the child’s preferred use of their vision. By reporting visual function and particularly functional vision, the low vision assessment plays an essential role in guiding significant decisions made by families, educators and professionals, and contributes to the child’s readiness for school.
ABOUT THE AUTHOR: Dr Sue Silveira is the Course Director of the Master of Disability Studies, Macquarie University, and a research fellow with the NextSense Institute (formerly the Renwick Centre, Royal Institute for Deaf and Blind Children).