Low Vision News

For low vision specialists and those who consult them

Monthly Archives: July 2010

How can teachers help children with visual impairment?

I saw a 5-year old child with albinism in the low vision clinic this morning. She is going to start school in September, and her mother asked me to give her a list of things she should ask the teacher to do, to help her daughter to see more easily.

Of course, each child with visual impairment should have access to a Teacher of the Visually Impaired or Peripatetic Teacher to assess the child’s performance in the classroom and to create specific advice for the teacher. Nevertheless, I thought it worth repeating my advice below. This girl’s visual acuity was 6/60 (20/200), she had only moderate photophobia, and her near visual acuity was N12.

My advice was:

Things which the school can do to make things easier for **** include:
– Ensuring that she sits close to the board
– Ensuring that the writing on the board is large and bold enough for **** to read, and that the contrast is high (black ink on a whiteboard; white chalk on a blackboard)
– Enlarging text to at least font size 24 for printed work and worksheets [this girl’s near visual acuity was 12 point. An acuity reserve of 2x is the minimum for fluent reading, so I usually recommend at least double the near visual acuity]
– Making sure that she does not have to share books (as she will have to be close to them to read them easily)
– Allowing her to use her glasses, sunglasses, magnifier, binoculars, bookrest, and a hat if needed
– Allowing her to use a thick black pen to write in if this helps her
– Ensuring that **** has access to a large screen computer, that the text and cursor are enlarged to an appropriate size, and that she is allowed to sit as close to the screen as she needs to
– Making sure that there is enough light for **** to see clearly
– Making sure that window blinds are used if the sun is shining towards ****’s eyes (causing glare)
– Ensuring that **** is able to fully participate in all school activities, including sport, play activities and music

I would appreciate comments from other clinicians, teachers and rehab workers about this list: maybe we can create a universal list of items which teachers should consider when they find they have a child with visual impairment in their class.

Don’t forget refraction!

There is a nice paper in the most recent issue of Ophthalmology by Janet Sunness and Jaafar El Annan which reminds us of the importance of performing a refraction (spectacle test) for our patients with low vision. This should not be newsworthy to people who perform low vision evaluation routinely, but should emphasise the importance of refraction to our colleagues who do not see many patients with visual impairment.

In the paper, Sunness examines the records of 739 low vision patients newly referred to her clinic. In 11% of them, visual acuity was significantly improved (by more than 2 lines on a logMAR chart) by prescribing them new spectacles.

The authors make the point that people with eye disease often inappropriately assume that ‘new glasses’ will solve all of their visual problems, which is very rarely the case. However, that doesn’t mean that a spectacle test should not be performed for people with low vision: for these 81 patients in Sunness’ practice, visual function is likely to be better (although not perfect) after new glasses are prescribed.

The paper also makes the excellent point that retinoscopy and keratometry can be useful adjuncts to refraction in people with low vision. For this reason, I think it is important that an optometrist (or an ophthalmologist who performs refraction) is an integral part of the low vision multidisciplinary team.

In summary: low vision practitioners should not forget to perform a refraction for all of their clients with low vision. And whilst people with severe eye disease should not expect glasses to solve all of their visual problems, they may find they perform slightly better with an updated spectacle prescription.