Vision is one of our five senses. Being able to see gives us tremendous access to learning about the world around us—people’s faces and the fine details of facial expressions and non-verbal communication, what different things look like, how big they are, and the physical environments where we live and move, including approaching hazards.
When a child has a suspected visual impairment, it is cause for immediate attention. That’s because so much learning typically occurs visually. Eighty-five to 95% of what we learn is through the visual channel. When vision loss goes undetected, children are often delayed in developing a wide range of skills. While they can do virtually all the activities and tasks that sighted children take for granted, children who are visually impaired often need to learn to do them in a different way or using different tools or materials. Central to their learning will be touching, listening, smelling, tasting, moving, and using whatever vision they have. The assistance of parents, family members, friends, caregivers, and educators can be very important in that process.

Please click on the link below to view a short video about the anatomy of the eye.

http://youtu.be/RE1MvRmWg7I

Types of Visual Impairment

Not all visual impairments are the same, although the umbrella term “visual impairment” may be used to describe generally the consequence of an eye condition or disorder.
The eye has different parts that work together to create our ability to see. When a part of the eye doesn’t work right or communicate well with the brain, vision is impaired.
To understand the particular visual impairment a child has, it’s helpful to understand the anatomy of the eye and the functions of its different parts. Rather than go into those details here, in this general fact sheet, we’re pleased to refer you to the experts for easy-to-understand explanations and diagrams of the visual system.
Most of us are familiar with visual impairments such as near-sightedness and far-sightedness. Less familiar visual impairments include:
  • Congenital cataracts, where the lens of the eye is cloudy;
  • Retinopathy of prematurity, which may occur in premature babies when the light-sensitive retina hasn’t developed sufficiently before birth;
  • Retinitis pigmentosa, a rare inherited disease that slowly destroys the retina;
  • Coloboma, where a portion of the structure of the eye is missing;
  • Optic nerve hypoplasia, which is caused by underdeveloped fibers in the optic nerve and which affects depth perception, sensitivity to light, and acuity of vision; and
  • Cortical visual impairment (CVI), which is caused by damage to the part of the brain related to vision, not to the eyes themselves.
  • Albinism is a defect of melanin production that results in little or no color (pigment) in the skin, hair, and eyes
  • Ocular albinism in an inherited condition in which the eyes lack melanin pigment, while the skin and hair show normal or near-normal coloration.

There are also numerous other eye conditions that can cause visual impairment. For a more complete list of conditions, here are two resource pages you’ll find helpful:

American Foundation for the Blindhttp://www.afb.org/section.aspx?FolderID=2&SectionID=93

American Academy of Pediatricshttp://www.healthychildren.org/English/health-issues/conditions/eyes/pages/Specific-Eye-Problems.aspx

Because there are many different causes of visual impairment, the degree of impairment a child experiences can range from mild to severe (up to, and including, blindness). The degree of impairment will depend on:
  • the particular eye condition a child has;
  • what aspect of the visual system is affected (e.g., ability to detect light, shape, or color; ability to see things at a distance, up close, or peripherally); and
  • how much correction is possible through glasses, contacts, medicine, or surgery.
The term “blindness” does not necessarily mean that a child cannot see anything at all. A child who is considered legally blind may very well be able to see light, shapes, colors, and objects (albeit indistinctly). Having such residual vision can be a valuable asset for the child in learning, movement, and life.

Signs of a Visual Impairment


It’s very important for a medical eye care professional to diagnose and address visual impairment in children as soon as possible. Some vision screening may occur at birth, especially if the baby is born prematurely or there’s a family history of vision problems, but baby wellness visits as early as six months should also include basic vision screening to ensure that a little one’s eyes are developing and functioning as might be expected.
Common signs that a child may have a visual impairment include the following.
  • Eyes that don’t move together when following an object or a face
  • Crossed eyes, eyes that turn out or in, eyes that flutter from side to side or up and down, or eyes that do not seem to focus
  • Eyes that bulge, dance, or bounce in rapid rhythmic movements
  • Pupils that are unequal in size or that appear white instead of black
  • Repeated shutting or covering of one eye (as noticed with Julian)
  • Unusual degree of clumsiness, such as frequent bumping into things or knocking things over
  • Frequent squinting, blinking, eye-rubbing, or face crunching, especially when there’s no bright light present
  • Sitting too close to the TV or holding toys and books too close to the face
  • Avoiding tasks and activities that require good vision.
If any of these symptoms are present, parents will want to have their child’s eyes professionally examined. Early detection and treatment are very important to the child’s development.

Understanding how Children with Visual Impairments Learn


Children with visual impairments can certainly learn and do learn well, but they lack the easy access to visual learning that sighted children have. The enormous amount of learning that takes place via vision must now be achieved using other senses and methods.
Handsare a primary information-gathering tool for children with visual impairments. So are the senses of smell, touch, taste, and hearing. Until the child holds the “thing” to be learned and explores its dimensions—let us say, a stuffed animal, a dog, a salt shaker, or a CD player —he or she cannot grasp its details. That is why sensory learning is so powerful for children with visual impairment and why they need to have as many opportunities as possible to experience objects directly and with other senses.
Being able to see enables us to capture the “whole” of an object immediately. This isn’t so for children with a visual impairment. They cannot see the “whole,” they have to work from the details up to build an understanding of the whole.

How IDEA Defines Visual Impairment


IDEA provides the nation with definitions of many disabilities that can make children eligible for special education and related services in schools. Visual impairment is one such disability the law defines—as follows:
Visual impairment including blindness…
…means an impairment in vision that, even with correction, adversely affects a child’s educational performance. The term includes both partial sight and blindness. [§300.8(c)(13)]

How the State of Tennesse Defines Visual Impairment


1. Definition
Visual Impairment including blindness means impairment in vision that, even with
correction, adversely affects a child’s educational performance. The term includes
both partial sight and blindness.
Visual Impairment includes at least one of the following:

(1) visual acuity in the better eye or both eyes with best possible correction:
(a) legal blindness – 20/200 or less at distance and/or near;
(b) low vision – 20/50 or less at distance and/or near.

(2) visual field restriction with both eyes:
(a) legal blindness – remaining visual field of 20 degrees or less;
(b) low vision – remaining visual field of 60 degrees or less;
(c) medical and educational documentation of progressive loss of vision,
which may in the future affect the student's ability to learn visually.

(3) other Visual Impairment, not perceptual in nature, resulting from a medically
documented condition.

Educational Considerations


Children with visual impairments need to learn the same subjects and academic skills as their sighted peers, although they will probably do so in adapted ways. They must also learn an expanded set of skills that are distinctly vision-related, including learning how to:
  • move about safely and independently, which is known as orientation and mobility (O&M);
  • use assistive technologies designed for children with visual impairments;
  • use what residual vision they have effectively and efficiently; and
  • read and write in Braille, if determined appropriate by the IEP team of the child after a thorough evaluation.
These are just some of the skills that need to be discussed by the student’s IEP team and included in the IEP, if the team decides that’s appropriate. Each of the above skill areas—and more—can be addressed under the umbrella of special education and related services for a child with a visual impairment.