Chapter 4

Who Needs Visual Efficiency Evaluation and Instruction?

You may need to review your caseload to determine which students are most likely to need visual efficiency instruction. Lueck (2004) identifies the following six target populations:

Visual skills still developing

The BVEP addresses the needs of students with low vision who are developmentally 3 years old or older. The basic skills developed by young children with typical vision in the first 3 years of life may develop at a slower pace in children with low vision. Young students with low vision should be evaluated and receive instruction if visual efficiency needs are identified.

Recent vision loss or improvement

A significant change in visual ability, an increase or a decrease, may have a significant impact on visual functioning. Anxiety, confusion, and frustration related to change, even if the change is potentially an improvement, may cause a child with low vision to avoid the use of vision. Students who experience these changes should receive visual efficiency evaluation and instruction. If change reduces capability, you will need to provide visual skill instruction for a period of time so that you and your student can evaluate the efficiency of visual and alternate sensory strategies.

Rudimentary visual skills

Sometimes there is significant disparity between eye specialists’ reports of visual abilities based on formal measures and TVIs’ reports of functional vision based on observations of typical tasks. The difference may be characterized by more functional use of vision than reports of abilities would suggest. If visual functioning is useful, but still very limited, visual efficiency evaluation and instruction should be provided for a period of time to determine whether or not improvement occurs as a result. Conversely, if eye reports indicate that a child with low vision has the ability to respond to visual targets that would typically be demonstrated by infants in the first few months of visual development, but you do not observe those responses in typical tasks, visual efficiency evaluation and instruction should be provided for a period of time to determine whether or not improvement occurs as a result.

Recovery from neurological insult

A child who suffers a neurological insult that impairs vision, for example head injury, stroke, shunt failure, development of a cerebral tumor, and so forth, should receive visual efficiency evaluation and instruction. In this case, you will need specific information about cortical visual impairment (CVI) and post trauma vision syndrome (PTVS) associated with traumatic brain injury (TBI). You will need to plan your intervention collaboratively with other members of the educational team who have information about physical, cognitive, and psychological changes that have occurred as a result of the insult. The severity of the insult and the duration and speed of recovery are factors medical and educational teams must consider in determining whether or not the student is a child with a visual disability.

The BVEP does not provide specific tools for the evaluation and instruction of students with CVI, including those with CVI and PTVS resulting from TBI.

Intervention for this population is essential. See Appendix B for information about the unique needs of students with cortical visual impairment. See Appendix C for information about students who have suffered a traumatic brain injury that results in post trauma vision syndrome.

Sensory deprivation

All children with low vision experience some degree of sensory deprivation in the sense that impaired ocular abilities limit access to visual information in certain ways. A baby with typical vision may enjoy lying on his back in his crib, looking at pastel-colored zoo animals attached to a mobile circling over his head. A baby with low vision might not even be aware that a mobile is present because it is too far away, the colors are not bright enough, the room is too dark, or the background is too cluttered. The first baby will develop a variety of important visual skills as he enjoys looking at his mobile. The second baby will not.

Perhaps the most important aspect of comparing visual behaviors of children with low vision to typical visual development is to see where gaps in development exist and to evaluate whether the absence of skills is related to permanent limitations due to impaired abilities or to lack of opportunity to develop skills because of limited access to visual experiences. Students with low vision who have had limited access to appropriate visual experiences in early childhood and have resulting gaps in visual development should receive visual efficiency evaluation and instruction.

A photo shows a boy child holding two tangle balls in each of his hand.

Access to visual experiences in early childhood prevents gaps in visual develpment.

Limited application of developed skills

When a student with low vision uses a visual skill efficiently in a specific task, but not in other tasks where the same skill would improve performance, visual efficiency evaluation and instruction should be provided for a period of time in order to give the student the opportunity to evaluate which sensory strategies work best for him.

1 Adapted from “Characteristics of Instructional Programs to Encourage Use of Vision,” Functional Vision: A Practitioner’s Guide to Evaluation and Intervention, (pp. 266-267) by A. H. Lueck (Ed.), 2004, New York: AFB Press. Copyright 2004 by the American Foundation for the Blind. Adapted with permission.