Chapter 5

What Do I Need to Know Before I Start?

Good instruction is based on good evaluation. Before you target visual efficiency needs and begin instruction, you need to conduct or review the evaluations done as part of the student’s full individual evaluation (FIE) (IDEA, 2004). Look for information about your student’s visual abilities (capacities), visual functions (skills), functional vision, and visual efficiency. Corn and Erin (2010) define each as follows.

It would be nice if everyone used the same vocabulary, but they do not, and some confusion is an inevitable result. For example, Lueck (2004) uses the term “visual capacities” rather than “visual abilities.” Visual capacities are “visual functions that are basic to the processing of visual stimuli, including visual acuity, visual field, contrast sensitivity, color, and response to light, as well as oculomotor functions used to control the receipt of visual information, including accommodation, convergence, saccadic eye movements, and pursuit eye movements” (p. 490). Corn and Erin (2010) use the term “visual functions” to describe behaviors called “visual skills” elsewhere. In fact, Corn and Erin include these behaviors in their definition of visual skill instruction. The BVEP uses the term “visual skills” to refer to fixation, tracking, localization, shifting gaze, and scanning.

Look for information about visual abilities or capacities in the general eye examination and the clinical low vision evaluation. Look for information about functional vision and visual efficiency in the functional vision evaluation, the learning media assessment, and the orientation and mobility evaluation.

Mandated evaluations

Three evaluations are mandated when a child is suspected of having a visual impairment and referred to an agency for special services (IDEA, 2004).

  • Eye examination: An ophthalmologist or optometrist evaluates ocular health, refractive error, visual acuities, visual fields, oculomotor function, and accommodation. Visual problems are diagnosed and corrective procedures prescribed. Correction may include surgery, medication, or corrective lenses. If after correction, a serious visual problem still exists, the child receives two additional evaluations.
  • Functional Vision Evaluation: TVIs, sometimes in conjunction with Orientation and Mobility Specialists (OMS), observe the student’s use of vision in the performance of tasks in a variety of environments. Using this information, they do three things.
    1. Determine whether or not the serious vision loss after correction reported by the eye specialist adversely affects the student’s educational performance. If it does, the student is eligible for special education services and must have an individualized education program (IEP).
    2. Include in the student’s IEP relevant goals and objectives and the specific accommodations, modifications, and supports needed by the student. Schools are required by law to make information about these accommodations, modifications, and supports available to all members of the educational team who provide instruction so that they can be used in accordance with the IEP [IDEA, 323(d)(2)(ii)].
    3. Request additional evaluations related to observed behaviors that seem to adversely affect educational performance in other areas.
  • Learning Media Assessment: TVIs assess the relative strengths of the sensory channels available to the student for performance of different kinds of tasks. Primary and secondary sensory channels are determined, and specific learning media are recommended related to each. These assessments allow TVIs to make evidence-based decisions about what kinds of sensory strategies work best for the student.

Additional evaluations

Two additional visual evaluations must be considered.

  • Clinical Low Vision Evaluation: Optometrists and ophthalmologists specializing in low vision use methods not used by typical optometrists and ophthalmologists to provide more precise information about refractive error, acuities, field, contrast sensitivity, responses to light, color vision, oculomotor function, and accommodation (Lueck, 2004). Referral for a clinical low vision evaluation can be initiated at any time, but TVIs are required to address the need for this evaluation in their Functional Vision Evaluations. Clinical low vision evaluations are not just for students with low vision who may need optical devices for reading. The decision to refer a child for a clinical low vision evaluation should be made, in part, on the basis of the quality of the information provided by the general eye examination. If the areas listed in the eye examination section above are not addressed or results such as “unable to test” are noted, a clinical low vision evaluation should be requested. TVIs need to make sure that vision is corrected to the maximum extent possible for both near and distance visual tasks before they conduct functional vision evaluations.

A boy travels safely with his cane.
  • Orientation and Mobility Evaluation: Orientation and Mobility Specialists (OMS) evaluate the student’s ability to attain systematic orientation to and safe movement within his environments in school, home, and community. Needs may include, as appropriate, environmental concepts and use of sensory information to establish, regain, or maintain line of travel; use of mobility devices such as the long cane for safety; and use of distance low vision devices (Fazzi & Naimy, 2010). In some states, TVIs are required to address the need for this evaluation in their Functional Vision Evaluations. Other states require that students with visual impairments receive an O&M evaluation upon initial referral, and for any reevaluations, the OMS must be part of the team that decides if an O&M evaluation is needed at that time.

One additional evaluation may be needed.

  • Visual Efficiency Evaluation: This evaluation identifies tasks in regularly occurring activities where performance is adversely affected by visual inefficiency and might be improved by providing visual skill instruction or accommodation of environments and learning media. TVIs are not required to evaluate visual efficiency. Some teachers base their instruction in the ECC area of Sensory Efficiency on the information contained in the Functional Vision Evaluation and Learning Media Assessment. If these reports are based on observations of all of the important environments and related tasks in the student’s typical day and the accommodations, modifications, and supports described are very specific, they may suffice. If the information in these reports is based on brief observations in two or three environments and recommendations are described in broad generalizations such as “provide preferential seating,” an additional visual efficiency evaluation is essential.

For example, use a Functional Visual Evaluation to gain information about visual capacities, and then use the Barraga Visual Efficiency Evaluation to make sure that information about capacities and related needs–described in the FVE–is used to improve performance levels in specific activities where performance is compromised by poor visual efficiency.