Low-Vision Assessments and Services: The Earlier Your Child Starts, The Better

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Perhaps your young child has trouble reading, even though they’ve started building a vocabulary. Maybe a teacher says your teen is having problems seeing the blackboard from an assigned seat or isn’t meeting their full potential working online. Or it could be that you take your child to the family eye doctor before they start kindergarten – which is always a good idea – and are referred to a low-vision specialist for different tests.

These are some of the signs your child may have low-vision issues. Not only can these issues vary widely, but the sooner your child is diagnosed and can begin receiving services tailored to their needs, the better.

Seeking a Low-Vision Assessment

“I see children as young as five, even four if they’re a good communicator and mature for their age,” says Emily Gorski, O.D., an Assistant Clinical Professor at the University of California, Berkeley, School of Optometry, who performs low-vision assessments. “We want to get a good evaluation to see if we can describe their vision better and get them what they need to start in a school environment.”

She adds that regular eye exams can seem scary to children because of things like dilation drops that sting and bright lights, so it’s helpful for parents to let their children know a low-vision assessment is different.

“It’s more focused on the child’s visual function,” Emily says, “so it’s a lot more fun vision games and just talking with the child.”

Rajiv Panikkar holds multiple certifications: COMS, CLVT, and TVI. Based in Washington, he specializes in blindness and low vision. Before a low-vision assessment, he ensures students understand the process. Typically, a TVI prepares extensive paperwork for the optometrist. This happens when referring a student for evaluation. Rajiv recommends that the TVI should, if possible, be present during the assessment.

“Depending on how much time a teacher has had with the student, the information they provide for the evaluation can be very helpful,” Emily adds. “Maybe it’s what the child found has worked for them, or the teacher has noticed things the child hasn’t figured out yet.”

Collaboration is vital to student success.

Rajiv and Emily agree a collaborative approach is essential if a child is diagnosed with a low-vision issue.

“Once the evaluation has taken place, whatever the doctor recommends, there’s a coordination between the staff and the doctor – and it’s constant,” Rajiv says. “A device that works in a clinical setting may not work in a classroom setting. So communication between the doctor and the TVI or the low-vision specialist at the school is critical.”

Emily and Rajiv advise seeking a low-vision specialist, despite some optometrists and ophthalmologists having experience in this area. Regrettably, specialists aren’t always easily accessible. This means parents might need to travel for their child’s evaluation. Before the pandemic, specialists often visited schools for assessments. It’s best to ask your child’s eye doctor for a referral.

Rajiv underscores the importance of having a low-vision assessment from an expert before a TVI or Orientation & Mobility (O&M) specialist begins making recommendations about services and tools.

Importance of an Assessment

Without a formal assessment, there’s too much reliance on trial and error. A formal assessment can really give you a much more directed recommendation that will set that child up for success more quickly.

Not every student’s needs are alike, so an assessment is so important. Some students require glare control or specific screen brightness. Others need high contrast. For example, teachers should use a black pen on whiteboards instead of yellow. In cases of peripheral vision challenges, the best solution might be seating the student on one side of the classroom. This maximizes their vision use. It’s crucial to remember that young children need early intervention, even if book print is larger. An early diagnosis equips them with low-vision device skills. This training becomes vital as they grow and face smaller print sizes in books.

Addressing the needs of older students

A low-vision assessment is equally important when a student begins having vision issues in middle school or high school. However, students at this age may resist assistive devices or accommodations.

“Students at that age don’t want to stand out among their peers or some of them get teased about their devices or even their canes,” Rajiv says. “That’s our biggest challenge, so we must help them understand it will make their lives easier – including when they are out of school because a soup can isn’t going to use 18-point type. They have to get used to the tools they will need.”

Fortunately, it’s easier for students now that technology is more common in classrooms. “We can assure the student that there are technological options that won’t make them seem any different from their classmates,” Emily says, “or their tablet or computer might already have accessibility options built-in.”

It is Never Too Late

Both Rajiv and Emily agree that early intervention is essential, no matter when a child begins having vision issues. In fact, Rajiv advocates connecting students with adult and transition services through the state as early as middle school. Therefore, students are ready to progress immediately after high school. Their next steps could be college or employment. He also suggests that students learn to articulate their eye condition. This skill is essential, especially when explaining to people like employers

“Whatever age a child is, a huge theme in low vision is early intervention: getting things in place and planning for the future,” Emily says. “That way, when they get out into the working world – where they’ll have to take a lot of responsibility for asking for or getting resources themselves – they’ll know what they need. It’s also very important in encouraging independence. The more self-reliant a child can be as a student, the more successful they’ll be as an adult.”