Pediatric Low Vision Rehabilitation
Vision rehabilitation should be recommended when a child has a visual impairment that affects his or her ability to access the visual environment (as occurs with best-corrected visual acuity worse than 20/40 in the better-seeing eye, decreased visual field, central field loss, reduced contrast sensitivity, nyctalopia, or impaired visual processing). From diagnosis onward, the ophthalmologist plays an important role in recommending that children with low vision receive comprehensive vision rehabilitation. Early referral is essential for setting the family and child on a course to achieve optimal visual performance, access to instruction, and safe and independent mobility, and for enabling children with acquired visual impairment to adjust successfully to vision loss. Even though preschool-aged children may function well without any low vision aids, early-intervention programs can offer important stimulation and introduce strategies for transition to school.
Pediatric vision rehabilitation involves pediatric ophthalmologists, vision rehabilitation clinicians, teachers of the visually impaired (TVI), occupational therapists, teachers, orientation and mobility specialists, technology experts, state societies, and other professionals and organizations. In the United States, a variety of approaches exist to educate children with visual impairments. Some states have state-funded residential schools for the visually impaired. Elsewhere, districts may cluster students with visual impairment into one school. More commonly, neighborhood schools work with itinerant TVI. An Individualized Education Plan (IEP) outlines the needs of an individual child in the school setting. The child’s needs at home and in other nonacademic settings must be considered as well.
Many children can function well with partial sight, with the help of low vision aids, whereas others will benefit from braille literacy, which is most easily acquired in childhood. Because most children have large accommodative amplitudes, enabling them to hold a given object closer than normal to enlarge its retinal image, magnification may not be necessary for very young patients with low vision. However, accommodative amplitudes decrease and visual demands increase with age (as students are faced with smaller print size), so holding objects closer may not be a sustainable strategy for older children. Printed material can be enlarged, and dome-type magnifiers may be helpful for performing near work; video magnification can be used for near- or distance-vision tasks. For distance viewing, handheld monocular telescopes may help. Tablets, smartphones, e-textbooks, and text-to-speech conversion have greatly expanded the opportunities available to visually impaired children and have the benefit of being socially acceptable for older children trying to fit in with their peers. Table 16-1 lists sources of information on low vision.
Table 16-1 Sources of Information on Low Vision
The American Academy of Ophthalmology’s Preferred Practice Pattern guidelines on vision rehabilitation outline the rehabilitation process for preschool-aged children to young adults. The availability of rehabilitation resources varies across communities, but the following online resources, which can be searched by location, may be helpful for clinicians and families in identifying such services in their community: afb.org/directory.aspx (American Federation for the Blind) and tsbvi.edu/tagged-resources (Texas School for the Blind and Visually Impaired resources home page). To learn about the Academy’s Initiative in Vision Rehabilitation, visit the Low Vision and Vision Rehabilitation page, which also offers a patient handout, available on the ONE Network at https://www.aao.org/low-vision-and-vision-rehab.
See also BCSC Section 3, Clinical Optics, for a detailed discussion of low vision aids.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.