Visual Problems FInal

• Cortical visual impairment
• ROP
• optic nerve hypoplasia
• structural abnormalities
• albinism

cortical visual impairment

• injury to brain or visual pathways in the brain rather than abnormal structures of the eyes
• From O2 deprivation, prematurity, PVL, trauma, meningitis

• Many children with CVI (and ROP) have co-occurring health conditions
• Infants and toddlers with CVI and ROP who depend on technology may have unique medical needs that effect early intervention
• Common conditions: legally blind, developmental delays, seizures, eating disorders, dependent on technology (trach, GT),
• respiratory problems

• severity varies from child to child and from environment to environment
• these kids may experience improvement in visual function

• neuro abnormalities in addition to other ocular disorders
• vision fluctuates with fatigue and levels of sensory input
• may have limited or no eye contact because peoples faces look different at different times
• vision generally improves overtime but does not extend to typical levels of vision

improved technology that allows for smaller and younger infants to survive

500-550 per year

• more complicated hospital stays
• RDS
• pneumothorax
• PDA
• IVH
• sepsis
• other complications from prematurity

optic nerve hypopasia

present at birth from the abnormal development of nerve fibers that make uo the optic nerve

• young mother
• 1st pregnancy or >4th
• smoking
• premature birth
• SGA
• LBW

• enables infants to learn about people, objects, and events
• encourages play behaviors, visual imitation skills and activities
• facilitates social development and self-help activities
• plays a critical role in attention and cognitive development
• motivates infants and toddlers to stay awake, alert and attentive to people, objects and events

• squinting, closing or covering one eye
• holding objects close to the face
• excessive clumsiness
• tilting head to one side
• over/under reaching for objects
• rubbing or pressing eyes repeatedly
• drooping eyelids
• watery eyes constantly
• jerky eyes that dont move together
• child doesnt look at your eyes (after 3 months of age)
• doesnt look directly at the object, looks above, below or off to one side
• trouble seeing at night
• searches for things on ground by feeling

• structural abnormalities may be dx at birth or very early but many are not
• lag time bw dx and referral suggests that closer collaboration with eye specialists is needed
• earlier referral could lead to more immediate supports for the family and facilitate optimal development

• Corrected visual acuity of 20/70 or worse in the better eye &/or
• remaining visual field of 20 degrees or less in the better eye &/or
• state from an ophthalmologist that a child would benefit from services provided by a teacher or visually impaired

• Functional vision assessments
• Visual efficiency & low vision training
• orientation and mobility
• assessment and intervention
• emergent braille and braille instruction
• Family support services and activities
• developmental assessments
• IFSP & IEP
• service coordination
• staff development opportunities

• Slow is not a behavior but a need for processing
• children with VI may need additional time to process visual impairments

The differences in light and dark create clear edges, boundaries and patterns

• Selection of sizes and forms of objects are determined by degree of the visual field and accuity
• Ex: if have poor visual acuity then bigger is better but if have poor visual fields bigger is not better they need smaller
• Shapes such as pentagons are sharp and easier to see versus oval or circle

• Movement is one of the most motivating intervention strategies
• the visual system is sensitive to direction, orientation and speed of movement in central and peripheral fields
• A slinky is very good at movement

About 70% of children with ROP have additional disabilities including MR, CP, behavioral problems, deafness/hard of hearing

• More Myopic (near-sighted) at birth when ROP is present
• Have small papillary aperture so the response to light may vary depending on the degree of prematurity
• Visual skills may emerge at a slower rate

May effect one or both eyes

Visual function ranges from normal to total blindness

• Hypopituitarism is associated with impaired growth, hypoglycemia, developmental delay, seizures, and death
• When combined with optic nerve hypoplasia �condition icalled septo-optic dysplasia is usually present

• Associated with the absence of the septum pelucidum and a thinning of the corpus callosum accompanied by small optic nerves
• These children usually have hypopituitarism and may exhibit clinical signs that are similar to those children with ONH alone

• Vision loss
• Hypopituitarism

• A plan for families and the child
• Used in early intervention

Educational plan for the child when he enters school

At age 4

• Located in all 100 counties in NC
• Serve children birth-5 regardless of the impairment
• Services are provided in the childs natural environment
• Collaborate with other professionals to benefit the child
• NC is the only state to provide full services until age 5

• Copy of an eye report that is current within one year
• Referrel form completed by the parent, ophthalmologist or other care providers

They need additional time to process visual information

The differences in light and dark create clear edges , boundaries and patterns

Selection of sizes and forms of objects is determined by the degree of the visual field and/or acuity

The visual system is sensitive to direction, orientation and speed of movement in central and peripheral fields

• hearing is our only other distance sense
• when residual vision alone has not gained a response add sound

Childrens manipulation of objects contributes to a knowing of the edges and patterns which reinforces what their brain interprets visually