Resources

        Bailey, B. R., Downing, J. (1993). Helping young children with visual impairments make use of their vision. Terre Haute, IN.: Indiana State University Press.

        DB-LINK,(1999, June 30). The National Information Clearinghouse on Children Who Are Deaf-Blind. [Online]. Available. http://www.tr.wosc.osshe.edu/dblink.

        Baraldi, P., Ferrari, B., Fonda, S., & Penne, A. (1981). Vision in the neonate(full term and premature): Preliminary result of the application of some testing methods. Documenta Opthalmologica, 51, 101-112.

        Fantz, R. (1963). Pattern vision in newborn infants. Science, 140, 296-297.

        Goetz, L., & Gee, K. (1987). Innovative program design for individuals with dual sensory impairments. Baltimore, MD.: Brookes Pub.

        Hanson, M. (1988). Beyond tracking: Enhancing vision development from birth to one year of age. Justice, IL: Vision Unlimited.

        Langley, M. (1980). Functional vision inventory for the multiple and severely handicapped. Chicago, IL.: Stoelting Pub.

        Sailor, W., Utley, B., Goetz, L., Gee, K., & Baldwin, M., (1982). Vision assessment and program manual for severely handicapped and/or deaf-blind students. Washington, DC.: U.S. Government Printing Office.

        Teller, D., McDonald, M., Preston, K., Sebris, S., & Dobson, V. (1986). Assessment of visual acuity in infants and children: The acuity card procedure. Developmental Medicine and Child Neurology, 28, 779-789.
 
 
 

Synthesis of Information

A vision screening is often used to determine if a visual problem exists. Unless an infant is born prematurely with the risk of Retinopathy of Prematurity, or with a recognized syndrome, a vision screening is not done. A parent and/or a pediatrician must request a complete eye exam, done by a Pediatric Optomologist.

There are many ways to test a child’s vision. The method that is used depends on several things:

• The child’s age
• The child’s ability to read letters or numbers
• The child’s attention span
• The child’s health
• The child’s mental condition and alertness

• Visually Evoked Response (VER)or Visually Evoked Potential (VEP) – Used extensively to determine the visual acuity of infants and children with neurological handicaps(Baraldi, Ferrari, Fonda, & Penne, 1981)

• Electroretinogram (ERG) – This test yields useful information about the functioning level of the retina.

• Functional Vision Inventory for the Multiple and Severely Handicapped (Langley, 1980) – This test has been developed both for individuals with visual impairments and for those with multiple handicaps.
• The Visual Assessment Manual(Sailor, Utley, Goetz, Gee, & Baldwin, 1982) – This assessment was also developed for individuals with multiple handicaps.
• The Opkinetic Nystaqmx (OKN ) – This test provides information on the acuity threshold of the infant through the use of spinning cards to determine fixation ability.
• The Forced Preferential Looking Test (FPL ) – This is a promising test that can be used with infants up to 6 months old and for difficult-to-test children such as those with dual sensory impairments,(Fantz, 1963).
• The Operant Preferential Looking Test (OPL) – This test is geared for infants over the age of 6 months. It also works well with individuals with multiple disabilities.
• The Teller Acuity Card Technique – This test was normed on 0-to-3-year-old children without disabilities. It has been shown to be effective for children who are developmentally delayed or at risk for this dual sensory impairment, (Teller, McDonald, Preston, Sebris, & Dobson, 1986).

• Efficient vision use is important for learning.
• A battery of assessments must be completed before developing a training program.
• Visual function can improve,(Goetz & Gee,1987).

Below, is a comprehensive list of physical characteristics and behaviors for parents and/or childcare workers, that may represent a child’s visual problem, (Bailey & Downing, 1993):

Appearance:

• Red rimmed eyelids.
• Swollen eyelids.
• Crust near lashes.
• Frequent sties.
• Red or watery eyes.
• Eyes in constant motion.
• Crossed eyes or one eye turning in and the other eye out.
• Eyes that cross when the child is tired.
• Eyes with pupils of different sizes.
• Unusual appearance of eyes.
• An eye that appears cloudy
• A white spot in the pupil

• Normally notices a colorful and interesting toy only when it is placed in a certain position.
• Typically overreaches or underreaches for objects.
• Explores the environment with his/her hands instead of eyes.
• Brings things very close to his/her face to look at.
• Flaps hands very close to his/her eyes.
• Blinks eyes constantly or rubs eyes often.
• Tends to have eyes crossed when reading.
• Seems overly sensitive to light.
• Stumbles or trips over objects.
• Holds book "too close" or "too far away" when reading.
• Frequently changes distance of book from far to near when reading.
• Shuts or closes one eye when reading.
• Tilts head to one side when reading.
• Screws up face when reading.
• Frowns or holds body tense when trying to see distant objects.
• Reads only brief periods without stopping.
• Has short attention span when doing chalkboard, bulletin board, or map work.

Parents, teachers, or childcare professionals can use The Vision Development Checklist as a general guideline for assessing an infant’s visual development. Although not all infants will develop visual skills at the same rate, failure to reach the major visual milestones within two to three months of those listed in The Vision Development Checklist is reason for the infant to have a professional eye exam.
 

A child is never too young to have his eyes examined. Modern technology makes it possible for eye doctors to complete an examination on a child too young to read. After talking with Pediatric Opthamologists and Optometrists, the consensus was that besides an examination of the eyes at birth for signs of congenital eye problems, a universal screening should be done on infants at least 6 months of age. Unfortunately, these examinations are costly, and until a government mandate exists, will not be done for every child.

To provide appropriate and crucial intervention services to infants with dual sensory impairments and their families, it is vital that the identification process be improved. Firm connections should be established within the medical community such as obstetricians, neonatologists, and pediatricians to promote and facilitate the identification process. Agencies should proactively assist families in finding appropriate services for their children at risk.

Classroom and homebound teachers need to be trained on how to interpret the results of both clinical and functional assessments in order to develop a comprehensive intervention program. It is also crucial that supplemental information and instruction be available for teachers and/or childcare givers in order to determine the best methods for helping children acquire functional sensory skills to become more independent.

The importance of early intervention for children with handicapping conditions has been well documented. When infants have two or more handicapping conditions, such as deaf-blindness, the need for early intervention is greater.
 
 

Bibliography

        Huebner, K. M., Prickett, J. G., Welch, T. R., & Joffee, E. (1995). Hand in hand: Essentials of Communication and Orientation and Mobility for your students who are deaf-blind. N.Y., N. Y.: AFB Press

        McInnes, J. M. (1982). Deaf-blind infants and children: A developmental guide. Toronto, Ont.: University of Toronto Press

        NTAC, (1999, June 30). The National Technical Assistance Consortium for Children and Young Adults who are Deafblind. [Online]. Available: http://www.tr.wou.edu/ntac.

        SKI*HI Institute. (1993). A resource manual for understanding and interacting with infants, toddlers, and preschool age children with deaf-blindness. Logan, U.T.: H.O.P.E., Inc.

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