What’s Up Doc?
Demystifying Low Vision Reports
MAER
April 27, 2012
Optical Prescription
Distance Visual Acuity
Near Visual Acuity
Oculomotor Skills
Visual Field
OPTICAL PRESCRIPTION
INTENT AND IMPACT
O.D. +3.50 -1.50 X 180
O.S. +4.00 -3.75 X 170
add +2.00
O.D. +5.50 -1.50 X 180
O.S. +6.00 -3.75 X 170
(equivalent +2.00 add)
O.D. -3.50 +1.50 X 180
O.S. -4.00 +3.75 X 170
add +2.00
O.D. -1.50 +1.50 X 180
O.S. +0.50 +1.50 X 180
(equivalent +2.00 add)
STANDARD BIFOCAL
progressive vs flat top or round
up to +3.50D
HIGH ADD BIFOCAL
+4.00D - +8.00D
MICROSCOPIC SYSTEM
unilens vs e-system or r-system
2X - 8X
TELESCOPIC SYSTEM
handheld vs prescriptive
2.2X - 8X
CONTACT LENSES
Advantages
Need for reading glasses
DISTANCE ACUITY
INTERPRETATION AND
ACCOMMODATIONS
Visual acuity Seating
Power of near add
20/70 range 5-6 feet
Power of
TS
2-3X
20/100 range 4 feet
3-4X
+2.00 -+3.00D
20/200 range 3-4 feet
4X
+4.00 - +5.00D
20/300 range 2 feet
6X-8X
+6.00 - +8.00D (2X
MS)
3X MS
20/400 range 1 foot
+2.00D
Distance acuity within classroom
with preferential seating
Distance Accommodations
Provide preferential seating at a specified distance, directly in line
or to the student’s right/left side relative to vision screening results.
Write larger on the board/overhead with black marker to enhance
contrast.
Stand near student when giving instructions.
Display work samples near student’s desk.
Provide seat copy of board/overhead notes (prior to instruction
when possible).
Refer to examples from textbook to supplement instruction on the
board.
Teacher verbalizes what is written on the board/overhead.
Arrange for a notetaker (using carbonless notepad).
Provide seat copy of important reference materials located on the
classroom walls (i.e. Wall Words, alphabet strip).
Provide individual instruction (i.e. correct letter formation, math
process).
Use high contrast balls, field markers and modify rules or positions
of play during Physical Education activities.
Recommend lighting accommodations relative to vision screening
results.
Low/High Tech Options
Utilize handheld telescope to view group instruction.
Position stuent at teacher’s computer to view instruction presented
using a data projector.
Increase size (using zoom function) and contrast (increasing
thickness and color) of text on electronic classroom board
(SmartBoard or Prometheon).
Use a distance CCTV to view group instruction.
Using a distance CCTV, take a snap shot of board notes to reduce
need for notetaking.
Use prescriptive telescopic glasses to view group instruction.
NEAR VISUAL ACUITY
INTERPRETATION &
ACCOMMODATIONS
threshold vs functional
Required print size
Importance of reading distance
O.D. +3.50 -1.50 X 180
O. S. +4.00 -3.75 X 170
0.8M at 3 inches
w/+2.00 equivalent single vision
reading Rx: 0.8M at 8-10 inches!
w/out Rx:
24-point print at 10 inches
w/Rx:
O.D. +3.00 -2.50 X 180
O.S. +2.00 -3.00 X 180
add +5.00
10-point at 8 inches!
w/out Rx:
8-point at 3 inches
w/Rx:
O.D. -11.00 -3.00 X 180
O.S. -11.00 -3.00 X 180
12-point at 10 inches
w/ +3.50 solamax:
8-point at 13 inches!
Text size decreases as reading
becomes more fluent
Nearpoint Accommodations
Enlarge nearpoint educational materials to size of text relative to
vision screening results.
Provide Large Print textbooks.
Enlarge worksheets/handouts using 11 x 17 inch paper and
enlargement capabilities of school xerox machine.
Enlarge computer-generated worksheets using a simple (arial or
APHont), bold, large font of a specific size relative to vision screening
results.
Increase line spacing on computer-generated worksheets.
Use Bright Line Reading Guide to help keep one’s place and reduce
visual clutter.
Use a handheld magnifier to enlarge text.
Utilize prescriptive magnification in the form of a bifocal or
microscopic reading glasses or single vision reading glasses.
Use bold-line writing paper and felt-tip pen
Allow extended time to complete assignments or tests.
Permit breaks to reduce visual fatigue
Use a CCTV to magnify view of text.
Use an e-reader (Kindle/Nook/i-Pad) to view text. Choose a larger
font and increase spacing between lines. Use text-to-speech option
to read text, if desired.
Scan text onto the computer. Enlarge the font and increase spacing.
Use a text reader to read the text, if desired.
Use digitally recorded books (Learning Ally) to augment reading.
Follow along in text.
Use a computer screen magnifier or large monitor (21-25 inch) to
enlarge computer display.
Customize Accessibility Options with MAC (preferences/zoom) and
within Windows environment (accessibility/magnifier).
Use magnification software (ZoomText, iZoom, etc. ) to provide
magnification of all computer applications.
OCULOMOTOR SKILLS
Eye Preference
Visual posture
bifocal vs single vision glasses
Visual Tracking
head movement and
eye movement
2
5
3
7
5
5
6
1
6
7
5
6
5
5
9
5
2
7
8
3
4
3
4
1
7
4
9
1
0
9
3
7
3
8
6
7
3
4
5
2
3
7
2
1
5
9
6
6
9
5
3
2
9
7
8
5
2
3
0
7
4
6
0
3
1
3
4
0
4
7
5
7
9
7
4
7
4
5
2
6
5
4
7
3
1
9
5
4
4
1
8
6
3
5
5
4
2
2
6
9
4
5
3
1
1
4
8
6
3
3
5
2
0
9
7
4
3
5
1
7
Not impacted by reading level
Comparison with same age peers
Ability to test effectiveness of visual
strategies, reading adds, Large Print
Estimate of time needed to
complete work and need for
alternative formats
Oculomotor Accommodations
Use a typoscope/ line marker to keep one’s place (Bright Line Reading
Guide).
Use one’s finger to keep place while reading.
Use the left index finger to locate the left margin and move accurately
to the next line and the right index finger to track text as one reads.
Provide greater spacing between letters and between lines of text to
help compensate for inaccurate eye movements.
Use Large Print materials to increase spacing and separation of text.
Consider introducing electronic text or an e-book reader to decrease
line length and increase spacing between lines of text.
When copying from another paper, encourage the student to use one
hand as a locator to keep his place on the text he is copying and the
other hand on his paper as he writes.
Reduce clutter, mask extraneous text, fold paper into sections.
When the student demonstrates an A-pattern or prefers a forward or
upward gaze (chin down), consider elevating reading material. If a
reading prescription is warranted, consider a reading segment placed
unusually high in the lens or single vision reading glasses.
When the student demonstrates a V-pattern or prefers a downward
gaze (chin up), reading material should be placed flat on the desktop. If
a reading prescription is warranted, a traditional bifocal reading
segment is appropriate.
If a student skips letters or transposes letters, introduce visual tracking
activities (Marzden ball, Ann Arbor Tracking series).
VISUAL FIELD
INTERPRETATION &
ACCOMMODATIONS
Configuration and position of
visual field loss
Common pathologies
Examples:
heminopsia
Stargardt’s disease
retinitis pigmentosa
Visual Field Accommodations
Use a typoscope/ line marker to keep one’s place.
Use the left index finger to locate the left margin and move
accurately to the next line and the right index finger to track text as
one reads.
Mark the left margin (green) and the right margin (red) to insure the
student tracks the entire line.
Place reading material on the desktop positioning the text within
the visual field.
Increase viewing distance to maximize field.
Consider introducing electronic text or an e-book reader to
decrease line length and increase spacing between lines of text.
Use a CCTV to present reading material within the visual field.
Use negative image setting on the CCTV.
Use high contrast.
Provide a defined, organized work space.
Keep page format simple, separate areas, fold the paper.
Teach systematic search patterns.
Teach student to scan environment.
Use contrasting tape to mark leading edge of stairs, edges of
doorways.
Provide preferential seating reflective of visual field and eye
preference.
Importance of Educational
Low Vision Assessment
-Actual classroom distance
environment and classroom near
point materials
-Input from parent, teachers, &
student
-Demonstration of vision and LV aids
and technologies
MDE-LIO PILOT PROJECT