Goals
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Review past trends in key areas in low vision education
Understand influences that led to past and current practices
Discuss future needs and questions about current services that
need to be addressed collaboratively
Key Issues
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Educational Services for Children with Low Vision
Changes in the Low Vision Population
Vision Intervention Practices
Lessons Learned from Print Enlargement Systems to Access
Educational Material
Continuum of Services
Range of Services
Personnel Preparation
Very Quick History of Educational Services for Children with Low Vision
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Special schools began in the early 1800s in the US; children who
were legally blind were taught braille
Some children who were low vision but not legally blind may have
entered special schools and taught braille (some ended up visually
reading the braille dots)
http://perkins.pvt.k12.ma.us/museum/popphoto_small.php?id=199
Perkins School circa 1830’s
“Conservation of Vision” Classes
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Began around 1913 in the US (later called sight-saving classes)
Read large print for short time periods to “conserve” their
vision
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Either segregated classes or integrated for “oral” work with
typically sighted peers
 Classes were for children without additional disabilities
Caption: Reading braille with weak eyes causes dangerous eye-strain
Students with low vision were 2 to 3 times the number who were blind in
Cleveland schools in 1920s – 1 per 1000 pupils. (Irwin, 1920)
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Low Vision Population in Early
Sight Conservation Classes in Cleveland
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Degree of vision of 181 children circa 1920 (Irwin, 1920)
Key Developments of 1930’s to Early 1950’s
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Increased use of large print in 1930s:
ophthalmologists no longer thought use of vision would lead to
further damage to sight
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Local school programs increased:
influx of children from retrolental fibroplasia (RLF) now called
retinopathy of prematurity (ROP) born from the late 1940s to
early 1950s
Low Vision Services Prior to the mid-1960’s
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Many children with low vision who were not legally blind and in local
school programs received minimal services: large print books and
learn typing
Children who were legally blind were expected to learn braille and
use tactile and auditory learning modes (Hatlen, 2000)
Educational Services for Children
with Low Vision
Techniques developed by the early 1960s were mostly materials and
environmental adaptations and included the importance of good lighting
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H
In 1950’s, suggested definition of children with partial sight for
educational services
 20/70 or less in better eye with all necessary
medical and surgical treatment plus necessary
lenses. Must have a residue of sight
 Visual deviation from normal, who, in the
opinion of eye specialist, can benefit from the
special educational facilities provided for the
partially seeing
 Undergone eye operations, especially
enucleation of an eye and need re-adaptation in
use and psychological adjustments
 Muscle anomalies, especially strabismus, in cases
in which re-education of the deviating eye and
psychological adjustments are necessary
(Hathaway et al, 1959)
Hathaway goes on to say:
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Legal definition of blindness in the US is “not a useful definition of
blindness from the educational viewpoint” and many children who
are legally blind should be identified as partially seeing (Hathaway,
1959 p.17)
Consider special needs of each child
Determine educational procedures by medical advisers in
cooperation with educational authorities
More Changes in Low Vision Population in the 1960s
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In the 1960s there was another epidemic –congenital rubella
syndrome
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Increase in number of deaf blind who had multiple disabilities
in the schools
Education systems had to adjust over the years to
accommodate this “new” population of children
Change Takes Time
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Even into the 1960s many teachers believed use of vision for near
tasks would damage eyes (Hatlen, 2000)
Natalie Barraga’s landmark work on vision utilization in 1964
changed everything…
Quick History Of Vision Intervention
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Conservation of vision until 1930’s (and later)
Provision of enlarged materials was predominant practice as local
programs grew
Other interventions were known (e.g., listening skills instruction,
handwriting instruction) but often minimally provided in local
school programs
Major shift in mid-1960’s to direct instruction in vision use along
with optical and electronic devices. More on technology later.
Current Vision Intervention Techniques:
It’s More than Large Print
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Adapted materials
Assistive devices
Use of other senses
Integrate vision with other senses
Instruction in use of vision
Instruction in Vision Use
Vision stimulation was the predominant trend to encourage use of vision
up until the late 1980’s (and perhaps beyond)
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Fuzzy term that often meant presentation of high intensity visual
targets to stimulate or improve sight (Bell, 1986)
Assumption is that high intensity stimuli would be reinforcing. It can
be if done thoughtfully and with a purpose.
Instruction in Vision Use is Now Thought to be More Complex
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From isolated, direct instruction of a vision skill
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To infusion of vision skill instruction into functional tasks
Instruction in Vision Use
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Currently: Sensory Rooms – dark rooms with lights, color to
stimulate sight in children with visual impairments
In current sensory rooms, activities might be facilitated by a teacher
to promote specific visual skills or promote next step in a
developmental progression
http://sensoryequipment.wordpress.com/category/sensory-rooms-forchildren/
Print Enlargement Systems to Access Educational Material
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Print Size
Robert Irwin, who started “conservation of vision” classes in the US,
also introduced 36 point type in Clearface font around 1913
This Clearface type proved too large for most students
Further studies from 1919 to 1920 by Irwin found that Caslon Bold
24 point type was the most effective print for the production of the
Cleartype Series books
Print Size (cont’d)
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Offset lithography (using photographic enlargement) allowed
greater ability to adjust print sizes in the 1940s. (Cleartype books
were typeset.)
Print size recommendations have varied from 14 to 24 point by
various agencies.
Print Size Today
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Standard school textbooks in primary grades are 16 to 18 point and
sometimes 20 point
Textbooks in later grades are 10 to 14 point
Large print textbooks in California from K to 8th grade are required
to have a minimum print size of 20 point.
American Printing House for the Blind’s usual font size is 18 point
No Longer “One Size Fits All”
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With the advent of e-readers and digital textbooks, print size and
other print features can be adjusted to meet individual needs
Print size can be determined systematically for individual students
for typical literacy tasks
Optical Devices
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Anne Corn (2000) spearheaded a movement to raise people’s
awareness of the drawbacks on reliance on large print and
advantages of optical devices in the schools
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Portable
Relatively inexpensive
Allow ready access to material
Improved reading performance
Children with low vision were not and probably still are not
regularly and systematically provided with optical devices and,
most importantly, optical device training
Optical Device Applications
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Uses for optical devices have likely changed now that there are ebooks and portable electronic devices that can take over optical
device functions
But optical devices are still less expensive, less prone to
breakdowns and still have a major role for specific visual tasks
Closed Circuit Television Systems
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First model developed by Sam Genensky in 1969
Supplanted optical device use and, in some cases, large print
Allowed very high levels of magnification
Equipment evolved over time, including the major addition of
highly portable electronic devices including e-tablets
CCTV Affects Teaching of Braille Literacy Skills
Into the early 1990s, some children with very low vision were using
extremely high levels of magnification to read
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Seeing a few letters at a time on the CCTV screen
Reading was slow and laborious
Many TVIs were not teaching braille which would be a more
efficient literacy medium these children
Call for increased teaching of braille literacy in the schools by
consumer organizations
Swing in the Pendulum by Early 1990’s
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Earlier in the 20th century, children with sufficient vision to read
print were taught to read using braille
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Late in the 20th century, children who could not read print efficiently
and who needed to learn braille were not braille literate
As a result of these past practices, there is a great emphasis on
choosing the most appropriate literacy medium or media, from the
results of *functional vision assessment *learning media
assessment
Lessons Learned:
Technology Can Drive Practice
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Field must keep up with technology
Set standards for use of various technologies
Adjust standards as needed
Provide preparation of personnel to handle the innovations and
modified standards using evidence-based practices
Overcome inertia where field wants to stay the same
Temper enthusiasm where quick adoption of technology or
methods supplants careful educational assessment and planning
Not discontinue past methods that may still play a role in literacy
Who Are the Children with Low Vision?
Recent years - increase in children with visual impairments, many with
multiple disabilities due to
 improved care of very low birth weight premature infants
 improved medical care of newborns with life-threatening
conditions
 Majority of students in schools are low vision and most children in
the schools have multiple disabilities – 85%
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(Kirchner & Diamont, 1999 per Lueck)
Damage to the Visual Brain
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CVI is now the major cause of visual impairment in children in the
US
Hard to estimate numbers
 Children with traditional hallmarks of VI measured by acuity
and field loss.
 Many children with additional disabilities have undiagnosed
CVI
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Children with near-normal acuity but visual processing
disorders. Many of these children are undiagnosed and not
receiving services.
Low Vision Population Changes have Led to Changes in the Educational
System Over Time
Over time, educational system needed to adjust to meet the needs of
influx of children due to
 RLF (ROP)
 Congenital Rubella
 Life-preserving medical procedures
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CVI
Children with multiple disabilities
Latest Adjustments to Changing Population of Low Vision Children
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Revisiting of definition of students with visual impairments
Development of appropriate assessment and intervention
techniques
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New information for personnel prep programs
Additional training of veteran teachers
Inclusion of other personnel in educational teams
May require re-thinking of some current systems and personnel
responsibilities
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Questions about what professional specialties should serve children
with normal/near normal vision but who have damage to the visual
brain
Appropriate school environments for children enfolded into
Universal Design for all students
Appropriate school placements
Range of Services: It’s More Than Large Print
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Access to core curriculum
Expanded core curriculum
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Compensatory and Functional Academic Skills including
communication modes
Orientation and Mobility Skills
Social Interaction Skills
Independent Living Skills
Recreation and Leisure Skills
Career Education
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Assistive Technology
Self-Determination
Sensory Efficiency Skills
Range of Services: It’s More Than Large Print
Emphasize service needs in low vision for
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Early intervention
Transition after high school
Instruction for students who have multiple disabilities
Continuum of Services Today
from full inclusion to special schools:
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Full inclusion in regular education
• Accommodations under Section 504 of Rehabilitation Act
of 1973, or
• Services of TVI
Special resource room part of day (TVI)
Full day resource room for VI
Special day class for additional disability with TVI services
Special school for VI
Types of Teaching Assignments
Tied to Continuum of Services
 Consultant service (TVI)
 Itinerant teacher service by teacher of visually
impaired (TVI)
 Resource room teacher
 Special day class teacher
 Teacher in special school for VI
Types of Services Available & Students’ Access to Appropriate Services
Affected by:
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Funding and staff availability
Changes in what children need due to
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Changes in population
Exponential growth of knowledge
Changing emphases in general education
Current Dilemma in VI Education
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There is so much more to be taught
Decrease in services due to funding along with shortage of qualified
TVIs and O&M specialists Increased use of consultation services,
This has led to
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Increased case loads
Many in the field of visual impairments are concerned that the
range of services are not being provided in the core and
expanded core curricula
How to provide services to the population of children with CVI
with resources so tight
Some Solutions
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Methods to increase services: para-educators, interveners for deafblind. Is this enough?
Should there be more teaming by educators with interventionists
from other educational area and medical teams
for children with vision loss due to
brain injury?
Collaborative solutions
Personnel
Preparation
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Address the expansion of knowledge and changes in population
served in pre-service programs
Continuing education needs for veteran teachers
Collaborative training needs with other fields
Summary: Complex Interplay of Factors Affect Service Provision
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Aside from funding issues, changes in low vision services in schools
have been affected by changes in:
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Overall climate of general and special education
Populations of children who have low vision
Technological advances and accessibility
Medical philosophies and developments
Definition of low vision
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Education background and philosophy of service providers
Future Directions in The Education of
Children Who Have Low Vision:
A Few Questions
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Should the VI education field consider the development of subspecializations: technology, low vision, braille literacy, early
childhood, children with VI & multiple disabilities, CVI?
Is there a need to again clarify the definition of children served by
teachers of the visually impaired and O&M specialists with the
changing low vision population?
Should educators collaborate more closely in planning services for
children with low vision with the medical community including
occupational therapists in order to provide the full range of service
needs to the increasingly complex pediatric low vision population?
Thank you!
Selected References
Ayer, S. (1998). Use of multi-sensory rooms for children with
profound and multiple learning disabilities. Journal of Intellectual
Disabilities, 2,(2) 89-97.
Bell, J. (1986). An approach to the stimulation of vision in the
profoundly handicapped visually handicapped child. British Journal of
Visual Impairment, 4, 46-48.
Corn, A., Wall, R., & Bell, J. (2002). Impact of optical devices on
reading rates and expecttions for school-age children and youth with
low vision. Visual Impairment Research, 2000, 2(1), 33-41
Goetz, L. & Gee, L. (1987) Functional vision programming: A model
for teaching visual behavior in natural contexts. In L. Goetz, D. Guess,
& K. Stremmel-Campbell (eds.) Innovative program design for
individuals with dual sensory impairments: Paul Brookes
Goetz,L. & Gee, K. (1987) Teaching visual attention in functional
contexts: Acquisition and generalization of complex motor skills.
Journal of Visual Impairment & Blindness, 81, 115-117.
Hathaway, W., Foote, F.F., Bryan, D., Gibbons, H. (1959). Education
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and health of the partially seeing child. New York: Columbia
University Press for National Society for the Prevention of Blindness.
Hatlen, P. (2000). Historical perspectives in Holbrook, M.C., & Koenig,
A.J. (Eds.) Foundations of education Volume 1.History and theory of
teaching children with visual impairments. NY: AFB Press. pp.1-54
Hatlen, P. (2000). Historical perspectives in Holbrook, M.C., & Koenig,
A.J. (Eds.) Foundations of education Volume 1.History and theory of
teaching children with visual impairments. NY: AFB Press. pp.1-54
Irwin, R.B. (1920) Sight-saving classes in the public schools. Harvard
University, Cambridge.
Kirchner, C., & Diamant, S. (1999) Estimate of number of visually
impaired students, their teachers, and orientation and mobility
specialists: Part 1. Journal of Visual Impairment & Blindness. 93, 600606.
Kitchel, E., (2004). Large Print: Guidelines for Optimal Readability and
APHontTM a font for low vision.
http://www.aph.org/edresearch/lpguide.htm retrieved April 3, 2006.
Lundervald, D., Lewin, L., & Irvin, L. (1987) Rehabilitation of visual
impairments: A crticial review. Clinical Psychology Review, 7, 169-185