Functional Vision Assessment
Student Name: Henrietta Cooper
DOB: 10/27/01
Age: 8 years 11 months
Grade: 3rd
Review of Medical Information:
Date of Most Recent Eye Information: 11/10/12
Eye Professional: Dr. William Young
Office/ Facility: Pediatric Ophthalmology Associates
Diagnosis: bilateral optic nerve Hypoplasia and nystagmus
Distance Acuity: Right Eye 20/600 Left Eye 20/600
Near Acuity: Both Eyes – 20/200 print at 3 inches
Definitions: Optic Nerve Hypoplasia is a congenitally small optic disc usually surrounded by a
light halo and representing a regression in growth during the prenatal period. It can cause
decreased visual acuity, which may vary from light perception to normal acuity, field defects
and nystagmus.
Nystagmus are involuntary eye movements that can be horizontal, vertical, circular or mixed.
This can cause inability to maintain steady fixation, reduced visual acuity and fatigue.
Review of Educational Plan:
Type of Plan: IEP
Dates: From 10/26/11 To 10/25/12
Area of Eligibility: Visual Impairment
Additional Areas of Need: none
Goals and Objectives: 1. Given adapted equipment and modifications when needed, Henrietta
will demonstrate increased upper body strength, 2. Using a smooth tracking motion, Henrietta
will read sentences and passages that include short form symbols and letter by letter words that
she has learned with fewer than 5 errors per lesson. 3. Henrietta will follow 3 and 4 step
directions and remain on topic in her classroom and during pullout sessions. 4. During reading
instruction, Henrietta will move her reading material with smooth motions under her desk top
magnifier to achieve grade level fluency and use her handheld magnifier without reminders. 5.
Henrietta will have at least 85% accuracy and 20 words per minute during touch typing lessons.
Accommodations: Extended time, magnification devices, preferential seating, read aloud
student marks in book, testing in a separate room
Testing: NA
Placement: Regular
Related Services: none
Interviews and Observations:
Interview with Teacher: Ms. Rogers says that Henrietta is on academic level when she wants to
be. There is a major concern about her hearing loss which she has appointments for but this
makes it difficult. She does not trip that the teacher has noticed. She sometimes makes excuses
for not getting work done.
Interview with the vision teacher Ms. Thompson revealed that Henrietta uses her Clarity CCTV
independently at both near and distance. She uses her Dome magnifier sometimes and also has
one at home. She does not have glasses as Dr. Young said they would not help enough to
make a difference. She began touch typing last year and knows the home row but they quit as
her fingers were not big enough but they plan to begin again this year.
Interview with Student: Henrietta said that it is hard for her to play basketball. “I just duck so it
won’t hit me.” She used to take the magnifier back and forth but does not any more. She
prefers the larger size dome that she uses at school rather than the small dome used at home.
She said that it is sometimes hard to keep her CCTV camera focused on the teacher as she
tends to move around the room. She sits very close to the TV at home. When asked if she likes
to read, she said “I struggle with books.” Reading is not one of her favorite things. She did not
like Braille because when she read the sentence wrong she had to do it over.
Classroom Environment: Unfortunately the students were not in their regular classroom due to
a fire in the air conditioner. Lighting is old fluorescents and floors are grey tile in her regular
room. She has two desks together and sits facing the windows.
Observation of Student: Henrietta leans within 8 inches of the CCTV while reading a book which
has 1 ¼ inch size print on a muted white screen. She navigates to the white board to check her
name on the Smart Board, which she does visually. While reading the CCTV, she moves the
book one handed. Her movement of the book is very jerky. Her writing under the CCTV is
legible but sloppy when she uses a dark carpenter pencil. It is a matching exercise and she is
not able to see all the items at once but easily maneuvers the paper to do the work. She draws
lines and matches items. The page she is working on has 8.0M print. She finishes the
assignment in a timely manner. She now holds her paper 1 inch from her nose to read. The
teacher points out a couple of errors and tells Henrietta to check her work. She is slow to go
back and proof read. The bookmark flies out of her book and she visually reaches for it at 20
inches with a combination visual tactual approach and a slight overreach. While reading her AR
book during free time, her tracking again is very jerky – she does not really have room for her
book under the camera in this temporary situation. The assistant 6 feet away asks a question
and Henrietta does not hear her and the question is repeated in a slightly louder voice and now
it is heard. The calendar is on the AR board but Henrietta does not have it zoomed in. She
watches but does not enlarge. Henrietta said that she can see the purple writing of a student
which is on the board. White dry erase boards are handed out and a student hands out
markers. Henrietta gets a dark blue marker. The CCTV accidentally unplugs and the teacher
moves it to the right. Now there is even less room for her book under the camera. Within 1 to 2
inches she writes the problem on the rather smudged white board. The marker has good
contrast. She complains to the assistant that she is tired during the third problem. She is doing
problems with regrouping and her one problem takes up the entire white board. She turns it
over to do the proof. She sees a problem written in green on the white board at 20 feet which
is magnified under her camera. She is not as close to the work when the writing is bigger. At
reading group time she is given a choice of using her dome and working with the group or
using the CCTV at her desk. She chooses the CCTV. This is a tremendously tricky sheet to work
with under the CCTV as it is a code sheet with vertical information running down the left side of
the paper and she has to transfer the information to the horizontal spaces on the rest of the
paper. Henrietta is adept at using her CCTV and manages to complete the assignment. She
uses the Clarity to look at the sheet but chooses to write directly on her paper. She has her
nose almost on the paper to write. When asked she says that she does not use a dictionary.
She is able to copy typed spelling words that the teacher is projecting onto the Smart Board. In
the computer lab the teacher says students are to use size 16 point font. Henrietta has her nose
on the screen. I show her Zoom but she switches back to the 16 point size. She does leave it on
Tahoma bold which I set for her. She leans in to look at the keys at 1 to 2 inches. She uses 1
finger to type. Her nose is about on the screen to read what she has written. The students line
up to go back to their room and the teacher uses a hand signal to tell them it is time to go. At
recess she navigates the blacktop track without a problem. When told to go to playground the
teacher tells her to turn around and use the path that is closer since the grass is wet. Henrietta
does this. The teacher gives an auditory/visual signal that it is time to go in. Henrietta knows I
am there at 4 feet and speaks to me. Back in class they are doing flashcards. Some of the time
she cannot see the cards even though she has her camera turned that way. When it is her turn
2
to compete, the teacher does it auditorily but she is not first either time. She independently
goes through the lunch line but does not seem to know what they have. The teacher said that
they read the menu during announcements in the morning.
Functional Assessment Information: A functional assessment determines how an individual
uses their vision in daily activities under a variety of environmental conditions.
Distance Vision:
Test Used: Feinbloom Distance Test Chart
This chart presents numbers singly and in rows for identification. Distance Acuity is normally
tested from 20 feet. In a Functional Vision Evaluation the test may also be presented at 15, 10
and 5 feet or less also.
@ 20 ft. @ 15 ft. @ 10 ft. @ 5 ft. @ 20 ft. with 4x12 @ 10 ft. with 4x 12
monocular
monocular
700 All
All
600 none
None
All
All
400
None
All
All
350
All
All
300
All
All
225
None
All
All
200
All
All
180
-1/pass All
160
All
All
140
All
None
All
120
-1/pass
All
100
-2/fail
All
80
All
60
None
40
Explanation: Henrietta has very compromised distance vision. The closer she is the better she
will see but even at 5 feet she could only see bold items that were 2 ½ inches high. With the
trial of a 4x12 Walters Monocular she was able to see 20/160 and 10/80. Note that Henrietta
also trialed the Microlux afocal monocular and did not care for it at all. She often exhibits a right
head turn. She was able to read red writing of 2 inch size at 6 feet using the 4x12 monocular.
See Attached Samples.
Near Vision:
Test Used: Lighthouse Letters Near Reading Chart
This chart presents line letters. Each row gets progressively smaller and is calibrated to
correspond to visual acuity. The standard distance for this test is 16 inches. During a Functional
3
Vision Evaluation the student is asked to read from the standard 16” as well as from shorter
distances to determine the smallest print they can view at any distance.
Lighthouse Near Line Letter Chart #1
Size
Both eyes
Comments
8.0M
None at 16 inches all at 8 inches
6.3M
All at 8 inches with 1 self corrected
5.0M
All at 5 ½ inches
4.0M
All at 2 inches
3.2M
All at 2 inches
2.5M
All at 1 ½ inches
2.0M
All at 2 inches
1.6M
All at 2 inches
1.25M
All at 2 inches
1.0M
All at 1 ½ inches
.8M
See attached sample for size
Test Used: My Bird Sings
This chart presents continuous text from 8.0M to .4M print.
My Bird Sings
Both eyes
Comments
8.0M
None at 16 inches – Read at 8 inches
6.4M
Read at 8 inches
5.0M
Read at 8 inches
4.0M
Read at 4 inches
3.2M
Read at 4 inches
2.5M
Read at 4 inches
2.0M
Read at 4 inches – fluent at beginning and
hesitant at end.
1.6M
Read at 1 ½ inches from page
1.25M Read at 1 ½ inches from page
1.0M
Read at 1 inch from page and missed 2 words
Fluent with Dome
.8M
Missed one word with Dome
.6M
Can’t read
Henrietta prefers information to be up in front of her rather than flat on the table.
Henrietta spotted a moving ant that was on her chair during evaluation.
See attached sample
Functional Responses:
Eye Preference.
Right eye on three trials of kaleidoscope
Central fields
Henrietta uses a slight right head turn
Muscle Balance –
Tracking-(Ocular Pursuits)
The ability to maintain fixation on a
moving target
Using the Hirschberg Corneal Reflex test to observe the
position of light in the eyes revealed an uneven
response.
This is almost non existent. She has jerky responses
and very uneven tracking at near. She was observed to
track on distance items.
Scanning- scanning a line of print,
objects or pictures.
Henrietta scans quite well. She uses a systematic
approach and does not miss fields.
4
Shift of Gaze – ability to visually
move from one fixation point to
another as in reading a line of print
or looking at an object in the
distance and then close up.
She does shift gaze although she often uses an
eccentric view rather than a direct gaze.
Convergence – the ability of the eyes
to turn inward to focus on an
approaching object. This ability
affects depth perception, visual
attention and stability
Sensitivity to Light-
Her eyes seem to converge however this was difficult to
observe as she shifts into a downward gaze as the
object approaches.
Contrast Sensitivity - a measure of
how faded or washed out an image
can be before it becomes
indistinguishable from a uniform
field.
Henrietta located items of color on like backgrounds
without a problem. She does have a preference to high
contrast when writing is on the white board.
Peripheral Vision- the ability to see
objects or movement outside the
direct line of vision.
She seemed to respond in all fields without a problem.
Color PerceptionDiscrimination and naming of colors
Henrietta identified 11 basic colors. She matched
shades of color but had difficulty with shades of blue,
purple, gold, and green. It took her a long time and she
had to use comparison to match.
She does not fuse the stereo fly and therefore lacks
depth perception. She often exhibited an overreach or
used tactile help. She compensates well for this.
Depth Perception- the visual blending
of two images into one which results
in perception of solidity and depth.
None noted
Visual PerceptionThe Motor-Free Test of Visual
Perception presents items that deal
with visual discrimination, figureground perception, visual memory
and visual closure.
Henrietta easily matched 14 out of 14 DLM visual
perceptual pictures.
Reading Media
Head Tilt
Print that is enlarged. She was learning Braille but that
has been stopped
Right head turn
Visual Clutter/ Figure Ground - the
ability to discern an object from its
background.
Other:
No problems with colored or black and white visual
clutter pictures. She has to get very close to see them
but is able to locate details.
Hearing loss may be an issue.
Summary: Henrietta is a sweet little girl who was completely cooperative during this
evaluation. She has extremely compromised vision due to optic nerve Hypoplasia and
nystagmus. Functional distance testing revealed 20/700 vision. Trial use of a Walters 4x12
monocular allowed her to read the 20/160 line. She currently uses a Clarity CCTV with distance
magnification in the classroom. She read 6.3M (approximately 48 point) print at 8 inches. As
she moved closer, she read smaller print. She read 1.25 (11 point) print at 1 ½ inches from the
paper. On continuous text, which is more indicative of print size needed, she read 5.0M (38
5
point) print at 8 inches, 2.5M print (20 point) at 4 inches, 1.25M (11 point) at 1 ½ inches. She
was fluent on 1.0M print using a Dome magnifier and leaning in very close. Henrietta has a
right eye preference. She often shows a right head turn. She has an uneven light response,
uneven and jerky tracking, and it appeared that her eyes converged normally. No sensitivity to
light was noted. She did not have problems locating items on like color backgrounds but did
have a preference for high contrast writing on the white board. She responded in all visual
fields. She can identify colors but had some problems with shades of color. She did not fuse the
stereo fly and therefore lacks true depth perception. She often showed an overreach but
compensates well. No problems with visual perception were noted. Her current reading media is
enlarged print. She was being taught braille but that has stopped. No problems with visual
clutter were noted. She may have a hearing loss.
Recommendations to meet Unique Visual Needs:
Based on all available information, I hope the following recommendations will assist in planning
appropriate accommodations/modifications for Henrietta as related to her visual impairment:
Medical
 The school should request updated eye reports every time Henrietta visits the eye
doctor.
 Henrietta should be placed on the Federal Quota List of legally blind. The school system
does this to access certain materials.
 Please exclude Henrietta from mass vision screenings at school.
 It is my strong opinion that Henrietta would benefit from a clinical low vision evaluation
to help determine if additional magnification for near or distance devices would be
helpful to her. The current CCTV works for her but using a monocular is more portable
and might be appropriate for her in some circumstances. She was adept at locating the
target and excited during the trial. The low vision doctor does not replace the child’s
current eye doctor. This is a specialist who works with magnification.
 If devices are prescribed, the visual impairment teacher should train Henrietta on them.
 Henrietta should have a large magnifier at home that is as large as the one at school.
 A copy of the Community Low Vision application form will be included with the parent
and teacher copy of this report. They can provide low vision devices for home use on a
loan basis. They are interested in increasing the literacy of low vision children.
Orientation and Mobility (O&M)
 The school may wish to seek an Orientation and Mobility (O&M) screening to determine
if O&M direct services would be appropriate for Henrietta. She has extremely reduced
distance acuity.
 Teachers will need to be especially careful of Henrietta on field trips where she is
navigating in unfamiliar territory.
Seating/Placement
 Henrietta needs to be seated so her CCTV camera has an unimpeded view of the white
board or any distance information she needs to access.
 When not using the CCTV, she should be seated as near to the presentation as possible.
 Avoid sunlight coming directly at her as this will interfere with her view on the CCTV
screen. Glare on the screen itself also needs to be avoided.
 Since Henrietta has a preferred right gaze her current seating is probably appropriate as
long as the sun does not shine into her eyes.
Presentation
6











Henrietta needs enough desk space so she is able to have her book straight under the
camera so she is able to achieve more efficient scanning. Her current scanning is jerky
and not as smooth as it should be.
Teachers should use black or dark blue markers on the white board for the best
contrast.
Teachers should continue to verbalize all information when they are presenting on the
board or showing visual information.
Henrietta should have copies of word wall words and other information displayed on the
walls at her desk. Even though she may be able to locate the items with her distance
camera this would allow her to work on close work and have the distance information in
a format to use under the close camera at the same time.
Realize that Henrietta may not be able to “see the whole picture” which is important
when looking at maps and graphs. When enlarged, the whole item may not appear at
the same time.
Be aware of the time it will take to complete worksheets that have both vertical and
horizontal information on the same page. She was able to do a sheet like this while I
observed which was amazing but it does take additional time.
Always use verbal directions as Henrietta will not see facial expressions or gestures at a
distance.
The teacher adjusted the flash card activity and made it auditory when it was Henrietta’s
turn. This was an excellent modification.
When any distance work is being presented, Henrietta should be expected to have the
camera zoomed in and she should be paying attention.
Since Henrietta writes so large she might need an additional white board during math.
A Franklin talking dictionary might be considered if it is felt her hearing would allow her
to access it.
Reading
 Allow Henrietta to move as close to the reading material as necessary to see it. As print
becomes smaller she needs to get closer. This may be uncomfortable on her back but
will not hurt her eyes.
 Henrietta was able to identify 20 point text at 4 inches. She read smaller print with her
nose on the page. She should be encouraged to use her camera on the CCTV or her
Dome.
 She may need breaks from extended near reading tasks. When planning classroom
activities, alternate near and far activities. Remember that computer work is a near
activity.
 Henrietta should have access to a reading stand when not using her camera. It should
be adjustable in height so information can be brought up to her central line of vision and
also this will reduce the strain on her back.
 A brief learning media assessment was conducted for Henrietta. Please see the results
of the attached assessment.
 Henrietta needs additional practice scanning with both her CCTV and with her Dome
magnifier.
 Due to her severe loss of vision, reading may need to eventually be supplemented with
auditory input. Her reading speed and comprehension need to be at grade level before
adding a lot of auditory information. If she is unable to do this with print, then braille
should be considered.
 The school and parent should consider the free services offered by the North Carolina
Library for the Blind and Physically Handicapped. The website is:
http://statelibrary.ncdcr.gov/lbph/ augmenting some of her reading materials with
auditory input may reduce eye strain and visual fatigue.
7
Writing
 Continue to allow Henrietta to use the carpenter’s pencils which have a dark bold effect.
 For extensive writing, Henrietta should be using touch typing.
Computer
 Henrietta should be taught formal touch typing, the kind where she does not look at
the keys. She currently leans in very close to look at the keys. True touch typing is a
skill which is critical for a visually impaired student to learn. It will increase the legibility
of the written work and make it possible to print out material that they can
independently read. If the school has questions about how to do this, contact me. There
are overlays for the computer keyboard that should be used so the student cannot look
at the keys. The vision teacher will be able to provide an appropriate typing program.
Timed exercises are not appropriate. Henrietta will require more that the regular amount
of computer time to learn this so it might be considered as a goal on the IEP.
 It would be beneficial for Henrietta to begin learning the key commands on the
computer. This is often easier for a visually impaired student than trying to locate each
item with the mouse and then clicking on it.
 The school should download trial versions of screen enlarging software such as Zoom
Text or Magic and trial it with Henrietta. It appeared that she was very resistant to
looking different. She chose the regular font over enlarged when I observed and had to
put her nose on the screen to see it. Henrietta will require large font on the computer
so she can sit back from the screen. Large print with speech might also be tried if her
hearing problem is resolved.
 When she becomes more proficient at typing she will need a dedicated laptop that she
can use in all settings which is loaded with her software.
 Consider having her use the zoom feature on Windows to allow her to see the screen
until software is purchased. She was resistant to this but I think she should be required
to use a size that she can see from a distance even if she does not like it. Practice may
eventually make her used to it.
 When in the AR program, the teacher can use control+ and control – to increase and
decrease the size of the print. Also there are size buttons on the bottom tool bar.
Student Responsibilities
 Henrietta needs to realize that she may have to use modifications even when she does
not want to do things differently. As an adult, it will be her responsibility to help herself
when modifications are available.
Other
 Make sure that all teachers working with Henrietta are aware of her visual condition and
the need for modifications.
 The PE teacher may consider using equipment that has high contrast or sound.
 Henrietta needs additional practice tracking a moving object or person with her CCTV
camera.
 Henrietta may not hear the announcements so the teacher should review the menu
choices before lunch. She will not be able to see posted menus and may not be able to
tell what the food is when looking in the cafeteria case.
8