Visual Conditions and Functional Vision:
Early Intervention Issues
Working With Families and Eye Care Professionals
Session 1
The University of North Carolina at Chapel Hill
Early Intervention Training Center for Infants and Toddlers With Visual Impairments
FPG Child Development Institute
Objectives
After completing this session, participants will
1.
compare and contrast the roles of different
eye care professionals.
2.
describe the components of an eye care
examination and information families should
expect to receive following the exam.
3.
describe strategies that TVIs use to support
families who seek to understand their
children’s visual diagnoses.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1A
Objectives
After completing this session, participants will
4. discuss factors such as learning styles and
language and cultural barriers that affect families’
abilities to access and understand information and
describe strategies for providing support to
overcome these barriers.
5. describe strategies for facilitating interactions and
communication between eye care specialists and
families.
6. describe the role of TVIs when working with eye
care specialists and other professionals using the
transdisciplinary model.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1B
Eye Care Specialists
Different eye care specialists have different
responsibilities and training.
• Ophthalmologist
• Optometrist
• Low vision specialist
• Orthoptist
• Optician
• Ocularist
TVIs should assist families and other members
of the team in understanding the roles of these
different professionals.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1C
Components of a
Clinical Eye Exam
Knowing what to expect may make
visits less stressful for families.
1. Gather family
and child history
2. Assess external
appearance
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1D
Components of a
Clinical Eye Exam
3. Measure visual
acuity
4. Observe pupil
reaction and
movement of
eyes
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1E
Components of a
Clinical Eye Exam
5. Examine the
interior of eye
6. Evaluate
child’s need
for corrective
lenses
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1F
Expected Results
From the Exam
• Explanation of child’s visual
condition and prognosis
• Information about secondary visual
conditions
• Prescription for corrective lenses,
if applicable
• Information about size of objects
and materials the child can see
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Stiles & Knox, 1996
Visual Conditions 1G
Expected Results
From the Exam
• Recommendations for
environmental lighting
• Prescription for medication, if
necessary
• Information about restriction of
physical activity, if applicable
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Stiles & Knox, 1996
Visual Conditions 1H
Responding to Families
TVIs should be aware of the types of
responses they can offer families
and how their responses may be
received.
• Critical response
• Clarifying response
• Empathy response
• Recommending response
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1I
Families Need Support
• Emotional support (e.g., demonstrating
positiveness and responsiveness to the
family)
• Informational support (e.g., providing
names and locations of specialists and
support groups, books, videos, and
pamphlets relating to diagnosed condition)
• Material support (e.g., providing nonoptical
devices such as lighting sources, reading
stands, dome magnifiers, and sunglasses)
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1J
How Families Access Information
Individuals have different learning styles—
• global preference: overview of
•
information, followed by individual
facts, or
analytical preference: presentation of
individual facts first, then the bigger
picture.
Information presented in a manner accessible
to the family should result in improved
communication that enhances early intervention.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1K
Strategies for Helping Families
Understand the Diagnosis
• Introduce families to another family
whose child has a similar visual
condition.
• Introduce families to successful
adults with visual impairments.
• Provide simulation activities to
depict what the child might see
(using vision simulators).
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1L
Cultural Considerations
Guidelines for Interpreters and Translators
• Use qualified, bilingual, professional
personnel.
• Explain the importance of confidentiality.
• Explain the importance of neutrality and
impartiality in interpreting and translating.
• TVIs should monitor interactions between
interpreters/translators and families.
Milian & Conroy, 2001
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1M
Cultural Diversity and
Visual Impairment
Some cultures
• believe that caring for the child is more important
than teaching independence,
• do not expect adults with visual impairment to
hold jobs or expect them to hold only certain
jobs,
• value oral communication over written words,
• vary in their gender expectations, and
• ascribe special cultural meanings to specific
types of visual impairments.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Erin, 2002
Visual Conditions 1N
Religious Diversity and
Visual Impairment
• Many religions still connect the
•
•
presence of visual impairments with
the idea of retribution for sin.
For some families, religious leaders
and heads of the family may be the
critical decision makers.
Many families visit religious healers
during their children’s early years.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Erin, 2002
Visual Conditions 1O
Cultural Reciprocity
According to Harry (as cited by Warger, 2001), professionals
and families must engage in a two-way process to gain
understanding and respect for each others’ values. This twoway process is the basis for cultural reciprocity and involves
•
•
•
•
identifying cultural values,
determining whether you and the family are aware
of each others’ assumptions and how you differ,
identifying and respecting cultural differences—
explaining and discussing cultural bases of
assumptions—and
determining the best way to adjust
recommendations to match family’s values.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1P
Cultural Influences
When language or cultural barriers exist,
families may have additional obstacles to
understanding or accepting the diagnosis
of a child’s visual impairment.
• Use an interpreter with eye care specialists
when English is not the family’s primary
language.
• Recognize that different cultures respond
differently to diagnosis of visual impairment.
This may affect the family’s motivation to
treat VI or provide interventions.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1Q
Gathering Information
• Ask the family what they were told.
• Review existing reports with the family.
• Take notes while the family talks.
• Ask the family if they have any
•
•
questions.
Choose topic discussed and share
additional information with the family.
Identify date and time of the next visit
to an eye care specialist.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1R
Eye Report Interpretation
TVIs may need to identify and
discuss the following components
of an eye report with families.
• History/background information
• Results of the eye examination
• Implications/treatment plan
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1S
Preparation for Eye Care Visit
TVIs can assist the family in preparing
for the exam by
• formulating questions to ask relating to
the child’s etiology, prognosis, and
treatment options;
• anticipating questions that the eye care
specialist might ask; and
• Helping them develop a portfolio of the
child’s medical and intervention
information.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1T
Role of the TVI
During Eye Care Visits
The TVI can offer to accompany the family
to an appointment in order to
• provide encouragement to the family,
• share additional information about the
child’s visual abilities,
• interject if communication between the
family and the specialist is not going
well, and
• ask for clarification if the family seems
hesitant to do so.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1U
The TVI as Liaison to
Eye Care Specialists
TVIs can provide additional information
about how children use their vision in
different settings across time that will
help eye care specialists to better
understand the child’s visual condition.
By working collaboratively and sharing
information, TVIs and medical
personnel will be more effective in
supporting families and children.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1V
Initiating Interactions
With Eye Care Specialists
The TVI can initiate interactions with
eye care specialists through
• letters of introduction,
• phone calls, and
• electronic mail
in order to establish collaborative
relationships and encourage referrals
to early intervention.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1W
The TVI as Liaison to
Team Members
TVIs collaborate with other team members
when providing information or asking for input.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1X
The TVI as Liaison to
Team Members
• TVIs should share medical information
with other team members.
• Professionals from other disciplines
collaborate with TVIs to learn more
about how a child’s visual impairment
may affect growth and development.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1Y
Transdisciplinary Team Success
Three elements are necessary for
the successful implementation of a
transdisciplinary team:
• collaboration,
• staff development, and
• role release.
Correa et al., 2002
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1Z
Benefits and Challenges of the
Transdisciplinary Approach
• An integrated and holistic approach that
facilitates consistency and better
communication among families and team
members.
• Difficult to sustain due to additional time
needed to coordinate and collaborate with
other team members, to train members
across disciplines, and to monitor role
release.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1AA
The TVI as Liaison to Families
Some families report negative experiences
with eye care professionals because families
• were unable to understand eye exam
procedures,
• were devastated by the diagnosis,
• felt rushed during the visit, or
• received contradictory information.
In such instances, TVIs can follow up with the
eye care specialist to gather more information.
Killebrew & Corn, 2002
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
June 10, 2004
Visual Conditions 1BB