Aiming high for children with low vision

What is low vision?

Low vision is a term used in the UK for eyesight that cannot be fully corrected with spectacles and/or contact lenses, so that the adult or child still has a vision impairment. The World Health Organisation (WHO) suggests what low vision means in terms of how far down the eyesight test chart a child can read, but in the UK most services prefer to look at how someone is functioning. So, if as a direct result of an impairment to their vision, a child has difficulty carrying out everyday tasks such as reading, seeing facial expressions or moving around the home, we would describe them as having low vision.

How could a low vision assessment help my child?

Firstly, it is an opportunity to think about how your child uses their eyesight and to ensure they have the equipment and skills to make best use of it.

Many issues affect your child’s wellbeing and use of sight. A comprehensive low vision service is likely to look at emotional wellbeing, as well as the skills your child needs to use devices and find different ways of doing everyday tasks.

The assessment should help you and your child have a clear idea of what vision they have and how to use it. This might include information about:

• what spectacles are needed for particular tasks
• how well your child sees in poor light conditions
• if your child has a loss of vision affecting detail
• if your child has peripheral vision loss (peripheral vision allows us to be conscious of objects either side, above and below our gaze. We do not see them in full detail, but it helps us to judge space, distance and objects or people approaching us).

The next stage might identify any equipment that would help such as optical magnifiers, binoculars and telescopes, reading stands, lighting, electronic devices and bold text and contrast.

It’s then important to equip your child with the skills to use these devices. As well as, instructions from an orthoptist or optometrist, your child should have ongoing training in using equipment and making the best use of their sight. Learning techniques such as scanning across a page, using a magnifier systematically or focusing a telescope are important, if a child is to make best use of their vision.

Who conducts a low vision assessment?

Low vision assessments are provided by hospital eye clinics or optometrists depending on where in the UK you live.

How is it different to the functional vision assessment my child’s QTVI did?

A functional vision assessment aims to help your child and their significant people understand how your child uses their eyesight to get around and access learning materials at school. While this information is an important part of the low vision assessment, sometimes more clinical measurements are needed in order to help describe your child’s eyesight, work out optimum magnification levels, lenses and to quantify changes. These clinical assessments should be carried out by an orthoptist or optometrist.

The information about how your child uses their sight and their day to day needs is used to make recommendations about the equipment required. A good assessment will include advice about handling techniques, focus of devices and how best to make use of very small working distances and lens sizes. Understanding the limitations of a device or magnifier is just as important as knowing what it can do.

Does it matter how old my child is?

Very young children can have their vision assessed and their parents be given advice about use of eyesight and equipment. Some services have skills in working with preschool children using optical and electronic equipment, and there are some magnifiers that very young children find enjoyable and easy to use.

How can I get a low vision assessment?

Parents or a GP can request a low vision assessment from the hospital eye department. However, as it is important that clinical services work with education and habilitation services, it is best to ask your child’s specialist teacher (QTVI) to provide information to the clinicians about day to day needs and ensure that social and emotional concerns are addressed. Sometimes when an ophthalmologist certifies a child as vision impaired this triggers a review of low vision needs. Your child does not need to be registered or have a Statement of Special Educational Need, Education Health and Care Plan, Co-ordinated Support Plan or Independent Development Plan to have a low vision assessment.

Is it free on the NHS?

Assessments provided in NHS hospital eye departments are free. In Wales or Scotland, local optometrists (opticians) also provide services paid for by the NHS. Any optical devices and magnifiers might be provided on loan.

Although on loan, your child will be encouraged to keep the equipment for as long as it is suitable and useful. Specialist services understand children and within reason will replace equipment that has been lost or damaged through good use. After all, a child who has worn out or outgrown a device is a successful low vision user.

What sort of advice and equipment might be on offer?

Equipment might include optical magnifiers – hand-held or designed to rest on the page, with and without illumination. Reading stands and line guides and writing equipment may also be recommended.

Electronic equipment such as computers, iPads, CCTV is most likely to be provided by the school or local authority after an educational assessment. However, information from a clinical low vision assessment might help make decisions about how to make best use of sight.

Advice might also be offered about your child’s eye condition, how your child sees contrast and any problems with glare. You should be advised about working distances, posture and different ways of working. For example, some children with certain types of field loss read more easily if their book is rotated at a particular angle.

Can low vision aids (LVAs) only help with close work?

No. Depending on their vision, some children can use telescopes and binoculars as well as specialist spectacles to provide magnification past arm’s length and into the distance, enabling them to read signs or see more of what’s going on in assembly. Prisms and special lenses (like the fish eye lenses used in hotel doors) can expand a child’s field of vision.

Who will teach my child how to use them?

Services work best when clinical services work closely with education and mobility services. Technical information, such as what spectacles are required, what working distance is needed and how devices are best suited to your child’s eyesight might be provided by a clinical professional (orthoptist, optometrist or optician) while your child’s QTVI will be skilled in strategies to help your child to make the best of the devices. This might include training in scanning and searching techniques or looking after and cleaning lenses.

Is a low vision assessment a one-off or should my child have another one?

Most services expect to see children and young people at least yearly and assessments are particularly important at times of transition – for example, to secondary school, further study or work.

My child is reluctant to use their low vision aids. What can I do?

Talk to your low vision specialist and QTVI. It might be that a more user-friendly device is available. Younger children often prefer paperweight type devices and may like it to look more like a toy. One QTVI stuck a tail on a pebble magnifier so that it looked more like a mouse! Older pupils tend to favour something that looks more like a mobile phone or tablet.

Try to encourage your child to use it for tasks that increase their independence so they can see the value. For a young child this might be a magnifier that is in a pocket to look at books, small toys or leaflets while travelling. An older child might value the ability to quickly check notes, shop labels or adjust nail varnish or jewellery.

Magnifiers and low vision techniques are not limited to school work or reading.

All my child’s work is enlarged at school, what’s the point of learning to use magnifiers?

Some people think that children and young people who learn the techniques to use devices actually access the curriculum more easily, efficiently and independently. These skills ensure your child is making the best use of vision. Outside of school your child will come across lots of information that is not enlarged and low vision aids can give instant access.

Even with many electronic tools it’s likely that optical devices will provide a consistent and low maintenance way of enabling independence. Young people at secondary school also find LVAs useful for spotting the number of their bus, working out maps, and for independent research. Many adults who use both find their optical aids invaluable for travel and independent reading.

Large print does not help children with retinitis pigmentosa but a low vision aid is invaluable in helping them to see more of the page at one time. Becoming a confident user of low vision aids can help a young person adapt more easily to stronger LVAs if their vision deteriorates.

My child will soon be 16, how do adults get low vision assessments?

Talk to your QTVI about getting a low vision assessment before moving on. Your GP can also request a low vision assessment from the hospital eye clinic. Many local societies for blind and partially sighted people also provide low vision services and may be able to advise about how these link to adult social care and rehabilitation services.