This chapter focuses on individuals with visual impairments. Educational and other definitions of visual impairments are discussed and a description of how the eye works is provided. Different visual impairments are described. A history of services for individuals with visual impairments is provided. Prevalence information about visual impairments is provided. The etiologies of visual impairments as well as prevention strategies are discussed. Characteristics of individuals with visual impairments are described in terms of academic, social, emotional, independence, and vocational areas.  Information about the assessment of visual impairments includes typical vision testing, functional vision evaluations, learning and literacy media assessments, educational, and program planning assessments focused on determining eligibility and for other purposes. Educational considerations include meeting the needs of the student with visual impairments’ needs in the general education classroom through instructional modifications and orientation and mobility training. In serving young children with visual impairments it is important to focus on all developmental domains, engage families in the intervention process, and to have the child involved in appropriate early intervention and preschool programs for young children with visual impairments.  In preparing for the transition in to adulthood, IEP teams should focus on vocational choices, postsecondary education, travel skills, technology, reading options, community participation, and independence in all environments. Adults with visual impairments’ needs are discussed. Family and diversity issues are reviewed. An extensive discussion of the use of technology with individuals with visual impairments is provided. The chapter ends with a discussion of trends, issues, and controversies that are related to working with students with visual impairments. 

Learning Objectives:

• Define legally blind, functionally blind, deaf-blind, and low vision.
• Explain the vision process and associated vision disorders.
• List the most common visual impairments affecting school-age children.
• Outline the historical evolution of educational services for children and youth with visual impairments.
• Provide examples of observable characteristics of vision difficulties.
• Describe how visual acuity is assessed.
• Define literacy medium and learning medium.
• Summarize educational services for persons with visual impairments across the life span.
• Explain how technology benefits individuals with visual impairments.

Lecture Outline:

1. Defining Visual Impairments
   
   1. IDEA definition: Visual impairment that, even with correction, adversely affects an individual’s educational performance
   2. Legally blind: Corrected vision has acuity of 20/200 or less
   3. Functionally blind: Very limited vision
   4. Low vision: Minimal vision
2. The Eye and How it Works
   
   1. Light enters the eye through the cornea and then moves through the iris into the pupil. The light is converged by the lens and moves through the vitreous humor to focus on the retina where the light is changed into electrical signals that are sent along the optic nerve to the occipital lobe of the brain for interpretation as visual images
   2. Common difficulties
      
      1. Myopia (near sightedness): Light focuses before it reaches the back of the eye
      2. Hyperopia (far sightedness): Light has not focused when it reaches the back of the eye
      3. Astigmatism: One or more surfaces of the cornea or lens are not spherical but cylindrical
3. Classification of Visual Impairments
   
   1. Amount of vision loss and how the loss affects educational performance
   2. Cataracts
   3. Glaucoma
   4. Optic nerve atrophy
   5. Myopia
   6. Albininsm
   7. Eye injury
   8. Cortical visual impairment
   9. Retinopathy of prematurity
4. Brief History of the Field
   
   1. 1700s: First school for blind youth (in Paris)
   2. 1800s: Louis Braille created a system of Braille dots for communication Schools for the blind opened in the U.S.
   3. 1950s and 1960s: Public school classes for child with visual impairments
   4. 1970s: Vision training to maximize residual sight
   5. 1990: IDEA requires specialized services
5. Prevalence of Visual Impairments
   
   1. 2.4% of American school-aged children experience a vision loss significant enough to require special education
   2. The U.S. Department of Education (2010) reports approximately 26,000 children ages 6-21 received special education services during the 2011-2012 school year
   3. Visual impairments are considered a low-incidence disability since they impact a relatively small percent of children who receive special education services.
   4. It is important to note that students with visual impairments may also have other disabilities that are reported as their primary disability category.
6. The Vision Process and Etiology of Visual Impairments
   
   1. Cornea: Damage/infection limits acuity and visual field
   2. Aqueous fluid: Glaucoma limits acuity and visual field
   3. Iris: Malformation causes light sensitivity
   4. Lens: Cataracts affect vision, color, light sensitivity
   5. Vitreous body: Infection/disease blurs and distorts vision
   6. Retina: Light disruption results in blurred vision
   7. Rod cells in retina: Shape, motion, photosensitivity
   8. Cone cells in retina: Color
7. Prevention of Visual Impairments
   
   1. Most visual impairments are genetic in nature but others can be prevented or controlled.
   2. Prenatal care
   3. Early detection through vision screening routinely occurs in schools and during health examinations and physicals
   4. Eye injuries can often be avoided with care and the use of eye protection.
8. Characteristics of Individuals with Visual Impairments
   
   1. Vision Function Problems
   2. Academic Performance
   3. Social and emotional development: Children learn social interactions through nonverbal language that is often perceived through visual means
   4. Educational implications: Children with visual impairments may rely on tactile and auditory stimuli to maximize their learning
   5. Independent living skills: Skills for independent living are taught from an early age
   6. Travel skills
   7. Vocational skills: Vocational skills are taught from an early age
9. Assessment of Individuals with Visual Impairments
   
   1. Identified at birth, after trauma, or through screening procedures
   2. Ophthalmologist or optometrist evaluations may include:
      
      1. Functional vision evaluation
      2. Academic skills
      3. Learning and literacy media
      4. Verbal communication
      5. Social skills
      6. Nonverbal communication
      7. Visual skills
      8. Orientation/mobility
      9. Assistive technology
      10. Independent living skills
      11. Career skills
   3. Children are eligible for special education services if their visual impairment affects their educational performance.
10. Educational Considerations
    
    1. Instructional interventions
    2. Curriculum-Specific Equipment to assist across domain areas
    3. Environmental adaptations
11. Visual Impairments Across the Lifespan
    
    1. Young Children with Visual Impairments
       
       1. Early intervention
       2. Individualized Family Service Plan (IFSP)
       3. Early childhood programs for young children with visual impairments teach: Visual and auditory skills, sensory development, fine and gross motor development, social development, receptive and expressive language development, self-help development, daily living skills
    2. Transition into Adulthood
       
       1. Transition planning includes:
          1. Vocational selection: May involve support services or personnel
          2. Continuing education: The ADA requires institutions of higher learning to provide accessible facilities and support
          3. Travel skills (orientation and mobility)
          4. Low vision devices: To maximize residual vision
          5. Social adjustment: To develop social skills related to nonverbal behaviors
          6. Community resources: To assist the student and the family in accessing community supports
          7. Family education: Families may need support to deal with adolescents with visual impairments
          8. Independence: Adolescents with visual impairments should acquire as many skills as possible to prepare for independent living
    3. Adults with Visual Impairments
       
       1. Employment: Job training or adaptations may be needed
       2. Transportation may be an issue particularly in rural areas without public transportation
       3. Technology advances have created many opportunities for adults with visual impairments
       4. Social opportunities: Adults who develop vision loss may feel isolated
       5. Orientation and mobility training: Assists adults in navigating their home, work, and community environments
    4. Eligibility determination requires that vision impairment negatively impacts academic progress.
12. Educational considerations
    
    1. Predominantly served in general education classroom
    2. Instructional considerations
       
       1. Communication skills
       2. social competency
       3. employability
       4. independence
       5. academic progress
       6. Expanded core curriculum
    3. Orientation and mobility
13. Young Children with Visual Impairments
    
    1. All developmental skills must be taught with modifications
    2. Early intervention programs work with families and young children
    3. Early childhood class for children with visual impairments at age 3 years
14. Transition into Adulthood
    
    1. Vocational training
    2. Postsecondary educational opportunities
    3. Travel skills (orientation and mobility)
    4. Technology
    5. Reading options
    6. Use of community resources
    7. Social adjustment
    8. Independence at home and at work
15. Adults with Visual Impairments
    
    1. Employment possibilities and acquiring job skills
    2. Leisure time activities and community participation
    3. Orientation and mobility training
    4. Using technology
16. Family Issues
    
    1. Families may need support as they learn to accept and support their child who has a visual impairment.
    2. Families need assistance in finding support programs and programs that will help them to advocate for their children with visual impairments.
    3. Families may also need support during the school years as they learn about educational options and they may wish to learn Braille.
17. Issues of Diversity
    
    1. Cultural susceptibility to eye diseases: Diet leading to vitamin deficiency, susceptibility to glaucoma or diabetes
    2. Socioeconomic status influences availability of eye care: Families who live in poverty may not have access to health and eye care
    3. Cultural implications: Cultural customs may create barriers, for example, in some cultures, communication is face to face and it would be considered rude to walk while conversing which can interfere with mobility and orientation training.
18. Technology and Individuals with Visual Impairments
    
    1. Assistive technology
    2. Technology and literacy: Technology can assist students with visual impairments by helping them to develop their written communication and reading skills.
    3. IDEA requires the IEP team to consider the provision of assistive technology devices and services in the development of the student’s IEP. Under IDEA, Braille instruction is required unless the IEP team determines that it is not appropriate after evaluation of the student’s reading and writing skills, needs, and appropriate reading and writing media.
    4. Accessibility for Individuals with Visual Impairments
19. Trends, Issues, and Controversies
    
    1. Teacher shortages: National shortage of certified teachers of the visually impaired
    2. Orientation and mobility specialist shortages nationally
    3. Reading media assessment: Conducted to determine the best types of services to meet the individual’s needs including enlarged print, Braille, technology, books on tape, etc.
    4. Vocational training