What’s Up Doc? Demystifying Low Vision Reports MAER April 27, 2012

1. What’s Up Doc?Demystifying Low Vision ReportsMAERApril 27, 2012

2. Optical PrescriptionDistance Visual AcuityNear Visual AcuityOculomotor SkillsVisual Field

3. OPTICAL PRESCRIPTIONINTENT AND IMPACT

4. O.D. +3.50 -1.50 X 180O.S. +4.00 -3.75 X 170add +2.00O.D. +5.50 -1.50 X 180O.S. +6.00 -3.75 X 170(equivalent +2.00 add)

5. O.D. -3.50 +1.50 X 180O.S. -4.00 +3.75 X 170add +2.00O.D. -1.50 +1.50 X 180O.S. +0.50 +1.50 X 180(equivalent +2.00 add)

6. STANDARD BIFOCAL progressive vs flat top or roundup to +3.50D

7. HIGH ADD BIFOCAL+4.00D - +8.00D

9. MICROSCOPIC SYSTEMunilensvs e-system or r-system2X - 8X

11. TELESCOPIC SYSTEMhandheld vs prescriptive2.2X - 8X

13. CONTACT LENSESAdvantagesNeed for reading glasses

14. DISTANCE ACUITYINTERPRETATION AND ACCOMMODATIONS

16. Distance acuity within classroom with preferential seating

17. Distance Accommodations • Provide preferential seating at a specified distance, directly in line or to the student’s right/left side relative to vision screening results. • Write larger on the board/overhead with black marker to enhance contrast. • Stand near student when giving instructions. • Display work samples near student’s desk. • Provide seat copy of board/overhead notes (prior to instruction when possible). • Refer to examples from textbook to supplement instruction on the board.

18. Teacher verbalizes what is written on the board/overhead. • Arrange for a notetaker (using carbonless notepad). • Provide seat copy of important reference materials located on the classroom walls (i.e. Wall Words, alphabet strip). • Provide individual instruction (i.e. correct letter formation, math process). • Use high contrast balls, field markers and modify rules or positions of play during Physical Education activities. • Recommend lighting accommodations relative to vision screening results.

19. Low/High Tech Options • Utilize handheld telescope to view group instruction. • Position stuent at teacher’s computer to view instruction presented using a data projector. • Increase size (using zoom function) and contrast (increasing thickness and color) of text on electronic classroom board (SmartBoard or Prometheon). • Use a distance CCTV to view group instruction. • Using a distance CCTV, take a snap shot of board notes to reduce need for notetaking. • Use prescriptive telescopic glasses to view group instruction.

20. NEAR VISUAL ACUITYINTERPRETATION & ACCOMMODATIONS

21. threshold vs functional

23. Required print size

24. Importance of reading distance

25. O.D. +3.50 -1.50 X 180O. S. +4.00 -3.75 X 170 0.8M at 3 inchesw/+2.00 equivalent single vision reading Rx: 0.8M at 8-10 inches!

26. w/out Rx: 24-point print at 10 inchesw/Rx:O.D. +3.00 -2.50 X 180O.S. +2.00 -3.00 X 180add +5.0010-point at 8 inches!

27. w/out Rx:8-point at 3 inchesw/Rx:O.D. -11.00 -3.00 X 180O.S. -11.00 -3.00 X 18012-point at 10 inchesw/ +3.50 solamax:8-point at 13 inches!

28. Text size decreases as reading becomes more fluent

29. Nearpoint Accommodations • Enlarge nearpoint educational materials to size of text relative to vision screening results. • Provide Large Print textbooks. • Enlarge worksheets/handouts using 11 x 17 inch paper and enlargement capabilities of school xerox machine. • Enlarge computer-generated worksheets using a simple (arial or APHont), bold, large font of a specific size relative to vision screening results. • Increase line spacing on computer-generated worksheets. • Use Bright Line Reading Guide to help keep one’s place and reduce visual clutter.

30. Use a handheld magnifier to enlarge text. • Utilize prescriptive magnification in the form of a bifocal or microscopic reading glasses or single vision reading glasses. • Use bold-line writing paper and felt-tip pen • Allow extended time to complete assignments or tests. • Permit breaks to reduce visual fatigue • Use a CCTV to magnify view of text. • Use an e-reader (Kindle/Nook/i-Pad) to view text. Choose a larger font and increase spacing between lines. Use text-to-speech option to read text, if desired.

31. Scan text onto the computer. Enlarge the font and increase spacing. Use a text reader to read the text, if desired. • Use digitally recorded books (Learning Ally) to augment reading. Follow along in text. • Use a computer screen magnifier or large monitor (21-25 inch) to enlarge computer display. • Customize Accessibility Options with MAC (preferences/zoom) and within Windows environment (accessibility/magnifier). • Use magnification software (ZoomText, iZoom, etc. ) to provide magnification of all computer applications.

32. OCULOMOTOR SKILLS

33. Eye Preference

34. Visual posturebifocal vs single vision glasses

35. Visual Trackinghead movement and eye movement

39. Not impacted by reading levelComparison with same age peersAbility to test effectiveness of visual strategies, reading adds, Large PrintEstimate of time needed to complete work and need for alternative formats

40. OculomotorAccommodations • Use a typoscope/ line marker to keep one’s place (Bright Line Reading Guide). • Use one’s finger to keep place while reading. • Use the left index finger to locate the left margin and move accurately to the next line and the right index finger to track text as one reads. • Provide greater spacing between letters and between lines of text to help compensate for inaccurate eye movements. • Use Large Print materials to increase spacing and separation of text. • Consider introducing electronic text or an e-book reader to decrease line length and increase spacing between lines of text.

41. When copying from another paper, encourage the student to use one hand as a locator to keep his place on the text he is copying and the other hand on his paper as he writes. • Reduce clutter, mask extraneous text, fold paper into sections. • When the student demonstrates an A-pattern or prefers a forward or upward gaze (chin down), consider elevating reading material. If a reading prescription is warranted, consider a reading segment placed unusually high in the lens or single vision reading glasses. • When the student demonstrates a V-pattern or prefers a downward gaze (chin up), reading material should be placed flat on the desktop. If a reading prescription is warranted, a traditional bifocal reading segment is appropriate. • If a student skips letters or transposes letters, introduce visual tracking activities (Marzden ball, Ann Arbor Tracking series).

42. VISUAL FIELDINTERPRETATION & ACCOMMODATIONS

43. Configuration and position of visual field loss

44. Common pathologiesExamples:heminopsiaStargardt’s diseaseretinitis pigmentosa

45. Visual Field Accommodations • Use a typoscope/ line marker to keep one’s place. • Use the left index finger to locate the left margin and move accurately to the next line and the right index finger to track text as one reads. • Mark the left margin (green) and the right margin (red) to insure the student tracks the entire line. • Place reading material on the desktop positioning the text within the visual field. • Increase viewing distance to maximize field. • Consider introducing electronic text or an e-book reader to decrease line length and increase spacing between lines of text.

46. Use a CCTV to present reading material within the visual field. • Use negative image setting on the CCTV. • Use high contrast. • Provide a defined, organized work space. • Keep page format simple, separate areas, fold the paper. • Teach systematic search patterns. • Teach student to scan environment. • Use contrasting tape to mark leading edge of stairs, edges of doorways. • Provide preferential seating reflective of visual field and eye preference.

47. Importance of EducationalLow Vision Assessment-Actual classroom distance environment and classroom near point materials-Input from parent, teachers, & student-Demonstration of vision and LV aids and technologies

48. MDE-LIO PILOT PROJECT