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Only about one in 1,000 school-aged children has a visual impairment; for these students, however, the difference in vision can have a significant effect on their ability to learn efficiently. Most children who are visually impaired have low vision, meaning that they use vision for learning along with some tactile and auditory adaptations. About 10% of children with visual impairments are blind; they have insufficient vision to help them learn, and their education will depend on tactile and auditory methods.

The etiologies of visual impairment have changed over time, as medical treatments evolve and new conditions arise that result from medical conditions or complex premature births. The most common causes of visual impairment in children in the United States vary according to reporting sources and extent of other disabilities. According to Huebner (2000) and Steinkuller (1999), the most commonly named conditions are

• Retinopathy of prematurity (ROP), a retinal deterioration common in premature infants
• Cortical visual impairment, a visual impairment related to neurological damage or underdevelopment
• Albinism, an absence of pigmentation in the body that also causes low vision
• Cataracts, or opaque lenses, that are usually removed in infancy and result in visual impairment
• Optic nerve hypoplasia or atrophy, an underdevelopment or deterioration of the optic nerve

Educational Curriculum

Children with visual impairment often require adaptations to access the regular educational curriculum. For the student with low vision, these may include increased contrast and color highlighting, lighting adaptations, varied time requirements, use of optical devices, and auditory materials. A student who is blind may use Braille, tactile adaptations such as raised maps, speech access, use of real objects and materials, and auditory descriptions.

Students with visual impairments may also benefit from specialized instruction in skills that are not part of the standard curriculum. Orientation and mobility instruction is vital to teach students to use all senses to identify their position in space and to move to a destination. For many students, efficient travel will include instruction in the use of a long cane to provide information on the immediate environment. Skills in orientation and mobility should be taught by professional orientation and mobility specialists.

Other curricular areas important for students who are visually impaired include instruction in daily living skills, career development, communication including literacy, use of assistive technology, use of functional vision, and social skills. Teachers with certification in visual impairment can work with the classroom team to plan for instruction in these areas.

Reading and Information Access

Students who are visually impaired may read using one or more of the following methods:

• Standard print, which can often be read comfortably with decreased viewing distance or by using a hand magnifier or other optical devices.
• Enlarged print, if the student cannot read standard print efficiently using aids and adaptations
• Braille, if the student cannot use print efficiently or comfortably for moderate periods of reading; and/or
• Auditory learning, in combination with the above media or as the primary medium if print or Braille cannot be read due to other disabling conditions

A procedure called the Learning Media Assessment (Koenig and Holbrook, 1995) is often used to identify the best media for a student to use for reading and other learning activities. It will help the educational team to identify a primary medium and any secondary media. To be most efficient, a visually impaired student should have several ways of reading and writing, often with the use of appropriate technologies and portable personal tools such as the slate and stylus for Braille writing.

Use of Vision

Most students with visual impairments are able to use vision for some activities. Families and professionals could encourage use of vision for activities where it is more efficient or can provide information. Use of vision in regular activities can be determined by administration of a functional vision evaluation, an observational assessment completed by a certified teacher of visually impaired children. This assessment should include recommendations for adaptations, services, and instructional skills that will help the student learn to use vision appropriately.

The learning environment can be adapted to encourage efficient use of vision for individual learners as recommended on the functional vision evaluation. Adaptations may include

• High contrast in materials, usually best achieved by black on non-glare white background
• Color contrast or highlighting
• Even, steady lighting without glare
• Reading stands or reading positions that allow reduced viewing distances
• Use of low vision devices as prescribed by a low vision clinical evaluation, conducted by an eye specialist with low vision background:
• monoculars and telescopes for distance viewing
• hand-held or stand magnifiers that can be used for near point tasks; and
• use of technological adaptations such as closed circuit televisions (CCTVs) or screen enlargement programs for computers

Use of Senses Other Than Vision

A few students will not use vision for learning, and their education will emphasize tactile and auditory materials. Braille is the most efficient tactile code used for reading, and current technology has expanded the options for Braille access. Not only can it be produced in standard paper and book form, but Braille can also be written and read using portable notetakers with Braille displays or computer output. Rapid Braille readers can read as fast as print readers, and many people who are blind prefer Braille as a way of reading that offers the opportunity to actively review and reread. Young children who learn Braille are taught the code along with reading, usually by a teacher of students with visual impairments in conjunction with the reading curriculum in the regular classroom.

In addition, students who are blind will need opportunities for direct experiences with materials and objects because they do not gain information from pictures. The opportunity to pat a cow, to stand in the ocean, or to climb a tree will be more valuable for young children who are blind than relying on verbal descriptions. As children grow older, they will understand raised line representations of concepts such as maps, charts, and other graphics that can be reproduced through technology to allow tactile examination.

Most students with visual impairments rely on auditory information for some part of their learning. Books on tape or CD, spoken output from the computer, and use of tape recorders for memos provide a quick means of access that has the advantage of being meaningful to sighted peers.

Educational Models

In the mid-1900's, most students with visual impairments were educated in residential schools or separate classrooms. Now the trend is reversed: About 90% of the students are educated in public schools, and most of these children spend some time in the regular classroom with students of their own age. The most common model for providing necessary adaptations is the assignment of an itinerant teacher to serve the student directly in the regular classroom or to provide consultation to the educational team. This professional is also responsible for obtaining specialized materials and textbooks, conducting assessments related to the visual impairment such as the functional visual evaluation, and collaborating with the educational team to ensure that team members understand the child's educational needs.

In some cases, children with visual impairments are educated in separate classrooms or specialized schools. A specialized placement may be due to the presence of additional disabilities that create complex educational needs or to the preference of the student's family. Some specialized schools encourage short-term placements for students with visual impairments who need to work on a specific skill such as orientation and mobility or assistive technologies. This option may be especially worthwhile after a student experiences a decrease in vision and needs an intensive opportunity to learn adaptive skills. Specialized schools may offer summer programs that allow students with visual impairments to socialize with peers who have common experiences, and many students remember such programs as valuable in helping them develop an understanding of the effects of their own low vision or blindness. The National Agenda for the Education of Children and Youth with Visual Impairments, Including Those with Multiple Disabilities, a set of goals established by families and professionals in 1995, has provided a framework for advocacy for a continuum of high quality educational services for learners who are visually impaired (Corn, A.L., Hatlen, P., Huebner, K.M., Ryan, F., & Siller, M.A., 1995).

Children with visual impairments vary widely in their learning abilities and needs, and educational support from a professional in visual impairment is vital in their learning. As they grow older, it is important for them to have contact with adults who are visually impaired and to have the opportunity to participate in regular work experiences. Not only must education provide information access, but it must also help them develop the skills needed to make decisions and experience the results of these decisions. Educators and families should resist the temptation to provide assistance where it is not needed; only through initiative and experience will a student understand his own capabilities and develop a realistic plan for his future.

References

Barraga, N., & Erin, J. (2001). Visual impairments and learning (4th Edition). Austin: Pro-Ed, Inc.

Corn, A.L., Hatlen, P., Huebner, K.M., Ryan, F., & Siller, M.A. (1995). The national agenda for the education of children and youth with visual impairments, including those with multiple disabilities. New York: American Foundation for the Blind.

Huebner, K. (2000). Visual impairment. In M.C. Holbrook and A.J. Koenig (Eds.), Foundations of education (2nd edition.) Volume 1. History and theory of teaching children and youth with visual impairments (pp. 55-76). New York: AFB Press.

Koenig, A.J., & Holbrook. M.C. (1995). Learning media assessment of students with visual impairments: A resource guide for teachers (2nd edition). Austin: Texas School for the Blind and Visually Impaired.

Steinkuller, P., Du, L., Gilbert, C., Foster, A., Collins, M., & Coats, D. (1999). Childhood blindness. Journal of AAPOS: American Association for Pediatric Ophthalmology & Strabismus, 3, 26-32.