Observational Abilities

I mentioned recently we had begun the process to get an Individualized Education Plan with the county’s school system.   It’s a slow and complicated process, but it will ultimately give my daughter some help from educators who know how to address visual deficits.    While we were in Detroit I  received the evaluation from the sight expert we’ve been working with.   Her name is Jane and my daughter likes her very much.   Below is a summary of what Jane reported from her observations:

Functional Visual Acuity
Visual acuity is assessed by the smallest identifiable object that can be seen at a specified distance. Her central acuity is limited. She sees best in her left temporal field and will hold objects about 1-2 inches from her left eye to identify them. Visual clutter further reduces her ability to see. In mid to distance ranges her functional acuity is severely reduced. She is unable to visually identify a classmate sitting next to her and she cannot identify her parents at four feet.

• She could not identify any named details in pictures with complexity. She had difficulty identifying pictures with a solid white background as well. For example, she could identify a 4 inch by 4-inch photo of an orange on white background correctly, but could not identify a 4 by 4 inch photo of a Volkswagen. She labeled it a telephone. 
• When she dropped some crayons during her assessment she used a tactile approach to locating them on the floor. 
• She was not able to visually identify any named details in simple line drawings on solid backgrounds (Boehm Test of Concepts) 
• She could name 300-foot size numbers from 24 inches away (e.g. Feinbloom Low Vision Test) 
• She was able to cut along bold black lines of a triangle. 
• She could stack 5 blocks and imitate a model using 5 blocks. 

Visual Field
A visual field refers to the entire region of space off to all sides that is visible when the person is steadily looking and facing straight ahead. Despite visual loss, she is able to navigate her familiar classroom with ease. She does not bump into other children or furniture, or the mats spread on the floor. She was able to move around most of the exhibits at the Children’s Museum, without bumping into objects or people. This suggests that she has some good peripheral vision. When she did bump into objects (a pole and a large sign) it was on the right side or it was a low contrast feature (e.g. wall of netting).

Color, Contrast and Lighting
Despite her apparent functional vision challenges, she is able to match and name 3 inch by 3 inch primary color squares, except for brown and black, which she confuses. She does appear to have reduced contrast sensitivity. She uses a tactile approach to locating objects on the floor. Her classroom teacher has noted better vision with good lighting (play next to the window). She shows some reluctance to move in dim places. She was not able to see dark colored beads on the dark carpet, but did appear to see them when they were placed on a white dish. Her classroom teacher noted that she could see black or dark blue bold high contrast lines on white paper but not red or green.

Depth Perception
Depth perception requires that both eyes work together in order to achieve a 3-dimensional fusion. During observations at the Children’s Museum, this appeared to be the case. She came very close to bumping into numerous people which is indicative of reduced depth perception. She had some difficulty perceiving height differences between stepping stones. She asked for help to ascend the spiral staircase to the slide (despite this being familiar to her). She did not see the outside cement steps when leaving but did respond to the command to “stop!” She would have fallen down 4 cement steps.

She used a handrail when moving on steps at the Children’s Museum. This was a good strategy for locating steps and for recognizing the beginning and end of steps. Her teachers reported that she has no difficulty when moving on her familiar playground. However, since Thanksgiving she is typically choosing to stay inside to do art activities rather than outside active play.

Movement and Navigation
She appears to have good visual memory for familiar places. Even though she presumably no longer sees detail, she can recognize large classroom features such as shelves, tables, doors and mats on the floor. She knows what to look out for and how to interpret what she sees. Because she had normal vision early on, she developed gross motor skills in a typical fashion.

Oculomotor skills

Oculomotor skills include fixation, tracking and shifting gaze. Fixation is the ability to direct a gaze and hold an object in steady view. Tracking is the systematic use of the eyes to follow an object. Shifting gaze is the ability to fix on an object, shift visual attention to another object, then return to the first object again. She is able to fixate on an object or symbol from about 1 -2 inches away from her left eye. When presented with very large numbers (using the Feinbloom Low Vision Test) She could fixate on numbers 12 inches away.

The Big Boy Update:  Today was my son’s last day of After School care at our school.   When school resumes in January he will be a member of the Extended Day class, which is the Montessori equivalent of Kindergarten.   He will stay after noon for lunch with the other “extended dayers” and have another work cycle in the afternoon.    He is very excited about his recent promotion.

The Tiny Girl Chronicles:  I asked for a refund today for the Tae Kwon Do classes I signed my daughter up for earlier this month.   They were fine with her being in the class with her vision in its current state, but with the ultimate outcome uncertain and the impending surgery (surgeries?) and the need to protect the eye, we decided to pull her out of the class.  The staff wished her the best and we all hope she’ll be able to join the class again someday.