Jill Roter, MAjill.roter@lehman.cuny.edu

Assistant Director, Student Disability ServicesCUNY Lehman College

July 28, 2010

A person’s acuity (sharpness of vision) and medical eye condition are important pieces of information for determining services. But more important is how someone’s acuity and eye condition translates from medical data to fulfillment of aspects of daily living (ADLs). (In other words, their functional vision.)

To provide statistical context for visual impairment in New York City

To introduce common eye pathologies

To examine 7 factors that impact functional vision, their academic implications, and possible accommodations

To provide hands-on simulation experiences as time allows

Visual impairment (VI): Any chronic

visual deficit that impairs everyday

functioning and is not correctable by

glasses or contacts. Clinically, it is

measured as 20/70 in the better eye or

total field loss of 140 degrees.

Legal blindness: Clinically measured acuity

(sharpness of vision) of 20/200 in the better eye,

with best correction, or a visual field of 20

degrees or less. Visual acuity has often been

used as a measure for functional impairment due

to vision loss, but it is a limited measure. From

our definition of VI, a person can be visually

impaired without being legally blind.

Functional vision: It is the use of vision for

everyday activities. In other words, what is the

“REAL WORLD” impairment, and how can

remaining vision be used in conjunction with

other senses?

Visions/Services for the Blind and Visually Impaired (NYC based agency) estimates that there are 60,000 blind people and 363,000 people with severe visual impairment in NYC.

Less than 2 percent of New Yorkers who are blind or visually impaired currently access rehab services.

(Source: American Foundation for the Blind; www.afb.org)

The number of students enrolled CUNY-wide who are blind or visually impaired has remained relatively stable. (During the 1990s there was a low of 305 students and a high of 479 students by the end of the decade.)

Recent data, specifically fall 2008 and fall 2009, showed an enrollment of 273 and 264 students with visual impairments, respectively.

Congenital:◦ Retinopathy of prematurity (ROP)◦ Deficits in the visual center of the brain (cerebral visual

impairment [CVI])◦ Structural abnormalities (coloboma, aphakia, aniridia)◦ Retinitis pigmentosa (RP)◦ Albinism

Age-related:

◦ Age-related macular degeneration (ARMD; Stargardt’s=juvenile form)

◦ Diabetic retinopathy◦ Cataract (can be congenital)◦ Glaucoma (can be congenital)

Congenital/Age-related/Trauma-induced◦ Retinal detachment

What a person with low vision might experience

Person with normal visionCredit: National Eye Institute, National Institutes of Health Ref#:EDS01

Person with ARMDCredit: National Eye Institute, National Institutes of Health Ref#: EDS05

Person with normal visionCredit: National Eye Institute, National Institutes of Health Ref#:EDS01

Person with Diabetic RetinopathyCredit: National Eye Institute, National Institutes of Health Ref#: EDS0

Person with normal visionCredit: National Eye Institute, National Institutes of Health Ref#:EDS01

Person with CataractCredit: National Eye Institute, National Institutes of Health Ref#: EDS03

Person with normal visionCredit: National Eye Institute, National Institutes of Health Ref#:EDS01

Person with RPCredit: National Eye Institute, National Institutes of Health Ref#: EDS07

Person with normal visionCredit: National Eye Institute, National Institutes of Health Ref#:EDS01

Person with GlaucomaCredit: National Eye Institute, National Institutes of Health Ref#: EDS02

Source: www.theeyeacademy.com/info_diseases_retinal.html

ARMD CATARACT GLAUCOMASource: www.macula.org/low_vision/simulations.html

Visual acuity (near and far)

Visual field

Control of involuntary eye movement

Color vision/Contrast sensitivity

Light sensitivity (photophobia)

Motivation/intelligenceSource: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low

Vision

Cataract Deficits in visual center of the brainAlbinism Structural abnormalities ROPDiabetic retinopathy

General/Academic Implications: ◦ May hold reading materials closer than normal◦ May experience eye fatigue◦ May have glare issues

Possible Accommodations: ◦ May benefit from the use of prescribed optical aids◦ May benefit from good lighting (evaluate seat placement)◦ May benefit from increased contrast (e.g., bold writing)◦ May benefit from alternative media; assistive technology software

(JAWS, ZoomText, Kurzweil); scribes/notetakers; human readers; and extended time for exams

Source: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low Vision

Glaucoma ROPRP Retinal detachment

General/Academic Implications: ◦ One of the most fatiguing and stressful types of vision loss◦ These students are very confusing to profs. and peers; can see

some things well and others not at all ◦ Night travel/evening classes will be difficult

Possible Accommodations:◦ May benefit from prescribed optical aids and large print◦ May benefit from alternative media; assistive technology

software (JAWS, ZoomText, Kurzweil, CCTV); scribes/notetakers; human readers; and extended time for exams

Source: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low Vision

ARMD/Stargardt’s Deficits in the visual center of the brain Diabetic macular edema

General/Academic Implications: ◦ Difficulty especially with near-vision tasks (reading & writing)

Possible Accommodations: ◦ Magnification is generally helpful, as are prescribed optical aids◦ May require increased lighting and/or direct lighting (evaluate seat

placement, lighting for near-vision tasks)◦ High contrast printed materials are helpful (e.g., bold writing, white print

on black paper)◦ May benefit from alternative media; assistive technology software

(JAWS, ZoomText, Kurzweil, CCTV); scribes/notetakers; human readers; and extended time for exams

Source: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low Vision

Congenital CataractDeficits in visual center of the brainAlbinismStructural abnormalities

General/Academic Implications:◦ Will often tilt head to find the null point (point where eye motion is at its

slowest)◦ Fatigue

Possible Accommodations:◦ Usually benefit from high contrast materials◦ Usually benefit from large print◦ May also benefit from the use of prescribed optical aids◦ May benefit from alternative media; assistive technology software

(JAWS, ZoomText, Kurzweil, CCTV); scribes/notetakers; human readers; and extended time for exams

Source: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low Vision

Cataract Glaucoma Diabetic Retinopathy Detached RetinaARMD/Stargardt’s Deficits in visual ctr. of brain

General/Academic Implications:◦ May not be able to discriminate between different colors,

making color-referenced tasks difficult/impossible

Possible Accommodations:◦ Will require high-contrast materials (bold writing, white on

black)◦ May benefit from alternative media; assistive technology (JAWS,

ZoomText, Kurzweil, CCTV); scribes/notetakers; human readers; and extended time for exams

◦ Will benefit from proper lighting, especially for near-vision tasks◦ May benefit from tactile diagrams

Source: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low Vision

Albinism Structural abnormalitiesGlaucoma Diabetic RetinopathyRetinal Detachment ARMD/Stargardt’sCataract Deficits in visual ctr. of brainROP

General/Academic Implications:◦ Require glare reduction apart from bright sunlight

Possible Accommodations:◦ May benefit from alternative media; assistive technology

(JAWS, ZoomText, Kurzweil, CCTV) ; scribes/notetakers; human readers; and extended time for exams

◦ Consider seat assignment; sunglasses or visor may be needed, even indoors; tinted lenses/fitovers may also be helpful

Source: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low Vision

A student’s motivation, emotional maturity, self-awareness, and intelligence will play a critical role in their ability to make the most of their remaining vision.

Source: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low Vision

American Foundation for the Blind (www.afb.org)

National Eye Institute(www.nationaleyeinstitute.org)

Lighthouse International (www.lighthouse.org)

Low Vision Online (www.lowvisiononline.unimelb.edu.au)

Texas School for the Blind (www.tsbvi.edu)

WebAIM Low-vision Simulation (www.webaim.org/simulations/lowvision-sim.htm)