Teachers from three different special education classrooms selected one child each to participate in the pilot program. The names of the children are changed, but the information describing their vision problems is accurate.
First team meeting:
Crystal is a ten (?) year old girl with mild cerebral palsy. She can walk with effort, but often uses her Amigo for transportation. Teachers noticed that Crystal was not seeing distant objects clearly. When her teacher selected Crystal to participate in the pilot program, he did not know that Crystal had been seen in the Special Needs Clinic two years ago and glasses had been prescribed. Crystal did not wear glasses as far as anyone knew prior to this knowledge.
Glasses were dispensed in 2003. These were lost and replaced one month later. Evidently, this second pair of glasses was also lost and never replaced. She missed her two month follow up appointment and never returned. We do not know if she saw another doctor since these events unfolded. This scenario is common in special education. Children lose or break their glasses often. Since this is not acceptable, the team decided to do the following:
1. Re-examine Crystal to determine her current visual needsCrystal needs her glasses not only to see clearly, but also to improve her ability to concentrate at near point. In 2003, her visual acuity was about 20/40 for distance vision and 20/100 at near point O.U. (both eyes). Crystal is a 2.50 diopter hyperope. The left eye also ocassionally turned inward. Functionally, this diagnosis means that Crystal's eyes are working harder than normal to see clearly at a distance. When she tries to look at near point objects, her eyes must work even harder to focus. This makes concentration at near point very difficult to sustain. Bionocular vision is also disrupted when the eyes break fusion. All of these functional problems could be solved with glasses that correct Crystal's hyperopia.
2. Get Crystal another pair of glasses (maybe two pair)
3. Establish a behavioral plan to safeguard the glasses
4. Discuss the behavioral plan with Crystal's parents and get their agreement
5. Explain the visual condition to Crystals parents and her teachers
6. Keep a second pair of glasses for school use only in the event that the first pair is lost or broken
7. Record changes in Crystal's behavior after using her new glasses for school activities. Crystals teacher will list several functional goals for Crystal and measure results before and after glasses are prescribed (time on task, ability to see objcets in the classroom, ability to catch a ball, etc.)
John is a severely autistic 12 year old boy. He has tremendous difficulty focusing (attending) to tasks, and he appears, in the words of his teacher "not in this world; It seems like too much is going on inside his mind". He is heavily medicated. Acuity measurements were in the 20/200 range, but he functions much better than this, and the doctor feels that lack of attention may be more of an issue than acuity. His mobility is normal as long as he stays attentive to the route and is not distracted (he routinely delivers messages to the office for the teacher). His ocular patterns appear to be neurologically normal, and although he has a low hyperoptic condition, no glasses are indicated.
He uses an emotion board to view pictures of faces displaying various moods. He can point to these faces to indicate how he is feeling when he arrives at school in the morning. He can recognize individuals. He likes eye contact, but only if his face is very close. His parents take him to public places and he "behaves" in these situations. He seems to take in more of his environment than many autistic children. He can hear and repeat- his speach is echolalic. His teacher says that he processes very slowly; there is a long gap between the time information is requested and his response. Structure activities are very important to John. Once a sequence is set, he likes to stay with it.
The room contains no special lighting, and he resists sunglasses. He does like to watch objects drop in front of his eyes (bits of paper, for example) and he does this self-stimulating behavior when he can get away with it.
Based on this information, the team decided to take the following steps:
1. Do an O&M informal assessment
2. Bring John to the clinic for regular figure identification lessons
3. Experiment with the Optokinetic drum to substitute for the stimulation John gets from the falling objects. Explore the theory that autistic kids are trying to alter their visual processing speed through various self stimulations.
4. Contact the Irlen Foundation to get access to their color filters and experiment with them, especially in association with altered rates of processing speed.
Terry is a young boy, age X, who has severe cerebral palsy. Typical of children with severe CP, Terry has very little control of his ocular motor muscles. His eyes seem to move independently and to float all around. It is extremely difficult for Terry to point his eyes at any object of regard, and certainly he cannot sustain fixation long enough for any near point activities. Also, typical of this type of physical impairment, Terry can process at distance much better than at near point. His oculomotor control varies with the level of his body tone. Head and body must be stabilized before there is any hope of stabilizing the eye muscles. Terry has minimal refractive error and does not need glasses. Sunlight and wind trigger reflex eye closing.
Based on this information, the team decided to take the following steps:
1. Experiment with over the counter 2.50 plus lenses for all near point activity
2. Make Terry VI eligible
3. Experiment with positioning of head and body to find a maximun stabilization; search for the best null point
4. Experiment with face shields that block the wind; reduce glare, and provide optical correction