Low-Vision Assessments and Services: The Earlier Your Child Starts, The Better

Child using a video magnifier reading a book.
Child using a video magnifier reading a book.

Perhaps you’ve noticed your young child is having trouble reading, even though they’ve started building a vocabulary. Maybe a teacher says your teen is having problems seeing the blackboard from an assigned seat, or isn’t meeting their full potential working online. Or it could be that you take your child to the family eye doctor before they start kindergarten – which is always a good idea – and are referred to a low-vision specialist for different kinds of tests.  

These are some of the signs your child may have low-vision issues. Not only can these issues vary widely, the sooner your child is diagnosed and can begin receiving services tailored to their needs the better.  

“I see children as young as five, even four if they’re a good communicator and mature for their age,” says Emily Gorski, O.D., an Assistant Clinical Professor at the University of California, Berkeley, School of Optometry, who performs low-vision assessments. “We want to get a good evaluation to see if we can describe their vision a little better, and get them what they need to start in a school environment.” 

She adds that regular eye exams can seem scary to children because of things like dilation drops that sting and bright lights, so it’s helpful for parents to let their children know a low-vision assessment is different.  

“It’s more focused on the child’s visual function,” Emily says, “so it’s a lot more of fun vision games and just talking with the child.” 

Rajiv Panikkar, a Certified Orientation & Mobility Specialist (COMS), Certified Low Vision Therapist (CLVT), and Teacher of the Blind and Visually Impaired (TVI) in Washington, adds that he always explains the process ahead of time if a student is headed to a low-vision assessment. A TVI will usually complete detailed paperwork for the optometrist if they’re sending the student for an assessment, he says, and if possible it’s beneficial to have the TVI attend the evaluation. 

“Depending on how much time a teacher has had with the student, the information they provide for the evaluation can be very helpful,” Emily adds. “Maybe it’s what the child found has worked for them, or the teacher has noticed things the child hasn’t figured out yet.” 

Collaboration is vital to student success 

Rajiv and Emily agree a collaborative approach is essential if a child is diagnosed with a low-vision issue.  

“Once the evaluation has taken place, whatever the doctor recommends there’s a coordination between the staff and the doctor – and it’s constant,” Rajiv says. “A device that works in a clinical setting may not work in a classroom setting. So communication between the doctor and the TVI or the low-vision specialist at the school is critical.” 

Although some optometrists or ophthalmologists have experience with low vision, it’s best to seek out a low-vision specialist, according to Emily and Rajiv. Unfortunately, they’re not always as readily available as they should be, so parents may have to travel to take their child for an evaluation – or sometimes, at least pre-pandemic, low-vision specialists travel to schools to perform evaluations. It’s best to ask your child’s eye doctor for a referral.  

Rajiv underscores the importance of having a low-vision assessment from an expert before a TVI or Orientation & Mobility (O&M) specialist begins making recommendations about services and tools. 

“I am not in favor of TVIs and O&M specialists providing magnification devices without a low-vision exam,” he says. “The first step needs to come from a low-vision doctor and then they can collaborate. It can’t be done in isolation.” 

Emily adds that without a formal assessment, there’s too much reliance on trial and error. “A formal assessment can really give you a much more directed recommendation that will set that child up for success more quickly,” she says.  

Not every student’s needs are alike, which is why an assessment is so important. Some students need glare control or a particular level of screen brightness, while others need high contrast – such as the teacher sticking to a black pen instead of yellow on a whiteboard. In other instances, if peripheral vision is an issue, the student may simply need to sit on one side of the classroom to make the best use of the vision they have. It’s also important to note that in younger children, just because the print in books tends to be larger doesn’t mean they shouldn’t have early intervention. A diagnosis will provide them with training and a comfort level with low-vision devices as they get older and book type gets smaller. 

Addressing the needs of older students 

When a student begins having vision issues in middle school or high school, a low-vision assessment is equally important. However, students at this age may be resistant to assistive devices or accommodations.  

“Students at that age don’t want to stand out among their peers or some of them get teased about their devices or even their canes,” Rajiv says. “That’s our biggest challenge, so we have to help them understand it will make their lives easier – including when they are out of school because a soup can isn’t going to use 18-point type. They have to get used to the tools they will need.” 

Fortunately, it’s somewhat easier for students now that technology is more common in classrooms. “We can assure the student that there are technological options that won’t make them seem any different from their classmates,” Emily says, “or their tablet or computer might already have accessibility options built-in.” 

Both Rajiv and Emily agree that early intervention is essential, no matter when a child begins having vision issues. In fact, Rajiv advocates connecting students with adult and transition services through the state as early as middle school so they are prepared to move forward right after high school graduation, whether they want to go to college or work. He also recommends that students learn to explain their eye condition to people who may need to understand it, such as an employer. 

“Whatever age a child is, a huge theme in low vision is early intervention: getting things in place and planning for the future,” Emily says. “That way, when they get out into the working world – where they’ll have to take a lot of responsibility for asking for or getting resources themselves – they’ll know what they need. It’s also very important in encouraging independence. The more self-reliant a child can be as a student, the more successful they’ll be as an adult.”