Visual Impairments,

including Blindness
A publication of NICHCY
Disability Fact Sheet #13
November 2012

Julians Story sent by the weaker eye, resulting about the world around us
in permanent vision problems in peoples faces and the subtleties
When Julian was almost two that eye. of expression, what different
years old, he developed this things look like and how big they
adorable habit of closing one eye Julian took good care of his are, and the physical environ-
when he looked at you. It almost glasses, but he didnt take well to ments where we live and move,
seemed as if he were winking. the patch, unfortunately. He including approaching hazards.
The possibility that Julian had a ripped it off every time his
visual impairment didnt initially parents put it onand back on... When a child has a visual
occur to his parents, but when and back on again. So today his impairment, it is cause for
Julians right eye started crossing eye still turns inward if he doesnt immediate attention. Thats
inward toward his nose wear his glasses. because so much learning typi-
cally occurs visually. When vision
Off they went to the eye Visual Impairments loss goes undetected, children are
doctor, who confirmed that, yes, in Children delayed in developing a wide
Julian had a visual impairment range of skills. While they can do
amblyopia, often called lazy eye. Vision is one of our five virtually all the activities and
As the most common cause of senses. Being able to see gives us tasks that sighted children take
vision problems in children, tremendous access to learning for granted, children who are
amblyopia is the medical term visually impaired often need to
used when vision in one eye is learn to do them in a different
reduced because that eye and the way or using different tools or
brain are not working together materials.2 Central to their
properly.1 Julian was also very learning will be touching, listen-
farsighted, especially in the eye ing, smelling, tasting, moving,
hed taken to closing. and using whatever vision they
is the have.3 The assistance of parents,
Soon Julian had a brand-new
National Dissemination Center family members, friends,
pair of durable glasses suited to
for Children with Disabilities. caregivers, and educators can be
his active two-year-old self. The
indispensable in that process.
eye doctor also put an eyepatch
NICHCY More will be said about this in a
over Julians better eye, so that he
1825 Connecticut Avenue N.W. moment.
would have to use the weaker eye
and strengthen its communica- Washington, DC 20009
tion with the brain. Otherwise, 1.800.695.0285 (Voice / TTY)
the eye doctor said, the brain 202.884.8200 (Voice / TTY)
would begin to ignore the images nichcy@fhi360.org
http://nichcy.org

Disability Fact Sheet #13 (FS13)

 Types of Visual Impairment
Visual cortical visual impairment (CVI), which is
caused by damage to the part of the brain related
Not all visual impairments are the same, al- to vision, not to the eyes themselves.
though the umbrella term visual impairment may
be used to describe generally the consequence of an There are also numerous other eye conditions
eye condition or disorder. that can cause visual impairment. For a more com-
prehensive glossary of conditions, here are two
The eye has different parts that work together to resource pages youll find helpful:
create our ability to see. When a part of the eye
doesnt work right or communicate well with the
American Foundation for the Blind
brain, vision is impaired. http://www.afb.org/
section.aspx?FolderID=2&SectionID=93
To understand the particular
visual impairment a child has,
American Academy of Pediatrics
its helpful to understand the http://www.healthychildren.org/English/health-
anatomy of the eye and the issues/conditions/eyes/pages/Specific-Eye-
functions of its different parts. Problems.aspx
Rather than go into those details Because there are many different causes of visual
here, in this general fact sheet, impairment, the degree of impairment a child experi-
were pleased to refer you to the ences can range from mild to severe (up to, and
experts for easy-to-understand including, blindness). The degree of impairment will
explanations and diagrams of the visual system. depend on:

National Eye Institute | Visit the Institute the particular eye condition a child has;
online for a diagram of the eye, what different
parts are called, and what aspect of vision each what aspect of the visual system is affected (e.g.,
part is responsible for. ability to detect light, shape, or color; ability to
http://www.nei.nih.gov/health/eyediagram/ see things at a distance, up close, or peripherally);
index.asp and

Most of us are familiar with visual impairments how much correction is possible through glasses,
such as near-sightedness and far-sightedness. Less contacts, medicine, or surgery.
familiar visual impairments include:
The term blindness does not necessarily mean
strabismus, where the eyes look in different that a child cannot see anything at all. A child who is
directions and do not focus simultaneously on a considered legally blind may very well be able to see
single point; light, shapes, colors, and objects (albeit indistinctly).
Having such residual vision can be a valuable asset
congenital cataracts, where the lens of the eye is for the child in learning, movement, and life.
cloudy;
retinopathy of prematurity, which may occur in
Signs of a Visual Impairment
Visual
premature babies when the light-sensitive retina Its very important to diagnose and address visual
hasnt developed sufficiently before birth; impairment in children as soon as possible. Some
retinitis pigmentosa, a rare inherited disease that vision screening may occur at birth, especially if the
slowly destroys the retina; baby is born prematurely or theres a family history
of vision problems, but baby wellness visits as early
coloboma, where a portion of the structure of as six months should also include basic vision
the eye is missing; screening to ensure that a little ones eyes are devel-
oping and functioning as might be expected.
optic nerve hypoplasia, which is caused by
underdeveloped fibers in the optic nerve and
which affects depth perception, sensitivity to
light, and acuity of vision; and

NICHCY: http://nichcy.org 2 Visual Impairment, including Blindness (FS13)

 That said, common signs that a child may have a Each year States must report
visual impairment include: to the U.S. Department of
Education how many
Eyes that dont move together when following an children with visual impair-
object or a face ments received special
Crossed eyes, eyes that turn out or in, eyes that education and related
flutter from side to side or up and down, or eyes services in our schools
that do not seem to focus under the Individuals with
Disabilities Education Act
Eyes that bulge, dance, or bounce in rapid rhyth- (IDEA), the nations special
mic movements education law. Data reported
in 2011 (for the school year
Pupils that are unequal in size or that appear
2010) indicate that the following
white instead of black
numbers of children were served in the U.S. and its
Repeated shutting or covering of one eye (as outlying areas:
noticed with Julian)
3,447 children (ages 3-5) with visual
Unusual degree of clumsiness, such as frequent impairment8
bumping into things or knocking things over
25,670 children (ages 6-21) with visual
Frequent squinting, blinking, eye-rubbing, or face impairment9
crunching, especially when theres no bright light
present Understanding How
Children with Visual Impairments Learn
Visual
Sitting too close to the TV or holding toys and
books too close to the face Children with visual impairments can certainly
learn and do learn well, but they lack the easy access
Avoiding tasks and activities that require good
to visual learning that sighted children have. The
vision4
enormous amount of learning that takes place via
If any of these symptoms are present, parents will vision must now be achieved using other senses and
want to have their childs eyes professionally exam- methods.
ined. Early detection and treatment are very impor-
Hands are a primary information-gathering tool
tant to the childs development.
for children with visual impairments. So are the
How Common senses of smell, touch, taste, and hearing. Until the
child holds the thing to be learned and explores its
are Visual Impairments?
Visual dimensionslet us say, a stuffed animal, a dog, a salt
Very common, especially as we grow older. But shaker, or a CD player he or she cannot grasp its
there are many causes of visual impairments that details. That is why sensory learning is so powerful for
have nothing to do with the aging process, and children with visual impairment and why they need
children certainly can beand areaffected. In the to have as many opportunities as possible to experi-
U.S., there are approximately: ence objects directly and sensorially.

490,420 children with vision difficulty (The term Families, friends, and others can support senso-
vision difficulty refers only to children who rial learning in many ways.
have serious difficulty seeing even when wearing Do you smell dinner? appeals to the childs
glasses and those who are blind.)5 sense of smell.
42,000 children with a severe vision impairment Listen to that bird singing outside calls to the
(unable to see words and letters in ordinary childs hearing. Thats a robin gives the child a
newsprint)6 name for the bird that sings the song he or she is
59,341 children who are legally blind7 hearing.

NICHCY: http://nichcy.org 3 Visual Impairment, including Blindness (FS13)

 Isnt the bunny soft? And feel how
long his ears are! speaks to the
childs sense of touch and helps the
How IDEA Defines Visual Impairment
Visual
child build a picture of the whole IDEA provides the nation with definitions of many disabilities
from the many details.10 that can make children eligible for special education and related
Being able to see enables us to services in schools. Visual impairment is one such disability the
capture the whole of an object law definesas follows:
immediately. This isnt so for children Visual impairment including blindness
with a visual impairment. They cannot
see the whole, they have to work means an impairment in vision that, even with
from the details up to build an under- correction, adversely affects a childs educational
standing of the whole. performance. The term includes both partial sight
and blindness. [300.8(c)(13)]
The Help Available
under IDEA
Accessing early intervention (EI) | To identify
If you suspect (or know) that your child has a
the EI program in your neighborhood, consult
visual impairment, youll be pleased to know theres
NICHCYs State Organizations page for your state,
a lot of help available under IDEAbeginning with a
online at: http://nichcy.org/state-organization-search-
free evaluation of your child. IDEA requires that all
by-state
children suspected of having a disability be evaluated
without cost to their parents to determine if they do Early intervention is listed under the first section,
have a disability and, because of the disability, need State Agencies. The agency thats identified will be
special services under IDEA. Those special services able to put you in contact with the early intervention
are: program in your community. There, you can have
your child evaluated free of charge and, if found
Early intervention | A system of services to
eligible, your child can begin receiving early interven-
support infants and toddlers with disabilities
tion services designed to address his or her develop-
(before their 3rd birthday) and their families.
mental needs associated with the visual impairment.
Special education and related services | Services
Accessing special education and related ser-
available through the public school system for
vices | If your child is between 3 and 21 years of age,
school-aged children, including preschoolers
we recommend that you get in touch with your local
(ages 3-21).
public school system. Calling the public school in
Visual impairment, including your neighborhood is an excellent place to start. The
blindness, is one of the disabilities school should be able to tell you the next steps to
specifically mentioned and defined having your child evaluated free of charge. If found
in IDEA. If a child meets the eligible, your child can begin receiving services
definition of visual impairment in specially designed to address his or her educational
IDEA as well as the States criteria (if needs and other needs associated with the disability.
any), then he or she is eligible to
Developing a written plan of services | In both
receive early intervention services or
casesin early intervention for a baby or toddler
special education and related services
with a visual impairment and in special education for
under IDEA (depending on his or her
a school-aged child, parents work together with
age).
program professionals to develop a plan of services
IDEAs definition of visual impairment is given in the child will receive based on his or her needs. In
the box above. early intervention, that plan is called the IFSP (indi-
vidualized family service plan). In special education,
the plan is called the IEP (individualized education
program). Parents are part of the team that develops
their childs IFSP or IEP.

NICHCY: http://nichcy.org 4 Visual Impairment, including Blindness (FS13)

 Theres a lot to know about early intervention for Adapting
infants and toddlers with disabilities and about
special education and related services for school-aged
the Environment
children. Visit NICHCYs website and find out more Making adaptations to the environment where a
about these crucial services for eligible children with child with a visual impairment lives, works, or plays
visual impairments, beginning at: makes evident sense, but it may be difficult for
Early intervention families, daycare providers, or school personnel to
http://nichcy.org/babies decide what kinds of adaptations are necessary to
ensure the childs safety while also encouraging his or
Special education and related services her ability to do things independently.
http://nichcy.org/schoolage
Two resources you can consult, depending on
Working with the your role in the childs life, are:
Medical Community Family Connect | Adapting Your Home
http://tinyurl.com/c6gaq7o
If you have a child with a visual impairment,
youll probably find yourself dealing with a variety of IRIS Center | Offers a professional
eye care professionals who become involved to development module for teachers called
diagnose and address your childs specific disability Accommodations to the Physical Environment:
or eye condition. Wondering who these professionals Setting up a Classroom for Students with Visual
might be, what qualifications they should have, and Disabilities.
what kind of expertise they can bring to your childs http://iris.peabody.vanderbilt.edu/v01_clearview/
care? chalcycle.htm
Family Connect is an excellent source of this Educational
information. Family Connect is an online, multime-
dia community created by the American Foundation
Considerations
for the Blind (AFB) and the National Association for Children with visual impairments need to learn
Parents of Children with Visual Impairments the same subjects and academic skills as their sighted
(NAPVI). We suggest you download (or read online) peers, although they will probably do so in adapted
Family Connects toolkit called Working with Medical ways. They must also learn an expanded set of skills
Professionals. that are distinctly vision-related, including learning
The toolkit is available online in English how to:
and Spanish, at: http://tinyurl.com/8an8all move about safely and independently, which is
Need a glossary? |Becoming familiar with known as orientation and mobility (O&M);
medical terminology relating to the visual system use assistive technologies designed for children
may also prove helpful, especially when talking to with visual impairments;
medical professionals and reading about your childs
impairment. If youre baffled by the terms you hear, use what residual vision they have effectively
visit the Glossary of Eye Terminology, which lists and efficiently; and
common terms that eye doctors use when discussing
read and write in Braille, if determined appropri-
symptoms, tests, treatments, surgery, diseases and
ate by the IEP team of the child after a thorough
conditions, and the anatomy of the eye.
evaluation.11
The glossarys online at:
These are just some of the skills that need to be
http://www.eyeglossary.net/
discussed by the students IEP team and included in
the IEP, if the team decides thats appropriate. Each of
the above skill areasand morecan be addressed
under the umbrella of special education and related
services for a child with a visual impairment.

NICHCY: http://nichcy.org 5 Visual Impairment, including Blindness (FS13)

 Tips for TTeachers
eachers

Learn as much as you can about the tional goals will be listed there, as well as
students specific visual impairment. What the services and classroom accommoda-
aspects of vision are affected, and how tions he or she is to receive.
does that affect the students ability to
move about the classroom, see the board, Consult with others (e.g., special educa-
or read a textbook? Parents (and the tors, the O&M specialist) who can help
student!) can be an excellent source of this you identify strategies for teaching and
information. supporting this student, ways to adapt the
curriculum, and how to address the
Learn about the many instructional and students IEP goals in your classroom.
classroom accommodations that truly help
students with visual impairments learn. Weve Find out if your state or school district has
listed a few in the resource section. Strongly materials or resources available to help educators
support the student by making sure that needed address the learning needs of children with
accommodations are provided for classwork, visual impairments. Its amazing how many do!
homework, and testing. These will help the Communicate with the students parents.
student learn successfully. Regularly share information about how the
If you are not part of the students IEP team, ask student is doing at school and at home.
for a copy of his or her IEP. The students educa-

References

1
Centers for Disease Control and Prevention (CDC). (2009, July). Vision health initiative: Common eye disorders. Atlanta,
GA: Author. Online at: http://www.cdc.gov/visionhealth/basic_information/eye_disorders.htm
2
American Foundation for the Blind. (2011). Accommodations and modifications at a glance. Retrieved September 24, 2012
from the Family Connect website: http://tinyurl.com/7p5b7bk
3
American Foundation for the Blind. (2011). What's different about the way visually impaired children learn? Retrieved
September 24, 2012 from the Family Connect website: http://tinyurl.com/9pjyx2d
4
Zundel, I.H. (n.d.). Signs of possible vision problems in toddlers. Retrieved September 24, 2012 from the EduGuide website:
http://www.eduguide.org/library/viewarticle/932/
5
American Foundation for the Blind. (2012, January). Children and youth with vision loss. New York: Author. Online at:
http://www.afb.org/section.aspx?SectionID=15&TopicID=411&DocumentID=4896
6
Lighthouse International. (n.d.). Prevalence of visual impairment. Online at: http://www.lighthouse.org/research/statis-
tics-on-vision-impairment/prevalence-of-vision-impairment/
7
American Foundation for the Blind. (2012, January). School experience for children and youth with vision loss. New York:
Author. Online at: http://www.afb.org/section.aspx?SectionID=15&TopicID=411&DocumentID=4897
8
Data Accountability Center. (2011, July). Table 1-2. Number of children ages 3 through 5 served under IDEA, Part B, by
disability category and state: Fall 2010. Online at: https://www.ideadata.org/TABLES34TH/AR_1-2.pdf

References are continued on the next page.

NICHCY: http://nichcy.org 6 Visual Impairment, including Blindness (FS13)

 Tips for PParents
arents

Learn as much as you can about your childs Work with the early interven-
specific visual impairment. The more you know, tionists or school staff (de-
the more you can help yourself and your child. pending on your childs age) to
build a solid individualized plan of
Understand that your child is receiving small services and supports that address
bits of information at a time, not all at once your childs unique developmental and
through vision. Help your child explore new educational needs.
things with his or her senses and build up a
concept of the whole. Talk to other parents of children who have
visual impairments similar to your childs. They
For example, your child might need to be shown can be a great source of support and insight in
a banana, help you peel it, feel the banana the challenges and joys of raising a child with
without its skin, have a bite of it, and then help vision problems. Many of the organizations
you mash it in her bowl to understand the weve listed in the Resources section have state or
qualities of bananas and that bananas can be local chapters you can contact.
eaten in different ways.12
You can also visit Parent to Parent, which
Encourage curiosity and explore new things specializes in teaming new parents up with
and places often with your child. Give lots of veteran parents of children with similar disabili-
opportunity to touch and investigate objects, ask ties. P2P is online at: http://www.p2pusa.org/
questions, and hear explanations of what some- p2pusa/sitepages/p2p-home.aspx
thing is, where it comes from, and so on.
Keep in touch with the professionals working
Learn how to adapt your home, given the range with your child. Offer support. Demonstrate any
and degree of your childs visual impairment. assistive technology your child uses and provide
Help your son or daughter explore the house and any information teachers will need. Find out
learn to navigate it safely. how you can augment your childs learning at
Encourage your childs independence by letting home.
him or her do things, rather than you doing them.
Teach how to do a chore by using hands-on
guidance, give lots of practice opportunities with
feedback. Now, your child knows the skill, too.

References (continued)
9
Data Accountability Center. (2011, July).Table 1-3. Number of students ages 6 through 21 served under IDEA, Part B, by
disability category and state: Fall 2010. Online at: https://www.ideadata.org/TABLES34TH/AR_1-3.pdf
10
American Foundation for the Blind. (n.d.). Promoting your babys growth and development. Retrieved September 24, 2012
from the Family Connect website: http://tinyurl.com/92kzgt7
11
American Foundation for the Blind. (n.d.). The expanded core curriculum. Retrieved September 24, 2012 from the Family
Connect website: http://tinyurl.com/97ora5j
12
American Foundation for the Blind. (2011). What's different about the way visually impaired children learn? Retrieved
September 24, 2012 from the Family Connect website: http://tinyurl.com/9pjyx2d

NICHCY: http://nichcy.org 7 Visual Impairment, including Blindness (FS13)

 Resources of Additional Information

Organizations Accessible Materials

American Council of the Blind
Booksharefor those with print disabilities, includ-
800.424.8666 | http://www.acb.org
ing visual impairments or blindness. Offers free
American Foundation for the Blind membership to qualified U.S. students and schools,
Find services in your state right on the home page. and makes more than 169,000 titles available
800.232.5463 | http://www.afb.org digitally. https://www.bookshare.org/

American Printing House for the Blind Learning Allyfor those cannot read standard print.
800.223.1839 | http://www.aph.org/ Offers more than 75,000 digitally recorded textbooks
and literature titles for download. Formerly Record-
Association for Macular Diseases ing for the Blind and Dyslexic. | 800.221.4792 |
http://www.macula.org/ http://www.learningally.org/
Family Connect LOUISdatabase of info on more than 386,000
http://www.familyconnect.org/parentsitehome.asp titles in accessible formats, including braille, large
En espaol: http://www.familyconnect.org/ print, sound recording, and electronic files.
parentsitehome.asp?lang=esp http://louis.aph.org
Foundation Fighting Blindness National Center on Accessible Instructional Materi-
Find your state chapter right on the home page. als (AIM)excellent info for educators and families
800.683.5555 | 800.683.5551 (TTY) on getting AIM for students with visual impairments,
http://www.blindness.org/ blindness, or other print disabilities.
Lighthouse International http://aim.cast.org/
800.829.0500 | http://lighthouse.org/ Other Helpful Resources
En espaol: http://lighthouse.org/espanol/
Resources for Livingan entire section of NFBs
National Braille Association | website that includes state and local connections for
http://www.nationalbraille.org/ areas of life such as: aids and appliances, Braille,
National Braille Press closed circuit TVs, guide dog schools, low vision, and
888.965.8965 | http://www.nbp.org technology.
http://www.nfb.org/living
National Federation of the Blind
http://www.nfb.org/ Education for Students with Blindness or Visual
Impairmentan entire section of Perkins School for
National Library Service for the Blind and the Blinds website.
Physically Handicapped, Library of Congress http://www.perkins.org/resources/scout/education/
http://www.loc.gov/nls/
National Eye Institute, National Institutes of Health
| http://www.nei.nih.gov/
En espaol: http://www.nei.nih.gov/health/espanol/
index.asp
This publication is made possible through Cooperative
Prevent Blindness America Agreement #H326N110002 between FHI 360
800.331.2020 | http://www.preventblindness.org and the Office of Special Education Programs, U.S.
Department of Education. The contents of this document
do not necessarily reflect the views or policies of the
Department of Education, nor does mention of trade
names, commercial products, or organizations imply
endorsement by the U.S. Government.