#6 - COMPONENTS OF THE FUNCTIONAL VISION ASSESSMENT: STUDY NOTES
QPVI Pre-Service Class - Nancy Toelle and Chrissy Cowan
The following is based on Looking to Learn, Chapter 2, Tanni Anthony. F.M. D’Andrea and C. Farrenkopf, eds.
Explanatory information has been added to assist teachers in training in understanding the details of conducting a FVA.
These materials should be used in conjunction with the text.
FVA COMPONENT / DESCRIPTION / WHY TESTED OR OBSERVED / HOW TO TEST OR OBSERVE / TEST/OBSERV. RESULTS
1. Appearance of eyes and presence of corrective lenses / Observed appearance of the eyes indicating possible disorder or disease. If prescribed, glasses MUST be worn for FVA / Appearance of eyes can be your first indication that there is a visual disability. / Observe students eyes and make notation of appearance.
2. Visual Reflexes / a) Pupillary response,
b) Defensive blink / Indicators of gross light or object perception (in developmentally delayed students) / a. Change lighting level in room and observe rate at which pupils respond
b. Move opened fingers of 1 hand rapidly toward student’s eyes
3. Reception and perception of visual stimuli / Student’s visual system receives the stimuli and reacts to it.
  1. Light perception
  2. Light projection
  3. Shadow and form perception
  4. Detection of motion
/ To determine the student’s ability to detect and respond to: light, shadow, form, and motion. These are the first indicators of degree of visual loss. /
  1. Darken room, wait 30 seconds, turn light on and note student’s response/awareness (eyes opening, head turn, etc)
  2. Student looks toward source of light
  3. Pass large object in front of student blocking light and note if student attends to object
  4. Dangle silent object (slinky) in front of student, note eye orientation or head turn following movement.

4. Muscle Balance
4. Muscle Balance
(continued) / Both eyes move in the same way at the same time and in the same direction / Eye muscle movements can affect student’s acuity, tracking, and peripheral vision /
  1. Hirschberg Test: hold penlight 3 ft away from students eyes, pointed at bridge of nose – reflection should be symmetrical in both eyes.
  2. Cover-Uncover Test: (with glasses, if prescribed) student fixates on a visual target in central position. Cover one eye and notice if there is movement in uncovered eye. Repeat with other eye

5. Eye Preference / When acuities are unequal, the student frequently prefers to use the better eye. / Impacts positioning of materials, student’s mobility, preferential seating in classes / Ask student to cover one eye to look at a distant target and note which eye is covered or hand the student a kaleidoscope or monocular and note which eye is used. For young students a toilet paper roll works well.
6. Oculomotor Behaviors
6. Oculomotor Behaviors (continued) / a. Fixation
b. Convergence and divergence
c. Tracing
d. Tracking
e. Shift of gaze
f. Scanning
g. Eye-hand coordination (see #16. Visual Motor Coordination) / Determine how the eyes move in relation to visual targets. Difficulties can impact fixating on objects, focusing, mobility, reading, copying, visually locating /
  1. Fixation - Observe student, noting objects seen at near and distance, note eccentric viewing (head turn), head and body positioning. Look for some indication that student is actually fixing on the object, such maintaining gaze or reaching for it.
  2. Convergence/divergence – ability to maintain binocular vision as objects approach or retreat. Hold finger puppet 8” from bridge of the nose, wait for child to fixate and slowly move toward bridge of the nose. Note if eyes moves symmetrically inward as object approaches and back as it retreats.
  3. Tracing – visually following a stationary line. Ask student to visually follow a line in the environment from start to finish to locate an object.(follow line of desktop to find trash can)
  4. Tracking – Ability to track a moving object horizontally, vertically, circularly, and diagonally. Standing close enough for the student to see your hand or a larger object, trace capital letters H, O, and / noting eye movements in all directions. Are they smooth or jerky?
  5. Shift of Gaze – Moving fixation between two objects. Note if the student can look from one object to another or copy from the board
  6. Scanning – Ability to shift gaze from one stationary object to another in a series, using both head and eye movements, and identifying each object. Examples are identifying words in a row or columns without skipping words or naming individuals standing in a row.

7. Field of Vision / Normal field of vision is 160-180 degrees from side to side and 120 degrees from top to bottom, this includes the central field of vision / Field loss has implications for student’s safe travel, placement of materials; detection of objects moving and stationary in the environment (P.E.) An O&M is the person to assess safe travel vision. / Confrontation field test – this requires two people. A person in front of the student provides a visual target (a clown nose for young children) and notes at what point the student detects the target presented in each quadrant. A person behind the student slowly moves a target into areas of the student’s visual fields: from right, left, top and bottom. Performance should be reported in functional terms, such as; the student’s response indicates there may be a reduction of field to the left, not in terms of degrees.
8. Color Vision / Ability to detect the full spectrum of colors / Colors are often important in classroom instruction, mobility, daily living / Match yarn samples or paint chips in primary colors. This is for young students or students who have never been administered or passed a test of color vision.
9. Depth Perception / Ability for eyes to team together to detect depth and dimension / Safety and efficiency in travel, eye-hand/foot coordination. An O&M is the person to assess safe travel vision. / Note student accuracy while reaching for objects and the student’s ability to respond to changes in ground surfaces and drop-offs. Note details of observations.
10. Figure-Ground Perception / Ability to discern an object from its background / To determine how objects & materials are presented or how a communication system is designed / a. Ask the student to locate a specified object on a busy background, locate detail in a busy illustration, and/or locate an object in a jumble of other objects.
11. Light Sensitivity and Light-Dark Adaptation / Unusually sensitive to light, shielding the eyes from light sources. The amount of time it takes for the eyes to adjust to an increase or decrease in lighting. / Affect mobility, stamina, comfort, and acuity. This is especially critical for students with albinism and retinal disorders, such as retinitis pigmentosa. An O&M can assess travel at night. /
  1. Light sensitivity – observe the student’s visual performance and facial expressions in a variety of lighting levels, always including outdoors and high/low light and with light producing equipment.
  2. Light-Dark adaptation – observe student’s mobility and behavior moving from bright light to dark, noting the amount of time needed for student to accommodate.

12. Contrast Sensitivity / Ability to see differences in the brightness of symbols or in objects against their background / Affects the student’s ability to recognize faces, decode pictures, letters or words, to locate one item in a group, or travel safely /
  1. Young students: Place several 1” or smaller objects on a same color background - ask student to point to each.
  2. OR- Provide samples of print on a variety of colored backgrounds and ask student which background color works best from them.
  3. OR - Administer commercial contrast sensitivity test.

13. Visual. Acuity / The measurement of the sharpness of vision as it relates to the ability to discriminate detail at near, far, and intermediate distances. / Acuity measures (formal and informal combined) provide information that is used to determine the choice methods, modifications, materials across all domains. /
  1. Formal – commercially available cards or charts for both distance and near acuities (Distance: Snellen Letter Chart, Lea Symbol Chart and cards, Near: Lea Symbols, GAME Card, Continuous Text Read. Card)
  2. Informal – a functional estimate of acuity by observing the student’s performance with a variety of visual stimuli from a variety of distances (for example: 2” letters on the chalkboard from 10’, 8’, 5’) Describe the smallest object seen at near and distance. Assess ability to perform with print on overhead, chalkboard, computer screen.

14. Current Print Functioning / Ability to read print in texts and in the environment. / To determine if modifications, adaptations or assistive technology are needed. / Document the size print used for near point (under 16”), intermediate (16” – 3’), distance (3’ and beyond as appropriate to developmental level), material used, task, viewing distance, positioning of materials, head movement, low vision device use. A printer’s rule, available for under $5 at a printer’s supply store is very useful in determining font sizes of print used.
15. Reading Rate and Comprehension / A reading inventory will be covered in the Learning Media Assessment / It is critical to have literacy information on all VI students as literacy is a foundation skill. / Note the literacy media used (real objects, pictures of objects, shaded drawings, line drawings, symbols, print) & their success in using it. Note reading level, if tested. Request a reading inventory if one hasn’t been done. Note size of materials presented and his/her ability to use them.
16. Visual Motor Coordination /
  1. visual fine motor skills – coordination of hands with eyes (reaching)
  2. visual gross motor skills – moving body in relation to visual target (kicking a ball)
/ Students use of fine (reaching, stacking, writing, copying), and gross motor skills (kicking a ball, traveling safely, using steps) in their school careers contributes to successful school performance. / This may be evaluated with O&M, O.T., Adaptive P.E. teacher
  1. Examples: Note if student has an accurate visually directed reach for small objects (size of object, distance from student, contrast to background), handwriting samples (darkness and spacing of lines preferred), coloring within lines, cutting, tracing.
  2. Examples: walking up or down steps, kicking a ball rolled toward the student, calisthenics

17. Visual-cognitive Skills / a. Visual imitation of movement
b. Identification, matching, sorting, and classification of objects and pictures
c. Visual sequencing / Measures student ability to acquire knowledge through vision – For example, can they observe the gym teacher demonstrate a movement. /
  1. Model different movements for the student at various distances and observe the accuracy of their imitation (touch nose with finger or thumb, raise arm or leg)
  2. Identification by naming objects or pictures, match objects or pictures, sorting silverware by separating forks from knives, classifying objects or pictures by function, such as things we eat with, modes of transportation, toys.
  3. Patterns produced by stringing beads to follow a pattern or arranging pictures in sequence to tell a story.

18. Visual perception skills / a. Visual closure
b. Part to whole relationships
c. Pattern recognition
d. Figure-ground discrimination
e. Spatial orientation / Tests of visual perception can help determine if the student’s difficulties are related to perception not impaired vision. O.T.s & classroom teacher can be involved in testing. / Commercially produced tests of visual perception are available. Such testing would be indicated if a student is experiencing difficulty processing print materials, but would not necessarily be completed on every student as part of a FVA.
ENVIRONMENTAL ANALYSIS AND CONSIDERATIONS
  • The TVI should note what environmental conditions enhance or reduce visual functioning and write recommendations in the FVA Report.
  • Consider the educational implications of the student’s visual impairment in each environment and activity

Lighting / Type, amount and position of lighting / These all contribute to the ease or difficulty of a visual task / Note the student’s performance regarding lighting throughout the FVA. Is performance enhanced or reduced by bright or low light, is lighting on a task helpful, does the rate of travel increase or decrease with different lighting.
Glare / Discomfort glare is light that, because of its intensity or duration causes discomfort, but does not interfere with visual performance
Disability glare reduces visual performance due to blinding or dazzling effects. / Glare can interfere with a student’s ability to perform tasks visually that he or she would otherwise be able to perform. Glare on the board, computer screen, or on any other shiny surface should be evaluated and minimized. / Observe and evaluate all environments to identify if glare is an issue. Address glare by such strategies as using filters, closing window coverings, or perhaps refer the student for a clinical low vision evaluation to determine if light absorptive lenses are appropriate.
Color and Contrast
Color and Contrast (continued) / The difference in shade between an object and the background behind it. Are materials used in the room of sufficiently contrasting color, providing a level of contrast that is adequate for the student’s visual functioning. / If a teacher uses a yellow marker on the white board, even if the letters are of sufficient size, the poor contrast would render the writing unreadable. Is there enough contrast between room furnishings and floor covering to allow a low vision student to navigate around furniture? / The student’s performance with color and contrast can be observed and tested. When observing the student in the classroom, note if he or she is able to read or copy from the chalk or whiteboard and note the color and contrast involved. You may assess this by writing on the board in a variety of colors yourself, noting which works best for the student. Generally the darker colors work best, but students with abnormal color vision must be evaluated to note what colors the teacher can use. As a TVI, you may want to provide the teacher with a supply of markers of the best colors. For younger students, note the student’s ability to identify objects of varying contrast in the distance, such as a green tennis ball on a light or dark floor, a white toy on a light or dark background.
Visual Clutter
Visual Clutter (Cont.) / The complexity of the visual learning environment. / The more complex the environment, the lower the proficiency of functional vision. Visual clutter may dramatically influence some students’ ability to visually decipher classroom activities and/or materials / Note the amount of visual clutter in the instructional environment and evaluate the student’s response by trials with cluttered and uncluttered settings. If the student performs markedly better without clutter, their workspace should be arranged accordingly. Students with cortical visual impairments may be especially sensitive to clutter.
Ambient Noise or Auditory Clutter / The noise level or complexity of the auditory learning environment / A noisy environment may be disruptive or distracting to a student with a visual impairment, reducing performance. / Note student performance in a variety of environments with varying noise levels. Noisy environments: gym class, cafeteria, halls between classes, auditorium. Quiet environments: classrooms when students are working quietly, library, hallways during class, outdoors.

NOTES:

WRITING THE FVA REPORT
  • A sample of a completed report of a functional vision assessment appears in Appendix 2.B, on page 78

  • An FVA should be concise, informative, and factual. Since it is to be read by parents, teachers and others, it should not be too lengthy. Neither should it be so short as to leave out important information.
  • The report should be written in simple and direct language, containing explanations of specialized terms whenever used. For example, instead of saying a student has poor figure-ground perception, relate an example, such as the student has difficulty reading print that is written over a background photo, with the recommendation that work with confusing figure-ground should not be given to the student or should be reproduced on a plain background.
  • The report should be factual, but also represent a personalized view of the student.
  • The purpose of the FVA should be stated, whether it is to help establish eligibility, needed adaptations due to a change in vision, or impact of the visual impairment in all environments.
  • Any person interviewed for the assessment should be mentioned in the report.
  • Provide the dates of assessment and date the report. The report should look presentable and be well formatted. Subheadings will help the reader organize information. Use of bullets or numbered lists may make it easier to read.
  • It is helpful to link recommendations with student-specific needs: if the student is photophobic, recommend sunwear for outdoors and facing the student away from brightly lit windows.
  • Predictions of student’s future visual performance should not be made.
  • Observations of student performance should be reported, as well as details about lighting conditions, the size of objects, viewing distances and other pertinent information should be reported.
  • It is preferable to frame observations positively, stating what the student can do, rather than what he or she cannot do.
  • If a student used other senses to complete a task, this should be viewed as an important strategy for the child.
  • Avoid creating a hierarchy of sensory skills. Say a student was able to complete a task using tactile input, rather than the student had to use tactile input to complete the task. It is particularly important to phrase references to Braille in positive terms to overcome negative stereotypes.
  • Report only medical information that is pertinent to the current situation of the student. Any medical terms used should be defined briefly. All acronyms should be spelled out: FVA written as Functional Vision Assessment. Write the report for people without VI training
  • The FVA is a combination of art and science. The science refers to the technical aspects of the assessment process. Art is involved in the keen observation, interpretation and synthesis of the student’s visual skills and the engineering of the appropriate environment, adaptations, and programming to meet the resulting needs.
  • Practice and experience with a variety of students increase the assessor’s skills over time.
NOTES:

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