Pediatric low vision: How to help young patients navigate the world more easily

Image credit: AdobeStock/JordiMora

The term pediatric low vision describes visual impairment in children that cannot be corrected with contact lenses, glasses, or other medical or surgical procedures. Visual impairment can profoundly affect a child’s overall development, encompassing their educational, social, and emotional well-being.

The etiology of pediatric vision loss can be derived from congenital factors or acquired during early development. The most common congenital etiologies include congenital cataracts, congenital glaucoma, and retinopathy of prematurity. Congenital cataracts involve the opacification of the ocular lens present at birth. This could lead to amblyopia and irreversible visual impairment if not addressed promptly. Congenital glaucoma occurs when intraocular pressures increase, causing vision loss due to optic nerve damage. Retinopathy of prematurity is diagnosed in premature infants and can result in neovascularization in the retina, potentially leading to retinal detachments.

Genetic disorders of the eye can also lead to pediatric vision loss. Retinitis pigmentosa is a retina degeneration that leads to progressive vision loss, starting with the loss of peripheral vision. Leber congenital amaurosis is a rare genetic condition affecting the retina, resulting in severe visual impairment or blindness from an early age. In the realm of neurological and developmental disorders, cerebral visual impairment (CVI) is common in patients with developmental delays or premature birth. CVI involves damage to the brain’s visual pathways, which affects visual processing, even if the eyes are healthy. Optic nerve hypoplasia is another observed reason for pediatric low vision and involves the underdevelopment of the optic nerve.

Assessment and diagnosis

Early identification and intervention are essential for children with visual impairments. Pediatric ophthalmologists and optometrists specializing in low vision perform thorough evaluations to identify the child’s visual capabilities and requirements. Evaluations include visual acuity testing, visual field assessment, visual complexity assessments, and a review of the child’s overall development.

A collaborative approach involving the child’s low vision specialist, parents, rehabilitation specialists, and teachers is crucial in managing the child’s vision loss. Timely intervention and regular evaluations are essential to ensure the child can achieve maximum potential.

Low vision can profoundly affect a child’s general development, impacting education, social relationships, and emotional well-being. The effect of low vision on a child might differ based on factors such as the etiology and severity of the visual impairment, the age of onset, and the existence of accompanying conditions. There are several ways in which visual impairment may affect a child.

Children with low vision face various challenges that affect their education, social interactions, and overall development. In terms of reading and writing, these children may struggle with standard print materials and often require alternative formats such as large print, braille, or audiobooks. Participating in visual classroom activities, such as watching presentations on a board, can also be challenging. Limited access to visual aids like charts and graphs may hinder their understanding of certain subjects, affecting their overall academic progress.

Social and peer interactions can be equally challenging for children with low vision. Difficulty in recognizing facial expressions and body language can impact their ability to interpret social cues, whereas participation in sports and outdoor activities may require additional support. These limitations can sometimes lead to social isolation if peers are unaware of the child’s needs or if the child struggles to join group activities.

Emotionally, vision loss can have a significant impact. Children with vision impairment often have lower self-esteem as they navigate school and social settings with peers who do not have the same disabilities and experience the difference. The struggle with visual tasks at school can also cause feelings of frustration and anxiety. Additionally, the path to achieving independence in activities of daily living, such as getting dressed, eating, and showering, is more complex and delayed due to alternative techniques.

Solutions

Low vision aids for children aim to enhance their remaining vision and support their educational and daily activities. The selection of aids depends on the child’s visual needs and preferences. Here are some common low vision aids for children:

Optical aids, specialized materials, and adaptive tools can significantly enhance the learning experience and daily life of children with low vision. Magnifiers, available in handheld or stand-mounted formats with various magnification levels, can help children read books, view classroom materials, or examine objects closely. Telescopic lenses, often mounted on glasses, improve distance vision and facilitate activities like watching presentations or participating in sports.

Assistive technologies such as digital magnifiers and text-to-voice readers can help children access learning material and participate in class. Numerous screen magnification software programs can be downloaded directly onto a computer or tablet, allowing for zooming in and voice activation and enhancing overall accessibility with higher-contrast buttons and thoughtfully positioned apps and widgets.

Consuming large amounts of learning material with limited vision can be extremely tiring and slow for children with visual impairments. Audiobooks and text-to-speech software allow the child to access information in a way that would be less fatiguing and quicker.

Tactile aids in books and models could offer a hands-on approach to learning, such as using a raised map to teach topography, using tactile objects to learn about arithmetic, and using puzzles to develop spatial awareness.

Large-print materials like books and worksheets allow better visibility and readability with large fonts, higher contrast, and increased spacing. For children with severe visual impairment or blindness, braille books and materials foster literacy and access to learning resources.

Educational accommodations are necessary to address challenges pediatric patients may face in school. Individualized education plans can help the child in specific ways through support services and strategies. Vocational planning and exploring career options become important as the child considers the next steps after high school. This process may involve exploring technological or accommodative options necessary to pursue the child’s plans despite their visual limitations.

It is essential to recognize that each child is unique, and the effects of low vision might differ significantly. Timely intervention, nurturing educational settings, and availability of suitable resources and services can substantially alleviate the difficulties linked to low vision, enabling the child to flourish and achieve their maximum potential. Cooperative efforts among parents, schools, health care experts, and low vision specialists are crucial for adequate support. This collaborative strategy ensures that the child’s medical, developmental, and educational requirements are met, improving their overall well-being and quality of life.