Foundation of Special Education and Inclusive Education

Module 5 –Learners with Difficulty Seeing (Visual Impairment)

Learning Objectives

At the end of the module, you are expected to be able to:

1. distinguish the different types, identifications, etiologies, causes, characteristics of

learner with difficulty seeing;
2. describe the different types and levels/degrees, etiologies, causes and characteristics of
these learners; and
3. demonstrate knowledge of teaching strategies that are inclusive of learners with
difficulty seeing.

Topic Outline

Lesson 1. General Description of Visual Impairment

Lesson 2. Causes, Treatment and Management at School
Lesson 3. Prevention
Lesson 4. Strategies

Lesson 1. Basic Principles of Visual Impairment

Description

Vision plays a vital role in school learning and it is essential that teachers understand the
visual abilities of their students. Serious vision problems are not common in schools but there are
some students who have serious vision loss or who are blind. Many students who have mild to
moderate vision impairments are not identified as such, so teachers have an important role in
detecting vision impairment. As is the case with hearing impairment and some other disabilities,
students with vision impairment can sometimes be mistaken for students with intellectual disability
or learning difficulties, so when a teacher finds that a student is struggling at school, they should
always check the student’s vision and hearing. When vision impairment is not addressed at school, it
can lead to learning difficulties and even behavioural problems, as the student misses important
information, struggles to keep up with other students, loses confidence and becomes frustrated.

Courtesy of Callan Services, Wewak

Lesson 2. Causes and Treatment of Vision Impairment

Eye Condition Observable Effects Management at School

Cortical visual impairment Often occurs with other Use clear and simple
Eyes appear normal but disabilities (e.g., cerebral objects and colours to try to
there is damage to the palsy). Very low or no teach visual recognition. Use
nervous system that the vision. Problems making other senses (touch and
brain uses to process visual sense of visual information hearing) for teaching and
information. CVI is caused communicating.
by brain damage.

Dry eyes Night blindness and gradual Leafy vegetables and

Also called xeropthalmia or loss of vision. The white vitamin A supplements can
keratomalacia. A vitamin A part of the eye becomes reverse the condition.
deficiency resulting from dull and wrinkles. The
malnutrition. The eye cornea may bulge and
becomes very dry and the burst, causing blindness.
cornea softens and forms The condition is reversible
ulcers. in its early stages.

Eye Condition Observable Effects Management at School

Glaucoma Fluctuating vision loss, Children with glaucoma
High pressure inside the over-sensitivity to light, loss experience pain, which
eyeball. Eye becomes of visual field. Glaucoma worsens during times of
enlarged and blindness can can be stopped with stress.
occur. medicine.
Hemianopia Loss of visual field. Teach scanning skills. Use clear
Loss of vision in half the Students scan a lot. markers at the beginning
visual field of each eye. Condition can be helped and end of sentences and
with surgery and medicine. If to mark other important
not corrected, reading visual information.
ability and other school
activities.can be seriously
affected

Hypermetropia Eye strain when reading. No special management is

Long-sightedness. Glasses are needed. needed if the child wears
glasses.

Keratoconus Decreased distance vision in Avoid heavy contact sports. Avoid

The cornea becomes coneT both eyes. Vision is glare.
shaped. distorted. Can be corrected
with glasses but in some
cases a corneal transplant is
needed.

Macular disease Loss of clear vision and Students need to sit close to the
Degeneration of the central extreme short-sightedness. chalkboard. Visual information
part of the retina. Over-sensitivity to light. needs to be very clear and well
Loss of colour vision. Tinted marked.
glasses and very strong
glasses for distance
viewing can help.

Myopia Blurry distance vision. No special management is

Short-sightedness. Glasses are needed. needed if the child wears
glasses. Very clear
materials need to be
provided if glasses are not worn.

Nystagmus Uncomfortable vision, Provide shorter visual tasks.

Rapid, involuntary eye which worsens at times of Allow the child to position
movement. stress. themselves comfortably.

Optic atrophy Fluctuating vision loss. Very Larger, clearer printed

Degeneration of the optic strong glasses needed for material. Visual information needs
nerve. close and distant viewing. to be very clear and well marked.

Optic nerve hypoplasia Decreased vision, Larger, clearer printed

Small, undeveloped optic depending on severity of material. Visual information needs
nerves. the condition. Very strong to be very clear and well marked.
glasses are needed for
close and distant viewing.
Eye Condition Observable Effects Management at School
Retinal detachment Partial or total loss of sight. Surgery Avoid contact sports. Use bright
Detachment of the retina can correct the condition. Very lighting for reading and other visual
from head injury or other strong glasses can help. activities.
condition.

Retinitis pigmentosa Loss of peripheral vision, loss of Restricted mobility in

Progressive degeneration vision in unlit places, tunnel vision, unfamiliar places.
of the retina. overt sensitivity to light. Encourage scanning. Caution
needs to be taken in darker places.

Retinoblastoma Depth perception is If the student has lost an eye,

A tumour of the retina. affected if one eye is position the child where they
removed. Central or can best see the chalkboard.
peripheral vision loss,
depending on the position of the
tumour.

Retinopathy of prematurity Loss of vision or blindness, short- Use large print materials.
Scars of the retina in very sightedness and glaucoma. Encourage use of remaining
premature babies. Surgery may help. vision. Assist with mobility in
unfamiliar places.

Strabismus Affects hand-eye Allow extra time for visual tasks.

Muscle weakness, causing coordination and depth
turned-in eye perception. Surgery or
corrective glasses may help.

Toxoplasmosis Loss of central or peripheral vision. Use large print materials and
Inflammation and scarring Blind spots. clearly marked visual material.
of the retina.

Trachoma Irritation and inflammation of the Ensure that students and parents
An infection of the eyelids eyes, small lumps under the adopt good hygiene practices, keeping
and cornea, usually eyelids, and partly cloudy eyes and faces clean.
resulting from poor hygiene. cornea. Antibiotics can stop
Can also be spread by flies. trachoma but good hygiene is the
best prevention.

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 As a general rule, students with vision impairments need clear, well-marked visual materials
(e.g., diagrams with important information highlighted or with arrows marking relevant parts), large,
clear print in reading material and good lighting. Teachers should also ensure that the classroom is
kept free of hazards and that chairs, desks, and so on, are not moved around all the time. This is to
ensure that students with very low vision do not trip or stumble but, rather, can learn the layout of
their classroom. Teachers should also compensate for students’ low vision by using more spoken
information and asking other students to help students with vision impairments with their work.

Students with vision impairments are often very poor spellers, as they are not able to
recognize the patterns in words or to picture words, in the ways that students with normal sight
do. Teachers need to be sensitive to this particular need and not assume that the student has a
learning difficulty because of their poor spelling.

Lesson 3. Prevention and Intervention

Prevention

Many types of vision impairments are inherited and cannot be prevented. However, some vision impairments
can be prevented, as follows:
• Students need to be educated to never throw stones, sticks or other small or sharp objects at other
children.
• Students need to be educated about keeping chemicals such as lime, cement, petrol, and cleaning products
away from their hands and eyes.
• Students and parents need to be educated about hygiene, especially keeping eyes, faces and hands clean.
• Eyes should only be cleaned with clean water; no chemicals should be placed in or near the eye.
• Children should always be taken to a health clinic if they have any kind of eye problem or irritation.
• Children and mothers need a diet that is rich in vitamin A. The best foods for vitamin A are leafy
vegetables, cassava, paw paw and other yellow and orange vegetables.
• Girls should be vaccinated against rubella (German measles).

Intervention:

Children with visual impairments should be assessed early to benefit from early intervention programs, when
applicable. Technology in the form of computers and low-vision optical and video aids enable many partially sighted, low
vision and blind children to participate in regular class activities.

Assistive Technology for Learners with Difficulty Seeing

The wide range of assistive technologies for people with difficulty seeing provides plenty of choices for users at all
stages of sight loss.
a. Screen readers. A screen reader is a specialized type of software that converts electronic text to speech and
outputs it to headphones, speakers or refreshable Braille devices, in line with user preference. Screen readers
utilize an accessibility API (a software “hook”) to access either a web browser and the web content it renders or a
computer’s operating system, which in turn communicates with certain computer software.

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b. Screen magnifiers. A screen magnifier is software that interacts with a computer to present enlarged screen
content.
c. Speech Recognition Software. Speech recognition software allows people to operate their computer and enter
data during voice rather than a mouse or a keyboard.
d. Text-to-speech (TTS) Software. Text-to-speech software converts written text such as, text files, web pages, PDFs
and emails into audio files that can play on a wide range of devices, such as computers, MP3 players, iPods and CD
players.
e. Optical Character Recognition (OCR) Software. OCR software takes scanned text and converts the scanned image
into an electronic text file, which can be saved and edited.
f. Large Monitors. Large monitors make on-scree reading easier by providing more space onscreen, for people
tomanage preferences in their operating systems for how certain elements are displayed.
g. Closed Circuit Television (CCTV). CCTVs are stationary standalone devices that use cameras to magnify large format
printed materials and objects. The materials are inserted into a shelf in the device, which displays the magnified
images on-screen.
h. Hand held Electronic Magnifiers. Hand held magnifiers work in similar way to CCTVs, are standalone devices but in
like CCTVs, they are smaller and are laid flat on objects to magnify smaller items of pieces of text.
i. Dictation Devices and Transcription. Dictation devices allow people to record meetings or take notes that can be
transcribed from the recording made. Most devices are standalone and require human translation, although there
are some devices that have integrated or bolt-on translators, but the output is not always accurate so human
review is still required.
j. Scanners. Scanners convert images from printed material to a computer file. The type of scanner used in
the context of assistive technology is a flatbed scanner, which scans at a high resolution and can be
accessed by a wide range of other assistive technology devices.
k. Standalone Reading Machines. Standalone reading machines integrate a scanner, optical character
recognition software (OCR), and speech software and function without the need for a computer. Users
place printed materials or an object that they would like to read into the device, which scans it, coverts
it into text and then reads the text out loud.
l. Fusers and Swell paper. Fusers are used to produce tactile printed materials, such as diagrams and maps
on especially designed swell paper.
m. Braille Technology. There are several different types of devices that utilize Braille technology and
provide discrete outcomes based on user needs.
• Refreshable Braille Displays. Refreshable Braille Displays are electronic devices that connect to
computers and produce tactile Braille output from what is on-screen.
• Braille Note takers. Braille note takers are mobile devices that use either a Braille or QWERTY
keyboard for input and voice and/or refreshable braille for output. They also use a variety of
methods to connect to and transfer information to and from other devices.
• Braille Embossers. Braille Embossers are specialized printers that produce Braille embossed
documents. They use Braille translation software to convert electronic documents into Braille
before printing.
• Braille Writers. Braille writers can be either manual or electronic devices that are used for Braille
input. Manual Braille writers produce Braille onto paper and electronic Braille writers input
Braille directly into a computer.
• Braille Translation Software. Braille translation is used in conjunction with a Braille embosser.
Electronic documents are loaded into the translation software and can be edited, if necessary,
before printing.
n. Alternative Keyboards. A standard keyboard may not be suitable for people who have low vision. Many
people who have low vision use their large print keyboards with high contrast colors or large print
adhesive keyboard stickers in high contrast colors than are affixed to a standard keyboard.
o. Audio Description. Audio description is the provision of an additional narration track for audio visual
content displayed on a television, video, computer or cinema screen, for viewers who wish to access it.

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 It describes what is happening on-screen and utilizes the natural pauses in the audio order to be
unobtrusive.
p. Audio Players. There are devices available for Visually Impaired people using a variety of formats, but
the main formats that are being promoted are the DAISY format. Which requires a DAISY player, and the
mp3 format, which is the standard format for digital audio music, podcasts and audio books.
q. Digital Books. Digital books are available via handheld devices or tablets and use a variety of formats,
many of which are specific to the device being used.

Strategies to support reading and writing

General strategies to supporting a child with visual impairment
Where should a child with visual impairment sit in class?

Some children do not like bright light shining in their eyes. Other children need extra light to see well. Teachers
will need to discuss with each child what works best for them by using a trial and error approach. The teacher
needs to sit the child in different positions in the classroom then ask the child what works best so they can see,
read and write to their maximum ability. Dependent on the feedback from the child the following methods can
help:
1. If the child needs less light, sit the child away from the window. Use paper or cloth to cover the window to
stop bright light shining into the classroom
2. If the child needs more light, sit the child with their back to the window. The bright light will come over their
shoulders and shine on the book in front of them
3. Sit the child at the front of the class so they are close to the chalkboard and can hear the
teacher.
4. Sit the child next to a friend that can help them follow teacher’s verbal instructions.

Think about your classroom. Where do students with visual impairment sit? How can you make it brighter for
children who need extra light? How can you make it darker for children who need less light?

Best practices to support students with visual impairment

• Children with visual impairment may work more slowly than other students when reading
and writing. Allow more time to complete work and tests.
• If the child reads and writes very slowly the amount of writing may be reduced by using
other methods. For example, the student writes for 50% the test and speaks the answers
for the other 50%.
• The teacher needs to consider all options when writing lesson plans and make
modifications so all students can complete class work.
• Provide extra help to support children with visual impairment, but also give them
opportunity to work alone so they learn to be independent.
• Encourage them to use their vision as much as possible. Give lots of praise and
encouragement for completing work.
• Encourage children with visual impairment
to be neat and tidy and look after school
materials. This helps them to be organised

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 and be able to find equipment and books
easily.

Equipment to help children with visual impairment Eyeglasses

Some children will benefit from eyeglasses to help them see more clearly. The type of eye problem they
have will determine when they should wear their glasses:
• Near vision problems- wear eyeglasses in class for reading, writing and other activities only
• Far vision problems- wears eyeglasses when moving around outside
• Near and far vision problems- wears eyeglasses all the time

The teacher needs to be aware of which students require eyeglasses and support the child to wear
their eyeglasses in school and take care of them. Some children will be shy to wear their glasses
especially if other students tease them or call them names. The teacher can talk to the whole class
about problems with seeing and why some people wear glasses. Playing the game described below
with all the students in class can help them understand and prevent teasing or name calling of a
child with visual impairment.

Magnifying glasses
Magnifying glasses are useful for people that have very poor near vision. It helps them to see small detailed
things close to them. It can help with reading text and
looking at pictures.

Equipment and methods to support students with reading

Reading stands are useful for children with poor near vision. By placing a book or paper on the reading stand
the student will find it easier to read and write as they don’t have to lean forward to look. Instead they can sit
up straight. This is more comfortable and better for their backs.

Reading stands can be made from different materials. Reading stands from specialist shops are often
made of plastic. However they are easily made from local materials. For a strong reading stand that will
last a long time, a local carpenter can make one out of wood. An easier option is for the teacher or
parent to make a reading stand from cardboard. A temporary reading stand can be made by using
a lever arch file. The pictures below provide examples of reading stands made from different materials

Using large letters

Often students with visual impairment can see large letters better. The letters stand out more.
Books written in large letters can help a student, or the teacher can copy the text from the book on the
chalkboard or paper in big letters.

Letter size Size 10

Letter size Size 12
Letter size Size 14

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 Letter size Size 18
Letter size Size 20

Some students with visual impairment do not like large letters and prefer small letters. How do you
know what size letters to use? Show the student with visual impairment different size letters and ask
them which one they can see and like best.

Chalkboards

When writing on the chalkboard always make sure the board is clean and write with large clear letters. A
dirty chalkboard can be difficult to read for students with visual impairments. Wipe it clean at the end of every
day to remove the chalk dust. If the chalkboard is old it can sometimes be painted again with black paint to
make it clean. What is the chalkboard like in your classroom?

Best Practices to support students with low vision

• Use print size 18 point or above
• Keep the layout clear and simple.
• Avoid text on a patterned background.
• Printing on coloured paper may make text easier for some visually impaired students toread.
• Black text on a yellow background provides maximum contrast.
• Avoid using red and green ink.
Using fingers to follow the words
Students with visual impairments often lose their place when reading from a book. All students can
do this when reading. Teaching all students to follow the line of text with their finger helps them to
not lose their place.
Reading Guides
A reading guide can also help students to keep place when reading. A guide can be made out of a
rectangular piece of card with a slit cut out the size of one reading line. The card is placed on the page
so the student can only see one
line through the slit. The student slowly moves the reading guide down the page, so they reveal a new
reading line whilst hiding the previous one.
A reading guide is useful for students with visual impairment and learning difficulties. It is also useful
for students that have difficulty concentrating or remembering, or are easily distracted by lots of
visual information on the page they are trying to read.

Place the reading guide on the book for the

Reading guides can be made from card. Get a
student. The student will move the reading
piece of card and cut out a rectangle hole.
guide down as the read the sentences

LEARNING ACTIVITY

Activity 1

Ask for someone at home to participate at least three children or even adult. Put a cloth over their
eyes, then guide them walk around at home and let them feel different things. After the game, talk to
the participants about:

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• How did it feel not being able to see?
• What did your friend do to help you?
• How can we help children who cannot see at school?
You put their answers into writing and ask permission from them to record and take a picture during
the activity.

Activity 2

Write a sentence in your smallest handwriting. Then write it again in slightly bigger handwriting.

Continue doing this until you have written a sentence in very big handwriting. As your handwriting gets
bigger, use pens with thicker tips. This will make your handwriting BOLDER as well as bigger.

You can use at least 2 bond papers for this activity.

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