May be present at birth (congenital) or it may develop during infancy or childhood (adventitious). Some visual impairments get worse over time, some stay about the same and a few may even get better. Some students have "fluctuating vision" or functioning that is different at different times of the day depending on the environmental factors.  

A child with visual impairment is one whose vision, even with correction, adversely impacts a child's educational performance. Examples are children whose visual impairments may result from congenital defects, eye diseases, or injuries to the eye. The term includes both visual impairments and blindness as follows:  

• Blind refers to a child whose visual acuity is 20/200 or less in the better eye after correction or who has a limitation in the field of vision that subtends an angle of 20 degrees. Some children who are legally blind have useful vision and may read print.

• Visually Impaired refers to a child whose visual acuity falls within the range of 20/70-20/200 in the better eye after correction or who have a limitation in the field of vision that adversely impacts educational progress. 

The first step in determining what type of vision support the student may need is to obtain a current eye report. Children's vision commonly changes as they grow as does their ability to cooperate with visual assessments. For this reason it is vital to have information that is current, within one year. The eye report must be from an Ophthalmologist or Optometrist. Having a visual diagnosis will assist the Teacher of Students with Visual Impairments (TVI) in knowing what part of the eye is affected and if the condition is progressive or stable. This information is necessary to make appropriate recommendations. The TVI is trained to interpret the eye report and determine implications. Other helpful information includes other medical diagnosis and medications. Neurological reports can be helpful in understanding if part of the visual pathway is affected.  

Once the TVI is able to review medical reports, it will be necessary to conduct a Functional Vision Evaluation (FVE), including a Learning Media Assessment (LMA). This will determine how the student is using vision throughout the day and within certain settings interact with and learn from the environment. A combination of information from the medical reports, the FVE results with assist the TVI in determining appropriate levels of service an adaptations and modifications the student will need in order to learn best from the educational setting. It will also include a determination of student's primary and secondary learning or reading mode. This information is helpful in determining if a student is a print, visual, tactual, braille, or auditory learner.  

The Process of receiving vision services begins when there are concerns about a child's vision. The following is a list of the ABC's of vision problems. If a student is experiencing difficulties using their vision, the first step is to take the student to the optometrist or ophthalmologist to determine the cause, recieve a visual a diagnosis, approximated visual acuity, and determine if the student needs to be referred for school based vision services.

APPEARANCE

• One or both eyes turn inward or outward, or one is slightly higher or lower than the other eye
• ​Crusty or red eyelids or red eyes​
• Eyes that are constant, rapid motion
• ​Drooping eyelids
• Pupils of different sizes, or different reactions to light and accommodations
• ​Glands that are enlarged, inflamed, or otherwise infected
• ​Excessive tearing, light sensitivity, lid spasms

BEHAVIOR

• Lack of or reduced eye contact
• Shows poor eye muscle coordination
• Covers or closes one eye for critical seeing
• Thrusts head forward to see distant objects
• Tilts head to one side for critical seeing
• Tries to "brush away" a blur
• Rubs eyes often or blinks often while reading or looking at books
• Frowns or squints when looking at or trying to see distant objects
• Stumbles often over objects, is awkward
• Holds book, toy, or picture too close or too far away

COMPLAINTS

• Sensitivity to light
• Burning or itching of eyes or eyelids
• Seeing double or blurred vision
• Headaches, usually after a critical visual task
• Nausea or dizziness

​SCHOOL RELATED​

• Difficulty copying from the board
• Difficulty with handwriting
• Confuses similar words
• Needs more light to read than expected
• Reading comprehension deteriorates with time
• Doesn't read to the end of a sentence before going to the next
• Head moves instead of eyes when reading or looking at pictures
• Loses place when reading and skips lines
• Needs to use finger as line marker
• Difficulty solving maze puzzles and word searches
• Math errors due to misalignment of numbers