1. Jill Roter, MA jill.roter@lehman.cuny.edu Assistant Director, Student Disability Services CUNY Lehman College July 28, 2010

2.  A person’s acuity (sharpness of vision) and medical eye condition are important pieces of information for determining services. But more important is how someone’s acuity and eye condition translates from medical data to fulfillment of aspects of daily living (ADLs). (In other words, their functional vision.)

3.  To provide statistical context for visual impairment in New York City  To introduce common eye pathologies  To examine 7 factors that impact functional vision, their academic implications, and possible accommodations  To provide hands-on simulation experiences as time allows

4.  Visual impairment (VI): Any chronic visual deficit that impairs everyday functioning and is not correctable by glasses or contacts. Clinically, it is measured as 20/70 in the better eye or total field loss of 140 degrees.

5.  Legal blindness: Clinically measured acuity (sharpness of vision) of 20/200 in the better eye, with best correction, or a visual field of 20 degrees or less. Visual acuity has often been used as a measure for functional impairment due to vision loss, but it is a limited measure. From our definition of VI, a person can be visually impaired without being legally blind.

6.  Functional vision: It is the use of vision for everyday activities. In other words, what is the “REAL WORLD” impairment, and how can remaining vision be used in conjunction with other senses?

7.  Visions/Services for the Blind and Visually Impaired (NYC based agency) estimates that there are 60,000 blind people and 363,000 people with severe visual impairment in NYC.  Less than 2 percent of New Yorkers who are blind or visually impaired currently access rehab services. (Source: American Foundation for the Blind; www.afb.org)

8.  The number of students enrolled CUNY-wide who are blind or visually impaired has remained relatively stable. (During the 1990s there was a low of 305 students and a high of 479 students by the end of the decade.)  Recent data, specifically fall 2008 and fall 2009, showed an enrollment of 273 and 264 students with visual impairments, respectively.

9.  Congenital: ◦ Retinopathy of prematurity (ROP) ◦ Deficits in the visual center of the brain (cerebral visual impairment [CVI]) ◦ Structural abnormalities (coloboma, aphakia, aniridia) ◦ Retinitis pigmentosa (RP) ◦ Albinism  Age-related: ◦ Age-related macular degeneration (ARMD; Stargardt’s=juvenile form) ◦ Diabetic retinopathy ◦ Cataract (can be congenital) ◦ Glaucoma (can be congenital)  Congenital/Age-related/Trauma-induced ◦ Retinal detachment

10. What a person with low vision might experience

11. Person with normal vision Credit: National Eye Institute, National Institutes of Health Ref#:EDS01 Person with ARMD Credit: National Eye Institute, National Institutes of Health Ref#: EDS05

13. Person with normal vision Credit: National Eye Institute, National Institutes of Health Ref#:EDS01 Person with Diabetic Retinopathy Credit: National Eye Institute, National Institutes of Health Ref#: EDS0

14. Person with normal vision Credit: National Eye Institute, National Institutes of Health Ref#:EDS01 Person with Cataract Credit: National Eye Institute, National Institutes of Health Ref#: EDS03

15. Person with normal vision Credit: National Eye Institute, National Institutes of Health Ref#:EDS01 Person with RP Credit: National Eye Institute, National Institutes of Health Ref#: EDS07

16. Person with normal vision Credit: National Eye Institute, National Institutes of Health Ref#:EDS01 Person with Glaucoma Credit: National Eye Institute, National Institutes of Health Ref#: EDS02

17. Source: www.theeyeacademy.com/info_diseases_retinal.html

18. ARMD CATARACT GLAUCOMA Source: www.macula.org/low_vision/simulations.html

20.  Visual acuity (near and far)  Visual field  Control of involuntary eye movement  Color vision/Contrast sensitivity  Light sensitivity (photophobia)  Motivation/intelligence Source: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low Vision

21. CataractDeficits in visual center of the brain AlbinismStructural abnormalities ROP Diabetic retinopathy  General/Academic Implications: ◦ May hold reading materials closer than normal ◦ May experience eye fatigue ◦ May have glare issues  Possible Accommodations: ◦ May benefit from the use of prescribed optical aids ◦ May benefit from good lighting (evaluate seat placement) ◦ May benefit from increased contrast (e.g., bold writing) ◦ May benefit from alternative media; assistive technology software (JAWS, ZoomText, Kurzweil); scribes/notetakers; human readers; and extended time for exams Source: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low Vision

22. GlaucomaROP RPRetinal detachment  General/Academic Implications: ◦ One of the most fatiguing and stressful types of vision loss ◦ These students are very confusing to profs. and peers; can see some things well and others not at all ◦ Night travel/evening classes will be difficult  Possible Accommodations: ◦ May benefit from prescribed optical aids and large print ◦ May benefit from alternative media; assistive technology software (JAWS, ZoomText, Kurzweil, CCTV); scribes/notetakers; human readers; and extended time for exams Source: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low Vision

23. ARMD/Stargardt’s Deficits in the visual center of the brain Diabetic macular edema  General/Academic Implications: ◦ Difficulty especially with near-vision tasks (reading & writing)  Possible Accommodations: ◦ Magnification is generally helpful, as are prescribed optical aids ◦ May require increased lighting and/or direct lighting (evaluate seat placement, lighting for near-vision tasks) ◦ High contrast printed materials are helpful (e.g., bold writing, white print on black paper) ◦ May benefit from alternative media; assistive technology software (JAWS, ZoomText, Kurzweil, CCTV); scribes/notetakers; human readers; and extended time for exams Source: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low Vision

24. Congenital Cataract Deficits in visual center of the brain Albinism Structural abnormalities  General/Academic Implications: ◦ Will often tilt head to find the null point (point where eye motion is at its slowest) ◦ Fatigue  Possible Accommodations: ◦ Usually benefit from high contrast materials ◦ Usually benefit from large print ◦ May also benefit from the use of prescribed optical aids ◦ May benefit from alternative media; assistive technology software (JAWS, ZoomText, Kurzweil, CCTV); scribes/notetakers; human readers; and extended time for exams Source: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low Vision

25. Cataract Glaucoma Diabetic RetinopathyDetached Retina ARMD/Stargardt’s Deficits in visual ctr. of brain  General/Academic Implications: ◦ May not be able to discriminate between different colors, making color-referenced tasks difficult/impossible  Possible Accommodations: ◦ Will require high-contrast materials (bold writing, white on black) ◦ May benefit from alternative media; assistive technology (JAWS, ZoomText, Kurzweil, CCTV); scribes/notetakers; human readers; and extended time for exams ◦ Will benefit from proper lighting, especially for near-vision tasks ◦ May benefit from tactile diagrams Source: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low Vision

26. AlbinismStructural abnormalities GlaucomaDiabetic Retinopathy Retinal DetachmentARMD/Stargardt’s CataractDeficits in visual ctr. of brain ROP  General/Academic Implications: ◦ Require glare reduction apart from bright sunlight  Possible Accommodations: ◦ May benefit from alternative media; assistive technology (JAWS, ZoomText, Kurzweil, CCTV) ; scribes/notetakers; human readers; and extended time for exams ◦ Consider seat assignment; sunglasses or visor may be needed, even indoors; tinted lenses/fitovers may also be helpful Source: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low Vision

27.  A student’s motivation, emotional maturity, self-awareness, and intelligence will play a critical role in their ability to make the most of their remaining vision. Source: Steinberg, Bonnie, Pogrund, Rona & Fazzi, Diane, CAOM 1990. Functional Implications of Low Vision

28.  American Foundation for the Blind (www.afb.org)  National Eye Institute (www.nationaleyeinstitute.org)  Lighthouse International (www.lighthouse.org)  Low Vision Online (www.lowvisiononline.unimelb.edu.au)  Texas School for the Blind (www.tsbvi.edu)  WebAIM Low-vision Simulation (www.webaim.org/simulations/lowvision-sim.htm)