Subsequent Exam Findings

In his early childhood, he received services for the visually impaired and regular follow-ups every three months. At the age of six, he started learning Braille as the prognosis for his vision was uncertain. He was taught Braille in addition to print.

Exam at 6 years

  • VA OD NLP, OS 20/125 ETDRS
  • Refractive Error +20.00/+3.00
  • IOP OD 21mmHg, OS 14mmHg
  • Learning Braille
  • Large Print (using 48pt)
  • Black marker/Bold lined paper for writing
  • Aide in the classroom

By the age of seven, he had lost all vision in his right eye except for light perception. This made him essentially monocular.

Exam at 7 years

  • VA cc OD LP
    • cc OS 10/100
    • cc OU 10/100(20/200) Feinbloom
  • Near VA 0.4/3M (20/150) Lighthouse
  • Fundus Exam:
    • OD complete cupping
    • OS 80% cupping with good rim
  • Current Meds: Timoptic, pilocarpine and diamox

Low Vision Recommendations at 7 years

Bifocals are an important part of treating a child who has had surgery for cataracts, as the surgery involves removing the lens. The spectacles perform the function of the lens, which is to focus light, but since the overall prescription is to correct refractive errors for distance, the bifocal is needed to correct errors in near vision.

  • Spectacle Prescription
    • OD +20.00/+3.00 add
    • OS +20.00/+3.00 add
  • 1.8X bright field magnifier (20/40)
  • 3X illuminated magnifier with battery plug–in-handle (20/40)
  • 4.2X12 telescope (10/25)
  • External light source at work area
  • Services of TVI
  • Services of O + M (caning)
  • Braille/hypotonia and poor touch sensitivity are an issue
  • CCTV introduced
  • Bold-lined paper/black felt tipped pen

Exam at 9 years

  • VA cc OD LP
    • cc OS 10/120
    • cc OU 10/120 Feinbloom
  • Near VA cc 0.4/3M (20/150) Lighthouse
  • Visual Field restriction

Vision concerns at 9 years

  • Difficulty reading standard print without use of CCTV
  • Cannot see blackboard
  • Teacher using overhead projector
  • Hand devices prescribed last time seem insufficient to enhance vision

Low vision recommendations at 9 years

  • Spectacles
  • CCTV/only mag device effective
  • Hard copies of overhead projections at his desk
  • Telescope is of limited benefit because of reduction in visual field and contrast sensitivity
  • Intense Braille studies

This chart shows his declining field of vision:
progression of visual field loss

He did not maintain his vision, having significant decline year after year. He never became a good Braille reader because of poor touch sensitivity. His primary education was switched to an auditory format.

Exam at 11 years

  • VA cc OD LP
    • cc OS 10/200 Feinbloom
  • Near VA cc 0.4/5M (20/250)
  • Visual Field Restriction continued decline

Low vision recommendations at 11 years

  • Braille – can type well but reading Braille is slow due to poor touch sensitivity
  • Kurzweil reader for long term reading
  • Talking calculator for math
  • Audiotapes in class and books on tape
  • Jaws (screen reading program for word processing/ Internet)
  • Notebook computer with Jaws and Zoomtext
  • CCTV still effective (prefers 72 point)

Notebook- most effective method to accomplish written tasks in class. Teacher can monitor his work which cannot be done with Braille N speak. Helpful to take notes and transfer tasks home for homework. Fatigue and hypotonia contribute to his ability to persevere from a visual standpoint.