Our nation’s special education law, the Individuals with Disabilities Education Act (IDEA) defines visual impairment, including blindness, as follows:
“…an impairment in vision that, even with correction, adversely affects a child's educational performance. The term includes both partial sight and blindness.”
[34 Code of Federal Regulations §300.8(c),(13)]
TYPES & CAUSES
The umbrella term “visual impairment” may be used to describe generally the consequence of an eye condition or disorder. Understanding a bit about the anatomy of the eye may be helpful to understanding different types of visual impairments.
Visual impairments are usually caused by traumatic injury like getting hit in the eye or head with a baseball or having an automobile or motorcycle accident. Some babies are born with congenital blindness, which means they are visually impaired at birth. Congenital blindness can be inherited or caused by an infection, like measles, that is transmitted from the mother to the developing fetus during pregnancy.
- Near-sightedness (myopia) – objects nearer to the individual are clearer; can result when the cornea is too curved for the length of the eyeball, the lens is too thick, or from an eyeball that is too long that focuses the image in front of the retina instead of on it. Myopia can be inherited and is likely correctable.
- Far-sightedness (hyperopia) – objects further from the individual are clearer; can be caused by an abnormally shaped cornea, lens, or an eyeball that is too short that focuses the image behind the retina instead of on it. Hyperopia can be inherited and is likely correctable.
- Amblyopia (lazy eye) – occurs when one eye is favored or used more than the other and the weaker eye does not work well with the brain; the most common visual impairment in children affecting as many as 3% of all children; can be caused by crossed eyes (strabismus), cataracts, eye focus issues (near- or far-sightedness), and astigmatism (irregularly shaped eyes).
- Cataracts – lens of the eye is cloudy; age, smoking, and diabetes are the leading causes of cataracts. Prolonged exposure to UV sunlight and a family history of cataracts may also increase risk.
- Glaucoma – a group of diseases that cause vision loss by damaging the optic nerve; can occur congenitally, genetically, or as a result of high blood pressure and/or diabetes.
- Retinopathy of prematurity (ROP) – may occur in premature babies (born before 31 weeks) when the light-sensitive retina hasn’t developed sufficiently before birth; one of the most common causes of vision loss in children and can lead to lifelong blindness and visual impairment.
- Retinitis pigmentosa – a rare inherited disease that slowly destroys the retina; affects approx. 1 in 4,000 people worldwide.
- Coloboma – a condition in which a portion of the structure of the eye is missing; can be caused by interrupted eye development in a fetus during the first two months of pregnancy; can be genetic.
- Optic nerve hypoplasia – caused by underdeveloped fibers in the optic nerve which affects depth perception, sensitivity to light, and acuity of vision.
- Cortical visual impairment (CVI) – caused by damage to the part of the brain related to vision, not to the eyes themselves.
- Stargardt disease – an inherited disorder of the macula of the retina which senses light and sends signals to the brain for image processing; may experience slow progressive vision loss most often during childhood or adolescence.
(Center for Parent Information and Resources, CPIR, 2017)
(Lighthouse Guild, 2019)
Because there are many different causes of visual impairment, the degree of impairment a child experiences can range from mild to severe (up to, and including, blindness). The degree of impairment will depend on the particular eye condition a child has, what aspect of the visual system is affected (e.g., the ability to detect light, shape, or color; ability to see things at a distance, up close, or peripherally), and how much correction is possible through glasses, contacts, medicine, or surgery.
- Partially sighted indicates that some type of visual problem has resulted in a need for special education.
- Low vision generally refers to a severe visual impairment, not necessarily limited to distance vision. Low vision applies to all individuals with sight who are unable to read the newspaper at a normal viewing distance, even with the aid of eyeglasses or contact lenses. They use a combination of vision and other senses to learn, although they may require adaptations in lighting, the size of print, and, sometimes, braille.
- Legally blind indicates that a person has less than 20/200 vision in the better eye or a very limited field of vision (20 degrees at its widest point);
- Totally blind students learn via Braille or other non-visual media.
Visual impairment is the consequence of a functional loss of vision, rather than the eye disorder itself. Eye disorders which can lead to visual impairments can include retinal degeneration, albinism, cataracts, glaucoma, muscular problems that result in visual disturbances, corneal disorders, diabetic retinopathy, congenital disorders, and infection.
FACTS AND STATS
According to the 2017 American Community Survey (ACS), there are approximately 568,202 children with vision difficulty in the U. S. According to the 2015 ACS, there are 282,164 girls and 286,038 boys under the age of 18 (0-17) that have vision difficulty in the U. S. These include only children that have serious difficulty seeing even when wearing glasses as well as those who are blind.
American Foundation for the Blind (AFB, 2019)
Globally, it is estimated that approximately 1.3 billion people live with some form of distance or near vision impairment. People with vision impairment are more likely than those without to be over the age of 50 years and/or experience higher rates of poverty and disadvantage. Uncorrected refractive errors and cataracts are the leading causes of vision impairment. It is estimated that 80% of all visual impairment is considered avoidable.
Children with visual impairments should be assessed early to benefit from early intervention programs, when applicable. Prevention and early detection of a serious eye disease can help preserve residual eyesight. Prevention of visual impairment, when possible, includes the following:
- Schedule regular comprehensive eye exams.
- Commit to healthy lifestyle choices including eating a nutritious diet, maintaining a healthy weight, regular exercise, and getting 7-9 hours of sleep.
- Quit smoking.
- Maintain healthy blood glucose, blood pressure, and cholesterol levels.
- Wear UV protected sunglasses.
- Protect eyes from injury and damage by wearing safety glasses, goggles, and safety shields during certain sports, while working with power tools, and other work related situations.
- Take periodic eye breaks from a computer or object that may make you blink less and cause eye fatigue. A 20 second break every 20 minutes is recommended.
- Keep clean hands, contact lenses, and contact lens cases.
- Know your family’s eye health history. Many eye diseases are genetically inherited.
These preventative actions can help reduce the risk of age-related macular degeneration, sun damage, cataracts, diabetic retinopathy, and glaucoma.
(Lighthouse Guild, 2019)
The organization Prevent Blindness recommends a continuum of eye care for children to include both vision screen and comprehensive eye examinations. All children, even those with no signs of trouble, should have their eves check at regular intervals. Guidelines are provided at the website.
(Prevent Blindness, 2020)
Common signs that a child may have a visual impairment include:
- Eyes that don’t move together when following an object or a face.
- Crossed eyes, eyes that turn out or in, eyes that flutter from side to side or up and down, or eyes that do not seem to focus.
- Eyes that bulge, dance, or bounce in rapid rhythmic movements.
- Pupils that are unequal in size or that appear white instead of black.
- Repeated shutting or covering of one eye.
- Unusual degree of clumsiness, such as frequent bumping into things or knocking things over.
- Frequent squinting, blinking, eye-rubbing, or face crunching, especially when there’s no bright light present.
- Sitting too close to the TV or holding toys, books, and other devices too close to the face.
- Avoiding tasks and activities that require clear vision.
The effect of visual problems on a child’s development depends on the severity, type of loss, age at which the condition appears, and overall functioning level of the child. Many children who have multiple disabilities may also have visual impairments resulting in motor, cognitive, and/or social developmental delays. A young child with visual impairments has little reason to explore interesting objects in the environment and, thus, may miss opportunities to have experiences and to learn. This lack of exploration may continue until learning becomes motivating or until intervention begins. Because the child cannot see parents or peers, he or she may be unable to imitate social behavior or understand nonverbal cues. Visual disabilities can create obstacles to a growing child’s independence.
There may be ways to improve sight. Treatment is dependent upon the type and cause of visual impairment. Eyeglasses, contact lenses, and surgery are all possible treatments for various visual impairments. LASIK eye surgery is the most commonly performed laser eye surgery to treat near- and far-sightedness as well as astigmatism. Children with a lazy eye (amblyopia) may wear an eye patch on one eye, receive surgery to help with weak eye muscles, or intentionally blur vision in the stronger eye to encourage use of the weaker eye with medicated drops or glasses. Surgery and medication may be appropriate in certain instances of cataracts and glaucoma. More specialized procedures and medications may be considered for conditions like retinopathy of prematurity and retinitis pigmentosa.
Therapists who have been trained in vision problems can suggest exercises that may improve some vision problems. If vision cannot be improved, training and special devices may help the person adjust to the impairment.
(Lighthouse Guild, 2019)
Children with visual impairments should be assessed early to benefit from early intervention programs, when applicable. The prognosis generally relates to the severity of the impairment and the ability of the aids to correct it. A good low vision exam is important to be aware of the latest low vision aids.
It is possible to live an active lifestyle with most visual impairments. Many people use eyeglasses or magnifiers so they can still perform certain activities. To function safely, affected people may, however, need to rely on signals other than sight. For example, some lighted signals at a crosswalk also make beeping sounds to indicate when it is safe to cross the street. People who have severe vision problems or are blind can benefit from special devices and training. A white cane and a guide dog are familiar aids for helping blind people function on their own. Computers and smart devices are able to read screens and recognize speech effectively and can talk to the person. Keyboards with Braille symbols, Braille books, and audio books are also widely available.
Children with visual impairments need to learn the same subjects and academic skills as their peers, although they will probably do so in adapted ways. They must also learn an expanded set of skills that are distinctly vision-related, including learning how to move about safely and independently in their environment, use assistive technologies, use what residual vision they may have effectively and efficient, and read and write in Braille if determined appropriate by the IEP team.
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. Students with visual impairments may need additional help with special equipment and modifications in the regular curriculum to emphasize listening skills, communication, orientation and mobility, vocation/career options, and daily living skills. Students with low vision or those who are legally blind may need help in using their residual vision more efficiently and in working with special aids and materials. Students who have visual impairments combined with other types of disabilities have a greater need for an interdisciplinary approach and may require greater emphasis on self-care and daily living skills.
See the AFB website for a number of key links related to education issues, laws, and policies. (AFB, 2019).
Also see the CPIR website related to blindness/vision impairment and sections for Educational resources and Accessibility Solutions at the site for the American Printing House (APH, 2019). Several sites below have resources and services specifically related to music, music teaching, and music learning.
ORGANIZATIONS & RESOURCES
American Council of the Blind (ACB)
1703 N Beauregard St, Suite 420
Alexandria, VA 22311
The American Council of the Blind is the nation's leading membership organization of blind and visually impaired people. It was founded in 1961 and incorporated in the District of Columbia. The Council's membership numbers in the tens of thousands. The majority of its members belong to one or more of its 71 affiliated organizations. There are also members-at-large. Membership is not limited to blind or visually impaired individuals. There are many sighted members. Legal blindness, however, is a requirement to serve on the ACB Board of Directors.
Music: The site provides a list of several resources that include different types of software for composition and reading music as well as piano technology and accessible guitar chords and scales are provided.
American Foundation for the Blind (AFB)
1401 South Clark Street, Suite 730
Arlington, VA 22202
The American Foundation for the Blind (AFB) is a national nonprofit that expands possibilities for people with vision loss. AFB's priorities include broadening access to technology; elevating the quality of information and tools for professionals who serve people with vision loss; and promoting independent and healthy living for people with vision loss by providing them and their families with relevant and timely resources. AFB's work in these areas is supported by the strong presence the organization maintains in Washington, DC, ensuring the rights and interests of people with vision loss are represented in our nation's public policies.
American Printing House for the Blind
1839 Frankfort Avenue
Louisville, Kentucky. 40206
The American Printing House for the Blind maintains a comprehensive body of information and research relating to blindness and visual impairment. They publish essential professional textbooks for universities program and make available an immense, free catalog of tactile images for teachers.
Austin Classical Guitar (ACG)
PO Box 4072
Austin, Texas 78765
Austin Classical Guitar’s mission is to inspire individuals in the communities we serve through musical experiences of deep personal significance. At the heart of the organization’s mission is ACG Education, a program that was launched in 2001 in an effort to improve the quality of classroom-based guitar instruction in Austin schools. ACG provides a flexible and comprehensive curriculum which was expanded for youth who are incarcerated or on probation, as well as braille-adapted instruction for blind and visual impaired students.
The Blind Children’s Center is a family-centered agency which serves children with visual impairments from birth to school-age. The center-based and home-based programs and services help the children acquire skills and build their independence. The Center utilizes its expertise and experience to serve families and professionals worldwide through support services, education, and research. The organization was founded to serve children from birth to school-age who are blind or severely visually impaired. The Center’s goal is to provide a comprehensive program of specialized education and training which will optimize the blind or visually impaired child’s development and consequent opportunities to lead a meaningful and productive life.
20 Roszel Road
Princeton, NJ 08540
Formerly known as Recording for the Blind & Dyslexic (RFB&D), Learning Ally has its roots in providing vinyl recordings of textbooks for returning soldiers who were blind. Moving from vinyl disks, to tapes, to CD’s, and now a mobile app, Learning Ally continues to be on the forefront of technology to ensure our students have state of the art solutions specifically designed to seamlessly integrate into the classroom and at home. Our transition from a library to a solution that helps drive student engagement and outcomes was based upon deep research to understand the needs of educators and students we serve. Today, our innovation is cultivated in Learning Ally Labs, where we mine student usage data and learning behaviors, learn what teachers need and what works in the classroom, and develop relationships with world-class researchers to build better resources for both our educators and students.
250 West 64th Street
New York, NY 10023
800.284.4422 – TTY 711
Lighthouse Guild is the leading organization dedicated to addressing and preventing vision loss. They coordinate care for eye heath, vision rehabilitation, behavioral health, and related services. Lighthouse Guild was officially formed in December 2013 when Jewish Guild Heathcare and Lighthouse International combined, to become the leading non-profit vision and heathcare organization. The goal is to reduce the burden of living with vision loss; it is the cornerstone of what we do.
National Braille Association, Inc. (NBA)
95 Allens Creek Road
Bldg. 1, Suite 202
Rochester, NY 14618
The mission of the National Braille Association, Inc. is to provide continuing education to those who prepare Braille, and to provide Braille materials to persons who are visually impaired. Among its resources is a link which is a gateway many useful websites for Braille.
The National Federation of the Blind is the oldest and largest nationwide organization of blind Americans. Founded in 1940 and currently headquartered in Baltimore, the NFB consists of affiliates, chapters, and divisions in all fifty states, Washington, DC, and Puerto Rico. Through a network of blind members, NFB coordinates many programs, services, and resources to defend the rights of blind Americans, provide information and support to blind children and adults, and build a community that creates a future full of opportunities. The International Braille and Technology Center for the Blind (IBTC) is located at the NFB facility. A comprehensive technology evaluation, demonstration, and training organization, they welcome those who are blind or losing vision, students, parents, and technology developers. Access technology experts assist in determining technology, providing comparisons of software and device, provide information on training and equipment, among other services.
The National Library Service for the Blind and Print Disabled (NLS).
Library of Congress
Washington, DC 20542-4962
Formerly known as the National Library Service for the Blind and Physically Handicapped, National Library Service (NLS) is a free braille and talking book library service for people with temporary or permanent low vision, blindness, or a physical disability that prevents them from reading or holding the printed page. Through a national network of cooperating libraries, NLS circulates books and magazines in braille or audio formats, delivered by postage-free mail or instantly downloadable. Under a special provision of the U.S. copyright law and with the permission of authors and publishers of works not covered by the provision, NLS selects and produces full-length books and magazines in braille and recorded formats. Reading materials are distributed to a cooperating network of regional and local libraries where they are circulated to eligible borrowers. Reading materials and playback machines are sent to borrowers and returned to libraries by postage-free mail. Braille books, magazines, and music materials are also made available on the Internet through Web-Braille. Established by an act of Congress in 1931 to serve blind adults, the program was expanded in 1952 to include children, in 1962 to provide music materials, and again in 1966 to include individuals who are blind, visually impaired, or who have other disabilities that prevent them from reading or holding the printed page.
Music: NLS will provide transcription services and, for print music, will provide a free library program of braille and recorded materials. The special music collection consists of more than 30,000 braille and large-print music scores, texts, and instructional recordings about music and musicians on cassette. Persons interested in music materials may receive them directly from the Music Section of NLS. The collection consists of scores in braille and large print; textbooks and books about music in braille and large print; music appreciation cassettes, including interviews and opera lectures; and self-instructional cassettes for voice, piano, organ, electronic keyboard, guitar, recorder, accordion, banjo, harmonica, and other instruments. Braille scores and books are also available on the Internet. Contact local libraries for services and more information.
National Instructional Materials Access Center (NIMAC)
502-899-2230 or 877-526-4622
Created by IDEA 2004, NIMAC is a federally funded, online file repository of source files in the NIMAS format, a technical standard that is used to prepare electronic files that can be used to convert printed instructional materials into specialized formats (braille, digital audio, DAISY text, DAISY audio, large print), or other student-ready formats. Teachers, parents, and students who need accessible formats for K-12 textbooks generally do not work directly with the NIMAC. Accessible formats are distributed to students via state systems.
Founded in 1908, Prevent Blindness America is the nation's leading volunteer eye health and safety organization dedicated to fighting blindness and saving sight. Focused on promoting a continuum of vision care, Prevent Blindness America touches the lives of millions of people each year. The organization carries out important roles such as screening, providing educational programs, advocacy, research, and training for screening instructors.
This organization sponsors projects for the blind and visually impaired such as the Bold Note Project and Braille Transcription Project. The Braille transcription project educates Braille transcribers in literary and music Braille for the completion of projects for the Library of Service for the Blind and Physically Handicapped. The Bold Note project assists those with partial vision by creating musical scores with enlarged print.
Last updated January 2020.