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WHAT and HOW Does This Child See?

Assessment of Visual Functioning
Development and Learning

Lea Hyvärinen and Namita Jacob

“WHAT and HOW does this child see?” is a question that is asked each day by many professionals in early intervention and education. This book tries to help you structure your questions so that you can look for answers together with other members of your team. This book is a collection of questions and answers from our lectures in a number of countries. It is written for teachers and members of early intervention and rehabilitation teams of all disabled children, but it can also be read by ophthalmologists, optometrists, neurologists, pediatricians, psychologists, and research workers in early intervention and special education.


Chapter 1 - To the Reader

Chapter 2 - Ocular Motor Functions
2.1 Fixation
2.1.1 Children with severe motor disabilities
2.2 Saccades
2.3 Following eye movements
2.4 Accommodation
2.5 Convergence, strabismus and amblyopia
2.6 Nystagmus
2.7 Ocular motor functions during reading
2.7.1 Assessment of near vision tasks at special schools
2.8 Visual ergonomics
2.8.1 Assessment of complex problems in resource centres
2.8.2 Meeting motor and magnification needs for the future occupation
Questions to Dr. Lea
References in chronological order

Chapter 3 - Visual acuity
3.1 Preparing for measurement of visual acuity
3.1.1 Spectacles during testing
3.1.2 Preparing to test
3.2 Recognition visual acuity: child able to match
3.2.1 Measurement of near vision acuity: single, line, crowded
3.2.2 Measurement of distance vision acuity: single, line
3.2.3 Demonstration and reporting of visual acuity values
3.3 Detection visual acuity: child not able to match
3.3.1 Detection acuity tested with small objects
3.3.2 Grating acuity as detection acuity
3.4 Important details in testing
3.4.1 Pointing at the optotype to be read changes the test
3.4.2 Children may not see all optotype tests as well
3.4.3 A difficult to test child
3.4.4 Visual Acuity and Legal Blindness
Questions to Dr. Lea

Chapter 3b - Technical Details on Visual Acuity Tests
3b.1 International recommendations
3b.2 Recognition acuity tests
3b.3 Why do we have several tests for recognition acuity?
3b.4 Notations of visual acuity values
3b.5 Luminance level on the visual acuity tests
3b.6 How to measure the power of the spectacle lenses
3b.7 Measurement of refractive power without retinoscopy
3b.8 Optimal text size and reading strategies
3b.9 LogMAR values in research work
3b.10 Other visual acuity tests

Chapter 4 - Contrast Sensitivity
4.1 The functional relevance of Contrast Sensitivity
4.2 The relationship visual acuity / contrast sensitivity
4.2.1 Contrast sensitivity in young healthy children
4.3 Measurement and interpretation of contrast sensitivity
4.3.1 Optotype tests to measure contrast sensitivity
4.3.2 Grating tests to measure contrast sensitivity
4.3.3 Tests for challenging situations
4.4 Translating results into recommendations

Chapter 5 - Visual field
5.1 Normal visual field
5.2 Specific field losses and their functional implications
5.2.1 Scotomas in the central visual field LEA Campimeter
5.2.2 ‘Tunnel vision’ and communication field
5.2.3 Hemianopia
5.3 Observations and portable tests of visual fields
5.3.1 Observation of use of visual field
5.3.2 Confrontation technique
5.2.3 LEA Flicker wand
5.3.4 Vice Versa test
5.3.5 Demonstration spectacles for visual field losses
5.4 Clinical testing and interpretation of results
5.4.1 Goldmann and automated perimetry in retinitis pigmentosa
5.4.2 Changes that are not measurable in the visual field in RP
5.4.3 Goldmann fields in assessment of visual field loss in CP
5.5 Comparing clinical findings and visual functioning
5.5.1 Special considerations for individuals with field loss
5.5.2 Changes in identity
Questions to Dr. Lea

Chapter 6 - Colour Vision
6.1 How we see colours
6.1.1 Changes in colour perception due to common eye disorders
6.1.2 Inherited colour vision deficiencies
6.2 Colour vision tests
6.2.1 Training for testing
6.2.2 Colour vision tests for screening
6.2.3 Quantitative colour vision tests
Question to Dr. Lea

Chapter 7 - Motion perception
7.1 Functional relevance of motion perception
7.1.1 Motion perception and moving
7.1.2 Motion perception and communication
7.2 ssessment of motion perception
Question to Dr. Lea

Chapter 8 - Visual Adaptation
8.1 Light levels and cone and rod cell functioning
8.2 Causes of changes in visual adaptation
8.3 Assessment of cone adaptation
8.4 Filters as treatment of photophobia
8.5 The science behind the filter lenses
8.6 Photophobia and night blindness due to other causes
Questions to Dr. Lea

Chapter 9 - Processing of Visual Information
9.1 Brain structures involved in visual processing
9.2 Typical Behaviours
9.3 Assessment, general considerations
9.3.1 Functions to be tested
9.4 Early visual processing functions
9.4.1 Direction and length in the early processing of visual information
9.5 Ventral stream functions
9.5.1 Pictures as representations of objects and activities
9.5.2 Copying basic forms, texts, and pictures as visual tasks
9.5.3 Face blindness, prosopagnosia
9.5.4 Perception and recognition of facial expressions
9.5.5 Recognition of concrete objects and landmarks
9.6 Reading
9.7 Mathematical spatial, memory and recognition problems
9.8 Dorsal stream functions
9.8.1 Spatial awareness and orientation
9.9 Depth perception
9.10 Simultaneous perception, simultanagnosia
9.11 Eye-hand coordination
9.12 Integration of sensory and motor information
9.13 Mirror neuron system
9.14 Visual and auditory overload
9.15 Reporting on visual processing problems
9.15.1 Profile of visual functioning
9.15.2 Dual sensory processing losses
9.15.3 Summary
Questions to Dr. Lea

Chapter 10 - Summaries of Assessments
10.1 Teenager with retinitis pigmentosa
10.2 Child with normal visual acuity using a CCTV
10.3 Five-year old boy with brain damage at birth
10.4 Toddler with late development of vision
10.5 Assessment of Disability
10.5.1 Vision for communication and interaction
10.5.2 Vision for orientation and moving
10.5.3 Vision for activities of daily life, ADL
10.5.4 Vision for sustained vision tasks
10.5.5 Assessment without clinical findings
10.5.6 Activities and Participation
10.5.7 Environmental factors
10.5.8 Summary

Chapter 11 - Planning of Assessment
11.1 Planning the first assessment of an infant/a child with a transdisciplinary team
11.2 Case history
11.3 Factors affecting visual functioning in test situations
11.3.1 External factors
11.3.2 Individual factors Visual sphere Visual attention Motivation Visual memory Motor functions
11.3.3 Quality of incoming information Fixation and scanning Visual field Effect of spectacles
11.4 Plan of the testing
11.5 Assessment as a part of therapy or teaching
Questions to Dr. Lea

Chapter 12 - Epilogue

Appendix I
Visual Pathways and Retina

Appendix II
Letter to the ophthalmologist/optometrist, a model

Appendix III
Short info for Administration


References in Alphabetical Order