University of Edinburgh

CVI and Common Ocular Conditions

Presented on 14 December 2012

Supporting the Visually Impaired child in the classroom

Alison Attwood, Head of service
Knowetop Primary School

Service delivery

  • Team of 8 teachers - qualified teachers of the visually impaired or in process of completing the PG Di;loma in Additiona Support Needs (Visual Impairment)

  • Deliver support to
    - Primary school children across North and South Lanarkshire
    - Pre-school children in North Lanarkshire - home/nursery
    - Special schools in North Lanarkshire

  • Knowetop Primary (VI Unit)
    - 15 VI children included in the mainstream setting from across North and South Lanarkshire
    - 8 Additional Support Needs Assistants
    - Resource base - production of adapted materials/resources
    - VI teaching room

  • Peripatetic Service
    - 67 mainstream pupils across NLC
    - 46 mainstream pupils across SLC
    - 22 pre-5 children
    - 76 special school children

  • New Referrals - Session 2011/12 - 57 cases referred

Types of Visual Impairment

Nystagmus Cataracts
Optic Nerve Hypoplasia Marfan's Syndrome
Aniridia Coloboma
Albinism/ocular albinism Retinopathy of Prematurity
Retinoblastoma Haemianopia
Uveitis CVI
Retinitis Pigmentosa Conversion disorder (hysterical blindness)
Achromatopsia Leber's Amaurosis

The Service offers:

  • Consultation, advice and support to staff, pupils and parents.
  • In-service training.
  • Preparing appropriate resources - enlarged print, Braille, tactile diagrams.
  • Training in use of hi-tech and lo-tech aids.
  • Liaison with other agencies, eg health, social work to ensure appropriate support. This includes the voluntary sector (GIRFEC approach).

Visual Impairment Assessment Team VIAT

  • Meets 4 times a year.
  • Team consists of psychologists, TVI, community paediatrician, mobility and rehabilitation officer.
  • Discuss cases, new referrals and plan support particularly at times of transition.

Functional Vision Clinic

  • Joint assessment by health and education - each descipline brings their knowledge and understanding of the child.
  • Parents share their wealth of experience of their child in a relevant environment.
  • One appointment under one roof.
  • Enables better support of child in school as it determines how a child uses her vision.

Low Vision clinic

  • Offers assessment for LVA.
  • Teacher/orthoptist identify children who need LVA.
  • Joint assessment carried out by orthoptist and teacher.
  • Appropriate LVA prescribed.
  • Teacher ensures appropriate skill development in use of the aids.

Case Study
Educational Implications for a child with cortical visual impairment

Sally Paterson, VIS North Lanarkshire

"Appropriate and meaningful curriculum can only be developed for students who are blind and visually impaired when their unique learning style and requirments are clearly understood"

Barclay in Goodman and Wittenstein, 2003, p39


  • 2010 Sarah was diagnosed with pinealblastoma.
  • Following chemotherapy and radiotherapy shw was referred to our service in 2011.
  • The tumour had damaged Sarah's vision.
  • She has light perception in her left eye and a visual acuity of 1/60 in her right eye.
  • Sarah has severely reduced visual field.
  • She wears a +5 prescription for distance viewing.

Educational history

  • Sarah is currently in Primary 2 (she repeated P1 due to prolonged absences during treatment).
  • She is bright, capable and generally has a good memory.
  • She started the P1 curriculum with her peers but reading and writing became a problem.

CVI Indicators

Specific visual behaviours linked to CVI (Dr James Jan)

Sarah presents issues with

  • Visual complexity
  • Colour preference
  • Reduced enquiry skills

Understanding dhil's visual needs and preferences KEY to encouraging the best use of their vision (Roman-Lantzy, 2007).


Koenig and Holbrook (in Corn and Erin, 2010, p 442) express the opinion that any decision made concerning the teaching of literacy must be made by analysis of the way a child uses their senses.

  • Sarah's boks were enlarged to print size N36-48.
  • Sarah was learning the Braille code alongside her sighted peers' literacy programme.
  • Displayed some tactile sensitivity.
  • Writing with black pen on wide black lines.

STILL aproblem with visual complexity of prictures - reading disadvantaged with no picture clues.


Creation of P1 reading books with

  • Enlarged print size
  • Simplified black line drawings
  • Tactile drawings


  • Sarah was learning Grade 1 Braille code.
  • Difficulties overcome by using a Braille code doll - combination of Sarah's visual and tactile recognition skills.
  • P2 problems with quantity of print - decision to teach reading, writing and maths tasks in Braille.
  • Need for Sarah to hang on to old skills using her vision but still encourage Braille as primary learning medium.
  • Delay transferring to Braille - allow for family adjustment.

Barclay (Goodman & Wittenstein, 2003)

Emphasises the importance of assessing social and emotional wellbeing in the light of a child being aware of the changes occurring, as a certain amount of stress will inevitably accompany any change3 to a child's learning mode.


HMIe 2010

Arrangements for assessment should ensure that all children and young people have an equal opportunity to show what they can achieve.

P1 Baseline Assessment adapted for Sarah

  • De-cluttered pictures
  • Concrete materials
  • Olal responses

With these adjustments Sarah achieved a near perfect score.


  • Slow, sometimes rocking gait.
  • Reduced vision and significant depth perception issues - changes in surface perceived as change in depth.
  • Sarah can trip over/bump into anything in lower field and on her left side.
  • CVI indicator (reduced enquiry) inability to plan a route - tendency to stand still and wait to be led.
  • Lack of resilience skills.


  • Sarah displays short-term memory issues with language and spelling NOT with numbers - possiblity that the Braille code is perceived as more mathematical and easier to retain?
  • Sarah's spelling ability has improved greatly using Braille but writing the words is a huge struggle.
  • Reading ability improved using Braille instead of print.
  • Sarah draws pictures that are NOT consistent with visual acuity and visual complexity issues.

As progress can vary greatly from day to day, flexibility of approach is critical for Sarah to achieve.

What happens now?

  • Sarah is fully included in the class literacy and numeracy programme.
  • Written tasks completed in Braille with support.
  • Reading specific Braille texts - aim to return to class readers with Braille script.
  • Number work in Braille and written.
  • Use of vision encouraged where appropriate.

The success of children with a visual impairment in mainstream schools is heavily dependent upon the quality of support that is available to them.