Pre-Employment Transition Services and the Expanded Core Curriculum: A Low Vision Rehabilitation Approach

Sensory efficiency

Sensory efficiency involves how an individual uses their senses to access their environment. For those with low vision, other strategies including touch and hearing are used to compensate for reduction in vision. When assessing vision, it is important to consider all areas of visual function to properly meet a person’s needs. Low vision professionals must gather information regarding the student’s eye condition, age of onset of visual impairment, and any visual changes that have occurred. Considerations of disease progression and future changes are important for recommendations and patient education.

To understand the student’s sensory efficiency as part of the Pre-ETS programming, university optometrists assessed distance visual acuity using the Students of Optometry Serving Humanity (SOSH) acuity chart (Lobby & Johnson, 1979), functional visual field using confrontation testing, and contrast sensitivity testing using the Mars Letter Contrast Sensitivity Test (Mars Perceptrix Organization, 2007). Establishing the refractive status and best correctable visual acuity allowed for the determination of proper magnification. Using this magnification power, the appropriate device selection and recommendation of print size for school material can be determined.

Low vision professionals should also consider the visual efficiency and functional vision of a student as related to their goals. Evaluating near acuities using the Lighthouse continuous text acuity cards (Lighthouse International, n.d.) versus single-letter or single-word options will better assess the fluidity and ease with which a student can read. Single-letter or -word cards may show a better acuity, but they do not allow for efficient and sustainable reading required for higher education and many employment settings. This factor will often aid in decision making as to whether large print size or alternative ways of reading, including through video magnification and text-to-speech are more appropriate. Similarly, although a static visual field assessment is important to understanding the student’s functional visual field, performing an early warning assessment can provide additional information on the functional visual field, which will aid the team in making decisions about further recommendations related to mobility (Smith & Geruschat, 2010).

Compensatory access

Based on the information gathered by evaluating sensory efficiencies, compensatory access strategies were explored and recommended. Compensatory strategies included optical and nonoptical approaches, print size recommendations, technology, and visual field enhancement. Visual field and contrast sensitivity were also considered when making recommendations.

Based on a student’s near visual acuity, critical print size, and target goal, the magnification starting point for devices and font size was determined. Additionally, visual field enhancement was explored utilizing Fresnel prisms and reverse telescopes for students with visual field constrictions. Video magnification and assistive technology would be recommended and trialed during the program if the sensory efficiency evaluation deemed them necessary.

Recommendations were trialed throughout the program, and upon completion, the student and university low vision rehabilitation team reported the students’ feedback to the program directors. This information was vital for making final decisions in recommending devices for use outside the program.

Assistive technology

As a program partner, a local technical and training network loaned various low vision assistive technologies to the program. With the assistance of both assistive technology specialists and low vision therapists, students explored desktop, portable, transportable, and digital video magnifiers in the classroom, dormitory, and community for tasks such as viewing a science lab activity, reading recipes and food labels in the cooking lab, and reading price tags in a grocery store. Additionally, students learned about various settings and features on their mobile devices to maximize functional vision, such as a built-in magnifier, color contrast settings, and large text.

Orientation and mobility

Transportation is one of the most significant factors related to successful employment outcomes for individuals who are visually impaired (McDonnall, 2011; Cmar, McDonnal, & Crudden, 2018). Students participated in several travel lessons devoted to orientation and mobility (O&M), exposing them to orientation strategies, street crossings, bus travel, night-time travel, and pedestrian signal identification. Daytime and night-time wearable filter and flashlight evaluations were conducted to maximize contrast and illumination while simultaneously minimizing glare. Attention was given to assessing the time it took for students to adapt when moving from dim to bright and from bright to dim lighting conditions. Based on the magnification calculations from the low vision screenings, students trialed monocular telescopes for identifying street name signage, pedestrian signals, and bus signage. Some students brought their own telescopes to the program and the university faculty and interns refreshed them on visual efficiency skills for telescope usage, including localization, alignment, focusing, tracing, tracking, and scanning.

Social interaction

Social interactions with peers who are visually impaired were infused throughout the program. Students who signed up for a low vision elective engaged in games such as Movie Bingo and Jeopardy! to win prizes. The bingo card spaces included minified images of movie posters, requiring students to use low vision devices and strategies to see them. The Jeopardy! games incorporated handheld and spectacle-mounted telescopes, lighting and glare strategies, and additional related interventions. During the cow eyeball dissection activity, students were placed in lab groups according to eye conditions and connected with one another over this shared commonality.

Independent living skills

All students had the opportunity to participate in a “Managing Your Own Doctor’s Appointments” lecture, co-taught by a low vision specialist and low vision therapist from the university. This lecture helped prepare students for attending doctors’ appointments independently. Students learned the differences between eye health professionals, including optometrists, ophthalmologists, and opticians, as well as definitions related to blindness, legal blindness, and low vision.

Students were introduced to relevant information about health insurance, the Health Insurance Portability Accountability Act (HIPAA), and how to order and obtain medical prescriptions. Tools, strategies, and materials to accompany them to their various doctors’ appointments were also reviewed.

In the community, students shopped at a local grocery store for items to prepare a meal. University faculty and interns reinforced the use of unaided vision to locate aisle signage and grocery items, followed by using various low vision interventions, including handheld optical devices, video magnification, and mobile applications, to accurately identify printed information. Similar activities also occurred when shopping at the local mall, using an automated teller machine, and at restaurants.

In the cooking laboratory, students prepared meals using both the stove and oven under the supervision of vision rehabilitation therapists. University faculty and interns worked with students who needed additional magnification on transportable video magnifiers to read recipes and product labels.

Recreation and leisure

At a local recreation center, students participated in canoeing, a high ropes course, and rock climbing. University faculty and interns worked with students on using handheld and spectacle-mounted distance optical devices to view their friends on the courses.

Career education

A portion of the programming was devoted to exposure in the fields of science, technology, engineering, and math (STEM). University faculty and interns assisted with visual access to laboratory activities including analyzing pH tests and constructing tactile models from a mock crime scene investigation. Students found near and distance video magnification to be particularly helpful in identifying fine details, colors, as well as viewing activities beyond arm’s reach, especially when observing minerals and crystals with a minerology professor.

Self-determination

Throughout the program, students had the opportunity to trial low vision interventions and provide ongoing feedback about whether they found them to be beneficial. At the end of the program, students participated in an exit interview with university faculty and interns, during which they reviewed all of the low vision interventions trialed and selected which ones they would like to continue using. One student found the low vision interventions to be so beneficial that she requested documentation to be submitted to her individualized education program (IEP) team.

Students in another state transition program designed for middle school students learned about their own eye conditions during a cow eyeball dissection led by low vision specialists, optometric interns, and low vision rehabilitation faculty. Through hands-on activities, students related their eye conditions to functional implications that connected with other students with the same condition. All materials were placed directly beneath the camera of a transportable video magnifier for enhanced visual access.

Students who attended the session on managing doctors' appointments discussed the importance of self-advocacy. University faculty emphasized the importance of asking clarifying questions when something is not understood and receiving medical information in accessible formats.