The last thing most children want is to stand out as “different” from their peers. So when a child faces low vision challenges, the task to eye care professionals and educators is to find the most effective ways to overcome the child’s visual impairment, allowing full participation in the classroom while minimizing the “I’m different” factor.

The primary objective of pediatric low vision programs is to help children function maximally in their educational environment, explains Duke pediatric ophthalmologist Sharon Freedman, MD, who has taken the lead in establishing the Duke Pediatric Low Vision Program.

“There are a fair number of children with eye conditions or diseases that leave them with less-than-optimal vision,” Freedman says. “Beyond the care they receive from their pediatric ophthalmologist, they also need guidance to meet their needs in school. There are very few programs that specialize in providing pediatric low vision services, and there is a strong need, which is why we decided to establish a formal program at Duke.”

Low vision can be the result of a range of childhood conditions -- including albinism, pediatric cataracts or glaucoma, various retinal and optical abnormalities, and nystagmus, a condition that causes involuntary eye movement. Fortunately, most of these conditions are very rare, but that also means a child may be one of the only children in the school -- or even in a whole school system -- with that issue.

As one of the nation’s top specialty pediatric ophthalmology programs, Duke sees patients with uncommon conditions from all over the world. Through this new service, the Eye Center can more effectively share its expertise and experience to help school systems and families meet the needs of these children.

School Is the Focus

In North Carolina, any child with best-corrected vision of 20/70 or worse is entitled to the services of a teacher for the visually impaired (TVI), who works with the student to help him or her function at the highest level in the school environment.

TVIs are well versed in various techniques and devices -- from simple options like good lighting or a handheld magnifi er to special glasses or a small portable telescope to help the student see the blackboard. They can even help with assistive technologies such as computerized enlargement of print or a device that projects magnifi ed images from the blackboard onto a computer screen.

To determine what types of assistive devices and strategies would best serve a particular child in the school and home settings, each child goes through a low vision evaluation, generally with a specially trained optometrist. The low vision specialist then works with the TVI, school system, and family to implement these recommendations.

Elana Scheiner, OD, an optometrist who specializes in pediatric low vision, has joined the Duke Eye Center to help lead Duke’s new service. Scheiner, who also has a private family practice in Apex, North Carolina, and works with the Governor Morehead School for the Blind in Raleigh, is an expert in helping children with low vision succeed in school.

“I’m excited that Duke has taken such a huge step in adding visual rehabilitation and low vision services to what they have to offer,” says Scheiner. “My ultimate goal is that these children can meet all of their goals: within the classroom and without, they can see what they need.”

In addition to seeing referred patients, Freedman and Scheiner as well as Eye Center social worker Renee Halberg, MSW, will be working with the Governor Morehead School to reach out to educators and children in school systems that do not have professionals to provide local pediatric low vision evaluations. The plan is to bring visually impaired children from underserved counties to Duke where Scheiner will provide consultation and low vision planning for the child and the TVI in the student’s school.

Children Have Unique Needs

For adults with limited vision who often want help to continue to read, sew, or watch TV, for instance, cost may not be a major issue, nor is the need to stay in one place to use the device. For young patients where the priority is to smooth their educational path, cost and mobility are both big factors.

“Generally, the school system is paying for the devices that the student will use at school,” Freedman explains. “If the device is expensive and delicate, or if it is too heavy or cumbersome to move from class to class, what do you do? If the equipment has to stay at school, how can the student do his homework? Our role is to find solutions so these kids can function both in the school environment and then also at home.”

With students there’s also the “fitting in” factor. “Generally, that means a solution that is portable and, if possible, lower in cost so it can either be duplicated or brought home. For instance we might recommend a little magnifier that the student can put in his backpack and carry around school and take home. It’s not glitzy, but it’s better for the kid. They want to look normal. If you give them some big thing that stands out, they often won’t use it,” she says.

The Pediatric Service will benefit greatly from the resources and expertise of the new Duke Vision Rehabilitation Program for adults, Freedman acknowledges. “I am thrilled by the program that Diane Whitaker and Jerry Mansell have established. Although the populations we serve have different needs, there will be many opportunities to collaborate to help our patients better.”

Gifts Make New Service Possible

Pediatric low vision is an important field but not a lucrative one. Such programs are lucky if they can break even financially.

The Duke Eye Center has been exceedingly fortunate, Freedman notes, to have received very generous gifts from LC Industries and from the Peter and Tracy Douglass family to purchase the low vision examination equipment and devices needed to launch the Pediatric Low Vision Program.

“These gifts were absolutely critical in getting this program started,” Freedman says. “We are very excited to be able to offer this resource, not only for our own patients but for children, families, and schools throughout the region.”