We got the formal results of the assessment from Vision Australia a week or so ago, here are some excerpts from the letter:

Background
Bethany was seen by the Opthamologist who has said that the structures of the eyes appear normal, and hence has diagnosed probably Cortical Visual Impairment.  This is a broad term which is used to indicate that the eyes have formed normally, but the reduced visual functioning may be caused by disturbance in the visual cortex or the visual pathways of the brain.

 

Results
Bethany's eyes appeared straight with normal ocular movements, and she appeared to be able to track a 4-5cm object at about 30cms.  Bethany appeared to prefer objects presented at 30-40cms, less interest was shown in objects presented at a greater distance than this.

 

At times, Bethany demonstrated a tendency to look fleetingly at objects of interest, and then sometimes to give a more concentrated look.  This is a common characteristic associated with Cortical Vision Impairment.

 

Bethany gave positive reactions to both the Stycar Balls test and the Lea Gratings paddles, which are both recognised preverbal vision tests for testing children's vision.  The accuracy of these tests increase with age.  Children's vision usually increases until approximately 8 years of age.  Fairly accurate results are usually available from approximately nine months old in children with normal visual functioning.

 

The above tests have an approximate visual acuity of 6/90 to 6/200.  The normal range for vision at four months is 6/24 to 6/90.    Bethany's vision of 6/90 places her vision at the lower level of normal vision for her age.  It is important to note that this was the best vision achieved today, and there will be times when Bethany's vision fluctuates to lower levels than this.

 

A visual acuity of 6/90 means that at 6m, Bethany sees what a person with normal vision sees at 90m.  6/200 means that Bethany sees at 6m what an person with normal vision sees at 200m.  These measurements are approximate only, and are calculated from Bethany's responses to the above tests and then compared with the standardised visual acuity tests.

 

Bethany appeared to enjoy looking at faces, especially a smiling face.  Bethany appeared to prefer yellow and orange over other colours presented.  She also responded to black patterns such as concentric circles and diagonal stripes.  Bethany appeared to enjoy a reflective tinsel pom pom both visually and tactilely.

 

Bethany has intermittent nystagmus, an involuntary shaking movement of both eyes generally associated with poor vision.  With Bethany the nystagmus appeared when in extremes of peripheral vision or if she was trying hard to focus, especially when an object was presented closer than 30cm.

 

Comments and Recommendations

On testing Bethany appeared to have a visual impairment but her best vision did appear to be at the lower level of the normal range for her age.  This vision will give her visual pleasure.  Toys with good contrast that are bold and bright will encourage Bethany to use her residual vision.  It is important to remember that using her vision will be hard work for Bethany, and visual fatigue will be a factor to consider.

 

A multi-sensory approach to play and learning is recommended, as this will provide Bethany with information from a number of senses, and supplement what she may miss visually.

 

• The reduction of visual clutter around pictures and tasks will be beneficial.
• Give Bethany extra time to respond to visual activities.  She may appear to be disinterested in an activity, however, she may just be taking a little longer to process the information, and to action a response.
• A sound cue may be used to gain Bethany's attention if necessary.
• Be mindful of the amount of time spent on visually demanding activities, as this will lead to visual fatigue.  An interactive play session followed by a restful activity will help decrease this.
• Have a variety of activities available to suit fluctuations in vision.  Bethany will be capable of more when she is well, rested and free of distractions.
• Cortical Vision Impairment cannot be treated or corrected.  However, by encouraging overall development  through appropriate play activities, a child's ability to use their remaining vision can improve.