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22 June 2008

LOW VISION

(How to help an infant/child grow up with low vision)

Our child was born with low vision. To be specific the eye doctor said it was PHPV (Persistent Hyperplastic Primary Vitreous). The problem lies in the optic nerve. Images seen through the eyes do not reach the point of vision at the back of the eye as the optic nerve. Why this happens? Our doctor could not explain. It’s a birth defect that happens to 1 in 100,000 people. Something that doesn’t happen often apparently. He is very nearsighted and can see just the first two lines on the eye chart even with spectacles. The spectacles helped him see the second line.

Anyway, it was devastating to us, to say the least. Parents who have a child born with a disability will often feel this way as it is unexpected and many are not ready to cope and don’t know how to cope. Unless you are a professional eye doctor plus psychologist, it’s something you have to deal with and something you have to learn about as your child grows up. Many people will have a negative reaction to your child’s disability but this should not stop you from giving him/her the best and from teaching him/her how to cope and grow up as normally as possible. The most important things is to teach him/her self esteem, independence in getting about, and ways to adjust to this different way of looking at things.

The more time you spend and invest in your child’s upbringing, the better he/ she will be able to cope and the more loved he/she will feel despite having a disability in life. Life goes on, and so must we.

We, as parents have had to learn from scratch on how to help our child. We are our child’s first teacher. When our child was just a few months old the eye doctor recommended that we train him to focus by giving him a lot of bright and stimulating things look at with the hope that it will help him while his eyes are still developing. Below are a few things we have tried and tested. Although he remains nearsighted, he has learnt to focus and read and write. We hope it will help you in some way. Do consult your child’s eye doctor and read as much books or articles as you can. Improving your own knowledge does help. We have been given pointers by our ophthalmologist on a few eye training which we will share with you.

MOBILES

Bright and colourful musical Mobiles will not only attract your low vision child to its sound but also train him/her to focus. You need not make it go around. If you do wind it up, it goes around slowly and will help your child train his/her eyes on moving objects.

You can also make your own from light materials that can be hung up. Be creative and imaginative. Find handicraft pointers from books, magazines, friends, teachers or the internet.

PLAYGYM

Again something colourful and bright for your baby to focus on. Some have music to attract your child’s attention. When he/she is able to reach out while lying on his/her back, the toys will not only train the eyes to focus but also the arm and finger muscles to hold and grasp. Later the baby will be able to spin the toys for entertainment. Be careful to make sure the paint/plastic is LEAD FREE if you do allow your baby to bite the toys.

SHAPE SORTER

Shape sorters can come in various designs. Some are in the form of cups. Some are in the form of rings and others are boxes etc. The brighter and more colourful they are the better.

These too you can make on your own. Find colourful plastic cups. Get boxes out from your storage area and paint them or wrap them in present paper. Use your imagination.

WALL POSTERS

There are many types for many age levels. Choose one suitable for your child’s age. Toddlers and younger children like posters with large colourful pictures. Post them at the child’s eye level on blank walls around the house to give your child something to focus on as he/she learns to move around the house. Use blue tack instead of selotape or double sided tape. Blue tack are easily removed and don’t ruin your wall/paint. They can also be reused again and again.

Often adults forget that there is nothing for kids to look at. Most pictures and paintings are at adults’ eye level.

PICTURE BOOKS


These come in various sizes. Some are made of soft, colourful cloth, some are made from hardcover with thick pages and others are the usual type of books with soft pages. The more advance ones are electronic books which uses batteries and even have sounds with the pictures. Depending on your budget, get some suitable for your child’s age.

The pictures sometimes come with words and sometimes not. The child can look at the pictures at his/her own eye comfort level. You cannot force a low vision child to look at a book like a person with normal sight would. This is torturing the child. If others make comments, tell them your child has low vision. There is nothing to be ashamed about.

If you can’t afford brand new books, shop around for second hand ones or make your own. Get sheets of cardboard paper (discarded cardboard boxes are a good place to start) and cut out pictures from magazines or newspaper.

READING BOOKS

Depending on your child’s vision, you can still buy books for them. As they grow older, you and your eye doctor/optometrist will be able to decide what font size your child will be able to read. People with low vision may not be able to see far but some do have good near sight and small writings are not a problem for them. The larger and bold the writing the easier for a low vision person to read it.

I have a few sample of different font size here for comparisons.

If your child still has problems reading the larger font sizes, you can use magnifying glasses and there are also various equipments which you can use to magnify the writings in book. Contact your nearest Blind/low vision centre or Eye doctor for more information on these equipments.


PUZZLES


For older kids, there are puzzles with small to extra large pieces available in the market. Choose those suitable for your child’s vision level. This is a fun way for him/her to focus, first on the small items then on the larger picture once it is done.

NIB SIZE, CLARITY

Once your child starts to go to school it is good to help him/her as much as possible in being able to write as well as read his/her own writing.

Start with pencils and colour pencils which have large nibs so that when your child starts to scribble or write, he/she will be able to see the effects of the pencil. Compare pencils nibs and clarity of writing when buying them. Very light writing are those marked with HB or H. Darker ones are B or 2B.

COLOUR

Low vision people can see darker colours better than lighter ones. Darker ones are like Dark Blue, Black or Purple. Medium colours are like Red, Green and Orange. Light colours are like yellow, light green and cream. Unless used on a dark paper, light colours cannot be easily seen.

If your child has the added problem of colour blindness, consult your eye doctor on which colour he/she can see best. Use these to your child’s advantage as he/she grows up.(ie; buy clothes and toys in these colours).

When your child is older and can read buy your child his/her own colour pencil set and write the names of the colour (with permanent ink) at the end of the colour pencil with large bold print. Sometimes school work requires that a child colour a certain picture this or that colour which can be quite frustrating for the colour blind child.

DEPTH PERCEPTION

Train your child to see depth perception. Get him/her to colour sample pictures like this and to look at art pictures which has depth perception.

SEQUENCING

This exercise trains the child’s eyes to focus from one thing to anther. You can make it easier by spelling and reading the word for him/her but if he/she is old enough let them try it on their own. Let them be independent.

This second exercise is harder. Not only is the writing smaller but there are more numbers/alphabet to follow. You can help by enlarging the writing for your child if he/she still can see it with the help of magnifying glass.

SEEING VERTICAL, HORIZONTAL AND DIAGONAL

A school age child should be able to spell simple words and find the words in the box. You can help by making a window on a piece of paper or by giving him/her a ruler to locate the words. Once he/she is getting good at this exercise, take away the ruler/ window and let him/her use the eyes instead. This may take time to improve but be persistent and patient.

Give encouragement.

MEMORY IMPROVEMENT 1

This exercise is similar to the one above but it is harder. It has more words to search for. Once your child knows how to read, train him/her to memorize the words before looking for them.

MEMORY IMPROVEMENT 2

Be creative. Find other ways to help your child to improve his/her memory so that he/she will be able to learn better and faster once he/she is of school going age. Even if he/she has to stand near the board to see something, he/she won’t need to do it often.

1. Shopping lists: Start with just a few things to buy (pretend) then as his/her memory improves, make the list longer and longer.

2. Object identification: Find a picture book, magazine or photo. Start with those which has only a few things or people in them. Give a time of say 1 min to memorize. Take away the picture or photo and ask your child to tell you what he/she sees in the picture. Its al right to make mistakes. Keep practicing until he/she gets better. Then find a harder picture or photo to look at and to memorize.

3. Sentences: Start with short sentences, then longer and longer. Don’t expect him/her to memorize whole paragraphs yet. Keep practicing as far as he/she can go. Don’t pressure him/her. Make it fun. Poems are good sentences to remember. Start with Nursery Rhymes.

4. Giving faces names; Cut out faces from magazine or newspapers. Give them a pretend name. Ask your child to identify and remember their names. Take away their labels and try again. Make more and more faces and names to remember as your child improves. One way of doing this is by imagining a funny feature of the person and linking it to the name (ie: Mrs White has white hair, Mr. Becks wear Specs. etc.)

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