1. Which of the Following Are Likely to Be Among Jacob S Visual Characteristics?

FINAL EXAM SPE 516 2013

PART 1 Answer the following questions based on the scenarios that precede them. Always select the BEST answer.

You are a TVI in a small rural school district. You have just had a new student added to your caseload. The new addition, Jacob, is a six month old baby who was born at 24 weeks gestation. Because he was so premature, his retinas did not develop completely, leaving him with a condition called retinopathy of prematurity (ROP). Jacob also has a slight but persistent nystagmus.

1. Which of the following are likely to be among Jacob’s visual characteristics?

I. His eyes are likely to be larger than those of a normal infant. II. It is likely that his pupils will be efficient in regulating the amount of light that enters the eye. III. He will probably have difficulty in moving his eyes smoothly. IV. He will likely have problems with visual acuity.

a. I, II, and III b. II, III, and IV c. I, III, and IV d. I, II, and IV 2. As Jacob’s TVI, you know that the following fact(s) is (are) true. I. As Jacob grows older and more mature, his nystagmus will probably dampen. II. Very little can be done to help Jacob learn to use his vision more efficiently. III. Because he cannot respond verbally, it is not possible to derive a measure of refraction for Jacob. IV. New synapses will continue to develop in Jacob’s brain until he is around 10 years old.

a. I only b. II, III, and IV c. I and III d. I and IV

3. Since Jacob has a severe problem with his retinas, which of the following categories of visual loss would you expect him to have? a. Visual field b. Cortical visual impairment c. Binocularity d. Esotropia

You are a vision professional (TVI or COMS) who has just gotten a new student, Janette, on your caseload. Janette is currently 12 years old. When she was 7, she was involved in an automobile accident that resulted in her having a fairly significant head injury. While she is mobile, she is not verbal beyond some semi- predictable gestures. Janette is pleasant and eager to please.

4. Which of the following is most likely the cause of Janette’s visual losses? a. Amblyopia b. Cortical visual impairment c. Color blindness d. Retinitis pigmentosa

5. Based on what you know about Janette’s condition, which of the following is expected to be true?

a. Her visual abilities should remain constant b. Her ability to perceive color should be the same c. Her impaired vision is a result of damage to her eyes d. Her visual processing will be without difficulty 6. Which of the following part of the visual system is most effected by the condition that Janette has?

a. The retina b. The sclera c. The optic tract d. The choroid

7. You accompany Janette and her mother to the optometrist’s office. There are a number of techniques that you observe. Which of the following is used to assess the vitreous and retina?

a. The retinoscope b. The tonometer c. The slit lamp d. The computer retinoscope ______

FUNCTIONAL VISION ASSESSMENT

Name: Amanda Hoeffer Date of birth: May 11, XXXX Age: 6 years District: Oasis ISD Placement/Grade: First Grade Date of assessment: January 24, XXXX Evaluator: James McClelland, COMS

I. Background Information

Amanda Hoeffer is a 6 year old student at Clear Creek Elementary in Oasis Independent School District. She is currently placed in a regular first grade classroom and her primary teacher is Mr. Terrence Adams. This assessment was performed at the request of Ms. Jo Simpson, Diagnostician for OISD as part of a three year reevaluation.

II. Eligibility Information

Based on the most current report from an eye specialist, and upon the results of this Functional Vision Assessment, it is the professional opinion of this evaluator that Amanda does qualify as a student with visual impairments under Texas law and current Commissioner’s Rules.

III. Medical History

A. General

Medical records contained in Amanda’s special education folder indicate that her birth history included no significant factors. She was the product of a normal, full term pregnancy, and weighed 7 pounds, 6 ounces at birth. Currently, Amanda is healthy, active, and seemingly unimpaired with the exception of her visual disabilities.

B. Visual

The most current report of an eye exam which is available for Amanda is dated November 20, XXXX, and was based on an examination performed by Dr. Jason Lewis of the Children’s Eye Center in Houston, Texas. This report indicates that Amanda’s visual impairment is due to high myopia, amblyopia, and ocular albinism. A moderate esotropia was also noted. Dr. Lewis also states that Amanda demonstrates behavioral characteristics which are consistent with moderate photophobia.

Amanda’s visual acuities using both eyes are listed as: ○ 20/200 at distance with glasses ○ 20/80 at near with glasses

Amanda is currently being treated for this condition with glasses (see attached copy of prescription). No prognosis for Amanda’s condition was provided by this report.

8. The diagnosis of myopia means that Amanda has problems with:

I. Seeing things at a distance. II. Only one good eye. III. A loss of acuity based on the focal point in her eyes. IV. A refractive error.

a. I, II, and IV b. I, III, and IV c. II and III d. I and III

9. As the vision professional working with Amanda, which of the following would be information that you would want to convey to her teachers?

I. She should be included in all classroom activities to the maximum extent possible. II. She will need extensive help and protection. III. She should be placed in a position in the classroom which is relatively close to the demonstration and teaching area. IV. She should be encouraged to wear her glasses at all times.

a. I and IV b. II and III c. I, II, III, and IV d. I, III, and IV 10. If you looked through Amanda’s glasses, you would immediately note that:

I. Things look bigger. II. Things look smaller. III. The lenses are concave. IV. The lenses are convex.

a. II and III b. I and IV c. I and III d. II and IV

11. Which of the following visual issues is likely to be most important in deciding on how to program for Amanda?

a. color perception b. acuity c. visual attention d. field.

12. Based on the information provided for Amanda, which of the following most nearly reflects the likely prognosis for her.

a. progressive b. improving c. will lead to total blindness d. stable

13. In order to correct Amanda’s refractive error, the eye care specialist would need to prescribe I. a plus lens II. a minus lens III. a lens that would neutralize some of the refraction produced by Amanda’s eyes IV. a lens that would contribute more refraction to Amanda’s visual system

a. I, II, and III b. II and IV c. III and IV d. II and III 14. Refraction (here used to describe the ability to bend light) is measured in units called a. foot candles b. focal points c. diopters d. millimeters

15. Which of the following is true about refraction of light in the eye? 1. The lens contributes more units of refraction than any other structure of the eye. 2. The retina contributes a significant amount of the refraction in the eye. 3. The tears and conjunctiva are refractive structures. 4. Appropriate refraction is essential for forming a clear image on the retina.

a. I and II b. III and IV c. I and IV d. II and III

As you prepare for his Functional Vision Evaluation, you see that the last ophthalmologist to see your student Paul indicated that he had a retinal condition that affected the macula in both eyes. However, in one eye, the entire macula had been affected and in the other eye, only random spots had been affected.

16. Which of the following categories of visual loss is most likely to characterize Paul’s vision? (Explain your answer) a. Visual field loss b. Acuity loss c. Cortical visual impairment d. Binocularity

17. Among the consequences of Paul’s visual condition will almost certainly be

I. He will have a difficult time with seeing in the dark. II. He will have a difficult time perceiving color. III. He is likely to develop an eccentric viewing pattern (holding his head at an unnatural angle). IV. Near vision tasks are likely to be difficult for him.

a. I and II b. II, III, and IV c. I, II, and IV d. I and II

18. As you read the report from Paul’s latest eye evaluation, you note that the doctor indicates that Paul has no pupillary response. You interpret this to mean

I. That Paul will need braille in order to maximize his academic functioning. II. That Paul may be night blind. III. That Paul may have neurological problems. IV. That Paul may have elevated sensitivity to light.

a. II, III, and IV b. III and IV c. I and II d. I and IV

19. What do the terms HM and CF mean when it is used in an eye report?

20. Which refractive error is a convex lens is designed to correct?

Answer the following questions based on the prescription provided.

Spherical Axis Add OD -8.50 3.50 OS -3.00 5.5 X 180 3.50

21. Is this person myopic or hyperopic in the right eye?

22. A.Is the condition in the right eye mild, moderate or serious? B. Do they have astigmatism? 23. How old is the person likely to be?

Part 2 Use information below to answer the following question

STATE OF TEXAS Interagency III. Eye Examination Report

Patient’s Name _Melanie Ann Shelton______Date of birth _02/02/04______Social Security No. ______

Address______City: ______State ______Zip ______

Attention Eye Care Specialist Address each item below. Your thoroughness in completing this report is essential for this patient to receive appropriate services.

Ocular History (e.g. previous eye diseases, injuries, or operations) Age of onset 2 yrs. History Car accident; head trauma; traumatic hydrocephalus; highly variable visual functioning; lesions located posterior to the optic chiasm with more damage on the left hemisphere.

Visual Acuity If the acuity can be measured, complete this box using Snellen acuities or

Snellen equivalents or NIL, LP, HM, CF. If acuity cannot be measured, check the most appropriate estimation. Distance OD HM 3’ OS 20/600

Near unable to test Not Legally Blind

She is legally blind. Legally Blind

These acuities represent my best guess based on two observations of Melanie. Acuity with glare testing, if applicable: R ______L ______

Muscle Function Normal Abnormal Describe

Intraocular Pressure Reading R ___18______L ____16______Visual field Test There is no apparent visual field restriction.

There is visual field restriction. Describe most pronounced in OS; visual fields are likely to be variable. Based on observation and available medical records, there is an almost total loss of central OD.

Yes No The visual field is restricted to 20 degrees or less.

Color Vision Normal Abnormal Photophobia Yes No Variable, but reacts most to red, yellow, and orange.

Diagnosis (Primary cause of visual loss) Cortical Visual Impairment; hydrochephalus; trauma to the visual cortex.

Prognosis Permanent Recurrent Improving Progressive Communicable Can be improved

Treatment Recommended

Glasses Surgery

Patches (Schedule): Hospitalization will be needed for approximately

R ______days.

L ______Name of hospital ______

Medication ______

Refer for other medical treatment/exam: Name of anesthesiologist or group:

______

Low Vision Evaluation

Other No further ophthalmological treatment is anticipated.

Precautions or Suggestions (e.g., lighting conditions, activities to be avoided, etc.)

Scheduling Date of Next Appointment __March, 2009_____ Time ______

A. IMPORT Check the most appropriate statement. This patient appears to have no vision.

This patient has a serious visual loss after correction.

This patient does not have a serious visual loss after correction. Dr. Rita Marshall

Print or Type Name of Licensed Ophthalmologist or Optometrist Signature of Licensed Ophthalmologist or Optometrist

Address Date of Examination March 2, 2010

City State Zip Telephone Number

RETURN COMPLETED FORM TO:

Name Address

Agency City State Zip

24. Which of the following would be acceptable methods for assessing Melanie’s visual field? I. Observing her as a paraprofessional feeds her lunch. II. Asking her to indicate broken lines on an Amsler grid. III. Bringing a puppet into different areas around her. IV. In a darkened room and from behind her head, introducing a pen light with a red filter into different parts of her visual field.

a. I and II b. III and IV c. I, II, and IV d. I, III, and IV

25. The etiology of Melanie’s vision loss is cortical visual impairment. Based on what you know about CVI, which of the following is likely to be true of her visual performance?

I. She will have fluctuating visual performance. II. She will tend to “look, look away, touch.” III. She will have a tendency to have trouble with novelty and clutter. IV. She will have a tendency to see in shades of gray. a. I, II, III, and IV b. I, II, and III c. I, III, and IV d. I, II and IV

26. As you begin to prepare for Melanie’s FVA, which of the following pieces of information from the reports that you have are significant from a VI perspective?

I. Melanie has a mild to moderate hearing loss in her left ear. II. Melanie’s brother receives full day self contained special education services. III. Melanie is monitored closely by a neurologist. IV. Melanie takes Phenobarbital for seizures.

a. I, II, III, and IV b. I. III and IV c. II and III d. II and IV

27. As you peruse the information provided, which of the following pieces of background information would be crucial in planning Melanie’s FVA and educational programming?

a. a more specific and complete birth history. b. a more specific and complete description of the automobile accident in which Melanie sustained her head injury. c. a more complete description of Melanie’s family and their socio- economic status. d. a more complete interview with Melanie’s mother and brother regarding her visual performance.

Cameron Lester

Identifying Information:

Name: Cameron L. Parents: Marilyn and Kary L.

Birthdate: 09-17-xx School: Gate City

Elementary Age: 11- 6 Report Date: 03-17-xx

Teachers: General Ed. S. Miller/Resource E. Priddy

Reason for Referral:

Cameron was initially referred for services at the age of 18 months, by his mother Marilyn L. Cameron is visually impaired due to Oculocutaneous Albinism. At 18 months he was able to receive support services through the Early Education Program in San Jose, CA. and has been on an Individualized Education Program (I.E.P.) since xxxx. Currently, as part of the I.E.P. Team, Cameron is helping to develop goals for his annual review and transition plan to junior high.

Background Information:

Cameron was born at Kaiser Hospital in CA., after a normal pregnancy and delivery. Birth weight was 8lbs. and 1oz. At the time of birth it was noted that Cameron had white hair, a lack of pigment in his eyes, and visual nystagmus. Two days later he was seen by an ophthalmologist, and was to be seen by a doctor in Genetics. It was determined that Cameron had Oculoctaneuos Albinism. Developmental milestones have been within the average range. In xxxx Cameron had strabismus surgery. April of xxxx, Cameron had eye muscle surgery to correct 40-degree head turn. While the family lived in Santa Clara County CA., Early Intervention goals dealt with mastery of basic concepts, orientation and self-advocacy. First grade goals continued with self-advocacy goals, vision goals of access to adaptive materials equipment and group sports. The family then moved to Pocatello, Idaho. Grades 2nd and 3rd dealt with consult goals from Resource Room and 15 minutes per month consult from a vision specialist. The current TVI began working with Cameron as he entered the 4th grade. At this time a Learning Media Assessment was done to provide more comprehensive information on Cameron’s learning and literacy media needs. After the Learning Media Assessment, it was determined that Cameron would benefit from expanding his literacy tools. Large print textbooks and bold – lined paper were ordered. Books on tape and a CCTV (closed circuit television) were also implemented at this time. Keyboarding skills were intensified with the use of a large monitor, screen magnification software, and a screen reading program. Presently, Cameron has more formal instruction after school for keyboarding skills. Increasing organizational skills are also a focus of his new plan.

Cameron has two younger siblings Ellen and Matt, who also have Albinism. TESTING HISTORY

March xxxx M.D. eye exam – Dr. Fishel CYCLOPLEGIC EXAM; Rx: - 4.50+ 6.00 x 80 OD =20/400 - 3.50 + 6.00 x 86 OS =20/400 Absent foveal reflexes OU; Hypopigmentation OU

November xxxx Low Vision Clinic – Low Vision Specialist, Bryan Gerritsen 20/280 for distance visual acuity For near vision – 20/200 in the right eye and 20/150 in the left eye

February xxxx Wechsler Intelligence Scale for Preschoolers and Primary

Children – Revised (WPPSI-R) was administered with a Full Scale Intelligence Quotient of 114.

March xxxx Learning Media Assessment – Cameron’s main channel of learning is vision. Cameron’s oral reading rate was 136 wcpm (words correct per minute) using grade level material in 18 point type. Cameron obviously compensates very well.

March xxxx Academic – grade point average is 3.5 Cameron Lester

28. Cameron’s visual condition is often accompanied by which of the following characteristics?

I. A lack of development of the retina in utero. II. A loss of visual field in the peripheral areas. III. A strabismus. IV. A nystagmus.

a. I, II, III b. II, III, IV c. I, III, IV d. I, II, III, IV

29. The spectacle prescription that is provided in Dr. Fishel’s report indicates which of the following

a. Cameron has no significant refractive error. b. Cameron has both myopia and an astigmatism as well as optic albinism. c. Cameron’s only alternative for improving his visual acuity is to use a low vision device. d. Dr. Fishel is unsure as to the optimum correction necessary for Cameron. 30. The structures of the eye typically affected by optic albinism are: I. The fovea II. The lids and lashes III. The lacrimal system IV. The ocular muscles

a. I and IV b. II and III c. I, II, and IV d. I, II, III, and IV

31. Based on Cameron’s near vision acuity report, the Closed Circuit Television set (CCTV) might be very helpful for some tasks such as looking at pictures in a book or reading a map. However, a major area of concern with CCTV use would be a) over enlargement b) cognitive difficulties in understanding operation c) glare from either the screen itself or back lighting d) inability to enlarge sufficiently.

32. As you prepare to complete Cameron’s required Functional Vision Evaluation which of the following factors (based on what you’ve learned about OA and on the scenario material) would you be most likely to be able to adequately assess through observation in the classroom and on the playground? I. Visual field II. Visual acuity III. Presence or characteristics of head turn IV. Level of photophobia

a) I and II b) II and III c) II and IV d) I. III and IV

33. Which of the following characteristics might you expect in terms of Cameron’s visual functioning? I. The inability to read print, even under optimal conditions. II. Difficulty in moving securely from low to high light areas. III. The inability to travel independently throughout the campus. IV. Lack of motivation to use adaptive techniques because of social pressures and concerns.

a) I and III b) II and IV c) II, III, and IV d) I, II, III, and IV

Short answer – (give me enough to give you credit)

34. Describe the steps that should be undertaken to complete a Functional Vision Evaluation?

35. What is the iris and what is its role in the eye? What implications would you expect if your student had an iris that did not work properly?

36. Why is it important to review the student’s files (school and medical) and interview the parent? Include any areas that you should discuss.

37. Describe diplopia, strabismus, and amblyopia – and how they may be connected.

38. If a person has a problem with their retina which of the five areas of dysfunction could be affected (list the related areas of dysfunction and tell why or how the retina is or could be involved).

39. A) Prisms are generally used to deal with what types of visual problem? B) Why do you need to address portability when looking at optical devices? How does portability impact usage of devices?

40. Which two evaluation recommendations MUST be part of an FVE/LMA?

1. Please tell me your opinion of the FACT SHEET assignment. Please tell me if you feel that it was an effective learning tool. Do you have any suggestions for change or improvement? 2. Please tell me your opinion of the group assignment. Please tell me if you feel that it was an effective learning tool. Do you have any suggestions for change or improvement? Add comments about your group please!