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Orthoptic vision assessment (ova) reports –
communicating with educators and employers about functional vision impairment
Focus: Transition from school to work, or continuing education
Topic: Assessment / low vision.
Ruth Nicholson
Senior Orthoptist
The Royal Victorian Institute for the Blind
557 St. Kilda Road
Melbourne 3181
Victoria
Australia
Tel: + 61 03 9522 5222
e-mail: ruth@rvib.org.au
The Royal Victorian Institute for the Blind (RVIB) has a vision to be the leading provider of services, resources and information, which enable people who are blind or vision impaired to maximise their independence and quality of life. RVIB offers a range of services to adults and children throughout Victoria; with a majority of clients who are not totally blind. As part of the Client Services’ multidisciplinary framework, Orthoptists are available to provide specialist vision assessments, vision training programs and information on eye conditions to clients of all ages.
Orthoptists are paramedical health professionals, with a background in neuroscience, ocular anatomy and pathologies. In a traditional setting, Orthoptists work with Ophthalmologists as Ophthalmic assistants, providing quantitative information, assisting in differential diagnosis, and determining therapeutic regimes of treatment to enhance binocularity of vision. Rehabilitation Orthoptists work with those who are experiencing degenerative vision conditions, or have congenital ocular pathology, and consequential low vision. At RVIB, referrals to the multidisciplinary and Orthoptics services are received from Ophthalmologists, Optometrists, concerned family members or the clients themselves. Frequently, Orthoptics services are requested when clients experience difficulties in a transition situation, and specific needs pertaining to their vision status are not being met.
The provision of an Orthoptic Vision Assessment (OVA) report is a unique service offered by RVIB Orthoptists. Developed with client input, the report is used by the client to communicate specific needs to educators and employers. Those who make the transition from school to work, or continuing education are often faced with continuously informing others of their limitations in completing certain tasks, or the specific environmental modifications required to maximise the use of any remaining vision. The OVA aims to inform, educate, and support the educator or employer so that the needs of the individual with a vision impairment are met with minimal disturbance to others, thus providing an inclusive environment for all.
An extensive functional vision assessment is conducted by an RVIB Orthoptist, with the aim to gathering meaningful information about the client’s vision status and preferred visual environment. The client’s transitional circumstance is taken into account, as this is an important consideration when compiling relevant information for the OVA report.
For example, the needs of the student in transition may be different to a young person who is job seeking or in a work environment and requiring job support.
The Orthoptic Vision Assessment report (OVA) is structured so that firstly, the client’s eye condition(s) is described in simple terms, to provide a background to and an understanding of the possible cause, progression and available treatments specific to the condition. The functional implications of having the eye condition(s) are also discussed in a standard description. Any information pertaining to the client’s eye condition(s) is discussed, and included with the client’s consent. All diagnoses are provided by an Ophthalmologist, with this information obtained by the Orthoptist at the time of referral. Often a formal diagnosis is not available, so the information and discussion pertaining to the eye condition is purely descriptive.
The ‘clinical‘ vision assessment information follows discussion of the eye condition, and is reported along with a descriptive analysis and interpretation of the results, in layperson terminology. Standard visual acuity (vision) assessment charts and tools are used, in accordance with the client’s ability to complete the task eg. considerations of level of intellectual capacity, literacy etc. are made. Visual acuity is examined both for distance and near, using the client’s preferred correction (if worn). Although the client may be in possession of a more recent prescription, or an alternative type correction eg. bifocals, multi-focals etc; it is the functional vision result which is most useful to report. Hence, the vision test results represent the ‘normal’ situation for the client. As the assessment may also be conducted in the client’s more familiar home, school or work environment, the ‘artificial’ environment of the clinical assessment room and its associated ‘false positive’ vision results can be avoided.
The functional distance visual acuity test results are provided in Snellen fraction format, and accompanied by a descriptive explanation of the result. A comparison with a result for a fully sighted person is also made. If the level of visual acuity alone can be used to determine legally blind status, this information is also provided with the client’s consent. The measurement of near vision is obtained with use of the logMAR® word reading chart, which allows for an appreciable near vision result of between N2 and N80 size print. Both ‘functional’ or comfortable print size, as well as maximal print size is reported. The above-mentioned reading chart is a high contrast (black on white) reading card, designed for use at 25cm. The RVIB client may prefer a much closer reading distance, and be time limited depending on the print size being read. This is explained within the context of a work or school environment, where small print may be provided to a client who may manage this maximally, but where it is not a practical or functional size print for reading for any length of time. Examples of preferred print size are provided, and described in terms of standard or familiar printed materials such as newsprint, novels etc. Following Orthoptic assessment for the most appropriate magnification aid, the functional near vision result with the recommended magnifier is provided. This provides the educator or employer with an understanding of the client’s visual potential, when utilising a low vision aid. The low vision aid (for near) is detailed and an example of attainable print size is again provided.
Visual fields (area) of vision are examined clinically, using standard testing procedures to obtain quantitative results; in order to discuss the relevance of a visual field defect and the functional implications associated with it. RVIB Orthoptists use non-automated perimetry to examine the client’s visual field defect, and descriptively report the extent of the defect in terms of central or peripheral field loss, and the quantitative measurement of this. The functional implications for the person with low vision and an associated visual field defect are discussed.
Following the provision of the clinical vision assessment information, the client and Orthoptist confer on the relevant and most appropriate recommendations, which require implementation in order to support the student or employee in the chosen environment.
Areas of recommendation included in the OVA report for a student may include general information as well as specific guidelines on the following:
eg. preferred print size, contrast needs, time requirements for reading print, ability to access audio-visual materials
eg. strategies which may be employed by the tutor to ensure the student’s full participation, environmental needs / modifications required
eg. locating resources, special considerations to loans
eg. size of font, colour and/or contrast needs, technological modifications
eg. deadlines, feedback requirements
eg. time allowance, format, use of assistive technology
eg. mobility, information sharing
eg. type, level of illumination, placement, glare control
Areas of recommendation included in the OVA report for an employee or a young person in transition to work may include general information and specific guidelines along the same lines as those made for a student. However the individual requirements of the position are taken into consideration and recommendations are made accordingly. For example, the requirements for environmental modification for a person seeking clerical work will differ greatly from those of a person seeking employment in an industrial or outdoor setting.
The RVIB client is required to approve the content of the OVA report, prior to a formal report being produced. The report is prepared by the examining Orthoptist and provided directly to the client. The report becomes the property of the client, who is free to use and distribute this personal report as he/she chooses. Students in transition are encouraged to establish a meeting with a tertiary studies representative at the chosen educational institution, often known as a ‘Disability Liaison Officer’ (DLO). The DLO may then use the OVA report as a tool of advocacy, in order to ensure that the student’s needs are met and that recommendations for inclusive learning are adhered to. Students are also encouraged to meet directly with tutors / lecturers prior to undertaking any classes to self-advocate, using the OVA report as a springboard to discussion and information sharing with the tutor. Government regulations and Disability legislation in Australia supports the student’s right to equal access in an educational setting, and requirements such as for alternative formatting must be met.
A person utilising the OVA report for job seeking purposes or in an established work environment may also introduce the report as a means of ‘simplifying’ for the (prospective) employer, some of the perceived needs of the employee with a vision impairment. Eg. providing information as to how a worker will access e-mail, or even why one worker with a vision impairment has different needs to another. Recommendations made in the OVA report may also preclude the alteration of a physical work environment, where the employer may incur a financial cost. Therefore it is important for the young person in transition to work to be fully informed about their vision condition and status, personal requirements in the work setting, and how best to communicate this information to the employer. The OVA report aims to facilitate this process of establishing an open and communicative (prospective) employer / employee relationship.
An evaluation analysis of the outcomes for people who have received an RVIB OVA report was recently conducted. The evaluation incorporated all clients who received an OVA report over an eighteen month period, who were also over the age of sixteen. Results were as follows:
and/or suggestions for change adhered to (68.6%)
In the majority of cases, the OVA report is recognised as a useful tool to inform, educate and support educators and employers, where there is little or no previous experience with the general needs of people who have vision impairment. The OVA report aims to provide specific information regarding the vision status and individual needs of the person with a vision impairment, in transition, so that equality of access to learning and employment is ensured. The ongoing development of rehabilitation practice and activity, along with continued evaluation and feedback received from clients who have used an OVA report, will determine how information pertaining to functional vision impairment may best be communicated to those seeking information. Hence the OVA report is recognised as an important aspect of the Orthoptics service at RVIB, and allows the service to support the vision of moving toward an inclusive community.
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