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The sense of sight plays a central role in how our children perceive the world. However, some children may have to live with a condition defined as “low vision” due to various reasons. Low vision in children means vision loss that cannot be fully corrected with glasses, contact lenses, or medical/surgical interventions, and which significantly affects daily activities and learning. This situation can be challenging for both the child and the family; however, it must be remembered that with the right approaches, early intervention, and a comprehensive rehabilitation process, children with low vision can also utilize their potential to the maximum, leading happy and successful lives.
As an ophthalmologist, our primary priority is to inform families about low vision in children, offer the most current diagnostic and rehabilitation methods, and produce solutions tailored to the individual needs of every child. We will cover in detail what low vision in children is, its causes, symptoms, diagnosis and assessment processes, rehabilitation approaches, and support strategies for families.
Table of Contents
What is Low Vision? How Does It Differ from Blindness?
Low vision (subnormal vision), according to the World Health Organization (WHO) definition, is the condition where the visual acuity in the better-seeing eye, with the best possible correction (glasses, etc.), is between 3/10 (or 0.3) and 1/20 (or 0.05), or the visual field is narrower than 20 degrees. If the visual acuity is lower than 1/20 or the visual field is narrower than 10 degrees, this condition is defined as “blindness.”
Important Points:
- A child with low vision is not a child who is completely blind. They have existing visual potential, and this potential can be utilized in the best way through special assistive devices and educational strategies.
- Low vision means the child may perceive light, colors, shapes, and movement to different degrees.
- Every child with low vision has a different level of vision and faces different challenges. Therefore, a personalized assessment and rehabilitation plan is essential.
What Are the Causes of Low Vision in Children?
There are many different conditions and diseases that can lead to low vision in children. These causes can be congenital or acquired later in life.
| Causes of Low Vision | Example Conditions and Diseases |
|---|---|
| Congenital and Genetic Causes | Albinism, congenital cataracts, congenital glaucoma, Leber’s congenital amaurosis, retinal dystrophies (e.g., retinitis pigmentosa, Stargardt disease), optic nerve hypoplasia, coloboma, aniridia, microphthalmia/anophthalmia. |
| Problems Related to Prematurity | Retinopathy of prematurity (ROP) and related complications. |
| Acquired Causes | Traumatic brain injury, head and eye trauma, brain tumors, hydrocephalus, sequelae of infections like meningitis, retinopathy due to uncontrolled diabetes (rare), ocular effects of certain systemic diseases, conditions like Stevens-Johnson syndrome. |
| Refractive Errors (High Degree) | Refractive errors such as very high-grade myopia, hyperopia, or astigmatism that are resistant to treatment may rarely remain within the low vision range (especially if amblyopia is present). |
| Amblyopia (Lazy Eye) | In cases of especially unilateral and deep amblyopia that is not treated early and effectively, permanent low vision can occur in the affected eye. |
| Nystagmus | This condition, characterized by involuntary, rhythmic oscillations of the eyes, can be due to many underlying diseases and can cause low vision by reducing visual acuity. |
Symptoms of Low Vision in Children
Children, especially at a young age, may have difficulty expressing their vision problems. Therefore, careful observation by parents and teachers plays a vital role in the early detection of low vision. If one or more of the following symptoms are present, it is important to consult an ophthalmology specialist:
- Difficulty with Reading and Writing:
- Holding books or writing very close to the eyes.
- Frequently losing the line while reading or following the text with a finger.
- Difficulty seeing the board or writing at a distance.
- Writing letters disproportionately or crookedly when writing.
- General Visual Behaviors:
- The need to get very close to or touch objects to recognize them.
- Extreme sensitivity to light (photophobia) or, conversely, needing very bright light to see better.
- Frequent eye rubbing, squinting, or closing one eye.
- Constantly tilting or turning the head in one direction to look (abnormal head posture).
- Mixing up colors or seeing bright colors as faded.
- Significant difficulty seeing in dim light or at night (night blindness).
- Constant eye shaking (nystagmus).
- Avoiding or having difficulty making eye contact.
- Motor Skills and Movement:
- Frequent falling, bumping into things, clumsiness (especially in unfamiliar environments).
- Difficulty going up or down stairs or walking on curbs.
- Difficulty tracking moving objects such as in ball games.
- Social and Academic Difficulties:
- Difficulty understanding friends’ facial expressions or social cues.
- Reluctance to participate in games.
- Learning difficulty, lack of concentration at school.
- Poor performance in subjects involving visual materials.
While these symptoms do not always mean low vision, they are important signs that require assessment by a specialist.
Diagnosis of Low Vision in Children
If you suspect low vision in your child, the first step is to consult a pediatric ophthalmology specialist like Dr. Semrin Timlioğlu for a comprehensive eye examination. The diagnosis and assessment process typically involves the following steps:
- Detailed Anamnesis (History Taking): Information is gathered about the family history of eye disease, the child’s birth history, developmental milestones, observed symptoms, and general health status.
- Visual Acuity Assessment: Visual acuity of each eye separately and together is measured using special tests appropriate for the child’s age and communication skills (LEA charts, HOTV, Snellen chart, etc.). Near and distant vision are evaluated.
- Refractive Error Examination (Refraction): It is determined whether the child needs glasses and, if so, their power. A more precise measurement is taken after dilating the pupils with drops (cycloplegia).
- Contrast Sensitivity Tests: The ability to distinguish shapes at different contrast levels is measured. Contrast sensitivity is usually reduced in individuals with low vision.
- Color Vision Tests: The ability to distinguish colors is evaluated.
- Visual Field Tests (Perimetry): The child’s central and peripheral visual field is assessed using age-appropriate methods.
- Biomicroscopic Examination: The anterior segment of the eye (cornea, iris, lens) is examined in detail.
- Fundus Examination: After the pupils are dilated, the retina, optic nerve, and other structures in the posterior part of the eye are examined to investigate underlying pathologies.
- Electrophysiological Tests (If Necessary): Tests such as ERG (Electroretinography) and VEP (Visual Evoked Potentials) can provide more detailed information about retinal and optic nerve functions.
- Functional Vision Assessment: The child’s use of their existing vision in daily life activities (reading, writing, walking, playing, etc.) is observed and evaluated. This forms the basis of the rehabilitation plan.
As a result of these assessments, the degree, type, and underlying causes of low vision are determined.
Low Vision Rehabilitation in Children
The primary goal of low vision rehabilitation is to enable the child to utilize their existing visual potential to the maximum, increase their independence, and support their full participation in educational and social life. The rehabilitation process requires a multidisciplinary approach and is conducted with the close cooperation of the ophthalmologist, low vision specialist, special education teacher, psychologist, and the family. The Main Methods and Tools Used in Low Vision Rehabilitation:
| Rehabilitation Area | Methods and Tools |
|---|---|
| Optical Aids | Magnifiers: Hand magnifiers, stand magnifiers, bar magnifiers, telescopic glasses (for distance), telemicroscopic glasses (for near). Training is provided for the selection and use of the correct device. |
| Electronic Aids | Closed-Circuit Television Systems (CCTV): Magnifies text and images to the desired degree and projects them onto a screen. Portable electronic magnifiers, screen reader software, screen magnification programs, audiobooks, smartphone and tablet applications. |
| Non-Optical Aids | Lighting Adjustments: Providing correct and sufficient lighting (anti-glare lamps, adjustable light sources). Contrast-Enhancing Materials: Light-colored text on dark backgrounds, thick-tipped pens, colored filters. Reading Stands, Non-Slip Surfaces. |
| Educational Strategies | Large Print Materials: Textbooks, worksheets. <br> Braille: In cases of severe low vision or blindness. Use of Tactile and Auditory Materials. Classroom Arrangements: Sitting in the front row, appropriate lighting. Individualized Education Programs (IEP). |
| Daily Living Skills Training | Independent movement (orientation and mobility) training (white cane use), teaching skills like personal care, household chores, and money identification. |
| Psychosocial Support | Counseling and psychotherapy services for the child and family to adapt to the new situation, develop self-confidence, and enhance social skills. Peer support groups. |
Recommendations for Parents and Teachers
The role of family and teachers in the development of a child with low vision is very significant:
- Emphasize Early Diagnosis and Intervention: Consult a specialist as soon as you suspect a problem.
- Be Positive and Supportive: Focus on what your child can do, encourage them, and support their self-confidence.
- Become Informed: Be knowledgeable about low vision and your child’s specific condition. Maintain constant communication with the rehabilitation team.
- Adapt the Home and School Environment: Make adjustments such as providing appropriate lighting, using high-contrast materials, and removing unnecessary clutter.
- Encourage Independence: Give your child age-appropriate responsibilities and create opportunities for them to do things on their own.
- Encourage the Use of Other Senses: Help them learn by using their other senses, such as touch and hearing.
- Support Social Participation: Encourage them to play with friends and participate in social activities.
- Collaborate with the School and Teachers: Work closely with your child’s teachers regarding their educational needs. Actively participate in the preparation and implementation of the Individualized Education Program (IEP).
- Be Patient: The learning and adaptation process can take time. Be patient and understanding.
There is Hope for Children with Low Vision!
Although low vision affects a child’s life to a certain extent, it does not have to limit their dreams and goals. Thanks to developing technology, effective rehabilitation methods, and increasing social awareness today, children with low vision can complete their education, become professionals, and lead a fulfilling life.
As Dr. Semrin Timlioğlu and her team, we are always by the side of our children with low vision and their precious families. We offer personalized solutions with a multidisciplinary approach to maximize your child’s visual potential and open the doors to an independent future for them.
Remember, every child has the right to discover the world and radiate their own light. Low vision is not an obstacle to this right. You can contact us for detailed information, assessment, and the rehabilitation process.
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