October 2004 • Volume 98Number 10

Speaker’s Corner

A Half Century Later: Where Are We? Where Do We Need to Go?

Although it was 80 years ago when Anne Sullivan Macy was shown a pair of telescopic lenses and remarked, “I never knew there was so much in the world to see,” (Koestler, 2004, p. 408) we are still struggling with a universal commitment to those we now refer to as persons with low vision. Fifty years have passed since the first low vision clinic was established primarily for adults who were losing vision. Although ophthalmologists knew in the 1930s that using impaired vision would not further harm the eyes, the “sight-saving” philosophy took another few decades to diminish in schools.

Historical perspective

It was not until 40 years ago, when my book Increased Visual Behavior in Low Vision Children (Barraga, 1964) was published, that educators began to attend to the capabilities of children with low vision to develop their students’ visual efficiency skills. Through scientific research, we had established that learning to use impaired vision was developmental in nature and could be taught through a series of sequentially specific visual tasks. For the next 20 to 25 years, every effort was made to provide teachers and other professionals with assessment and instructional materials and techniques to ensure that all students with low vision in the educational system had every opportunity to make efficient use of their vision for both functional and educational purposes.

Visual efficiency for all persons with low vision became a worldwide concern as early as 1972 through resolutions adopted in conferences of international organizations. Both developed and developing countries recognized that only about 20% of so-called blind people (using the legal definition of 20/200 visual acuity) were without sight. Even those who had light or object perception or both could make use of that vision for movement and functional purposes. Those with measurable acuity could recognize letters and words and possibly read print with magnification. Further research in the United States and other countries resulted in changes in terminology and curricular offerings through legislation in many states and throughout the world. Eleanor Faye (an ophthalmologist) and Randy Jose (an optometrist) led clinicians in communication and collaboration with educators to emphasize the use of low vision.

The status quo

The tremendous progress that was made during those years seems to have gradually diminished until today, when many children with low vision do not receive low vision assessments for the functional use of vision and are not taught how to use their vision efficiently. Many children with low vision are not receiving clinical low vision evaluations, prescriptions for optical devices, or instruction in the use of these devices. We need to ask why. Have we deluded ourselves into thinking that special attention to low vision is no longer needed? Although we have accepted multimodal approaches to learning, have we convinced ourselves that high-quality low vision services can be replaced with nonvisual approaches to learning? Several factors may have contributed to the current state of affairs, including the following:

  • There is still no universally accepted definition of low vision.
  • Personnel preparation programs may place less emphasis on the process involved in developing visual efficiency as compared to other subjects.
  • With the advent of the “full inclusion” model and a shortage of teachers of students with visual impairments and orientation and mobility instructors, less attention than was previously given is focused on teaching visual efficiency.
  • Despite the research literature, general education teachers and administrators may believe that providing large-print books is all that is needed—unless parents and teachers of students with visual impairments convince them otherwise.
  • Parents may not feel empowered to insist that Individualized Education Programs include assessments and instruction that are considered “promising practices” in the provision of an appropriate education for children with low vision.
  • Teachers of students with visual impairments may not have received high-quality course work related to the provision of low vision educational services, such as how to conduct a functional vision assessment and learning media assessment and how to teach the use of prescribed optical devices.
  • Local education agencies may be reluctant to use local funding for assessments and devices when large-print and nonvisual instructional materials are available through federal quota funds.
  • The 1997 regulations of the Individuals with Disabilities Education Act (IDEA) emphasize a consideration of braille for students with visual impairments (both those with low vision and those who are blind), but they do not address children’s need for visual efficiency or optical devices.

A philosophical and ethical issue?

Do educators face a philosophical or ethical dilemma when they do not provide access to the visual environment for children with low vision? This issue has been raised by such educators as Corn and Koenig (2002) and Stokes (1976). Would it be considered ethical not to provide language instruction or hearing aids to children with hearing impairments who could learn to speak or provide wheelchairs to children who could learn to walk with crutches? Why, then, is it considered a luxury to instruct children in visual efficiency and to provide clinical low vision evaluations and optical devices?

We are often asked whether instructional programs in visual efficiency and optical devices are medical or educational approaches. If they are medical, then gatekeepers are withholding treatment; if they are educational (as I believe they are), are educators withholding access to the general curriculum in a least-restrictive environment, both tenets of IDEA? To provide a paraprofessional to read to a child what is on the chalkboard—and hence could be within the child’s “visual reach”; to provide only large-print materials and not provide access to school libraries or to standard-print materials in classes and school environments; and not to share all there is in the world to see, as Anne Sullivan Macy learned when she was shown a pair of telescopic lenses, is indeed a moral and ethical issue that must be faced.

The future

I call on educators, parents, and eye care professionals to address this issue of providing multidisciplinary low vision educational services to children who can benefit from them. I urge professional organizations, medical organizations, and parents’ groups to pay immediate attention to the provision of what we have known for years needed to be done for children with low vision. Since the 1960s, we have known that many children could learn to become more visually efficient. More recently, we have seen evidence of the educational benefits of optical devices for such literacy skills as increased reading rates and a reduction in the need for accommodations in the classroom (Corn et al., 2002). Since the 1980s, the professional literature and even the federally adopted Policy Guidance Paper (Huemann, 1999) have reported the benefits of such services in educational programs.

If we could consider the present as a lull before the storm, we might be able to join together to reengage the quality of services from past decades. Doing so would revive the focus on children with low vision as a distinct population who deserve all our creative efforts in assisting them to realize their maximum visual efficiency. We have the knowledge of what to do. Now let’s do it!

References

Barraga, N. (1964). Increased visual behavior in low vision children. New York: American Foundation for the Blind.
Corn, A. L., & Koenig, A. J. (2002). Literacy for students with low vision: A framework for delivering instruction. Journal of Visual Impairment & Blindness, 96, 305–321.
Corn, A. L., Wall, R. S., Jose, R. T., Bell, J. K., Wilcox, K., & Perez, A. (2002). An initial study of reading and comprehension rates for students who received optical devices. Journal of Visual Impairment & Blindness, 96, 322–334.
Huemann, J. E. (1999). Educating blind and visually impaired students: Policy guidance. In G. S. Pugh, & J. N. Erin (Eds.), Blind and visually impaired students: Educational service guidelines (pp. 134–145). Watertown, MA: Perkins School for the Blind.
Koestler, F. A. (2004). The unseen minority (p. 408). New York: AFB Press. (Original work published in 1976)
Stokes, L. (1976). Educational considerations for the child with low vision. In E. Faye (Ed.), Clinical low vision (pp. 343–354). Boston: Little, Brown.

Natalie C. Barraga, Ed.D., Ph.D., professor emerita, Department of Special Education, University of Texas at Austin, Austin, TX 78212; e-mail: <barraga.natalie@mail.utexas.edu>.


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