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Functional Vision Evaluation: Children with Special Needs

What is a Functional Vision Evaluation?

In our office we designate our in depth vision assessment for children with special needs as a FUNCTIONAL VISUAL EVALUATION and we do this with the intention of accommodating your child the extended time and appropriate testing environment that will best meet your child’s unique needs.

special needs child sitting on bench

When visual or ocular problems are left undetected or untreated, a child’s personal well-being, learning capability and cognitive development will all be adversely affected. Specialized eye exams for kids with disabilities are critical, as they may diagnose problems that can be treated to improve the child’s quality of Life

The term “children with special needs” encompasses a broad group of kids who need assistance with medical, psychological or mental disabilities. Children with cerebral palsy, Down syndrome and autism are some common examples of special needs conditions often accompanied by significant visual complications. When visual or ocular problems are left undetected or untreated, a child’s personal well-being, learning capability and cognitive development will all be adversely affected. Specialized eye exams for kids with disabilities are critical, as they may diagnose problems that can be treated to improve the child’s quality of life.

Autism & Vision

According to a 2014 report issued by the Centers for Disease Control (CDC), approximately 1 in every 68 kids in the U.S. is diagnosed with an Autism Spectrum Disorder (ASD). Vision conditions, such as trouble with focusing, eye teaming and general problems with perception, are common in people with autism. In general, kids with autism will find it hard to make eye contact and recognize facial expressions, and they’ll feel stress when others gaze directly at them. However, the effects of ASD on vision are highly individual.

Cerebral Palsy & Vision

The most common pediatric disability, cerebral palsy is described as a non-progressive motor disorder that results from damage to neurologic brain pathways. A range of cognitive and motor disabilities are associated with this disorder, many of which have negative effects on the visual system. Both neurological issues and ocular issues may be to blame for visual impairments, and a skilled eye doctor will be able to diagnose the root of many eyesight problems during an eye exam designed for patients with cerebral palsy.

Common diagnoses include blurred vision, trouble focusing, inability to recognize faces and strabismus (eye misalignment). Vision aids and correction eyewear are frequently prescribed, and a number of specially designed eyeglasses for cerebral palsy are available, with adjustable nose-pads and arms that provide non-slip wear with a good fit.

Down Syndrome & Vision

This condition affects children around the globe and is the most common chromosomal abnormality. Common eye disorders detected in children with Down syndrome include strabismus, tear duct abnormalities, keratoconus (misshaped cornea) and congenital cataracts. Specialized eye exams for kids with Down syndrome can drastically improve quality of life, as they allow eye doctors to identify vision difficulties early and recommend helpful, corrective treatments. Eyewear for Down syndrome includes designs that accommodate unique facial features, such as a low nasal bridge and modified temples that help keep eyeglasses snug and comfortable over the ears. Kids’ eyeglasses will be constructed from flexible, resilient materials that stand up to tough use!

Eye Exams for Nonverbal Patients

While many parents may be concerned about how vision will be tested accurately when their child can’t communicate properly, this shouldn’t be reason for worry. Qualified eye care professionals know how to perform effective eye exams for nonverbal patients too. Vision tests and evaluations are adapted according to the level of verbal responsiveness. In addition to customized procedures, an upbeat, compassionate and patient manner must be applied when dealing with all special needs children – especially with nonverbal patients.

Overview: Visual Disorders Commonly Diagnosed in Special Needs Kids

During a complete, specialized eye exam for nonverbal and verbal children with disabilities, particular attention will be given to check for the following conditions:

Refractive Conditions: nearsightedness and farsightedness

Untreated farsightedness or nearsightedness directly impacts how a child interacts with their world up-close and in the distance. Many kids with autism, Down syndrome or cerebral palsy have refractive conditions that complicate reading or viewing a computer screen. When significant refractive error is left uncorrected for a long time, it will often progress into amblyopia, which leads to reduced vision.

Strabismus & Amblyopia

Commonly known as “crossed eyes”, strabismus is due to the brain’s inability to coordinate both eyes at the same time. Kids with strabismus only see out of one eye at a time; there is no binocularity. Diagnosed often and efficiently by an eye exam for patients with cerebral palsy, Down syndrome and autism, strabismus is not outgrown and must be treated as soon as possible, since it tends to worsen with time. There are a variety of treatments and a qualified pediatric eye doctor will recommend the best approach.

Amblyopia, also called “lazy eye”, is associated specifically with autism. This condition leads to diminished vision, yet fortunately it is highly treatable. Eyeglasses and/or vision therapy are generally enough to do the trick. Eyewear custom-made for kids is a great solution, as it is extra-durable, lightweight and comfortable, and features non-slip nose pads so glasses stay in place even while jumping or running.

Hyperactive or Hypoactive Visual System

A condition experienced by kids with autism, a hyperactive visual system works in overdrive and bright, colorful stimuli will generally be very disturbing. Sharp light flashes will be jarring, and children may cover or close their eyes in response. Even tiny particles of dust floating by may be bothersome. As a result of this hyperactivity, autistic kids may develop a habit of always looking down

Kids with hypoactive vision may constantly seek out vivid and lively images in order to energize their visual system. Some signs of this disorder are: when fingers are moved repeatedly in front of eyes, the child fixates a strong gaze on people or objects, reflections seem to fascinate the child, and/or their hands are always exploring the edges of objects.

Focusing Abnormalities

Children with cerebral palsy and autism often exhibit trouble with a number of focusing skills necessary in classroom learning. For example, trouble with Fixation causes an inability to focus on a target, such as the school board. Saccadic abnormalities are also common, which hinder a child’s ability to make eye jumps in a coordinated manner – as needed when reading lines or rows of text. Another common problem is Pursuit abnormalities, which prevent the eyes from tracking slow moving objects or reading smoothly.

Cortical Visual Impairment & Optic Atrophy

Both of these conditions demonstrate a type of reduced eyesight that’s typically found in children with cerebral palsy. As kids develop, a lack of oxygen to the brain may affect changes in the brain or optic nerve, leading to decreased vision quality that eyewear isn’t able to correct effectively. Instead of eyeglasses, the child’s learning environment and methods must be modified. Approximately 60-70% of all kids with cerebral palsy demonstrate these problems, and a professional eye doctor must assess the vision loss thoroughly with an eye exam for cerebral palsy.

Reduced Sensitivity to Contrast

Discerning contrast between shades of gray is integral to a healthy visual system. Without this ability, mobility is impacted. In cerebral palsy patients, this is highly significant because motor skills are already compromised; appropriate changes to one’s surroundings are therefore required. Reduced perception of contrast is also diagnosed commonly in patients with Down syndrome. Specialized ophthalmologic equipment is necessary to test contrast sensitivity, and this testing can be performed even during eye exams for nonverbal patients.

Reduced Peripheral Vision & Depth Perception

Blind spots and problems with perceiving 3-D make movement very challenging, and specialized eye exams must check for these gaps in a child’s vision. Visual field defects or unstable depth perception are often identified in kids with cerebral palsy, and physical and occupational therapy can then be tailored for optimal benefits.

Visual Perceptual Conditions

Visual perception refers to how we process and make sense of the information that we see. This is how we recognize a table as a table, even if it is upside-down or mixed up in a jumble of furniture. Problems with visual perception are typical in special needs children and especially common with cerebral palsy. It’s important to detect these difficulties at an early age in order to maximize learning and prevent future problems.


Cataracts involve a clouding of the lens of the eye, which makes vision hazy. Common in patients with Down syndrome, cataracts can be removed by laser surgery. Yet when left untreated, amblyopia can ensue.

Brain Vision Move (1)