Review of DETA criteria for Vision Impairment

1. Review of DETA criteria for Vision Impairment

2. Key Issues • Ensuring understanding of links between the vision impairment and the educational impact. • Ensuring the criteria are based on sound evidence for the given purpose. • Reflective of national and international trends. • Decision making is consistent. • Driven by consultative and collaborative involvement of specialists in the area of paediatric vision impairment.

3. Focus of the Review • Investigated models used for identifying vision impairment. • What is an activity limitation/participation restriction for Vision Impairment. • Effectiveness of 2006 verification form.

4. Models for Identifying Vision Impairment

5. International Classification of Functioning, Disability and Health “Seeing Function” – identifies vision as “sensing the presence of light and sensing the form, size, shape and colour of the visual stimuli”. (WHO, 2001, p62) It includes: • visual acuity functions (sensing form and contour, both binocular and monocular, for both distance and near); • visual field functions (relating to the entire area that can be seen with fixation of gaze); • quality of vision (involving light sensitivity, colour vision, contrast sensitivity and the overall quality of the picture); • the functions and structures adjoining the eye that facilitate seeing functions. It does not include Perceptual Functions

6. National and International Criteria • National and International criteria were inconsistent in definitions used. (This seemed to be determined by funding) • National criteria were consistent with their usage of: • Visual acuity • Field loss • A report (e.g. functional vision report, educational impact statement or assessment of need) • Visual Acuity and Field loss varied based on state department funding models. • No state/territory consider quality of vision or the functions and structures around the eye

7. Criteria (until 12 November 2007) • DETA recognises a Vision Impairment when: • visual acuity is 6/18 or less corrected in the better eye; or • a field loss impairs visual functioning; or • damage to visual centres of the brain impacts on visual functioning. A diagnosis of cerebral (cortical) Vision Impairment is necessary for this to apply. • A diagnosis of a condition that results in a Vision Impairment is provided by an ophthalmologist, or in some cases of Cerebral (Cortical) Vision Impairment by a paediatrician or neurologist.

8. Under this criteria a number of students who were diagnosed with a vision impairment and had associated educational impact were excluded. • DETA has a duty of care to ensure that information is provided to schools regarding the unique characteristics of these conditions which may be at risk if appropriate adjustment aren’t made.

9. Current Research • visual acuity below a critical level of 6/12 is associated with disability and affects participation (Taylor, 2003) • a moderate level of vision impairment –that is less than 6/12 has a significant impact in…daily living, social functioning (Taylor 2003) • with increasing human development the visual acuity requirements are also increasing. This would indicate that even a mild visual loss has a greater impact in today’s society (Dandona & Dandona, 2006). • Students with visual acuity <6/12 are limited in career options, transport arrangements and lifestyle choices. • In Australia a visual acuity of <6/12 inhibits the capacity to get a drivers license.

10. Even though studies indicate that a visual acuity of less then 6/12 has a significant impact there are no indicators regarding the prevalence. It is recommended that further studies be undertaken to investigate the educational impact of acuity between 6/12 and 6/18 and the consequent prevalence. • Due to the unknown prevalence the usage of <6/12 was not accepted.

11. Current Practice • The most common testing tool is the Snellen chart. The limits of this chart is it cannot measure acuities which may fall between 6/12 and 6/18. • Some students may be tested using more refined tools which are able to identify an acuity of 6/15. Under the old criteria these students would have effectively been excluded. • By identifying the testing tool as the Snellen (6/18) it will ensure that students identified using more refined tools are included if their acuity falls between 6/12 and 6/18.

12. New Criteria (from November 12 2007) Criterion 1 • Student must be diagnosed with a vision Impairment involving: • Ocular components; or • The Visual Cortex; or • the Functions and Structures Adjoining the eye. • With either: • a visual acuity of  6/18, according the Snellen Chart, best corrected; or • a visual field loss; or • significant fluctuating visual access

13. New Criteria (from November 12 2007) Criterion 2 • Have documented evidence of activity limitations or participation restrictions resulting from the Vision Impairment in one or more of the following focus areas: • Curriculum, • Disability Specific curriculum, and • Learning environment

14. Vision Impairment - Activity Limitation / Participation Restriction in the school context

15. ICF’s nine domains of life • learning and applying knowledge • general tasks and demands • communication • mobility • self-care • domestic life • interpersonal interactions and relationships • major life areas • community, social and civic life

16. Impact in an educational setting • Delays in concept development which severely impact on the student's social, emotional, academic, and vocational development; • Compromised capacity to be independent, both in immediate learning environment and the wider school community. • Reduced reading rates to that of sighted peers, requiring additional time for all reading tasks and regular monitoring of low vision aids. • Required development of alternate mediums, i.e. tactile and auditory sense, for learning; • Reduced access to standard learning materials, requiring the development of specialised skills as well as modified specialised books, materials and equipment for learning through alternate modes, • Compromised capacity to gather information through observation and therefore reduced incidental learning. (Lewis and Allman, 2000)

17. Educational Focus Areas These areas are: • Curriculum; • Disability specific Curriculum; and • Learning Environment. Students must have a significant impact in one or more of the three focus areas for verification in the DETA criteria for the category of vision impairment. Appendix 4

18. New Criteria (from 12 November 2007) Criterion 1 • Student must be diagnosed with a vision Impairment involving: • Ocular components; or • The Visual Cortex; or • the Functions and Structures Adjoining the eye. • With either: • a visual acuity of  6/18, according the Snellen Chart, best corrected; or • a visual field loss; or • significant fluctuating visual access Criterion 2 • And have documented evidence of activity limitations or participation restrictions resulting from the Vision Impairment in one or more of the following focus areas: • Curriculum, • Disability Specific curriculum, and • Learning environment

19. Verification Form

20. 2006 Verification Data Indicated: • The need to clarify the link between impairment and educational impact. • The need for consistency in information provided by medical specialists. It is expected that the Specialists information be current. This does not mean that the report needs to be recent but rather that the information within the report is reflective of the student at the time of the verification request. 2007 EAP Verification – VI Form

21. Curriculum • Reduced volume of work; • Uses concrete materials • Modified assessment delivery e.g.auditory • Alternative format presentation e.g. Braille, large print, auditory • Planning • Alternative subject/content/activities • Additional support e.g. 1:1, small group • Extra time to comprehend and process work

22. Disability Specific Curriculum • Functional Academic skills • Communication Skills • Concept development • Orientation & Mobility • Social Interaction Skills • Sensory Motor Skills • Independent Living Skills • Career or Voc Ed skills • Recreation and leisure skills • Technology • Visual efficiency skills

23. Learning Environment • Specialised equipment • Modified access • Glare reduction. • Lighting • Seating • Adaptive Technology • Visual Aids • Modified room set up • Excursions/camps/night activities

24. Verification Reviews and Removal from Category

25. Review of VI Verification • No mandatory review for most diagnoses • Eg conditions that are lifelong and stable • Reviews required for some diagnoses • Eg conditions that fluctuate or after intervention such as patching • Date of review determined by Verifier Removals from Category

26. Contact Details • chris.gilbert@deta.qld.gov.au • For VI specific Verification questions • Ph: 3240 9348 (Alt Fridays – pay weeks) • Ph: 4616 9175 (Alt Fridays – non pay weeks) • For general Verification questions • Ph: 3240 9348 (Jeannie Grace) • Fax: 3240 9300 • EAP Verification Team 141 Merton Rd WOOLOONGABBA Q 4102