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Lighting for Children with Immature Visual Systems and those with Cortical/ Cerebral Visual Impairment This presentation belongs to APH. If you’d like to borrow this presentation, APH will be glad to loan it to you provided that you: • Do not change it. • Give APH proper attribution • Let APH know what you plan to use it for. (We like to keep records. We’re research based .) • Call Elaine Kitchel at (800) 223-1839 ext: 313 to arrange it. When it comes to learners who are very young or who have CVI, and how they are affected by light, we don’t know much. But we do know some things. We know that some learners who have CVI or are very young, • Experience light in ways different from adults with typical vision • Experience light in ways different from learners the same age • Experience light in ways different from youth and adults with the same vision diagnosis • Sometimes experience light in a synesthetic way. • Experience confusion and avoidance in the presence of blue light • Experience confusion and avoidance in the presence of very bright light What are some of the ways this is manifest? • Child turns away from light • Child shows signs of stress (squint, yawn, close eyes, rapid blink, waves arms, cries) • Child becomes non-responsive • Child respirations change • Child returns to his/her normal responsiveness when the offending light source is removed Research has shown: • Studies that involved children with cortical dysfunction showed that certain wavelengths of light relieved problems of characters that shift or move during reading activities. • The same studies showed dysfunction could be induced by certain wavelengths of light presented during reading activities. Can we extrapolate to learners with CVI? • Some students, especially those with CVI often become overwhelmed by certain colors of light or specific intensities of light, or combinations of each. We have observed this when students turn away from a lighted task. • Some students are not as bothered by the light or its color until they have to perform a reading task, or use small muscles in a task. Then, some become overwhelmed. Why? We must learn a little about the physics of light We can see only 3 colors of light. But you say you can see more than 3 colors! You can see more than 16 mil. In Addition, Science and Observation have shown: • Blue light makes the visual system work 2,000,000,000,000 (2 trillion) times harder than red light and billions of times harder than green light. • Ultraviolet makes it work even harder, processing billions more waves per second, even though we can’t see it. • Learners with CVI most often prefer red and yellow toys, tools, paper, crayons. Why do you suppose that is? Are they selecting by instinct? Does he choose based upon what makes him comfortable? In my practice, I have tested: • Visually impaired learners 12 and younger, most were found to be very sensitive to blue and ultraviolet light, some more than others. • Children with CVI and children with very immature neurological and visual systems worked more efficiently for longer under red, yellow, and sometimes green light. They also preferred working under red or yellow light, and maintained their preferences over the period I worked with them. Follow up, 10-12 years after testing has shown: • All but two of the 94 that preferred to work in red light, still do. • Of the twenty three that preferred yellow light, all still do. • Of the 10 that preferred green light, 7 now prefer yellow. The other 3 are migraine sufferers. Three primary ways you can help: • Eliminate blue light from the learning environment. This means changing the color of the walls and floors if necessary. • Add red light to the learning environment. • Allow the child to show you his/her light preference through his/her toy choices and alternatives presented during functional vision assessment. Before you add color to the environment of a learner with CVI or an immature visual system • Make sure the learner is rested, well-fed, calm and ready to learn. • Ascertain what his/her favorite color is • Use that color as a guide for what color works for your learner during educational activities • Situate your learner in a place where the light is dimmable. • Be prepared to switch from overhead light to flashlight or headlamp. So let’s say you are a little child with CVI… Like Lindabelle Saylor You are easily overwhelmed by bright light, and you become downright wild in the presence of blue light. • The people who educate you are not aware of lighting limitations for children with CVI. They put you here. Or worse, here: Can learners like Lindabelle benefit from sensory stimulation rooms at all? • Even appropriately lit sensory rooms usually have too much overall stimulation going on. Yes, if we focus on one appropriately colored thing at a time, and rest in between. Darn Good Sensory Room What if you’re a little guy with brain damage and you have a bedroom like this, Some principles to remember are: • Simplify • Remove blue • Use black, grey and white • Use yellows, reds for accent • One large geometric • Provide hideaway place. Nursery This is an almost perfect nursery for a child with CVI. Variations One dominant geometric pattern Or maybe black with just a little color Things you can do to eliminate blue light from the learning environment: • Replace cool white, full spectrum, daylight tubes and lights with warm white (2700K) • Provide children with filters to wear Provide hats to reduce light in the eyes. • Provide dim light learning environments. • Provide tinted windows. • Limit light experiences to small scale ones that you can control. • Provide walls in warm colors. You want a classroom like this. Not like this: It takes time to implement these changes. So lets get started! We owe it to our students. Adryanna Now I must go to get ready for my real job! Resources • Bergmanson, J. P. (1993). Ultraviolet radiation damage to the corneal endothelium? Ophthalmology, 100(4), 442-443. • Bradnam, M.S., Montgomery, D. M., Moseley, H., & Dutton, G. N. (1995). Quantitative assessment of the blue-light hazard during indirect ophthalmoscopy and the increase in the “safe” operating period achieved using a yellow lens. Opthamology, 102(5), 799-804. • Chen, E. (1993). Inhibition of cytochrome oxidase and blue-light damage in rat retina. Graefe’s Archive for Clinical and Experimental Ophthalmology, 231(7), 416-423. • Chou, B. R. (n.d.). Ocular health and the atmospheric environment. Ontario, Canada: University of Waterloo, School of Optometry. Resources • • • • • Coutts, L. Cooper, C.E., Elwell, C.E., & Wilkins, A.J. (2012). Time course of the haemodynamic response to visual stimulation in migraine, measured using near-infrared spectroscopy. Cephalalgia 32(8) 621–629. Creech, L. L., & Mayer, J. A. (1997). Ultraviolet radiation exposure in children: a review of measurement strategies. Annals of Behavioral Medicine, 19(4), 399-407. Fedorovich, I. B., Zak, P. P., & Ostrovskii, M. A. (1994). Enhanced transmission of UV light by human eye lens in early childhood and age-related yellowing of the lens. Doklady Biological Sciences, 336(1), 204-206. Ham, W. T., Jr. (1983). Ocular hazards of light sources: review of current knowledge. Journal of Occupational Medicine, 25(2), 101103. Ham, W. T., Jr., Ruffolo, J. J., Jr., Mueller, H. A., & Guerry, D., III. (1980). The nature of retinal radiation damage: dependence on wavelength, power level and exposure time; the quantitative dimensions of intense light damage as obtained from animal studies, Section II. Applied Research, 20, 1005-1111. Resources • Hightower, K. R. (1995). The role of the lens epithelium in development of UV cataract. Current Eye Research, 14, 71-78. • Hao, W., & Fong, H. K. (1996). Blue and ultraviolet lightabsorbing opsin from the retinal pigment epithelium. Biochemistry, 35, 6251-6256. • Knowlton, M. (1986). Ultraviolet light: some considerations for vision stimulation. Education of the Visually Handicapped, 17(4), 147-153. • Organisciak, D. T., Darrow, R. M., Barsalou, L., Darrow, R. A., Kutty, R. K., Kutty, G., & Wiggert, B. (1998). Light history and agerelated changes in retinal light damage. Investigative Ophthalmology & Visual Science, 39(7), 1107-1116. • Pautler, E. L., Morita, M., & Beezley, D. (1989). Reversible and irreversible blue light damage to the isolated, mammalian pigment epithelium. Proceedings of the International Symposium on Retinal Degeneration (pp. 555-567). New York: Liss. Resources • Rapp, L. M. & Smith, S. C. (1992). Morphologic comparisons between rhodopsin-mediated and shortwavelength classes of retinal light damage. Investigative Ophthalmology & Visual Science,33, 3367-3377. • Rozanowska, M., Wessels, J., Boulton, M., Burke, J. M., Rodgers, M. A., Truscott, T. G., & Sarna, T. (1998). Blue light-induced singlet oxygen generation by retinal lipofuscin in non-polar media. Free Radical Biology and Medicine, 24, 1107-1112. • Sliney, D. H. (1983). Biohazards of ultraviolet, visible and infrared radiation. Journal of Occupational Medicine, 25(3), 203-206. • Sperling, H. G. (n.d.). Position paper for workshop on longterm visual health risks of optical radiation. Houston: University of Texas, Health Science Center. Resources • Sperling, H. G., Johnson, C., & Harwerth, R. S. (1980). Differential spectral photic damage to primate cones. Vision Research, 20, 1117-1125. • Tezel, T. H., & Kaplan, H. J. (1998). Harvest and storage of adult human photoreceptor cells: the vibratome compared to the excimer laser. Current Eye Research, 17, 748-756. • Van der Leun, J. C., & Gruijl, F. R. (1993). Influences of ozone depletion on human and animal health. In M. Tevini (Ed.), UV-B Radiation and Ozone Depletion: Effects on Humans, Animals, Plants, Microorganisms, and Materials. (pp. 95-123). Boca Raton, LA: Lewis.