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FINAL EXAM
SPE 516
2013
PART 1
Answer the following questions based on the scenarios that precede them.
Always select the BEST answer.
You are a TVI in a small rural school district. You have just had a new
student added to your caseload. The new addition, Jacob, is a six month
old baby who was born at 24 weeks gestation. Because he was so
premature, his retinas did not develop completely, leaving him with a
condition called retinopathy of prematurity (ROP). Jacob also has a slight
but persistent nystagmus.
1. Which of the following are likely to be among Jacob’s visual
characteristics?
I. His eyes are likely to be larger than those of a normal infant.
II. It is likely that his pupils will be efficient in regulating the amount of
light that enters the eye.
III. He will probably have difficulty in moving his eyes smoothly.
IV. He will likely have problems with visual acuity.
a.
b.
c.
d.
I, II, and III
II, III, and IV
I, III, and IV
I, II, and IV
2. As Jacob’s TVI, you know that the following fact(s) is (are) true.
I.
As Jacob grows older and more mature, his nystagmus will
probably dampen.
II.
Very little can be done to help Jacob learn to use his vision more
efficiently.
III.
Because he cannot respond verbally, it is not possible to derive a
measure of refraction for Jacob.
IV. New synapses will continue to develop in Jacob’s brain until he is
around 10 years old.
a.
b.
c.
d.
I only
II, III, and IV
I and III
I and IV
3. Since Jacob has a severe problem with his retinas, which of the
following categories of visual loss would you expect him to have?
a. Visual field
b. Cortical visual impairment
c. Binocularity
d. Esotropia
You are a vision professional (TVI or COMS) who has just gotten a new student,
Janette, on your caseload. Janette is currently 12 years old. When she was 7,
she was involved in an automobile accident that resulted in her having a fairly
significant head injury. While she is mobile, she is not verbal beyond some semipredictable gestures. Janette is pleasant and eager to please.
4. Which of the following is most likely the cause of Janette’s visual losses?
a. Amblyopia
b. Cortical visual impairment
c. Color blindness
d. Retinitis pigmentosa
5. Based on what you know about Janette’s condition, which of the
following is expected to be true?
a.
b.
c.
d.
Her
Her
Her
Her
visual abilities should remain constant
ability to perceive color should be the same
impaired vision is a result of damage to her eyes
visual processing will be without difficulty
6. Which of the following part of the visual system is most effected by the
condition that Janette has?
a.
b.
c.
d.
The
The
The
The
retina
sclera
optic tract
choroid
7. You accompany Janette and her mother to the optometrist’s office.
There are a number of techniques that you observe. Which of the
following is used to assess the vitreous and retina?
a. The retinoscope
b. The tonometer
c. The slit lamp
d. The computer retinoscope
________________________________________________
_______
FUNCTIONAL VISION
ASSESSMENT
Name:
Date of birth:
Age:
District:
Placement/Grade:
Date of assessment:
Evaluator:
Amanda Hoeffer
May 11, XXXX
6 years
Oasis ISD
First Grade
January 24, XXXX
James McClelland, COMS
I.
Background Information
Amanda Hoeffer is a 6 year old student at Clear Creek Elementary in Oasis
Independent School District. She is currently placed in a regular first grade
classroom and her primary teacher is Mr. Terrence Adams. This assessment was
performed at the request of Ms. Jo Simpson, Diagnostician for OISD as part of a
three year reevaluation.
II.
Eligibility Information
Based on the most current report from an eye specialist, and upon the results of
this Functional Vision Assessment, it is the professional opinion of this evaluator
that Amanda does qualify as a student with visual impairments under Texas law
and current Commissioner’s Rules.
III.
Medical History
A. General
Medical records contained in Amanda’s special education folder indicate
that her birth history included no significant factors. She was the product
of a normal, full term pregnancy, and weighed 7 pounds, 6 ounces at
birth. Currently, Amanda is healthy, active, and seemingly unimpaired with
the exception of her visual disabilities.
B.
Visual
The most current report of an eye exam which is available for Amanda is
dated November 20, XXXX, and was based on an examination performed
by Dr. Jason Lewis of the Children’s Eye Center in Houston, Texas. This
report indicates that Amanda’s visual impairment is due to high myopia,
amblyopia, and ocular albinism. A moderate esotropia was also noted. Dr.
Lewis also states that Amanda demonstrates behavioral characteristics
which are consistent with moderate photophobia.
Amanda’s visual acuities using both eyes are listed as:
○ 20/200 at distance with glasses
○ 20/80 at near with glasses
Amanda is currently being treated for this condition with glasses (see
attached copy of prescription). No prognosis for Amanda’s condition was
provided by this report.
8. The diagnosis of myopia means that Amanda has problems with:
I.
II.
III.
IV.
Seeing things at a distance.
Only one good eye.
A loss of acuity based on the focal point in her eyes.
A refractive error.
a.
b.
c.
d.
I, II, and IV
I, III, and IV
II and III
I and III
9. As the vision professional working with Amanda, which of the following
would be information that you would want to convey to her teachers?
I.
IV.
She should be included in all classroom activities to the maximum
extent possible.
She will need extensive help and protection.
She should be placed in a position in the classroom which is
relatively close to the demonstration and teaching area.
She should be encouraged to wear her glasses at all times.
a.
b.
c.
d.
I and IV
II and III
I, II, III, and IV
I, III, and IV
II.
III.
10. If you looked through Amanda’s glasses, you would immediately note
that:
I.
II.
III.
IV.
Things look bigger.
Things look smaller.
The lenses are concave.
The lenses are convex.
a.
b.
c.
d.
II and III
I and IV
I and III
II and IV
11. Which of the following visual issues is likely to be most important in
deciding on how to program for Amanda?
a.
b.
c.
d.
color perception
acuity
visual attention
field.
12. Based on the information provided for Amanda, which of the following
most nearly reflects the likely prognosis for her.
a.
b.
c.
d.
progressive
improving
will lead to total blindness
stable
13. In order to correct Amanda’s refractive error, the eye care specialist
would need to prescribe
I.
a plus lens
II.
a minus lens
III.
a lens that would neutralize some of the refraction produced by
Amanda’s eyes
IV.
a lens that would contribute more refraction to Amanda’s visual
system
a.
b.
c.
d.
I, II, and III
II and IV
III and IV
II and III
14. Refraction (here used to describe the ability to bend light) is measured
in units called
a. foot candles
b. focal points
c. diopters
d. millimeters
15. Which of the following is true about refraction of light in the eye?
1.
The lens contributes more units of refraction than any other
structure of the eye.
2.
The retina contributes a significant amount of the refraction in the
eye.
3.
The tears and conjunctiva are refractive structures.
4.
Appropriate refraction is essential for forming a clear image on the
retina.
a.
b.
c.
d.
I and II
III and IV
I and IV
II and III
As you prepare for his Functional Vision Evaluation, you see that the last
ophthalmologist to see your student Paul indicated that he had a retinal
condition that affected the macula in both eyes. However, in one eye, the
entire macula had been affected and in the other eye, only random spots
had been affected.
16. Which of the following categories of visual loss is most likely to
characterize Paul’s vision? (Explain your answer)
a. Visual field loss
b. Acuity loss
c. Cortical visual impairment
d. Binocularity
17. Among the consequences of Paul’s visual condition will almost certainly
be
I.
II.
III.
IV.
He will have a difficult time with seeing in the dark.
He will have a difficult time perceiving color.
He is likely to develop an eccentric viewing pattern (holding his
head at an unnatural angle).
Near vision tasks are likely to be difficult for him.
a. I and II
b. II, III, and IV
c. I, II, and IV
d. I and II
18. As you read the report from Paul’s latest eye evaluation, you note that
the doctor indicates that Paul has no pupillary response. You interpret
this to mean
I.
II.
III.
IV.
a.
b.
c.
d.
That Paul will need braille in order to maximize his academic
functioning.
That Paul may be night blind.
That Paul may have neurological problems.
That Paul may have elevated sensitivity to light.
II, III, and IV
III and IV
I and II
I and IV
19.
What do the terms HM and CF mean when it is used in an eye
report?
20.
Which refractive error is a convex lens is designed to correct?
Answer the following questions based on the prescription provided.
Spherical
Axis
Add
OD -8.50
3.50
OS -3.00
5.5 X 180 3.50
21.
Is this person myopic or hyperopic in the right eye?
22.
A.Is the condition in the right eye mild, moderate or serious?
B. Do they have astigmatism?
23. How old is the person likely to be?
Part 2
Use information below to answer the following question
STATE OF TEXAS
Interagency
III.
Eye Examination Report
Patient’s Name _Melanie Ann Shelton________ Date of birth _02/02/04______ Social Security No.
_____________
Address____________________________________ City:
____________________ State _______________ Zip ________
Attention Eye Care Specialist
Address each item below.
Your thoroughness in completing this report is essential
for this patient to receive appropriate services.
Ocular History (e.g. previous eye diseases, injuries, or operations)
Age of onset 2 yrs. History Car accident; head trauma; traumatic hydrocephalus;
highly variable visual functioning; lesions located posterior to the optic chiasm with
more damage on the left hemisphere.
Visual Acuity
If the acuity can be measured, complete this box
using Snellen acuities or
Snellen equivalents or NIL, LP, HM, CF.
Distance OD HM 3’
OS 20/600
If acuity cannot be measured, check the
most appropriate estimation.
Near unable to test
Not Legally Blind
She is legally blind.
Legally Blind
These acuities represent my best guess based on two observations of Melanie.
Acuity with glare testing, if applicable: R _________ L ____________
Muscle Function
Normal
Abnormal
Describe
Intraocular Pressure Reading
R ___18__________
L ____16__________
Visual field Test
There is no apparent visual field restriction.
There is visual field restriction.
Yes
No
Describe most pronounced in OS; visual fields are
likely to be variable. Based on observation and
available medical records, there is an almost total
loss of central OD.
The visual field is restricted to 20 degrees or less.
Color Vision
Normal
Abnormal
Variable, but reacts most to red, yellow, and orange.
Photophobia
Yes
No
Diagnosis (Primary cause of visual loss)
Cortical Visual Impairment; hydrochephalus; trauma to the visual cortex.
Prognosis
Permanent
Progressive
Recurrent
Communicable
Improving
Can be improved
Treatment Recommended
Glasses
Surgery
Patches (Schedule):
Hospitalization will be needed for approximately
R ________________
L ________________
___________days.
Name of hospital _______ _______________
Medication ____________________
______________________________________
Refer for other medical treatment/exam:
Name of anesthesiologist or group:
________________________
_____ _____________________
Low Vision Evaluation
Other No further ophthalmological treatment is anticipated.
Precautions or Suggestions (e.g., lighting conditions, activities to be avoided, etc.)
Scheduling
Date of Next Appointment __March, 2009_____ Time __ _____________
A.
IMPORT
ANT to have no vision.
This patient appears
Check the most appropriate statement.
This patient has a serious visual loss after correction.
This patient does not have a serious visual loss after correction.
Dr. Rita Marshall
Print or Type Name of Licensed Ophthalmologist
or Optometrist
Signature of Licensed Ophthalmologist or
Optometrist
Address
Date of Examination
March 2, 2010
City
State
Zip
Telephone Number
RETURN COMPLETED FORM TO:
Name
Address
Agency
City
State
Zip
24. Which of the following would be acceptable methods for assessing Melanie’s
visual field?
I. Observing her as a paraprofessional feeds her lunch.
II. Asking her to indicate broken lines on an Amsler grid.
III.
Bringing a puppet into different areas around her.
IV. In a darkened room and from behind her head, introducing a pen
light with a red filter into different parts of her visual field.
a.
b.
c.
d.
I and II
III and IV
I, II, and IV
I, III, and IV
25. The etiology of Melanie’s vision loss is cortical visual impairment. Based on
what you know about CVI, which of the following is likely to be true of
her visual performance?
I.
II.
III.
IV.
She
She
She
She
will
will
will
will
have fluctuating visual performance.
tend to “look, look away, touch.”
have a tendency to have trouble with novelty and clutter.
have a tendency to see in shades of gray.
a.
b.
c.
d.
I,
I,
I,
I,
II, III, and IV
II, and III
III, and IV
II and IV
26. As you begin to prepare for Melanie’s FVA, which of the following pieces of
information from the reports that you have are significant from a VI
perspective?
I.
II.
III.
IV.
Melanie has a mild to moderate hearing loss in her left ear.
Melanie’s brother receives full day self contained special education
services.
Melanie is monitored closely by a neurologist.
Melanie takes Phenobarbital for seizures.
a.
b.
c.
d.
I, II, III, and IV
I. III and IV
II and III
II and IV
27. As you peruse the information provided, which of the following pieces of
background information would be crucial in planning Melanie’s FVA and
educational programming?
a.
b.
c.
d.
a more specific and complete birth history.
a more specific and complete description of the automobile
accident in which Melanie sustained her head injury.
a more complete description of Melanie’s family and their socioeconomic status.
a more complete interview with Melanie’s mother and brother
regarding her visual performance.
Cameron Lester
Identifying Information:
Name: Cameron L.
Parents: Marilyn and Kary L.
Birthdate: 09-17-xx
School: Gate City
Elementary
Age: 11- 6
Report Date: 03-17-xx
Teachers: General Ed. S. Miller/Resource E. Priddy
Reason for Referral:
Cameron was initially referred for services at the age of 18 months, by
his mother Marilyn L. Cameron is visually impaired due to Oculocutaneous
Albinism. At 18 months he was able to receive support services through
the Early Education Program in San Jose, CA. and has been on an
Individualized Education Program (I.E.P.) since xxxx. Currently, as part of
the I.E.P. Team, Cameron is helping to develop goals for his annual review
and transition plan to junior high.
Background Information:
Cameron was born at Kaiser Hospital in CA., after a normal pregnancy
and delivery. Birth weight was 8lbs. and 1oz. At the time of birth it was
noted that Cameron had white hair, a lack of pigment in his eyes, and
visual nystagmus. Two days later he was seen by an ophthalmologist, and
was to be seen by a doctor in Genetics. It was determined that Cameron
had Oculoctaneuos Albinism. Developmental milestones have been
within the average range. In xxxx Cameron had strabismus surgery. April
of xxxx, Cameron had eye muscle surgery to correct 40-degree head turn.
While the family lived in Santa Clara County CA., Early Intervention
goals dealt with mastery of basic concepts, orientation and selfadvocacy. First grade goals continued with self-advocacy goals, vision
goals of access to adaptive materials equipment and group sports. The
family then moved to Pocatello, Idaho. Grades 2nd and 3rd dealt with
consult goals from Resource Room and 15 minutes per month consult from
a vision specialist. The current TVI began working with Cameron as he
entered the 4th grade. At this time a Learning Media Assessment was
done to provide more comprehensive information on Cameron’s learning
and literacy media needs.
After the Learning Media Assessment, it was determined that Cameron
would benefit from expanding his literacy tools. Large print textbooks and
bold – lined paper were ordered. Books on tape and a CCTV (closed
circuit television) were also implemented at this time. Keyboarding skills
were intensified with the use of a large monitor, screen magnification
software, and a screen reading program. Presently, Cameron has more
formal instruction after school for keyboarding skills. Increasing
organizational skills are also a focus of his new plan.
Cameron has two younger siblings Ellen and Matt, who also have
Albinism.
TESTING HISTORY
March xxxx
November xxxx
February xxxx
M.D. eye exam – Dr. Fishel
CYCLOPLEGIC EXAM;
Rx: - 4.50+ 6.00 x 80 OD =20/400
- 3.50 + 6.00 x 86 OS =20/400
Absent foveal reflexes OU;
Hypopigmentation OU
Low Vision Clinic – Low Vision Specialist, Bryan Gerritsen
20/280 for distance visual acuity
For near vision – 20/200 in the right eye and
20/150 in the left eye
Wechsler Intelligence Scale for Preschoolers and Primary
Children – Revised (WPPSI-R) was administered with a
Full Scale Intelligence Quotient of 114.
March xxxx
Learning Media Assessment – Cameron’s main channel of
learning is vision. Cameron’s oral reading rate was 136
wcpm (words correct per minute) using grade level
material in
18 point type. Cameron obviously compensates very well.
March xxxx
Academic – grade point average is 3.5
Cameron Lester
28.
Cameron’s visual condition is often accompanied by which of the
following characteristics?
I.
II.
III.
IV.
A
A
A
A
lack of development of the retina in utero.
loss of visual field in the peripheral areas.
strabismus.
nystagmus.
a.
b.
c.
d.
29.
I, II, III
II, III, IV
I, III, IV
I, II, III, IV
The spectacle prescription that is provided in Dr. Fishel’s report indicates
which of the following
a.
b.
Cameron has no significant refractive error.
Cameron has both myopia and an astigmatism as well as
optic albinism.
c.
Cameron’s only alternative for improving his visual acuity is
to use a low vision device.
d.
Dr. Fishel is unsure as to the optimum correction necessary
for Cameron.
30.
The structures of
I.
II.
III.
IV.
the eye typically affected by optic albinism are:
The fovea
The lids and lashes
The lacrimal system
The ocular muscles
a.
b.
c.
d.
I and IV
II and III
I, II, and IV
I, II, III, and IV
31.
Based on Cameron’s near vision acuity report, the Closed Circuit Television
set (CCTV) might be very helpful for some tasks such as looking at
pictures in a book or reading a map. However, a major area of concern
with CCTV use would be
a) over enlargement
b) cognitive difficulties in understanding operation
c) glare from either the screen itself or back lighting
d) inability to enlarge sufficiently.
32.
As you prepare to complete Cameron’s required Functional Vision
Evaluation which of the following factors (based on what you’ve learned
about OA and on the scenario material) would you be most likely to be
able to adequately assess through observation in the classroom and on
the playground?
I. Visual field
II. Visual acuity
III. Presence or characteristics of head turn
IV. Level of photophobia
a) I and II
b) II and III
c) II and IV
d) I. III and IV
33.
Which of the following characteristics might you expect in terms of
Cameron’s visual functioning?
I.
II.
III.
IV.
a)
b)
c)
d)
The inability to read print, even under optimal conditions.
Difficulty in moving securely from low to high light areas.
The inability to travel independently throughout the campus.
Lack of motivation to use adaptive techniques because of
social pressures and concerns.
I and III
II and IV
II, III, and IV
I, II, III, and IV
Short answer – (give me enough to give you credit)
34. Describe the steps that should be undertaken to complete a Functional Vision
Evaluation?
35. What is the iris and what is its role in the eye? What implications would you
expect if your student had an iris that did not work properly?
36. Why is it important to review the student’s files (school and medical) and
interview the parent? Include any areas that you should discuss.
37. Describe diplopia, strabismus, and amblyopia – and how they may be
connected.
38. If a person has a problem with their retina which of the five areas of
dysfunction could be affected (list the related areas of dysfunction and tell
why or how the retina is or could be involved).
39. A) Prisms are generally used to deal with what types of visual problem? B)
Why do you need to address portability when looking at optical devices?
How does portability impact usage of devices?
40. Which two evaluation recommendations MUST be part of an FVE/LMA?
Bonus
1. Please tell me your opinion of the FACT SHEET
assignment. Please tell me if you feel that it was
an effective learning tool. Do you have any
suggestions for change or improvement?
2. Please tell me your opinion of the group
assignment. Please tell me if you feel that it was
an effective learning tool. Do you have any
suggestions for change or improvement? Add
comments about your group please!