c to Mwith  in 2017 to It’s not always easy to pinpoint exactly what OTs (and OTAs under OT supervision) can do in a school-based setting when it comes to vision.  

According to the Individuals with with Disabilities Education Act (IDEA), Occupational Therapy is an educationally relevant related service. If a child is classified as a student with a disability, the school district is legally mandated to provide the services that a child requires to benefit from their Individual Education Program (IEP). 

A child may be classified if they have a disability in one or more of the categories below.

• Intellectual disability
• Hearing impairment (including deafness)
• Visual impairment (including blindness)
• Serious emotional disturbance
• Orthopedic impairment
• Autism
• Speech or language impairment
• Another health impairment
• Specific learning disability
• Deaf-blindness
• Traumatic brain injury
• Multiple disabilities  

A visual impairment as defined by IDEA, is “any impairment in vision that even with correction adversly effects a child’s educational performance. (IDEA, as cited in ” The definition includes conditions caused by any etiology, including ocular pathology, oculomotor, and brain injury.” 

School occupational therapists work with a wide variety of children with a myriad of diagnosis such as Autism, Down’s syndrome, spina bifida, sensory integrative dysfunction, developmental delays and learning disabilities.  Studies show that children with these disabilities have a high prevalence of vision disorders. In fact, “Many children with special needs have undetected and untreated visual problems.” 

Children with undetected and untreated visual problems may struggle with school-based occupations such as reading, writing, copying from the board, playing sports, participating in physical education, and more.  If a child ability to perform these school-based tasks is affected by a visual problem, occupational therapy can be important for improving the child’s ability to access their curriculum. 

“Occupational therapists are most likely to see children with accommodation, binocular vision, eye movement, visual information processing problems and SHOULD BE FAMILIAR with how to screen for these problems” (Scheiman, pp. 866).

“In order to be maximally effective in their therapy, occupational therapists should understand the complexity and importance of vision and how visual deficits an interfere with occupation.” (Scheiman et al., 2020).

Aren’t these “medical” issues?

Some school administrators may consider visual deficits a “medical” issue. However, these issues are included under IDEA’s visual impairment category. If the deficit is effecting a child’s academic performance, an occupational therapist may be able to address the deficit.  For best results, the child should have a complete binocular vision exam by a developmental optometrist.

In the past, some states had excluded some children from qualifying as a child with a visual impairment. Parents and school professionals raised concerns that some student’s weren’t receiving the services they need to access their curriculum. 

In response to these concerns, the Office of Special Education and Rehabilitation Services issued a Memorandum in 2017: Eligibility determinations for children suspected of having a visual impairment including blindness under the Individuals with Disabilities Education Act.  This document clarified the term “visual impairment” and specifically states that children with ocular motor issues such as convergence insufficiency may be included in this classification. Many other documents were created as a result of this clarification. 

To be clear, the OSEP does not state that the school must provide particular services (Ex. vision therapy) for children by a particular professional (occupational therapist, reading specialist, Teacher of the visually impaired).

The purpose of the document (link provided below) was to provide the additional guidance requested on this important issue, and share information about outside resources that may be helpful as you examine your State’s procedures related to the identification and evaluation of children suspected of having a visual impairment including blindness. 

But what school professional can support the student?

A school OT can support the optometrists recommendations and incorporate recommendations and exercises into the student’s occupational therapy sessions.   Occupational therapy goals will be academically based, such as copying from the board, scanning left to right, etc.  

The occupational therapy practice framework – 3 (OTPF-3) describes occupational therapy’s domain and scope of practice. It illustrates the distinct contriution to school systems by promoting health and participating in occupationals. School practitioners may use the OTPF-3 to demonstrate the full scope of practice to school administrators who may question the role of OT in addressing vision defcitis. 

The OTPF-3 clearly outlines the various “occupations” in which people engage, including ADL, IADL, education, work, play, leisure, and social participation. The client factors section describes body functions and body structures that are needed to carry out an occupation/activity.  

These particular areas can be used to support OT working on visual goals to support the student’s participation in the school environment.

• Perceptual body functions include—visuospatial perception, interpretation of sensory stimuli (tactile, visual, auditory, olfactory, gustatory)
• Seeing functions include visual acuity, visual field functions
• Muscle functions
• Movement functions
• Body structure – The eyes, ears, and related structures 

The student may also be referred to a Teacher of the Visually Impaired. The educational team should review the student’s records and make a plan to fit the student’s needs.    

What vision deficits can Occupational Therapists treat?

OTs routinely assess for visual perceptual deficits, but there’s a catch.  Are our assessments working if our children can’t see properly?

There is a lot more to vision than identifying the need for a vision screening for glasses.

Many visual efficiency deficits can—and should—be treated by school occupational therapists!

Here’s what OTs and OTAs (under the supervision of an OT) can do to work on vision in the school setting:

• Screen and evaluate 
• Administer standardized tests 
• Developing goals 
• Develop intervention plans 
• Monitor progress 
• Provide direct intervention 
• Document service 

For these areas:

• eye movements / ocular motor skills (includes saccades, visual pursuits)
• binocular vision (includes convergence, divergence)
• accommodation (near to far, etc.)
• visual perceptual skills
• visual motor integration

Get this quick reference sheet about our vision capabilities. It’s also good for parents and other school professionals.​

Read more

References

American Occupational Therapy Association. (2014b). Occupational therapy practice Framework: Domain and process (3rd ed.). American Journal of Occupational Therapy 68 (Suppl. 1) S1-S48.

Individuals with Disabilities Education Improvement Act (2004). Pub. L. 108-446, 20 U.S.C. §§ 1400-1482.

Lampert, J. (2019). Best practices in supporting students with visual impairments. In G. F. Clark, J. E. Rioux, & B. E. Chandler, (Eds.), Best practices for occupational therapy in schools (2nd ed., pp. 321-327). AOTA Press/The American Occupational Therapy Association, Inc. 

Office of Special Education and Rehabilitation Services (2017). Memorandum: Eligibility determinations for children suspected of having a visual impairment including blindness under the Individuals with Disabilities Education Act. Retrieved from https://sites.ed.gov/idea/files/letter-on-visual-impairment-5-22-17.pdf

Scheiman, M., & Kuhaneck, H. (2020). Vision impairment. In J. Clifford O’Brien (Ed.), Occupational therapy for children and adolescents (8th ed., pp. 844–869). Elsevier, Inc.

https://sites.ed.gov/idea/files/letter-on-visual-impairment-5-22-17.pdf#:~:text=On%20November%2012%2C%202014%2C%20the%20Office%20of%20Special,suspected%20of%20having%20a%20visual%20impairment%20including%20blindness.

https://www.afb.org/newsletters/directconnect-newsletter/osep-eligibility-memo-may-2017#:~:text=On%20Monday%2C%20May%2022%2C%202017%2C%20the%20Office%20of,Blindness%20under%20the%20Individuals%20with%20Disabilities%20Education%20Act.%E2%80%9D

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