[ music ] >> Lois Harrell: Hi, I'm Lois Harrell. I'm a Pediatric Vision Specialist. I started out about 40 years ago as a counselor with Blind Babies Foundation, and worked with them for several years; and then moved to University of California Davis, Department of Ophthalmology, Project Director of Children's Vision Center. When I retired from that job, I realized that nobody was doing it, so I remain a free agent and see about 30 families a month in about 5 counties in California. Many years ago I developed the Functional Vision Assessment Kit primarily because it was becoming recognized that early diagnosis and early intervention with children with vision problems can make a difference. But functional use of vision is more than following a light from a babies perspective; as in, 'I've looked at that light, now what do you want me to do with it? You won't let me have it!' So, I decided to make a kit that was interesting, that would capture many of the qualities that we're looking for. So the first item is the Pen Light. One is for looking at the eyes to see if there are any differences or to see if the pupils are different, to see if the pupils respond. It can then be used -- to have some interesting little objects put on it -- help the child to activate his visual curiosity as he does track. Just a variety interesting little objects. Because, again, we're talking about children. This bounces! And we things that they may not have seen before. So that they can be curious about it. If we use their familiar rattles, if use their things, like spoons and things they've had in the house... It's like, 'Ahh, I already know what that is! Why should I look.' They can just be brought up -- brought to the side and... just sometimes... we made need to touch the item to the child's hand to bring it into his attention space. And then invite him to even try to reach for it. We can bring around an object from the back to the front, and at what point does he -- while focusing on this -- get attracted to that object coming in from the side; which gives us information on Peripheral Vision. Faces are great! Because there's a genetic predisposition to facial attraction. But they also -- other picture -- simple pictures. It's fun to take another identical book, or pages and skip through them. 'What are we looking for? We're looking for...? No... that's not it. That's not it.' And the triangle. And it's kind of interesting, how many kids start recognizing this -- and the goal is to establish Comparative Looking. We also want to assess... um... Alternating Gaze. And this one's gonna be a little challenge here, because what I use, often, is a ball that I let the child track and follow, and then I say, 'Oops, watch!' And it falls apart! And they look from one side to the other and reach for it. There they go. Two bubbles. Bunk! And... many time kids watch at first, and they're very curious, and it's like, 'What is that?' And then pretty soon you start seeing them reaching their hand up and then they start -- they start following and -- so bubbles are really exciting for children that have some vision going for them. And they're also very indicative if the vision isn't that good. Cars. Balls. Little things that will role are good to get Tracking. And... also following Moving Objects. Now the challenge here is that... it's not gonna necessarily go someplace -- but you get it in the loop and you let it go. Like that! And often it will scoot on a little bit farther. And sometimes the kids don't know where to look when they're going. So the count of, '1... 2... 3...' And the first time they're, 'What's happening?' But then the second time, you do, '1... 2... 3...' And then they really watch to see where it goes. The string can be a pretty valuable piece of equipment. Once they've kind of looked at it, we bring it around, slowly! But remember, if we're wanting the child to track across -- if we go straight, we're asking him to converge and to follow. So it has to be in a loop, going out. And going up and over. And we want to look for how they eyes are tracking -- if they're both tracking together. If they -- the other thing we're looking for is -- as we're going across, does the child kind of follow and then disengage at mid-line? Sometimes that can be an indicator of some neurological problems, other CNS, central nervous system problems. ^*Just a sock, but all you need is some stripped material. And you bring it across in front of the child, and as he tracks -- Does he skip? So are his eyes -- and it's called Saccadic Movement, but are his eyes skipping on the lines? That means he's getting some visual input of the pattern. Kids like to see their faces. So... So is he looking at the face? And when he brings it up, does he smile? Is there an indication that he's got eye contact with himself? This is a glow stick. When you bend them, sometimes they light up, and the kid gets interested in the light and follows the light. You can bring it across this way and this way, and then they can grab it and... and hold it... and it's... rather safe. An interesting thing. Just recently I was with an ophthalmologist, and she said, 'Lois, this is the first time I've done this!' And she's been doing it for 20 years! 'But I had a kid that would not cooperate at all! So I had some glasses, and they were 2.5 glasses -- and I knew he had a vision problem, but I was having trouble. I put the glasses on the child and he all of a sudden woke up! And just looked and looked...' These are curious little objects. They're actually small erasers... with happy faces. So we need to be cautious with them to make sure that the child doesn't grab it and put it in his mouth first. But what I do with these... is I present them to the child, and I say... 'Watch!' And I take one. 'On!'... 'On!'... 'On!' And I'm always amazed at after they've had the demonstration, they often try, 'On!' And many times I've had kids get up to six, that were very challenged! Are they using their fingers to hold as they go to the next one? Is there Depth Perception or Depth Conception? Depth Perception means that both eyes focus on the target together; so I can just drop it right on the target. And Depth Conception is I'm conceptualizing the space and by putting it this way, I can guide it with my fingers. Just take pipe cleaners. Ok! And these little beads. Now you could use blocks with holes in them, too. But what I found is -- kids that I didn't expect to be able to be interested in this -- they can feel the hole! And I demonstrate one. And then I demonstrate, two. And then I go, 'Hey! Look! It can go off.' And I let the child take one off, or see me take it off -- let him take the other one off. They like the monitoring -- or the modeling. This is just one of those things for Depth Perception, Eye-Hand Coordination, and something that's just kind of unique, that they're not going to find in their in their little toy box. The other thing that's useful... is... just paper. And then take a pen -- I have black right here, but red and green -- and just, 'Da, da, da.' And then give him the pen and see if he wants to do it. Has he seen the lines? And then, does he kind of imitate with it? You can even draw a face... with the eyes and with the mouth. And have the child point to the eyes. And we want the child to do this -- the same things with those small hard board -- hard books. Put a glue dot on the nose of the dogs -- on each page. So he can point to the nose of the dog and he can feel it, he'll get touch feedback. So just a little glue dot, or a pin from the underside of a page gives touch feedback. Because if we can get the child to point, we'll start to learn to understand his detail vision and how he's doing comparative looking, too. I have dots and dots. And I want to take that line and I want to make it so that it's raised. The child has touch input to go across from one side to the other. And the touch input, sometimes, invites more detailed looking or processing. There are lots and lots of fun objects with which to do Functional Vision Screening. We're looking for so many characteristics, the Peripheral Vision, the Central Vision, the ability to Track. What kind of Detail Vision he may have. [background music] And giving us an opportunity to provide suggestions for adaptation. These things give us information on how to provide intervention that will make a difference. [ music ]