Why Visual Performance Matters: Foundations for Occupational Therapy Practice: facilitator notes

Presenter cues

• Say the frame before the condition list: these are the mechanisms other people diagnose, and knowing them tells you what ceiling you are working under.
• The red-flag slide is the safety slide of this course. Slow down and read it.
• End on the standing rule: diagnosed and managed = address it; undiagnosed, unclear, or changing = refer it, and keep working either way.

Answer key

Which underlying conditions could plausibly produce this picture, and which of them would a passed acuity screen fail to detect?

Plausible: intermittent strabismus or a decompensating phoria (head tilt, intermittent diplopia), convergence or accommodative insufficiency, an uncorrected refractive error including astigmatism, photophobia from an anterior-segment or albinism-spectrum condition, or a superior oblique palsy driving the tilt. A distance acuity screening detects none of them: it does not test binocular alignment, fusion, near function, accommodation, contrast sensitivity, or light sensitivity. Also flag urgency — new or worsening diplopia, or a new head tilt, is a prompt-referral item, not a wait-and-watch item.

Write the one sentence of documentation that names the functional limitation you will treat, without naming a diagnosis.

Model: "During sustained near reading, [student] maintains a right head tilt, reports intermittent blur and doubling after approximately five minutes, and loses place on 6 of 10 lines; near-work endurance and place-keeping are the OT targets while a comprehensive eye examination is pending." No condition is named, urgency is implied, and the OT target is explicit.

Examples to read aloud

• Reflection model answer (Module 3): "During a 15-minute writing task, Marcus closed his left eye for most of the session and moved to 12 cm from the page; this matters because he completes half the written work of his peers in the same time."
• Mini-exercise model answer: three commonly missed on a school screen — (1) convergence insufficiency, because the screen tests distance, not near; (2) CVI, because acuity can be normal while visual processing is not; (3) contrast-sensitivity loss, because high-contrast charts do not test it.

Watch-outs

• Participants will want to "rule out" CVI. OT observation cannot rule any condition in or out. Describe the behaviors and route it.
• Someone will ask whether ONH means the child is autistic. It does not. Autistic-like behaviors — light gazing, stereotypies, atypical social gaze — are frequently reported in ONH, and they are described functionally, never diagnosed by OT.