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Why Visual Performance Matters: Foundations for Occupational Therapy Practice

3 contact hours · 0.3 AOTA CEUs · Module 3 · 19 slides

Presenter-side material. Each block shows the slide as the audience sees it, the talk track, and space for your own notes. Model answers appear here — do not hand this version to learners.

Module 3

3.1 — Module 3

Transition

Module 3

Module 3

Why Visual Performance Matters: Foundations for Occupational Therapy Practice
1 / 19

Say this

Transition: "Module 3."

My notes

3.2 — Underlying Conditions vs. Functional Limitations

Title

Module 3

Underlying Conditions vs. Functional Limitations

The eye and brain conditions that may sit under what you observe — and the functional problems OT actually treats.

Why Visual Performance Matters: Foundations for Occupational Therapy Practice
2 / 19

Say this

Open here. "Underlying Conditions vs. Functional Limitations." The eye and brain conditions that may sit under what you observe — and the functional problems OT actually treats.

Say why this section matters for their caseload, then advance.

My notes

3.3 — Condition recognition

Poll

Poll

Condition recognition

Which condition are you least confident recognizing functionally?

Select one.

Why Visual Performance Matters: Foundations for Occupational Therapy Practice
3 / 19

Say this

Ask the poll: "Which condition are you least confident recognizing functionally?"

Options:

• Cortical Visual Impairment (CVI)

My notes

3.4 — How to use this module

Teaching slide

Scope reminder

How to use this module

  • These are possible underlying diagnoses, not OT findings — diagnosis belongs to ophthalmology, optometry, and neurology.
  • OT does not diagnose or treat the condition; OT describes and treats the functional limitation it produces.
  • The point is vocabulary and mechanism: knowing the condition tells you what ceiling you are working under and which supports are worth trying.
  • A short red-flag list still warrants prompt medical eye care, and OT intervention continues in parallel either way.

CVI

Variable function, latency, color/movement preference

Optic nerve hypoplasia

Reduced acuity, field loss, nystagmus

Albinism

Photophobia, nystagmus, reduced acuity

Strabismus

Eye turn, suppression, depth judgment errors

Amblyopia

Monocular acuity gap, crowding effects

Nystagmus

Null point head posture, reading endurance loss

Recognize and refer. The OT contribution is the functional description of each pattern during occupation — the diagnosis belongs to eye care.

OT observation cannot rule an eye condition in or out. Describe function; recommend an exam when none is documented.

Why Visual Performance Matters: Foundations for Occupational Therapy Practice
4 / 19

Say this

Frame the slide: "How to use this module."

Walk each point, one sentence each:

• These are possible underlying diagnoses, not OT findings — diagnosis belongs to ophthalmology, optometry, and neurology.

My notes

3.5 — Cortical Visual Impairment (CVI)

Comparison

CVI

Cortical Visual Impairment (CVI)

What it is

  • Brain-based, not ocular — the eye exam is often normal
  • A visual-processing problem, not low vision
  • Often described as a "kaleidoscope" visual experience

Functional limitations OT treats

  • Strong color preference
  • Vision improves with movement or positioning
  • Visual latency — delayed response
  • Breaks down in visual clutter
RetinaChiasmLGNV1striate cortex
Retina → optic nerve → chiasm → LGN → primary visual cortex (V1), then divergence: the dorsal stream travels superiorly to parietal cortex, the ventral stream inferiorly to temporal cortex.

Source: Visual Minds Learning, "Cortical Vision Impairment (CVI)".

Why Visual Performance Matters: Foundations for Occupational Therapy Practice
5 / 19

Say this

Contrast the two columns: What it is versus Functional limitations OT treats.

What it is:

• Brain-based, not ocular — the eye exam is often normal

My notes

3.6 — Optic Nerve Hypoplasia (ONH)

Comparison

ONH

Optic Nerve Hypoplasia (ONH)

What it is

  • Congenital under-development of the optic nerve
  • Prenatal drug or alcohol exposure is commonly cited
  • Ranges from mild nerve dysfunction to complete loss
  • Frequently presents with autistic-like behaviors — light gazing, stereotypies, social-gaze differences

Functional limitations OT treats

  • Acuity and field loss — print size, contrast, materials placement
  • Performance varies by lighting and setting; one acuity number does not predict the day
  • Near-work endurance and visual attention
  • Autistic-like behaviors are described functionally, never diagnosed by OT
Why Visual Performance Matters: Foundations for Occupational Therapy Practice
6 / 19

Say this

Contrast the two columns: What it is versus Functional limitations OT treats.

What it is:

• Congenital under-development of the optic nerve

My notes

3.7 — Misalignment and its downstream cost

Comparison

Strabismus & amblyopia

Misalignment and its downstream cost

Strabismus

  • Eyes are not aligned with one another; can be congenital or acquired
  • Creates a double image the CNS may suppress from one eye ("sensory suppression")
  • Can present as a phoria (fusion holds it in check, but effortful) or a tropia (constant, observable deviation)
  • Phoria drives visual stress, reduced concentration, slowed reading, and headaches even without a visible turn

Amblyopia

  • Functional "blindness" in central vision from ongoing sensory suppression
  • Significantly reduced acuity in the suppressed eye
  • Impairs binocular vision — eyes do not work together effectively for daily tasks
  • Timing matters medically: the treatment window narrows with age, so an unexamined eye turn is worth naming in your report
Why Visual Performance Matters: Foundations for Occupational Therapy Practice
7 / 19

Say this

Contrast the two columns: Strabismus versus Amblyopia.

Strabismus:

• Eyes are not aligned with one another; can be congenital or acquired

My notes

3.8 — Naming the direction — vocabulary, not diagnosis

Teaching slide

Types of tropia

Naming the direction — vocabulary, not diagnosis

  • Esotropia — eye turns inward.
  • Exotropia — eye turns outward.
  • Hypertropia — eye turns upward.
  • Hypotropia — eye turns downward.
  • OTs may describe an observed eye position; the eye care team confirms and classifies the diagnosis.

Esotropia

turns inward

Eye turns toward the nose. Watch for closing one eye at near.

Exotropia

turns outward

Eye drifts out, often with fatigue or distance viewing.

Hypertropia

turns upward

Eye sits higher. Head tilt is a common compensation.

Hypotropia

turns downward

Eye sits lower; chin-up posture may appear.

Deviation is named for the direction the non-fixating eye turns, with the left eye deviating in each illustration. OT documents the functional signature — head posture, eye closing, place-losing — and refers for the diagnosis.
Why Visual Performance Matters: Foundations for Occupational Therapy Practice
8 / 19

Say this

Frame the slide: "Naming the direction — vocabulary, not diagnosis."

Walk each point, one sentence each:

• Esotropia — eye turns inward.

My notes

3.9 — Two conditions that often travel together

Comparison

Albinism & nystagmus

Two conditions that often travel together

Ocular albinism

  • Hereditary condition; excess light enters through an unpigmented iris
  • Reduced visual acuity and severe photophobia
  • Frequently co-occurs with nystagmus and severe astigmatism

Nystagmus

  • Involuntary, rhythmic eye movement — horizontal, vertical, or torsional
  • Reduces acuity through poor gaze stability; often experienced as blur
  • Rarely isolated — seen with albinism, cataract, optic atrophy, vestibular/cerebellar or brain-injury involvement
  • Some individuals find a "null point" head position that improves stability and acuity
Why Visual Performance Matters: Foundations for Occupational Therapy Practice
9 / 19

Say this

Contrast the two columns: Ocular albinism versus Nystagmus.

Ocular albinism:

• Hereditary condition; excess light enters through an unpigmented iris

My notes

3.10 — Three more conditions that change the sensory floor

Comparison

ROP, RP, cataracts

Three more conditions that change the sensory floor

Retinopathy of Prematurity & Retinitis Pigmentosa

  • ROP: abnormal blood vessel growth unique to preterm infants; incidence approaches 100% in the smallest, lowest-birth-weight infants
  • RP: inherited, progressive rod-cell loss beginning mid-periphery ("donut" pattern), progressing centrally and peripherally over years
  • Both carry a progressive or high-risk course — flag for ongoing ophthalmologic monitoring

Congenital cataracts

  • Present at birth; causes include genetic factors and in-utero exposures (e.g., rubella)
  • Most are non-progressive and many do not cause significant impairment
  • Bilateral, significant cataracts are typically removed within the first two months of life
  • Intra-ocular lens replacement is not used in infancy; corrective lenses or contacts follow surgery
Why Visual Performance Matters: Foundations for Occupational Therapy Practice
10 / 19

Say this

Contrast the two columns: Retinopathy of Prematurity & Retinitis Pigmentosa versus Congenital cataracts.

Retinopathy of Prematurity & Retinitis Pigmentosa:

• ROP: abnormal blood vessel growth unique to preterm infants; incidence approaches 100% in the smallest, lowest-birth-weight infants

My notes

3.11 — Diagnosis names the mechanism — you treat the limitation

Comparison

The translation

Diagnosis names the mechanism — you treat the limitation

What the diagnosis tells you

  • Reduced acuity — detail is limited
  • Field loss — part of the world is unavailable
  • Photophobia — light load is intolerable
  • Unstable fixation or misalignment
  • Complexity intolerance (CVI)

What you write and treat

  • Print size, contrast, working distance
  • Scanning and placement in the usable field
  • Lighting, glare control, seating
  • Near-work endurance, tracking, place-keeping
  • Array density and response latency
Finding
Diagnosed & managed → OT addresses
New / undiagnosed / changing → refer
Reduced acuity
Magnify (optical, electronic, or digital), enlarge print, increase working-distance control, reduce visual clutter, seat for viewing angle.
No comprehensive eye exam on file, correction not worn or outgrown, or a new drop in near/distance performance.
Reduced contrast sensitivity
High-contrast materials, bold line paper, dark-on-light or reverse-polarity screens, glare and lighting control, edge marking on stairs and thresholds.
Contrast difficulty never evaluated, or a functional loss that is new, worsening, or does not match the documented diagnosis.
Field loss
Teach systematic scanning, anchoring, and line-tracking; position materials and seating into the intact field; organize the workspace; travel-safety routines with the O&M specialist.
Field loss suspected but never documented, or new field complaints, bumping, or missed content on one side.
Ocular alignment, oculomotor, accommodation
Grade the visual demand of the occupation, build near-point stamina, chunk and space text, schedule visual breaks.
New eye turn, new double vision, headaches or pain with near work, or no eye care follow-up in place.

OT addresses diagnosed, medically managed limitations. A new or undiagnosed finding is a referral — the diagnosis has to come first before we treat that finding as a known visual limitation.

The standing rule: OT addresses the functional limitation only when the ocular condition is already diagnosed and medically managed. If the finding is new, undiagnosed, unclear, or changing, the appropriate OT action is referral.

Left column belongs to eye care. Right column belongs in your plan of care.

Why Visual Performance Matters: Foundations for Occupational Therapy Practice
11 / 19

Say this

Contrast the two columns: What the diagnosis tells you versus What you write and treat.

What the diagnosis tells you:

• Reduced acuity — detail is limited

My notes

3.12 — When a screening result is not the whole story

Case

Application

When a screening result is not the whole story

A 2nd-grade student passed a school acuity screening this year. In therapy, he tilts his head to one side while reading, occasionally reports "things look blurry and double," and squints in bright hallway light.

  • Q1.Which underlying conditions could plausibly produce this picture, and which of them would a passed acuity screen fail to detect?
  • Q2.Write the one sentence of documentation that names the functional limitation you will treat, without naming a diagnosis.

Same-day / urgent

Ophthalmology or ED via family and school nurse

  • • Sudden vision loss or new double vision
  • • New eye turn, new head tilt, or new nystagmus
  • • Eye pain, trauma, or acute photophobia

Routine eye care referral

Optometry / developmental optometry

  • • Blur, squinting, or headaches with near work
  • • Suspected phoria: fatigue, place loss, avoidance
  • • No comprehensive exam within the past year

Educational vision team

TVI · O&M specialist

  • • Documented low vision or field loss
  • • Navigation or travel safety concerns
  • • Braille, large print, or AT decisions

OT continues in parallel

You

  • • Environmental and task modification today
  • • Functional description for the IEP team
  • • Re-check performance after the modification
Referral routing. A referral never pauses OT — modification, documentation, and re-measurement continue while the eye care team works.
Why Visual Performance Matters: Foundations for Occupational Therapy Practice
12 / 19

Say this

Read the scenario aloud, slowly:

A 2nd-grade student passed a school acuity screening this year. In therapy, he tilts his head to one side while reading, occasionally reports "things look blurry and double," and squints in bright hallway light.

Then put these questions to the room:

My notes

3.13 — Module 3 video — underlying conditions and the functional problems they produce

Video

Lecture

Module 3 video — underlying conditions and the functional problems they produce

Why Visual Performance Matters: Foundations for Occupational Therapy Practice
13 / 19

Say this

Set up the clip in one sentence, play it, then debrief with "what did you notice?"

My notes

3.14 — Address it, refer it — or both

Comparison

The standing rule

Address it, refer it — or both

Diagnosed and managed → OT addresses it

  • Low acuity: magnification, enlarged print, working distance, seating.
  • Contrast loss: bold-line paper, reverse polarity, glare control.
  • Field loss: systematic scanning, anchoring, materials in the intact field.
  • The OT target is the limitation, never the eye condition.

Undiagnosed, unclear, or changing → refer

  • No comprehensive exam on file, or correction unworn or outgrown.
  • A functional loss no one has evaluated, or one that does not match the diagnosis.
  • Anything new: eye turn, double vision, field complaint, pain.
  • Refer and keep working — the modification goes in today.
Finding
Diagnosed & managed → OT addresses
New / undiagnosed / changing → refer
Reduced acuity
Magnify (optical, electronic, or digital), enlarge print, increase working-distance control, reduce visual clutter, seat for viewing angle.
No comprehensive eye exam on file, correction not worn or outgrown, or a new drop in near/distance performance.
Reduced contrast sensitivity
High-contrast materials, bold line paper, dark-on-light or reverse-polarity screens, glare and lighting control, edge marking on stairs and thresholds.
Contrast difficulty never evaluated, or a functional loss that is new, worsening, or does not match the documented diagnosis.
Field loss
Teach systematic scanning, anchoring, and line-tracking; position materials and seating into the intact field; organize the workspace; travel-safety routines with the O&M specialist.
Field loss suspected but never documented, or new field complaints, bumping, or missed content on one side.
Ocular alignment, oculomotor, accommodation
Grade the visual demand of the occupation, build near-point stamina, chunk and space text, schedule visual breaks.
New eye turn, new double vision, headaches or pain with near work, or no eye care follow-up in place.

OT addresses diagnosed, medically managed limitations. A new or undiagnosed finding is a referral — the diagnosis has to come first before we treat that finding as a known visual limitation.

The standing rule: OT addresses the functional limitation only when the ocular condition is already diagnosed and medically managed. If the finding is new, undiagnosed, unclear, or changing, the appropriate OT action is referral.

OT never diagnoses the condition; OT always owns the occupational performance problem.

Why Visual Performance Matters: Foundations for Occupational Therapy Practice
14 / 19

Say this

Contrast the two columns: Diagnosed and managed → OT addresses it versus Undiagnosed, unclear, or changing → refer.

Diagnosed and managed → OT addresses it:

• Low acuity: magnification, enlarged print, working distance, seating.

My notes

3.15 — When medical eye care gets involved — and what OT keeps doing

Comparison

Take with you

When medical eye care gets involved — and what OT keeps doing

Refer promptly

  • New or intermittent eye turn, head tilt, or double vision
  • Sudden acuity change, eye pain, or light sensitivity that is new
  • No comprehensive eye exam on file, or glasses outgrown or unworn
  • Function that does not match the documented diagnosis

OT continues in parallel

  • Print size, contrast, and lighting adjusted today
  • Scanning, place-keeping, and copying strategies taught
  • Near-work endurance graded and monitored
  • Functional observations documented for the eye care report

Same-day / urgent

Ophthalmology or ED via family and school nurse

  • • Sudden vision loss or new double vision
  • • New eye turn, new head tilt, or new nystagmus
  • • Eye pain, trauma, or acute photophobia

Routine eye care referral

Optometry / developmental optometry

  • • Blur, squinting, or headaches with near work
  • • Suspected phoria: fatigue, place loss, avoidance
  • • No comprehensive exam within the past year

Educational vision team

TVI · O&M specialist

  • • Documented low vision or field loss
  • • Navigation or travel safety concerns
  • • Braille, large print, or AT decisions

OT continues in parallel

You

  • • Environmental and task modification today
  • • Functional description for the IEP team
  • • Re-check performance after the modification
Referral routing. A referral never pauses OT — modification, documentation, and re-measurement continue while the eye care team works.

Referral refines OT involvement. It never pauses it.

Why Visual Performance Matters: Foundations for Occupational Therapy Practice
15 / 19

Say this

Contrast the two columns: Refer promptly versus OT continues in parallel.

Refer promptly:

• New or intermittent eye turn, head tilt, or double vision

My notes

3.16 — So what? Urgency decides your week, not your caseload order

So what?

So what?

So what? Urgency decides your week, not your caseload order

Some findings move to the front of the line the day you see them; most do not. Knowing which is which protects the student and your scope.

Pain, sudden change, new diplopia, new head tilt, or an unexplained acuity drop are same-day referrals regardless of caseload.

What you do with it

  • Keep the same-day list somewhere you can see it during observations.
  • Refer and document on the same day for those findings.
  • Continue OT services alongside the referral, never instead of it.

Watch for

A new sign in a student you already know — change is more informative than a static finding.

Why Visual Performance Matters: Foundations for Occupational Therapy Practice
16 / 19

Say this

Land the "so what": Some findings move to the front of the line the day you see them; most do not. Knowing which is which protects the student and your scope.

Explain the mechanism plainly: Pain, sudden change, new diplopia, new head tilt, or an unexplained acuity drop are same-day referrals regardless of caseload.

Then give them the moves — say each one as something they can do Monday:

My notes

3.17 — Two-minute case: how fast do you move?

Mini case

Two-minute case

Two-minute case: how fast do you move?

During a Thursday session, a student you have treated for months suddenly holds his head tilted to the right and reports "two of things" when he looks at the board.

What is your action today?

Why Visual Performance Matters: Foundations for Occupational Therapy Practice
17 / 19

Say this

Two-minute case. Read it aloud:

During a Thursday session, a student you have treated for months suddenly holds his head tilted to the right and reports "two of things" when he looks at the board.

Put the question to them: "What is your action today?" Give 60 seconds, no talking.

My notes

3.18 — Reflect and share

Reflection

Reflect and share

Reflect and share

Write a one-sentence referral note for a student you suspect may have a visual condition that needs eye care. Include only what you observed and why it matters.

THINKPROCESSSHARE
Why Visual Performance Matters: Foundations for Occupational Therapy Practice
18 / 19

Say this

Reflection prompt: "Write a one-sentence referral note for a student you suspect may have a visual condition that needs eye care. Include only what you observed and why it matters."

Offer the sentence starter: "During [activity], [student] was observed... This matters because it affects..."

Think for one minute, write, then take two shares.

My notes

3.19 — Knowledge check — red flags

Self-check

Knowledge check

Knowledge check — red flags

Which finding requires the most urgent referral?

Self-check only — it does not affect your post-course quiz score.

Why Visual Performance Matters: Foundations for Occupational Therapy Practice
19 / 19

Say this

Knowledge check: "Which finding requires the most urgent referral?"

Options:

• A student who reads slowly with large print

My notes