NECO, Perkins School continue joint low vision clinic
At the NECO Center for Eye Care’s Low Vision Clinic at Perkins School for the Blind, NECO’s Barry Kran OD, FAAO, is testing the acuity of a 15-year-old boy. This is not a traditional exam: The boy is deafblind (meaning some level of vision impairment and some level of hearing impairment), has cerebral palsy, cognitive challenges, and limited ability to communicate.
Dr. Kran cannot use symbols to assess acuity as the patient does not have expressive communication skills, nor can he indicate whether or not he can see a symbol through a forced-choice matching paradigm. The doctor needed another way to assess the boy’s acuity.
Watching the boy’s eyes, Dr. Kran uses Teller Acuity Cards — a series of grey rectangular cards with alternating black and white vertical lines on one side, which start off being course and become finer with each card — to determine the finest level seen by the patient. In spite of using various ways of engaging the patient, it was not possible to determine a threshold acuity.
By the way he moved through space and interacted with his teacher and doctor, it was clear he had functional vision. The key was to find a way of engaging him to understand the limits of his use of vision. Next, Dr. Kran tests the boy’s ability to see Cheerios placed against high- and low-contrast backgrounds. This is a way of assessing contrast and to a lesser extent acuity since the size of the object is known as is the distance it is seen.
The Cheerios test was a success: The boy snatched up the Cheerios only from the darker, high-contrast background. This was a breakthrough for the boy’s teacher, who developed a plan with Dr. Kran to make some adaptive changes in the classroom. By adapting the student’s environment, his access to learning, activities of daily living, and travel were all significantly improved.
This boy is just one of hundreds of patients seen every year at the Low Vision Clinic at the NECO Center for Eye Care at Perkins. Dr. Kran, the clinic’s optometric director, tailors vision tests to the individual’s abilities. The clinic is built on a history of collaboration with Perkins and a dedication to innovation in research, education, and practice — with the goal of sharing knowledge and improving lives.
“I believe we’ve made an impact, because the types of patients I saw 19 years ago in this clinic are now being seen closer to where they live, with doctors who have more affinity to working with special populations,” Dr. Kran says. “We are now seeing more and more complicated cases. Treating these kinds of patients forces us to think differently, enabling us to write, lecture, and share information that pushes everyone forward — sending the information downstream so the scope of practice can improve in our communities.”
Moving the Field Forward
Multiple professionals at the Low Vision Clinic are committed to the decades-long collaboration that has made it a place of learning, innovation, and progress. Joining Dr. Kran with patient care at the clinic are Nicole Ross, OD, MSc, FAAO (consulting optometrist) and D. Luisa Mayer, PhD, vision scientist and visual field specialist. They not only provide clinical supervision of NECO fourth-year students and other students in special programs and residents, but also conduct research into low vision and special needs populations. They publish their findings, as well as present at conferences and symposia, to share what they’ve learned and move the field forward.
For example, Dr. Kran is investigating the various aspects surrounding the diagnosis of individuals with cerebral visual impairment, the leading cause of pediatric vision impairment. He has lectured on these topics throughout North America, as well as in Africa, Australia, Europe, the Middle East, and India on breaking the barriers to eye care for individuals with visual and other impairments.
Drs. Kran and Mayer submitted a paper on a test for assessing contrast sensitivity in patients who are nonverbal or do not know symbols. This work was based on projects with former residents who presented the results of their project at the annual American Academy of Optometry meeting.
NECO’s Dr. Nicole Ross supervises interns present during patient visits at the Low Vision Clinic at Perkins and the NECO Center for Eye Care at Commonwealth Avenue. She is the instructor of record for the college’s low vision course, has mentored numerous students and master’s students, and is actively engaged with nationally funded research projects.
The reach of NECO’s institutional collaboration and commitment to share knowledge is illustrated by the March 17th interprofessional conference on cerebral vision impairment, sponsored by the David Yellin Academic College of Education in Jerusalem and Perkins.
Dr. Kran will be a co-keynote speaker and lecturer and will spend additional time working with faculty and students in the optometry programs at both Hadassah Academic College in Jerusalem and at Bar-Ilan University in Tel Aviv.
Commitment to Collaboration
Together, NECO and Perkins have made progress advancing education and clinical practices that can help optometrists administer effective eye exams to people with multiple, complex challenges.
Vision educators familiar with the student accompany them to the Low Vision Clinic and are invited to aid with the evaluation of the child. This collaboration and modeling of care happens with both future eye care providers as well as with vision educators in training at Perkins, and with visiting educators from developing countries around the world.
NECO is committed to not only serving the patients who visit the clinic, but to disseminating research and best practices with other eye care providers including vision educators, optometrists, and ophthalmologists — so they too can better assess and work with children with vision and other impairments.
Serving People with Complex Needs for 30+ Years
The Low Vision Clinic serves as a bridge between education and eye care. Since the mid-1980s, the NECO Center for Eye Care and Perkins have fostered an inter-professional collaboration to provide the low vision care on site. Its roots began in the Deafblind Program and soon spread to provision of eye care to all students on campus and ultimately to individuals from throughout the region.
It is the only clinic in New England solely dedicated to providing quality, comprehensive eye care to all individuals with multiple impairments using a collaborative approach.
Photos by Michael Brook of Perkins School for the Blind.