Chapter II - Focus on Kids

19 MILLION CHILDREN WORLDWIDE ARE VISUALLY IMPAIRED!

CHILD CARE SERVICES:

CoverKids
https://www.kidcentraltn.com/health/insurance/coverkids.html
Full health coverage for children 18 and under and pregnant women whose families cannot afford employer-sponsored insurance or individual insurance and who make too much to be eligible for TennCare. CoverKids is part of the Children’s Health Insurance Program, which provides health insurance to uninsured children in all 50 states. Any child or pregnant woman who is eligible for TennCare will be covered by TennCare, not CoverKids. Children and pregnant women who aren’t eligible for TennCare may be eligible for CoverKids.

For qualifying families, there is no monthly premium—only copayments, for sick visits and medications. However, you can’t be part of any other health plan.

InfantSEE
Phone: 314-983-4160
www.infantsee.org
Managed by Optometry Cares® - the American Optometric Association Foundation. InfantSEEis designed to ensure that eye and vision care becomes an essential part of infant wellness care to improve a child's quality of life. Participating optometrists provide a comprehensive infant eye assessment between 6 - 12 months of age as a no-cost public service. Vision development and eye health problems are easier to correct if treatment begins early.

KidsCentral
www.kidcentraltn.com
Tennessee's one-stop shop for children's health, education, development and support.
Early Periodic Screening Diagnosis and Treatment (EPSDT) is a program of checkups and health care services for children, teens and young adults up to age 21. EPSDT check-ups are provided by all county health departments in the state. These services make sure that babies, children, teens and young adults receive the health care they need and include physical exam, lab tests, immunizations and vision and hearing screening. Children, teens and young adults up to age 21 enrolled in TennCareor uninsured are eligible for these screenings.

Lions Eye Center @ Vanderbilt University
1211 21st Ave.
Nashville, TN 37212
Tel: 615-936-1034
Fax: 615-936-2118
Provides vision services to children. Financially needy children may be referred for Tenn Care and their community Lions club for sponsorship of services.

P.A.V.E.
Vanderbilt Eye Institute
2311 Pierce Ave.
Nashville, TN 37232
Phone: 615-936-3718
www.vanderbilthealth.com/eyeinstitute/23641
Contact Person: Brandi McRedmond
Project PAVE (Providing Access to the Visual Environment) works with local education agencies and the Tennessee School for the Blind to meet the visual needs of patients, ages 3 - 21, with low vision. With funding from the TN Department of Education, our team provides low-vision evaluations, optical devices, instruction and technical assistance, at no cost to TN families. PAVE helps young patients gain visual independence and continue their education.

TennCare Kids
www.tn.gov/tenncare/section/tenncare-kids
Tennessee has made a commitment to promoting good health in children from birth until age 21. It's called the TennCare Kids program.
TennCare Kids is a full program of checkups and health care services for children who have TennCare. These services make sure that babies, children, teens, and young adults receive the health care they need. Good health begins at birth, so it's important to Check In, Check Up and Check Back!

Tennessee Disability Pathfinder
Phone: 800-640-4636
www.familypathfinder.org
Contact if additional resources are needed.

Tennessee Deaf-Blind Project (TNDB)
Phone: 615-936-0262
www.childrenshospital.vanderbilt.org/services.php?mid=2966
A federally funded program that provides families, educators, and other professionals with information and training to help improve outcomes for individuals, from birth through age 21, who have a combined hearing and vision loss.

TN School for the Blind Outreach
115 Stewarts Ferry Pike
Nashville, TN. 37214
Martin Monson, Education Director
Phone: 615-231-7316
www.tsbtigers.org
The Outreach Program of the Tennessee School for the Blind (TSB) offers a variety of services to children with visual impairments. These include both assessment and direct educational services. Assessment services include, but are not limited to: functional vision assessments, orientation and mobility assessments, daily living skills assessments and technology assessments. These assessments are typically completed at the student’s school.
Direct educational services provided by a certified Teacher for Students with Visual Impairments and/or an Orientation and Mobility Specialist are also available on a limited basis. Each Local Education Agency (LEA) Supervisor of Special Education may make a request for direct services at any time during the year. At that time the TSB Outreach Committee will review the request.
School districts that do not currently employ a certified Teacher for Students with Visual Impairments and/or an Orientation and Mobility Specialist are eligible for direct services through the program. All others will be considered on an individual basis.

TN Department of Human Services
CHILD-CARE SERVICES
www.tn.gov/humanservices/topic/child-care-services

BLIND & VISUALLY IMPAIRED SERVICES
Phone: 615-313-4914
Toll Free: 800-628-7818 (In-State Only)
TTY: 615-313-6601 (Local)
TTY: 800-270-1349 (Long Distance)
FAX: 615-313-5815
www.tn.gov/humanservices/ds/blind-visually-impaired-services.html

*Check-out a full listing of the TN Dept. of Human Services in Chapter IV: Rehabilitation

CHILDHOOD EYE DISEASES:

INHERITED EYE DISEASE
More than 60 percent of cases of blindness among infants are caused by inherited eye diseases, such as; congenital (present at birth) cataracts, congenital glaucoma, retinal degeneration, optic atrophy, Retinitis Pigmentosa, Stargardt, and eye malformations.
Up to 40% of patients with certain types of strabismus (ocular misalignment) have a family history of the disease and efforts are currently under way to identify the responsible genes.
Genetic ophthalmologic researchers now have evidence that the most common vision problems among children and adults are genetically determined. The list includes strabismus (cross-eyes), amblyopia (lazy eye) and refraction errors such as myopia (near-sightedness), hyperopia (far-sightedness) and astigmatism.
In adults, glaucoma and age-related macular degenerationare two of the leading causes of blindness, and both appear to be inherited in a large portion of cases. Researchers have mapped several genes for glaucoma and are starting to identify genes involved in macular degeneration. They also are making very significant progress in identifying the genes that cause retinitis pigmentosa, a degenerative disease of the retina that causes night blindness and gradual vision loss.
Genetics also play a role in vision problems that occur in otherwise healthy eyes.
*Note: You may find some of the inherited eye diseases listed above in Chapter I, Common Eye Diseases.

ACCOMMODATIVE ESOTROPIA
Accommodative Esotropia refers to a crossing of the eyes caused by farsightedness. It is a type of strabismus.
Children who are farsighted easily and automtically focus on objects at distance, and near through accommodation. As a result, a child who is farsighted usually does not have blurred vision. However, in some children who are farsighted, this accommodative effort is associated with a reflex crossing of the eyes. Accommodative esotropia can begin anywhere from 4 months to 6 years of age. Full-time use of the appropriate hyperopic glasses or contact lenses will often control the esotropia. When wearing the correction, the child will not need to accommodate and the associated eye-crossing reflex will disappear. However, after removing the prescribed correction, the crossing will reappear, perhaps even more than before the child began wearing the correction. Sometimes the correction will only cause the crossing to disappear when the child views a distant object. When gazing at near objects, crossing may persist despite the use of the correction. In these circumstances, a bifocal lens is often prescribed to permit the child to have straight eyes at all viewing distances. One potential advantage of contact lenses compared to spectacles when correcting hyperopic powers is the decrease in accommodative demand. The increased effort to converge the eyes with spectacles requires one to overcome the resultant base out prism when viewing a near object.

AMBLYOPIA
Amblyopia is sometimes called a “lazy eye,” amblyopia occurs when one or both eyes do not develop normal vision during early childhood. Babies are not born with 20/20 vision in each eye. 20/20 vision is developed between birth and 6-9 years of age. This is accomplished by using each eye regularly with an identical focused image falling on the retina of each eye. If this does not occur in one or both eyes, vision will not develop properly. Instead, vision will be reduced and the affected eye(s) are said to be amblyopic. This common condition, affecting up to 4% of all children, should be diagnosed and treated during infancy or early childhood to obtain optimum three-dimensional vision, and to prevent permanent vision loss. The #1 Cause of Preventable Vision Loss in the USA is Amblyopia.

What causes amblyopia?

• Misaligned eyes(strabismus)
  Misaligned eyes are the most common cause of amblyopia. When both eyes are not aimed in exactly the same direction, the developing brain “turns off” the image from the misaligned eye to avoid double vision and the child uses only the better eye - the dominant eye. If this persists for a period even as short as a few weeks, the eye will not connect properly to the visual cortex of the brain and amblyopia will result.
• Unequal refractive error(anisometropia)
  Unequal refractive error is an eye condition in which each eye has a different refractive error. Therefore, both eyes cannot be in focus at the same time. Amblyopia occurs when one eye (usually the eye with the greater refractive error) is out of focus because it is more nearsighted, farsighted or astigmatic than the other. Again, the brain “turns off” the image from the less focused eye, and this eye will not develop normal vision. Because the eyes often look normal, this can be the most difficult type of amblyopia to detect and requires careful vision screening of acuity measurements at an early age. Treatment with glasses or contact lenses to correct the refractive error of both eyes, sometimes with part-time patching of the better seeing eye, is necessary in early childhood to correct the problem.
• Obstruction of or cloudiness(deprivation)
  Obstruction of or cloudiness in the normally clear eye tissues may also lead to amblyopia. Any disorder that prevents a clear image from being focused can block the formation of a clear image on the retina and lead to the development of amblyopia. This often results in the most severe form of amblyopia. Examples of disorders that can interfere with getting a clear image on the retina are a cataract or cloudy lens inside the eye, a cloudy and or irregular shaped cornea, a droopy upper eyelid (ptosis), or eyelid tumor. It is not easy to recognize amblyopia. A child may not be aware of having one normal eye and one with reduced vision. Unless the child has a misaligned eye or other obvious external abnormality, there is often no way for parents to tell that something is wrong. In addition, it is difficult to measure vision in very young children in which treatment is most effective. To treat amblyopia, a child and their caregiver must be encouraged to use the weaker eye. This is usually accomplished by patching the stronger eye. This covering of the stronger eye with an adhesive patch, an occlude contact lens or temporary surgery often proves to be a frustrating and difficult therapy. Patching will often continue for weeks, months, or even years in order to restore normal or near normal vision and maintain the improvement in the amblyopic eye. Occasionally, blurring the vision in the good eye with eye drops or lenses to force the child to use the amblyopic eye treats amblyopia. In some cases, cataract surgery or glaucoma surgery might be necessary to treat form deprivation amblyopia. Patching may be required after surgery to improve vision, and glasses or contact lenses may be required to restore appropriate focusing. Previously, eye care professionals often thought that treating amblyopia in older children would be of little benefit. Surprising results from a nationwide clinical trial in 2005 funded by the National Eye Institute show that many children age 7 - 17 with amblyopia may benefit from treatments that are more commonly used on younger children.

CONGENITAL CATARACT
A congenital cataract, or clouding of the crystalline lens, is present in 2-3 per 10,000 live births. The presence of a visually significant cataract in a child is an urgent disorder. The resultant form deprivation of vision requires immediate surgery to remove the obstruction, prompt optical correction and amblyopia therapy in unilateral cases. Until the 1970s, it was generally believed that there was no means of restoring the vision in an eye with a unilateral congenital cataract. However, subsequent studies demonstrated that excellent visual results could be obtained with early surgical treatment coupled with optical correction with a contact lens and patching therapy of the fellow eye. Treatment results continue to be poor in some infants with unilateral congenital cataracts due to a delay in treatment or poor compliance with contact lens wear or patching therapy of the fellow eye.

DIABETES
Childhood diabetes is the most common chronic metabolic syndrome affecting children. It is characterized by high blood sugar levels. (Impaired insulin secretion and action leads to poor glucose tolerance, which forms the basis of this disease.)
Several diverse disorders in carbohydrate metabolism attribute to impaired glucose utilization seen in both types of diabetes mellitus.
Autoimmune mechanism and genetics of many of these contributing disorders have been documented. The autoimmune mechanism is known to be triggered by several external factors. Though there is definite proof that several environmental triggers set off the autoimmune mechanism that plays a crucial role in clinical presentation of diabetes in children who are genetically susceptible to the disease, the search for precise triggers yet continues.

The two forms of childhood diabetes…
Type 1 Diabetes (T1DM)
In Type 1 diabetes, pancreas' ability to secret insulin is reduceddue to damage of insulin producing cells. It is commonly known as "insulin dependent diabetes".
Being the most common endocrine disorder of children and teens, it is referred to as “juvenile diabetes”. Childhood diabetes leads to significant consequences on physical and emotional development. Rising incidence of childhood diabetes is a cause of great concern. Worldwide, millions of children below 14 years of age are suffering from Type 1 diabetes. Incidence of diabetes in children increases as age advances. Type 1 diabetes most frequently strikes at the onset of school (5-6 years of age) and at onset of puberty (10-14 years of age). Boys and girls are equally affected.

Type 2 Diabetes (T2DM)
In Type 2 diabetes, the action of insulin is impaired at the cellular level. The glucose is not optimally utilized by muscles, liver and fatty tissue. It may also be associated with various degree of functional impairment of beta cells in the pancreas.

Diabetic eye disease is a group of eye conditions that affects people with diabetes…
• Diabetic retinopathy – A leading cause of blindness in American adults, it is caused by damage to the small blood vessels of the retina - the seeing layer of the eye.
• Diabetic macular edema (DME) – A complication of diabetes caused by leaking blood vessels, which leads to fluid accumulation in the macula, the center of the retina used for central vision. DME can cause central vision to become blurry.
• Cataract – The clouding of the lens in the eye, which blocks or changes the passage of light into the eye. Cataracts can cause vision to become blurry.
• Glaucoma – Optic nerve damage and possible loss of side vision, usually caused by increase in fluid pressure inside the eye.

How to Prevent Diabetic Eye Disease:
• Maintaining good blood sugar, blood pressure, and cholesterol control.
• Getting a comprehensive dilated eye exam and/or obtaining retinal photographs that are examined by an eye doctor at least once a year
• Keeping a healthy lifestyle that includes exercising regularly, not smoking and following a healthy diet. Talk to a dietician about your eating habits and a doctor before starting an exercise program.

Diabetes is a chronic condition that occurs when blood sugar levels are constantly high that can cause serious health complications, including heart disease, kidney failure, nerve damage, and blindness.
More than 29 million Americans have diabetes. Considered as a "chronic disease epidemic" by the Centers for Disease Control and Prevention, the prevalence of diabetes has increased dramatically over the past forty years. All people with diabetes are at risk of developing eye disease that can permanently damage their vision and even lead to blindness. In fact, individuals with untreated diabetes are 25 times more likely to lose their sight than the general population.
Both Type 1 and Type 2 diabetes are serious diseases, and can lead to similar complications, including diabetic eye disease. People with diabetes can take several steps to stay well. Most important are eating a healthy diet, exercising regularly, maintaining good control of blood sugar levels, and learning as much as possible about living with diabetes.

Juvenile Macular Degeneration
Other less common types of Macular Degeneration, which are hereditary and affect younger people: Best, Stargardt and Sorsby diseases. Other diseases of the retina, and extreme Myopia (severe near- sightedness or myopic degeneration) can also result in degeneration of the Macula. These conditions are not to be confused with AMD, but the end-result, loss of central vision, can be the same.

NYSTAGMUS
Nystragmus is a vision condition in which the eyes make repetitive, uncontrolled movements, often resulting in reduced vision. These involuntary eye movements can occur from side to side, up and down, or in a circular pattern. As a result, both eyes are unable to hold steady on objects being viewed. Unusual head positions and head nodding in an attempt to compensate for the condition may accompany nystagmus. Most individuals with nystagmus can reduce the severity of their uncontrolled eye movements and improve vision by positioning their eyes to look to one side. This is called the “null point” where the least amount of nystagmus is evident. To accomplish this, they may need to adopt a specific head posture to make the best use of their vision. The direction of nystagmus is defined by the direction of its quick phase (e.g. a right-beating nystagmus is characterized by a rightward-moving quick phase, and a left-beating nystagmus by a leftward-moving quick phase). The oscillations may occur in the vertical, horizontal or torsional planes, or in any combination. The resulting nystagmus is often named as a gross description of the movement, e.g. downbeat nystagmus, upbeat nystagmus, seesaw nystagmus, periodic alternating nystagmus. Having nystagmus affects both vision and self-concept. Most people with nystagmus have some sort of vision limitations because the eyes continually sweep over what they are viewing, making it impossible to obtain a clear image. If a refractive error is found, contact lenses may be the most effective way of obtaining best-corrected vision.

STRABISMUS
Strabismus is a misalignment of the eyes. It is estimated that 4% of the US population has strabismus. Strabismus is most commonly described by the direction of the eye misalignment. Common types of strabismus are esotropia (turn in), exotropia (turn out), hypotropia (turn down), and hypertropia (turn up). Eye misalignment can cause amblyopia in children. When the eyes are oriented in different directions, the brain receives two different visual images. The brain will ignore the image from the misaligned eye to avoid double vision, resulting in poor vision development of that eye. In addition, an eye that sees poorly tends to be misaligned. The goal of strabismus treatment is to improve eye alignment, which allows the eyes to work together (binocular vision). Treatment may involve eyeglasses, contact lenses, eye exercises, prism, and/or eye muscle surgery.

*Other Eye Diseases may be found in Chapter I.

CAMPS:

CAMP VIVA
TN Association of Blind Athletes
Phone: 615-544-5222
www.facebook.com/TNABA.TN
Usually holds a 3 day sports camp at the TN School for the Blind each year.

CHALLENGE ASPEN
P.O. Box M
Aspen, Co 81612
Phone: 970-923-0578
Fax: 970-923-7338
www.challengeaspen.com
Winter sports camp for disabled children and adults.

CAMP INDIAN CREEK
Christian Record Braille foundation
444 South 52nd Street
Lincoln, NE 68516
Phone: 402-488-0981
Fax: 402-488-7582
www.christianrecord.org
Camp for legally blind persons age nine and up, usually held for one week in the summer.

NATIONAL CAMPS FOR BLIND CHILDREN
www.brailleworks.com/summer-camps-for-the-blind-and-visually-impaired/
National Camps for Blind Children® have various locations across the United States and Canada and is affiliated with Christian Record Services for the Blind. They are FREE for children who are blind and/or legally blind, except for a small nonrefundable processing fee of $35! Children aged 9+ and whose corrected vision is no better than 20/200 are welcome to register. Fun and adventure provide motivation, recreation, and education with activities such horse riding, tandem cycling, canoeing, archery, talent programs, and much more.

FAMILY SUPPORT:

Support Training for Exceptional Parents (STEP)
480 Craighead Street
Nashville, TN 37204
Phone: 931-431-6644
Fax: 615-383-1176
E-mail: tnstepmtoc@aol.com

FamilyConnect
www.familyconnect.org/parentsitehome.aspx
FamilyConnect offers a virtual lifeline to parents of vision impaired children. We provide information and resources, and host an online community where families find support, comfort and help.

FUN STUFF:

Art Circle Library
3 E. Street
Crossville, TN 38555
Phone: 931-484-6790
www.artcirclelibrary.info
Has many children’s programs: Puppet shows, kids contests, storytelling and other special kids programs. With a library card you can: read books and stream video from Tennessee READS at www.reads.lib.overdrive.com

Braille Bug
www.braillebug.afb.org/
AFB's award-winning website that introduces children to the magic of braille through games, secret messages, and other fun activities. They have help for parents & teachers.

Braille Tales Print/Braille Book Program
www.aph.org/dolly-partons-imagination-library/apply/
Participating families receive six free print/braille books per year up to the child’s 6th birthday.

Carson City Natives and Newcomers
Email: WENARCED2@aol.com
This senior club works with Nevada prisoners to make free decks of brailled playing cards. Individuals can send an email with "Braille Cards" in the subject line. The email should include the person's name and address, the number of decks needed, and how they will be used.

Governor’s Books from Birth Foundation-GBBF
The Cumberland County Imagination Library and the GBBF is committed to enrolling every child from birth to age five in Tennessee’s statewide Imagination Library. This program is free and open to all eligible-age children in Tennessee at no cost to families, regardless of income.To begin receiving one new, high quality, age-appropriate book in the mail every month.
Please Visit: www.governorsfoundation.org/enroll
Complete the 4-step registration process, or fill out a registration form at the Art Circle Public Library.

Seedlings Braille Books for Children
www.seedlings.org/resources.php
www.seedlings.org
Seedlings Braille Books for Children offers a wide variety of braille materials for blind and visually impaired children.

SmartPhone Apps for Kids:
*Note: The VIS Group does not endorse any of these apps or websites in this Resource Guide and they might not always reflect the views of this organization.

*Parents/Guardians: You may go to these websites for Fun Apps for the Blind & visually Impaired. Hopefully, you will find apps age appropriate for your child…

www.appadvice.com/applists/show/fun-apps-for-blind-and-visually-impaired

www.blindfoldgames.org/

• Accessible Mindsweeper: Typhlos Accessible Software (simple game for kids)
• Blindfold Pong: Physical game in which you swing your device like a paddle similar to TV screen based games, but uses only audible feedback, not visual.
• Blindfold Solitaire: Kid Friendly Software
• Blindfold Sudoku: Kid Friendly Software (for voice over Sudoku player)
• Introducing Stem Stumper:
  www.ananseproductions.com/stemstumperA blind-accessible puzzle game for mobile phones.
• The Blind Legend: Uses no screen whatsoever and follows the journey of a man home from war whose family has been taken. You must play with headphones, as you are asked to move yourself to the sounds. Free. Recommended for older children.

*There may also be some helpful apps in Chapter XIV