Adapting the Educational Setting

Things to keep in mind

• Uveitis is not an “obvious” illness
• Fluctuating vision is common
• Physical complaints are an important clue about disease activity and can aid in diagnosis. Please report any observations in this regard to parents.
• Students with uveitis will have to miss class in order to go to medical appointments. Sometimes these appointments will be urgent and will interfere with school and and family routines. The urgency may also be upsetting to the student.
• Homework and other assignments may need to be adjusted during a “flare” of the illness so that the child’s eyes can rest.
• Children will often need help to take prescribed medications during school hours
• Kids hate being different than their classmates. This can lead some children not to report difficulties they are having.
• Students whose vision is affected may miss subtle nonverbal cues (body language/facial expression) used for classroom management. Teachers may want to consider combining these messages with an auditory prompt if the student with uveitis is missing them.
• The brothers and sisters of children who have uveitis may also need educational considerations and support.
• Initiate Special Education proceedings as indicated
• Reach out for help. Involve the school’s vision specialist early on. Parents will know a lot about what to do. Participate yourself in our online support community.

What you may observe in the classroom

The extent to which vision is affected by uveitis is different for each child. The complications of uveitis can be obvious, as in the case of severe vision loss, or subtle, as in the instance of a student whose vision has been preserved by treatment with immunosuppressive chemotherapy. Vision may fluctuate widely and be affected by the illness and, sometimes, but the medications used to treat it For example, eye drops make vision blurry.

Students being treated with immunosuppressive chemotherapy may be fatigued or less focused cognitively on some days. Some children experience significant eye pain (photophobia) during illness flares, others do not. Children can feel unwell in a wide variety of ways during a “flare” or during certain phases of treatment. And they can feel very distressed if changes in physical appearance.

Children generally adjust to all of this in some proportion to how the adults around them are handling things. But, kids have questions too. They worry, sometimes, about going blind. They get upset when the adults around them are upset. And, they worry about fitting in at school and especially about “being different”.

Knowing that a teacher is “tuned in” to these fluctuations and is someone to whom the student can turn is the single most valuable resource a student can have at school.

• The school vision specialist (or Vision Rehabilitation Center specialist) can help you determine what materials will benefit your student.
• Use Large Print material. Generally, font sizes may need to range from 14 to 20 point.
• Seat your student so that light falls onto the work surface from behind (over the shoulder)
• For some children, especially in second and third grades, the print itself is large enough, but there may be too much printing on a page, causing ‘visual clutter’, and increasing eye strain and eye fatigue.
• Decrease competing background on written materials (make them less “busy”)
• Decrease the amount of print on a page
• Most class room materials can easily be enlarged with any good photocopier
• Use materials that provide extra contrast (e.g. bright colors on light paper, light colors on dark surfaces, yellow or colored chalk on the chalkboard).
• Allow the child to hold the book as close or as far away as necessary, even to tilt the book to see better. The child will learn appropriate adaptations as to what is most comfortable to see well. None of these things will ‘hurt’ his or her vision
• Use different color “manipulatives” or color coding to help the student find materials or papers more easily
• Encourage the student to take frequent breaks from reading or close work
• Assess rather it may be necessary to excuse students periodically from homework if there are significant symptoms

Use books on tape, and encourage the student to use them, especially for book reports and projects. These are a beneficial tool to encourage listening skills and listening comprehension. Books on tape help the student to complete reading assignments or prepare for book reports or projects

Dealing with Glare

Many children with uveitis experience an increased sensitivity to glare. Glare can be caused by sunlight, commonly used lighting sources, and reflections from schoolroom surfaces. Reducing glare will improve the student’s ability to see what is on the page or board. Common situations that produce the glare are: fluorescent lighting, having to stare into a bright light while trying to see detail; projectors, cloudy or snowy days, very bright sunshine, oncoming headlights.

The adaptations listed below for reducing glare may also help the student with symptoms of photophobia (light sensitivity). Light sensitivity is a common problem that children experience, especially during times of flare, or if medications are needed to dilate the pupils. When the student is experiencing photophobia, pain can be significant and vision decreases when too much light floods the retina.

• Test different kinds and levels of lighting to determine what is most comfortable for your student.
• Fluorescent lighting, of all available light types, produces the most glare. Turn off fluorescent lighting if possible. Full spectrum lighting is the closest to natural sunlight and the most comfortable for people with most visual pathologies. Incandescent lighting casts a yellow light. It is the most common form of light bulb, frequently used in desk or table lamps.
• Seat your student so that they are not directly facing a window as the glare produced by that cold “wash out’ images. Think of how your vision is reduced when driving a car directly into the setting sun.
• Drapes or blinds reduce sunlight coming in through windows. Polarized glass or tinted shades will eliminate glare.
• Replace white paper with newsprint or soft green paper to reduce glare from the page. This will improve the student’s ability to see what is on the page. Newsprint is generally available in schools and is inexpensive when compared with white paper.
• Glasses can prescribed that filter light to reduce problems with glare. Encourage your student to experiment with colored lens (“sun glasses”) and hats with brims to reduce glare from overhead and outside light.
• A piece of yellow acetate over white paper can help decrease the glare from overhead lights on bright white paper
• Encourage the student to take frequent breaks from close work (reading, writing, computer work) to reduce eye fatigue
• Anticipate that your student may need more time than others to adjust to lighting changes, particularly when coming in from outside or when walking into bright light.

Adapting to the Playground

Children with uveitis should be encouraged to participate in playground and athletic activities but must, at all times, take special precautions to protect their eyes from injury. One parent’s solution to her daughter’s refusal to wear protective eye gear during soccer was to buy the whole team the same eye gear. Now, all of the kids want to have this “equipment”

• The student with uveitis should ALWAYS wear shatter proof eye glasses or athletic eye shields during playground activity or athletic games where sticks or balls are used or where hard contact is expected.
• Injury to an eye can cause the disease to get worse or cause permanent damage to vision.
• UV coated sun glasses should be worn on sunny days when outdoors.
• If the student’s vision is fluctuating widely, or vision is impaired by glare, students should suspend participation in hard contact sports and not drive a car.