Macular Degeneration

Description and implications

  • macular degeneration can be a hereditary disease which causes a disturbance
    in the part of the retina used for fine discrimination tasks and central vision.
    It causes a progressive deterioration of the macula (the central part of the
    retina). The degeneration begins with some disturbance to central vision or
    maybe a small central scotoma (blind spot) which gradually increases in size
  • the ‘blind spot’ is not necessarily a black spot in the field
    of vision, it may be a greyed area or, a blurred area, or simply an absence
    of vision
  • macular degeneration is more common in the aged (referred to as senile
    macular degeneration)
  • the juvenile form is called Stargardt’s Disease. It may sometimes
    be referred to as Bull’s Eye maculopathy
  • it is necessary for the student with macular degeneration to use eccentric
    vision (use the parts of the retina outside the central macula area). The
    discrimination of fine detail will be more difficult using eccentric or peripheral
    vision
  • as the disease progresses, discrimination of detail becomes more and more
    difficult
  • colour vision can also be affected by the loss of central vision. The student
    may have difficulty discriminating or recognising some hues and shades more
    than others
  • the effects of macular degeneration are difficult to see on the retina
    (through an ophthalmoscope) in the early stages. For this reason, students
    have sometimes been mis-diagnosed or diagnosed as ‘hysterically
    blind’ or functionally amblyopic (temporary blindness caused by
    psychological trauma)
  • electroretinogram testing does not always provide conclusive results until
    the disease has reached a certain stage of manifestation
  • macular degeneration is not treatable. It cannot be prevented or reversed.

Suggested teaching strategies

  • ensure that all staff working with the student, including replacement teachers
    and volunteers, are aware of the vision impairment and its educational implications
  • students with macular degeneration will need to look using the area of
    their retina outside the affected region. This is called using their ‘eccentric
    vision’. The best part of the field to be used will depend on the shape
    and extent of the scotoma. For example, if the scotoma is small, the student
    may still be able to use the unaffected part of the macula to view close objects.
    If the scotoma is wide, the student may benefit from using the part of their
    vision above or below the scotoma. In this case they will need to fixate just
    above or just below the print. On the other hand, if the scotoma is irregular
    the student might need to fixate slightly to the left or right of the viewing
    target
  • tracking and scanning techniques will require training and practice
  • if there is a refractive error as well, glasses sometimes help. Reading
    glasses may be prescribed to magnify print materials.
  • students with macular degeneration will usually require magnification of
    reading material. The degree of magnification will depend on the extent of
    the central scotoma
  • for young students, the best form of magnification is simply bringing the
    print closer to the eyes
  • for older students, enlargement may be required or optical magnification
    aids may be prescribed
  • a telescopic aid (eg monocular) may also be helpful to enlarge distant
    objects
  • the use of shiny surfaces (eg white boards, shiny paper for flashcards or
    worksheets, shiny table tops) should be avoided as they can reflect light
    toward the student’s eyes
  • the utilisation of materials produced in alternative format eg tactual
    diagrams, large print, audio tapes and braille may assist the student. The
    use of audio tapes reduces visual fatigue. Braille may be used for labeling
    and/or general reading
  • utilise high contrast materials eg black texta for writing, textas for drawing,
    coloured paste, using clear bold illustrations to cut around
  • bold lined paper may assist
  • always use a clean chalk board with white or yellow chalk or white board
    with black marker. Use a consistent layout when presenting information on
    a board eg homework is always found on the far right hand side of the board
  • a reading/writing stand can often assist, especially in primary school
    or for prolonged visual tasks
  • seating position within the classroom is critical. Students will normally
    need to be seated in the front row
  • students with macular degeneration should be made aware of which lighting
    conditions are best for him/her. If the student is aware s/he can ask for
    variations which are favourable or control lighting accordingly. S/he may
    need additional lighting. This may be provided by a desk lamp at school and
    at home. Individual assessment as to the most appropriate lamp and globe should
    be conducted
  • students will benefit from desktop demonstrations ensuring visual access
    eg correct handwriting formation of a new letter, science experiment etc
  • organisational skills may require development. Developing efficient organisational
    skills will assist a student with a vision impairment eg having a large pencil
    case to store pens, calculator and visual aids; setting aside extra time to
    collect any equipment required; allowing extra time to complete visual tasks
    etc
  • additional verbal description and verification may be required to ensure
    the student has access to his/her environment eg describe a new classroom
    or excursion venue, provide verbal praise etc. The student with a vision impairment
    may miss a smile of encouragement
  • the use of a personal computer (eg laptop) may be of great assistance to
    a student with a vision impairment as an alternative to handwriting and to
    reduce visual fatigue. Software is available for enlarging text and graphics,
    including icons, menus etc. Voice output is available for both IBM and Macintosh
    computers. Individual assessment of the needs of each student is essential.
    Keyboarding skills should be taught in primary school
  • strategies to reduce vision fatigue should be considered eg appropriate
    visual rests may include listening to audio tapes both for information and
    relaxation
  • students with a vision impairment often need to be taught social skills
    using a direct teaching approach. Modeling appropriate social behaviors can
    be difficult when you cannot see them accurately
  • students with a vision impairment may need additional orientation and mobility
    training
  • reading environmental signs eg street signs may cause difficulties
  • understanding and acceptance of the student’s vision impairment,
    individual learning modes and work production methods (eg braille, computer
    etc) may be facilitated through carefully planned simulation activities and
    class education programs
  • older students with macular degeneration may benefit from genetic counseling.
    This advice is available through the Royal Children’s Hospital which
    also conduct clinics at the Royal Women’s Hospital, Monash Medical Centre
    and in some country centres.
    Telephone (03) 9345 5157

These notes were made by the staff of the Statewide Vision Resource Centre.
They are general statements and may not apply to all students with this
condition.