Helping Children…

Low vision expert Thomas Porter, O.D., shares his strategies for working with kids



“Kids don’t want to stand out, so have the teacher and family use the child’s classroom aid as a show-and-tell opportunity. Let everyone in the class try it out. That makes it something cool.”

what are the challenges and rewards of working with young low vision patients? Here, low vision expert Thomas Porter, O.D., shares his insights and tips for treating tots and teens. Dr. Porter is director of Low Vision Services at the Saint Louis University School of Medicine’s Department of Ophthalmology, and reports that 20% of his low vision practice in the Greater St. Louis area is children.

He recently addressed the topic of pediatric low vision care in a webinar sponsored by Eschenbach Optik. Here, he expands on some of the points he presented in that program.

Thomas Porter, O.D.
Director of Low Vision Services at the Saint Louis University School of Medicine’s Department of Ophthalmology


Though it’s clearly a different experience from working with adults with low vision, there are plenty of benefits to working with kids, Dr. Porter says.

LEARNING. “Kids learn more readily. They have a lot of it figured out before the exam. So, don’t be surprised if the majority of the visit involves counseling and educating the parent.”

TRAINING. “With kids, there’s less training and breaking of old habits than with adults.”

COPING. “By the time you see them, they’ve already figured out some coping mechanisms, such as relative distance magnification.”

FUN. “They’re usually more fun than adults. They don’t feel sorry for themselves, and they usually try harder.”


There are also challenges inherent with a younger patient group. Here, says Dr. Porter, are some of the challenges of working with kids and how he addresses them.

WIIFM. Getting children used to using low vision aids can be tricky. Dr. Porter’s advice? “Introduce aids really early—between ages 5 and 6. And, always position them in terms of What’s In It For Me (WIIFM). That is, ‘How will this make things easier than just holding things closer?’”

TBI. “I’m seeing more and more cortical vision loss from TBI (traumatic brain injury) and hits to the head.”

PRINT. “As a youngster progresses in school, the print size gets smaller, while the amount of required reading increases. If you don’t address that early on, in my experience, by ages 10-12, kids with unmet needs often will lose interest in reading.”


So what has he discovered through his work with children? Here, he shares some ideas that can help children.

CONTRAST-ENHANCING FILTERS. “We never used to talk about contrast with kids. Now we do. And we’re emphasizing with parents and teachers that task lighting is key. [Contrast] is the most overlooked area, but use of acetate overlay sheets also shows some success.”

GLARE. “Teachers need to look at getting appropriate task lighting in order to create a glare-free environment.”

FIGURE-GROUND RELATIONSHIP. “White on white is hard to see. A white object with black background is easy to see. Some teachers I’ve worked with will put black construction paper on the desk so the child can see edges of their paper.”

DESKTOP. “I like to recommend a stand magnifier and sometimes an LED one.”

PREFERENTIAL SEATING. “The bad eye should be farthest away from the whiteboard, and the better eye closest to the board, TV, etc.”

What’s most important? “Coordinate services with the school,” says Dr. Porter.


Here are some business tips from Dr. Porter for cultivating a pediatric low vision specialty, and for being successful with young patients.

BUILD BUSINESS. “Very few practices offer care for pediatric low vision, so it represents a real opportunity.”

FAVORITE. “If I had to pick a cause of loss I enjoy working with, it would be albinism. It’s congenital, not progressive, so it is what it is.”

UNDERSTAND POV. “Adults compare their current vision to the way it used to be. For most kids, this is the level of vision they always had.”

USE ANALOGIES. “If it’s a retinal problem, I explain to families that it’s a good camera, but a bad roll of film.”

PRINT SIZE. “The problem is that if you double the size of print, you also increase the number of pages. The fact is that we don’t live in a large-print world. We need to help kids function in a normal print world.”

—Grace Hewlett