Vision is a performance system, not a single measurement. A passed acuity screening tells you the student can resolve a letter at distance — nothing about whether they can use vision to do the work of the day.

• You are already treating vision
• Understand → assess → intervene
• Vision is the dominant channel for learning
• Why schools are required to respond
• Where OT sits relative to the eye care team

• Visual performance is already on your caseload; the only question is whether it is named and measured.
• Understanding without assessment is a guess; assessment without intervention is abandonment.
• Vision is a gateway system; visual deficits appear as reading, writing, mobility, and participation problems.
• Typical visual development follows a predictable timeline; persistent gaps past those windows warrant referral.
• OTs describe functional visual performance and occupational impact; eye care providers make the medical diagnosis.
• IDEA and Section 504 both welcome OTs' functional, performance-based evidence.

A kindergarten teacher reports a student "just isn't paying attention" during calendar time and bumps into classmates during transitions. The school vision screen was passed six months ago. What visual-performance questions would you ask before assuming this is attention or behavior?

In one sentence, describe the OT role in vision without using the words "diagnose," "therapy," or "eye doctor."

This week, write one observation of a student using only the language of functional visual performance and occupational impact. Avoid any diagnostic or medical terminology.

Different visual jobs travel different routes. Identifying what something is and knowing where it is in space are separate demands, and students can be strong in one and weak in the other.

• What a ventral-stream (parvocellular) signature looks like in class
• What a dorsal-stream (magnocellular) signature looks like in class
• We do not treat tracts — we treat the functional components

• Ventral stream = "what" (object identity, detail, recognition); dorsal stream = "where" (spatial mapping, posture, movement guidance).
• Classroom signatures differ: ventral problems look like recognition errors; dorsal problems look like spatial, navigation, and postural errors.
• OTs describe the behavioral signature in occupational terms, not as a neurological diagnosis.
• Both streams feed Level 3 of a structured visual performance framework; observations must be tied to functional performance.

A third-grade student reads words accurately in isolation but cannot find her place after looking up from the page and frequently loses items on a busy desk. Which stream pattern does this sound more consistent with, and how would you phrase it for the teacher without using stream terminology?

Write a one-sentence present-level statement that names a stream-related observation and ties it to a Level 3–5 classroom task.

Pick one student on your caseload. List three visual observations and sort them by whether they look like "what" (identification) or "where" (spatial/movement) problems.

The diagnosis belongs to medicine. The functional limitation belongs to you. This module is about knowing which eye and brain conditions may be sitting underneath what you are watching, so you can name the functional problem accurately instead of guessing at a cause.

• How to use this module
• Naming the direction — vocabulary, not diagnosis

• The diagnosis names the mechanism; the functional limitation names the OT target. Document the second, not the first.
• CVI is brain-based and often pairs with a normal eye exam; ONH, albinism, nystagmus, strabismus, amblyopia, ROP, RP, cataract, and refractive/vergence disorders change the sensory floor.
• Each condition maps to functional problems OT treats: print size, contrast, working distance, lighting, scanning, endurance, and array complexity.
• OT observation cannot rule an eye condition in or out — "see this and refer" is the wrong model; describe function and recommend an exam when none is documented.
• A short red-flag list (sudden vision loss, pain, new diplopia, unequal pupils, new turn after age 5, trauma, halos/flashes) still warrants prompt medical eye care.

A second-grade student with a known history of prematurity looks away from the smart board, prefers bright yellow objects, and needs repeated prompts to look at a visual target. Which conditions could plausibly sit underneath this picture, and how would you write the functional limitation you are going to treat?

Name three conditions in this module that are commonly missed on a school vision screen, and explain why each one is missed.

Take two students on your caseload with a documented eye diagnosis. For each, write the diagnosis on the left and the two functional limitations you are actually treating on the right.

Visual performance findings rarely arrive alone. The same child often carries an attention, learning, or developmental diagnosis, and the visual piece gets absorbed into that label.

• Association is not causation
• Visual performance signs associated with dysgraphia
• The numbers behind the urgency

• Autism commonly co-occurs with visual attention and ocular motility concerns; do not assume visual findings are "just autism."
• ADHD can coexist with genuine visual inefficiency; test whether reducing visual demand improves performance.
• Dyslexia is language-based, not vision-based; OTs avoid unproven visual cures and support occupational impact instead.
• Dysgraphia is strongly linked to visual-motor and spatial-planning deficits — a core OT intervention area.
• Comorbid plans are integrated, but scope boundaries remain clear: OT treats performance, eye care treats ocular health.

A student with ADHD and dyslexia complains that reading makes his eyes "tired." The school team wants to try a colored overlay first. How do you respond in a way that respects evidence and keeps the student's occupational needs in focus?

Write a one-paragraph team note that distinguishes dyslexia from a possible co-occurring visual efficiency problem, using correct scope language.

Review one IEP for a student with a diagnosis from this module. Identify one visual performance question that has not been addressed, and one sentence you would add to the present levels.

Adaptation is intervention. You do not wait for the eye exam to make the task usable.

• Two categories of clients drive two different plans
• Lighting is a modifiable variable, not a fixed constraint
• Positioning the student inside the room
• Low vision: what OT addresses, and when OT refers
• Organization, mobility, and multisensory support

• The low-vision model has four levels: increase visibility, enhance with magnification, augment with another channel, substitute with another channel.
• Environmental modifications (lighting, glare, contrast, size, typeface, seating) are core OT interventions.
• Modifications must be selected for a specific occupation and goal, not applied generically.
• OTs do not diagnose low vision or prescribe optical devices; we partner with eye care providers and document functional outcomes.

A high school student with albinism needs to read a textbook and navigate the hallway. Name one modification for each of the four low-vision levels for each goal.

Choose one low-vision level and write a one-sentence accommodation for a student in your caseload or a hypothetical case.

Walk through one classroom in your building and list three environmental changes that would increase visibility for a student with reduced acuity or contrast sensitivity.

You now have observation, referral, and modification. What you do not yet have is a repeatable structure for deciding what to look at, in what order, and how to defend the plan.

• Five blocks in, here is the skill set
• Observation alone is unordered
• What the VPA™ adds on top of structure

• Observation is the entry skill; without structure it is unordered and hard to defend to a team.
• A level-based organization of visual performance tells you where to look first, what a finding means, and how to sequence targets in documentation.
• Standardized administration and scoring turn a clinical impression into a comparable, re-measurable baseline.
• Every participant leaves with one described student, one referral decision, and one modification with an observable check.

Take the student you have had in mind through this course. Write the referral-or-not decision in one sentence, the modification you will make in one sentence, and the observable indicator you will watch in one sentence. Would a colleague reading only those three sentences know what you saw and why you acted?

In one sentence, state what a structured, level-based organization of visual performance would give you that your current observation notes do not.

Before your next treatment day, put one modification from Module 5 in place for one student and record the single observation you will use to judge whether it helped.