An innovative program brings devices and services to children with low vision at no cost to eligible families.

Low vision is a significant barrier to learning and development, particularly for children lacking the specialized devices and services they need to succeed at school.

With this in mind, Providing Access to the Visual Environment (Project PAVE) was created at Vanderbilt University Medical Center to help Tennessee students reach their reading and educational goals despite having permanent reduced vision.

“Low vision is a reduction of eyesight caused by eye conditions or diseases that is not correctable with medication, glasses, contact lenses or surgery,” said Lori Ann Kehler, O.D., an associate professor of ophthalmology and visual sciences and the program’s principal investigator.

Kehler and her team provide vision evaluations, low-vision devices and instruction by certified Teachers of Students with Visual Impairments – all at no cost to eligible families.

Bridging the Gap for Decades

Since its inception three decades ago, Project PAVE has provided low-vision evaluations for thousands of school-age children across Tennessee, serving 750 students since 2014. Most children referred for evaluation are seen at the Tennessee Lions Pediatric Eye Center at Vanderbilt Eye Institute by either an ophthalmologist, optometrist, pediatrician, or sometimes a teacher from their school.

To be considered for the program, students must be between the ages of 3 to 21 with low vision, which is defined as maximium corrected visual acuity of 20/70 or worse in the better-seeing eye.

“These students need significant help in the classroom,” Kehler said.

After a student’s eligibility is confirmed, a comprehensive vision examination takes place, and a patient plan is developed by Kehler or another optometrist. Patients typically receive prescription optical devices, such as stand-alone and hand-held magnifiers, and telescopes. Video magnifiers can also be provided in some cases, along with other needed classroom support.

For some families, these specialized tools and services would be out of financial reach without Project PAVE, which is supported by both the Tennessee Department of Education and the Tennessee Department of Intellectual and Developmental Disabilities.

Proving Classroom Support

Upon entry to the program, students get an initial visit to their classroom by a Project PAVE teacher. The certified teaching specialist gives instruction on use of any optical devices prescribed and offers technical assistance in the classroom.

“We know that if you give a child a magnifier but don’t teach them how to use it, it won’t get used,” Kehler said.

“We know that if you give a child a magnifier but don’t teach them how to use it, it won’t get used.”

Three years after the initial examination, students undergo a follow-up evaluation and receive updates for their optical-device prescriptions where changes have occurred.

“Even if their vision hasn’t changed, their needs more than likely have changed after their preliminary examination,” Kehler said.

An Expanding Scope

“The impact of PAVE on the wellbeing of visually impaired children in Tennessee is incalculable,” Kehler said. “With new and continued funding, we can expand our reach and impact.”

Kehler notes that the program typically operates at full capacity during the academic school year, but plans to expand access to care could eliminate the waiting list.

“Long-term, we hope to publish data on the use of low-vision devices in our pediatric population,” she said. “We anticipate that our program can be used as a model for other institutions nationally.”

About the Expert

Lori Ann Kehler, O.D.

Lori Ann Kehler, O.D., FAAO, holds the Jean Ewing Love and James Randall Love directorship in ophthalmology at Vanderbilt Eye Institute and is an associate professor and division chief of optometry at Vanderbilt University Medical Center. Her clinical focus is pediatric optometry, including the treatment of amblyopia and non-surgical strabismus. Her research interests include myopia and other children’s eye conditions.