Monday 31 January 2011


I had some original thoughts today. What you are reading did not come from books but is my own original thinking. WOW! 

TWO WEEKS AGO Georgie started at a mainstream nursery. Since then I have started a 10 week course with the two nursery workers who work directly with him. I have a new resource book/manual you will find under LINKS and it works a treat. As we go through the chapters each week they are picking up the issues faced by Georgie and applying them with a little help from me to his time in the nursery. The following springs out of my meeting with them today. 

Georgie has an issue with tactile defensiveness. Now with some children who have been hospitalised for lengthy periods I can understand perfectly well why they react negatively to being touched on their hands etc; hospitals are distressing places and children have ‘bad’ things done to them like needles sticking into them and so on. But in Georgie’s case it is not quite the same. So why is he tactile defensive? (a great phrase by the way – I wish I had invented it!)

Think of touch (a) in terms of hearing. There can be a loud noise which is startling and surprising to the child. There can be a ‘loud’ touch that is strong and powerful to the child. Touch sensitivity might be that the tactile experience is overly ‘loud’ or too strong. Take an example from Georgie last week. And please note this is not theory; this is the result of my observations and my drawing conclusions. Georgie reacts badly to a particular touch – dry or wet / cooked pasta. He pulls his hand away and resists. He does not like the touch of pasta. Now you might say that is comparable to a ‘loud’, startling noise. The strong touch of pasta is too much for Georgie. 

Then you have the extra element (b) of ‘surprise’. Surprise is what we experience when we meet with something we did not expect without being warned in advanced or without adequate preparation. It may be we are presented with something unfamiliar, something we do not recognize, without warning. A silly example happened to me today. I was walking along the road and some youths leaned out of a car window and shouted some nonsense at me and I was taken quite by surprise. That was malicious but I was taken aback, naturally. We know that children with brain damage have what we might call an ‘aversion to novelty’. They do not take easily to anything that is new or unfamiliar. Presenting Georgie with pasta could be in either category. It is both ‘loud’ and it is unfamiliar. 

A further dimension to this is what we might call (c) ‘empowerment’. When you place Georgie’s hand into the bowl of wet pasta it is as if his private space is being invaded. He is not in control. He is not choosing to do this. It is done to him. There is the world of difference between my putting my hand tentatively into a bowl of soggy slimy pasta to test it out and having my hand held and put into the bowl. It is all about control. I do not feel in control and Georgie does not feel in control. He is effectively ‘disempowered’. So this could be another reason for his dislike for pasta. 

So how can we deal with this? Two possibilities as I see it. (1) You can reduce the ‘intensity’ of the touch. This is rather like turning the sound down. Children shouting loudly will definitely startle or overload Georgie as does touching pasta. You can lower the sound by moving Georgie away or acoustically dampening the walls (or telling the children to quieten down). Similarly you can lower the touch intensity by giving Georgie a small dose, an inoculation as it were. When you have a flu jab you are given a very very small dose of something quite powerful and disturbing to your body’s equilibrium. But that small dose inoculates you against the big illness and makes your body resistant towards it so that it does not succumb to the germ/virus. In the case of pasta ‘turning the sound down’ could be done by giving Georgie a small piece of pasta into his hand, rather than dipping his whole hand into the pasta. Placing a piece into his palm to get used to it may well be enough to acclimatize him to the plate or bowl of pasta. Or if not you could try two pieces and then three pieces and so on until he becomes used to it. 

(2) Another way of dealing with this is to choose something with similar properties as pasta, which he has no aversion to, but rather he enjoys and has a positive feeling towards. By associating what is disliked with what is liked may develop a positive attitude towards the new material. That is association. For instance you know that Georgie quite enjoys water play. He likes to place his hand in water and he likes soapy water and bubbly water. Thicken the constituency of the water so it is almost like wet pasta. Possibly try corn flour, which quickly develops into a thick and gluey constituency. Or something lighter like bubble bath may be a good start. Get him to feel the bubble bath or corn flour in his hand. Once he is tolerant towards this he may be ready for a small amount of pasta. 

Placing a piece into his hand also does not make him feel disempowered. He can hold it or reject it. He does not have to move his hand; he does not have to enclose his fist. But he may want to, in which case he remains in control of his hand.

There is a little bit more to this. Exactly the same principle applies to Georgie’s experience in the sandpit last Friday. When Georgie stood in his bare feet only in the sand he was fine and happy and enjoyed the experience. However when his clothes were taken off and he was made to sit down in the sandpit he didn’t like it and protested much. Overload you see. Too loud and too strong. Quieten it down. Keep it quiet! Thats my advice anyway. And I am pretty sure the nursery took it on board.

Wednesday 26 January 2011


What is this you say a CVI pupil in mainstream schooling? A child with complex needs and learning difficulties in an ordinary primary school and not in a special school? Yes of course I reply. It is increasingly common these days with the global inclusion agenda. As a matter of social justice and equality of opportunity children have to be offered mainstream education before special is even considered. I am not getting into politics today, but I have just visited a young man of eight in a mainstream public school with 29 other pupils and the placement is challenging to say the least. But I have a strong suspicion that all the issues concerning his support are highly relevant to anyone teaching children like this lad. Let us for today call him Raymond. It is not his name and I don’t know children called Raymond so we’ll leave it at that. Ray for short. Like a lot of children in his position he is a really friendly boy and has an endearing manner – but is also a manipulator. 

What are Ray’s needs? Ray is seven and a half years old. He is in a year three class. He has albinism and he was also born with microcephaly. He is delayed in his development and is behind all the other children in his class in his levels of attainment. I would say in many areas he is still working at p levels or towards National Curriculum level 1. I talked about these in my last post. There is a gap between his and their ability which increases year by year as he gets older. Along with this he is physically weak and small and he has a mum who dotes on him and is seriously overprotective and keeps him off school at the slightest hint of a cold. So he inevitably forgets what he has learnt by the next time he is in school. He is also extremely isolated in school, has 75% one to one support and consequently does not interact much with the other children. In the playground he plays on his own. So you have here all the key issues of a child with a disability in a mainstream setting.

I want to look at issues that were flagged up just this morning in the classroom. Most of them are directly related to CVI. One issue is around independence. Ray finds it is very hard to direct his own learning. Whether it is because he is so used to having help all the time and he is psychologically dependent on adults and has a form of learned helplessness we don’t know. I suspect this is part of it. He does not initiate his learning. He requires constant prompting and constant help. This of course is a great challenge. Each year we all try to set up targets around his independence. But they fall short either because of his ‘laziness’ or because mum does not cooperate does too much for him at home. It may even be because he has learned ways of getting others to do things for him.

Another issue is the environment. I am always going on about this and it is simply because it is crucial to the child’s learning. I have a whole chapter on this - and all the other points -  in my book (see links). This is what I observed. The boy works in a small corner of the room. The wall directly in front of him is covered by key words and pictures. The desk is covered by his exercise books and pens etc. The rest of the classroom is covered by a very busy array of display material. Now you may be a teacher and you won’t like to hear this but children with autism and indeed many kinds of learning difficulties do not like a cluttered or crowded environment. This situation is amplified when a child has a visual impairment added to a processing impairment. Present things to the child singly and sequentially and create a plain background for the child so that whatever he sees is set against a plain background and he can then see it clearly. He must be able to see things without being distracted by lots of other things.

The teaching materials were not adapted to his level of eyesight and his particular eye condition.  This is a common scenario and it is largely a training issue. Let me be specific. The teacher turned off the light while she used the interactive whiteboard and projector, which is good practice and removed glare from the screen. But the print was small – barely 1” tall letters on the screen most of the time. Also the font used was comic sans which is an ok font on the whole but it was in bold which made it actually less clear. Now I know sometimes it is advised to make text bold but what this did was to reduce the gaps between the letters and with nystagmus – wobbly eyes – the gaps merge and the letters are blurry. Generally the contrast was good and things were well separated but one other issue I had to point out was the following. On the screen the teacher made use of the whole screen to fill it with information.  This is definitely not good for a CVI child. Keep it simple stupid we say ( I am not being rude)! I would you have to have one item per slide and blow it right up. This makes it fill the screen and cuts out everything unnecessary. After all, the child can only look at one thing at a time, why put unnecessary stuff on the board that will distract them? With PowerPoint you can move one slide to another very quickly and painlessly. So one at a time please! I like what Gordon Dutton said once (you must have heard of leading expert on CVI Prof Dutton – he retires this week by the way – best wishes to Gordon on his retirement). He said that in a museum exhibits are put on their own and you can give all your attention to the one exhibit. That is how it should be.

Well this has become a long blog. I will say that the boy is making some progress but it is painfully slow and that is often the nature of things. This happens to be a good school in inner London; the class are well managed and there is a calm, quiet and studious atmosphere. If it had been noisy or chaotic I would have a few things to say about that...I Frankly  suspect that he is more likely to be stretched or pushed in this school rather than in any special school. I don’t want to get into the special – mainstream debate now but I have noticed that some of my kids moving from mainstream to special tend to stop moving up the national curriculum levels. It does help to have the challenge of others more able around you. I would like to see Ray making more friends but there are things that can be done to encourage that. Maybe you have some ideas? Well as always if you have something to say even if you disagree please comment. Have a good day!

Tuesday 25 January 2011


How do teachers set targets for a CVI child who could be at the lowest ability level, a pmld child with visual difficulties? In England we have something called the p levels. They are a set of descriptions for recording the achievement of pupils with special educational needs (SEN) who are below the national curriculum levels. Reporting P scales has been mandatory from September 2007; schools must use P scales to provide data for pupils with SEN who are working below level 1 of the National Curriculum. To give an example here is the P scale for English: speaking / expressive communication.

P1(i) Pupils encounter activities and experiences. They may be passive or resistant. They may show simple reflex responses, for example, startling at sudden noises or movements. P1(ii) Pupils show emerging awareness They may have periods when they appear alert and ready to focus their attention on certain people, events, objects or parts of objects, for example, grasping objects briefly when they are placed in their hand. They may give intermittent reactions, for example, sometimes showing surprise at the sudden presence or absence of an event or objectP2(i) Pupils begin to be proactive in their interactions. They communicate consistent preferences and affective responses, for example, showing a desire to hold a favourite object. They recognise familiar people, events and objects, for example, looking towards their own lunch box when offered a selection. They perform actions, often by trial and improvement, and they remember learned responses over short periods of time, for example, repeating an action with a familiar item of equipment. 

Whichever side of the pond you happen to be if you are a teacher you will be setting targets for your CVI pupil. We know that targets should be SMART, i.e. they should be specific, measurable, attainable, relevant and time-bound

You have to really know your child well to be able to do this effectively. And bearing in mind we are mainly talking about visual targets or visually related targets this needs to be carefully thought through. Let us take a girl like Harriette, she is PMLD as well as VI and CVI. To be time-bound and attainable you must work within her limits and her abilities. We know she can see something big and brightly coloured a few metres away. We know she has her favourite things. She knows the layout of the classroom by now and can go and find the storage box where her toys are kept. We also know she does not take favourably to anything new or unfamiliar. Yes she needs a more precise vision assessment but even without this we can set some targets that she can realistically attain in 3 months, which is before the end of April. In April she may have to move to another room and this will seriously disturb her routine and no doubt set her progress back. So let us be realistic and set April as the target deadline. A three month target. It has to be specific and measurable so let us choose an action or activity that she can do and link it with an activity or object that is as yet new and unfamiliar to her. Also it would be practicable to set something that is soon to be done  ORECS for instance have to be chosen. This refers to Objects of Reference Exchange Communication System. It’s a form of picture exchange communication system.

PECS is a visual communication system which can be easily understood by communication partners. For example, a waiter with no prior knowledge or experience of this system is likely to understand the message if they are handed a ‘sentence strip’ with pictures attached to it representing ‘I want’ and ‘coffee’. PECS is usually introduced to students who are non-verbal or who have limited language. Potential students need to have the fine motor skills necessary to manipulate the pictures. PECS can also be modified for students who are at an object level of symbolic development i.e. we use real objects rather than pictures. When we use this version of the system we call it ORECS (Object of Reference Exchange Communication System).

So linking all this together perhaps it could be possible to have an OREC that is as yet unfamiliar and part of the target could be to enable Harriette to become familiar with it and use it as part of her ORECS. And to make it even more of a visual target we might say she should be able to see it or distinguish it when it is next to one or more other objects. In other words when there is a small element of crowding impairing her vision. That at least is a start. Please feedback to me on this one. 

Saturday 22 January 2011


Here are a few brief thoughts on independence and PMLD youngsters (Profound and Multiple Learning Difficulties) in general. A very large number of PMLD children also are / have MDVI (Multiple Difficulties and Visual Impairment). Sorry about all the acronyms and abbreviations but these labels have become an increasing and essential part of any conversation about special needs but they do make it easier to talk about particular issues. 

Independence is a difficult one with PMLD for obvious reasons. Not the least is that they are sooo very dependent on adults. However I have noticed E the PMLD teacher has been telling me that Harriette is starting to become more independent. She is now quite used to her teachers and workers and is starting to become more and more self-motivated. This week for example I watched her walk independently from the hall, open the door and go over to the storage box and take out her favourite toy. E also says she will now walk to the bathroom on her own without having to be taken. 

Independence is an essential target for Harriette. It affects everything we do with her. It means that we try to wait a bit longer for her to do something by herself rather than step in too quickly. It means giving her more space to be herself to have her favourite things around her so she can interact with them at her own time and pace. It means providing a stable environment so that Harriette feels secure enough to get up and move around without bumping into things. Harriette is really short sighted so becoming familiar with the surroundings is really important if she is to be confident enough to explore. And she is starting to do this so that’s great. 

Wednesday 19 January 2011


A rare syndrome - possibly as rare as 1 in 30,000 children.  The child has microcephaly (small brain) with its associated  central processing difficulties. They also have  severe high myopia and nystagmus, so their vision is always pretty poor. You can look up the symptoms on the web but I have been working in a class with a teacher who has a child with CdLS this past week. I have a couple of thoughts for the teachers and anyone else who works with these children. So I am sharing my comments for anyone who is interested. Feel free to contact me about my comments.

Harriette (a pseudonym) is about 15 years old and she was initially lying down in a corner on a cushion and rug. when I came in. She had just been changed and was a bit uncooperative no doubt thinking, ‘leave me alone’. CdLS children tend to be reactive. That is they have some distinctive somewhat aggressive or anti-social behaviours that may be provoked by something happening to them. In this case it was having her private space invaded and it left her wanting to lie down and withdraw into herself. Once the circumstance is over however they can get back to normal.

There was a good attempt to get Harriette up and walking or marching for a PE lesson to the tune of ‘I will walk 500 miles’. A great song by the way and made me feel like marching. She seemed quite engaged for a little while, though it looked an effort to hold her as she walked. She is hard to keep sustained on a task. Her attention span is limited of course. 

The first thing I would say is that my comments are not criticism. There is no right or wrong way and the teachers and TAs are the experts because they know the kids better than I do. But what I have found in the past is that as I talk with TAs and teachers I am a catalyst for their own adaptations. I bounce ideas off them and make suggestions and then they go away and think about how to incorporate that into their work. Working with children like Harriette is not a precise science but also it’s not exactly ‘rocket science’. There are basic principles and a lot of it is about understanding how the brain works and how brain damage affects learning. Once you get hold of how different the way they process sensory information is then it will have an impact on whatever the teacher does.  A lot of it is common sense once you have an idea of the problem.

The commonest part of the brain that gets affected in these kids is a part called the parietal lobes. That’s because it is the furthest part of the brain away from the heart and blood takes the longest to get there. So anytime the heart stops in and around birth oxygen fails to get here and cells die. The cerebral cortex has four pairs of lobes each with different functions. The occipital lobes (vision - visual cortex) are at the back and the parietal lobes are over the top. The parietal lobes deal with making sense of all the sensory information that the brain receives. It is the sensory integration region. It also integrates the senses with motor skills and functions. So it is possible and common that a child with damage here will not be able to coordinate movement and vision. So visually guided movement is difficult. A prime example is cerebral palsy. Reaching using vision alone is challenging for these kids. They will look and turn away and use their hands to find things.

Back to Harriette. If sensory integration is challenging then it is hard to make sense of complicated sights and sounds or sensory info coming at her simultaneously. So what I would say is sensory info should be simplified and sequential. That is things should be slowed down dramatically and presented to her one at a time. She cannot process things simultaneously just we would have a problem listening to two people at once.

The two key things for this week for teachers to remember

1.     Slow things down – speech, movement, events. Try slowing your speech down; it may sound funny at first but with some kids it can have a dramatic effect. Anyway even if you don’t see a response there can be something going on inside.
2.     Events to be one at a time or one after the other. Say something and wait for her to respond, or show her something, then say something again. People should not speak at the same time near her.

That’s it for today. Have a great day!

Saturday 15 January 2011


He had hydrocephalus when he was born. Water on the brain and a shunt was installed into his brain to drain the fluid. The shunt business was worrying for mum and dad and sometimes the shunt had to be re-fixed or re-adjusted. He lost his sight at first. He was a miracle baby. After time through a lot of prayer and attention he recovered his sight. His mum and dad had three boys to look after. It was not easy. He had constant visits to the hospital. I became involved early on and after assessing him I suspected hemianopia. This means no visual field in the left side of both eyes. Sadly this proved to be accurate and soon he had to go to his first setting to a nursery and then to reception. Reception was a very rocky ride and mainstream schooling proved to be not right for him. Mum wanted the mainstream school because his brothers went there. But it was not for him. It isn’t for everyone. It was a bit overwhelming for him. He often just shut down with the noise and the hustle and bustle. 

He was given a place in the special school for visually impaired children. He loved it there. Small classes, teachers experienced in visual problems, appropriate and adapted work. He really flourished. But after a short time he developed epilepsy. It went on and on and nothing no medication stopped it. He had weeks off school. He was not progressing. He was in distress and not learning.
Mum was told of an operation to remove half his cerebral cortex – the half that was constantly fitting. It was drastic. It was irreversible. A lot of heart searching and careful thought and then the decision was made. He would have the op. 

I spoke to mum after the op and it was incredible. With half his brain disconnected he was virtually as he was before. He was happy and he was back at school. The marvels of modern medicine! The wonderful ‘plasticity’ of the brain. I have not been in touch recently but the last thing I heard was that he is doing well. And there has been no recurrence of the epilepsy. 

Some children are amazing. He is amazing. With so many problems this little boy is happy and brings happiness to all his family and teachers. He is a wonderful kid. A SUPERBOY
PS. I was reminded of this lad after a mom contacted me yesterday about her little boy with hydranencephaly

Friday 14 January 2011


A youngster with microcephaly started in the mainstream nursery this morning and it was an interesting if challenging experience. So for the benefit of all concerned and other teachers out there who are supporting young children with CVI I will offer some reflective thoughts. 

I’ll give him a name, ‘Georgie’ – obviously not his real name. My first observation is that he was sat at a table with Playdo and a number of other things in front of him. Now it has been said many times in these pages that CVI gives rise to attentional difficulties. In practice this means that when looking at a crowded scene Georgie will usually be initially confused and this was the case today. He did not reach out to take the clay and he did not look at it. But then we removed everything but the clay from his field of view and low and behold what did he do? He reached out straight away and took hold of the clay. He saw it for the first time. When it was surrounded by other things he didn’t see but when it was on its own he saw it. Admittedly he didn’t hold it for long but he did hold it. Unfortunately he was actually quite soon after distracted away from it and he let go. 

Distraction is one of his main challenges in the nursery. There is a lot of patterned background on the floor and on the walls. There are many, many objects, musical instruments and toys and all sorts of things in a child’s immediate surroundings. All of these likely provide a form of visual distraction for Georgie. Then there are the several adults’ smiley faces and Georgie loves to look at smiley faces. He is real charmer and can get anyone to smile back. The trouble is that those faces can too easily become a distraction for Georgie and take him away from the Playdo and other objects and surfaces he could be experiencing. Then after an hour other children started to come into his space and the noise level rose and that wasn’t good for Georgie. He started to look around and lost his concentration completely. 

However there were some really positive things today. Georgie sat on a rug (heavily patterned unfortunately but never mind), and started to play with a drum. This occupied him for a good few minutes until he fell over backwards and banged his head and needed some serious comforting. But for all the time he was banging on the drum he was getting positive feedback and he turned the drum over and around and explored it and then banged his hand on it again. A wonderful experience. I suspect he has a drum at home and he takes to this because it is familiar. Familiarity is important for kids like Georgie. They take time to get used to anything new and giving him something familiar to play with is a great idea.

Thursday 13 January 2011


I spent this morning in the special school talking with staff and watching the children so I want to use this post to link up with the teachers there and make some constructive comments on something I saw. Of course what I say will hopefully be relevant to all who read this blog but especially so to the teachers I work with. Anyway here goes and it is all positive by the way. 
I watched a VHS video (I didn’t know people still used those!?) of that quite old children’s programme, the Teletubbies, in one classroom. What struck me was the way the kids were captivated by this video. I think they still have re-runs on CBeebies. But this is what I thought. Everything I would suggest to teachers (and parents) regarding modifying visual material, especially material on the television, is demonstrated perfectly by the Teletubbies. Let me list the ways as I see it that it meets the needs of CVI children. 
(1)    The action is slow. The characters move slowly; their arms and legs move slowly. Everything in the programme is slow moving, which is actually wonderful for a slow processor like your CVI child.
(2)    Events are sequential. The narrator speaks and after that the TTs speak and move. Then the narrator speaks again. Events are thus sequential, one thing happening after another. Things don’t merge into one continuous single action stream. This is great for our kids as they can’t process information simultaneously. It has to be sequential.
(3)    The characters are VERY large, bright and colourful. The faces are large, big eyes and big mouth (nose a bit invisible but never mind). They are big and easy to see. The spaces between the figures are big and this reduces any crowding there might be.
(4)    The huge sun face appears at the beginning and as we all know children love faces, especially smiling faces. The brain of a baby is hard-wired to look at faces. This immediately gets the kids into the show. 

More of this please you inspired teachers!!!

Teletubbies - Time to Play   Teletubbies - Oooh! Springtime Surprises and Magical MomentsTeletubbies - Naughty Noo-noo! - Messy Messes and Terrific Tidying


Wednesday 12 January 2011


'...Got to make the morning last'.  That was Simon and Garfunkel 'feeling groovy'. Its as if they had an insight into the world of the brain damaged CVI child. With them it's all about slow motion. Slow it down is what I say.
CVI children have slower responses to other children and gaining their attention takes longer. One rarely receives an immediate response from a child with brain damage and visual impairment. There is always a waiting time. With CVI children there is a distinctly slower response time. To use an analogy from the world of information systems, it is as if there is not enough RAM in their computer-brain, or as if there are too many programs open. It was said that Windows Vista needed 1GB of ram to run. If you loaded this OS and only had 250meg of Ram the processing of every programme stopped or slowed right down; it would take ages just opening one document.  As they say it can be like watching paint dry and it can be very frustrating.  It is just the same when there are too many programmes open in your computer, or even when the network or internet is busy. The system runs much slower than normal.That is how it is with your avaerage CVI child. Dont expect them to react quickly. Dont expect an immediate answer. Wait...Wait...Wait...Wait...

And give them time...

Dont do things for them...

Wait for them to do things for themselves...

Sunday 2 January 2011



CVI children have an aversion to complexity. Any visual scene that is crowded or has a degree of visual complexity is a challenge to children with cerebral visual impairment. This can range from a highly patterned background, a patterned carpet, a mural of wall displays in a classroom to a picture on  apage with more than one or two elements to it. The child cannot make sense of information unless it is simple and clear – in  contrast & definition. Complex images present severe problems. 

The classic children's book, Where's Wally, is fun for many children but for children who have severe attentional problems it is just visual overload. Be careful when purchasing books for your child to look out for particular books with very thick outlines and large details. Make sure there is not too much on the page to distract the child.  I like the Maisy books by Lucy Cousins. The Mr Men are also quite good and some of the Peppa Pig series can be suitable. But read each book through carefully, dont make the assumption that it will be sutable just because it is in a certain series.

After spending a lot of time pouring over children's books in places like Waterstones, I strongly commend the following for CVI children. They are visually simple, with  good separation between the figures, incorporate excellent contrast and their figures have thick bold outlines and a plain background. You can have confidence in buying these.

Saturday 1 January 2011



No, I dont mean Martin Shaw and Lewis Collins from the vintage television series, but the people you go to for your eye health issues. 

Today is a rather unusual and unique date - 1111. Whatever that may mean to you, on this first day of the New Year may I take the opportunity to wish all my watchers a Happy New Year. In the days ahead I hope to have some interesting interviews with well known eye specialists. Some ophthalmologists I personally liaiase with in my work in London are Dr Gill Adams and Dr Claire Roberts. Dr Alastair Fielder is unfortunately now retired but I hope to contact him too for an interview. Meanwhile I am looking forward to doing my interview with Professor Gordon Dutton in a few days. For those who are unclear of the differences between the various professionals here is an attempt at some explanation. 

Doctors specializing in eye and vision care: their training involves providing for the full range of eye care, from prescribing glasses and contact lenses to complex and delicate eye surgery. Many are also involved in research into the causes and cures for eye diseases and vision problems. As a medical doctor, an ophthalmologist is licensed to practice medicine and surgery. An ophthalmologist diagnoses and treats all eye diseases, performs eye surgery and prescribes and fits eyeglasses and contact lenses. Their training is lengthy and comprehensive. It involves four years of college, four years of medical school, one year of internship and three years of hospital-based training (residency) in the diagnosis and surgical treatment of eye disorders.

Optometrists have a Doctor of Optometry (OD) degree and are licensed to practice optometry, not medicine. Optometry involves examining the eye for the purpose of prescribing and dispensing corrective lenses, screening vision to detect eye abnormalities, and prescribing medications for eye diseases.

Opticians are trained to design and fit eyeglass lenses and frames, contact lenses, and other devices. They use prescriptions supplied by ophthalmologists or optometrists. They do not test vision or write prescriptions for visual corrections. Opticians do not diagnose or treat eye diseases.