"Introduction": This study examined implications of literacy instruction for children with visual impairment (VI) with/without an additional disability at a specialized preschool in a large Midwestern city. "Methods": Teachers participated in interviews and revealed their perspectives for providing literacy instruction, and students were video recorded participating in literacy activities. Literacy opportunities were coded for themes. "Results": Six themes of literacy opportunities emerged from this study (i.e., literacy opportunities, accessibility, frequency, assessment, settings, and cues for understanding). Results provide evidence of instructional strategies, challenges and strengths described by teachers, types of activities used to promote literacy and the frequency and accessibility of literacy opportunities delivered. Activities include opportunities to read, write, and practice phonological awareness, and embedded opportunities to read and/or write "Discussion": Perspective of expectations and barriers from teachers enlighten strengths and challenges faced when working to develop literacy skills for children with VI with/without an additional disability. Student outcomes for participation in literacy opportunities provided are reported. "Implications for Practitioners": Collaboration is necessary among educators and service provides to provide the best opportunities for children with VI to learn to read and write. The instructional strategies, types of activities, frequency and accessibility to literacy opportunities used could generalize to other environments. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]