We developed a series of questions that reflects the functional abilities of severely visually handicapped children. The study population comprised 100 patients aged 30 to 60 months (mean 43.23), mostly afflicted with retinopathy of prematurity. Visual acuity was measured by preferential looking. Preferential looking acuities of the patients ranged from 20/25 (0.8) to 20/6400 (0.003) (mean 20/470 (0.04)). Ten activities were analyzed and correlated with preferential looking acuity. Among the selected visual activities, when children are not interested in television (p = 0.0001), toys (other than those that make sounds (p = 0.0001), and people (p = 0.001)), their preferential looking acuities were very low. For example, 73 out of 100 patients who were visually interested in television had preferential looking acuities (mean 20/245 (0.082)) that were significantly higher (p = 0.001) than 21 patients not interested in television (mean 20/2806 (0.007)). Patients with nystagmus (n = 79) had significantly lower preferential looking acuities (p = 0.0001) (mean 20/1114 (0.018)) than patients with no nystagmus (mean 20/57 (0.35)). When evaluating visual function in young, severely visually impaired patients, in addition to preferential looking testing, analyzing visual behavior within the environment is important to accurately evaluate their remaining visual abilities.