Evidence that children with special needs all require visual assessment

Abstract

Design: A protocol-based ophthalmological assessment was performed on-site by a skilled investigator.

Patients: Children attending schools for special needs in Glasgow were offered eye care within their school. Outcomes for the first 240 participants are reported.

Outcome measures: Number of children for whom visual acuity could be measured and the results of refraction. Results 228/240 (95%) children were able to co-operate in a complete or nearly complete assessment of visual function. Visual acuity could be reliably assessed in 190 children using a range of tests from preferential looking to logMAR charts. 23/190 (12.1%) were found to be visually impaired according to WHO criteria. 105/228 (46.1%) subjects were found to have a refractive error which required correction. 50/105 subjects were wearing an adequate correction (ie, difference of less than 0.75 D sphere or cylinder compared with the retinoscopy result obtained on screening) and 55 (24.1%) children were prescribed a new correction. The prevalence of all types of refractive error was found to be significantly higher in the population with special needs, in particular the learning disabilities subgroup, compared with normal children. High hyperopia and astigmatism were common.

Conclusion: With patience, suitably adapted methods, a familiar environment and skill, visual assessment is feasible in the majority of children with special needs. The prevalence of reduced visual acuity is high and unaddressed correctable refractive error is a major cause.