Research Article: Findings from an opt-in eye examination service in English special schools. Is vision screening effective for this population?

Date Published: March 11, 2019

Publisher: Public Library of Science

Author(s): Lisa A. Donaldson, Marek Karas, Donna O’Brien, J. Margaret Woodhouse, Ahmed Awadein.


Our objective was to present the findings of an opt-in, school-based eye care service for children attending 11 special schools in England and use these findings to determine whether a vision screening programme would be appropriate for this population. Data from eye examinations provided to 949 pupils (mean age 10.7 years) was analysed to determine the prevalence and aetiology of visual deficiencies and reported eye care history. For 46.2% (n = 438) of pupils, a visual deficiency was recorded. 12.5% of all the children seen (n = 119) had a visual deficiency that was previously undiagnosed. Referral for a medical opinion was made for 3.1% (n = 29) of pupils seen by the service. Spectacle correction was needed for 31.5% (n = 299) of pupils; for 12.9% (122) these were prescribed for the first time. 3.7% (n = 11) of parents/carers of pupils needing spectacles chose not to use the spectacle dispensing service offered in school. Eye care history was available for 847 pupils (89.3%). Of the pupils for whom an eye care history was available, 44% (n = 373) reported no history of any previous eye care and10.7% (n = 91) reported a history of attending a community optical practice/opticians. Only one pupil from the school entry 4–5 age group (0.6% of age group n = 156) would have passed vision screening using current Public Health England screening guidelines. Children with a diagnosis of autism were significantly less likely to be able to provide a reliable measurement of visual acuity. This study supports previously published evidence of a very high prevalence of visual problems in children with the most complex needs and a significant unmet need in this group. It demonstrates routine school entry vision screening using current Public Health England guidelines is not appropriate for this group of children and very low uptake of community primary eye care services.

Partial Text

Sight is a critical sense for everyone and understanding a child’s visual abilities and limitations is vital to optimally support their development [1]. There is a body of evidence that children with learning disabilities are significantly more likely to experience eye and vision problems than members of the general childhood population [2–7]. Children with the most complex needs are likely to be taught in special schools. In England 79% of children with severe learning disabilities and 81% of children with profound and multiple learning disabilities attend such schools [8]. The total population attending special schools in England at the time of writing is estimated at 117,888 [9].

Eye examinations were offered to children attending 11 special schools in London (8 schools), Buckinghamshire, Durham and Manchester. Informed parental consent (see S1 Fig.) was obtained prior to the eye care team visiting the school and parents were given a detailed questionnaire exploring previous ocular and general health history prior to the first visit [14],(see S2 Fig).

Over the four-year period 949 new children were seen; 509 were of primary school age and 440 secondary school age. Mean age was 10.7 years (range was 3.0 to 19.8 years).

This evaluation shows that many children in our special school population have undiagnosed visual needs. Our findings align with those of previously published studies which reported the prevalence of ocular and visual anomalies among children with learning disabilities, including those in special schools elsewhere in the UK [2,4,5] and in other countries [3,6,7].

The study did not explore the eye care history or status of around 20% of pupils who did not opt into the service in the schools where the service was offered. These findings cannot therefore be taken to represent the entire special school population.

The very low uptake of free NHS eye examinations in our population suggests that the NHS General Ophthalmic Service is currently failing children with complex needs in England. Furthermore, only one child of 156 of school entry age would have passed routine vision screening as currently recommended by the National Screening Committee [11]. Routine vision screening is demonstrably inappropriate for this population. This and other UKstudies [2,4,5], provide evidence of a high incidence of visual deficiencies, including a high incidence of correctable refractive error, in the UK special school population. The study provides evidence that existing eye care services in England are failing to identify and manage a significant proportion of children with visual deficiencies This is evidence that children attending special schools need a targeted in-school eye care service that provides full, regular, routine, eye examinations and spectacle provision as described by the Framework for provision of eye care in special schools in England [12] and recommended by Public Health England’s screening guidelines [13].




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