Eye Examinations in Special
Schools
SeeAbility’s Children in Focus Campaign
Marek Karas
Optometrist
SeeAbility
SeeAbility is a UK charity supporting people with
sight loss and multiple disabilities
Services
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Supported living services
Residential services
Outreach services
Skill centres
Advisory and training services
Advocacy
Acts as a national advocate
• Peer advocacy network to promote eye care
• Training for health and social care staff on eye care,
vision and VI
• Vision charter for organisations to sign up to committing
to standards on eye tests, glasses and VI support.
• Adult eye care pathway
Adult pathway
• Higher prevalence of visual impairment in people with
Learning Disability (1)
• Low uptake of eye examinations and other services. (2)
• Worked with professional bodies to create a enhanced
pathway. (3)
• Designed to allow people with LD to access NHS sight
tests in the same way as others.
Ophthalmic Services for Children (4)
Neonatal
examination
Screening at age 4
to 5 years
Screening at other
ages
Free NHS eye examination up to the age of 16 (19 if in full time
education) by community optometrists.
Ophthalmic Services for Children (4)
Targeted surveillance of high risk groups
• Sensorineural hearing impairment
• Neurodevelopmental impairments inc. Downs syndrome
• A family history of a childhood onset ophthalmic disorder
e.g. retinoblastoma
Ophthalmic Services for Children (4)
Neonatal
examination
Screening at age 4 to
5 years
Screening at other
ages
Free NHS eye examination
Targeted surveillance of high risk
groups
Hospital Eye Services
Ophthalmic Services for Children (4)
Offer of certification
Input into the EHCP
Hospital Eye Services
Low Vision Assessment
Recommendation is for
multidisciplinary assessment
Ophthalmic Services for Children (4)
Neonatal
examination
Screening at age 4 to
5 years
Screening at other
ages
Free NHS eye examination
Targeted surveillance of high risk
groups
Special Schools
• A school which is specifically organised to make special educational
provision for pupils with SEN (5)
• 4,080 maintained and non maintained special schools in England (6)
• 101,475 pupils (6)
• Primary SEN listed:
– 8,795 had a profound and multiple learning difficulty,
– 24,735 had a severe learning difficulty and
– 22,490 had autistic spectrum disorder identified as their primary special
educational need.
– under 1% of pupils (750) had visual impairment listed as their primary
special educational need (6)
Children with SEN
Children with SEN are more likely to have refractive errors,
ocular conditions and visual impairment than children
without SEN
Children with SEN
• Estimated prevalence of visual impairment amongst
children (0-19 years) with learning disabilities to be
almost 1 in 18 (5.66%) in the UK.
• Estimated prevalence of these refractive errors were
shortsightedness - 7.93%, longsightedness -13.54% and
astigmatism – 25.3
• It was predicted that figures would rise by 0.5% each
year over the next two decades.(1)
Children with SEN
• The estimated prevalence of visual impairment is 0.2%
of the general population of children (7)
• Children with learning disabilities are 28 times more
likely to have serious sight problems than other children.
Children in Special Schools
“A clear vision, 2012” (8)
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151 pupils in 5 special schools in Wales
More than a third had never had a sight test
53% needed glasses (only 38% had them)
47% had at least one eye health issue
Children in Special Schools
• 200 pupils in special schools in Glasgow (9)
• 46% had refractive error that needed correction
• 12% had low vision or blindness (WHO criteria)
Aims of the campaign
• Assess current eye care services in special
schools through a survey of special schools in
England.
• Design and deliver an eye care service in a
number of special schools.
• Evaluate that service and make
recommendations for future service delivery.
Results of the survey
• 220 (13.6%) of the 1618 schools surveyed
responded
• 19,122 pupils (203 schools)
• 74% said they were aware that pupils were at
greater risk of sight problems
• 58% reported no vision screening
Establishing pilot sites
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Establish four pilot sites
Gather a data set to build on “A Clear Vision” (8)
Ethics from Cardiff University
Principal investigator Maggie Woodhouse
Location of the Pilot Sites
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Persaid School- Epsom and St Hillier
Village School- Central Middx. Hospital
Moorcroft- Hillingdon Hospital
Grangewood- Hillingdon Hospital
Aims of the work
• Prevalence of sight problems among pupils in special
schools.
• Collect evidence on previous access to eye care among
pupils in special schools
• Identify and correct sight problems among pupils in
special schools, including referring to other services if
needed.
• Test a model of service delivery
Key Elements of the service
• The service is delivered in the school.
• A joint optometric and orthoptic assessment of children starting
school at 4 to 5 years old.
• Regular assessment of children throughout all other years at school.
• Provision of spectacle dispensing in the school free of charge.
• Co ordination with local hospital ophthalmology services and
education services.
• Communication of results to parents, teaching staff and qualified
teachers for visually impaired children (QTVI’s).
• A leavers report for pupils moving on from the school.
Pre visit Questionnaires
• Parents are sent a pre visit questionnaire
• Telephone follow up
Outputs
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Assessment of visual function
Refraction
Binocular status
Examination for pathology
Eye movements
Glasses dispensed at the school
Five key questions for CVI
Explain it all
Five Key Questions
Referral to QTVI
• 3/5+ on Five Key Questions so full inventories
need to be used
• Glasses prescribed
• Visual impairment
Results 2013-14
• 220 children seen (mean age 12.1 yrs range 3.9 years to
19.6 years.
• 36.5% of pupils had no history of eye care
• Of those seen by hospital eye service and discharged,
74.0% had not subsequently seen an optometrist.
• 33.6% needed glasses (10.9% for the first time)
Evaluation
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School questionnaire
Focus groups
Parents questionnaire
Practitioner feedback
www.seeability.org
Referral to QTVI
• 3/5+ on Five Key Questions so full inventories
need to be used
• Glasses prescribed
• Visual impairment
Conference on CVI
Friday 26th June 2015
Birmingham
• Conference:
www.seeability.org/CVIconf2015
• Survey:
https://www.surveymonkey.com/s/SeeAbilityQTVICVI
Why are we doing this?
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Establish a data set
Explore funding
Catalyse change
Build a consensus/platform for interested parties
across England
References
1.
2.
3.
4.
5.
Emerson, E. and J. Robertson, The estimated prevalence of visual impairment
among people with learning disabilities in the UK. Improving Health and Lives:
Learning Disabilities Observatory report for RNIB and SeeAbility, 2011.
McCulloch, D., et al., Vision care requirements among intellectually disabled
adults:
a residence‐based pilot study. Journal of Intellectual
Disability Research, 1996.
40(2): p. 140-150.
LOC Support Unit. Community Eye Care Pathway for Adults and Young People
with Learning Disabilities. 2014 [cited 2014 13/8/14]; Available from:
http://www.locsu.co.uk/community-services-pathways/community-eye-carepathway- for-adults-and-young-pe.
Mike Clarke on behalf of the Paediatric Subcommittee, Ophthalmic services for
children, 2012, The Royal College of Ophthalmologists.
Department for Education and Department of Health, Special educational
needs and disability code of practice: 0 to 25 years., 2014, Crown: London.
References
6.
7.
8.
9.
Health, D.f.E.a.D.o. Special Educational Needs in England SFR 26/2014:
School Census: National Tables (Tables 10a and 11). . 2014 [cited 2015
5th February 2015 ]; Available from:
https://www.gov.uk/government/collections/statistics-special-educationalneeds-sen
Social Research Group. Key facts about vision impairment in children and
young people. 2015 [cited 2015 1/3/2015]; Available from:
http://www.vision2020uk.org.uk/library.asp?libraryID=5823&section=.
Woodhouse, J.M., et al., Ocular and visual status among children in
special schools in Wales: the burden of unrecognised visual impairment.
Archives of Disease in Childhood, 2013.
Das, M., et al., Evidence that children with special needs all require visual
assessment. Archives of Disease in Childhood, 2010. 95(11): p. 888-892.
Campaign Steering Group
Paula Spinks-Chamberlain (SeeAbility’s Director of Advisory Services)
Gordon Ilett (Optometrist and SeeAbility Trustee)
Maggie Woodhouse (Senior Lecturer and Optometrist, Cardiff University)
Kathryn Saunders (Subject Head - Optometry, University of Ulster)
Rachel Pilling (Consultant Ophthalmologist, Bradford Teaching Hospitals NHS Foundation
Trust)
Jane Leitch (Consultant Paediatric Ophthalmologist, Epsom & St Helier NHS Trust)
Annette Dillion (Clinical Specialist Orthoptist & Deputy Head Orthoptist Warrington and Halton
NHS Foundation Trust Hospitals) alternating with Pamela Bowen (Orthoptist at Wrightington,
Wigan & Leigh NHS Foundation Trust)
Jennifer Browers – Dispensing Optician and Low Vision Practitioner
Jim Barlow – retired NHS England Commissioner and Chair of NHS England Eye Health
Steering Group
Marek Karas (SeeAbility’s Clinical Lead – Optometry)
Alister Riedl (SeeAbility’s Eye Care and Vision Development Officer – Children)
Nathan Davies (SeeAbility’s Eye Care and Vision Development Officer – Impact and
Evaluation)
marekpkaras@gmail.com