A clear vision:Eye care for children and young people in special schools in Wales

Nathan Davies

September 2012

With thanks to the Welsh Government, Dr Maggie Woodhouse, Dr Barbara Ryan, Nicola Crews and Aideen McAvinchey

Structure of presentation

• Overview of the special school project

• Key results and case studies

• Feedback from schools and parents

• Summary of recommendations

Overview of the project • Funded by the Welsh Government as part of the

Children's Low Vision Project in Wales

• Five special schools took part in the pilot project:

Maesgwyn School Aberdare

Ysgol Heulfan Y Canol Wrexham

Crownbridge School Pontypool

St.Christopher's School Wrexham

Portfield School Haverfordwest

• Optometrist carried out sight tests in school with all pupils who had consent to take part.

• Glasses prescribed and referrals made when required.

Overview of the project (2)

Key results

Pupils who participated

• 152 pupils had a sight test

• Aged between 3 years 6 months and 22 years

(mean: 13 years)

• 43 pupils (28.3%) were of primary age (under 12 years).

Previous history/ consultations

Previous consultation Number of pupils

% of total pupils who had sight test

No previous consultation 58 38%

Local optometrist 62 41%

Hospital clinic 32 21%

Total 152 100%

Over one third of pupils had never had a sight test.

Prescription of glasses

• Overall:

– 53% (80 pupils) received a prescription for glasses

– 47% (72 pupils) did not need a prescription for glasses.

Prescription of glasses (2)

% (number of pupils)

Reason for prescription

% (number of pupils)

Glasses not prescribed

48% (72) n/a n/a

Glasses prescribed

53% (80) First time prescription

24% (36)

Change in prescription

15% (23)

New pair because of wear and tear

14% (21)

Total 100% (152) 53% (80)

Pupils with visual impairment/ low vision

• The survey showed that 6% of pupils had visual problems recorded as a primary or secondary need in their statement of special educational need.

• The project found:

– Overall, 20% of pupils (30) had visual impairment in their habitual state (0.3 or 6/12 or poorer)

Pupils with ocular or eye movement disorders

• Of 151 pupils, 47% (71 pupils) had at least one ocular disorder, e.g.

– 27% (41 pupils) were found to have blepharitis (inflammation of the eye lids)

• 10.5% (16) of pupils had nystagmus

• 24.5% (37) of pupils had strabismus (squint)

Case study 1

Pupil A is 15 years old, is severely autistic and has Down’s

syndrome. Mum had taken A into a community optometry

practice 2 years before but they were asked to leave the

practice as the child’s behaviour was upsetting other

patients. Since then, A has had no form of glasses despite

needing a high prescription for long-sight and astigmatism.

Mum was so embarrassed that she had almost resorted to

buying A glasses online rather than going to an optometrist.

Case study 2

The school has been struggling to get an appropriate head

rest for pupil D (who was 15 years old) but, unfortunately,

due to lack of communication between the different

professionals, his nystagmus had never been considered.

The head rests in question were placed at a point

maximising the nystagmus and his head had been

strapped in place. This may have induced oscillopsia

(perception that the world is moving). D had been trying to

pull his head in the opposite direction.

Feedback from schools

Brilliant project, please come back next year !

A worthwhile project that the school has been very happy to take part in. Please can we have you back on an annual basis? This has been such a benefit for our pupils.

We were delighted to be part of the programme and feel that it has had excellent outcomes for our pupils and staff.

Feedback from parents

A big thank you to all the project team. It's been a great project. Our child asks for their glasses first thing in the morning and has adapted very well to wearing them. We've noticed a huge improvement in her behaviour since she was prescribed glasses. School has noticed that her behaviour has improved.

The whole project was very professional but was also child-friendly. Children are more receptive and relaxed in school. It's a brilliant idea to test them in school and we look forward to taking part in the future.

Summary of recommendations • An optometric service should be provided to pupils in special

schools.

– Optometrists accredited to provide one or more of the Welsh Eye Care Services should be offered training and accreditation to provide the service in special schools.

– A trained optical assistant or dispensing optician should accompany the optometrist.

– A central administration team should book appointments and order spectacles and equipment.

– Optometrists testing in special schools should link with school nurses.

Thank you very much. Diolch yn fawr.

Nathan DaviesChildren's Low Vision Advocate for Wales

Nathan.davies@rnib.org.uk01558 650281