Eye tests in special schools help children reach their full potential

Researchers funded by children’s charity Action Medical Research have established that offering comprehensive eyecare services in the familiar setting of a child’s school offers ‘measurable visual and behavioural benefits’ for children with special educational needs (SEN) or autism.

Over 130,000 children and young people attend special schools in the UK.^1-4 Children with learning disabilities are 28 times more likely to have a serious sight problem than other children – but more than 40% have never had an eye test or any eye care.^5,6

Kathryn Saunders, Professor of Optometry and Vision Science at Ulster University, explains: “Failing to identify and treat problems with vision can only add to underlying disabilities and further disadvantage children with special educational needs.”

Part of the problem is that access to eyecare can be extremely challenging for children with developmental disabilities and their families.

So, with funding of almost £190,000 from Action Medical Research and support from a Department for the Economy PhD studentship to Ulster University, Professor Saunders and her team launched The SEE (Special Education Eyecare) Project.

The researchers set out to determine whether comprehensive eyecare delivered in school would benefit children and young people across three important and interlinked areas: children’s eyesight and eye health; their classroom behaviours; and how well their visual needs are met.

Two hundred children and young people aged from three to 19 years of age took part in the study. A visual history, full eye examination and information from teachers and parents were all taken into account to help build a holistic picture of each child’s visual needs and the extent to which these were met.

After conducting an in-school eye examination, researchers provided a Vision Report for parents and teachers which gave tailored advice to help them support each child. Importantly, all the reports were jargon-free and written in plain English, helping teachers and parents understand the nature of any vision problems and how to manage these. Children’s classroom behaviours were observed and recorded before and after the in-school eyecare.

The design of The SEE Project, particularly the use of follow-up visits two to five months after the initial in-school eye examination, enabled researchers to see whether their recommendations – such as using larger text or reducing clutter in the classroom environment – had been implemented and whether the children’s visual needs were better met.

Key findings showed that the in-school approach is effective:

• 61% of the children who took part were found to have at least one significant eye or vision problem.
• 45% had at least one unmet visual need, for example no glasses or no provision of large print learning materials. But on follow-up, the number of pupils with unmet visual needs dropped significantly to 18%.
• Younger pupils, and those with no previous history of eyecare, were more likely to demonstrate unmet visual needs when first tested.
• Classroom engagement was found to improve after actions to help address unmet visual needs were communicated to parents and teachers.

“Our study demonstrates, for the first time, measurable benefits to children and young people in a special education setting,” says Professor Saunders. “Benefits were apparent in both children’s vision and behaviour. In-school eyecare services offer an opportunity to improve health and education outcomes for people with learning disability.”

The idea of eyecare services being provided in school has firm support from parents and SEN teachers, with more than 80 per cent agreeing it is beneficial.⁷

The findings, published on 1 August 2019 in PLOS One, the open access scientific journal produced by the Public Library of Science, are set to help shape the delivery of eye care services from NHS England in 2020.

With around 130,000 children in special schools across the UK, this could benefit many thousands of children and young people.

Dr Tracy Swinfield, Director of Research at Action Medical research, comments: “We recognise how important vision is in relation to learning and the overall wellbeing of children with special educational needs. Poor vision can mask a child’s true potential. Thanks to Action Medical Research’s dedicated supporters, we were able to fund this top quality research. We look forward to seeing new advice being rolled out in more special schools in 2020 by NHS England.”

Notes for Editors

1. Professor Kathryn J Saunders PhD, Kathryn is Subject Lead for Optometry & Vision Science at Ulster University and is a Fellow of the College of Optometrists. Kathryn has a special interest in paediatric vision and visual development. Her research aims to provide improved methods for assessing and managing visual problems in children, particularly where developmental disability co-exists with vision deficits.
    
2. The team involved in this study comprises: Dr Julie F McClelland PhD BSc Hons MCOptom DiPTp (Ip) FHEA; Dr Julie-Anne Little PhD BSc MCOptom FHEA; Prof Karola Dillenburger ClinPsych BCBA-D; Dr A Jonathan Jackson PhD MCOptom FBCLA FAAO; Dr Pamela Anketell PhD MMedSci BSc, Dr Lynne McKerr, Ms Shelley Black BSc MCOptom and Ms Emma McConnell BSc MCOptom.
   
   The research team were located in the following locations: School of Biomedical Sciences, Optometry and Vision Sciences, Ulster University; the School of Social Sciences, Education and Social work, Queens University; Belfast Optometry department, The Royal Victoria Hospital, Belfast; Orthoptic department, The Royal Victoria Hospital, Belfast; Health and Social care Trust, Belfast. 
    
3. The study took place in Castle Tower School, Ballymena.
    
4. The three year study took place within the context of a framework for in-school eyecare for special educational settings developed collaboratively by eyecare stakeholders and charities in the UK, including SeeAbility.
    
5. The paper published in PLOS One on 1 August 2019 entitled ‘In-school eyecare in special education settings has measurable benefits for children’s vision and behaviour’ can be accessed here: https://bit.ly/2yxI6wk
    
6. Children, parents and teachers share their enthusiasm for the SEE Project approach in a short video filmed at Castle Tower School: https://vimeo.com/301346167

References:

1. GOV. UK National Statistics. Special educational needs in England:  January 2019 Department for Education 4July2019 https://www.gov.uk/government/statistics/special-educational-needs-in-england-january-2019  Website accessed 31July2019
    
2. Northern Ireland Department of Education. Revised 29April2019 - School enrolments - Northern Ireland summary data. Schools and Pupils in Northern Ireland 1991/92 – 2018/19. https://www.education-ni.gov.uk/publications/school-enrolments-northern-ireland-summary-data. Date published: 30 April 2019. Website accessed 31July2019
    
3. Welsh Government. Statistics for Wales. School census results, 2018. Table 3: Number of pupils by age group in maintained schools, 2014-2018 (a). 25 July 2018. https://gweddill.gov.wales/statistics-and-research/schools-census/?lang=en Website accessed 31July2019
    
4.  The Scottish Government. Summary statistics for schools in Scotland No. 9: 2018 Edition 11th December 2018 Corrected 16th January 2019. 11 December 2018. https://www.gov.scot/publications/summary-statistics-schools-scotland-9-2018/  Website accessed 31July2019
    
5. Emerson E and Robertson J. Prevalence of Visual Impairment amongst people with learning disabilities 2011. Available at: the Royal National Institute of Blind People (RNIB) website.
    
6. Special school sight testing https://www.seeability.org/special-schools Website accessed 31 July 2019
    
7. Emma McConnell; Shelley Black; Julie-Anne Little; Julie McClelland; Lynne McKerr; Karola Dillenburger; Pamela Anketell; Jonathan Jackson; Kathryn Saunders Testing a framework for eye care provision in special educational schools in the UK: are there measurable benefits? Invest. Ophthalmol. Vis. Sci.. 2019; 60(9):5450. doi:

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