Many studies view inclusive education practices as having the potential to improve equal access to education, where the existing barriers are reduced. In mathematics specifically, it is believed that providing more opportunities to learn for learners with special educational needs can improve their performance and result in scaling down the mathematics achievement gap. A differing perspective from recent empirical research that focused on mathematics instruction involving learners with special educational needs in regular classroom settings, however, found that these learners did not benefit much in the mathematics lessons when equal opportunities to learn were provided. The present study reports on how learners with visual impairment perceive and engage with the teaching of mathematics in inclusive classrooms of Lesotho. The study follows a qualitative case study design using the framework of opportunity to learn (OTL) as the main theoretical resource through which conditions that facilitate effective teaching and learning of mathematics are examined. The article argues that what are often defined as opportunities to learn do not always translate into effective learning opportunities for learners with special educational needs. The opportunities to learn are mediated through the learners, who select what is and/or is not useful for them at a given point in time. Empowerment of both learners and teachers in the mediation of opportunities to learn will be a critical factor to ensure the success of interventions for inclusion in such mathematics classrooms.