In-school eyecare in special education settings has measurable benefits for children’s vision and behaviour

Abstract

Objectives To determine whether implementation of comprehensive in-school eyecare results in measurable benefits for children and young people in terms of visual status, classroom behaviours and how well their visual needs are met. Design School-based observational study. Participants & Methods 200 pupils [mean age 10 years 9 months, 70% male, majority moderate (40%) or severe (35%) learning difficulty] of a special education school in the UK. A sector-agreed in-school eyecare framework including full eye examination and cycloplegic refraction, dispensing of spectacles (as appropriate) and written reporting of outcomes to parents/teachers was applied. Classroom behaviours were observed and recorded prior to, and after, the in-school eyecare. Surveys were employed to obtain visual histories from parents/teachers. School records and statutory documents were reviewed for diagnostic and learning disability classifications. Visual function and ocular health were profiled at baseline and significant visual deficits identified. Where such deficits were previously unrecognised, untreated or not compensated for (e.g. correction of refractive error, enlargement of educational material) they were recorded as ‘unmet visual need’. At follow-up, 2–5 months after initial (baseline) measures, eye examinations, parent/teacher surveys and behaviour observations were repeated. Follow-up measures were used to determine if measurable improvements were evident in visual function, ocular health, the level of unmet need and classroom behaviour following implementation of in-school eyecare. Results 199 participants completed baseline and follow-up measures. 122 (61%) participants presented with at least one significant visual or ocular health deficit and 90 (45%) participants had at least one unmet visual need. Younger pupils and those with no previous history of eyecare were more likely to demonstrate unmet visual needs at baseline (OR 1.12 95% CI 1.03 to 1.21) p = 0.012; (OR 4.44 95% CI 1.38 to 14.29 p = 0.007 respectively). On follow-up, the number of pupils with unmet visual needs dropped significantly to 36 (18%) (McNemar’s test p<0.001). Visual and behavioural metrics of participants without significant visual deficits or whose visual needs were adequately addressed at baseline remained relatively unchanged between baseline and follow-up (Wilcoxon signed rank p>0.05). Where significant refractive deficits were corrected at follow-up, near visual acuity improved significantly (Wilcoxon signed rank p = 0.013), however, poor spectacle compliance was a persistent cause of unmet visual need. Off-task behaviour reduced significantly after actions to address unmet visual needs were communicated to parents and teachers (Wilcoxon signed rank p = 0.035). Conclusions The present study demonstrates for the first time measurable visual and behaviour benefits to children in special education settings w...

Meeting vision needs of children with special educational needs: Case studies of the impact on behaviour and academic achievement

“…It is, of course, important to meet visual needs for all children but it can be particularly difficult to achieve for children who have additional identified special educational needs. Nine case studies were carried out to gain a detailed picture of the effects of whole‐school vision and ocular health assessments and bespoke recommendations for visual adjustments (cf., SEE Project; Black et al, ). Data included repeated direct classroom observations, parent and teacher reports, and academic scores.…”

“…This study was conducted in the “real world,” where research required flexibility and methodologies need to be tailored to the realities of often complex contexts (Robson & McCartan, ). The SEE Project included only two classroom observations for each child (Black et al, ). Clearly, a one‐probe baseline observation does not constitute a stable baseline and a once off post‐intervention observation does not allow for individual conclusions about long‐term effects on a single child.…”

“…The nine children included in the present study constituted a carefully selected sample from the SEE Project population ( n = 200) (Black et al, ). The SEE Project took place over two academic years in a large special school in a mid‐sized town in Northern Ireland and included very thorough in‐school vision tests, a bespoke visual needs report for parents and teachers, behavioural screening (parent and teacher SDQ) and two brief in vivo classroom observations, one before and one after the vision intervention.…”

“…The tests led to two main recommendations: (a) the need for a new spectacle prescription and (b) modifications to the learning environment (e.g., seating near the front of the class, employing large print material). Full details of the tests and test results are provided elsewhere (Black et al, ).…”

“…Research reported in the present paper was part of the large‐scale Special Education Eyecare (SEE) Project (Black et al, ). The SEE Project included 200 children and young people (4–18 years of age) with identified special educational needs, school staff and parents/guardians in a comprehensive in‐school vision assessment programme.…”