Ocular and visual status among children in special schools in Wales: the burden of unrecognised visual impairment

Arch Dis Child. 2014 Jun;99(6):500-4. doi: 10.1136/archdischild-2013-304866. Epub 2013 Nov 26.


Background/aims: The high prevalence of visual defects among children with special needs is well reported and guidelines for vision screening are in place. However, recent research has suggested that vision care for such children is neglected. This study set out to evaluate the current status of vision screening and eye care in special schools in Wales.

Methods: In phase 1, all 44 special schools in Wales received a questionnaire on current vision screening practices. In phase 2, full eye examinations were conducted with 173 pupils of five schools with no screening service; the pupils were aged 2-21 years. In phase 3, feedback about the service was obtained from all schools and from 15 parents whose children took part.

Results: In phase 1, vision screening was patchy and inconsistent among the 39 schools responding. In phase 2, there is a high proportion of pupils (42%) reporting no previous eye examination. Overall, 17% of the pupils in the five schools presented with low vision (WHO definition, poorer than 0.3 LogMAR), 50% needed a first-time or updated spectacle prescription and 51% had some ocular abnormality that was either sight-limiting or warranted action to prevent risk to sight. In phase 3, school staff and parents reported that school-based eye examinations were valuable and, for those children with previous experience, likely to be more successful than clinic-based or practice-based examinations for this particular population.

Conclusions: There is an urgent need for a school-based optometric service for this vulnerable group of children and young people.

Keywords: Refractive errors; Special needs; Vision screening; Visual defects.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Delivery of Health Care / standards*
  • Education, Special*
  • Female
  • Humans
  • Male
  • Prevalence
  • School Health Services / standards*
  • Schools*
  • Surveys and Questionnaires
  • Vision Disorders / diagnosis*
  • Vision Disorders / epidemiology
  • Vision Screening / standards*
  • Visual Acuity
  • Wales / epidemiology
  • Young Adult