Children with learning disabilities are 28 times more likely than average to have serious sight problems, and yet only one in 10 of these children has any history of attending a community optician. This serious discrepancy was just one of the findings contained within SeeAbility’s Children in Focus 2019: A change in sight report, which was released on October 10 to coincide with World Sight Day and the 220th anniversary of SeeAbility’s founding.
Informed and supported by SeeAbility’s project, NHS England has made a commitment in the Long Term Plan to roll out a new national programme of eye care in all special schools from 2020.
SeeAbility was founded in 1799, making it one of the oldest disability organisations in the world, and since then has provided specialist support and eye care to those with learning disabilities, autism and sight loss. The charity’s new report draws on the findings of its clinical team over the past six years of being embedded with 11 special schools and providing eye care. Over the years, the team has provided over 3,500 sight tests, dispensed over 1,700 pairs of glasses and supported nearly 1,500 children with their eye care needs.
Eye care at school is much less stressful for children than at a hospital
This comprehensive study has uncovered some striking statistics; close to half of the children seen in the special schools SeeAbility works with had a problem with their vision, and nearly a third required glasses. Children with special educational needs did not tend to engage with the standard avenues of eye care; SeeAbility found that among the children it works with, 44% had never had any eye care while the remainder attended often busy hospital eye clinics where their specialist needs are not always met. Importantly, 27% of the pupils had a vision problem that was previously unknown to school or parents, which would perhaps have gone undiagnosed.
SeeAbility’s report was launched at Perseid School in Morden, the first school to have committed to the project back in 2013. A day school for pupils aged between two and 19 who have severe or profound learning difficulties, Perseid has benefitted massively from working so closely with SeeAbility. Executive head teacher Tina Harvey told Optician: ‘The difference SeeAbility has made is profound, if they stopped coming in that would be a massive loss. It always positively impacts the children when they’re prescribed glasses and the holistic way SeeAbility provide care is so beneficial. The optical team can talk to the classroom teaching teams and share information, and that everything is provided onsite makes it less disruptive and stressful for the children. It’s much better than the stress of the hospital.’
Speaking about the provision of eye care before SeeAbility began its project, Harvey commented: ‘The provision used to be very haphazard – we had pathways in place for children with an obvious visual impairment but we now have stringent screening so we identify visual problems where they aren’t apparent. A lot of glasses that might never have been dispensed have been. We’re not at the end of the process because it’s an ongoing project, but it’s brilliant to have nearly reached the point where every child in the school has been screened when they arrived in reception.’
‘It’s brilliant to have every child in school screened when they arrive in reception'
Having embedded themselves in multiple special schools around the country, SeeAbility’s clinical teams are able to provide a level of specialised care hard to emulate elsewhere. Following a school assembly in which the children showed off glasses they had made in arts and crafts, Optician was shown exactly how the charity provides eye tests at the school. In a room just off of the main hall, Marek Karas, a senior optometrist for SeeAbility, pulled down the blinds to darken the classroom and welcomed his patient.Karas was sensitive to the difficulties of keeping the child’s attention and getting them to look in certain directions through a lens. He explained: ‘Performing sight tests with these children is really rewarding because of the unique challenges involved. I make use of some specialised testing protocols and simpler tests with the children because lots of them have never been for an eye test before. A lot of my job is to incrementally build up how comfortable they are with me performing the test and being so close to their faces so that I can accurately monitor their eye health. It doesn’t have to be in a room like this either, I can even go into the classrooms or follow a child around the hallways if they aren’t comfortable with this test setting.’
Onsite provision of eye care is ideal for the children in terms of familiarity and their stress levels, but also allows for the optometrists to respond more dynamically to their needs. During the eye test with Marek the patient’s mother told Optician: ‘It’s so much less stressful to deal with appointments now that I know Marek’s looking after my son. At Moorfields where he used to be seen I felt that they just didn’t get him and the stress of that was a bit traumatic. Now he actually has fun when he sees Marek. It’s so much better for me, and not having to worry if he breaks or bends his glasses helps too.’
A dispensing optician works alongside Marek at Perseid, providing support during the eye test and performing the essential role of finding suitable frames for the children. Special needs children will often have severe prescriptions and require thick lenses, and frames may need to be more supported or resilient to rough and tumble than in those for other children. Having a DO onsite is doubly essential, however, because of the frequency with which the children either break or lose their glasses. Many of the children cannot focus or interact effectively without their spectacles and can’t afford to wait to be seen at a hospital to have another pair dispensed. In SeeAbility’s model, a teacher can simply let the onsite DO know about a child’s lost glasses and they can be replaced at no cost, often within a week.
The success of SeeAbility’s report lies not just in its findings, but in its influence on national policy. The NHS Long Term Plan makes one mention of optometry, a commitment to ensuring children with complex needs have their eyesight needs met by improving access to care in the community. NHS England’s programme manager for Opticial Services Commissioning, Richard Everitt, was in attendance at the SeeAbility report launch, and explained: ‘We at NHS England have been monitoring SeeAbility’s work with these schools, and I’m happy to be able to say that the care model has been officially endorsed by the NHS with the aim to roll it out in 2020. We’ve really heavily involved stakeholders in the project, which means we’ve been able to identify the importance of certain things we may have previously overlooked, such as the necessity of dispensing glasses at school. SeeAbility has been the beta testers here and I’m excited to see this programme expand out to the 1,000 or so special schools in England.’SeeAbility’s chairman Gordon Ilett commented: ‘The message we want to communicate to the profession is that this work with special schools could be part of your portfolio of work for a day or two in your week. It’s really fulfilling work, and if you have a family and want to work school hours what could be better? There’s enormous opportunity here to diversify where you’re employed.’