Identifying and supporting children with evidence of cerebral visual impairment as part of an in-school eyecare service in special schools

Student thesis: Doctoral Thesis


Cerebral visual impairment (CVI) is the leading cause of childhood visual
impairment in the developed world. It arises due to damage to, or
underdevelopment of the brain. Children attending special schools are likely
to have a high prevalence of CVI due to the aetiologies surrounding the
The current project aimed to determine whether evidence of CVI could be
elicited during a comprehensive in-school vision assessment for children in
special schools.
Children (n=200) attending the largest special school in Northern Ireland
received a comprehensive vision assessment on the school premises.
Systematic review of the literature facilitated decision-making when selecting
which assessments to employ to probe for evidence of CVI. These included,
in addition to a full eye examination, parental questioning using the Visual
Skills Inventory (VSI) and Strengths and Difficulties Questionnaire (SDQ),
direct observation of visual behaviour, tests of visual perception and
evaluation of crowding ratios. Following the assessment, parents and teachers
were provided with jargon-free Vision Reports detailing the findings and
highlighting action points to address vision needs. Evaluation of the in-school
assessment and Vision Reports was conducted through feedback from
parents and teachers.
The key findings from the present study are summarised as follows;
• There is a lack of consensus in the reported literature regarding which
assessments are used to investigate and diagnose childhood CVI.
• The VSI was useful at identifying evidence of CVI and facilitated
provision of management strategies to parents and teachers to account
for CVI-related difficulties; almost 40% of the study population exhibited
evidence of CVI.
• Key features which differentiated between participants with and
without evidence of CVI were; i) a medical history of deficits affecting
neurological function/development, ii) impaired distance visual acuity
and iii) parent-reported difficulties on the SDQ.
• Observation of visual behaviour, crowding ratios and tests of visual
perception were not useful at distinguishing between participants with
and without evidence of CVI.
• Parents and teachers value and utilise written Vision Reports of visual
and CVI status, however they require additional support to implement
suggested actions.
This study has shown that eliciting evidence of CVI during an in-school vision
assessment is possible and warranted. It is crucial that in-school eyecare
models incorporate investigation of CVI to ensure associated vision difficulties
do not remain unrecognised which could ultimately hinder a child’s personal
and educational development.
Date of AwardJul 2020
Original languageEnglish
SupervisorJulie McClelland (Supervisor), Kathryn Saunders (Supervisor) & Julie-Anne Little (Supervisor)


  • Special educational needs
  • Paediatric
  • Visual status
  • Classroom modifications
  • Intervention
  • Teachers
  • Eye examination

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