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

Abstract

Background
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 condition.

Aim
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.

Methods
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.

Results
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.

Conclusion
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 Award	Jul 2020
Original language	English
Supervisor	Julie McClelland (Supervisor), Kathryn Saunders (Supervisor) & Julie-Anne Little (Supervisor)