Living in a Changing Europe
ICEVI July 2009
The Changing Face of Paediatric Visual Impairment
Prof AJ Jackson PhD MCOptom FBCLA FAAO
Royal Group of Hospitals - Consultant Optometrist/Head of Optometry,
Department of Ophthalmology
Queen’s University of Belfast – Visiting Professor, Faculty of Biomedical Sciences
Central Services Agency – Head of Professional Ophthalmic Services, Family Practitioner Services
The profile of the visually impaired child has changed very significantly over the last 30-40 years. The number of children with isolated visual problems (congenital cataract, albinism, congenital nystagmus) has decreased while the number of those with complex co-existing neurological disability has increased.
In a recent community based study in Belfast, we have identified that 79% of visually impaired children have multiple disabilities, 43% moderate to severe learning disability, 45% cortical visual impairment yet only 22% are registered as either blind or partially sighted (Flanagan et al 2003).
In a complimentary review of the changing visual profile of children attending Northern Ireland’s regional specialist school for the visually impaired, over a 30 year period, we found an increasing proportion of children to have cortical visual impairment. Over the same period, the proportion of children now referred to the regional paediatric low vision service, who attend specialist schools for those with complex multiple disability, has increased significantly (McClelland et al 2007).
The implications of these changes, upon those of us involved in the management of childhood visual impairment, are two-fold. Firstly, visual function and functional vision assessment procedures need to be modified and protocols refined in such a way as to maximise the possibility of getting accurate and repeatable measures of visual functions from children with complex behavioural and communication problems. Tests of visual resolution, contrast sensitivity and near function must use target symbols and strategies that attract the interest of children with reduced learning capacity. Refraction and clinical assessment procedures must be carried out using techniques and equipment designed to relieve apprehension and encourage participation. Secondly, advice on low vision management must change from being primarily “optical device” or “surgically” orientated to being practical, involving contrast enhancement, task lighting, object size modification and preferred working distances. All concerned with the child’s care must be fully informed of the rationale associated with issuing spectacles or alternative optical devices (Jackson et al, 1999).
Essentially, visually impaired children with complex needs will only be helped in maximising their visual potential if clinicians responsible for the diagnosis of eye disease and management of visual impairment, learn how to interact with these children and their carers in such a way as to increase understanding of each child’s visual potential. Thereafter, information must be shared with parents/carers, educationalists, rehabilitation specialists, other medical specialists and social services teams in a format that is intelligible and usable. Only by working as a team will we maximise each child’s potential.
In this presentation, I will review current literature on the subject and will share from 25 years experience of trying, in some small way, to help alleviate the effects of disability in these children’s lives.
References :
Jackson AJ, Saunders KS (1999)
“The Optometric Assessment of the Visually Impaired Infant and Young Child”
Ophthalmic & Physiological Optics Vol 19 1002 S47-S62
Flannagan NM, Jackson AJ, Hill AE (2003)
“Visual Impairment in Childhood : Insights from a Community Based Survey”
Child Care Health and Development 29:6 Pg 493-499
McClelland JF, Saunders KJ, Hill N, Magee A, Shannon M, Jackson AJ (2007)
“The Changing Visual Profile of Children Attending a Regional Specialist School for the Visually Impaired in Northern Ireland”
Ophthalmology & Physiological Optics 27:556-560