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Identifying visual difficulty in children with special educational needs: where should we look?
  1. Jenefer Sargent
  1. Correspondence to Dr Jenefer Sargent, Wolfson Neurodisability Service, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond St, London WC1N 3JH, UK: jenefer.sargent{at}

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In the UK, universal child screening for eye defects or reduced vision is recommended at birth, 6–8 weeks and 4 years.1 A physical examination of the baby's eyes is carried out to detect significant structural abnormalities or media opacities manifesting with an abnormal red reflex. Early diagnosis facilitates prompt treatment to preserve or restore vision, and/or the introduction of early support to improve visual and developmental outcomes if severe visual impairment is inevitable. In addition, babies born prematurely are screened for retinopathy of prematurity. At 4 years of age, screening should be orthoptist led; via measurement of monocular acuity, the principal aim is to detect children with significant amblyopia who will benefit from treatment to improve vision in the ‘blunted’ eye.

Although auditing of the programme is not well established, its contribution to the detection of severe visual impairment has been demonstrated by Rahi et al2 who reported on the outcome of a 1-year period of active case finding of children newly diagnosed with severe visual impairment (defined as acuity worse than logMAR 1.0)i (Snellen 6/60). A quarter of those with isolated severe visual impairment were identified through the UK screening programme, and for almost half of the children, paediatricians were the first key professional involved in the diagnostic journey. However, Rahi also highlighted the relative rarity of isolated severe visual impairment: for many children, this occurred in the context of additional, non-ophthalmic impairments. Of this group, almost half were diagnosed via clinical examinations arranged because of a known increased risk of a specific eye disease.

Rahi's study focused on children with severe acuity reduction; however, mild/moderate …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • i The logMAR notation (logarithm of minimum angle of resolution) for visual acuity measures gives a value indicative of visual loss: a higher value indicates greater acuity reduction. The logMAR charts incorporate a number of design features leading to advantages over older style charts. The logMAR values can be converted to Snellen equivalents, although different types of test may measure different types of acuity and so conversions may need to be treated with caution.

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