Supporting pupils with visual impairment

We began our last issue with reference to less-than-perfect hearing being a symptom of ‘advancing years’. Well, failing eyesight is also a common complaint among mature people. Many of you reading this will be wearing specs or contact lenses and may well have your screen settings adjusted to display a larger than usual font, or a coloured background. But many children have visual impairment from an early age, and often do not realise that they are seeing things differently from other people.

A report from the Association of Optometrists last year suggested that 5% of children aged six and 10% of 12-year-olds have an uncorrected eye problem – partly as a result of very little visual screening being carried out in schools. When problems go undetected, limited vision can seriously affect a child’s achievement in all areas of the curriculum: a child who has a dominant left eye but is right-handed, for example, may have difficulty with sport and handwriting; a child with binocular vision problems may have difficulty in reading. Some conditions let too much light into the eye, which leads to reduced vision in bright sunlight; others can result in patchy vision (a bit like looking through a colander), or images may be blurred, cloudy or parts of the ‘picture’ may be missing.

Monocular vision (seeing with only one eye) may occur as a result of injury, disease and, in some cases, after unsuccessful treatment for a squint. It means that:

• pupils may adopt a compensatory head posture turning their head to one side
• the field of vision is reduced, so a pupil may be unaware of people or objects on his blind side. This can be especially hazardous in an unfamiliar, busy or cluttered environment
• the child has no 3D stereoscopic vision. The environment may be confusing; steps and kerbs may not be recognised
• it’s difficult to judge speed and distances, so fast-moving games in the playground/PE may be frightening
• tasks such as threading needles or pouring liquids can cause difficulties.

These conditions can be detected by regular eye tests, and many of them can be corrected, so it’s very important that teachers and TAs are on the lookout for the signs of visual impairment and are able to nudge parents into taking advantage of free eye tests for under-16s.

Information for colleagues

Children’s eyes develop until they are seven or eight years old and during this time, the vision is quite flexible and, if necessary, can be improved by treatment (it can also get worse if a problem is not treated). Wearing the prescribed glasses at this age, and while the eyes are continuing their development, can give the child good vision that stays with them throughout their adult life. It’s important therefore, to encourage children to wear their prescribed glasses (and make sure they are clean!). Harry Potter has made wearing specs quite ‘cool’ for many youngsters – but the odd compliment from a teacher never goes amiss!

Signs of visual impairment include:

• holding head close to the desk/table or at an odd angle
• holding books too close/too far away
• blinking a lot, rubbing eyes
• screwing up eyes to look at things, squinting at the board
• sore-looking, weepy eyes
• clumsiness, often getting bruised
• headaches
• sensitivity to bright lights
• poor balance
• messy work
• confusion between similarly shaped letters/words
• difficulty with copying.

Teachers can help by:

• thinking about seating positions: lighting should be not too bright or too dim (for a monocular pupil, their good eye should be towards the teacher/whiteboard)
• not standing with your back to the window, as this creates a silhouette and makes it harder for the pupil to see you
• providing the pupil with his own copy of the text, with enlarged print (good contrast and layout are often more important than size of print)
• using ICT effectively (enlarged icons, talking text, teaching keyboard skills)
• seeking advice about special SATs and exam arrangements
• finding out about low-vision aids and lamps from the VI service as well as enlarged print dictionaries, lights, talking scales, play equipment etc.
• drawing the pupil’s attention to displays – which they may not notice
• keeping classrooms tidy and floors free of clutter:tell the pupil if there is a change to the layout of a space or any new/temporary obstacles, especially any at head height (hanging artwork, etc.)
• reading out what you are writing on the board and drawing attention to the spelling of new and unfamiliar words: an individual desk copy of board work may be needed (allow extra time for completing written work, if appropriate)
• expecting the same standards of behaviour, but remembering that these pupils may not see well enough to interpret the teacher’s gestures or facial expressions. A ‘look’ may not be sufficient to correct their behaviour!

The effects of various eye conditions are different and may vary from day to day, so it is important to seek specific advice from a specialist in your local authority visual impairment (VI) service.

Parents and pupils
You may need to encourage parents to take their children for an eye examination if you, or they, have any concern about visual difficulties: optometrists can examine children’s eyes even if they are unable to read letters, so it’s never too early to get them checked. If glasses are prescribed, parents must ensure that they are worn as specified (often all the time) in order for their child to gain maximum benefit. Regular check-ups are essential.

For older children, providing appropriate light for doing homework and ensuring that they take regular breaks from the computer screen can prevent exacerbating any problems. A good diet can also help. Eating certain fruit and vegetables, which contain nutrients called lutein and zeaxanthin (pronounced zee-uh-zan-thin) could help protect against some eye conditions: in particular broccoli, peas, spinach, sweetcorn, oranges, kiwi fruits, mangoes and grapes are thought to be beneficial, helping to protect the retina from the damaging effects of light.

SENCOs and teachers should talk with pupils who have VI to find out the extent of their difficulties and what really helps. If they need assistance in moving around school, find out how they prefer to be guided; letting them take someone’s arm or, in the case of a young child, holding hands, may be very helpful and reassuring. If buddies are nominated to help, make them aware of not leaving the child with VI ‘in space’; they should be shown a chair or left touching the wall or a piece of furniture. Being able to leave the classroom a few minutes ahead of ‘the crush’ may also be a useful strategy.

This e-bulletin issue was first published in November 2008

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