Watch our Children in Focus Campaign film above to learn just how important it is that children with learning disabilities receive good eye care and find out more about our sight testing programme in special schools.

How do we see, and is this different for children?

Eyesight, or vision, is produced by the brain, which interprets signals detected by the eye. The eye collects and focuses signals formed when light falls on special cells at the back of the eye (retina) and the signals are sent along the visual pathway, starting with the optic nerve, to a special region at the back of the brain. Normal vision therefore depends on having a healthy eye, a clear visual pathway, and a normally structured brain. Even if the eyes look normal and are healthy inside, a vision problem may still be present.

At birth a baby does not see as clearly as an older child or adult. The world looks fuzzy or ‘out of focus’. Other aspects of vision also develop over time, such as the ability to actively look at something. As the baby grows and develops, the brain undergoes a process of maturation, which involves new brain cell connections being made and others being discarded. As the visual pathway matures vision becomes less fuzzy and other visual skills develop, for example the ability to look actively at things. Of course such maturation also affects other parts of the brain and supports the baby in developing many new skills, like the ability to control movement and to make sense of sound.

How does vision help with development?

Vision is a very important sense in many areas of early childhood development. When a baby turns towards a sound made by an object that is out of sight, they begin to learn that the sound and the object that makes the sound are connected. If a baby can see an interesting toy that is out of reach, this can motivate the baby to reach out for it or to try to crawl towards it. Babies who have very limited vision may need help to learn these skills and do so more slowly.

Can vision be helped to develop?

Much in the same way that physiotherapy is used to prepare muscles for learning to walk, you can stimulate a child’s vision using appropriate sized toys to help them practice and learn to see. If a child needs glasses you can encourage them to wear them – it can take years for them to get used to them as there isn’t always an instant improvement. But vision is more likely to improve if the brain has a clear picture rather than a fuzzy one to learn from.

What about children with disabilities?

Children with disabilities also benefit from having good quality vision to support all these different developmental processes. We know that children with learning disabilities are 28 times more likely to have a serious sight problem than other children. If a child has a disability they are more likely to have an eye or brain problem, resulting in vision that isn't as developed as another child of the same age. If vision is less developed this could add further developmental difficulty for the child. It is therefore very important than any potential visual difficulties are identified so that appropriate treatment can be given. Some treatments can correct the problem itself and other treatments involve changing the ways a child is helped to learn. 

Why is it particularly important to think about vision for children with disabilities?

Good quality vision is important for all children as it helps with all parts of learning and development. If a vision problem is present it can be easier to identify in a child who is developing normally, and treatment and advice can then be given. However, for a number of reasons, a vision problem may not be identified so promptly in a child with disability, meaning that opportunities for treatment or advice are not taken. This can lead to further unnecessary disadvantage for the child. Depending on the type of disability some children may use their vision for a wider range of purposes than a typically developing child. For example children who cannot speak may be able to communicate using pictures and if vision problems are not identified this could lead to inappropriate materials being used.

Although some vision problems cannot be fully corrected, it is important that they are known about so that appropriate adjustments can be made.  Sometimes vision problems can be overlooked if there is no obvious eye abnormality or at times when other health problems are causing concern.

It’s important to understand what size objects a child can see so you can choose appropriate toys or activities. It can help to know what size food a child can see to encourage independence. An understanding of each child’s vision in school is essential to know if children need larger size pictures to make choices. It’s important to know if a child sees better from one side than the other so they don’t miss out on learning through observation, or trip up if they can’t see in the lower part of their vision.

How can vision be checked in children with disabilities?

A child does not need to be able to read - or even speak - for vision and eye health to be checked. The child’s responses to people, objects and pictures can be assessed by eye care specialists. They can check if a child needs glasses by using special lights and lenses without needing to cooperate with complicated tests. They can check if a child sees better from one side than the other, or if they find it difficult to see more than one object at a time. They can also check the health of the eye which is just as important as checking how good vision is.

Who can help?

If a child has a Paediatrician talk to them about any concerns. They can then make an appropriate referral for the child to be seen by the most appropriate specialist. This may depend on the particular concern and on how services are organised locally. Sometimes some specialists from the eye clinic conduct assessments in the Child Development Centre or Paediatric Outpatients. Alternatively, a child may be referred directly to an Ophthalmologist at your local eye clinic. If the child does not have a Paediatrician the GP should be able to advise.

All children are entitled to a free NHS eye test at a community optician. However, not all optometrists will have experience in testing children who cannot perform standard tests. There is more information about eye tests and a list of opticians who are willing to see people with a learning disability in the eye test section.

Links between disability and vision

Children with learning disabilities are 28 times more likely to have serious sight problems with other children. This is because the causes of a learning disability can affect the way the eye and vision system has developed or functions. There are hundreds of syndromes and conditions which cause a child to have a learning disability, some examples which also are likely to have an impact on vision are:

Down’s Syndrome

Long or short-sighted, nystagmus (wobbly eyes), cataract (cloudy lens), squint (turn in one or both eyes), keratoconus (abnormal curvature in the cornea, the clear window at the front of the eye)

Laurence Moon Bardet Biedl

Retinal dystrophy (abnormal function of the retina – the light sensitive lining at the back of the eye)

Cerebral Palsy

Long sighted, hypoaccomodation – problems focusing on near objects, visual field problems only being able to see to one side or only above or below their eyes. Problems with controlling eye movements- not being able to move eyes quickly or at all towards an object of interest.

What vision problems do children with a learning disability have?

Children with a learning disability may have normal vision, require glasses or have a squint (turn in the eye) much the same as other children. Other children may be born with eye conditions or develop them through life, which may need treatment or may result in visual impairment. Some children with learning disabilities have problems using their vision in the same way as other children due to difficulties in the way the brain processes the information from the eye - this is Cerebral Visual Impairment. More information about eye conditions and visual impairment can be found in our getting the right support section. 

Nasen Mini Guide

We have worked with the National Association of Special Educational Needs (nasen) to produce a mini guide about eye care and vision for education staff working with children and young people who have special educational needs and disabilities

This guide aims to:

  • Give an overview of how vision develops in children
  • Explore the higher prevalence of sight problems experienced by pupils with learning disabilities
  • Dispel some of the myths about eye care and vision
  • Share the impact on learning and development of undiagnosed sight problems
  • Suggest strategies for supporting children to wear glasses and cope with sight problems
  • Give explanations of some common eye problems
  • Explain the different eye care and vision professions and their roles
  • Provide practical solutions to ensure pupils are making the best use of the vision they have 

Useful links:

More information about Down’s syndrome

More information about learning disability

More information about Laurence Moon Bardet Biedl syndrome  

More information about disability

More information about Cerebral visual impairment

Starting point – help and support for parents and carers of visually impaired children