Why a Special Needs Vision Clinic?
Sight-related issues can impose several challenges for everyone, and it gets more complicated for people with disabilities or children with special needs.[1,2] Children with cerebral palsy, Down syndrome, and autism are some common examples of special needs conditions often accompanied by significant visual complications.[3,4] Comprehensive eye examinations for these children are essential, as they may be diagnosed with problems that can be treated to improve the child’s developmental milestones and ultimately their quality of life (QoL). The 2030 Agenda for Sustainable Development’s focal point of “Leave no one behind” is in sync with Mission for Vision’s (MFV) core value of “Services for all”. MFV works with leading eye hospitals across India to ensure that every single person has easy access to quality eye care and there is a special focus on “children with special needs (CSN)”.
What have we done?
MFV and RenewSys India Pvt. Ltd. joined hands to establish a Special Needs Vision Clinic (SNVC) in July 2018. CSN who require eye care benefit from this exclusive facility at the Institute for Vision Rehabilitation at LV Prasad Eye Institute (LVPEI), Hyderabad. The centre aims to provide comprehensive and customised eye care services for CSN by assessing their visual needs with special assessment tools, providing them with appropriate spectacle prescriptions, low vision devices, and therapies to maximise their functional ability and enhance their overall QoL and well-being.
Vision rehabilitation services at a glance
The SNVC gets majority of its patients as referrals from in-house sub-specialty clinics, external organisations, and private hospitals. Children visit the clinic accompanied by their parent(s) and are offered an initial screening and evaluation. Based on the initial case diagnosis, the child-parent pair is introduced to various rehabilitative and support interventions that require several follow-up visits over time. Since its inception, a total of 11,414 children with special needs were referred for ophthalmic screening, of which 53.6% were given a baseline visual assessment and about 33% were seen periodically in the clinic for follow-up vision assessments. A total of 9,003 (79%) children went through early intervention assessment for developmental delays and were offered various follow-up sessions that included vision and low-vision rehabilitation, speech therapy, physiotherapy, special education, and Sanet Vision Integrator (SVI) to enhance eye-hand coordination. A total of 24 awareness sessions with parents and other stakeholders were organised covering several important aspects that are relevant to children with visual impairment (VI) and for those with delayed development.
Combatting the COVID-19 lockdown effect
COVID-19-induced lockdowns were a huge deterrent and the number of patients visiting the facility declined by about 50% during the fiscal year (FY) 2020-2021 as compared to the preceding FY. There was a significant change in the pattern of service delivery as the clinic had to adapt to the emerging COVID-19 scenario. In response to the lockdowns, the clinic staff came up with the following novel strategies to deliver uninterrupted services:
- Virtual therapies were planned wherein the parents were advised to do simple therapies with the child at home using the available materials. Detailed instructions over the phone, including video and reading materials were shared to educate the parent on the ‘know-how’ of conducting such simple therapies. The initial set of parent-initiated sessions were supervised and observed by the clinic staff on a regular basis.
- Patient WhatsApp groups were formed. Periodic information and instructions were shared for the benefit of the patient and any questions/concerns related to home-self-care were addressed through video calling and messaging services.
- Online counseling sessions with the child-parent pair were organised periodically to assess and document the progress of the child. Telemedicine guidance and information, education and communication (IEC) materials were disseminated through social media apps.
As the COVID-19 situation improved, the services were back to normal. Gradually, patients were encouraged to visit the clinic for subsequent follow-up therapies. Post-lockdown, the number of clients visiting the clinic improved, and the data indicated that during the FY 2021-2022, the number of patients visiting the clinic increased by 60% as compared to the COVID-19 lockdown year.
Vision rehabilitation (VR) is a new emerging sub-specialty that aims to improve the functionality and independence of patients with multiple disabilities using a multi-disciplinary approach.
- Strengthening the SNVC services at all the tertiary level centres of LVPEI: Moving forward it is envisioned that the VR be decentralised and made available at diverse semi-urban towns and rural areas by establishing similar facilities at suitable tertiary hospitals to reduce the travel time and costs of the existing patients and to enable access to such services to wider populations.
- Continued medical education and training: Training eye health practitioners (EHP) and allied ophthalmic personnel (AOP) is being planned to meet the demands of providing VR services in the context of scaling up to diverse and rural geographies in India. There are plans to initiate long-term and short-term VR courses aimed at ophthalmic personnel to meet the shortfalls in skilled human resources for VR in India.
- Awareness generation: Despite the advances in the field, uptake of VR services still remains low due to lack of awareness amongst the patients as well as the EHP. Hence, emphasis on organising intense IEC activities to reach communities on VR and disabilities is vital. Moving forward, efforts would be made to reach out to larger populations through print, electronic, social media, and digital media platforms.
- Das M, Spowart K, Crossley S, Dutton GN. Evidence that children with special needs all require visual assessment. Arch Dis Child. 2010 Nov;95(11):888-92.
- Choi KY, Wong HY, Cheung HN, Tseng JK, Chen CC, Wu CL, et al. Impact of visual impairment on balance and visual processing functions in students with special educational needs. PLoS One. 2022 Apr 29;17(4):e0249052.
- Wilton GJ, Woodhouse R, Vinuela-Navarro V, England R, Woodhouse JM. Behavioural Features of Cerebral Visual Impairment Are Common in Children With Down Syndrome. Front Hum Neurosci. 2021 Jun 14;15:673342.
- Chandna A, Ghahghaei S, Foster S, Kumar R. Higher Visual Function Deficits in Children With Cerebral Visual Impairment and Good Visual Acuity. Front Hum Neurosci. 2021 Nov 16;15:711873.