Post date: 
Thursday, 9 February 2017
Julie-Anne Little

Julie-Anne Little is the Research leader of the Optometry and Vision Science Group at Ulster University in Northern Ireland. Currently, her main area of research concerns vision in children with learning disabilities. Find out more about her research.

We know that children with special needs are much more likely to have visual problems. They are more likely to require eye care treatment and wear glasses. Having a severe or profound learning disability substantially increases the risk of visual impairment and blindness.   
However, children with special needs often have other, perhaps more urgent health issues, so understandably the assessment of vision is not always given priority. And yet optimising visual development is a critical part of ensuring the best access to educational learning and in turn the greatest quality of life for these children.  

My work has contributed to a better understanding of the visual profile of children with Autism Spectrum Disorder (ASD). Until recently, there was a lack of knowledge about what clinicians should expect regarding visual function in ASD and a lack of confidence in how to best approach testing.   

We conducted a large-scale study in vision in ASD, recruiting a representative sample of children with ASD with a range of severity of the condition across the region of Northern Ireland. We used social stories in written and video form to help prepare children for their eye test and ensured familiarity with testing facilities by using local clinical locations and working with families to ensure the best time of day.  
Key findings 
  • Visual acuity is not reduced in ASD, unlike other neurodevelopmental disabilities, so clinicians should not allow for any reduction in vision to go unexplained nor further investigated
  • Astigmatic refractive errors were three times more common in ASD
  • Squints and focusing problems were also more common.   
Another area of my ongoing research is vision in children with Down syndrome. Chiefly through the pioneering work of Dr Maggie Woodhouse, a senior lecturer at Cardiff University, there is now much greater awareness of the frequent need children with Down syndrome have for glasses to help with accommodation problems and significant refractive errors. 
Our work has also contributed to knowledge of why vision can be reduced in children with Down syndrome, and one of our recent studies has been to investigate why accommodation deficits occur. We looked at how both eyes work together to focus on near objects and are continuing to work with Dr Woodhouse and colleagues to look at eye tracking. As most learning is done up close, and with the increasing utility of portable tablet devices, it is important we think about how children use their near vision and are appropriately visually corrected for work up close. Another current study is investigating the optics of children’s eyes who have Down syndrome, and characterising the more frequent lens opacities found in Down syndrome. 
More broadly, in the area of vision in special needs, our Optometry and Vision Science Group are also conducting a study looking at how visual function is assessed in special education. This builds on my previous research which looked at how vision was reported in educational statements of special educational needs (SEN). This study found that in the majority of cases, reduced vision and/or the need for glasses to help correct significant refractive error was not recorded in a child’s statement of SEN, highlighting the deficiency in communication between health care and education professionals. 
This is important because if visual limitations are not recognised by educational services, the child's needs may not be met during school life. More comprehensive eye care services, embedded with communication links with parents, professionals, teachers and schools are necessary to improve understanding of what vision children with neurological impairments have.

Final thoughts

I am a firm believer that research can be a positive tool for change, and to help drive improvement for our children and society.  So it’s nice to have the opportunity to contribute to a special feature for NB’s centenary year.  

One of the great resources we have developed for parents and professionals is the Ulster Vision Resources website. These webpages contain lots of information to help parents untangle the jargon eye health and sight loss professional’s use about vision, and it also gives professionals examples and frameworks to help their report writing. Recently, we worked with the disability charity SeeAbility to help develop this, and so I hope this will play a part in the vital role charities have in helping children and families with vision impairment.  
I recently had the honour of receiving an award from the College of Optometrists in acknowledgement of my research, the Neill Charman Medal for Research. However, this research only happens through teamwork with multidisciplinary collaborators and research students, and most importantly the children, parents and schools who take the time to participate in studies. My thanks go to all these people in our efforts to champion the clinical visual care of children with special needs. 
Julie-Anne is a Senior Lecturer in Optometry and Research leader of the Optometry and Vision Science Group at Ulster University. 

Further information

Julie-Anne and the Vision Science Group have published other papers on the subject of vision impairment for children with special needs. If you found this article interesting, please take a look:

Two more paper about how children with special needs are much more likely to have visual problems:

Read the second paper produced by Julie-Ann and the group in the large-scale study of children's vision with ASD:

Read the second paper from the recent study investigating why accommodation deficits occur in children with Down syndrome:

  • Professor Kathryn Saunders, Drs Maggie Woodhouse, Pamela Anketell, Lesley Doyle, Sara McCullough, Julie McClelland, Valldeflors Navarro, Stephen Gallagher, Claire Bailey and many other clinicians involved in facilitating this research, the National Autistic Society, PEAT, RNIB, Angel Eyes, Down Syndrome Causeway Family Support group and several teachers and schools. Thanks to research funders, and most importantly, thanks to all the children and parents. 
Best of NB Online (archive)