Ocular disorders in children with learning disabilities in special education schools of Pune, India.

Aim: The aim was to study and treat ocular disorders in children with learning disabilities (cLDs) and explore associations with their perinatal history. Materials and Methods: cLDs attending 11 special schools were examined by a team consisting of an ophthalmologist, optometrist, and a social worker in 2007 and followed up in 2008. The students‘ intelligence quotient (IQ) and their medical histories were noted. Distant visual acuities were measured using Kay pictures or Snellen's tumbling E chart and complete ocular examination was performed. Students were assessed at the pediatric ophthalmology unit and low vision center, if needed. Statistical analysis was done with SPSS and the Chi-square test for ordinal data. Results: A total of 664 students were examined, 526 of whom were <16 years of age; 323 (61.4%) were male. A total of 326 (60%) had moderate-to-severe learning disabilities (IQs <50), and the mean IQ was 45.4. Two hundred and thirty-eight (45.3%) had ocular disorder; 143 (27.3%) had an uncorrected refractive error, followed by strabismus in 83 (15.8%), nystagmus in 36 (6.8%), optic atrophy in 34 (6.5%), and congenital anomalies in 13 (2.5%), 103 children had more than one abnormality. Only 12 of the 143 students with refractive errors were using spectacles. A total of 132 (48.7%) children with a history of perinatal insult had ocular problems. Ocular disorders were also common in those with a history of epilepsy, Down's syndrome, and cerebral palsy. Conclusion: Nearly half the cLDs in this study had ocular disorders and one-fourth had their vision improved.

Visual impairment in the hearing impaired students.

Background: Ocular problems are more common in children with hearing problems than in normal children. Neglected visual impairment could aggravate educational and social disability. Aim: To detect and treat visual impairment, if any, in hearing-impaired children. Setting and Design: Observational, clinical case series of hearing-impaired children in schools providing special education. Materials and Methods: Hearing-impaired children in selected schools underwent detailed visual acuity testing, refraction, external ocular examination and fundoscopy. Ocular motility testing was also performed. Teachers were sensitized and trained to help in the assessment of visual acuity using Snellen's E charts. Refractive errors and squint were treated as per standard practice. Statistical Analysis: Excel software was used for data entry and SSPS for analysis. Results: The study involved 901 hearing-impaired students between four and 21 years of age, from 14 special education schools. A quarter of them (216/901, 24%) had ocular problems. Refractive errors were the most common morbidity 167(18.5%), but only 10 children were using appropriate spectacle correction at presentation. Fifty children had visual acuity less than 20/80 at presentation; after providing refractive correction, this number reduced to three children, all of whom were provided low-vision aids. Other common conditions included strabismus in 12 (1.3%) children, and retinal pigmentary dystrophy in five (0.6%) children. Conclusion: Ocular problems are common in hearing-impaired children. Screening for ocular problems should be made mandatory in hearing-impaired children, as they use their visual sense to compensate for the poor auditory sense.