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The Assessment of Vision in Children with Severe Learning Difficulties: A Systematic Review
Hareem Esmail1, Gemma Arblaster2,3, Laura Haslam4
1Orthoptic Department, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
Insights
Vision assessments for children with severe learning difficulties can utilize Visually Evoked Potentials (VEP), questionnaires, or the Bradford visual function box (BVFB) when standard tests are not feasible. Further validation is needed for the BVFB and questionnaires to improve their utility in pediatric vision assessment.
Area of Science:
- Ophthalmology
- Developmental Pediatrics
- Clinical Research
Background:
- Standard clinical vision tests like Forced Choice Preferential Looking (FCPL) are often not feasible for children with severe learning difficulties.
- A lack of standardized procedures exists for vision assessment in this vulnerable pediatric population.
- Identifying alternative, reliable methods is crucial for accurate diagnosis and intervention.
Purpose of the Study:
- To identify and evaluate vision assessment methods suitable for children with severe learning difficulties who cannot perform standard clinical tests.
- To review the literature for validated and reliable techniques in pediatric vision assessment.
Main Methods:
- A comprehensive literature search was conducted across CINAHL, PubMed, and Web of Science databases up to November 2022.
- Reference lists and grey literature were also searched to identify relevant studies.
- The McMaster University Critical Review form was employed to assess the methodological quality of the included studies.
Main Results:
- Five studies met the inclusion criteria, identifying three primary methods: Visually Evoked Potentials (VEP), questionnaires, and the Bradford visual function box (BVFB).
- VEP demonstrated reliability and validation, comparable to FCPL in success rates for children with learning difficulties.
- The BVFB offers standardization for threshold measurement but lacks validation, while questionnaires provide functional vision insights without interpretation guidance.
Conclusions:
- VEP, questionnaires, and the BVFB are potentially valuable tools for assessing vision in children with severe learning difficulties when standard tests are not possible.
- The BVFB and questionnaires require further development and validation to enhance their clinical utility.
- Standardized application of these methods is key to their effective use in pediatric vision assessment.
Background:
Children with learning difficulties that require a vision assessment may not be able to perform standard clinical vision tests, for example, Forced Choice Preferential Looking (FCPL). There is a lack of standardisation on the procedure of vision assessment in this group of children. The aim of this literature review was to identify and evaluate methods of vision assessment when standard clinical vision tests are not possible in children with severe learning difficulties.
Method:
Three databases (CINAHL, PubMed, Web of Science) were searched from inception to Nov 2022 for methods of vision assessment in children with learning difficulties. Reference lists and grey literature were also searched. The McMaster University Critical review form for quantitative studies was used to assess the methodological quality of the primary studies identified.
Results:
Five-hundred and seventy one papers were identified from databases and 16 were identified from searching reference lists and grey literature. Of the 587, five studies were relevant and fulfilled all the inclusion and exclusion criteria. Three methods of vision assessment were identified: Visually Evoked Potentials (VEP), questionnaires, and the Bradford visual function box (BVFB).
Discussion:
The VEP method was validated and reliable, although it had a similar success rate to the standardised FCPL tests in children with learning difficulties. The BVFB was a standardised method for measurement of vision threshold in children that cannot successfully complete FCPL tests, however it has not been validated. Questionnaires are an efficient way to gather descriptive information on the child's functional vision, however no guidance on the interpretation of the information is available. The BVFB and questionnaires require further development and validation. All three methods (VEP, questionnaires, and BVFB) can be useful as part of the assessment of vision in a child with severe learning difficulties where standard clinical tests are not possible, when used in a standardised manner.
