Ocular misalignment and unmet eye care needs among students with special education needs in Hong Kong

To determine the prevalence of ocular misalignment among students with special educational needs (SEN) in Hong Kong and to investigate their access to eye care services.

This cross-sectional study was conducted between 2023 and 2024 in three special education schools. Students with mild to moderate intellectual disabilities received vision screenings evaluating ocular alignment, visual acuity, and stereopsis. A questionnaire collected data on eye care history, caregiver awareness of vision problems, and access to financial support of eye care services.

A total of 334 students (mean age 13.5 ± 5.0 years; 73.7% male) participated. The prevalence of tropia (strabismus) was 8.1% (95% confidence interval [CI]: 5.6%-11.5%), with exotropia being the predominant type (6.3%). Clinically significant phoria was present in 10.5% (95% CI: 7.6%-14.3%). Tropia was associated with significantly worse visual acuity (p < 0.01) and stereoacuity (p < 0.01) compared to phoria and orthophoria. Alarmingly, major gaps in care were identified: 24% of students with tropia had never received a vision assessment, and 32% of their caregivers were unaware or unsure of their child's condition. Although vision screenings were the most common source of care, 80.6% of families reported receiving no financial support for comprehensive eye examinations.

Strabismus is common and functionally impactful in Hong Kong students with SEN, yet significant systemic barriers, including limited caregiver awareness and inadequate support, prevent access to essential care. These findings highlight an urgent need for public health reforms, including the implementation of integrated, 'closed-loop' referral systems and enhanced collaboration across health and education sectors, linking schools with eye care providers, to ensure timely and equitable eye care for this vulnerable population.