Failing to see the problem ALLEN THURSTON PROFESSOR

Failing to see the problem ALLEN THURSTON, PROFESSOR OF EDUCATION, DIRECTOR OF CENTRE FOR EVIDENCE & SOCIAL INNOVATION

Aims of the day Look at whether poor vision might influence learning to read Look at research data to tell us the extent of the issue Look at why this might not get picked up through traditional screening Think about what we could do to address the issue

Aims of the day? Look at whether poor vision might influence learning to read Look at research data to tell us the extent of the issue Look at why this might not get picked up through traditional screening Think about what we could do to address the issue

What are the main issues? Colour blindness Hyperopia Myopia

How does poor vision influence us? (www. webmd. boots. com) Difficult to distinguish green and red colours Tends to only affect male students

How does poor vision influence us? (www. webmd. boots. com) Myopia (can’t see near things clearly) Hyperopia (can’t see far away things clearly)

Why are images blurred? (www. webmd. boots. com) Myopia (can’t see near things clearly) Hyperopia (can’t see far away things clearly)

How does poor vision influence us in the classroom? (www. sightsavers. org/)

How does poor vision influence us in the classroom? (www. sightsavers. org/)

Accommodation (www. gsu. edu) Small muscles contract and the lens changes shape Brings time focus for a short

How do we measure refractive error? Lens strength Diopters +1. 25 glasses that magnify slightly +2. 5 D glasses that would be essential for reading the paper +3. 5 D glasses that are essential for reading your text messages on full magnification

What is the extent of the problem? The Royal National Institute of Blind People (RNIB) UK estimates at 20% (Solebo & Rahi, 2013) Mather Elementary School, Boston, USA 50% detected (Orfield, 2001) 23% of 6 -7 year-olds in Northern Ireland detected 11% of 12 -13 year-olds in Northern Ireland (O’Donoghue et al. , 2010, 2012)

Why aren’t these children picked up by screening? In some cases they are not detected Poor screening with no account of ‘accommodation’ Poor availability of expensive portable equipment e. g. autorefractometers Screening by nurses or orthoptists who can not prescribe Poor uptake of prescriptions by parents No follow up to see if prescription filled

Why aren’t these children picked up by screening? Not wearing glasses Only between 20 -30% of students wear glasses one year on (Preslan and Novak, 1998) Parents do not take screened children to the opticians (Scottish Government, 2010) 2229 children screened during the 2000/01 in Michigan, USA-25% went to the optician

Is poor vision associated with poor reading? A study of 1298, 8 year-old children in served by Rhondda Cynon Taff Community Paediatric Service, Wales Students with new diagnoses of hyperopia (refractive errors +1. 25 D in one eye) were about 3 months behind national assessments in literacy (SATS) than comparator groups with no vision problems Students with new diagnoses of hyperopia (refractive errors +3 D both eyes) were about 18 months behind national assessments in literacy (SATS) than comparator groups with no vision problems 30% of this sample had been referred to educational psychology services to investigate developmental delay (Williams, Latif, Hannington&Watkins, 2005)

Is poor vision associated with poor reading? In a study of vision and academic performance of 1329 students from Iowa, USA Regression analysis indicated that visual factors were a stronger predictor of student performance than ethnicity or socio-economic status Hyperopic students were about 9 months behind (Maples, 2001).

Is poor vision associated with poor reading? 191 Year 1 students in Ohio, USA (mean age 7. 78 years) Significant correlation between low vision and Stanford Reading Test Hyperopic students were about 8 months behind (Kulp, 1999)

Is poor vision associated with poor reading? 782 Year 1 - Year 5 students (age 5 -11 years) looking at relationship between reading development and visual errors (USA) Hyperopic students were 6 months behind students with no refractive error (Rosner & Rosner, 1997)

Would glasses help? Ice-cream sales and murders are correlated in the USA

Would glasses help? Randomised controlled trials are rare Effects of screening and treatment by glasses and patching of 177 three-year-old to five-year-old children Made gains of between +8 and +18 months progress on ability to read letters and symbols six months following examination (Clarke et al. , 2003 ) Conlon (2016) has completed a randomised controlled trial in China and found gains of +3 months for children presscribed glasses for myopia

Implications Take care with coloured text and pens Seeing the blackboard can be difficult for hyperopics Sit them closer to the blackboard/interactive white board Reading books can be difficult for myopics Hold the book very close Accommodation helps focus Both hyperiopics and myopics could benefit from spectacles Consider relationships with opticians Testing and prescription

Questions