In-school eyecare in special education settings has measurable benefits for children's vision and behaviour
In-school eyecare in special education settings has measurable benefits for children's vision and behaviour
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DOI：
10.1371/journal.pone.0220480
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发表时间：
2019-08-01
期刊：
影响因子：
3.7
通讯作者：
Saunders, K. J.
中科院分区：
文献类型：
--
作者：
Black, S. A.;McConnell, E. L.;Saunders, K. J.
目标确定实施全面的校内眼部护理是否会在视觉状态、课堂行为以及满足他们的视觉需求方面为儿童和青少年带来可衡量的好处。设计以学校为基础的观察研究。参与者和方法200名学生[平均年龄10岁9个月，70%男性，英国特殊教育学校的大多数中度（40%）或重度（35%）学习困难。部门商定的校内眼部护理框架，包括全面的眼部检查和睫状肌麻痹验光，分发眼镜（视情况而定），并向家长/教师书面报告结果。课堂行为进行了观察和记录之前，之后，在学校的眼睛护理。调查，从家长/教师获得的视觉历史。对学校记录和法定文件进行了审查，以确定诊断和学习障碍分类。视觉功能和眼部健康在基线时进行了分析，并确定了显著的视觉缺陷。如果这些缺陷之前未被识别、未得到治疗或未得到补偿（例如屈光不正矫正、教育材料放大），则将其记录为“未满足的视力需求”。在随访时，在初始（基线）测量后2-5个月，重复进行眼科检查、家长/教师调查和行为观察。后续措施被用来确定是否可测量的改善是明显的视觉功能，眼部健康，未满足的需求和课堂行为的水平实施后，在学校eyecare.Results199参与者完成基线和后续措施。122名（61%）参与者至少有一个显著的视力或眼部健康缺陷，90名（45%）参与者至少有一个未满足的视力需求。年龄较小的学生和既往无眼部护理史的学生更可能在基线时表现出未满足的视力需求（OR 1.12 95% CI 1.03至1.21）p = 0.012;（OR 4.44 95% CI 1.38至14.29 p = 0.007）。在随访中，视力需求未得到满足的学生人数显著下降至36人（18%）（McNemar检验p< 0.001）。没有显著视觉缺陷或其视觉需求在基线时得到充分解决的参与者的视觉和行为指标在基线和随访之间保持相对不变（Wilcoxon符号秩p> 0.05）。在随访时矫正明显屈光缺陷的情况下，近视力显著改善（Wilcoxon符号秩p = 0.013），然而，眼镜依从性差是未满足视觉需求的持续原因。任务外行为显着减少后，采取行动，以解决未满足的视觉需求被传达给家长和教师（Wilcoxon签署秩P = 0.035）。ConclusionsThe本研究首次证明了可衡量的视觉和行为的好处，儿童在特殊教育环境中，当他们接受全面的在校眼科检查，现场眼镜配药和无行话报告的结果，教师和家长。
ObjectivesTo determine whether implementation of comprehensive in-school eyecare results in measurable benefits for children and young people in terms of visual status, classroom behaviours and how well their visual needs are met.DesignSchool-based observational study.Participants & Methods200 pupils [mean age 10 years 9 months, 70% male, majority moderate (40%) or severe (35%) learning difficulty] of a special education school in the UK.A sector-agreed in-school eyecare framework including full eye examination and cycloplegic refraction, dispensing of spectacles (as appropriate) and written reporting of outcomes to parents/teachers was applied. Classroom behaviours were observed and recorded prior to, and after, the in-school eyecare. Surveys were employed to obtain visual histories from parents/teachers. School records and statutory documents were reviewed for diagnostic and learning disability classifications. Visual function and ocular health were profiled at baseline and significant visual deficits identified. Where such deficits were previously unrecognised, untreated or not compensated for (e.g. correction of refractive error, enlargement of educational material) they were recorded as 'unmet visual need'. At follow-up, 2-5 months after initial (baseline) measures, eye examinations, parent/teacher surveys and behaviour observations were repeated. Follow-up measures were used to determine if measurable improvements were evident in visual function, ocular health, the level of unmet need and classroom behaviour following implementation of in-school eyecare.Results199 participants completed baseline and follow-up measures. 122 (61%) participants presented with at least one significant visual or ocular health deficit and 90 (45%) participants had at least one unmet visual need. Younger pupils and those with no previous history of eyecare were more likely to demonstrate unmet visual needs at baseline (OR 1.12 95% CI 1.03 to 1.21) p = 0.012; (OR 4.44 95% CI 1.38 to 14.29 p = 0.007 respectively). On followup, the number of pupils with unmet visual needs dropped significantly to 36 (18%) (McNemar's test p< 0.001). Visual and behavioural metrics of participants without significant visual deficits or whose visual needs were adequately addressed at baseline remained relatively unchanged between baseline and follow-up (Wilcoxon signed rank p> 0.05). Where significant refractive deficits were corrected at follow-up, near visual acuity improved significantly (Wilcoxon signed rank p = 0.013), however, poor spectacle compliance was a persistent cause of unmet visual need. Off-task behaviour reduced significantly after actions to address unmet visual needs were communicated to parents and teachers (Wilcoxon signed rank p = 0.035).ConclusionsThe present study demonstrates for the first time measurable visual and behaviour benefits to children in special education settings when they receive comprehensive in-school eye examinations, on-site spectacle dispensing and jargon-free reporting of outcomes to teachers and parents.