18 June 2026
Providing eye care to children with learning disabilities and autism is “a whole different ball game to what you learnt at university,” eye care practitioners were told at 100% Optical 2026 (28 February–2 March), Excel London.
SeeAbility’s clinical lead optometrist, Malvi Patel, spoke alongside the charity’s senior dispensing optician and dispensing team lead, Martyn Howlett, on the final day of the optical trade show.
SeeAbility’s discussion workshop focused on what practitioners should be aware of when providing eye care and dispensing spectacles in the special school environment.
Howlett set the scene, by explaining to attendees that children with learning disabilities are 28 times more likely to need eye care than their peers.
The Special Schools Eye Care Service, which SeeAbility facilitates in more than 50 schools across London, started as a research project before being rolled out more widely in 2013, Patel noted.
“This training means we can have a collaborative approach to developing skills and strategies, developing a series of clinicians [to provide] specialist eye care,” Patel said.
The course is available through City St George’s, University of London, with the next round of applications due to open in July 2026 for September entry.
Patel explained that the About me and my eyes form, which children and their families can fill in before visits, can give practitioners extra information so that they can prepare for specific scenarios ahead of time.
Attendees also heard from Lance Campbell, who has benefited from the Special Schools Eye Care Service but had never had a sight test before SeeAbility visited his school.
The Special Schools Eye Care Service is a different way to provide care to those like him, Campbell said.
Adapting clinical practise
Sight tests in special schools will often mean limited engagement and the need to get as much information as possible ahead of time, Patel reiterated.
She noted that many of those undergoing eye examinations in special schools are likely to be non-verbal.
The About me and my eyes form can let practitioners know about how patients are likely to communicate, any accessibility devices that they use, their common gestures, and whether they use Makaton, she said.
Patel emphasised: “Just because they don’t speak, doesn’t mean they don’t understand.”
Patients might require a pre-test visual assessment, she said.
Patel also noted that practitioners should take care to present defined choices during the sight test, so it is clear what is being asked.
Practitioners should always address the child or young person, even if they are non-verbal, rather than a parent, carer or teacher, she added.
She told attendees: “If something isn’t working, move on. This is really important with this cohort of children or young people. Often, you won’t be able to get every single test done.”
Trying persistently without success is likely to mean the child gets bored or fed-up, and in that case the test will be over, Patel advised.
She emphasised: “Try something a couple of times, and if it doesn’t work, it’s fine – move on.”
Afterwards, practitioners should make a clear record of everything they have attempted, and should make their notes as robust as possible, Patel said.
She also noted that, in her experience, many children in special schools cannot use letters – but that this does not have to hinder the eye examination, because there is a range of different visual acuity tests available.
It is important at all times to have “a child-centred approach” during the visit, Patel added.
Successful dispensing in the special school setting
Howlett told attendees that a child’s eye and head movement control should impact the kind of lenses that might be suitable for them.
He encouraged attendees to get in touch with SeeAbility for resources and guidance if they are interested in providing eye care in special schools.
“We can’t teach you all the tricks today,” he said.
Howlett added that getting to the point that the dispensing optician feels like they have provided the right solution might feel like a “marathon.”
In terms of teaches, he noted the importance of explaining to the patient exactly what the spectacles are for, in order to get the test “off on the right footing.”
He also emphasised the importance of knowing the usual distance that the child works at.
Adaptation might be slower with high prescriptions, so it is important to show patience and encouragement, Howlett said.
After a dispense, he advised booking a check-in for eight weeks’ time.
The worst-case scenario would be to see a child in six months’ time and find that they have pristine glasses that are still in the case, Howlett said.
“It doesn’t matter if the child or the young person is non-verbal,” he emphasised: “Everybody has a right to that sight test, and there are many, many ways we can overcome that. Prescribing objectively is what we do.”
Two case studies were then considered by attendees, as part of the discussion workshop.
In the first, a discussion over a 12-year-old patient with Down syndrome considered potential reasons for poor reading ability, the procedure for dynamic retinoscopy, and whether bifocals or multifocals would be the most appropriate dispense in this scenario. The advantages and disadvantages of cycloplegia were also discussed.
The second case study considered a 17-year-old, who had not had a sight test for 10 years, had not liked the glasses prescribed at his last test, and was stimming due to his autism. The patient did not make eye contact, was anxious, and refused to come into the testing room, attendees heard.
Practitioners discussed what might need to be asked about the patient’s visual function, other adaptations to his usual routine, how to assess his refractive state, and ultimately what to prescribe.
“With the children that we’re seeing, so much else is going on, eye care can be at the bottom of that list,” Howlett acknowledged.
But he emphasised: “Together, we can change that narrative. This can be an amazing game-changer for these children and young people.”
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