British Journal of Visual Impairment

This article presents the research and development that underpins the Curriculum Framework for Children and Young People with Vision Impairment (CFVI): a new unifying framework that outlines the breadth of support that should be received by children and young people with vision impairment (CYPVI) in the United Kingdom (UK). The study used the Delphi method as a systematic process of participatory consultation with key stakeholders. Three rounds of consultation took place with a panel of 48 participants including young people, parents, professionals, and professional training providers. This process resulted in the agreed 11 curriculum areas of the CFVI with high levels of agreement and satisfaction among participants. The development of the CFVI responds to established evidence of the distinctive challenges to learning associated with childhood vision impairment, and the importance of addressing these through targeted intervention approaches. Drawing on a dual model of access (‘access to learning’ and ‘learning to access’), the framework acknowledges that these approaches should promote inclusive education by balancing universal inclusive practice with specialist skills-based interventions. Such an approach captures ‘what matters’ to the field of vision impairment education – ensuring fair access to a shared curriculum and education system while developing the specialist skills to develop personal agency and increase independence. The article is original in reporting on the development of the first curriculum framework for CYPVI in the UK. The CFVI was launched in March 2022 and provides clarity about what should be taught, when, and by whom. The CFVI promises a transformative contribution to UK policies and practice in ensuring CYPVI and their families will more easily be able to navigate complex education systems and secure equitable access to the services to which they are entitled.

The presence of childhood vision impairment has cascading effects on educational provision and global development across cognitive, physical, and mental health domains. Effective, appropriate, and targeted support in education is legislated across the United Kingdom, influenced by the ‘access to learning, learning to access’ model. Despite reasonable adjustment and specialist provision legislature, anecdotal parental reports suggest inconsistent and insufficient provision culminating in poor physical and mental health outcomes for school-aged children and young people with vision impairment in the United Kingdom. This pilot study aimed to evaluate the perceived effectiveness of provisional arrangement/specialist support from a parental viewpoint. We examined the questionnaire responses of parents/caregivers of children and young people with vision impairment to harness their views regarding provisional entitlement. An online questionnaire was developed in collaboration with parents/caregivers of children with vision impairment who identified a distinct need for research in this field. Forty-six parents/caregivers completed the questionnaire. Most parents reported their child accessing specialised provision; however, frequency of provision and qualification of staff administering provision was inconsistent. Parents reported that available provision more negatively impacted their child’s mental health, and resultingly, most parents lacked confidence in the arrangements their child received. We concluded that parental perception of provisional arrangements is seemingly influenced by the quality of the team supporting their child in educational domains. Future work triangulating parental views with that of the children receiving the support, and support staff, is needed for corroboration.

Despite recent emphasis within the literature on developing personal agency of learners with vision impairment through specialist educational provision to enable them to have control over their own life as independent and active individuals, little attention seems to be given to investigating how learners with vision impairment promote their independence skills in schools in Turkey. This study examined the views of 12 young people with vision impairment (aged between 16 and 19) studying at upper-level secondary schools through semi-structured interviews to gain an insight into how young people with vision impairment perceive enablers and barriers to their independence prior to starting higher education in Turkey. Interpretative phenomenological analysis revealed the following four superordinate themes relating to young people’s perceptions on internal and external factors affecting their independence and readiness for higher education: (1) personal characteristics (i.e., maturity, level of vision), (2) parental factors (i.e., feeling dependent to parents, parental attitudes), (3) educational support (i.e., access to curriculum, independent living skills training), and (4) people’s attitudes (i.e., low expectation, limited knowledge). Demonstrating the views of young people with vision impairment, this article has significance for inclusive educational practice and policy in Turkey since it provides evidence for professionals in considering how they may well provide educational support in order for young people with vision impairment to develop their personal agency. This article also offers valuable insights to previous research in different national contexts as it presents distinctive insights into how young people with vision impairment in Turkey identify the factors that enable or hinder their independence and participation.

Cerebral visual impairment (CVI) is one of the most common causes of visual impairment in children. CVI is a complex visual disorder to understand and explain to others. Understanding one’s diagnosis and being able to explain it to others may facilitate adaptive functioning. To educate children and young people on their CVI and accompanying needs, the computerized psycho-educational programme ‘My CVI’ has been developed.

A mixed-methods study was conducted to evaluate the effect of this programme. The aims of the programme are to increase participants’ knowledge of CVI, as well as self-esteem (SDQ), adaptive coping (SCQ), and well-being (Cantril, PERIK, HRQoL). Thirty-nine children (aged 7–16 years; 51% boys) participated in a pre-test, post-test, and follow-up assessment. Qualitative interviews were conducted for a subjective evaluation of the programme.

Participation in the psycho-educational programme resulted in increased knowledge of CVI, as well as a better teacher-reported social and academic self-concept and less self-reported feelings of social exclusion. No effects of participation were found on self-reported self-esteem, coping or other measures for well-being. An increase in knowledge of CVI was not associated with changes in psychosocial functioning. Qualitative data revealed that children enjoyed participating in the programme; they learned there are others with CVI, and gained more knowledge and practical tools on how to deal with their CVI.

The results provide preliminary evidence that participation in the psycho-educational programme ‘My CVI’ increases children’s knowledge of their visual impairment as well as improves social outcomes and feelings of inclusion. The highest gains may be achieved through a personalized approach, depending on a child’s (developmental) age and parental involvement.

This study aims to comprehend nuances of gender barriers to access cataract surgery in the rural population of Gurugram district, Haryana, India. Data from 100 male and 100 female cataract surgery patients who underwent surgery at the university-affiliated hospital’s department of ophthalmology were examined. Data on the patients’ ages, the better eye’s and operated eye’s visual acuity, the cataract’s maturity at the time of surgery and the type of cataract surgery chosen were examined. Visual impairment was defined when the better eye’s visual acuity was less than 6/18 (0.32). At the time of surgery, women had a serious visual impairment in the better eye and also opted for a less expensive surgery option. In-depth interviews and focus group discussions were planned to understand the attitude, social norms and nuances of women’s accessibility to cataract surgery. This essay includes a qualitative investigation on access restrictions based on gender.

Public transport is a viable option that can help persons with visual disability to overcome mobility challenges. The main aim of the review is to identify existing provisions, barriers, and/or access to public transport services for persons with visual disability. A scoping review was conducted based on the framework proposed by Arskey and O’Malley. A total of 16 studies were systematically selected out of 273 published literatures which was obtained from electronic database searches. Four themes emerged from the selected studies. The major theme was challenges related to accessing public transport from the perspective of persons with visual disability (PVD) with presentation of information, drivers/workers attitude, bus design, technological barriers, and accessibility of public spaces being the subthemes. The other three themes were the challenges reported by the transport drivers, available facilities/adaptations and resolutions, and policies and recommendations. In conclusion, the current review suggests that access to public transportation for persons with visual disability is considerably inadequate. Poor presentation of information, inappropriate driver attitude, and inconsistent bus design seem to be the major barriers persons with visual disability encounter during public transport travel.

Navigating indoor spaces is especially challenging for individuals with blindness and visual impairments. Although many solutions currently exist, the acceptance of most of them is extremely poor due to their technical limitations and the complete lack of taking into consideration factors, such as usability and the perceived experience among others, which influence adoption rates. To alleviate this problem, we created BlindMuseumTourer, a state-of-the-art indoor navigation smartphone application that tracks and navigates the user inside the spaces of a museum. At the same time, it provides services for narration and description of the exhibits. The proposed system consists of an Android application that leverages the sensors found on smartphones and utilizes a novel pedestrian dead reckoning (PDR) mechanism that optionally takes input from the Bluetooth low energy (BLE) beacons specially mounted on the exhibits. This article presents the extended Usability and User Experience evaluation of BlindMuseumTourer and the findings carried out with 30 participants having varying degrees of blindness. Throughout this process, we received feedback for improving both the available functionality and the specialized user-centred training sessions in which blind users are first exposed to our application’s functionality. The methodology of this evaluation employs standardized questionnaires and semi-structured interviews, and the results indicate an overall positive attitude from the users. In the future, we intend to extend the number and type of indoor spaces supported by our application.

Inclusive education strives to support all students, regardless of their differences, so no child is left behind. However, some teachers, especially those in high schools, may oppose inclusive education. This study aimed to examine the experiences and actions of high school mathematics teachers as they taught students with visual impairments to understand the challenges they faced and how these affected their willingness to embrace the inclusion of these students. Researchers conducted semi-structured interviews with eight mathematics teachers experienced in teaching students with visual impairments. The findings were organized into five themes: mathematics teaching practices, curriculum, material preparation, assessment practices, and beliefs about inclusive education and students with visual impairments. The results revealed that while mathematics teachers were conscious of not being adequately equipped to implement inclusive education, those with strong teaching efficacy beliefs were more inclined to teach rigorous mathematics to students with visual impairments.

With vision being our most powerful sense and cerebral vision impairment (CVI) being a growing concern in our special schools, it is crucial that support staff working with children have a thorough understanding of both CVI and how to support their individual levels of functional vision. Creating an inspiring new innovation to support learners with profound and multiple learning difficulties (PMLD) was the focus of this research. Using an approach provided by the Education Endowment Foundation, questionnaires were given to all 49 support staff; training via PowerPoint was then provided to volunteer participants who also spent time using the innovation in the classroom. The main findings were that the training increased participants’ overall confidence in CVI and how to support learners with a visual impairment. Using the innovation in the classroom also positively impacted the participants’ daily practice. Potential challenges such as ensuring staff all have a thorough understanding of the innovation and having a suitable learning environment for visual work were identified.

Assistive technology (AT) devices are designed to help people with visual impairments (PVIs) perform activities that would otherwise be difficult or impossible. Devices specifically designed to assist PVIs by attempting to restore sight or substitute it for another sense have a very low uptake rate. This study, conducted in England, aimed to investigate why this is the case by assessing accessibility to knowledge, awareness, and satisfaction with AT in general and with sensory restoration and substitution devices in particular. From a sample of 25 PVIs, ranging from 21 to 68 years old, results showed that participants knew where to find AT information; however, health care providers were not the main source of this information. Participants reported good awareness of different ATs, and of technologies they would not use, but reported poor awareness of specific sensory substitution and restoration devices. Only three participants reported using AT, each with different devices and varying levels of satisfaction. The results from this study suggest a possible breakdown in communication between health care providers and PVIs, and dissociation between reported AT awareness and reported access to AT information. Moreover, awareness of sensory restoration and substitution devices is poor, which may explain the limited use of such technology.

Mathematics training is a challenge for students with visual impairments (VI). However, there are few protocols to assess math skills for them, especially the content related to counting and measurement. The objective of this article was to develop and test the applicability of a protocol to assess math skills in counting and measuring for children and adolescents with VI. The work was organized into two studies. The first dealt with the development of a protocol for assessing pre-arithmetic skills and knowledge and the second study assessed its applicability. In the first study, the protocol was developed from the few papers found on a literature review. In the second study, the protocol was applied to 12 participants with VI aged 5 and 16 years. The results showed that 8 of the 12 participants had performance ranging from 83% to 100% of correct responses in the protocol application, both for counting and measuring skills. The protocol applicability and difference in participants’ performance are discussed. The study concludes that the protocol can be used as a tool to assess math knowledge for children at the end of Early Childhood Education or at the beginning of Elementary School, with or without VI.

The purpose of this study was to explore the availability, awareness, and utilization of assistive technologies among students with visual impairment (SVIs) in higher education institutions in Ethiopia by taking one of the oldest universities in the country as a case. To this end, the study employed instrumental case study design. Five undergraduate SVIs, two special needs educators, an AT service-delivery facilitator, and the resource center coordinator were purposively selected from Haramaya University. Data were collected using semi-structured interviews and an observation checklist. The collected data were analyzed by using thematic analysis method and three overarching themes were generated inductively: knowledge and understanding about assistive technologies, availability and access to assistive technology devices and services, and utilization and management of assistive technologies. The study findings show that a lack of awareness among SVIs, instructors, and practitioners in the field; an improper organizational arrangement that dichotomize and diverge student disability services provision from trained professionals in the area; and the absence of policies and guidelines for managing assistive technologies had a negative impact on the availability and utilization of assistive technologies in the University. Thus, it is recommend that the University management, special needs educators, and other concerned stakeholders devise a means to equitably avail assistive technology devices and services for SVIs in the University accompanied by a planned training on its utilization and a coordinated management for sustainability of service delivery.

This is a qualitative study that gives voice to 33 siblings of children with visual impairment in care at the Robert Hollman Foundation, focusing on their relationships with their brothers/sisters. Participants aged 7 to 22 recounted their daily life experiences and perspectives, expressing their feelings during semi-structured individual interviews. Data were analyzed according to the thematic analysis in the conceptual framework of ‘the new sociology of childhood’. The vast majority of siblings showed a special relationship with their brother/sister, characterized by unconditional love and willingness to help. Different emotions, such as happiness, empathy, sorrow and sadness, were expressed as well as how the experience of being siblings of children with visual impairment shapes their attitudes, highlighting a number of needs in some of the subjects.

Vision impairment could have debilitating effects on patients’ mental, physical, and emotional health. Our study aims to understand the role of meditation and breathing exercises in the management of vision loss and its effects on patient’s disease progression. This study is designed as a systematic review and meta-analysis. Eligible studies were retrieved from MEDLINE, EMBASE, and CINAHL databases and gray literature. Covidence software was used to conduct the systematic review. Duplicate records were removed, and two independent reviewers screened records for relevance. After the screening, a risk-of-bias assessment was carried out. Data were extracted, and a meta-analysis was performed using STATA 14.0. Fixed-effect and random-effect models were computed based on heterogeneity. Our results indicate that meditation and breathing exercises significantly reduce intraocular pressure (IOP) (ES = −1.76, 95% CI = [−2.69, −0.83]) in glaucoma patients, mean deviation of Humphrey visual field testing (ES = −0.20, 95% CI = [−0.37, −0.03]), and biomarkers such as cortisol (ES = −0.73, 95% CI = [−0.25, −2.22]) and reactive oxygen species (ES = −2.45, 95% CI = [−4.20, −0.71]). In addition, our results demonstrated significant increases in beta-endorphins (ES = 28.60, 95% CI = [25.61, 31.59]) following breathing and meditation exercises. Furthermore, our study demonstrated that these exercises were associated with non-significant decreases in inflammatory markers, such as interleukin-6 levels (ES = −1.25, 95% CI = [−2.75, −0.24]), retinal nerve layer fiber thickness (ES = −0.20, 95% CI = [−0.53, −0.14]), and non-significant increase in brain-derived neurotrophic factor (ES = 28.24, 95% CI = [−25.24, 81.71]). Our systematic review also found improvements in quality of life, physical fitness, and mood for vision loss patients. Meditation and breathing exercises offer a range of benefits to patients with vision loss, including improvements in IOP, biomarkers, quality of life, physical fitness, and mood. Further research is needed to better understand the mechanisms underlying their effects and the means to apply them in practice.

Children and adolescents with a functional neurological disorder (such as functional visual disorder [FVD]) experience a lower psychological quality of life with more mental health problems than healthy controls. While there is ample research about functional neurological disorder in general, there is also a general lack of research concerning FVD and the effectiveness of treatments given to children and adolescents suffering from it. Our aim was to provide a visual overview of common topics concerning treatments of children and adolescents with an FVD. VOSviewer is a programme that extracts information (terms) from the titles and abstracts of articles to generate bibliometric networks. The results show that common subject terms are paediatrics and children. The common diagnostic terms include conversion disorder, hysterical vision disturbance, somatoform disorders, hysterical disorders, and functional (psychogenic) visual loss. Common therapeutic terms are suggestion therapy, brief psychotherapy, hypnosis, psychiatry, therapeutic processes, and suggestibility. The results give insight into the treatments that children and adolescents with FVD currently receive. We also provide directions for future studies into the treatment of FVD in children and adolescents.

Camp Abilities (CA) is an educational summer camp for children and youth with visual impairment (VI), developed in 1996 by Dr Lauren Lieberman at The State University of New York at Brockport and implemented internationally. The uniqueness of the program is that it provides opportunities for sports exposure and motor development, teaching physical education (PE) and adapted physical education (APE) for undergraduate and graduate students and research. CA has contributed to numerous publications but, to date, no systematic review has been published. Therefore, the aim of this study was to conduct a systematic review of quantitative studies conducted in CA, to document the themes investigated, to analyze the characteristics of the studies and the effects of interventions delivered, and to synthesize the results. This process identified 24 articles that examined 11 research themes. It identified several key findings, research gaps to guide future research, as well as practical implications for practitioners.

Cerebral visual impairment (CVI) is the most common cause of visual impairment in children in the United Kingdom. The mainstay of management is providing strategies and environment adaptations to allow the child to use their vision for learning and independence. It is therefore important to understand educational access policies to facilitate timely and appropriate referral to qualified teachers for learners with visual impairment (QTVI) by ophthalmologists. QTVIs were recruited from VIEW (Visual Impairment England and Wales) and the Scottish Sensory Centre (QTVI organisations) via email, newsletter and social media. Respondents were directed to an online electronic questionnaire. 116 responses were received; this represents around 18% response rate. All services accepted referrals for children with cerebral visual impairment (CVI). The majority of services (97%) did not have a strict visual acuity threshold for children with CVI. There is an inconsistent approach in the diagnosis of CVI across the United Kingdom, with some QTVI expressing concern that this had prevented children with visual dysfunction from accessing help. QTVI indicated they would welcome more referrals for Cerebral VI, at an earlier age, and that a formalised referral pathway would be beneficial. Children with CVI are accepted for support by QTVI/sensory services regardless of visual acuity. Some services welcomed referrals for children undergoing assessment where CVI had yet to be confirmed. However, the formal diagnosis of CVI by an ophthalmologist as a pre-requisite to access services in other areas emphasises the need to improve clinicians’ confidence in the diagnosis of CVI. Ophthalmologists are encouraged to engage with local QTVI/sensory teams to facilitate exchange of information and appropriate and timely referral of children in need.

Paediatric vision impairment is a significant public health issue because of the associated health and economic consequences. This study aimed to determine the clinical characteristics and causes of vision impairment in paediatric patients who presented to a university-based low vision eye clinic in KwaZulu-Natal. The study used a retrospective design and included all paediatric patients with vision impairment who were younger than 18 years and presented to the university-based low vision eye clinic between January 2015 and December 2019. The sample consisted of 156 children with vision impairment with a similar proportion of males (n = 82) and females (n = 74). The mean age of the children was 13.5 ± 2.8 years, with a range of 5–17 years. Based on the best-corrected visual acuity (VA), most of the children (n = 111) had moderate vision impairment (VA worse than 6/18 to 6/60). The most common causes of paediatric vision impairment included albinism (n = 54), refractive error (n = 11), cataract (n = 10), and glaucoma (n = 10). The retina (n = 74) and normal globe (n = 26) were the most affected anatomical sites. Spectacles were prescribed to almost half of the sample (n = 76). A total of 126 optical and non-optical devices were recommended with telescopes (n = 43) and sun-protective measures (n = 20) being the most common. Paediatric vision impairment can have a negative impact on the quality of life. Local data related to the characteristics of children with vision impairment can be used to enhance the services provided in this university-based low vision clinic. This is important as efforts aimed at early identification, management, and rehabilitation will help minimise functional limitations and improve the quality of life of affected children.

Illustrations referring to the visible aspects of objects in tactile books may be difficult for children with visual impairments to understand. To solve this problem, a new illustration design was developed based on modalities other than vision. The objective of the study is to evaluate the comprehension by children with visual impairments of a multimodal book whose illustrations refer to haptic and audio modalities. To examine the role of residual visual experience in comprehension, the book was tested in children with two profiles of visual impairment: 5 blind children and 6 with low vision, aged 5–12 years. To assess their comprehension as they discovered the book, we observed a matching between the text and the exploration of the illustrations, and the production of expected manual explorations by children. After discovery, we asked the children about how they handled the objects in the book and the sounds they heard. The main results showed no significant difference between the two groups of children on the matching score, manual exploration expected, and description of sounds perceived or handling performed. The book was very well understood and appreciated by both groups. These results could indicate that residual visual experience is not necessary for this task. Results suggest that exploring other sensorial experiences could be a more inclusive way to represent objects in tactile books that are more suitable for all children, regardless of their visual experience.

The objective of this study is to identify the impact of a training program in Reading and Writing Braille symbols in English language for students with visual disability in the elementary stage in Jordan. Participants are 60 students with visual disability, from Grades 1–6, studying at the blind school in Abdoun. Members were divided into two groups: control and experimental. In order to evaluate the efficacy of the training program, the researcher developed a scale to measure pre- and post-ability to read and write Braille symbols in English language. Means and standard deviations were calculated for both groups. Analysis was carried out using two-way analysis of variance. The results indicate statistically significant differences on reading and writing dimensions and on the total score, as well as on the post training results in favor of the experimental group indicating significant impact of the training program. The results did not show any significant differences between blind and partial visual disability in the experimental group on reading and writing scores and on the total score. Findings demonstrated the efficacy of the training program, which introduced reading and writing in a simple and interesting way according to certain levels ranging in difficulty, in addition to using different forms of reinforcement to motivate students. As for the implications for practitioners, teachers in inclusive schools of schools of visually disabled students can use the training program to teach both blind and partially sighted students reading and writing English Braille using both the hands.