加強為特殊學校學生檢查視力的服務
你或親人有多久未曾檢查視力？單單在眼鏡店配眼鏡時所作的檢查是否足夠？是否足以及早發現眼病或視覺問題？
早前香港有智障青年因驗眼不合作而停止驗眼，結果由於視網膜脫落未有適時接受治療而最終失明，家長後悔不已。其實不單止智障，其他如肢體障礙的學生也需要定期驗眼，識別潛在問題、提供治療或配戴眼鏡。
英國與香港情況相似，一向有為學童提供定期牙科檢查，但卻未有提供定期的詳細視力檢查，尤其特殊學校學生。英國視障服務機構RNIB曾於2005年發表在蘇格蘭的調查，報告指出：學習障礙 (learning disability)者的視覺問題被忽略，當中三分一有視覺問題！(見下圖)
RNIB在英國威爾斯區亦曾進行調查，2012年發表的報告(原文見下面[參考資料])指出問題十分嚴重：
- 社會忽視為特殊學校學生檢查視力；
- 超過三分一的學生從沒有驗眼、只有6%在其個人特殊需要報告中列明視覺問題是主要或次要的需要；
- 五分一的學生的視障情況可能影響他們的教育；
- 超過一半學生需要驗配眼鏡，但只有三成學生曾有驗配眼鏡；有些沒有眼鏡的學生有高度遠視或高度近視；
- 最少五分一低視力(low vision)學生如果有戴眼鏡，可以有正常視力。
香港恐怕未有進行過同類調查，但情況估計與英國不相伯仲，上述英國的數字值得香港參考。
事實上，香港已有數間特殊學校，包括嚴重智障學校、肢體傷殘兒童學校、視障兼智障兒童學校，均曾自行安排視光師到校為學童檢查或篩查，始發現很多學生需要配戴眼鏡或有視覺問題需要跟進，但過往被忽略，以致影響學生的學習能力及生活質素、人際溝通、甚至語言發展、肌能發展、情緒行為等。因此視覺及視力問題，不單止看不清楚而已，其實對學生各方面的成長及情緒行為等表現，也有深遠影響，不容忽視。
其實肢體障礙學生不少有斜視，容易引致弱視眼。屈光問題(近視、遠視、散光)在特殊需要學生也容易被忽略，可能被其他問題蓋過，例如手腳活動能力、言語表達、情緒問題等。
然而部分智障學生因為較難適應陌生環境，或不理解檢查過程，或表現不合作等，令家長難以帶他們到診所或眼鏡店接受檢查，因此英國報告建議在校內進行檢查，令學生在熟悉的環境下，以及老師、家長的陪同下，可以較順利進行檢查。
當然，若果教師及家長事前與學生模擬練習檢查過程，也有助學生明白回應的要求，例如定睛、分辨形狀與執拾小白波。富經驗的視光師，亦會調整過程及運用較合適的工具去進行視力測試，例如要求學生執拾小白波，而非一般兒童所用的數字、E字方向等，令智障學生更容易明白回應的要求，以反映其真正視力。
報告並詳列多項建議，值得香港借鏡：
- 為特殊學校學生提供視光學檢查服務；
- 為學生提供適應訓練，令學生更熟習在社區設施接受視光學檢查；
- 每間特殊學校安排一間房間，以便檢查在校內進行；
- 視光師接受相關培訓，能夠為有學習障礙者進行檢查，以及在特殊學校提供服務；
- 視光師有眼科服務助手協助，視光師與學校護士協作；
- 索取家長同意書及向家長查詢過往病歷或情況；
- 提供眼科醫療劵；
- 中央行政組統籌服務；
- 向家長提供報告及轉介服務。
結論
特殊學校學生或智障人士的視力檢查，有賴各方面配合。希望政府衛生署、視障服務機構、視光學培訓機構、特殊學校等，能多做一點，尋找資源、加強培訓及改善相關服務機制。
參考資料：
“...RNIB Cymru has launched a report on the impact of the eye clinic liaison officer (ECLO) service in Wales.
In the last year alone, the service supported 6,730 patients in a variety of ways: everything from providing information on the patient's eye condition through to referral to specialist services such as RNIB Cymru's welfare rights service, employment service, and education and transitions services for children and young people...”
‘A clear vision: Eye care for children and young people in special schools in Wales, February 2012’
(http://www.rnib.org.uk/sites/default/files/A_clear_vision_English.pdf)Executive Summary:
“This report shows that as a society we are neglecting the eye care of pupils in special schools. The National Service Framework specifies that children and young people with disabilities need early diagnosis or identification of difficulties and early intervention (WAG 2005). Community dentists visit special schools to assess pupils and provide treatment for any problems identified. There is no such provision for eye care…
The report’s key findings are:
Over one third of pupils have never had a sight test
Only 6 per cent of pupils have visual problems recorded in their Statement of Special Educational Need as a primary or secondary need. This project found that one in five pupils have a visual impairment that is likely to impact on their education.
Over 50 per cent of all pupils need spectacles, whereas only 30 per cent had previously had them prescribed. Some children without glasses have high levels of long or short sight.
The study suggests that at least one fifth of pupils with low vision could have normal vision with spectacles…
Recommendations:
- An optometric service should be provided to pupils in special schools
- A transitional service should be established to support pupils in special schools to become familiar with having sight tests in a community practice
- Every special school should have a room allocated and equipped for sight testing
- Optometrists accredited to provide one or more of the Welsh Eye Care Services should be offered training and accreditation to provide the service in special schools
- A short consent form should be sent to parents / guardians and followed by a phone call to collect relevant history and symptoms
- A trained optical assistant and/ or a dispensing optician should accompany the optometrist
- Pupils who have a sight test in the special school service should be issued with a General Ophthalmic Services (GOS) voucher
- Parents and pupils should be able to choose spectacle frames from a selection offered by the special school service or attend an optometry practice
- Optometrists testing in special schools should work in partnership with school nurses
- A central administration team should book appointments and order spectacles and equipment
- Copies of reports and referrals should be provided to parents and (with parental consent) others who support or care for the child
- The administration team, the clinical lead and Welsh Eye Care Services Board should be responsible for quality assuring the service….”
