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School-age children with low vision: A multi-disciplinary approach and family reaction toward inclusion

School Years: Low Vision

Marcos Wilson Sampaio, Maria Aparecida Onuki Haddad, Newton Kara-José

Marcos Wilson Sampaio MD

Low Vision Service Coordinator

Department of Ophthalmology

University of São Paulo Clinical Hospital

São Paulo – SP

R. Luis Coelho 308/15  - 01309-000




Brazil has a population of 170.000.000, and over 200.000 public schools( basic education). Visually impaired students are reported in 3300 schools and number about 18000. The majority (70%) are considered blind and no data is available about ther actual visual status.

Every year circa 8.000.000 children are admitted to the public education system and there exist only a few units with capability to deal with students with special needs, particularly those visually impaired. There is a lack of information about the problem among  teachers and  those with some training in low vision are scarce.

With "The Eye in the Eye" Program of The Ministry of Education and the Brazilian Council of Ophthalmologists, now in its fourth year, every child in cities  with over 40.000 people is screeened for visual acuity. When necessary, they are referred to ophthalmic medical evaluation and receive a prescription and the glasses. Those with low vision need further specialized attention, but this is not available in many Brazilian states.

To deal with this problem, the Special Education Branch of the Ministry of Education, The University of São Paulo, the University of Campinas and its Rehabilitation Centre (CEPRE), and The Laramara and The Dorina Nowill Foundations made a partnership. Two Low Vision  Training Programs with 40 hours (5 days)  each were developped and implemented during 2001 at the University of São Paulo.

The first one was for ophthalmologists and attended by at least two from each state of Brazil selected among those with some link with the local educational system. The other was dedicated to teachers, also at least two from each state, that actually already deal with the children but lacked adequate training or exchange of experiences. A three day meeting by the end of the year integrated the two groups of professionals. They are expected to work together in the Special Education Centres throughout the country, at least one in each state, built and equipped by the public system. The Government also intends to provide every child with low vision with the optical devices prescribed as well as the educational material and assistance.

At the University of São Paulo Low Vision Service we provide Ophthalmic care and assistance to 322 children aged 0 to 16 years (mean 7,1 years). Of them, 49,4% are enrolled in public schools and  34,1% present moderate low vision and 25,5% have severe low vison. Congenital glaucoma (29,3%), toxoplasmic macular retinochoroiditis(15,8%), congenital cataracts(13,9%) and optic atrophy(10,5%) are the main causes of visual impairment. Optical devices were prescribed for 29,8% of the children. Telescopes were prescribed in 26,7% and near vision aids in 11,2% of the cases.

The unit has two Opthalmologists, a Psychologist, two Teachers, a Physiotherapist and a Mobility professional. It provides training for residents and fellows of the Ophthalmology Department

Each child receives a complete ophthalmic evaluation and if aged between 0-3 years passes through a functional evaluation and the family is oriented. Those aged 4-16 years receive the attention of a teacher that contacts the school and the class teacher as well as provides the necessary information to the family. Each child is evaluated at least twice a year. Every six months the unit promotes two meetings. One  is with the teachers from the schools attended by the children to provide information and the exchange of ideas on how to integrate them on their local environment and reality. The other is with the families, the children and the staff altogether. We are in the process of evaluating the impact of these actions.

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