Optometrists Rachel Hibbert and Faisal Jabbar describe the difference the Special Schools Eyecare Service has made to children and their families. The team has identified cases where a new pair of glasses or a simple visual aid completely changed a child’s ability to engage with learning, communicate, or move around safely.

The Special Schools Eyecare Service set out to address a critical gap in eyecare provision for children in Special Educational Settings (SES). The proof-of-concept (POC) work, which began in 2021, expanded on the work done by SeeAbility in schools in London, and the supporting research into visual and ocular issues for children with special needs

The POC started gradually and was first introduced in other areas before being introduced in the North East and Yorkshire region. The aim of the new service was to bring accessible eyecare to children, in a place where they are already likely to feel comfortable, and to assess the impact this had.

“Going to hospital or going to the opticians can be really stressful for these children and their families. Sometimes they’ve been before, but they’ve just not been able to achieve anything because fear has been such a big factor.

“The idea of taking it to them in an environment that the majority of them are comfortable and happy with and they know the staff has been a gamechanger.”

Rachel Hibbert, Optometrist Director, delivering the NHS Special School Eye Care Service in South Yorkshire

SEN children are 28 times more likely to have ocular issues than their mainstream peers, but much less likely to access eyecare due to a myriad of factors.

Many of these children face complex needs and are often unable to access community optometry services in the traditional way. By bringing the service directly into schools, the majority of these barriers are removed, ensuring children receive the same high standard of care as those routinely accessing community optometry services.

One of the optometrist directors delivering the NHS Special School Eye Care Service in South Yorkshire, Rachel Hibbert, explains. ”Going to hospital or going to the opticians can be really stressful for these children and their families. Sometimes they’ve been before, but they’ve just not been able to achieve anything because fear has been such a big factor.

The idea of taking it to them in an environment that the majority of them are comfortable and happy with and they know the staff has been a gamechanger.”

“We try to make it as pleasant an experience as possible for the children. You have to think on your feet. We go in with all our skills but can’t always use them with each and every child. It can be beneficial to go in really quickly and do what you can, before they lose interest.

“Or with some children, it’s better to get toys out first and get them to calm down and feel more comfortable with you before you can achieve anything. It’s very much an individual needs-in-the-moment based eye test and you have to be spontaneous. We often build up a fuller picture of the child’s visual world over several sessions.”

“One of the most memorable cases was actually the very first child I saw in the school…As soon as we provided the correct glasses, the transformation was immediate. The child lifted their head, sat upright, and you could just see the difference in their posture and confidence. I’ll never forget the smile on their face — a genuine “wow” moment for both of us.”

Faisal Jabbar, Optometrist Director, delivering the NHS Special School Eye Care Service in West Yorkshire

Making a difference to children’s lives

The service deals with a wide age range within primary and secondary educational settings. The youngest children are just 3 years old and it ranges all the way to 18 years of age. The staff in the schools and the children and families involved have, in the vast majority, been extremely positive about the service. Many have said it’s made a genuine difference to the child’s day-to-day quality of life.

One of the optometrist directors delivering the NHS Special School Eye Care Service in West Yorkshire, Faisal Jabbar, explains:

“What’s really driven the success is the collaborative environment. Teachers are often present during assessments, and their input is invaluable — they can highlight visual behaviours or difficulties that help shape the clinical decision-making.

“This two-way communication also means we can advise on how to tailor a child’s Education, Health and Care Plan based on their visual needs, ensuring more meaningful outcomes that support both learning and development.”

The schools have reported a noticeable improvement in the work and attention of many pupils with newly prescribed glasses, and families and carers really appreciate that the service is delivered in school time, so it is one less appointment for them to arrange for their child.

Many of the children had previously undiagnosed visual problems — some had never had an eye test before. The team has identified cases where a new pair of glasses or a simple visual aid completely changed a child’s ability to engage with learning, communicate, or move around safely.

They have also been able to help countless children who weren’t wearing their glasses due to poorly fitting or inappropriate frames and have been able to refit and monitor how wear is going when we are in school.

Rachel adds: “This type of tailored approach is possible when we are in the same school week after week, and just wouldn’t be workable in other settings.

“Sometimes we’re helping people who already have glasses, but perhaps the glasses are not the best for them in terms of the fit or the size or the condition isn’t great.

“These children frequently have atypical facial characteristics. They can also have helmets, hearing aids and wheelchair headrests, all of which impact the choice of the most suitable frame.”

Faisal continues: “It’s not just about correcting vision – it’s about unlocking potential, improving confidence, and supporting developmental and educational progress.

“One of the most memorable cases was actually the very first child I saw in the school. They were experiencing regular eye strain and headaches and had a noticeably poor head posture — always dipping their head down when working. On examination, I discovered they had high astigmatism, which was causing significant visual discomfort and the need to tilt their head constantly to try to see clearly.

“As soon as we provided the correct glasses, the transformation was immediate. The child lifted their head, sat upright, and you could just see the difference in their posture and confidence. I’ll never forget the smile on their face — a genuine “wow” moment for both of us. That experience was when I realised just how much of an impact this service could have on a child’s life, and it reinforced my commitment to delivering high-quality, consistent care for every child we see.”

Another case Faisal recalls involved a non-verbal child with complex learning needs who had been struggling with mobility and concentration. The team discovered a significant refractive error and provided tailored spectacles. The change was just as immediate — improved confidence, greater classroom engagement, and increased independence.

The team also encountered a child who had been misdiagnosed with behavioural issues, when in fact they were dealing with severe visual discomfort due to convergence problems. Once the correct visual support strategies were in place, their behaviour improved dramatically.

These cases highlight that when vision is properly addressed, everything else around the child — learning, development, behaviour, wellbeing — can improve too. Rachael also has a backlist of cases where the work of the optometrists has transformed young lives.

She recalls:

“We saw a child who was highly myopic but couldn’t tolerate their full prescription and their family did not believe that glasses were actually required. As a result, when we met them, glasses weren’t being worn at all and they had extremely poor vision. We were able to gradually step up the strength in the glasses allowing the child to adapt to each stage. They are now in their full amount and happily wearing them and enjoying much better vision.

“We also prescribed glasses to a child with Cerebral Palsy, whose vision had pretty much been written off due to their Cortical Visual Impairment diagnosis. Though the overall vision level would still be considered low, the right glasses have made a huge difference to their visual world”

Getting sighted on delivery

“A key part of the role is working closely with teachers and parents — explaining the child’s visual strengths and limitations, offering practical suggestions, and identifying classroom adaptations that can help the child thrive.”

Faisal Jabbar, Optometrist Director, delivering the NHS Special School Eye Care Service in West Yorkshire

Good new services don’t happen overnight and it took the team delivering the proof of concept work just over three years to refine the approach and deliver the service to a high standard. The journey has been far from simple. Faisal explains:

“One of the biggest challenges was starting from scratch and facing the lack of integration between different parts of the system, such as hospitals, GPs, and community services. Navigating those boundaries while building the right clinical pathways and operational processes required a huge amount of time, persistence, and learning on the ground.”

Delivering high-quality care in this setting is particularly complex. Providers like Faisal and Rachel have worked hard to set a benchmark for the service in their areas.

Faisal explains: “what’s often unseen is the amount of behind-the-scenes work involved. It takes significant time, effort, and coordination to deliver a service that truly meets the needs of these children.”

Rachel continues: “We did our first clinic in February 22. It took us quite a while to do all the training and to get up and running and to get assessed to get the contract, etc but now we’ve been doing it just over three years and it’s been amazing, We’ve seen such huge improvements in the children we see in terms of how enhanced vision impacts their lives in the classroom. Staff have repeatedly reported an increase in engagement and concentration which is lovely to hear.

We also witness the developments ourselves when the kids come back to see us.
They’re so much more relaxed because we’re able to take time with them and we see them on a regular basis. Now we’re just like another friendly face in the school…they say hello, when are you seeing us next?”

Rachel and Faisal are also keen to emphasise the service isn’t just about testing eyes and prescribing glasses. Faisal outlines the teams’ role as a key liaison point as follows:

“A key part of the role is working closely with teachers and parents — explaining the child’s visual strengths and limitations, offering practical suggestions, and identifying classroom adaptations that can help the child thrive.”

After the assessment, time is needed to provide a clear and accessible eye health report, and to answer any questions that arise from it. There is also a level of ongoing ongoing engagement, without which the impact of the service would be severely diminished. Says Faisal:

“there’s the ongoing care — following up on broken or lost glasses, making sure the right frames are available and suitable for each child. You also need to assess whether children are adapting well to their glasses. Some may struggle or resist wearing them, so part of the job is helping teachers understand strategies to build up wear time gradually and effectively.

“It’s also taken months and months of going back and forth to build trust and rapport with some of the children — especially those with complex needs or communication challenges. That kind of relationship-building is crucial, and it takes consistency, patience, and time.

“Given the proven positive impact this service has had on children and families, and with the new service specification in place, we very much hope to continue this valuable work.”

Optometrists delivering the service in schools need to be able to react according to the particular needs of the individual in front of them, recognising that they probably won’t achieve everything in a single session, while still meeting professional obligations.

Rachel concludes:

“You have to be willing to be spontaneous, and open to learning every single day on the job. There was a lot of training and that gives a brilliant opportunity to upskill. You do need slightly different techniques when you’re doing this type of work. You need to be quite confident with a retinoscope. For me, dynamic retinoscopy has become an invaluable tool, which I feel I’ve become very experienced and confident in through working in this service, and which greatly influences my clinical decisions

“This type of work is challenging, but it is extremely valuable and definitely satisfying. It is an excellent specialist route and I hope the scheme continues to roll out in other areas.”

The special schools eye care service has been running as a proof-of-concept since May 2021 and is currently live in 28 schools across the NEY region. Given the overwhelming success of the work, on 19 June 2023 the Department of Health and Social Care (DHSC) and NHS England issued a joint statement to confirm that sight testing in special schools would be expanded into all special school settings from April 2024. A new service specification has been published to enable the service to be rolled out across England

In North East and Yorkshire, integrated care board teams are engaging with schools and collaborating with other areas of primary care and local authorities to explore options for expanding the service in 2026.

For more information visit: NHS England » Special schools eye care service