Developmental Vision Clinic

The Developmental Vision Clinic (DVC) at Great Ormond Street Hospital is a specialist clinic for children with visual impairment and provides specialist assessment of a child’s development in the context of their visual differences. Based on our clinical assessment findings we will make practical recommendations to help the child at home and/or school.

We can also carry out assessment of a child’s level of functional vision to consider how this vision can be used to support everyday activities and learning. This should complement information available from the child’s eye doctor (Ophthalmologist) and Specialist Teacher for visual impairment.

We work closely with local services when providing advice and support for parents.

The team have expertise in understanding and supporting the development and progress of children with visual impairment. The team members involved in individual assessments vary depending on the child’s need, but most often include a consultant paediatrician and clinical psychologist and sometimes an occupational therapist or speech and language therapist.

We accept referrals from Ophthalmologists, Paediatricians and Community Paediatricians. We are not able to accept referrals from GPs or from Education professionals.

Referrals can be sent electronically from an nhs.net address to the Neurodisability Referrals inbox: gos-tr.neurodisabilityreferrals@nhs.net

After a referral is accepted our administrator will send a Pre-Visit Questionnaire to the family to complete in advance of the appointment. This helps the team understand the family’s concerns and questions in advance and to plan the best type of appointment.

• Infants and young children who face developmental challenges in the context of severe visual impairment. When we receive a referral we also check that the child has been referred to the local Specialist Teaching Service.
• Children and young people with severe visual impairment (LogMar 1.0 or above) where there is a specific concern about development (for example slow progress at school, behaviour difficulties, communication difficulties, difficulty forming social relationships, or concerns about autism). This may include children with motor impairment. We see this group of children and young people particularly if the local team feel unable to assess using methods appropriate for children with severe visual impairment.
• Children with moderate visual impairment (LogMar 0.5-1) and developmental challenges may be seen on some occasions. Children with mild visual impairment (LogMar <0.5) are not generally seen in the clinic as developmental concerns can be addressed locally.
• Children of all ages with suspected cerebral visual impairment, to provide vision and developmental assessment to clarify such difficulties, their impact, and the potential overlaps with other areas of developmental difficulty. A diagnosis of cerebral visual impairment will be given where appropriate.
• Children with complex profiles and a range of neurodevelopmental differences to unpick the impact of vision on learning and development.

Referral letters should contain a clear referral question with sufficient details of current concerns. Relevant background information should be enclosed with the referral including details of other professionals involved. We may decline referrals until all appropriate information is received.

An appointment date and time will be agreed with the child’s family in advance. Appointments are longer than some other hospital appointments and may last between 90 minutes and three hours.

Sometimes a first appointment lasting up to one hour may take place by video or phone; if more than one appointment is required to complete assessment a final video or phone appointment to discuss findings and recommendations may be arranged.

Local professionals are welcome to attend, but please inform the clinic administrator in advance.

The assessment usually takes the following format:

1. Time is spent talking to parents to learn about the child’s history and current skills and behaviour and to understand current concerns and questions.
2. An assessment of the child’s vision and development will follow, with parents closely involved.
3. The team will spend a short time together to consider the findings of the assessment.
4. We finish by discussing with parents the results of the assessment and our recommendations.
5. Parents may be given a short written summary of the findings and recommendations and a full report will be sent later.
6. Alternatively a further appointment to discuss assessment findings and recommendations will be made for a later date

We may ask for parents’ permission to video record the assessment for clinical and training purposes.

We also use anonymised patient data, collected during routine care, to understand more about the development of children with visual impairment. This increases our knowledge of children’s conditions and the impact of our care. In addition, we are actively involved in ethics approved research projects and may ask you and your child if you are interested in hearing more about how you could take part.

For professionals and parents of babies and young children with severe visual impairment, read The Developmental Journal for infants and young children with vision impairment.

For more information on the Developmental Vision Clinic please contact the service coordinator via email to gos-tr.Neurodisabilityenquiries@nhs.net or by phone via 0207 405 9200 ext 4543

Further practical information, advice and support on many other aspects of visual impairment is also available from the Eye Clinic Liaison Officer who is based within the Ophthalmology (Eye) Clinic. She can be contacted by via email on Paula.Thomas@gosh.nhs.uk or by phone on 0207 405 9200ext 0345