Vision care for your deaf child

Information for families Vision care for your deaf child Sense is accredited to the Information Standard

Our goal is for all deaf children and young people to receive timely and appropriate eye assessments and care.

Vision care for your deaf child Information for families 1 page Content 2 Why we have produced this booklet 2 How vision works 3 Development of vision in the early years 4 At what age does my child need an eye examination? 4 Why is an eye examination important if my child is deaf? 5 What happens when my child is referred? 5 Eye care professionals 6 What happens at the eye appointment? 8 What can be done to help if my child has an eye condition? 8 What can be done to help if my child needs to wear a patch or glasses together with hearing aids? 9 What happens if a severe visual condition is identified? 9 Follow-up 10 Transferring care to another service 10 Service standards 11 Eye conditions and syndromes 13 Useful publications for children 13 Useful organisations Note: we use the term deaf to mean all types of deafness from mild to profound. This term also includes deafness in one ear or temporary deafness such as glue ear. In this resource we use the words parent and family to include carers.

2 Vision care for your deaf child Information for families Why we have produced this booklet We have produced this booklet for parents and carers of deaf children. Most of the information children use to learn about the world around them comes from what they see and hear. Vision plays an important role in early communication, helping a baby to recognise people, be aware of facial expressions and body language, and identify what an adult is talking about. Vision has an even more important role in helping deaf children to learn language skills and explore the world around them. Deaf children use pictures and reading to help support their language learning, and to keep safe when they are out and about, for example, by watching for approaching traffic. This means that eye care and ongoing checks are important throughout your child s life. Recent research has shown that approximately four out of ten deaf children have some problem with eyesight. This booklet tells you about: You can get a copy of this document from our websites at www.ndcs.org.uk or www.sense.org.uk. How vision works The eye, the optic nerve and the brain all need to work properly to allow us to see. The eye focuses rays of light onto the retina at the back of the eye and the fovea within the retina enables us to see detail clearly. Cells in the retina change light rays into electrical signals and these signals are sent by the optic nerve to the brain, where information is decoded into pictures. why monitoring a deaf child s vision is important the types of tests that may be carried out what to think about before your child has their vision checked. It is important that you see vision care as a process that can have positive outcomes for your child, not only as a way of finding out about problems. We have produced this booklet with the help of professionals who have experience of working with deaf children and young people. Young deaf people and their parents have also assisted us. This booklet accompanies one for professionals, Quality Standards in Vision Care for Deaf Children and Young People (2009) published jointly by the National Deaf Children s Society and Sense. Eye muscles Lens Iris Pupil Cornea Retina Fovea Optic nerve

Vision care for your deaf child Information for families 3 LITTER With normal vision we can: see objects far away, such as a ship out at sea or a bird flying see small things close up, such as letters on a page, a speck of dust or a crumb on the floor notice objects at the edges of our visual field, such as an overhanging branch of a tree and moving objects that are not right in front of us judge the depth of a step as we walk downstairs see colours notice the difference between black, grey and white, to help us move around safely in dim light see at night when our eyes adapt to the dark. The eyes also form an important part of our balance system. The balance system allows us to stand upright, walk in a straight line and know whether we are standing, lying down or hanging upside down. To balance we use signals from part of the inner ear, our eyes and receptors in the legs. For some deaf children, the balance part of the inner ear does not work as well as it should and so they rely more on the information from their eyes. Development of vision in the early years During the first month of life, a baby with normal vision starts looking at close objects and is very interested in the human face, even though at first what the baby sees is blurred. At about six weeks the baby smiles and this encourages more eye contact and spoken response from the adult. For all babies, eye contact, responses to smiles and facial expressions are very important in developing communication, but this is especially important for deaf babies. At three months, the baby starts to bring their hands close to their face, and to watch and study them as they move. The tracking of objects (following objects with the eyes) also develops at this time. Between three to six months, most babies respond to activities around them - they watch keenly and recognise distant objects. From six months babies recognise toys and foods at a distance and can fix their sight on them and then track something that catches their attention. The baby will reach out for nearby things and watch movement, such as hanging mobiles that move when they kick in the cot, as well as the movement of people. Reaching out for interesting objects encourages babies to learn to sit up and crawl. What the baby sees provides motivation and security for moving around, and the baby begins to develop a concept of space, and their body in relation to space. The child will also develop an interest in books and pictures (if exposed to them). Pointing to objects (real objects first, but also objects in pictures) helps them to develop language. During the second year of life a child can see distant objects, recognise familiar people at a distance, recognise familiar places, and can look for and find their toys.

4 Vision care for your deaf child Information for families of their eyes as they grow older. The earlier a problem is found, the more effectively it can be managed. Children are entitled to free eye tests up to the age of 16, or the age of 19 if still in full-time education. At what age does my child need an eye examination? Eye tests can be done at any age. Very young babies cannot tell us what they see, but it is still possible to assess their vision using a range of techniques and modern equipment. Your health visitor or paediatrician will have done some tests for eyesight problems during early examinations. This includes an examination of the eyes to make sure they are healthy. All children should have their vision screened by an orthoptist between the ages of four and five. Children with permanent sensori-neural deafness should additionally be referred for a specialist eye examination by their local audiology service as soon as the deafness is confirmed, and then at regular times throughout their childhood. If your child has glue ear, a very common childhood condition that can cause temporary deafness, they will not normally need a specialist eye examination at the hospital or clinic. However, we do encourage you to take your child for an eye test with a local optometrist. Some special eye tests may only be done at a particular age. Your eye professional will discuss the tests and timing with you. Other professionals, for example your GP, may also refer your child for an eye examination at other times if there are concerns about their vision. It is important that all children have regular eye tests to make sure there have not been any changes, and to encourage them to take care A permanent sensori-neural hearing loss is the result of damage to the hair cells in the ear s cochlea, damage to the hearing nerve, or both. It can range from mild to profound and affects either one or both ears. Sensori-neural deafness results in not only changes to an individual s ability to hear quiet sounds but also to the quality of sound that they hear. Why is an eye examination important if my child is deaf? Research has shown that about four in every ten children who have a sensori-neural deafness also have a vision problem. Many of the common eye conditions can be treated easily and glasses are not always necessary. Most eye conditions are not serious but can cause educational difficulties if not treated. Some deaf children are born with a syndrome (syndrome is a medical term meaning a collection of signs or symptoms that appear together). Sometimes a syndrome has already been diagnosed, but sometimes hearing loss is the only apparent sign of a syndrome, even though it may

Vision care for your deaf child Information for families 5 be later recognised as this. An eye examination can help to diagnose a syndrome or to confirm that hearing loss is not part of a syndrome. The Royal College of Opthalmologists recommends targeted clinical surveillance of certain groups at high risk of eye disorders, including children with a sensori-neural deafness. It recommends the inclusion of a full orthoptic examination, cycloplegic refraction and a fundus examination. An orthoptic examination measures how much the eye turns from various positions. It can provide information on lazy eye (amblyopia), double vision, your child being unable to use both eyes together, and other abnormal eye movements. Cycloplegic refraction is a procedure carried out to determine refractive error, which means that a child cannot properly focus their vision. Examples of this are nearsightedness and farsightedness. A fundus examination looks for issues relating to the interior surface of the eye including the retina. What happens when my child is referred? The ophthalmology service (eye clinic) will contact you about the time, date and details of the appointment. They will also let you know if you need to make any special arrangements for the appointment. Your audiology service will normally have told the ophthalmology service (eye clinic) if you need a sign language or other language interpreter for the appointment. If you do need an interpreter at the appointment, and your appointment letter does not make it clear that an interpreter has been arranged, contact the ophthalmology department to make sure this will happen. Eye care professionals At the ophthalmology clinic you may meet different professionals, just as you would at the audiology department. An ophthalmologist is a doctor who specialises in detecting and treating eye disorders. An orthoptist is trained to assess vision, and assess and manage conditions related to the development and movement of the eye (for example, squints). They usually work with the ophthalmologist. Orthoptists often visit schools to check children known to have problems with their vision, or they may see them regularly in clinics. An optometrist examines eyes, recognises abnormal eye conditions, advises on eye care, and prescribes, fits and supplies glasses, contact lenses and other things to help correct vision (vision aids). Dispensing opticians are trained to fit, supply and sell glasses and vision aids, but do not examine eyes. Optometrists and opticians often have premises on the high street. Your audiology and ophthalmology teams should work closely with you and your child, involving you in every stage of their care. Your views should be valued and you should be considered as equal members of a well coordinated and accessible team.

6 Vision care for your deaf child Information for families What happens at the eye appointment? If your child uses lipreading or sign language, you may need to remind the staff at the clinic. Ask professionals to make sure they keep light on their face and to face your child when speaking. Ask what will happen during the appointment before they turn the lights off so that your child knows what to expect. You will be asked if you have any concerns about your child s eyes and vision. The letter asking for the appointment should have given information about your child s medical history, but it is always helpful to take copies of any medical reports you have including your child s red book early health record if they are very young. It is most likely that your child will see both an orthoptist and an opthalmologist during their appointment. The orthoptist It is likely you will meet an orthoptist, an eye professional who specialises in assessing a child s vision and in checking that their eyes are working together correctly. Many children enjoy their eye test as the orthoptist uses a range of small toys to keep their interest in testing and often reward children with stickers. The type of test used will depend upon the age and ability of an individual child. Young babies show interest in strongly contrasting bold shapes. A vision acuity test of contrasting black and white striped cards may be used, with a pattern on one side and plain grey on the other with the stripes of varying size alternating between the left and right side of the cards. The baby, if showing interest, may look from side to side like someone watching a tennis match until the stripes are too fine to see. Older children may be asked to point at, sign or name simple black and white pictures, such as cat, duck and house, that are printed to be of similar detail to the letters on an adult eye chart. The orthoptist will look for signs of a squint one eye pointing in a different direction to the other, or wandering in or out occasionally. They will shine a small light in the child s eyes to see if the reflection of the light falls in the same place on each eye. There will also be a cover test where the orthoptist covers one eye and watches the movement of the uncovered eye. They will do this by attracting the child s attention with a small object such as a finger puppet in front of the child at eye level. This is repeated with each eye in turn. The orthoptist will assess your child s eye movement as they watch a moving toy - looking up, down, and side to side. Side vision (or peripheral vision) may be assessed by bringing a toy into your child s peripheral vision from the side or from above whilst your child is concentrating straight ahead to check it is quickly noticed equally from all sides. Older children may perform a more precise test of visual field by putting their chin on a rest in front of a large bowl in a dimly lit room. The bowl then shows small lights in their side vision and when your child notices the light they are asked to press a buzzer. This helps to find out if the child can use the whole field of vision. During the eye appointment your child may be given eye drops. They are used to make the pupil bigger so the doctor can get a better view inside the eye. Eye drops can sting. Some people find

Vision care for your deaf child Information for families 7 them more uncomfortable than others but in all cases they soon stop stinging, much like shampoo accidentally getting in your eyes. Your child should be reassured about this. The eye drops blur their vision slightly after about 10 minutes, especially when looking at things that are close to them. Let your child know about this and reassure them the effects will wear off but may take several hours to return to normal. If your child signs it may be helpful to explain what examination will be needed later in the consultation before the blurring effect makes it harder for them to see your signing. Eye drops can increase light sensitivity and so take a peaked hat, sunglasses or make sure the baby carrier or pushchair has a shade or cover. Eye drops can raise a child s temperature so make sure they have layers that can be removed if they look or feel hot. A yellow eye drop may be used if eye pressure needs to be tested. This does not sting but does numb the eye so be aware of your child rubbing the eye hard as they won t know how hard they are rubbing it. The ophthalmologist The ophthalmologist (eye doctor) will examine the back of your child s eyes with various instruments that have bright lights including an instrument called an indirect ophthalmoscope. This involves a head-mounted light and a hand-held magnifying lens to check the back of the eye is healthy. The ophthalmologist may ask for ocular electrodiagnostic tests including an electroretinogram (ERG). An ERG records the retina s response to stimulation. It reflects the activities of many parts of the retina including the light sensitive cells (known as rods ) and the colour sensitive cells (known as cones ). Using special techniques, the responses of the different parts, including the rods and cones, can be separated. An ERG is one of the tests used to test for Usher syndrome. Other kinds of tests the opthalmologist may suggest A visual evoked response (VER) or visual potential test (VPT) is a record of the electrical activity in the brain as a response to stimulation of the retina. An electro-oculogram (EOG) measures the potential difference between the cornea and the back of the eye. These tests are often performed by vision professionals who sit your child in front of a television showing black and white flashing checks and, in some centres, cartoons to make the test child friendly. They also use a bright strobe light. To detect the signals from the child s eyes and brain, small sticky pads are placed on their skin near their eyes and at the back of the head. These are not routine tests and you will have to travel to a special centre if these tests are required. Support for hospital appointments If your child is worried or frightened about hospitals or is just very anxious, you can ask if the hospital has a play worker who can get in touch with you prior to your visit and work with your child to prepare them for the appointment. You can also ask if your hospital has an eye clinic liaison officer or Family team. They can attend your appointment with you, give advice on your child s diagnosis, tell you about what support and information is available in your local area regarding your child s vision levels, be emotionally supportive, and give practical advice about benefits and equipment.

8 Vision care for your deaf child Information for families What can be done to help if my child has an eye condition? Treatment varies depending on the eye condition. Sometimes treatment aims to prevent the condition from getting worse or becoming permanent, for example by using an eye patch for a lazy eye (amblyopia). Sometimes glasses may be all that is required to help your child see properly. Occasionally surgery may be required, perhaps to help align the eyes or if there is a condition affecting the cornea. Usually, the earlier the treatment, the better the outcome. Very occasionally the test results may show that although the eyes are functioning well now, they may deteriorate with time. This information could help your family prepare and adjust to the future. Low vision aids (LVA) may be helpful, and may be recommended if glasses, contact lenses or medical treatment cannot treat your child s eye condition. Low vision aids can help a person to see something more clearly. Some are portable and small enough to go in a pocket, for example, magnifiers and telescopes (these can be helpful to see bus numbers). Your family doctor (GP), local optometrist, eye doctor, teacher, or professional from social services will refer your child for a low vision assessment. The assessment and any low vision aids prescribed are free of charge. What can be done to help if my child needs to wear a patch or glasses together with hearing aids? Having to wear hearing aids and glasses together may seem a bit daunting, especially for a small child. It is very important that your child feels comfortable with them. Your optometrist and audiologist need to work together to help get the best fit. Often the arm of the glasses can be adjusted by your optometrist to give a better fit next to the hearing aid. Sometimes metal-framed glasses for children take up less space and wrap around the ear and so are a better fit than plastic framed glasses. Glasses with soft supports for the ear pieces may help. If your child has lazy eye (amblyopia), they may have to wear a patch on the good eye to help the lazy eye come into line with the other one. If your child needs to see to lipread and see sign language, make this clear to the orthoptist if they recommend patching. It may be helpful to get advice from a specialist teacher (for example, a Teacher of the Deaf or a teacher for children with visual impairments) to help with managing equipment and developing activities that will encourage a child to accept patching and glasses.

Vision care for your deaf child Information for families 9 What happens if a severe visual condition is identified? If your child has a syndrome identified that involves a severe visual condition, or a deteriorating visual condition, a referral should be made for specialist educational advice. This referral could be made by audiology professionals, eye professionals, or by your child s school. Depending on your child s needs, a qualified teacher for visual impairment, or a qualified teacher for multi-sensory impairment may become involved in providing advice and guidance to your child s school. A deaf child who later experiences visual difficulties may become quite worried and anxious. Organisations such as Sense, RNIB and Contact a Family may be helpful in suggesting ways to help, social networks that you may find useful and online games for young people who have visual impairments. Follow-up The vision system continues to develop throughout childhood and the early teenage years, and so deaf children should have assessments at different stages. Your local audiology and ophthalmology services will tell you the best times to have your child s eyes tested. The following signs may indicate poor vision: difficulty seeing the whiteboard or blackboard in the classroom more problems than usual seeing in poor light (for example, at night) difficulties reading a book or magazine problems seeing the scenery from the back of a car problems spotting a person in the crowd discomfort in bright light difficulty going from light to dark places, or from dark to light blinking or rubbing eyes more often than usual difficulty finding small items which have fallen onto the floor difficulty finding items against a busy or patterned background difficulty judging where things are in a space bumping into, or tripping over things more than usual. If your child develops any of these problems or you have any concerns about your child s vision between routine appointments, you should let a professional know. Your concerns should be taken seriously and an earlier appointment made. Ask your audiology service or your GP to refer your child back to the ophthalmology department.

10 Vision care for your deaf child Information for families Service standards This booklet accompanies the joint NDCS and Sense publication, Quality Standards in Vision Care for Deaf Children (2009). You can get a copy of this document from our websites at www.ndcs. org.uk and www.sense.org.uk. It sets out a number of quality standards that we (the National Deaf Children s Society and Sense) believe should guide audiology and ophthalmology services. Transferring care to another service If you are moving to a different area, remember to let your existing audiology and ophthalmology services know your new contact details and, most importantly, the address of your new GP so that they can arrange for your child to have any necessary follow-up appointments with the new services. They can also arrange for a summary of relevant records to be sent to your new doctor and/or audiology department, but only if they have this information. At an agreed age, young people will not usually continue to have routine eye tests at the hospital or clinic ophthalmology department. You will be told if they will need to continue to attend appointments. In many areas local health authorities no longer routinely screen for eyesight problems in older children. However, every child under 16 and every young person aged 19 or under and in full-time education is entitled to free NHS eye tests with an optometrist. You should take older children for regular eye tests and help encourage good eye care in teenagers to prepare them for adulthood, particularly if there is a family history of eye problems or short-sightedness. You can expect the following from these services: To receive all written information in a format that is accessible and easy to read. To receive written information before your appointment explaining what will be involved. To have access to a sign language or other language interpreter at appointments. Contact the department beforehand if this is necessary. To be given copies of all information and reports about your child s hearing and vision development. To be asked for your permission so that information can be shared with all professionals working with your child, including your GP. To be given the name of your child s key or link worker as soon as your child s deafness is diagnosed, and to have a say in who that person will be. To be given the name of a lead clinician who is responsible for coordinating all aspects of your child s care. To be seen by staff who have had training in deaf awareness. To be seen by professionals who have experience of working with children and who have a good understanding of the importance of good vision care in deaf children.

Vision care for your deaf child Information for families 11 If your child has a permanent conductive or sensori-neural deafness, they should be referred for a full ophthalmic assessment at key stages of their development. To be referred for an eye test at any time if you are concerned. When transferring from children s to adult services, or between services if you move to a new area, you can expect your existing provider to arrange an appointment with the new service and to transfer relevant notes before you move. To be asked for your feedback (by the audiology and ophthalmology services) to help them review their service. Eye conditions and syndromes Lazy eye (amblyopia) affects two to five in every 100 children. It is one of the most common eyesight problems found in preschool children. Lazy eye is reduced visual acuity (sharpness), in an otherwise healthy eye. The brain has not developed the ability to see properly with the affected eye because the picture signal it s sending is inadequate. Causes include: anisometropia is where a large difference between the two eyes results in one clear image and one blurred one. The blurred image is ignored. only treatment needed. Surgery may be needed to help align the eyes and for cosmetic reasons. Colour blindness about eight in every 100 boys and one in every 200 girls have some problems telling the difference between colours. Those affected usually have difficulty telling the difference between red and green, and minor faults are of little significance. Total colour blindness is rare. Some occupations are not open to people who have colour blindness, so it is recommended that teenagers have an eye assessment before considering career advice. Corneal dystrophies are a group of relatively rare conditions that may be part of a syndrome that includes deafness. They affect one of the five layers of the cornea that make up the outer layer of the eye. An early symptom may be a sensation of a foreign body in the eye. Treatment varies but may involve surgery. Glaucoma is the name for a group of disorders that can damage the optic nerve and affect the pressure of fluid in the eye. Although this is more common in older people, glaucoma can more rarely affect younger children, and may be part of a syndrome. Treatment will certainly include drops to help maintain normal fluid pressure, but could require surgery. cataracts or other conditions that block vision. The reduced vision may become permanent if not treated early. It is difficult to diagnose lazy eye until visual acuity can be easily measured (usually by three to four years of age). Treatment aims to prevent or reduce the severity of the condition. Lazy eye is usually treated with glasses or by covering the good eye with a patch to force the lazy eye to focus. The outcome is usually better if the treatment is started earlier. If lazy eye is caused by a squint, glasses may be the

12 Vision care for your deaf child Information for families Refractive errors about three out of every 100 four-year-olds have refractive errors, which include short-sightedness and long-sightedness where images are focused in front of or behind the retina, and astigmatism which causes a part of the visual field to be blurred. These conditions, particularly short-sightedness, become more common in older children. They can usually be corrected with glasses or contact lenses. Short-sightedness (myopia) occurs when light rays focus in front of the retina because the eyeball is slightly too long from front to back. This means that distance vision is blurred. There is often a strong family history. A child may bring things very close to them to look, and seem to peer at things. Long-sightedness (hypermetropia) occurs when light rays focus behind the retina because the eyeball is slightly too short from front to back. Distance and near vision can be blurred. A child may be reluctant to look closely at objects at close quarters. Astigmatism occurs when the cornea and lens do not have the same degree of curvature, resulting in distorted images. This can cause difficulty reading and working on a computer, as focusing on words can be difficult. Retinitis pigmentosa (RP) and pigmentary retinopathy are a group of rare inherited eye problems affecting the rods and cones in the eyes. Some types of RP are also associated with other problems such as deafness in Usher syndrome. Squint (strabismus) around four in every 100 four-year-olds have a squint. A squint is when both eyes are not coordinated in focusing on the same point. To prevent seeing double, the brain ignores the image from the squinting eye so that, effectively, the squinting eye is not being used. In young children (below eight years old) it can cause lazy eye (amblyopia). A squint can indicate that visual sharpness has been affected or, very rarely, that the child has a more serious condition that needs investigating. Usher syndrome is a genetic condition which affects around three to six % of children in the UK who are born with a hearing loss. During mid to late childhood, children with Usher syndrome start to have sight problems caused by a form of retinitis pigmentosa, where the retina slowly loses its ability to send pictures to the brain. Early symptoms include difficulty seeing in the dark and in different lighting conditions. Over time, the field of vision gradually deteriorates until tunnel vision develops. Changes in vision are usually gradual and most adults keep reading vision into middle age and beyond. Special eye tests are recommended for some profoundly deaf children to help to spot changes in the retina. For further information about Usher syndrome contact Sense (you can find their contact details at the back of this booklet).

Vision care for your deaf child Information for families 13 Useful publications for children Arthur s Eyes, Marc Brown, Atlantic Monthly Press/ Little Brown and Co, 2008 I Need Glasses: My visit to the optometrist, Virginia Dooley, Mondo Publishing, 2002 Luna and the Big Blur, Shirley Day. American Psychological Association, 2008 Magenta Gets Glasses, JP Reber, Simon & Schuster, 2002 Rugrats: Chuckie visits the eye doctor, Luke David, Simon Spotlight/Nickelodeon, 1999 Sight, Kay Woodward, Hodder & Stoughton, 2005 The Good Luck Glasses, Sara London, Cartwheel Books, 2001 Topsy and Tim Have their Eyes Tested, Jean and Gareth Adamson, Blackie Children s Books, 1997 Forest Books specialises in books about deafness and deaf issues. They sell books for children, as well as families and professionals. There is a comprehensive online catalogue on their website, www.forestbooks.com. You can find their contact details in the Useful organisations section. Full references are available on request from knowledge@sense.org.uk or helpline@ndcs.org.uk Useful organisations There are often local specialist organisations that can give advice and support. The organisations listed here can direct you to them. Your hearing and vision team, and local social services teams, will also have up-to-date information. Phone: 020 7608 8700 (v) Fax: 020 7608 8701 Freephone Helpline: 0808 808 3555 Freephone Textphone: 0808 808 3556 info@cafamily.org.uk www.cafamily.org.uk Forest Books Forest Books specialise in books and other resources on deafness and deaf issues. Phone: 01594 833 858 (v&t) Fax: +44 (0)1594 837573 Videophone: 01594 810 637 forest@forestbooks.com www.forestbooks.com LOOK The National Federation for Families with Visually Impaired Children A registered charity that provides support and information for families who have children with visual impairments, as well as activities for young people. Phone: 0121 428 5038 office@look-uk.org www.look-uk.org RNIB Royal National Institute for Blind People provides support and information for blind and partially sighted people. The website contains information about eye conditions, and also products and services that might be of interest to people who have severe visual impairments. Helpline: 0303 123 9999 helpline@rnib.org.uk www.rnib.org.uk Contact a Family The only UK wide charity providing advice, information and support to the parents of all disabled children. They also enable parents to get in contact with other families, locally and nationally.

14 Vision care for your deaf child Information for families Notes

Notes Vision care for your deaf child Information for families 15

Sense is the national charity that supports and campaigns for children and adults who have a combination of sight and hearing difficulties. We provide expert advice and information as well as specialist services to deafblind people, their families, carers and the professionals who work with them. In addition, we support people who have sensory impairments with additional disabilities. Our services include: Advice and support Sense covers all issues relating to dual-sensory impairment and has a library full of useful resources. We can offer practical and local advice, specialist assessments, casework and legal support, and training and consultancy. Contact our Information and Advice Service on 0300 330 9256 (voice and text) to find out more. Community resource centres In our community resource centres around the UK people are able to choose from a wide range of activities and programmes that can help them to develop their communication and living skills. Living options Our housing and support provides a range of accommodation choices to enable people to live in the way that they choose. One-to-one support Sense offers individuals in the community guiding, practical help and communication support and specialist support to develop learning, communication and independence. Children s support Our team of specialist advisory teachers, children s therapists and children and family support workers offer professional and experienced help to children who are deafblind and multi-sensory impaired as well as the professionals working with them. Short breaks and getting together Sense provides friendly holidays and short breaks for people of all ages. We also have fun groups for children and families and a wide range of community groups.

The National Deaf Children s Society (NDCS) is the leading charity dedicated to creating a world without barriers for deaf children and young people. We provide the following services through our free membership scheme for families with deaf children. To become a member, contact our Freephone Helpline (number below) or register through www.ndcs.org.uk. You ll also receive a quarterly magazine and email updates. Information and support on childhood deafness Our Freephone Helpline can give you help and information on all aspects of childhood deafness, from schooling and communication options, to parenting tips and new technology. Contact us through our Freephone Helpline on 0808 800 8880 (voice and text). Printed and online publications See our website at www.ndcs.org.uk for regularly updated information on childhood deafness. You can also access our free publications on topics including education, family support and hearing equipment. Events for families and deaf young people At our events you can meet other families, share experiences and get support from professionals. If your child is 8 or over, they can take part in our sports, arts and outdoor events. Online support Families can share their experiences and get advice through our online forum at www.ndcs.org.uk/parentplace. We also have a Facebook page at www.facebook.com/ NDCS.UK. Specialist support We can give you one to one help if you re worried your child is not getting enough support at school, or you re struggling to secure essential benefits. Try out technology Through our free loan service your child can try out products that can support your child to be independent at home and at school.

NDCS and Sense have worked together to produce this information for parents about how to make sure that their deaf child receives the right eye care. Was this information useful to you? Send your feedback to helpline@ndcs.org.uk or knowledge@sense.org.uk Sense Tel: 0300 330 9250 Fax: 0300 330 9251 Text: 0300 330 9252 Email: info@sense.org.uk www.sense.org.uk The National Deaf Children s Society NDCS Freephone Helpline: 0808 800 8880 (voice and text) Email: helpline@ndcs.org.uk www.ndcs.org.uk/livechat www.ndcs.org.uk Published by NDCS and Sense 2014. Review due March 2017 NDCS, Castle House, 37 45 Paul Street, London EC2A 4LS ISBN 978-1-909706-05-7 JR0397 Registered Charity: England & Wales (1016532) & Scotland (SC040779) Sense, 101 Pentonville Road, London, N1 9LG Charity No. 289868 This publication can be requested in large print, in Braille and on audio CD.