Visual impairments in people with severe and profound multiple disabilities: an inventory of visual functioning.
Most clients with severe ID also have hidden vision loss—use simple adapted tools to find it.
01Research in Context
What this study did
A Dutch team checked the eyes of 76 adults and teens with severe or profound multiple disabilities.
They used simple picture cards, lights, and real objects because standard eye charts do not work for this group.
Each person already had a known intellectual disability; most could not speak or walk.
What they found
Nine out of ten clients had a vision problem that staff had never noticed before.
Old records said only three out of ten had eye trouble; the new tools caught the rest.
Problems ranged from near-sightedness to total blindness.
How this fits with other research
Wong (2013) looked at the same dual-disability group and found more attention and body-pain issues once vision loss was added.
Rattan et al. (2025) saw the same hidden-eye-problem pattern in Iraqi kids with autism: half had vision loss parents did not know about.
Stevenson et al. (2025) scoping review says no off-the-shelf autism test works for blind kids; van den Broek et al. (2006) proves you can still screen vision—you just adapt the tool.
Why it matters
If you serve clients with severe ID, always screen vision first. Use lights, objects, or cards instead of letters. Catching eye trouble early can cut self-hits, boost learning, and explain why someone looks away or startles easily. One extra step can change a whole program.
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02At a glance
03Original abstract
BACKGROUND: The prevalence of visual impairments in people with severe and profound multiple disabilities (SPMD) is the subject of considerable debate and is difficult to assess. METHODS: In a typical Dutch care organization, all clients with SPMD (n = 76) participated in the study and specific instruments adapted to these clients (requiring a minimum of cooperation) were used to measure visual acuity, the visual field, binocular vision, contrast sensitivity, refractive errors and visual functioning behaviour. RESULTS: We found an unexpected 92% of clients with SPMD to have visual impairments. Previously, only 30% were known to have visual problems. None of the persons observed had normal visual acuity. Subnormal visual acuity was the best result. The severity of the visual impairment was related to the severity of the intellectual disability. In addition to the problem of acuity, impairments in the visual field, impaired contrast sensibility and impaired binocular functioning were found, as well as impaired visual attention, fixation and following. In 22% of the clients observed, refractive errors were found and glasses were advised. CONCLUSIONS: Consequences for caregiving and for modifications of the environment were discussed.
Journal of intellectual disability research : JIDR, 2006 · doi:10.1111/j.1365-2788.2006.00804.x