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Background: We evaluated the refractive status and visual function of children with special needs (other handicap) in 2010 and compared them with healthy 1st grade school students in Oman. Materials and Methods: This was a cohort study. Optometrists recorded vision using a logarithm of minimum angle of resolution (LogMAR) chart. Preferential looking method was used for testing 31 children. Cycloplegic refraction was performed on all children. Contrast sensitivity was tested using 2.5%, 10%, and 100% contrast charts. Ocular movement, alignment, and anterior segment were also assessed. A pediatrician reviewed the health records of all the children at the time of their enrollment in this study to determine if the child had been diagnosed with a systemic condition or syndromes. The visual functions were assessed by study investigators. We estimated the rates and the risk of different visual function defects in children with special needs. Result: The prevalence of refractive error in 70 children (4.7 ± 0.8 years) with special needs (group 1) and 175 normal healthy first grade students (group 2) were 58.5% and 2.9%, respectively. The risk of refractive error was significantly higher in children with special needs [relative risk, 48.1 (95% confidence interval, 17.54-131.8)]. Hyperopia (>1.00 D), myopia (= 1.00D) and astigmatism (= ±1.00 D) were found in 18.6%, 24.3%, and 27.1%, respectively, in group 1. Six children in this group had defective near vision. Sixteen (80%) children with Down syndrome had refractive error. Seven (50%) children with developmental disorder showed decreased contrast sensitivity. Conclusion: Prevalence of uncorrected refractive error was much higher in children with special needs. Prevalence of strabismus, nystagmus, and reduced contrast sensitivity was also higher in children with special needs. Early vision screening, visual function assessment, correction of refractive error, and frequent follow-up are recommended. [ABSTRACT FROM AUTHOR]