Children's Eye Health - A Report on Vision Screening for Children
This report, written by Professor David Thomson, Head of the Department of Optometry and Visual Science, CIty University, London, on behalf of the AOP, ABDO and FODO, is part of the professional bodies' efforts to help raise awareness about child eye care. The basic message is that until we can be certain that the majority of children are under the care of an optometrist, there is a strong case for reinforcing the weakened vision screening net by testing children at key stages of their development. The report can be viewed as a pdf document at the end of this page.
Screening
Screening for amblyopia fits in well with the WHO requirements for screening. 1 Some questions have been raised about the outcomes of screening 2 although the conclusions reached may be open to question. 3 In areas where screening is carried out effectively, subsequent treatment for amblyopia is shown to be effective, 4;5 even in the long term. 6 It is self evident that screening has to be followed by adequate procedures for treatment. 7 Children should be screened for visual defects by a suitably trained person at age 4-5. In many areas, if a defect is indicated, the child is referred to the secondary sector to be seen by an ophthalmologist. This can involve a wait of many months at a time when the visual system is at its most vulnerable. If a squint (strabismus) or lazy eye (amblyopia) is identified, treatment would be initiated and reassessed at regular intervals. This screening will often be undertaken in the community by an orthoptist who have been shown to be effective. 8 The use of health visitors has not been shown to be as effective. 9 Following this screening, pre-school children with vision which appears to be below normal, or with binocular vision problems, could be seen for examination by a community based optometrist. A version of this system has been shown to work well. 10 Refraction, the provision of spectacles where indicated, and commencement of therapy could be initiated swiftly. Pathological conditions causing strabismus or amblyopia are rare, but would be detected at this eye examination, resulting in a priority referral to ophthalmology. This is considered advisable in very early onset myopia. 11 Where amblyopia shows no improvement within three months, or where a refractive strabismus does not respond within this timescale, "fast track" referral to ophthalmology could be initiated. In all of these cases this would ensure that children were seen by an ophthalmologist when necessary, and within a shorter waiting time than most current systems. The present system around the country is haphazard, with little co-ordination of services, and children frequently have a long wait before being seen for an initial examination following screening. In many areas screening for teenage onset myopia does not take place at all.
Reference List
1. Rahi JS, Williams C, Bedford H, Elliman D. Screening and surveillance for ophthalmic disorders and visual deficits in children in the United Kingdom. Br J Ophthalmol 2001;85:257-9.
2. Snowdon SK, Stewart-Brown SL. Preschool vision screening. Health Technol Assess 1997;1:i-83.
3. Fletcher R. Should children be screened for visual disability before school. OT 1998;38:18:36.
4. Lithander J, Sjostrand J. Anisometropic and strabismic amblyopia in the age group 2 years and above: a prospective study of the results of treatment. Br J Ophthalmol 1991;75:111-6.
5. Lennerstrand G, Rydberg A. Results of treatment of amblyopia with a screening program for early detection. Acta Ophthalmol Scand Suppl 1996;42-5.
6. Bowman RJ, Williamson TH, Andrews RG, et al. An inner city preschool visual screening programme: long-term visual results. Br J Ophthalmol 1998;82:543-8.
7. Juttmann R. The Rotterdam Amblyopia Screening Effectiveness Study (RAMSES): compliance and predictive value in the first 2 years. Br J Ophthalmol 2001;85:1332-5.
8. Wormald RP. Preschool vision screening in Cornwall: performance indicators of community orthoptists. Arch Dis Child 1991;66:917-20.
9. Jarvis SN, Tamhne RC, Thompson L, et al. Preschool vision screening. Arch Dis Child 1991;66:288-94.
10. Donaldson LA, Karas MP, Charles AE, Adams GG. Paediatric community vision screening with combined optometric and orthoptic care: a 64-month review. Ophthalmic Physiol Opt 2002;22:26-31.
11. Marr JE, Halliwell-Ewen J, Fisher B, et al. Associations of high myopia in childhood. Eye 2001;15:70-4.
