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The effectiveness of preschool vision screening by health visitors
1Warrington Community Healthcare Trust. ros.thorburn@freezone.co.uk
Insights
Preschool vision screening by health visitors is effective, identifying amblyopia and refractive errors in young children. This approach offers an efficient alternative to orthoptic screening, despite current guideline discrepancies.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Preschool vision screening is crucial for early detection of visual impairments.
- Current national guidelines may not fully align with practical implementation in community settings.
- Warrington utilizes a secondary community orthoptic service alongside health visitor screenings.
Purpose of the Study:
- To evaluate the effectiveness of preschool vision surveillance conducted by health visitors.
- To assess the referral rates and diagnostic yield of health visitor-led vision screening.
- To compare health visitor screening with established orthoptic services and identify potential screening failures.
Main Methods:
- Health visitors screened 2041 children aged 3-3.5 years.
- Referral data to orthoptic and ophthalmology services were analyzed.
- Retrospective review of records for children diagnosed with amblyopia at age 5 was conducted to identify potential screening failures.
Main Results:
- 12% of children screened by health visitors were referred for further assessment.
- Significant conditions detected included amblyopia (11 children), squints (5 children), and refractive errors (25 children).
- Retrospective review identified only two potential failures in early screening, with one child having a minor defect.
Conclusions:
- Health visitor-led preschool vision screening is an effective method for detecting visual impairments.
- This screening approach represents an efficient use of resources and aligns with routine child health checks.
- Findings suggest health visitor screening is a viable alternative to primary orthoptic screening, optimizing orthoptic time allocation.
Abstract:
The aim of this study was to determine the effectiveness of preschool vision surveillance by health visitors in Warrington, a district with a secondary community orthoptic service. Of the 2041 children screened by health visitors at 3-3 1/2 years 12% were referred to the orthoptist for further assessment. Sixty-three per cent of these required more than one examination by the orthoptist and 28% were subsequently referred to an ophthalmologist for further assessment. Amblyopia was detected in 11 children, 5 had squints without amblyopia, and in addition 25 children had significant refractive errors. A retrospective review of the records of children identified with amblyopia following a school entry medical at 5 years was undertaken to detect possible failure of the earlier health visitor examination (i.e. false negatives at age 3-3 1/2 years). Possible failure of early screening was found in only two children, one of whom had a minor defect only (6/9). Vision screening for children aged 3-3 1/2 years by health visitors is an effective alternative to primary screening by orthoptists. However, the use of health visitors in this role is contrary to current national guidelines. The findings suggest that using health visitors to screen vision in preschool children makes efficient use of existing routine checks and may be the best use of orthoptic time.