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Preschool vision screening
S N Jarvis1, R C Tamhne, L Thompson
1Department of Child Health, Medical School, University of Newcastle upon Tyne.
Insights
Community orthoptist screening for preschool vision defects is more effective than health visitor or primary care screening. Early detection and treatment of visual acuity loss were significantly improved with orthoptist-led screening.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Preschool vision screening programs lack robust evidence of effectiveness.
- Existing screening methods may not adequately detect vision defects in young children.
Purpose of the Study:
- To compare the effectiveness of three different preschool vision screening methods.
- To evaluate screening sensitivity and the incidence of treated visual and ocular defects.
Main Methods:
- A comparative trial involving approximately 7000 children aged 5 months and 30 months.
- Follow-up over 18 months, with data from ophthalmology outpatients and optician records.
- Screening methods included community orthoptist surveillance, health visitor surveillance, and primary care screening for squint.
Main Results:
- Orthoptist screening at 35 months showed superior sensitivity (100%) compared to health visitor (50%) and primary care (50%) screening.
- Higher incidence of treated target conditions (17 per 1000 person-years) with orthoptist screening versus others (3-5 per 1000 person-years).
- Orthoptist screening identified more cases of straight-eyed visual acuity loss, which were treated.
Conclusions:
- Community-based orthoptist screening is a more effective method for preschool vision screening than current alternatives.
- Screening younger cohorts (5-9 months) yielded poor results across all tested methods.
- Targeted screening by orthoptists improves detection and treatment of significant visual impairments in preschoolers.
Abstract:
Although a good case for preschool screening for vision defects can be made there is very little evidence that existing programmes are effective in practice. A comparative trial of three different methods of preschool vision screening is described. Some 7000 children initially aged 5 months (younger cohorts) and 30 months (older cohorts) in three matched areas entered the trial during 1987. During 18 months of follow up new visual and ocular defects among these children were ascertained through ophthalmology outpatients and from optician records. Screening at 35 months by an orthoptist based in the community is superior to conventional health visitor surveillance at 30 months and to an agreed programme of primary care screening for squint at 30-36 months as judged by screening sensitivity (100% v 50% v 50%) and the incidence of treated target conditions (17 v 3 v 5 per 1000 person years). A notable feature in the area served by the orthoptist is that 13 children received treatment for straight eyed visual acuity loss from among 1000 children whereas there were no such cases among 2500 in the comparison areas. In the younger cohorts (that is, screening at age 5-9 months) all three programmes showed equally poor results, only one of the eight treated target conditions arising from all 3500 younger children being screen detected.