Related Experiment Video
Updated: May 25, 2026
Using an Automated Hirschberg Test App to Evaluate Ocular Alignment
Published on: March 24, 2020
Accuracy of referrals from an orthoptic vision screening program for 3- to 4-year-old preschool children
Victor H Hu1, Amanda Starling, Shelagh N Baynham
1Wolverhampton Eye Infirmary, Wolverhampton, United Kingdom. victorhu@doctors.org.uk
Insights
Preschool vision screening by orthoptists accurately identifies children needing further eye care. Early screening in 3-4 year olds showed good referral accuracy and potential for better outcomes in children diagnosed with conditions like amblyopia.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Public Health
Background:
- Preschool vision screening programs are crucial for early detection of visual impairments.
- The accuracy of orthoptist-led screenings in young children (3-4 years) requires evaluation.
- Understanding referral outcomes is essential for optimizing screening program effectiveness.
Purpose of the Study:
- To assess the accuracy of orthoptist referrals from a preschool vision screening program.
- To analyze the outcomes for children referred from this program.
- To evaluate the impact of early screening age on referral accuracy and outcomes.
Main Methods:
- Retrospective record review of a UK preschool vision screening program (2006-2007).
- Screening included visual acuity, ocular alignment, motility, and stereoacuity assessments by orthoptists.
- Comparison of screening results with subsequent Hospital Eye Service examinations.
Main Results:
- 78% of eligible children were screened; 413 were referred.
- High agreement between screening and hospital assessments for visual acuity (81%) and ocular alignment (94%).
- Of referred children, 87% had visual acuity ≥6/9, 46% needed only spectacles, and 17% were diagnosed with amblyopia.
Conclusions:
- The Walsall program's early screening age (3-4 years) did not result in excessive incorrect referrals.
- Early screening may lead to improved outcomes for children with visual impairments.
- Orthoptist-led screening in the UK is likely more accurate for this age group than non-specialist screening.
Purpose:
To determine the accuracy of orthoptist referrals from a preschool-based vision screening program for children 3-4 years of age and to report the outcomes of referred children.
Methods:
This was a retrospective review of records of participants in the preschool vision screening program in the Walsall, United Kingdom, area for the 2006-2007 school year. Screening examinations were performed by orthoptists and included assessment of visual acuity, ocular alignment, ocular motility, and stereoacuity.
Results:
For the 2006-2007 school year, 2,830 of 3,623 children (78%) were screened, Of these, 413 were referred to the Hospital Eye Service. Comparison of the screening results and the Hospital Eye Service examination revealed that recorded visual acuities were similar in 81% of subjects and ocular alignment in 94%. Visual acuity was 6/9 or better at the hospital examination in 87% of referred children, with 46% requiring spectacle use only; 17% of referrals were diagnosed with amblyopia.
Conclusions:
Although the Walsall vision screening program diverged from UK national guidelines by testing at an earlier age, there was no evidence that earlier screening led to a large number of incorrect referrals, and early screening may allow for better outcomes. Sensitivity of screening was not tested, and orthoptist screening in the United Kingdom is likely to be more accurate in this age group than nonspecialist or lay screening that is performed in many other areas.
