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APPG meet to consider children's vision screening
APPG meet to consider children's vision screening
30 October 2008
The All Party Parliamentary Group on Eye Health and Visual Impairment met on Wednesday 22 October to discuss Children’s Vision Screening. The Group, chaired by Sandra Gidley MP, heard from Dr David Elliman, Consultant in Community Child Health, Islington PCT and Great Ormond Street Hospital and member of the UK National Screening Committee and Professor David Thomson of the Department of Optometry and Vision Science, City University.
The meeting highlighted the Department of Health’s requirements for children’s vision screening, and the need to develop the screening to ensure the safeguarding of eye health and the educational development of children. Problems not detected during the critical period of development between the age of birth and seven can lead to lifelong visual impairment and can undermine children’s educational and social development.
Dr David Elliman’s presentation set out the current national screening recommendations and best practice, highlighting the importance of screening both for the reduction of preventable sight loss amongst children and safeguarding access and participation in education. He discussed how the National Screening Committee decides whether a screening programme should be continued or introduced, outlining the recommendations related to vision and the screening requirements from the Department of Health Child Promotion Programme. Dr Elliman indicated that the National Screening Committee was about to write to all Directors of Primary Care Trusts reminding them of the importance of local screening and suggesting an audit to develop a better understanding of the circumstances within their local area.
Professor David Thomson supported the case for vision screening, presenting evidence that eye problems among children are common (10-20%), usually remediable and have the potential to affect children’s social and educational progress. However, he argued that the recommendation that the screening should be carried out by orthoptists was unworkable given that over 700,000 children require screening each year and there are approximately 1300 orthoptists in the UK, many of whom are unavailable to carry out screening. He also argued that providing a single screening on school entry was inadequate because it assumed that the screening would be sensitive and specific (difficult when screening 4-5 year olds in school), and that children will not develop problems after this age or at least if they do, they are either unimportant or the child will recognise the problem and parents will take appropriate action.
Professor Thomson presented an alternative model that had been developed in collaboration with the orthoptists in Barnet and implemented by four Primary Care Trusts. He described how software had been developed to manage the entire screening process. Screening assistants, trained by the orthoptists and equipped with laptops, use the software to carry out the primary screening. The software then automatically generates customised letters for the parents of each child. He went on to describe how children who fail the screening are examined by a team consisting of orthoptists, optometrists and ophthalmologists in a secondary clinic. Results of an evaluation of the software on 336 children aged 4-5 years in six Barnet schools showed that the screener had a sensitivity and specificity of 94% and 98% respectively when compared to a clinical evaluation. This model had proved to be so cost-effective that an additional screening at the age of 7 was to be introduced in Barnet this academic year. Professor Thomson concluded, “given the amount of money that we spend on our children’s education, surely it is worth providing a 3 minute check to ensure that no children are disadvantaged by poor vision at school”.