Vision Screening for Children Vision Screening for Children

Providing optical services for childrenProviding optical services for children

• Reactive:– clinic based– outreach based

• Pro-active:– school vision testing programmes

• For both need to consider:– Magnitude of the problem (need)– personnel– spectacles needed– cost

School “screening” School “screening”

Decisions that need to be made:• Aim of the programme• Age at vision testing• Who will measure the vision and how• Will the programme include other components

e.g. eye health education • How will services be provided• Who will pay for the programme and the

services• How will the programme be monitored and

evaluated

Aim of school vision testingAim of school vision testing

• Options:– To detect visual

impairment in young children so that amblyopia can be prevented / corrected

– To detect all refractive errors however small, and whether unilateral or bilateral in older children

– To detect significant refractive errors and diseases in older children

Screening Screening

• -Frequency of screening will depend on available resources and magnitude of the problem

• -In countries where evidence indicates that the prevalence of significant refractive error is high in younger age groups, screening of these children should be considered.

Age of vision screeningAge of vision screening

• Options:– Preschool age– If the aim is to detect

and treat conditions that may lead to amblyopia (i.e., refractive errors, eye disease causing visual impairment, and strabismus) the programme must focus on pre-school age children.

– Primary school age Secondary school age

Age considerationsAge considerations

0-5 years:• very difficult to measure visual acuity• no “captive audience” so logistically difficult6-11years:• hypermetropia>myopia in most populations• most children are enrolled in primary school12+ years:• myopia > hypermetropia in most population• fewer children in secondary school• those with poor vision may have dropped out

What should the screening involve?What should the screening involve?

• -VA, Cover Test, Objective Retinoscopy???, Ocular health inspection????

• -Need an optom or ophthalmic nurse

• School teacher or community worker

How do we conduct screening?How do we conduct screening?

• -Wheel of Vision• Need an

occluder, pinhole and +2.00 lens

Method of TestingMethod of Testing

• The method of vision testing needs to be valid.

• The test should identify those children who will benefit from spectacles.

• The test should not refer too many children who cannot benefit from treatment (false positives), as this will cause anxiety in the families and overload the available services.

• The test should not miss children who need spectacles (false negatives).

ChildrenChildren

Refractive error in Children Refractive error in Children

• -Should only occur when appropriate resources for follow-up refraction and delivery of spectacles.

• -Visual acuity screening of children can be performed at community level by teachers, health care workers etc.

AmblyopiaAmblyopia

• Children with binocular vision of 6/12 or better, with a visual acuity difference between the two eyes of more than two lines on the chart, should be referred for a refraction as amblyopia is a consideration.

• Thank You