Vision Screening for Children

Providing 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 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 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 -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 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 considerations 0-5 years: very difficult to measure visual acuity no captive audience so logistically difficult 6-11years: hypermetropia>myopia in most populations most children are enrolled in primary school 12+ years: myopia > hypermetropia in most population fewer children in secondary school those with poor vision may have dropped out

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? -Wheel of Vision Need an occluder, pinhole and lens

Method 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).

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.

Amblyopia 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.

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