Vision Screening for Children

1. Vision Screening for Children

2. 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

3. 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

4. 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

5. 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.

6. 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

7. 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

8. What should the screening involve? • -VA, Cover Test, Objective Retinoscopy???,Ocular healthinspection???? • -Need an optom or ophthalmic nurse • School teacher or community worker

9. How do we conduct screening? • -Wheel of Vision • Need an occluder, pinhole and +2.00 lens

10. 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).

11. Children

12. 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.

13. 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.

14. Thank You