Information from the Paediatric Sub-Committee for Healthcare Professionals

Press release - Eye sector comes together to improve children's vision screening in schools (14 March 2012)

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Assessment and management of children with visual impairment - added 12 December 2011

The Vision 2020 UK Low Vision Committee has produced 4 articles relating to the assessment and management of children with visual impairment for ‘Optician’ which may be of interest to ophthalmologists.

Part 1 - Causes of vision impairment in children and young people, certification and registration

This article includes information on the causes of the certification. The College’s Paediatric Sub-committee notes that epidemiological data is also available from the research such as ‘Severe visual impairment and blindness in children in the UK’, Jugnoo S Rahi, Noriko Cable, on behalf of the British Childhood Visual Impairment Study Group (BCVISG), THE LANCET • Vol 362 • October 25, 2003 • www.thelancet.com

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Added 3 November 2011 - Squint Surgery Care Pathway Example

An example template form for strabismus/squint surgery has been added to the website for local adaptation. The form is in Word format so it can be tailored for local use.

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Statement on Visual Screening in Children and Young People

The Royal College of Ophthalmologists (RCOphth) supports the evidence-based national programme aimed at detecting vision defects in children through clinical examinations by appropriately trained staff (http://www.screening.nhs.uk/vision-child).

‘We are not aware of any evidence suggesting that there are a large number of children in the UK suffering irreversible visual loss and educational underachievement because of uncorrected refractive error. Children with significant visual problems should be detected by the evidence-based National Vision Screening Programs already in place. The RCOphth view is that a routine "sight test" is unnecessary in the absence of visual symptoms in children over 5 years of age.

There are certainly a few children who because of their social circumstances or co-existent medical/developmental problems manage to avoid having an ophthalmic or optometric problem diagnosed in a timely manner. Targeting such vulnerable groups would be a better use of resources and would also help to avoid the possibility of unnecessary prescription of low power spectacles to children with non-specific or unrelated symptoms.’

Paediatric Sub-committee of The Royal College of Ophthalmologists

The Royal College of Ophthalmologists strongly advocates screening for the detection of visual problems and eye disorders in children at the appropriate age. Early detection is important for improving the provision and outcomes for children with eye disease. Ophthalmic professionals should support local implementation of the existing national recommendations as shown in table 1 below.[1] All screening programmes should be part of a regular audit cycle.

Table 1

Target population	Recommendation
Neonatal period and early infancy
a. Very low birth weight and premature babies b. All newborns and 6-8 week infants	Specialist ophthalmic examination to detect retinopathy of prematurity UK retinopathy of prematurity guidelines 2008 Newborn and 6-8 week physical examination of the eye, including red reflex to detect media opacities (particular congenital cataract) and eye anomalies

Target population	Recommendation
Primary school age/entry (by 5 years)
All 4-5 year olds: to detect reduced visual acuity (primarily amblyopia)	Acuity measurement, each eye separately using LogMAR charts. Referral of children who do not achieve 0.2 in each eye (approx. 6/9 on a Snellen based linear chart), despite good cooperation. Conducted by orthoptists or by professionals trained and supported by orthoptists. To replace existing school entry vision screening programme if it exists. NO other preschool vision screening programme justified.

Target population	Recommendation
Secondary School age
11 years and above	Insufficient evidence to recommend either discontinuation of existing, or introduction of new, vision screening programme for refractive errors

There is no robust research to support any other vision screening in childhood.

July 2011

[1] Improving detection of visual problems and eye disorders in children through screening, JS Rahi and MP Clarke, Summer 2009, The Royal College of Ophthalmologists

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Paediatric CVI

The Paediatric Subcommittee has been working with the CVI Steering Group to improve the role of the CVI system as the national source of data on the frequency and causes of visual impairment in children. A new pilot paediatric form (paediatric CVI extended version,) has been developed which allows easier and more precise classification of paediatric eye disease and also allows international comparison of data.

Ophthalmologists are requested to complete the new form in addition to the current CVI and return them together in the usual way to The Royal College of Ophthalmologists, c/o Certifications Office, Moorfields Eye Hospital, City Road, London EC1V 2PD. The data collected using the new form will be analysed and disseminated along with an evaluation of the performance of the new form.

April 2007