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Paediatric Ophthalmology

The UK National Screening Committee policy on Vision defects screening in children – December 2013

The Royal College of Ophthalmologists supports the recommendation of the National Screening Committee that screening for visual impairment in children, between the ages of 4 and 5 years, should be offered by an orthoptic-led service. http://www.screening.nhs.uk/vision-child

The College strongly advocates early screening for the detection of visual problems and eye disorders in children at the appropriate age. Early detection of amblyopia, for this age group, is critical to avoid permanent visual impairment and improve the provision and outcomes for children with eye conditions such as refractive error and strabismus. Ophthalmic professionals should support local implementation of the existing national recommendations. All screening programmes should be part of a regular audit cycle.

The UK National Screening Committee regularly reviews policy on screening for different conditions in the light of new research evidence becoming available.


Added 3 November 2011 – Squint Surgery Care Pathway Example

An Squint Surgery Care Pathway Example has been added to the website for local adaptation. The form is in Word format so it can be tailored for local use.


Statement on Visual Screening in Children and Young People July 2011

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. 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.
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Guidelines for Screening for Uveitis in Juvenile Idiopathic Arthritis (JIA)

Aim of the screening programme: To reduce the incidence of visual impairment among children and young people with juvenile idiopathic arthritis (JIA) by early detection through screening allowing for early intervention.