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Scottish Pre-School Vision Screening – First 3 Years of National Data

ABSTRACT: Introduction: Pre-school orthoptic vision screening (POVS) was implemented by the Scottish government and is a standardised assessment to promote early detection of visual problems in children. The target conditions are amblyopia, refractive errors and strabismus. We present the preliminary findings for the first three years of the screening program. Methods: The data from POVS was collected retrospectively. The data includes screening years 2013 to 2016 inclusive. Data was collected from each health board in Scotland. We report the coverage, referral rate, true positives and positive predictive values. Results: A total of 167,962 children were due to have vision screening over the 3 screening years included in this paper. This figure does not include the children that opted out of the eye test (mean opt-out rate 1.8%) and children that already attend the hospital eye service (mean already attend rate 3.1%). The POVS program had a mean coverage of 85.5%, ranging from 63.7% to 94.8% between health boards. Over the 3 year screening period, the mean referral rate was found to be 17.9%. The mean true positive rate was 88.9%, and the mean positive predictive value was 86.9%. Conclusion: The Scottish data set on pre-school orthoptic vision screening has shown excellent mean coverage. A consistently high true positive rate over the three screening years demonstrates it is a sensitive screening program, which is essential for the detection of visual problems in children.

SUBMITTER: Pentland L

PROVIDER: S-EPMC7510547 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Project description:Background:We investigated whether specific appointments for quality-assured care could increase referral uptake, often low in China, in children's vision screening. Methods:We randomized children aged 4-7 years in Yudu, Jiangxi, China, by school to Control (free school-based eye screening, parents of children failing screening recommended for further examination [usual practice]) or Intervention (identical examinations, with parents additionally provided with specific appointments for further examinations by quality-assured doctors at a designated local hospital). Both groups could select any hospital for referral exams, which were not free. Six months after screening, parents were interviewed on referral compliance at any hospital (primary outcome) and potential determinants. This trial is registered at the ClinicalTrials.gov, number NCT03251456. Findings:Among 9936 children at 63 schools randomized to Intervention (32 schools, 5053 [50·9%] children) or Control (31 schools, 4883 [49·1%] children), 1114 children (11·2%) failed screening. Among 513 referred Intervention children (46·1%, 32 schools, mean age 5·36 years, 53·0% boys) and 601 referred Control children (53·9%, 31 schools, mean age 5·30 years, 57·7% boys), 104 (20·3%) and 135 (22·5%) were lost to follow-up respectively. Under Intention to Treat analysis, assuming children lost to follow-up were non-compliant, Intervention children had significantly higher compliance than Controls (308/513 = 60·0% vs. 225/601 = 37·4%, P < 0·001). In regression models, Intervention group membership (Relative risk [RR] 1·53, 95% confidence interval, 1·36-1·72), travel time to hospital (RR: 0·97, 0·95-0·999), baseline glasses wear (RR: 1·37, 1·17-1·60), strabismus (RR: 1·17, 1·01-1·36) and worse uncorrected vision (RR: 1·41, 1·03-1·92) were associated with compliance. Interpretation:Providing specific appointments for quality-assured eye care improved referral compliance in this setting.

Project description:BackgroundWe applied the National Screening Committee vision screening protocol [pass criterion monocular acuity ≤ 0.2 LogMAR in both eyes(BE)] to children four to five years old to investigate the visual profile of children who passed/failed. Previous studies have only evaluated those failing. The aim was to derive false positive and negative values, specificity/sensitivity of the vision screening protocol for detecting significant visual defects (strabismus and/or significant refractive error) and the utility of a 'plus blur test' in identifying hyperopia.MethodsParticipants included 294 children (5.2 ± 0.4 yrs). In addition to the vision screening protocol (monocular acuity-3 m crowded Keeler LogMAR letters), acuities were recorded through +2.50D and +4.00D lenses and ocular alignment and cycloplegic refractive error were assessed. Using acuity measures, participants were classed as passing/failing the screening protocol. Each participant was also classed as having a strabismus and/or significant refractive error (hyperopia ≥ +4.00DS; myopia ≤ -0.50DS; astigmatism ≤ -1.50DC; anisometropia ≥ +1.50DS) or no significant visual defects.ResultsOf the 284 children who completed all tests, 27.8% failed to achieve 0.2 LogMAR in BE. The acuity pass/fail criterion had a sensitivity of 70.4% and specificity of 82.2% for detecting strabismus and/or significant refractive error. Of those who failed, 51.9% (n = 41/79) had no strabismus and/or significant refractive error (false positives). Of those who passed, 7.8% (n = 16/205) had visual defects (false negatives). The 'plus blur tests' improved sensitivity in detecting significant refractive error (+2.50D & +4.00D 90.7%) but significantly reduced specificity (+2.50D = 65.2%; +4.00D = 60.9%).ConclusionsSchool-entry vision screening is reasonably sensitive and specific for detecting strabismus and/or significant refractive error. Most children with visions poorer than 0.2 LogMAR need refractive intervention, and the majority of the remainder are likely false positives for significant visual defects. One in 13 children who pass have either strabismus and/or significant refractive error (7.8%). The inclusion of a 'plus blur test' was not a useful addition to the vision screening protocol.

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Scottish Pre-School Vision Screening – First 3 Years of National Data

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