We believe that optometry is an important resource for all children and especially those with conditions where early intervention can prove successful, such as correction of refractive errors, amblyopia and strabismus. We want to ensure that all practices are equipped to deliver eye care for young children, and we encourage parents to take children for sight tests from an early age, building good eye health habits into adulthood.
Spotting visual problems early
Visual problems can have a significant impact on a child’s learning and social development through poor literacy, and non-diagnosis can lead to inappropriate interventions.1
Identifying visual problems early on in life will ensure that children receive the appropriate educational support and assistance. But while all optometrists are equipped to deliver eye care for children and detect visual problems, many don’t get the opportunity to maintain their skills because it’s uncommon for parents to take toddlers and young children for sight tests.
Many parents assume that their child will have their vision checked at school regardless of whether it happens or not. Unfortunately, not enough parents know that they should take their child for a sight test at least every two years. All children are entitled to an NHS-funded sight test when clinically necessary.
Following UK National Screening Committee guidance, vision screening should be provided for children across the UK by an orthoptic-led service. However, in practice this provision is patchy, with some areas providing no screening at all. A 2011 Which? survey reported that out of 110 Primary Care Trusts in England, 11 said that they had no screening programme, while 42 failed to respond. Evidence suggests that the situation has not improved . Statistics from the Centre for Workforce Intelligence (CFWI) reveal insufficient numbers of orthoptists to provide the service nationally.8
Even if sufficient vision screening for children took place across the UK, the screening protocol only consists of a measure of monocular vision, primarily designed to detect amblyopia (lazy eye) and strabismus. This monocular vision screening alone is a poor predictor of hyperopic (long-sightedness) or astigmatic refractive errors.4 Given that significant refractive errors are the most common reason for vision screening failure, it’s important for optometrists to play a central role.
A growing role for optometrists
Optometrists are already funded by the NHS, through GOS, to test children’s eye sight and can identify conditions including myopia, amblyopia, hyperopia, astigmatism and strabismus. If left neglected conditions such as strabismus and amblyopia may have a significant detrimental impact on children, yet they can often be corrected if caught early. What’s more, with the increasing prevalence of myopia and the possibility of limiting its progression through optical corrective means there’s a growing role for the optometrist throughout childhood and teenage years.5
Providing continuing eye care
Optometrists could also (through locally or nationally commissioned services) provide continuing care for children with specific conditions and refer them into secondary care if necessary. There are several regional examples of shared care pathways between optometrists and secondary care, for example, conducting cycloplegic refraction and managing the commencement of amblyopia or strabismus treatment with correction of significant refractive error. Optometric practices can also provide dispensing services where a child is under the care of hospital eye services.
Adapting to children’s needs
Children may not realise when their vision is poor and are less likely to mention visual problems. Spotting them is, however, critical to their future health. Children develop rapidly too and so are less likely to have stable refractive errors. Recent work has established that children with a mean spherical equivalent refractive error of less than +0.75DS at the age of six are at increased risk of developing myopia.6 Children with learning disabilities also have a higher prevalence of visual problems.7
There are benefits that reach beyond the young patients’ ocular health, too. Providing eye care to children can help develop practices build relationships with the whole family whose eye care needs can be looked after by an optometric practice in the community. As well as the benefits to the patient, practitioners often find that providing eye care for children and families is rewarding, stimulating, and enjoyable. Not only is providing children’s eye care a vital service in diagnosing eye conditions early on in life, it helps encourage continuing care into adulthood and cements the importance of eye health at the heart of every community.
- Zheng Y, et al. (2011) Literacy is an independent risk factor for vision impairment and poor visual functioning Invest Ophthalmol Vis Sci, 52(10): 7634-9
- ABDO (2015) ABDO commissioned survey reveals parents not focused on children’s eye care
- Knapton, S (2015) Thousands of children missing out on eye tests, Daily Telegraph
- O'Donoghue L, et al. (2012) Visual Acuity Measures Do Not Reliably Detect Childhood Refractive Error - an Epidemiological Study PLoS One, 7(3)
- Smith E III. (2013) Optical treatment strategies to slow myopia progression: Effects of the visual extent of the optical treatment zone Experimental Eye Research, 114: 77-88
- McCullough SJ et al (2014) British Congress of optometry and Vision science Ophthalmic & Physiological Optics, 34(6): 685-686
- Emerson E & Robertson J (2011) The Estimated Prevalence of Visual Impairment among People with Learning Disabilities in the UK RNIB and SeeAbility
- Centre for workforce intelligence (2012) Orthoptists: Workforce risks and opportunities
Position statement reviewed: November 2016
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