Children's eye care

There are some key things that all parents should know about their children's eye care:

• Spotting visual problems early in children is important
• Schools don’t always check for vision problems - and where they do, school vision screening is limited and less thorough than a full sight test
• Regular sight tests are the best way to spot vision problems in children early
• Sight tests for children are free and the NHS provides a voucher towards the cost of glasses
• We recommend parents arrange for their children’s sight to be tested by an optometrist at least every two years 

We think parents need better information about children's eye health, and public health organisations should do more to promote it.

Spotting visual problems early 

Visual problems can have a significant impact on a child’s learning and social development, and non-diagnosis can lead to inappropriate interventions¹.  Identifying visual problems early on in life will ensure that children receive the appropriate educational support and assistance and makes a lasting difference to their health and development. 

But there are currently many children whose vision problems remain undiagnosed. A recent report found that an estimated 13% of UK children may have undiagnosed common sight problems that undermine their literacy and education – this equates to more than one in 10 in every classroom². Some eye conditions do not display any signs or symptoms, so the only way to know for sure is through a sight test with an optometrist. Unfortunately, not enough parents know that they should take their child for a sight test at least every two years. Our recent Voice of Optometry survey found that nearly three quarters of optometrists had seen children in the past year with vision problems that could have been treated more effectively if they had been diagnosed at an earlier age³. 

All children can have an NHS-funded sight test once a year if needed and more often if clinically necessary. NHS Vouchers subsidise the purchase of spectacles for children at a level that reflects the cost and type of prescription needed. 

We have published more information for parents about the importance of detecting vision problems early, attending for sight tests and about vision screening.

Vision screening 

The UK National Screening Committee recommends that local authorities should provide vision screening in schools for children aged 4 – 5. However, in practice this service is inconsistent across the UK, with some areas providing no screening at all.

Findings from a Freedom of Information Request 2019 March 2020 BIOS and the CCEHC (Clinical Council for Eye Health Commissioning)⁵ found 94% of local authority areas provided some form of a child vision screening service. Where screening services are provided, less than half (47%; n=47/148) are fully compliant with PHE service specifications. Transfer of responsibility for commissioning vision screening services remains incomplete. 30% of services continue being commissioned by CCGs, and a further 5% of services are either not formally commissioned or there is uncertainty over who commissions the service. 

We believe that all Local Authorities should commission vision screening for 4 – 5 year olds. These services should be based on the guidance and resources issued by Public Health England. This should also ensure quality and consistency across different areas.

Why a full sight test is important 

Parents should be aware that the vision screening programme is not a substitute for a sight test carried out by an optometrist. The screening protocol is primarily designed to detect amblyopia, or lazy eye, and other issues which can lead to a squint (strabismus). This approach does not detect all types of vision defects caused by how the eye focuses light (refractive error). For example, it is a poor predictor of long-sightedness (hyperopia) and astigmatism⁴. 

Since some common and significant refractive errors are not detected by vision screening, it is important that parents take children for regular sight tests with an optometrist. We recommend that parents arrange for their children’s sight to be tested by an optometrist at least every two years from about the age of three.

Better information is needed

Because of the importance of spotting visual problems early and the limited availability and scope of vision screening, we believe that parents should be offered better information about children’s eye health. 

The Association of Optometrists regularly campaigns to promote the importance of children’s eye health to parents and the public. We have published resources for patients and for our members. We think that statutory organisations such as Public Health England should do more to promote children’s eye health to both parents and children - nationally, locally and through schools and health providers.  

References  

1. 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
2. Education Endowment Foundation (2018) Preparing for literacy report
3. Association of Optometrists Voice of Optometry insight survey 2018
4. O'Donoghue L, et al. (2012) Visual Acuity Measures Do Not Reliably Detect Childhood Refractive Error - an Epidemiological Study PLoS One, 7(3)
5. Vision screening provision in children aged 4-5 years in England - Findings from a Freedom of Information Request 2019, March 2020