Category: Vision Screening

Today, we’ve launched a crucial service evaluation to assess the current state of child vision screening in the UK and Ireland. This has been sent out to all heads of service across the UK, but we encourage responses from all orthoptists.

The current landscape of child vision screening is fragmented, and a unified dataset is required to drive systemic improvements. This strategic data collection is vital for understanding existing clinical practices and shaping future policy decisions.

The primary objectives are to generate data that provides a comprehensive overview of:

1. Current clinical protocols, referral pathways, and quality-assurance methods.
2. Map the overall provision across the UK and Ireland
3. Highlight barriers related to staffing, training, and service sustainability.

This service evaluation is being conducted as part of a research project led by Dr Cath Jukes. The aim of this BIOS project is to gather compelling information and develop proposals to support the creation of an equitable, high-quality nationwide vision screening program.

This is an opportunity for orthoptists to actively shape the future of eye care for children. Please help us advocate for the quality and accessibility of child vision screening services by taking part.

The results of our survey of child vision screening services in England show a concerning rise in the number of local authorities not offering any form of reception-age screening.

Since 2019, when we last surveyed services across England, a further five local authorities have decommissioned child vision screening, meaning that 14 no longer offer this service, affecting around 75,000 reception-aged children every year. There is a risk this could result in visual defects in children going undetected and potentially becoming irreversible. In addition, undetected vision problems can prevent children from fully accessing their education

Equitable population vision screening, organised and led by an orthoptist, is recommended by the UK National Screening Committee and in the Public Health England guidance from 2017. Orthoptist-led child vision screening primarily aims to pick up Amblyopia, where the vision in one or both eyes doesn’t develop properly.

It is estimated that 1 in 50 children will develop this condition but it is rare for children to complain of poor vision, particularly if it only affects one eye, meaning this can easily go unnoticed. Reduced vision can have an impact on a child’s learning and development. Vision continues to develop in children until around eight years of age, therefore early detection and treatment helps avoid permanent visual impairment.

• 57% of local authorities have orthoptic-led vision screening following PHE guidelines

• 33% of local authorities have vision screening services that do not follow PHE guidelines (29%) or did not confirm whether or not they follow PHE guidelines (4%)

• 10% of local authorities do not have any form of vision screening for 4-5 year olds

Of the 138 local authorities we received details on, 56.6% were covered by child vision screenings services that followed guidelines set out by Public Health England A further 33.3% of local authorities offered screening services that either did not follow these guidelines or we were not able to confirm whether they followed.

While the UK government, responsible for health policy in England, accepts the need for Orthoptic-led vision screening, they have not made this mandatory, unlike other forms of screening. This is in spite of the UK National Screening Committee of Public Health England recommending orthoptic-led screening for all 4-5 year olds.

This survey highlights the need for a nationwide mandatory orthoptic-led child vision screening programme. This would address the existing health inequalities in this vital area of a child’s development.

This has led to large inconsistencies in the availability of vision screening across England. Significant financial constraints and the lack of a mandate for vision screening has meant increasing numbers of local authorities decommissioning services. There is also some confusion as to who should be ensuring these services are provided.

As Health is devolved, the situation in Scotland, Wales and Northern Ireland is much more promising with all three countries offering nation wide programmes, demonstrating the feasibility of a nationwide approach.

Map showing child vision screening services decommissioned since 2020 (red), alongside services that did not exist in 2020 (pink)

BIOS advocates for a mandated orthoptic-led national screening programme in England, to ensure all children receive the same care when they need it, regardless of where they live.

Find out more about our campaign

Child vision screening 2019 – services are available but still work to do!

Orthoptic-led child vision screening aims to pick up amblyopia (commonly known as “lazy eye”), where the vision in one or both eyes does not develop properly. It is estimated that 1 in 50 children will develop this condition. Often younger children are unaware there is anything wrong with their vision, as they have grown up with and become used to it. If undetected, the condition can result in lifelong and irreversible reduced vision in the affected eye.

A Freedom of Information (FOI) in request in 2019 by the British and Irish Orthoptic Society (BIOS), on behalf of the Clinical Council for Eye Health Commissioning (CCEHC) shows that some form of vision screening is currently available in 94% of local authority areas in England, commissioned either by the Local Authority (LA) or by the local Clinical Commissioning Group (CCG).

However, there are variations in the delivery and quality assurance of vision screening services with only 47% of local authority areas fully compliant with service specifications recommended by Public Health England (PHE).  65% of areas providing the service had some processes in place for monitoring uptake of screening.

Where services do exist, some responses indicate they may be vulnerable to changing priorities and funding cuts, with six LAs reporting that their services were currently being reviewed, with the potential for them to be decommissioned.

Commenting on the findings:

Alison Bruce, co-lead of the vision screening clinical advisory group of BIOS said: “Screening to detect reduced vision at school entry should be available to all children no matter their socio-economic or ethnic background. It provides the opportunity to treat visual deficits that can impact on future life chances.”

Parul Desai Chair CCEHC and Veronica Greenwood Chair BIOS – “Given the current financial constraints, the CCEHC welcomes the wider availability of child vision screening services in England.  The focus should now be on ensuring that services compliant with PHE specifications are provided in all areas to address any disparities in service availability, quality and outcomes.”

• You can read the full report here.
• BIOS have created an interactive map, presenting the current level of service availability, which can be accessed here.

• Free NHS-funded sight tests are available at all Opticians (primary care optical practice) for children under 16 and for young people under 19 in full-time education. https://www.nhs.uk/using-the-nhs/help-with-health-costs/free-nhs-eye-tests-and-optical-vouchers/

https://www.orthoptics.org.uk/wp-content/uploads/2020/03/Map-e1583323632757.png

If you are interested in finding out more:

The full report can be downloaded here.

Access our interactive map here.

Read more about BIOS’s campaigning on vision screening here.