Children’s Vision Screening

Children’s vision screening during the Covid-19 pandemic

(Updated April 2021)

Covid-19 has meant that child vision screening services have been delayed, postponed or cancelled for some of the children who started reception year in 2019 (and possibly some who started in 2020), resulting in a backlog of children who have not been screened. In response to this situation, The Clinical Council for Eye Health Commissioning (CCEHC) has made recommendations for alternative arrangements for these children to have their vision tested.

Full details of the recommendations can be found here:

We have been advised by the head orthoptists at both Stoke Mandeville and Milton Keynes hospitals that the local plan is for the school nursing teams to address the backlog as soon as that is feasible, meaning that the impact on local community optometry should be minimal.

Prior to the pandemic, the LOC made contact with the head orthoptists at Stoke Mandeville and Milton Keynes, to clarify the local protocol for vision screening of primary school children. Their responses are reproduced below.

Milton Keynes (reviewed in December 2019)

“All vision screening of children in mainstream state schools in the Milton Keynes area is undertaken by the school nursing team in Reception year. The service is orthoptic led, in line with national guidance. As such, the hospital team set the guidelines, teach the school nursing team, assess their competency and audit their referrals. The visual acuity pass rate is 0.2, using the Sonksen Logmar Test (SLT). Children are tested to a pass/fail criteria, and any children who fail the test are referred to the hospital service for an orthoptic assessment and cycloplegic refraction with the optometrist. This process facilitates a more comprehensive data analysis for undertaking audit regarding outcomes, which enables the team to provide information for the BIOS led national screening audit. In addition, it enables those children who are not brought to their appointment to be identified, offered a further appointment, and appropriate action taken to notify their GP of the non-attendance.

There are plans to implement vision screening for children in special schools in the area, as this requires more specialist testing by an orthoptist, which is different from the screening provided in mainstream schools by the school nursing team.”

Tracy Crowley, Head Orthoptist, Milton Keynes University Hospital

Mid and South Bucks (reviewed in December 2019)

“All children in state schools in the mid and south Bucks areas are tested by a School Nurse or assistant in Year 1 or sometimes in Reception using the computerised Thomson LogMAR Vision Screening Tool. Referral is then made either to a High Street Optometrist or Orthoptist as per guidelines agreed between the School Nursing team and the Buckinghamshire Healthcare Trust Orthoptic Department. Our guidelines state that equal unilateral vision of 0.2 is satisfactory as per the British and Irish Orthoptic Society Vision Screening guidelines. Where there is a difference of one line only or equally reduced vision up to 0.375 then the parent will be advised to take the child to a High Street Optometrist. If there is two lines difference in vision or equally reduced vision of 0.4 or worse then referral to the Orthoptic Department is recommended. Whilst the School Nurses do not test specifically for strabismus, referral to the Orthoptic Department is recommended should there be any concern in that regard. When a child is referred to the Orthoptic Department from the School Nursing service, the first hospital appointment will include an orthoptic assessment and a refraction by a Hospital Optometrist.”

Asha Sharma, Lead Orthoptist, Buckinghamshire Healthcare NHS Trust

Special School Eye Care Service

Significant progress has been made on this project. A video has been produced for clinicians: NHS Special School Eye Care Service – Clinicians. Whilst the rollout hasn’t yet reached our area, when it does, the Special School Eye Service will be looking to engage performers to put their names forward.