Screening and surveillance for ophthalmic disorders and visual deficits in children in the United Kingdom

Children are a priority in “Vision 2020”, the World Health Organization's recently launched global initiative for the prevention of avoidable visual impairment by the year 2020.1Successful implementation in the United Kingdom will depend to a greater extent on improvements in secondary and tertiary preventive strategies, to treat and rehabilitate affected children, than on the currently limited primary preventive approaches to the major paediatric eye diseases. Early detection is important to the successful management of children with ophthalmic disorders. In recognition of this, over the past few decades in the UK diverse activities have been implemented to promote early detection of specific ophthalmic conditions in children as well as to monitor their visual development. These comprise physical examinations by various health professionals and effectively form a continuum of screening and surveillance whose purpose and value is best considered in terms of sequential gain. Although now well established, these practices have arisen haphazardly and few have been subject to rigorous evaluation of their benefits. Indeed the scientific basis of some has been seriously questioned.2 In the UK they are undertaken within the broader context of a national programme of child health surveillance.3 Changes in this, such as the increased emphasis on health promotion,3 increasing responsibilities of general practitioners,4 and reconsideration of the roles of health visitors and school nurses,5 consequently have implications for ophthalmological screening and surveillance. The Children's Sub-Group of the National Screening Committee (NSC) of the UK has recently reviewed screening for ophthalmic disorders and visual deficits in children for the first time. The NSC categorised existing activities into five separate screening programmes for retinopathy of prematurity (ROP) in preterm/low birthweight infants; congenital cataract and other ocular anomalies in newborn and young infants; amblyopia and impaired vision in preschool age children; impaired vision, …