Letters

Future of preschool vision screening

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7135.937a (Published 21 March 1998) Cite this as: BMJ 1998;316:937

Conclusions for or against services are invalid without appropriate research evidence

  1. C Williams, Senior registrar in ophthalmology,
  2. R A Harrad, Consultant ophthalmologist,
  3. J M Sparrow, Consultant senior lecturer,
  4. I Harvey, Consultant senior lecturer in public health medicine,
  5. J Golding, Professor of paediatric and perinatal epidemiology
  1. Taunton and Somerset Hospital, Taunton TA1 5AB
  2. Bristol Eye Hospital, Bristol BS1 2LX
  3. Department of Social Medicine, University of Bristol, Bristol BS8 2PR
  4. Institute of Child Health, University of Bristol, Bristol BS8 1TH
  5. Strabismus and Paediatric Service, Moorfields Eye Hospital, London EC1V 2PD
  6. Moorfields Eye Hospital, London
  7. Academic Unit of Ophthalmology, Imperial College School of Medicine, Western Eye Hospital, London NW1 5YE
  8. Moorfields Eye Hospital, London EC1V 2PD
  9. Department of Epidemiology and Public Health, Institute of Child Health, London WC1N 1EH

    EDITOR—Rahi and Dezateux highlighted the current dilemma about preschool vision screening.1 A systematic review has detailed the lack of published evidence on whether the target conditions (amblyopia, non-obvious squint, and refractive error) are disabling and whether detection at preschool age results in better treatment outcomes than detection at school age.2

    The review concludes that published hard evidence is lacking on preschool vision screening but then recommends that providers consider discontinuing current programmes. Without appropriate high quality research evidence, conclusions either in favour of or against these services are equally invalid. Ongoing research into this subject has occurred within a multidisciplinary birth cohort study of 14 000 children born in Avon between April 1991 and December 1992.3 A randomised controlled trial of screening methods for ocular defects in children under 3 years of age has collected data on whether any disability in social, physical, or cognitive function is associated with the target defects at the age of 41/2 years. 4 5 The birth cohort study aims to complete a detailed, multidisciplinary assessment of all 14 000 children at the age of 7 years, half of whom will have had preschool vision screening while the other half will have not. This will provide high quality data on whether the target defects are associated with suboptimal performance in other areas of life at this age and, if so, whether preschool screening resulted in a better outcome (visual, educational, or developmental) than screening at school age. As stated in the review,2 these data are necessary to decide whether to support preschool vision screening.

    The review's recommendations lack …

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