Ocular and vision defects in preschool children.

Ocular and/or vision defects are one of the commonest reasons for the referral of young children to hospital. In a survey of a birth cohort in one health district, 7.1% of children were diagnosed as having such defects by their fifth birthday; 2.1% were detected before the age of 2 years, and 5.1% between 2 and 5 years. Up to the age of 2 years, low birthweight children and those who require postnatal special care had a higher risk of having an ocular or vision defect diagnosed and were more likely to have serious visual impairment than other children. In contrast, between the ages of 2 and 5 years of age these high risk children showed no continuing increased risk of having a defect diagnosed, nor did they show any differences in the severity or type of vision defects compared with other children. Averaged over the years studied, the incidence of defects presenting to specialist eye clinics among all 2-5 year olds was 1.7%, higher than the 1.1% found for 0-2 year olds. This increase consisted primarily of children with refractive errors only.

Orthoptists reduce false-positive hospital referrals.

This paper describes changes in the pattern of new referrals of children from birth to 2 years-of-age to the Hospital Eye Service in Oxford, following the implementation of a community-based orthoptic secondary vision-screening programme. The findings show that the number of false positive referrals was reduced by a half following the introduction of the service; false-positive referrals were also discharged sooner. This paper reports the findings of this survey and the results demonstrate the cost-effectiveness of the programme compared to outpatient attendance.

Ocular and visual defects in a geographically defined population of 2-year-old children.

Ocular and/or visual defects were diagnosed by age 2 years in 2.1% of infants born in 1984 in one health district. Infants of low birth weight or infants requiring special care in the neonatal period had a two and a half times greater risk of vision and ocular defects than the remainder of the population. In particular, the rate of squint and neurological disease affecting the visual system was significantly greater in this high risk group than in the low risk group. The degree of visual impairment in the high risk group tended to be more severe than in the low risk group. Overall, however, the majority of children with vision or ocular defects (85%) were in the low risk group.

Vision screening at 8 and 18 months. Steering Committee of Oxford Region Child Development Project.

OBJECTIVE: To determine the effectiveness of an existing screening programme based in the community for ocular and vision defects in infants considered at increased risk of such defects. DESIGN: Children with ocular or vision defect by the age of 2 were ascertained by searching records. Those from populations at high risk were matched with their results from screening tests. The characteristics of the cases among this population were compared with those of the cases in the remainder of the population. Patterns of referral and age at referral were studied in both groups. SETTING: The study was conducted within Oxfordshire Health District. SUBJECTS: 433 Children at high risk born in 1984 to mothers living in the health district at delivery and who either weighed less than 2000 g or weighed 2000 g and over and required admission to a special care nursery for longer than 24 hours. The low risk population (6254) were infants without these characteristics who were resident in the health district at the time of referral. INTERVENTIONS: Screening tests for vision or ocular defects already routinely used were applied by health visitors at 8 and 18 months to the children at high risk. MAIN OUTCOME MEASURE: Comparison of results of screening tests with vision and ocular defects detected by the age of 2. RESULTS: Screening tests in current use for vision loss and squint in this age group were insensitive and had a low positive predictive value when applied to a high risk population. Defects that were not apparent on direct inspection were unlikely to be detected by these tests. In the high risk group the relative risk of having a defect was 2.8 (95% confidence interval 1.8 to 4.5) but 85% of all cases detected by the age of 2 were in children at low risk. Referral patterns and age of referral differed in the two groups. CONCLUSIONS: Screening by health visitors of high risk populations contributes little to the detection of vision and ocular defects. This type of evaluation needs to be applied also to low risk populations, who have different referral patterns and contribute most of the cases.