Literature review

National Children's Vision Screening Project

31 Jul 2008

The National Children’s Vision Screening Project has been funded by the Commonwealth Department of Health and Ageing to inform future policy by determining the effectiveness of vision screening for children aged from birth to 16 years in Australia. The literature review was commissioned to evaluate screening programs designed to detect vision conditions such as diminished visual acuity, amblyopia, strabismus or squint, refractive error, cataracts and glaucoma.

The review examines the effectiveness of vision screening programs for populations with a low to moderate risk of developing a vision condition. Populations who are at high risk of developing a vision disorder, including children born prematurely, children in remote indigenous communities and children with multiple disabilities, require separate assessment, diagnosis and follow-up treatment and care.

Vision screening programs alone are not considered appropriate to meet the particular needs of these populations. Vision screening is different to assessment and diagnosis, and this review focuses solely on the former. Screening consists of a test or tests, generally quick and easy to administer and score, that determine whether a child meets certain criteria considered normal or ‘healthy’ for his or her age group. A screen does not provide a definitive diagnosis, but determines who should and should not be referred on for a more comprehensive eye examination. The decision to commence, terminate or modify a health screening program can be contentious. There are certain criteria that screening programs ought to meet in order to effectively identify health conditions, and in order to effectively refer on for reduction, treatment or amelioration of these conditions.

The screening of vision in children has been widely debated in the literature, with researchers, eye experts, economists and other professionals divided over whether vision screening should occur at all. For those who believe an Australian vision screening program should be in place, there is a lack of consensus about how and when it should occur. There is a lack of evidence, or lack of consistent evidence, regarding when vision disorders can be detected, whether disorders detected can improve over time without treatment, at what age treatment is most effective, what tools or tests are the most accurate and effective measures of vision disorders and who is best placed (in terms of accuracy, availability and cost-efficiency) to conduct vision screens. 

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