Paediatrics: Vision screening in the UK

Vision screening in the UK

Neonatal examination

•   To detect congenital ocular abnormalities, e.g. cataract, corneal opacities, microphthalmia, glaucoma and retinoblastoma.

•   Ask about family history of these disorders.

•   Use a (bright) ophthalmoscope to examine the eye and red reflex.

•   An indistinct red reflex can be caused by cataracts/corneal opacities.

•   Retinoblastoma or abnormal retina can cause a white reflex.

•   The red reflex may be darker in Asian and Afro-Caribbean babies.

•   Refer on if in doubt.

Community screening

•   At 6wks: GP asks parents about their baby’s visual behaviour. Baby should be able to fix and follow a face and large toy. Red reflexes checked with an ophthalmoscope. Squint assessment.

•   At 7–8wks: health visitor observes visual behaviour. Parents advised of what to look for regarding expected future visual development.

•   At 4–5yrs: orthoptist checks monocular visual acuity and ocular alignment, children achieving <6/9.5 are referred.

Secondary screening 

Orthoptic programme for children referred by par-ents, health visitors and GPs whenever a concern regarding vision or squint is raised.

Eye examination techniques

Visual examination

•   6–8wks: baby should fix and follow a bright target and your face.

•   4mths: baby should not squint and should fix and follow toys.

•   6mths: baby should reach out for toys.

•   2–3yrs: use picture charts (e.g. Kays pictures).

•   4–5yrs: use letter charts (e.g. Snellen +/– matching letter card).

Eye movements

•   Use a bright toy to attract attention and move in a ‘H’ shape to assess the action of each muscle.

•   Cover test for squint assessment (see Fig. 24.1).

Anterior segment examination

•   Use ophthalmoscope set on +20 for a magnified view of the front of the eye, click in the cobalt filter for fluorescein examination.

•   Instill anaesthetic drops prior to examination if the child is in pain.

•   Check the diameter of the corneas are equal and that the light reflection from each is bright.

•   Check the red reflex in both eyes is equally bright.

Posterior segment examination

•   Ask the child to look at an interesting target over your shoulder when trying to examine the optic disc.

•   Dilating drops are safe to use, but will interfere with neuro-

observations for 24hrs: use 1% cyclopentolate (if <1yr old use 0.5%)