Vision screening referral criteria: an audit

Aims: To investigate whether children with significant refractive errors are going undetected at screening using the referral criterion of visual acuity worse than 0.20 logMAR. To review the refractive status of children referred to community clinics from the reception class screening test with visual acuities of between 0.15 and 0.20 logMAR inclusive. Methods: Primary visual and orthoptic screening was performed in the reception classes of the mainstream primary schools in the south Birmingham area. The children whose visual acuities were found to be between 0.15 and 0.20 logMAR inclusive were recorded. A spreadsheet was created for each academic year. The following were recorded: visual acuities at screening; the visual acuities at first visit to the clinic; the results of refraction; whether glasses were prescribed or not; and whether the child was followed-up. Results: Over a 5-year period, 348 children were recorded who came within the audit criteria. Of these, 275 attended their first appointment, 240 were refracted and 122 of these were prescribed glasses. These 122 represent 35.1% of all the children included in the audit and 50.1% of the children who were refracted. A total of 221 children (80.4%) had follow-up appointments. The reasons for follow-up were analysed. Conclusions: Significant refractive errors are going undetected at reception class screening with the visual acuity referral level set at less than 0.20 logMAR. The age at which the universal screening is carried out needs to be more precisely identified in screening programmes.