Former Orthoptics Australia president MARION RIVERS outlines her ambition for a gold standard vision screening program for pre-schoolers across the whole of Australia.
NSW introduced state-wide preschool vision screening in 2008. After 10 years, a review into the program concluded that the service achieved its stated outcomes and gave value for money and should be continued in its present form. The report, released in 2018, raised awareness about the lack of any acceptable standard for preschool vision testing across Australia. It also highlighted the importance of universal vision screening to detect loss of vision in preschool children in a cost-effective manner.
Vision 2020 Australia, the peak body advocating for better eyecare in Australia, aims to prevent avoidable blindness and improve vision care. Without the support of its broad base of eyecare members and vision support groups, it’s extremely difficult to pitch any change to governments – federal, state or territory.
What better organisation to try and garner support for the expansion of a national standard of preschool vision testing? This would enable the unseen loss of vision in young people to be identified and treated to prevent lifelong vision loss.
With that in mind, the matter was raised at the Prevention and Early Intervention Committee of Vision 2020 in 2019, with the aim of getting all peak bodies to agree and endorse a set of minimum standards for a universal screening regime across all jurisdictions in Australia.
A subcommittee was formed of those interested in paediatric eyecare consisting of optometrists, orthoptists and policy officers from various organisations who had a watching brief over the deliberations. Ophthalmologists through RANZCO were also consulted.
The committee and policy officers from Vision 2020 did extensive research into best international practice for screening this age group. We investigated whether a full-service eye test was necessary, warranted or cost effective.
We looked at the WHO guidelines for screening of medical conditions.
The committee particularly wanted to ensure this screening program could be gold standard, internationally-recognised and cost-effective. It’s also important there are no conflicts of interest in the guiding principles and administering of programs.
There was much debate about current models of screening in territories and states. The committee determined that a universal program for pre-schoolers, when we had a chance of correcting amblyopia in undetected vision loss, was the best and most efficient use of time and resources.
The committee needed to ensure that whatever testing method and standard we chose could be administered by lay practitioners after either face-to-face or online training. We needed to design a program that was repeatable, easily reported and ensure there was support for those that needed a follow-up investigation.
We had much debate about testing methods including “Tumbling E’s” and various Snellen and Logmar tests. The medical review literature guided our thoughts and we decided on a Logmar vision test administered at least three metres from the child. Rather than the simplified “Tumbling E” test, the committee decided the current gold standard of Logmar should be the standard for all children in Australia regardless of jurisdiction or residence.
Overarching principles
The National Minimum Standard for Vision Screening, determined by the committee, will be underpinned by the following principles:
• Vision screening is to be conducted at an age young enough for the visual system to be amenable to treatment of significant visual conditions, including amblyopia, strabismus and refractive error.
• The approach aims to maximise coverage and ensure access for all.
• The approach needs to be flexible, leverage existing state/territory platforms and accommodate local community needs, capacity, and infrastructure.
• It should adhere to the World Health Organization’s ‘Screening Programme Guide’ and produce valid information, leading to better child health outcomes.
• Screening must be supported by effective pathways for referral, follow up and access to appropriate eyecare.
• Screening must be supported by proactive strategies to improve community and parental awareness, education, involvement and follow up.
• A broad workforce should be utilised to maximise reach of the screening program, with all screeners to meet required standards/skill levels.
• Data collection, evaluation and reporting to be embedded to drive continuous improvement and transparency.
With these principles in mind, a full committee of the Prevention and Early Intervention has endorsed the program. The national program will be promoted at the upcoming federal election by Vision 2020 and its member constituents with approaches also being made to state and territory governments to promote a universal preschool screening program in every state and territory.
Let’s hope we can be successful in introducing a gold standard vision screening program for pre-schoolers across Australia.
ABOUT THE AUTHOR: Marion Rivers AM DOBA is an orthoptist and Past President of Orthoptics Australia with a particular interest in paediatric low vision. She is also Chair of Vision 2020 Australia’s Prevention and Early Intervention Committee.
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