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The role of screening and surveillance in the detection of childhood vision impairment and blindness in the UK
  1. Ameenat Lola Solebo1,2,3,4,
  2. Lucinda Teoh1,3,
  3. Jugnoo Sangeeta Rahi1,2,3,4
  4. for the British Childhood Visual Impairment and Blindness Study Interest Group
    1. 1Population, Policy and Practice Research and Teaching Department, University College London GOS Institute of Child Health, London, UK
    2. 2UCL Institute of Ophthalmology, London, UK
    3. 3Ulverscroft Vision Research Group, UCL GOS Institute of Child Health, London, UK
    4. 4Ophthalmology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
    1. Correspondence to Professor Jugnoo Sangeeta Rahi, Population, Policy and Practice Research and Teaching Department, University College London Institute of Child Health, London WC1N 1EH, UK; j.rahi{at}ucl.ac.uk

    Abstract

    Objective Understanding pathways to detection for childhood visual impairment (VI) is critical for planning services. We aimed to describe patterns of detection for childhood VI.

    Design and setting Cross-sectional study using data from British Childhood Visual Impairment and Blindness Study 2.

    Patients Children newly diagnosed with VI, severe vision impairment or blindness (SVI/BL)—that is, visual acuity worse than logMAR 0.5 in both eyes—were identified through active surveillance, with data collection at diagnosis and 1 year later.

    Outcome measure Method of detection of vision/eyes problem.

    Results 784 children (45%, 356 girls) were identified, of whom 313 (40%) had VI, 471 (60%) had SVI/BL. Additional non-ophthalmic disorders or impairments (VI/SVI/BL ‘plus’), were diagnosed in 72% (559/784). Of the 784, 173 children were detected through routine screening (22%), 248 through targeted examinations (32%) and 280 through family self-referral (36%). Parents and carers had only reported symptoms in 55% of children who manifested them, with evidence that families living in socioeconomically deprived areas were less likely to report concerns. Paediatricians were the professionals most likely to raise initial suspicion of visual disability.

    Conclusions Our findings show that targeted screening and surveillance is important for the detection of full spectrum childhood visual impairment (VI/SVI/BL), as a significant proportion of children will not have symptoms, or their parents or carers will not report symptoms. As paediatricians were the professionals most commonly involved in detection, it would be helpful if their core competencies included the skills needed to undertake simple assessments of vision.

    • epidemiology
    • ophthalmology
    • child Health
    • child development

    Data availability statement

    No data are available: deidentified individual participant data will not be made available as ethics and governance approvals do not allow this.

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    Data availability statement

    No data are available: deidentified individual participant data will not be made available as ethics and governance approvals do not allow this.

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    Footnotes

    • Twitter @lolaeyedoc

    • Presented at This work is presented on behalf of the collaborating clinical research group, the British Childhood Visual Impairment and Blindness Group (BCVISG, membership in appendix).

    • Contributors ALS conceptualised and designed the study, designed the data collection instruments, collected data, carried out the initial analyses, drafted the initial manuscript and reviewed and revised the manuscript. LT collected data, carried out the initial analyses, drafted the initial manuscript and reviewed and revised the manuscript. JR conceptualised and designed the study, designed the data collection instruments, supervised data collection and reviewed, revised the manuscript and acts as the guarantor.

    • Funding This work was funded directly by a Fight for Sight grant (1525/26) and was supported by funding from the Ulverscroft Foundation for the Ulverscroft Vision Research Group. ALS received support from the National Institute for Health Research Biomedical Research Centre (NIHR BRC) based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, and an NIHR Lectureship, and is supported by an NIHR Clinician Scientist award (CS-2018-18-ST2-005). JR is supported in part by the NIHR BRC based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, and an NIHR Senior Investigator award. This work was undertaken at UCL Institute of Child Health/Great Ormond Street Hospital for children, which received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centres funding scheme.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.