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Early Vision Tests Help Cure Childhood Eye Problems

30 July 2003

The long-standing debate over the need for toddlers’ eye tests is re-awakened by a new research paper published by the Children of the 90s project.

The long-standing debate over the need for toddlers’ eye tests is re-awakened by a new research paper published by the Children of the 90s project.

Controversially, pre-school screening for amblyopia – or lazy eye – has been abandoned in much of the UK on the grounds that it can be done more effectively at school age and that age at starting treatment is irrelevant.

Amblyopia is a condition that affects 3 per cent of children and is normally treated with an eye patch. If it goes untreated until age 7 or 8, the sight in the weaker eye will never improve.

Researchers from the Avon Longitudinal Study of Parents and Children (ALSPAC), based at the University of Bristol, examined the eyesight of 6,000 children at the age of 7½.

Of those children – almost 25 per cent had been offered pre-school screening at the age of three, and two thirds of them (16.7 per cent of the total) had attended. All children had been screened when they started school, as is currently recommended by the NHS.

We found that by the age of 7½, the children with amblyopia who had been tested and treated at 3 got better results in vision tests.

The prevalence of amblyopia was 45 per cent lower in the children who had received the 3-year eye test.

But – because only two thirds of children actually attended for their eye test at the age of three, Dr Cathy Williams says it raises doubts about the practicalities and overall population benefit of testing at three rather than at school entry.

“On a population level, the 3-year eye tests made little difference to the total numbers of children with sight problems by the age of 7, because a third of children who were offered the early test did not attend.

“The results emphasise that the patching treatment is more effective the earlier it is given, but it is also important to make sure that any screening test is actually received by all of the population, in order to make a real impact on the numbers of children with sight problems persisting into later childhood. Future eye test programmes need to take account of both factors.”

Notes to editors:

1. Williams C, Northstone K, Harrad RA, Sparrow JM, Harvey I. Amblyopia treatment outcomes after preschool screening vs. school-entry screening: observational data from a prospective cohort study. British Journal of Ophthalmology. doi:10.1136/bjo.87.8.988

2. Since a report in 1997 from the NHS Centre for Reviews and Dissemination at the University of York (CRD Report 9) found that there was no evidence that early treatment worked better than treatment at school age, in some areas tests for pre-school children have been discontinued. This has caused widespread debate and disagreement between professionals and highlighted the need for more research.

3. An earlier study by the ALSPAC team (published in June 2002) found that children with amblyopia have a much better chance of becoming cured if treatment starts before three years old,

4. ALSPAC The Avon Longitudinal Study of Parents and Children (also known as Children of the 90s) is a unique ongoing research project based in the University of Bristol. It enrolled 14,541 mothers during pregnancy in 1991-2 and has followed the children and parents in minute detail ever since.


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