Screening is a complicated issue. You often hear it stated that one role of the community optometrist is screening for eye disease, but this is not really the case. An effective screening strategy, as we all remember, should be sensitive enough to detect any particular disease and specific enough for a normal individual to easily pass as normal.
The influence of risk factors may help identify target groups for screening which improves the two ‘S’s for the restricted sample but fail those few individuals falling outside the selected sample. Screening whole populations brings in economic considerations – can the strategy be implemented easily enough by a large number of personnel with adequate training, can the strategy be accessible to all within the population, and can it be acceptable enough to the population to encourage good attendance and address any pre-held health beliefs?
There then needs to be considered whether the outcome of adequate screening is worth the cost of implementation in the first place. Early detection of an untreatable condition may not be the best use of resources, but detection of a treatable age-related condition which may, through an expensive intervention, result in a small improvement in quality of life for a limited period only might also be questioned.
Congenital and early developmental conditions may impact upon life quality for many decades so I am always surprised by the continuing variability of eye and vision screening throughout the UK. Visual development milestones might easily be incorporated in the ‘little red books’ and arguments about the lack of evidence for social and intellectual development retardation due to amblyopia are not cogent.
The ‘red reflex’ test is still the only guaranteed screening of infants and, as the sad death of Caroline Aherne last week reminded us, is successful at detecting early retinoblastoma. Optometrists are fully qualified to detect eye and vision problems – why not employ them more usefully in organising and developing paediatric screening?
