Inconsistencies in the services and pathways linking children who screen positive for visual impairment in school screening assessments with ongoing care has prompted the Clinical Council for Eye Health Commissioning (CCEHC) to call for a standardised approach throughout England.
The CCEHC said although local pathways had been developed in parts of the country to provide follow-on care, there were variations in how these were commissioned and delivered, their outcomes, and governance arrangements.
The report, Post-Vision Screening: Proposals and Recommendations, was pitched at policy makers and commissioners to give them a better understanding of the requirements of delivering what the CCEHC said was an ‘accountable’ service.
Key recommendations
Two key recommendations were highlighted in the report: Dedicated post-vision screening services should be commissioned for children who screen positive following their vision screening assessment, and the delivery of services through locally agreed pathways and governance processes, and the development of locally agreed service specifications for commissioning.
Parul Desai, chair of the CCEHC Vision Screening Working Group, said: ‘This report has highlighted a gap in service provision, and its recommendations serve to address it.
‘Their implementation would provide assurance to parents of the care they should expect if their child screens positive following a vision screening assessment, and form the basis for local discussions amongst commissioners, clinicians and provider organisations on how best to deliver it.’
Wojciech Karwatowski, chair of the CCEHC and Zoe Richmond, vice-chair of the CCEHC, added: ‘Once again, the CCEHC has produced a report and recommendations which facilitate the understanding of local need and design of service provision by commissioners and providers.
‘The CCEHC encourages commissioners to ensure these recommendations are used to review existing arrangements and support the development of new services where they currently do not exist. Once implemented, this will serve to provide consistency in the quality and effectiveness of the care provided.’
Post-pandemic screening
The report’s authors recognised the pressures that existed in management of the large number of children that screened positive and required further investigation. In conjunction with the highlighted inconsistent pathways, authors said the volume could create long waiting times and introduce the risk of permanent visual loss, especially when conditions such as amblyopia and strabismus have better outcomes with early and prompt intervention.
The impact of the pandemic was also addressed, with the thousands of cancelled clinical ophthalmology appointments and diagnostic assessments caused by lockdown exacerbating existing problems and inefficiencies.
The report said it was now timely to ‘consider the development of a national post-vision screening pathway to ensure effective use of available healthcare resources and develop integrated solutions.’
In addition, consideration should be given to streamlining the appointments that children may have in order to reduce stress and anxiety for children and parents by creating unnecessary hospital attendance, to limit the number of visits which are disruptive for family life, and to limit clinical visits for infection control.
The sensitivity and specificity of screening tools was another key consideration for the development of future pathways. When looking at visual acuity, the report’s authors said experienced examiners had repeatability of approximately +/-0.1LogMAR using logMAR visual acuity charts in adults, with similar findings reported for the Keeler crowded logMAR chart in children with amblyopia. In contrast, the report said orthoptic-led vision screening services were often undertaken by a wide range of personnel, including school nurses or non-registered support staff, and the repeatability of vision acuity measurements during screening processes in real-life settings was unknown and may not be reflected in any published findings.
The full report can be found at https://bit.ly/3N02hXW