Long-term visual and treatment outcomes of whole-population pre-school visual screening (PSVS) in children: a longitudinal, retrospective, population-based cohort study

Abstract

Background: This study reports the long-term visual and treatment outcomes in a whole-population, orthoptic-delivered pre-school visual screening (PSVS) programme in Scotland and further examines their associations with socioeconomic backgrounds and home circumstances.

Methods: Retrospective case review was conducted on 430 children who failed PSVS. Outcome measures included best corrected visual acuity (BCVA), severity of amblyopia (mild, moderate and severe), binocular vision (BV) (normal, poor and none), ophthalmic diagnosis and treatment modalities. Parameters at discharge were compared to those at baseline and were measured against the Scottish index of multiple deprivation (SIMD) and Health plan indicator (HPI), which are indices of deprivation and status of home circumstances.

Results: The proportion of children with amblyopia reduced from 92.3% (373/404) at baseline to 29.1% (106/364) at discharge (p < 0.001). Eighty percent (291/364) had good BV at discharge compared to 29.2% (118/404) at baseline (p < 0.001). Children from more socioeconomically deprived areas (OR 2.19, 95% CI 1.01-4.30, p = 0.003) or adverse family backgrounds (OR 3.94, 95% CI 1.99-7.74, p = 0.002) were more likely to attend poorly and/or become lost to follow-up. Children from worse home circumstances were five times more likely to have residual amblyopia (OR 5.37, 95% CI 3.29-10.07, p < 0.001) and three times more likely to have poor/no BV (OR 3.41, 95% CI 2.49-4.66, p < 0.001) than those from better home circumstances.

Conclusions: Orthoptic-delivered PSVS is successful at screening and managing amblyopia. Children from homes requiring social care input are less likely to attend and are more likely to have poorer visual outcomes.

Fig. 1. Pre-School Visual Screening cohort in study period.

Flow chart summarising the number of children who underwent pre-school visual screening (PSVS) and number of children included in the final analysis of this study.

Fig. 2. Vision outcomes versus attendance.

This graph shows the distribution of amblyopia based on the level of severity (mild, moderate and severe) at baseline and final visit for regular and poor attenders.

Fig. 3. Binocular vision outcomes versus attendance.

This graph shows the distribution of binocular vision (BV) at baseline and final visit for regular and poor attenders.