BIOS VISION SCREENING AUDIT: Academic Year 2017-2018

Aim: This audit utilises data submitted by Head Orthoptists to the British and Irish Orthoptic Society (BIOS). The aim is to describe vision screening practices across the United Kingdom (UK) for the academic year 2017-2018, compare the findings to the previous audits for academic years 2015-2016 and 2016-2017, and to provide evidence for future decision-making.

Method: An Excel spreadsheet and guidance for completion was sent to 204 Orthoptic Heads of Service for submission in March 2019. Submitted data was integrated and the information was analysed to identify types of provision and outcomes across sites.

Results: Twenty-eight sites (13.7%) responded to the data request, or these twenty-seven provided basic site data including consent policy and age at which tests are performed; a decrease from the previous academic years 2015-2016 (n=52 sites) and 2016-2017 (n=50 sites). Twenty-seven sites provided data on which professional administered screening, the test(s) used and the pass criteria adopted. These twenty-seven sites provided data regarding the referral pathway and twenty-five sites provided data on diagnostic examination and management criteria. Twenty-five sites provided data regarding the number of children screened (n=114,831), of which fifteen sites provided complete ‘accurate’ data on the number of children who failed screening (n=7,060 out of 65,959 screened). These twenty-five sites provided ‘accurate’ data on the number of children who attended their diagnostic follow-up (n=8,569). Eleven sites (n=4,645 children seen) provided data on initial outcomes of the eye examination and sixteen sites (n=2,366 children seen) provided diagnostic test data. The mean coverage increased to 98.3% (2016-2017=93%, 2015-16 =89%). True +ve rates were difficult to compare for each profession delivering screening, because of small numbers of submission with varied practice of test used, referral criteria and number of screens offered to each child.

Mean True +ve rates where a second screen was provided in school for children with borderline fail VA were 90% compared to a mean of 71% in sites where no 2nd screen was performed. Improved True +ve rates were also evident in sites who provided a second screen if the child was unable to perform the test. In both instances data relating to the second screening outcomes were limited and require further analysis.

Conclusions: This audit concludes that many screening services do not have reliable methods to collect data to assess the effectiveness of the programme. A more effective method for collecting data and consistency in reporting is required to allow comparison and benchmarking of services. Without this, it is not possible to definitively conclude the effectiveness of vision screening, whether the professional delivering screening and type of vision screener training influences True +ve rates. The current limited data suggests that a second screen of children with borderline fail results or unable to perform the test reduces false positive referrals; cost-benefit analysis is required. The implications of these points are discussed.