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Prevalence of presenting bilateral visual impairment associated with refractive error – findings from the See4School, pre-school vision screening programme in NHS Scotland

Pentland, L. & Conway, M. L. ORCID: 0000-0001-5016-0529 (2024). Prevalence of presenting bilateral visual impairment associated with refractive error – findings from the See4School, pre-school vision screening programme in NHS Scotland. Eye, doi: 10.1038/s41433-024-03047-8


The See4School programme in Scotland is a pre-school vision screening initiative delivered by orthoptists on a national scale. The primary objective of any vision screening programme is to identify amblyopia, given the common understanding that this condition is unlikely to be detected either at home or through conventional healthcare channels. The target condition is not bilateral visual impairment, as it is believed that most children will be identified within the first year of life either through observations at home or as part of the diagnosis of another related disorder. This belief persists even though bilateral visual impairment is likely to have a more detrimental impact on a child’s day-to-day life, including their education. If this hypothesis were accurate, the occurrence of bilateral visual impairment detected through the Scottish vision screening programme would be minimal as children already under the hospital eye service are not invited for testing. The overarching aim of this study was therefore to determine the prevalence of presenting bilateral visual impairment associated with refractive error detected via the Scottish preschool screening programme.

Retrospective anonymised data from vision screening referrals in Scotland from 2013–2016 were collected. Children underwent an assessment using a crowded logMAR vision test and a small number of orthoptic tests.

During the 3-year period, out of 165,489 eligible children, 141,237 (85.35%) received the vision screening assessment. Among them, 27,010 (19.12%) failed at least one part of the screening and were subsequently referred into the diagnostic pathway, where they received a full sight test. The prevalence of bilateral visual impairment associated with refractive error and detected via the vision screening programme (≥ 0.3LogMAR) was reported to range between 1.47% (1.37–1.59) and 2.42% (2.29–2.57).

It is estimated that up to 2.42% (2.29–2.57) of children living Scotland have poorer than driving standard of vision (6/12) in their pre-school year, primarily due to undetected refractive error. Reduced vision has the potential to impact a child’s their day-to-day life including their future educational, health and social outcomes.

Publication Type: Article
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Subjects: L Education > LB Theory and practice of education > LB1603 Secondary Education. High schools
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RE Ophthalmology
Departments: School of Health & Psychological Sciences
School of Health & Psychological Sciences > Optometry & Visual Sciences
SWORD Depositor:
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