An introduction to vision surveillance

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An introduction to vision surveillance

• Contributor
• Dr F Rahman
• Derby

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Vision surveillancelearning objectives

• 1. to describe the national recommendations
• 2. to establish what local arrangements are
• 3. to evaluate the quality of services provided
  locally
• Vision Surveillance/ Dec 02/Dr. Rahman /Central
  Derby PCT

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Vision surveillance screening 2002

• HFAC4 nationally agreed programmeat last!
• Orthoptist best pre-school
• (reliable but expensive)
• Snellen at 6 meters
• at school entry by school nurses (difficult
  pre-school)
• Vision Surveillance/ Dec 02/Dr. Rahman /Central
  Derby PCT

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Vision screening

• Many unknown
• ? effect of unilateral visual deficit on function
• Dose response curve to occlusion
• 8 referral rate at school age
• Prems x 10 problems
• Fast track eye clinic
• Vision Surveillance/ Dec 02/Dr. Rahman /Central
  Derby PCT

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Vision surveillance Derby

• Orthoptic and optician screen at 36-42 months
• Local clinic
• Sheridan Gardner at six meters
• Refraction under cycloplegia
• 110 referral rate
• Uptake vs parental perception and knowledge
• Early diagnosis of non squinting amblyopia
  refractive errors
• Vision Surveillance/ Dec 02/Dr. Rahman /Central
  Derby PCT

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Vision surveillancewhat can the doctor do?
History

• Detailed family history
• Squint / lazy eye / patch/ glasses below 40
• Ask about parents glasses / contacts
• High risk cerebral palsy / syndromes /
• deafness
• Prems / delayed development
• Visual behaviour does your baby look at you
• Vision Surveillance/ Dec 02/Dr. Rahman /Central
  Derby PCT

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Vision surveillancewhat can the doctor do? Exam

• Palpebral fissures / skull / orbits
• Corneal size shape clarity
• Red reflex
• Epiphora
• Following angle
• Squint / cover tests
• Vision Surveillance/ Dec 02/Dr. Rahman /Central
  Derby PCT

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James story 1

• Hospital letter from ophthalmologist
• Oculocutaneous albinism
• No further action
• Family history from hv notes
• Vision Surveillance/ Dec 02/Dr. Rahman /Central
  Derby PCT

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James story 2

• Examination
• Abilities
• Ethics/genetics
• Educational Psychologist
• Specialist Teacher for visual impairment
• Mobility Officer
• DLA/Voluntary Agency/Social Services
• Vision Surveillance/ Dec 02/Dr. Rahman /Central
  Derby PCT

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Measuring quality in vision screening

• Age at detection of severe impairment
• Coverage and yields of 3 year screen
• Equity across the population
• Effect of early treatment of anisometropia
• Detection of ROP
• Vision Surveillance/ Dec 02/Dr. Rahman /Central
  Derby PCT