A new project which aims to catch visual problems early has prompted calls for its expansion throughout the State. Theresa Judge reports.
An improved system of screening for the condition of lazy eye in children, which has been introduced in two Midlands counties, should ideally be extended to the rest of the State, according to the ophthalmologist who introduced it.
Treatment for lazy eye or amblyopia needs to be completed before a child reaches the age of seven when the visual system matures.
If undetected the condition can hamper a child's learning and development and in some cases lead to behavioural problems at school. Some 5 per cent of children are believed to have lazy eye.
The new system introduced in Longford and Westmeath by community ophthalmic physician Dr Marie Houlihan ensures that children are tested earlier and that screening is carried out by people with specialised training.
Dr Houlihan said the system, which is identical to that used in Britain, represented best practice and that it had also resulted in increased efficiencies in the service.
Generally around the State screening for lazy eye is carried out by public health nurses and children are usually tested in school when they are in senior infant class.
In Longford and Westmeath now children are screened in junior infant class and this extra year allows more time for treatment before they reach the age of seven. As many children in senior infant class are aged six this leaves very little time for treatment before correction becomes practically impossible.
Another crucial difference is that the screening is carried out by orthoptists, who have an expertise in childhood visual screening. "Nurses in the past have done a very good job, but orthoptists have specialised training for testing vision in young children," Dr Houlihan said.
She said it had been shown that screening by anyone other than an expert in the examination of children's eyes was far less effective and there was a much higher false negative and false positive rate.
The use of orthoptists, therefore, leads to greater efficiencies in the long run as much fewer children are unnecessarily referred to eye clinics for follow-up testing.
"This is very cost-effective really because otherwise there are a lot of inappropriate referrals, and any strategy that stems the high level of inappropriate child attendance at clinics frees up appointments," Dr Houlihan said.
She said this was particularly important because the numbers of people attending eye clinics was growing rapidly mainly because of the explosion in the number of people with diabetes and the growing elderly population.
She said that once children were referred by orthoptists to the eye clinic they were given priority treatment. There had been "a massive reduction in false positive referrals", she said, and as a result those children with the condition were getting earlier treatment.
The correction of the problem can make a huge difference to children's lives. "One child who came to us recently had been very disruptive in class, causing problems for parents and teachers, but after testing we realised that he could see practically nothing. When he got glasses he settled down and his personality totally changed," Dr Houlihan said.
In treatment, the child is first given glasses and then if necessary a patch is used. "The whole idea is to get the vision equal in both eyes. If it is not equal after using glasses then we use a patch," she said.
The scheme was initially introduced as a pilot project in the Mullingar area in May 2003.
After this demonstrated the feasibility and cost effectiveness of the approach, it was extended to all schools in Westmeath and Longford and all junior infants in these schools are now being tested by orthoptists.
She said there had been a lot of interest in the new system from other regions. While it would require the employment of extra orthoptists, Dr Houlihan said the many benefits, both for the children affected and the efficiency of the system, meant there was a strong argument for it to be extended throughout the State.
Following the success of the Midlands initiative, a pilot project based on the same model of screening was started in the north west region and the results of this are awaited.