Children's vision screening: Impact on inequalities in central England

Study objective - To investigate the relationship between age at presentation of amblyopia and social deprivation before and after the introduction of changes to a vision screening service. Design - Two cohorts of children treated for amblyopia in 1983 and 1992. Setting - The orthoptic department of Leicester Royal Infirmary. Participants - The 209 patients treated for amblyopia who first attended the orthoptic department in 1983, and 203 who first attended in 1992. Measurements - Age at presentation to the orthoptic department was the main outcome measure. Social deprivation was measured by Townsend deprivation score for the electoral ward in which the child lived, using 1981 and 1991 census data. Main results - After the introduction of changes in the screening programme, the mean age at presentation of amblyopia associated with microtropia or no strabismus was reduced from 6.6 years to 5.0 years. In 1983 there was a significant relationship between deprivation and age at presentation (p = 0.0001), with those from more deprived areas presenting later. No similar association was found in children referred in 1992 (p = 0.17). There was no change in the mean age of presentation of amblyopia associated with a large angle of strabismus (3.3 years in 1983 and 1992) and no relationship between deprivation and age at presentation 1983 or 1992 (p = 0.24 and p = 0.39 respectively). Conclusions - Since the introduction of changes to vision screening, the relationship between social deprivation and the age at presentation of asymptomatic amblyopia seems to have disappeared. Children are now referred earlier and those 6 om deprived areas are not being overlooked.