Alder Hey Children's Post Vision Screening Service

Overview

In collaboration between the Alder Hey Children's NHS Foundation Trust, Liverpool LOC, Sefton LOC and Primary Eyecare Services, the Children's Post Vision Screening (PVS) service has been developed to further examine children who are identified during school vision screenings, to not meet the expected visual standards. 

For children who do not pass the vision screening test, early diagnosis and treatment are essential to prevent the development of amblyopia and other conditions. This service is in line with the NHS 10-year plan, and allows parents and carers more access to and choice over the location of assessments, making care more accessible and closer to home. Safe, high-quality care that is compliant with the Royal College of Ophthalmologists' Diagnostic Pathway will be provided to patients, following guidelines for Child Vision Screening. Clear information regarding their child's eye health, treatment, and next steps are provided to parents and carers. The service will reduce waiting times after vision screening for sight tests and the dispensing of spectacles, increasing the capacity within Alder Hey to handle complex cases.

For access to the Children's Service Guide for Practices and Practitioners, click here

For access to the Local Service Summary One Pager, click here

For access to the launch event PowerPoint, click here

For access to the Alder Hey Children’s & Primary Eyecare Service’s printable FAQ leaflet, click here

Accreditations and Training

  • Complete WOPEC Paediatrics Distance Learning Modules OR hold an equivalent higher certificate e.g. the professional certificate in paediatric eyecare – please contact your LOC if you require a WOPEC code.
  • Working towards the Oliver McGowan mandatory training on Learning Disability and Autism - Part 1 online learning. This can be accessed via the NHS England e-learning for healthcare online platform.
  • Safeguarding Level 2 Children Training 
  • Valid Enhanced DBS (Disclosure and Barring) Certificate

Equipment

  • Access to Primary Eyecare Services online electronic referral platform
  • Age-appropriate functional sight test equipment including crowded LogMAR visual acuity test

Eligibility of Patients

  • Reception class children (aged 4-5) seen within Liverpool and South Sefton School Screening programme
  • If at the time of screening the child has not achieved a pass level of visual acuity of 0.20 LogMAR in either eye
  • Children who do not/are not able to complete the screening assessment 

Referral Pathway

  • Primary Eyecare Services receive referrals from Alder Hey and upload the referral to the OPERA platform.
  • Primary Eyecare Services send parent/guardian a letter detailing the next steps, including access to the patient choice portal where they can choose which local optometry practice to attend.

  • Once the parent/guardian has chosen, the optometry practice will receive an OPERA notification in ‘booking required’, informing the practice that a patient is waiting to have their first appointment booked.

  • The optometry practice will contact the parent/guardian on the telephone number provided within the OPERA referral and a convenient appointment can be arranged.

Screening Pathway

Initial appointment will include cycloplegic refraction

  • If VA better than or equal to 0.20 LogMAR (6/9.5) in both eyes and there is no significant refractive error, BV anomaly or pathology found, the patient can be discharged from the pathway with regular sight test advice.
  • If there is a significant refractive error with no pathology or ocular movement disorder, spectacles will be prescribed and dispensed as per NHS standards. The patient will then be followed up at 6-weeks. 
  • If a non- accommodative strabismus, ocular movement anomaly, unexplained reduced VA, ocular pathology is found or the child is unable to complete the appointment then a referral back to Alder Hey Children’s is made.

6-week review appointment

  • Check of spectacle fitting and tolerance, and measure VA with spectacles with crowded LogMAR chart. 
  • If VA is better than or equal to 0.20 LogMAR (6/9.5) in both eyes the child can be discharged from the pathway.
  • If spectacles fit and are worn well with VA worse than 0.20 LogMAR in either eye, then the child must be reviewed at the 18-week appointment.
  • If spectacles are not fitting well, then reassess spectacles and repeat spectacle wearing advice. Review child at 18-week appointment. 

18-week review appointment

This is indicated if VA is still reduced or the child is not wearing spectacles as advised:

  • Check of spectacle fitting and tolerance, and measure VA with spectacles with crowded LogMAR chart. Also complete cover test and binocular vision assessment with spectacles.
  • If VA is better than or equal to 0.20 LogMAR (6/9.5) in each eye the child can be discharged from the pathway.
  • If VA is still reduced or the child is not wearing spectacles as advised, or a manifest strabismus has been found, then a referral back to Alder Hey Children’s is made. 

Referrals to Alder Hey Children's Hospital

You can select which priority the patient's case is. Then select 'Children's & Adolescent Service' under 'Specialty' and the relevant clinic type for the patient. Search for Alder Hey Children's Hospital under the 'Providers' section.

Workflow Use

The workflow can be used to track patients individually by both clinicians and admin staff.

1. Select 'Post Vision Screening' under the Workflow tab on OPERA.

2. Input the patient's details.

3. Details of the patient's referral status will be shown.

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