Vision Screening

Statement on the introduction of corporate vision tests for children

BIOS information release 28 August 2016

Concerns about “Free Eye Testing Kits”

The British and Irish Orthoptic Society (BIOS) has concerns regarding the corporate approach to eye care being directed at schools and the provision of ‘free eye testing kits’ for parents, teachers or other school staff to use. The BIOS are not able to endorse these campaigns as there is no evidence to support the approach. This statement outlines the national guidance on vision screening, BIOS concerns and the need for corporations to clearly state that their eye testing campaigns are not intended to replace National Screening Committee (NSC) guidance on universal screening of children at age 4 - 5 years.

National Guidance should be implemented

In 2013, following a major review of the evidence, the NSC recommended that screening for visual impairment should be offered to all children aged 4 – 5 years ( The guidance states the screening is for the detection of reduced vision in one or both eyes (amblyopia).

BIOS has evidence that changes to the funding of health care has led to an inconsistent approach to the commissioning of the 4 – 5 year vision screening by Local Authorities (LAs). There are reports that some LAs are not commissioning vision screening where it does not already exist or decommissioning existing programmes.

BIOS is working with all stakeholders in children’s eye care to ensure that the specification and commissioning of vision screening contracts occurs in a consistent way that delivers on NSC recommendations. It is important that the NSC guidelines for universal vision screening of children are not undermined.

Concerns about the non-NSC approach

The free eye test kits and screening being offered to schools are not in line with the NSC guidance and is outside the recommendations of school vision screening. It is important that children at reception age are screened in line with national guidance and that this is undertaken by a compliant and fully audited service. Whilst schools may wish to consider other vision screening services, it is important the differences in the services being offered are understood by parents, schools and teachers.

The national guidelines provide a population based examination of all children ensuring the ‘at risk’ and vulnerable children in the population are reached. This is essential to those who do not seek advice or think they are at risk, and show no signs or symptoms of the condition. The NSC guidance ensures appropriate and efficient use of resources based on research evidence.

Potential implications

BIOS is concerned about the possible implications to children if vision screening that does not follow NSC guidelines is adopted:

  • It may lead to decommissioning of evidence-based services by local authorities to save money.
  • Not all schools will sign up for the corporate schemes.
  • At risk and vulnerable children will suffer if universal co-ordinated screening is not implemented.
  • Children may not receive vision screening at the appropriate age for specific eye conditions to be detected.
  • There is a risk that visual defects may be missed and / or not treated promptly.
  • The potential for unidentified eye defects to become irreversible.
  • Teachers may miss eye defects, which has serious risk of litigation.
  • There are associated child safeguarding issues if a parent / guardian does not act on the information that their child ‘failed’ a vision test and a pathway is not in place to follow up on this.
  • The undertaking of health checks which are not recommended by the NSC have the potential for producing unnecessary parental anxiety.

BIOS considers it to be essential that corporations clearly state to the public, teachers, schools, commissioners and relevant stakeholders that their eye testing campaigns are not intended to replace NSC guidance on universal screening of children at age 4-5 years.

Any queries should be addressed to

Additional information

Public Health England - Screening

BIOS news item

Visual Surveillance and Screening for Visual Defects in Children

BIOS press release 11 January 2016

Information for Commissioners on Vision Screening of children at age 4-5 years in school

Orthoptists are the eye care professionals recommended to lead on the delivery of vision screening of children aged 4 – 5 years by the National Screening Committee (NSC) 1. Orthoptists have specific expertise in the assessment of visual deficits in young children. It is essential that commissioners consult with Orthoptists in their area in the tendering process for this service. 

The British and Irish Orthoptic Society (BIOS) has developed recommendations and tools that support orthoptic-led delivery of the vision screening.  These recommendations are evidence-based and provide the standardising approach to screening required by the NSC.

Public Health Implication

The aim of screening is to identify children with amblyopia (reduced vision) at an age where treatment has the potential to improve vision. Amblyopia is a childhood condition which can go unrecognised.  If left untreated it can result in a permanent, lifelong visual deficit.  The effect of the condition on vision and quality of life is calculated to be relatively mild but it can have a more serious impact if sight in the other eye is lost or damaged.  Accurate detection of amblyopia is primarily achieved through vision testing.


1. National Screening Committee, 2013.


For more information contact BIOS Vision Screening Special Interest Group Lead:

Dr Helen Griffiths (