Vision screening in preschool children: Authors' reply
Authors: P G Bolger, S Stewart-Brown, E Newcomb, A Starbuck
Journal: BMJ (1992)

commercially interested parties for the use of likely to find many false positive referrals.Though or squint identified by programmes to screen expensive drug combinations should be resisted.'the measurement of binocular function is quoted as children's vision before they start school.'Bolger For many years the standard treatment has been one of the advantages of screening by orthoptists and colleagues rightly suggest that the effectiveness castration by surgical orchidectomy or, more compared with screening by clinical medical of treatment should be assessed by a randomised recently, analogues of luteinising hormone releas-officers, no data are provided.Did many of the controlled trial.I suggest that very many children ing hormone.children with 6/9 and 6/12 vision have good would have to be entered into such a trial to have Oral oestrogen treatment has been largely binocular function?Were they amblyopic at all? any hope of clarifying this issue in a reasonable abandoned because of the thromboembolism and Many of the children we see who have been time and that a multicentre trial would be neces- fluid retention that attend the use of conventional referred with 6/9 or 6/12 vision turn out to have sary.As some form of preschool vision screening doses necessary to suppress testosterone concen-only slight ametropia.In the absence of good is, unfortunately, already being carried out in some trations in all patients to the castrate range.Yet the longitudinal studies of such children the parents districts, would it not be sensible for some official castrate range of plasma testosterone concentration cannot be counselled properly, and it may not be body, such as the British Orthoptic Society, to in the context of subtotal androgen blockade was true to say that these children inevitably become coordinate collection of the results of treatment in only arbitrarily chosen, long ago, as the lowest amblyopic.the form of a randomised trial?that could be conveniently achieved.A smallerThe economic analysis provided is too simple.In Bolger and colleagues report false positive reduction of plasma androgen concentrations may most areas patients are referred to consultant referrals, but their study did not extend to identify- well provide optimal palliation.'As thrombo-ophthalmologists for further assessment, and in a ing false negative referrals-that is, children who, embolic complications are dose dependent a lower cash limited service this means that fewer patients having "passed" their preschool test, present after dose of oestrogen will often control prostatic from other sources of referral can be seen.In school entry with amblyopia and squint.These cancer with less risk of such complications.addition, it ignores the additional cost to the children undoubtedly exist,2 and it will be necessary Clinical trials by the Veterans Administration parents of a further screening visit to see the for any trial to take account of them.and more recently the European Organisation for orthoptist. R M INGRAMResearch Against Cancer (trial number 30805) (P Most screening programmes have to satisfy the Kettering and District General Hospital, Whelan et al, personal comimunication) have following criteria: the disease should be economic-Kettering, shown that survival statistics for treatment with ally important, early detection should be possible, Northamptonshire NN16 8UZ 1 mg stilboestrol daily are similar to those for and an effective form of treatment should be IBle G twr-rw L ecmeE trukA treatment with a larger dose or surgical orchi-available.These criteria have not yet been satisfied 1 isBonger P,Sewart-Bron prscol Nechimden EcoStarbuck A. dectomy.In a recent study I found that only 30% for preschool vision screening.Given the serious orthoptists and clinical medical officers as primary screeners.of patients taking 1 mg stilboestrol had mean underprovision of resources in ophthalmology BMJ7 1991;303:1291-4. (23November.)testosterone concentrations in the castrate range.we cannot support considerable investment in a 2 Ingram RM, Holland WW, Walker C, Wilson JM, Arnold PE, Sustained tumour suppression was frequently national programme for orthoptic vision sreig Daily S. Screening for visual defects in pre-school children.achieved with testosterone concentrations near to until the existing programmes have been properlyBr Ohalo1967162.