July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Evaluation of the NSW Statewide Eyesight Preschooler Screening (StEPS) Program
Author Affiliations & Notes
  • Amanda French
    Discipline of Orthoptics, University of Technology Sydney, Sydney, New South Wales, Australia
  • Kathryn Ailsa Rose
    Discipline of Orthoptics, University of Technology Sydney, Sydney, New South Wales, Australia
  • Footnotes
    Commercial Relationships   Amanda French, NSW Health (F); Kathryn Rose, NSW Health (F)
  • Footnotes
    Support  NSW Health Project Funding
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 4425. doi:
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      Amanda French, Kathryn Ailsa Rose; Evaluation of the NSW Statewide Eyesight Preschooler Screening (StEPS) Program. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4425.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : To investigate access and outcomes from a universal preschool vision screening program in New South Wales (NSW), Australia over the period 2009-2016.

Methods : The StEPS program is a universal screening program for 4 year old children, conducted through preschools and childcare facilities. Screening consists of monocular linear visual acuity (VA) testing by trained lay and nurse screeners. Children with VA of <20/30-2 (6/9-2) in either eye are referred for further assessment and those with VA <20/30 (6/9) but, >20/30-2 (6/9-2) are considered a ‘borderline pass’ and advised to be re-checked in 12 months. Those with VA ≤20/60 (6/18) are considered a ‘high-priority’ referral. StEPS activity data from January 2009 to December 2016 was used. Screening and referral rates were determined from projections of the number of 4-year-olds per local health district (LHD) based on the 2014 population Census data. To determine factors that impact screening referral rate, random effects panel analysis was undertaken. Analysis was performed using Microsoft Excel and Stata v14.

Results : From 2009-2016, 96.4% of eligible children (n=719,686) were offered screening. Of these, 84% accepted the offer and 564,825 children (overall 75.6%) were screened. The screening rate increased from 67.3% in 2009 to 74.5% in 2016, the most consistent rise noted in rural and regional LHDs. Of the children screened, 19.2% in total were referred or borderline pass. Of the 53,169 children directly referred, almost 25% were high priority (n=13,246), 58.3% were routine priority and 16.8% were referred as unable to be screened. An additional 55,214 children were classified as borderline pass. Screening rate was 19% higher in areas where catch up clinics were available. Referral rates were significantly lower in LHDs that employ vision screeners on a permanent, rather than casual basis (-3.2%). This equates to 18,130 fewer referrals made by permenant compared to casual screeners assuming all else is equal between LHDs and models of implementation.

Conclusions : StEPS is a unique model for preschool vision screening in that children are accessed through preschool and childcare facilities. This results in coverage comparable to many school-based programs, at an age likely to facilitate optimal treatment outcomes. The StEPS program is highly-successful and should be considered in other locations.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.


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