title: Improving detection of blindness in childhood: the British Childhood Vision Impairment study.
abstract: OBJECTIVE
  In industrialized countries, there are established programs of childhood vision screening and surveillance, but little is known about their performance. We investigated the patterns of presentation/detection and early treatment of a nationally representative cohort of children with severe visual impairment or blindness (SVI/BL) in 1 year (2000) in the United Kingdom.
  
  
  METHODS
  All children who were younger than 16 years and had a new diagnosis of SVI/BL were identified by active surveillance through the British Ophthalmological and Pediatric Surveillance Units. Data that were collected up to 1 year after diagnosis included sociodemographic characteristics, detection of SVI/BL, nonophthalmic disorders/impairments, ophthalmic findings, and early management.
  
  
  RESULTS
  Of 439 identified children, 65% were younger than 1 year at diagnosis, 28% were of nonwhite ethnicity, and 40% in the worst quintile of deprivation score. A total of 77% had associated nonophthalmic disorders/impairments. Although 70% had established symptoms or signs at diagnosis by a health professional, parents had suspected blindness in only 47%. A quarter of isolated SVI/BL was detected through routine vision screening; however, 46% of children's SVI/BL and associated nonophthalmic disorders/impairments were diagnosed through a clinical surveillance examination undertaken because of high risk for a specific eye disease.
  
  
  CONCLUSIONS
  The "patient journey" of children with visual impairment is markedly influenced by the presence of additional impairments/chronic diseases. Parents' understanding of normal visual development needs to be improved. Increasingly, new evidence-based formal programs of clinical (ophthalmic) surveillance are needed in response to the changing population of children who are at risk for blinding eye disease.
authors.affiliation: University College London, Institute of Child Health, MRC Centre of Epidemiology for Child Health, 30 Guilford St, London WC1N 1EH, UK. j.rahi@ich.ucl.ac.uk
authors.forename: Jugnoo S
authors.initials: JS
authors.lastname: Rahi
authors.forename: Phillippa M
authors.initials: PM
authors.lastname: Cumberland
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Peckham
mesh_terms: D000293:Adolescent; D001766:Blindness / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009885:Ophthalmology; D010372:Pediatrics; D010821:Physicians, Family; D006113:United Kingdom / Q000453:epidemiology; D015351:Vision Screening; D015354:Vision, Low / Q000175:diagnosis