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Comparison of amblyopia in schoolchildren in Ireland and Northern Ireland: a population-based observational cross-sectional analysis of a treatable childhood visual deficit
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  • Published on:
    Comparison of amblyopia in schoolchildren in Ireland and Northern Ireland

    Dear Editor

    We note the letter from Mr Declan McClements on September 9th 2019 and thank him for his interest in our work. As Mr McClements notes, the paper illustrates the significantly better outcomes achieved by children in Northern Ireland and the comprehensive school vision screening coverage that exists across the whole of Northern Ireland is acknowledged as a component of this success in our conclusions.

    Mr McClements is concerned regarding “the omission in this article of any reference to Orthoptics or Orthoptists.” We recognise the work in Northern Ireland and Ireland carried out by orthoptists, school nurses, optometrists and ophthalmologists; reference to orthoptists is made in Table 1 of the paper.

    The purpose of the study was to report and compare the prevalence and cause of persistent amblyopia in broadly similar population cohorts but different healthcare systems. Orthoptists, public health nurses, optometrists and ophthalmologists are comparable in Northern Ireland and Ireland with regard to training, qualifications and the functions they undertake, including their role in school-entry vision screening. The differences between the two jurisdictions, which were relevant to the disparity in outcomes on which we were reporting, relate to the less comprehensive nature of school-entry vision screening in Ireland and the differences in accessing treatment that exist between the two countries.

    Yours sincerely,

    Dr Siofra Harrin...

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    Conflict of Interest:
    None declared.
  • Published on:
    Query regarding Orthoptics Omission
    • Declan McClements, Ophthalmology Services Assistant Manager British and Irish Orthoptics Society

    Dear BMJ Open,

    I wish to raise a concern in relation to an article in the BMJ Open Volume 9 Issue 8 titled 'Comparison of amblyopia in schoolchildren in Ireland and Northern Ireland: a population-based observational cross-sectional analysis of a treatable childhood visual deficit' written by Siofra Harrington(1), Karen Breslin(2), Veronica O'Dwyer(3) and Kathryn Saunders(4).

    On behalf of Orthoptists within Northern Ireland we feel we should bring to your attention the omission in this article of any reference to Orthoptics or Orthoptists, and the excellent long established Orthoptic Led Vision Screening Service that exists across the whole of Northern Ireland for the detection of amblyopia as a preventable and treatable condition as recommended by Hall and Elliman in "Health for all children".

    In mainstream schools across Northern Ireland all consented children at four to five years of age are tested by their school nurse with the Keeler LogMAR crowded visual acuity test. Children tested that achieve a score of less than 0.2 LogMAR are referred into Orthoptic Services and the Multi-Disciplinary Eye Team (including Optometry and Ophthalmology) for assessment, diagnosis and treatment of many eye conditions including amblyopia. This is part of the school nurse training provided by Orthoptists described in their training manual relating to the vision screening pathway developed by the Public Health Agency and relevant stakeholders....

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    Conflict of Interest:
    None declared.