| Summary: | Aim: To compare the effectiveness of screening for visual defects in a cohort of pre-school children (3–3.5 years) versus screening in primary school children (4–5.25 years). Specifically we compared the numbers attending in each group and the visual outcomes at age 8 years. Methods: The design was an observational prospective cohort study comparing children screened and treated in two age groups on visual outcome in the worse seeing eye at 8 years of age. The cohorts were matched for socio-economic status by area of residence. A positive outcome was defined as an improvement in vision of 0.3 logMAR or more in the worse seeing eye from the baseline visual acuity to final follow-up. Results: In the pre-school group, 414 (52.3%) children were screened out of 792 invitees. In the school group, 785 (94.9%) children were screened out of 827 invitees. Sensitivity and specificity of the screening were similar for the two groups, but the increased uptake at school enabled many more children to be screened. After treatment, a positive outcome in the worse seeing eye was achieved in 18 of 42 children (43%) of the pre-school group and in 41 of 84 children (49%) of the school group. Conclusion: Our study suggests that it may be better to screen children at school because it is much easier to achieve coverage of the population. Visual outcome at age 8 years appears to be similar in children screened at pre-school age and those screened at school.
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