To the Editor: Routine school vision screening has been discontinued in many regions.1

Since 2000, children around Newcastle and Lake Macquarie in New South Wales only have their vision checked at school if their parents request it. I am particularly concerned that this may disadvantage young children with diabetes, who may also have undetected amblyopia. These children are already at risk of diabetes-related vision impairment, and simple screening could prevent further disability related to amblyopia.

Amblyopia, commonly known as “lazy eye”, is an asymptomatic, potentially treatable condition of poor vision in a “normal” eye. It is caused by the brain suppressing an unclear image from the affected eye. Amblyopia occurs in 2.5%–3.2% of the population.2 The condition needs to be detected early, and treatment needs to be instituted before the end of practical vision development at about 7–8 years of age, otherwise even intensive treatment is unlikely to restore normal vision.3 This is especially important because people with untreated amblyopia have an increased lifetime risk of loss or impairment of vision in their good eye,4 as well as the poor vision in their amblyopic eye.

The current Australian screening guidelines for children with diabetes recommend screening for retinopathy after 5 years of diabetes in those who are prepubertal, and annually in adolescents after 2 years of diabetes.5 The International Society for Pediatric and Adolescent Diabetes recommends retinopathy screening in children with diabetes of prepubertal onset at 5 years after the onset of diabetes, or 11 years of age, or at puberty, whichever is earlier.6 Neither document specifies other visual screening (although the National Health and Medical Research Council guidelines do recommend a clinical examination of the eyes for cataract soon after diagnosis). Thus, a 6-year-old child with diabetes would not have his or her vision screened until 11 years of age. An eye with significant amblyopia detected at this age will not achieve normal vision, and the child would be reliant on only one eye for his or her lifetime. Even a 3-year-old child with diabetes would not have visual screening until 8 years of age, the end of practical vision development.

The case has been made recently for biennial retinopathy screening for children with diabetes.7 I propose that diabetic children under 9 years of age have their vision fully assessed soon after the diagnosis of diabetes. Should amblyopia be detected then, treatment could commence before the end of active vision development.