Treatment of unilateral visual impairment on preschool vision screening

Editor—The report by Clarke et al showed that mild visual loss in preschool children benefited little by treatment and that current management of this group ought to be reviewed.¹

Their conclusion advocating “the use of relatively later screening” seems incorrect. This study and others show the benefits of treatment for greater degrees of vision loss.² Conversely, Simons and Preslan show the consequences of failure of treatment.³ To dismiss the findings of the study of Simons and Preslan as merely an inevitability of being a non-compliant group seems harsh.

Preschool screening should continue for all, perhaps even at an earlier age.² The results of the current study, however, imply that later referral and eventual expectant management of mild visual loss may be appropriate. Certainly, newer technologies to improve screening accuracy would be helpful.

As an aside, the report does not indicate whether any underlying eye disease was fortuitously diagnosed by the ophthalmological referrals.