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On the 30th of March 2022, the World Health Organization launched its first ever global guidelines to support women and newborns in the postnatal period (the first six weeks after birth).(1) Within these guidelines is a really significant milestone for child eye health – universal newborn eye screening (NES) was included. This means national governments will have to consider how universal NES can be delivered within their routine maternal and child health services.
Newborn eye screening is the examination of the eyes of newborns with the purpose of determining if there are any ocular abnormalities which may require referral to an ophthalmic specialist for further examination.The standard test includes using a torch light to examine the front of the eye and, traditionally, a direct ophthalmoscope to test the red reflex of the eyes to check for potentially blinding eye conditions such as cataract, corneal opacities, glaucoma or retinoblastoma.
In high-income countries, universal NES is considered standard of care. However, in low- resource settings, NES is more often not included in child health policies or practiced routinely. This leads to children presenting late to health services with serious eye problems. The early development period (newborn to 5/7 years old) of a child is critically important for eye conditions as a child’s vision is still developing, and any condition which stops the child seeing will also stop the child’s vision developing (amblyopia). Therefore, if children present late to health services it leads to poorer outcomes after treatment and avoidable permanent visual loss.
The inclusion of NES in the postnatal care guidelines sets the priorities for national health policies and means countries will need to consider how they can implement NES for every newborn, leading to more children being diagnosed with eye conditions while there is still potential for effective treatment.
Training, equipment, robust referral mechanisms and inclusion in newborn health checklists for the babies who fail the screening test are the basic requirements.
The majority of blind children are either born with potentially blinding conditions or develop them before the age of 5 years. (6,7) Therefore universal NES is the first opportunity in the health system to detect these children and refer for potentially sight-saving treatment. Recommending NES in the postnatal care guidelines places it within maternal and child health programmes and care highlighting its importance for all maternal and child health providers.
Delivering universal NES will be a challenge for many national governments. Health systems models of how NES can be effectively included in maternal and child services are needed, and sharing both the best strategies and challenges will be important. This is a huge opportunity for those within the child eye health sector to work with those implementing maternal and child health services in order to provide good quality services for NES.
Ensuring that right from when a child is born, they have access to eye screening gives them the best possible chance to see, thrive and develop to their full potential.
Image on top: Red reflex testing with poster on the wall/ANJ Malik
Focus on Child Eye Health engages some of the world’s best and brightest thought leaders throughout the year to share knowledge, inspire action, discuss ideas and push Child Eye Health to the forefront of pressing development issues. It is supported by CooperVision.