UTS orthoptists lead preschooler eyesight screening program

The unique StEPS program (State-wide Eyesight Preschooler Screening) has offered free vision screening to all four-year-old children in NSW since 2008. In 2017/18, a multidisciplinary team from UTS won a competitive NSW Health tender to determine just how effective the program is.

According to project lead, Professor Kathryn Rose, Head of Orthoptics at UTS’s Graduate School of Health (GSH), the purpose of the StEPS program is to test for, and treat, vision problems in children prior to their starting school.

“The ultimate intent is to promote, and contribute to, healthy lifelong vision. Although a partial evaluation of the program was conducted in 2014, NSW Health was keen to undertake a more comprehensive evaluation to determine the program’s effectiveness, including a cost/benefit analysis,” explains Kathryn.

Our top-line finding was that StEPS is a unique, cost-effective and highly-successful program in terms of its aims and objectives.

— Dr Amanda French, Orthoptics Senior Lecturer, Graduate School of Health

Dr Amanda French is a senior lecturer in Orthoptics and was largely responsible for project managing the evaluation process. She says that although the Orthoptics team led the project, they benefitted enormously by collaborating with the UTS Institute for Public Policy and Governance and the UTS Centre for Health Economics Research and Evaluation.

“Our top-line finding was that StEPS is a unique, cost-effective and highly-successful program in terms of its aims and objectives. It follows all the gold standard protocols for screening and reaches an incredibly high number of children in NSW. Over 90% of children in the State are offered screening and over 75% of them are screened,” says Amanda.

“We also found that the StEPS program is one of the largest, most systematically-implemented evidence-based vision screening programs available, not just in Australia, but globally, which makes it very special.”

A key reason the program is so effective is because it can detect ocular conditions which are time-sensitive to treat. One such condition, called amblyopia, occurs in about 2% of the population, and if discovered early enough (before age eight) it can be treated effectively.

Another condition is refractive errors. This occurs in about 17% of children and, again, it’s best to correct it before a child enters school so they can get the maximum benefit from their schooling.

“There are long-term consequences for children when these conditions aren’t picked up early enough. Adults with untreated amblyopia, for example, are much more likely to experience visual impairment later in life. This comes at a cost to both the individual, in terms of their ability and zest to learn, and socio-economically, in terms of their ability to contribute to society and the costs associated with providing disability support,” Kathryn continues.

“When we think that a screening program at age four can completely mitigate these negative outcomes, it’s obvious why we’ve concluded that, at just under $50 per child, it’s such good value for money.”

Both Kathryn and Amanda say they were thrilled to be part of the evaluation team and say their next steps are to spread the good news. “We are definitely keen to promote the program with the ultimate aim of inspiring other Australian states, and even other countries, to adopt such a worthwhile and successful program,” says Amanda.

Find out more about studying Orthoptics at UTS