1.1. The College of Optometrists welcomes the National Assembly for Wales’ Children, Young People and Education Committee for the consultation on the First 1,000 Days.

2. About us

2.1. The College of Optometrists is the professional, scientific and examining body for optometry in the UK, working for the public benefit.

2.2. Supporting its 14,000 members in all aspects of professional development, the College provides pre-registration training and assessment, continuous professional development opportunities, and advice and guidance on professional conduct and standards, enabling our members to serve their patients well and contribute to the wellbeing of local communities.

3. Executive summary

3.1. The College of Optometrists should recommend that children’s eye health be included in a First 1,000 Days plan. As highlighted by the Chief Medical Officer for Wales’ Annual Report 2014-15, Healthier, Happier, Fairer[1], there is strong evidence on the importance of getting things right in the first 1,000 days to give every child the best start in life; and eye health is key. Paragraph 3.4 below provides more detailed recommendations to protect and improve the eye health of children across Wales.

3.2. Welsh Government policies and programmes to support the early parent role and to support children’s emotional and social capabilities and development should include eye health.

3.3. Good eye health is key to supporting children’s wider life chances. Sight problems may have a negative impact on a child’s health and educational development[2].

3.4. We should like to highlight to members of the Children, Young People and Education Committee the following main points as key enablers to protect and improve the health and wellbeing of children across Wales:

3.4.1. Highlight the importance for parents to make sure they are thinking about their child’s sight from an early age.

3.4.2. Encourage parents to be more aware of the signs and symptoms to look out for that may indicate an eye problem.

3.4.3. Better train health, education and social care professionals working with parents and children to maximise opportunities for providing and reinforcing information about eye health.

3.5. The College of Optometrists launched Eyes on Our Future, a campaign to make parents and carers aware of children’s eye health and to encourage them to be more aware of the signs and symptoms to look out for. More information can be found here: http://www.college-optometrists.org/en/college/campaign_link/eyes-on-our-future.cfm

4. Why eye health is important for children?

4.1. Good eye health can have an impact on children’s wider life chances. Improved access to eye health services would help to:

4.1.1. Deliver improved child health outcomes across Wales: poor vision impacts on children’s lifelong health and wellbeing.

4.1.2. Tackle child health inequalities[3]: People from lower socioeconomic groups can be disproportionately affected by barriers such as a lack of education or isolation. This can contribute to a lack of awareness of the importance of eye health across families, and further barriers to accessing eye care services. In addition, evidence from an area study conducted in South Wales found that people who live in deprived socioeconomic populations have a higher incidence of undiagnosed refractive error and do not access optometry services to have it corrected[4].

4.1.3. Support effective child development and emotional and social wellbeing: poor vision impacts on a child’s ability to participate in a wide variety of intellectual and physical activities which are not only good for their physical health but also for their mental and wellbeing.

4.1.4. Focus on improving learning and development: Most of what children learn is through sight. Poor vision impacts on children’s education and their ability to learn and grow in confidence[5].

5. Why eye tests for children are important?

5.1. As recommended by the NHS Wales’ Together for Health: Eye Health Care Delivery Plan for Wales 2013-2018, the earlier any eye problems are picked up and managed the better the outcome[6].

5.2. If there are problems and they are not picked up at an early age, the child may have permanently reduced vision in one or both eyes. It's important for eye problems to be identified as early as possible, because they can have a significant impact on a child's intellectual development, education and lifelong health.

5.3. Routine eye checks offered soon after birth can detect some eye problems immediately. Children don’t need to be able to read or even talk to have an eye examination.

5.4. There are a number of different eye problems affecting babies and children that can be detected during eye tests including childhood cataracts and lazy eye (amblyopia)[7].

5.5.

6. Recommendations

6.1. Children’s eye health should be included in a First 1,000 Days plan if it is to give significance to the impact of the early years on children’s development:

6.1.1. Eye tests can help to detect some eye conditions before they affect vision.

6.1.2. Eye tests can make sure that children are making the most of their sight and that they can see as clearly as possible.

6.1.3. Eye tests can help detect other health problems such as diabetes at a very early stage.

6.2. It is critical that action is taken to ensure parents feel better and more informed about how they can protect their children’s eye health.

6.3. Parents should be able to identify any common signs that their child may benefit from an eye test. If parents have any concerns about their child’s eyes, or if there is a history of a childhood eye condition in the family, the College of Optometrists would recommend parents to take their child to a local optometrist for a sight test. This is free under the NHS for children under 16.

6.4. Information for parents and carers must improve, for example through a national awareness campaign.

6.5. The Personal Child Health Record (Red Book) should highlight the importance of children’s eye health, as well as potential risk factors for children’s eye health.

6.6. Better training on the importance of eye health is needed for all health, education and social care professionals working with parents and children to maximise opportunities for providing and reinforcing information about eye health.

6.7. Eye examinations should be recognised as an important preventative public health intervention which provides an opportunity to consider children’s eye health and visual status. Eye tests can help to detect some eye conditions before they affect vision.

[2] Bruce A et al, “Impact of visual acuity on developing literacy at age 4-5 years: a cohort-nested cross-sectional study”, BMJ Open, 2016.

[4] Biddyr, S. & Jones, A., ‘Preventing sight loss in older people. A qualitative study exploring barriers to the uptake of regular sight tests of older people living in socially deprived communities in South Walesʼ, Public Health, February 2015.

[5] Bruce A et al, “Impact of visual acuity on developing literacy at age 4-5 years: a cohort-nested cross-sectional study”, BMJ Open, 2016.