Viewpoint: Can the HSE not see the wood for the trees?

Childrens eye test wait a public scandalWhen I was seven, I had an operation to cure a squint, writes Brian Byrne. It was completely successful, even if one outcome was that a residual muscular imbalance denied me the possibility of becoming a commercial pilot. (Ironically, something which wouldn't be an issue today, but c'est la vie or whatever.)

Another outcome was that I have always valued my sight. Not least because I am an inveterate reader, have been since quite some time before that operation, and the short period after it when I wasn't allowed to read remains one of the really frustrating times of my remembered life. Also, my career over nearly four decades as a journalist and writer has absolutely depended on my ability to see.

So it is with a certain personal interest that I simply can't understand recent revelations about waiting times of up to several years for children who need further investigation after having eye screening at school. Especially when there's a cohort of practitioners out there in every community quite capable of dealing with much of that further investigation in relatively short order.

In schools, every junior infant gets routine vision screening by the public health nurse, which is simply checking how much they can see in each eye using a letter chart. It doesn't involve an eye health check, and any inability to see the letters may simply be because of a 'lazy eye' or short-sightendess. From that screening a number of children are referred to outpatient clinics for further investigation, and it is accepted that a proportion of these are what are described as 'false positives'. At the moment, more than 4,200 of these youngsters are waiting to be seen at one of the three such clinics operated by the hospitals at Temple St, Crumlin and Tallaght.

Waiting times for HSE-paid appointments are up to 42 months at the moment, according to the country's opthalmologists and optometrists. We're also told that an unspecified number of these eye problems are merely a requirement for spectacles prescriptions, new or changed.

Just for clarification, opthalmologists are medical doctors who specialise in eyes, some of them surgeons, and they are relatively few in number. Optometrists are specialists in examination for eyes health who can prescribe spectacles or lenses, and some medications, to correct problems. They can also refer patients to opthalmologists — directly or through GPs — for investigation and treatment of more serious issues.

However, because there's no current HSE system for having optometrists in the local community carry out the further investigations from schools vision screening, all those youngsters are referred to the three outpatient clinics I have mentioned. Bottom line, the clinics' limited facilities in the public eyecare system are swamped.

Children's eyecare has a critical timeline point. If problems aren't dealt with by the age of seven, many of them can lead to impairment of vision that's not reversible.

Equally, issues like dyslexia might not become apparent until further down the educational timeline. Optometrists can play a role in detecting that or eliminating it as an issue — in a good number of cases, children referred with suspected dyslexia simply need glasses to experience a dramatically improved reading ability.

To trim those waiting lists, bringing the country's 739 optometrists into the public system seems like a no-brainer. It is likely they would be able to deal with a significant chunk of the children currently on the waiting lists for unspecified 'further investigation'. At the very least, they would be easing the pressure on the 112 opthalmologists currently available in the country.

Bring that to a more local level. Just four of those opthalmologists are based in County Kildare. On the other hand, there are 19 qualified optometrists practicing in the county. One of them in little Kilcullen.

I don't have the numbers, but it is likely that there are Kilcullen children amongst those vision-screened in our local schools who are being delayed up to 42 months for appointments. They could be accommodated just across the road if the HSE system got logical. And this could be replicated in every community across the country.

Sight is arguably the most important of the senses. If a primary school pupil has to wait three and a half years before being 'further investigated', that's a crying shame. One with potentially serious consequences for the victims, but not, apparently for a State service which is needlessly tardy in dealing with the situation.

C'mon, guys. This is an easy one to fix. People, tell them. Tell your local TDs, your councillors connected with the HSE. This is your kids' sight at stake. You can have it checked privately. If you can't afford it privately, that's not a good reason why your child has to wait.

Sixty-two years ago, I was lucky that my parents were able to scrape together the money to have my eye problem dealt with at an age when it hadn't resulted in permanent impairment. There were probably others in my age cohort not so fortunate, simply because of circumstance.

That was then. In 2013, it shouldn't have to be like that any more.