Paul Coghlan (Fine Gael)
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I welcome the Minister of State, Deputy Jim Daly.

Maria Byrne (Fine Gael)
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I, too, welcome the Minister of State. I am concerned about the provision of eyesight tests for children in primary and secondary schools, especially given that nowadays children spend an awful lot of time on consoles, iPads, phones and other forms of digital media. According to a report launched recently by a cancer society, there are concerns that children are developing digital myopia or short-sightedness as a consequence of the amount of time they spend on digital platforms. The Government needs to consider this because, as the old saying goes, one's health is one's wealth. One's eyesight is of particular importance. When I was going to school, people did not think about their eyesight very much. The issue was never highlighted. People did not realise there were concerns about the importance of eyesight. Something needs to be done to make sure children will receive all of the care and attention they need to protect their eyesight.

Jim Daly (Cork South West, Fine Gael)
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I thank the Senator for focusing on this important issue and giving me an opportunity, on behalf of the Minister for Health, to address the issue of eye-testing for primary school children. A child's vision continues to develop until about the age of eight years. Vision surveillance and screening are conducted by hospital paediatric teams, public health nurses and general practitioners, depending on the stage of development, to identify children with a visual impairment or eye conditions that are likely to lead to visual impairment in order that a referral can be made to an appropriate eye care professional for further evaluation and treatment. Vision screening is carried out under the guidance of the HSE's national screening and surveillance programme, Best Health for Children Revisited. Children have their eyes checked at birth by the paediatric team in the hospital. Their eyes are also checked by a public health nurse during the neonatal visit and the GP during the two and six-week visits. Children have universal access to an ongoing vision surveillance programme provided by the public health nursing service until they commence school. The purpose of the vision screening children undergo when they enter school is to detect amblyopia, the reduction of visual acuity in one or both eyes, usually in an otherwise normal eye. It needs to be identified and managed before the age of eight years. A child who has a vision issue detected during preschool or primary school screening receives a HSE service provided by community ophthalmic physicians or a hospital until the age of 16 years. All children are eligible to have an eye examination and receive treatment until the age of 12 years. If the parents of a child have a medical card, the child will be eligible to have an eye examination and receive treatment until he or she is 16 years.

The HSE published the report of the primary care eye services review group in June 2017. The review group determined that there was a need to move from the management of all referrals by community ophthalmic physicians to a model centred on primary eye care teams. The report recommends that such teams be based in primary care settings, with optimum accommodation, facilities, equipment and resources. Each team will provide services along care pathways, as set out in the report, for children and adults and work in an integrated fashion supported by an IT patient management system. This will ensure hospital services are focused on patients who require more specialist diagnostics or treatments.

Further to a recommendation made in the review group's report, the HSE is in the process of agreeing an addendum to the community ophthalmic services scheme to allow children aged eight years and over to be seen by their local community optometrist. The HSE is in the process of establishing primary eye care teams in south and west Dublin and further developing a team in north Dublin. The report recommends that all routine sixth class screenings, including the colour vision test, be discontinued as there is little clinical evidence for providing visual screening for children in sixth class. Data have shown that very few or no new cases of eye diseases such as amblyopia are detected at that stage. Most countries no longer undertake school exit screening. Instead, screening is undertaken at an earlier age to ensure children with eye diseases are identified at the earliest possible stage and can access treatment services.

Maria Byrne (Fine Gael)
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I thank the Minister of State. While I understand what he has said, I continue to be concerned about the amount of screen time to which children are exposed. The cancer society has shown that screen time is linked not only with short-sightedness but also cancer.This issue must be kept on the agenda because children are destroying their eyesight. There should be an awareness campaign or other measure to highlight to children and parents the damage caused by excessive screen time. Screen time should be limited because it is affecting children's eyesight. The report was published in 2017, but all Members would agree that screen time has increased since then. I have seen many children sitting in a corner for hours on a phone or playing games on a screen while their parents are otherwise occupied. That needs to be monitored.

Jim Daly (Cork South West, Fine Gael)
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I have many strong views on screen time for children. When discussing the matter, I always point out that adults must be aware of their own screen time and the example they set for children in the home and elsewhere. I accept the Senator's point that it poses a risk to children's eyesight. Screen time may also affect children's social, language, communication, typing and writing skills and even their dexterity. It presents a myriad of challenges. It is an ongoing challenge in my area of mental health of which I am very conscious. The discussion of the issue in any forum, be it here in the Seanad or elsewhere, is always welcome as it affords an opportunity to make parents acutely aware of its potential physical, mental and holistic dangers.

I recently met representatives of Facebook regarding screen time and they told me that Facebook is moving towards making children aware of the amount of time they spend on screens. Many of us receive updates on our phones regarding our daily screen time, which is a welcome step towards acknowledging the problem. Some people would be frightened by how much time they spend staring at a screen. Physical eyesight will suffer as a result of such excessive usage. I am not aware of any links to cancer and would need to see concrete evidence of a relationship in that regard before pursuing the issue further. There is no doubt that screen time poses a challenge in terms of eyesight and other areas of which we must be aware. I thank the Senator for highlighting this issue.