Implementation of the HOTV Vision Chart in the Northern NSW Local Health District Statewide Eyesight Preschooler Screening Program

Published 8 September 2017. Last updated 8 November 2021.

This project delivered education and resources on HOTV vision charts to all staff in Northern NSW Local Health District (NNSWLHD) who deliver the Statewide Eyesight Preschooler Screening (StEPS) Program.


To implement the new StEPS HOTV vision chart in NNSWLHD.


  • Standardises vision screening for four-year-olds across NNSWLHD.
  • Enhances partnerships between education, community, non-government and healthcare organisations.
  • Improves knowledge of vision screening among community health staff.
  • Provides four-year-old children with evidence-based screening and access to interventions if required.
  • Improves the experience of parents and children participating in the StEPS Program.


The StEPS Program is an initiative of NSW Health and offers all four-year-old children free vision screening. School health nurses in NNSWLHD use StEPS vision screening as part of their Before School Assessment, which is an assessment of childrens’ physical health, including their height, weight, hearing, sight and general wellbeing. It ensures they are healthy, fit and ready to learn when they start school.

The StEPS Program was originally delivered using the Sheridan Gardiner Linear Chart (SGLC), however evidence presented at state clinical training in May 2016 suggested the new HOTV vision chart was the superior option for four-year-old children universally. In addition, existing SGLCs had reached safe work practice limits and a lack of resources and equipment meant the charts were no longer available for purchase worldwide.

As a result, it was determined that the new HOTV vision chart should be implemented across NNSWLHD. It was anticipated that standardising the tool used in vision screening would support universal screening criteria as well as reduce confusion among parents and children who participate in the StEPS Program.


  • A formal partnership was established in April 2016 between the NNSWLHD StEPS Program Coordinator, the Child, Family and Adolescent Health Clinical Nurse Consultant (CNC), Women’s and Child Health Program Coordinator and Richmond Community Health Manager.
  • Face-to-face HOTV training was delivered to all NSW StEPS coordinators and the Richmond Child, Family and Adolescent Health clinical nurse consultant in Sydney in May 2016.
  • StEPS vision screening staff were provided with separate face-to-face training in Lismore in May 2016, by a NNSWLHD StEPS coordinator. Staff needed to complete the practical and theoretical components of HOTV training in order to receive the screening equipment.
  • School Health staff were provided with face-to-face HOTV training in August 2016, delivered by the NNSW LHD StEPS coordinator and the Richmond Child, Family and Adolescent Health CNC.


Sustained – The project has been implemented and is sustained in standard business.


April 2016: Project partnerships established

May 2016: HOTV training to StEPS coordinators in Sydney and NNSWLHD StEPS staff in Lismore.

August 2016: HOTV training to school health staff

August 2017: Project evaluation

Implementation sites

  • Early childhood community events
  • Local eye health services
  • NNSWLHD Community Health Centres
  • Preschools and childcare centres


  • Aboriginal Health Services
  • Child, Family and Adolescent Health, NNSWLHD (including School Health)
  • Eye health professionals
  • Non-government organisations
  • Parents and communities
  • StEPS Program
  • NSW Ministry of Health


NNSWLHD is the first local health district in NSW to implement the HOTV vision chart for four-year-old children. An audit conducted between May and August 2016 showed that 100 per cent of StEPS screening and school health staff in NNSWLHD were trained in the use of the HOTV vision chart.

All 24 StEPS screeners were surveyed via email directly following their training, as well as three and six months following training. Feedback was positive and showed that the HOTV vision chart had reduced confusion for participating children, with feedback from one Paediatric Ophthalmologist, Dr Allan Hilton,  as follows:

“Your StEPS program is to be commended on again picking up children with decreased vision requiring treatment by way of spectacles and/or occlusion treatment.”

Prior to the project, NNSWLHD had a StEPS screening referral rate that was higher than the state average. In 2016-17, referral rates had reduced to the state average, with screening and referral rates reported to NSW Health on a quarterly basis. This evaluation and ongoing data collection ensures continuous quality improvement, to ensure high standards of clinical practice are maintained.

Lessons learnt

  • A collaborative approach was critical to the success of the project.
  • It is important to order enough HOTV vision charts for all StEPS screening organisations and school health staff in the local health district.

Further reading

  • Blows SJ, Murphy EP, Martin FJ et al. Vision screening in preschoolers: the New South Wales Statewide Eyesight Preschooler Screening program. Medical Journal of Australia 2014;200(4):222-25. DOI: 10.5694/mja13.10594.
  • The StEPS Program


Jennifer McKay
StEPS Program Coordinator
Northern NSW Local Health District
0448 076 439


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