A benchmarking exercise earned out in 2006 round that despite the recommendations for an orthoptist-led vision screening service1–5 many primary care trusts were not providing comprehensive vision screening (vision testing of every child of one age group). Where screening is carried out it is not always orthoptist-led and tests may be performed by health visitors, school nurses and school nurse assistants. Selective testing (testing a proportion of an age group using risk criteria) is being organised by health promotion groups and school health advisors rather than clinicians. The assessments vary from questions to identify children at risk6 to the recommended crowded logMAR letters test, but many children are being tested with single optotype pictures or letters. The exercise highlighted the inequality of access to screening for children from neighbouring primary care trusts, and in London it was generally the most deprived areas with the greatest health needs which had the least provision.