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PubMed1990

Vision screening in a primary care setting. A missed opportunity?

To determine the effectiveness of vision screening in a primary care setting, we administered a questionnaire and a vision test to 458 patients from a general medical clinic. Subjects were referred for complete ophthalmologic evaluation if they failed the vision test or met other "high-risk" criteria based on information contained in the questionnaire. Patient-initiated requests for eye examinations were also honored. A total of 169 patients were scheduled for eye examinations, and 148 actually underwent ophthalmologic evaluation. One hundred one of those examined were referred on the basis of the study criteria. "Serious eye disease" (cataract, glaucoma, diabetic retinopathy, or age-related macular degeneration) was diagnosed in 96 (95%) of these patients. Prompt surgical intervention was recommended in 27 (27%), and medical treatment was begun in 21 (21%). Of those with serious eye disease, 59% met the criteria by failing the vision test, while 69% met the high-risk criteria determined by the questionnaire. Of the 148 subjects who received ophthalmologic evaluations, 47 requested them. Serious eye disease was diagnosed in 23 (50%) of the 47 patients. None of these individuals required immediate surgery, and medical treatment for glaucoma was begun in eight (17%). These data suggest that screening for serious eye disease in a primary care setting is an efficient mechanism to use for the identification of patients with undetected ocular disorders that require follow-up or treatment.

Aged↗
PubMed1991

Comparison of the automated vision screening test to the Snellen test.

The comparison of an automatic vision screening machine using the Landolt rings and the usual Snellen Chart was carried out among 123 second grade and 149 fifth grade students in an elementary school in Jerusalem. The sensitivity of the test for a cut-off point of greater than or equal to 6/12 according to the Snellen test was 41.7% (CI = 16.5-71.4) and the specificity was 86.5% (CI 78.1-92.2) for second graders. For fifth graders the values were 50.0% (CI = 20.1-79.9) and 90.6% (CI 83.7-94.8) respectively. Diagnosis by a specialist decreased the number of 'false negatives' and confirmed the pathological cases. The automatic test was well accepted by the children. Though more time is needed for assessment using the automatic test, its advantage is that no professional staff are required.

Child↗
PubMed1976

Comparison of vision screening by lay and professional personnel.

A previously described vision screening procedure was administered to 652 elementary school children, using lay volunteers. These students were later screened by optometrists, using the Modified Clinical Technique (MCT). Using MCT as the standard, the lay screening correctly identified 90% of the children; the incorrect identifications included 28 children (4.3%) as false negatives and 36 children (5.5%) as false positives. Analysis indicates a lower cost for the combined lay and professional screening than for professional screening alone.

Allied Health Personnel↗
PubMed1992

An audit of preschool vision screening.

An audit was carried out to clarify the dispute surrounding the vision screening test at 3.5 years. The uptake was 53.5%, sensitivity 77%, specificity 96%, and positive predictive value 50%. In particular the uptake was poor and the test needed a clear policy for the future.

Child, Preschool↗
PubMed1989

Review of children referred from the school vision screening programme in Kettering during 1976-8.

The progress of 108 children who were identified by the vision screening programme in school as having defective vision (excluding those with puberty onset myopia) was reviewed. Treatment of these children resulted in improvement in visual acuity of the worst eye (two lines or better) for 16 children. Eighteen children had severe amblyopia (6/24 or worse). Among these the vision of only five was improved by treatment. Two thirds of the children had refractive errors in the better eye which required correction. It seems sensible to identify and treat children with bilateral refractive errors, but the need to treat children with lesser degrees of amblyopia is questioned.

Amblyopia↗
PubMedDate not supplied

Stereopsis testing to reduce overreferral in preschool vision screening.

Three- and 4-year-old children who obtain the minimum failing visual acuity result of one-line difference between eyes in preschool vision screening with isolated optotypes have a high rate of overreferral. We evaluated the Random Dot E Stereotest (RDES) to determine if a passing result at a high threshold on this test, as administered by lay screeners, could safely nullify referral for a minimum failing visual acuity test result. Fifty-eight children with a "one-line difference" result also had the RDES administered to them during screening at distances of 40 cm and 1.5 m. Upon subsequent ophthalmologic examination, 45 of these children were found to be normal, and 13 had abnormal findings. Thirty-nine of the children with normal examinations had correctly passed the RDES at 1.5 m. Seven of the 13 children with abnormal findings had correctly failed the RDES. Thus, the specificity of stereotesting was 87% and the sensitivity was 54%. Among the six children who falsely passed the stereopsis test during screening, best-corrected visual acuity was no worse than 20/40 and no child had greater than a one-line difference in acuity. Therefore, no amblyopia was missed. If a passing result on the stereotest at 1.5 m had been allowed to nullify a one-line difference referral, overreferral would have decreased 87% but underreferral would have increased 46%. We cannot yet recommend modifying current visual acuity referral criteria based on stereopsis testing results until the sensitivity of stereopsis screening by lay screeners at a sufficient threshold is improved.

Child, Preschool↗
PubMed1992

The Tokyo Metropolitan Home Vision Screening Program for amblyopia in 3-year-old children.

In August 1989, the Tokyo Metropolitan Government officially began a vision screening program for children aged 3 years 1 month. A 1988 pilot study of 1,303 children this age disclosed five cases (0.38%) of amblyopia. The home vision test, which uses picture cards of familiar figures, proved to be an efficient and inexpensive method of screening when incorporated into the existing health-check program for 3-year-old children. In the initial eight months of the program, 21,906 children were screened. Of these, 419 children (1.9%) were referred to an ophthalmologist for follow-up, and amblyopia was detected in 41 children (0.19%).

Amblyopia↗
PubMed1991

Vision screening of children: a review of methods and personnel involved within the UK.

The validity of vision screening of children for amblyopia, squint and significant degrees of ametropia is reviewed. The suitability of the tests used in screening, the age at which they are applied and the personnel involved is assessed. Some suggestions for improvement are made with particular reference to the optometrist's role, especially in view of the proposed child health surveillance scheme to be undertaken by selected general medical practitioners.

Adolescent↗
PubMed1991

Vision screening in preschool children: comparison of orthoptists and clinical medical officers as primary screeners.

OBJECTIVE: To see if there were differences in referral rates and abnormalities detected from two areas that were operating different preschool vision screening programmes. DESIGN: Cohort study using case notes of referrals. SETTING: Community based secondary referral centres in the county of Avon. PATIENTS: 263 referrals from a child population of 7105 in Southmead district, an area that used orthoptists as primary vision screeners; 111 referrals from a child population of 2977 in Weston-super-Mare, an area that used clinical medical officers for screening. MAIN OUTCOME MEASURES: Amblyopia and squint detection rates, together with false positive referral rates. RESULTS: The amblyopia detection rate in Southmead district was significantly higher than in Weston-super-Mare (11/1000 children v 5/1000), as was the detection rate of squint (11/1000 v 3/1000). However, the false positive referral rate from Southmead was significantly lower than that from Weston-super-Mare (9/1000 v 23/1000). CONCLUSION: Preschool vision screening using orthoptists as primary screeners offers a more effective method of detecting visual abnormalities than using clinical medical officers.

Amblyopia↗
PubMed1977

The Davidson and Hemmendinger color rule as a color vision screening test.

The Davidson and Hemmendinger (DH) color rule was evaluated for color vision screening of normal and congenital color-defective subjects. Ninety-eight normal and 14 color-defective subjects were tested on the color rule under Macbeth illumination of 5,400 K. The color-defective subjects were also tested on the Nagel anomaloscope, the Farnsworth D-15, and the H-R-R pseudoisochromatic plates. The DH color rule performed as accurately as the anomaloscope and was superior to the other two tests in detecting anomalous trichromats and in discriminating protanomalous subjects. The color rule also discriminated dichromats from anomalous trichromats. For severe color-defective subjects (dichromats, achromats), the color rule was more time-consuming than the other tests and discrimination was less certain. Response patterns on the DH color rule and response variability of the different classifications are reported.

Adolescent↗
PubMedDate not supplied

Vision screening in a national sample of 11-year-old children.

This report describes the results of vision screening carried out by local health authorities on a national sample of 11-year-old schoolchildren using a standard Snellen chart. Of the 12 772 children tested, 78% had an unaided distant visual acuity of 6/6 or better in both eyes (optimal vision), 10% had a distant visual acuity of 6/9 in the worse or both eyes (near-optimal vision) and 12% had a visual acuity of 6/12 or worse in one or both eyes eyes (definite visual defect). In addition, near visual acuity was tested for 12 737 children and 5% were found to have defective near vision. Glasses had been prescribed for current use in 12% of children but a quarter of those prescribed glasses did not have them available at the time of the test. Testing revealed that 22% of children whose glasses were available had optimal or near-optimal unaided distant vision, the number increasing to 98% when retested wearing glasses. In contrast, 43% of the children who were without their glasses had optimal or near-optimal vision; 27% had a bilateral defect. Amongst the children for whom glasses had not been prescribed 4-6% had a visual defect. A higher proportion of children from non-manual family background than from manual family background had visual impairment and had been prescribed glasses, but there was no significant social class difference amongst the children with visual defects for whom no glasses had been prescribed. A defect of red/green colour vision was recorded in 6% of boys and 1% of girls. The proportion of children with poor visual acuity was similar in the group of children with defective colour vision and the group with normal colour vision.

Child↗
PubMed1978

Comparison of vision screening performed by optometrists and nurses.

The rates of patient referral by optometrists and nurses working independently and conjointly in vision screening of schoolchildren are compared. Very few studies in the literature have examined the difference in referral rate; this difference is important because of the shortage of qualified manpower to screen the large number of children in the present school population. The study determined that the nurses correctly referred a greater percentage of children following an educational program and collaboration with the optometrist, but this increase in referral was not statistically significant.

Adolescent↗
PubMed1990

Random dot stereogram E in vision screening of children.

The random dot stereogram E (RDE) has been shown to be a simple and effective test for the detection of binocular abnormalities and defective visual acuity in children. We determined the validity of the RDE as a screening test for reduced visual acuity, amblyopia and strabismus in two separate populations of children. A nonselective group of 100 school children (aged 5 to 15 years) who presented consecutively to the ophthalmology department at Auckland Public Hospital were tested with the RDE. All cases of amblyopia and strabismus were detected by the RDE. Similar screening with the RDE test of 168 preschool children (aged three to four years) in the community resulted in an unacceptably high over-referral rate. The test was unreliable in the preschool age group because of difficulty in distinguishing between test failure and non-cooperation with the test. The low positive predictive value of the test in the younger age group suggests the test to be unsuitable for preschool vision screening.

Adolescent↗
PubMed1979

The influence of clinical judgment on the rate of referral from a school vision screening program.

It has been observed that black preschool children low income families have a higher than average rate of referral from a school vision screening program. One potential contributing factor results from the fact that examiners often modified the referral criteria based on their clinical judgment. This study was designed to investigate the influence of the application of clinical judgment on the proportion of referrals as a function of ethnicity and socioeconomic income level. The results suggest that modifying the referral criteria based on clinical judgment does not significantly influence the proportion of referrals based on ethnicity or socioeconomic income level.

Black or African American↗
PubMed1990

Evaluation and outcome of the vision screening programme in south Auckland intermediate schools.

Four thousand, seven hundred and fifty-nine form 1 intermediate school children (aged 11 years) in the south Auckland health district were screened in 1987. There were 88 (1.8%) new visual defects detected (defined as a visual acuity (VA) of 6/12 or worse in one or both eyes), while 103 (2.2%) wore glasses and a further 22 (0.5%) did not have their glasses available at the time of the VA test. The total prevalence of screening visual defects was 4.5%. A survey was carried out of those pupils who failed the VA screening test in the previous year and those recorded as wearing glasses. Sixty-seven (76%) of 88 children with newly detected visual defects were interviewed. An abnormal VA test was confirmed in 59 (88%), of which 39 (66%) required treatment. Thirty were prescribed glasses, of which 27 purchased them, but at the time of interview nine did not have them available. Twenty-one (20%) of the 103 children tested with glasses failed the VA test. Twenty-two children had glasses but were not wearing them at the time of the VA test. Only three of these children had a VA better than 6/12 bilaterally. These results highlight the importance of the vision screening programme in this age group and the follow up of children with known visual defects.

Child↗
PubMed1988

Simple procedures for comprehensive vision screening.

Visual problems can cause poor academic performance or inappropriate behavior. This article explains simple, easily administered procedures to determine if students have problems with acuity, accommodation, binocularity, or eye movements. The evaluator can use vision screening in conjunction with associated learning or behavior problems to initiate referral to the family vision care specialist.

Accommodation, Ocular↗
PubMed1988

Preschool vision screening: a service in need of rationalisation.

A survey of health districts in England and Wales was carried out at the end of 1984 to ascertain among other things the range of current programmes for preschool vision screening. The response rate was 81.3%. Altogether 94% of districts reported screening for both reduced visual acuity and squint; two districts screened for neither. A great variety of different types of tests were in use and screening was carried out at a variety of different ages. A high proportion of districts were screening children for reduced visual acuity in infancy, although screening tests applicable at this age have not been shown to be effective. Districts screened for squint between one and four times. Collection of routine monitoring information by districts was poor.

Child Health Services↗
PubMedDate not supplied

Color vision screening of young children.

Early detection of congenital color vision defects is desirable, but school screening studies have been stymied by lack of a suitable test. We evaluated a new color vision test, the APT-5, for use by volunteer screeners in schools and preschools. The screeners tested 1794 children, ages 3 to 13 years, and found the APT-5 easy to use with young children ages 5 years and up. Children who failed the screening were recruited for diagnostic color vision testing; for the children ages 5 to 13 years, 56% of those who failed the screening were successfully recruited. Data analysis indicated that the false-positive rate in this age group was 1% to 2%, and that for boys in this age group the positive predictive value was 71% to 81%. Retest data indicated that most false-positives were not due to the test itself, but to other factors in the school screening situation. Two thirds of all children scored as abnormal by anomaloscopy were simple deuteranomalous, indicating that the APT-5 effectively identified even mild color defects. The results of this trial indicate that the APT-5 is suitable for school color vision screening of children ages 5 years and up.

Adolescent↗