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PubMed1997

Vision screening, eye examination and risk assessment of display screen users in a large regional teaching hospital.

In January 1993 the Royal Group of Hospitals Trust, which employs approximately 5000 staff, implemented the Health and Safety (Display Screen Equipment) Northern Ireland Regulations (1992). During 1994 all regular display screen equipment users were offered a vision screening test. In total 571 employees were screened using computerized vision screening software (City Visual Systems Ltd). Risk assessments were completed for 293 display screen work-stations. One hundred and twelve full eye examinations, carried out by optometrists, were performed on those who failed vision screening and on those who specifically requested an optometric assessment. Results indicate that whereas the proportion of users experiencing visual and general symptoms differed markedly from department to department (28-82%), the median number of individuals failing the screening test was 25% (range 9-40%). Those involved in uninterrupted display screen equipment work for prolonged periods reported visual and general work-related symptoms twice as frequently as those who spent less time working with DSE. The outcome of full eye examinations confirmed that less than 5% of display screen users required spectacles solely for display screen use. Work-station analysis indicated that ergonomic problems were common. The authors conclude that the successful management of health risks from display screen equipment requires simultaneous attention to work-place design, working patterns and eye care.

Adolescent↗
PubMedDate not supplied

Preschool vision screening using the MTI-Photoscreener.

Amblyopia is a condition that, if detected and treated early, can improve vision for most children. Thus, both pediatric and ophthalmologic groups have acknowledged the need for preschool vision screening. However, vision screening is the exception rather than the rule for preschoolers, since traditional methods of vision screening are often inappropriate for the preschool population and almost impossible for those children who are preverbal or nonverbal, developmentally delayed, and/or have chronic illnesses or disabilities. This study evaluated the use of a photoscreener to detect vision problems in a preschool population. Fifty-one children ages 3 to 5 years were evaluated using the MTI Photoscreener. Results were compared with a complete ophthalmologic examination, including cycloplegia. The sensitivity and specificity calculated for this study was 83% and 68%, respectively. Findings conclude that the MTI Photoscreener detected a broad range of vision problems, seemed to require less time, and seemed more acceptable to preschoolers when compared with the traditional vision screening methods performed by registered nurses. Although the sensitivity and specificity rates for this study were less than desired, it is likely that both could be improved with additional photo interpretation training.

Child, Preschool↗
PubMed1986

A Random Dot E stereogram for the vision screening of children.

The purpose of school vision screenings is to detect those children with vision problems that may impede normal development (eg, amblyopia, refractive error, strabismus, suppression). In a double-blind investigation, 483 schoolchildren, ranging in age from 5 to 13 years, had their vision screened using both the Random Dot E (RDE) stereogram and the Modified Clinical Technique (MCT). The validity of each technique was determined using the phi coefficient and was compared with results of similar reports in the literature for the Modified Clinical Technique, Snellen letter acuity, and vision-screening kits. Our data show that the RDE is more effective than five of six other techniques in identifying those children who need further visual examination. In addition, screening with the RDE can be taught to nonprofessionals in ten minutes or less, can be completed on each child within two minutes, and is inexpensive.

Adolescent↗
PubMed1989

Analysis of a community vision screening program.

For 3 consecutive years a community vision screening program has been conducted on-site at the Walker Eye Clinic of the Indiana University (IU) School of Optometry. A group of 490 screened patients, including 86 who returned for comprehensive evaluation, was retrospectively studied for a variety of characteristics. It was determined that the typical participant was likely to be an adult female who learned of the screening program through the written media. She was likely to have had a previous vision examination but it probably took place 3 or more years earlier. She usually failed the vision screening for reasons of reduced visual acuity, a problem with binocularity or asthenopia. If she returned to the Walker Eye Clinic for a comprehensive examination, she was likely to do so within 5 months and would be found to have been accurately identified as being in need of vision care. The organization and implementation of this vision screening program are described, and its value as an educational tool for students of optometry and its technician program is discussed.

Adolescent↗
PubMed1998

Barriers to seeking care following school vision screening in Rochester, Minnesota.

School vision screening provides an effective way to identify children who require vision therapy, usually glasses. To benefit from screening, children with abnormal screening test results must receive follow-up eye care, but care may be delayed for months or years. This project used community focus groups in Rochester, Minn., to identify barriers that may delay seeking professional care following school vision screening. Major barriers identified included lack of community awareness about the frequency and potential effect of refractive errors in children, a parental perception of inadequate communication between schools and the parents and community, high cost of corrective lenses, limited availability of convenient eye care appointments, and adolescents reluctance to wear glasses. Program planners developed a community action plan to address the perceived barriers.

Adolescent↗
PubMed1995

Evaluation of vision screening practices of Illinois pediatricians.

A survey of vision screening practices of American Academy of Pediatrics physicians in Illinois is described. The response rate was 42%. Sixty percent of physicians tested visual acuity of children 5 years and older, and half of this group tested children 2 to 4 years old. The most common reasons for not testing visual acuity were inadequate time (42%), children too young (18%), or screening done at school (18%). The majority (88%) refer to an ophthalmologist after a single vision screening failure, while about half perform the cover-uncover test on infants and children. The results suggest many Illinois pediatricians do not perform vision screening of preschool children, though screening does occur at other sites.

Child↗
PubMed2001

Vision screening in central Iowa.

This study assessed the vision-screening practices of all preschools and elementary schools during the spring of 2000 in the Heartland Area Education Agency (AEA) in central Iowa. Surveys were returned by 7% of the preschools and 56% of the elementary schools. Survey questions were drafted based on recommendations from the Iowa Vision Screening Program Guidelines, which were distributed to all Iowa school districts in 1997. Areas surveyed included vision-screening personnel, attainment of students' visual history, rescreening practices, referral and follow-up, and screening procedures. Survey results indicated that there is a need for improvement to standardize vision-screening procedures within Heartland AEA. Time and effort are invested in activities that are not recommended, and not enough effort is being put into recommended activities such as obtaining vision histories, rescreening to avoid overreferrals, and follow-up to make sure students receive required treatment.

Age Factors↗
PubMed2004

Hearing and vision screening program for school-aged children.

BACKGROUND: Hearing and vision screening programs for school-aged children are common, yet little is known about their impact. OBJECTIVE: To evaluate Michigan's screening program, in which local health department (LHD) staff screen school-aged children using standardized protocols. METHODS: This project was completed in three phases: interviews with officials and screening technicians from ten LHDs, audit of LHD records regarding outcomes of screening during the 2000-2001 school year, and telephone interviews with randomly selected parents of children with an abnormal screen. RESULTS: Variations in LHD program implementation pertained to methods for tracking outcomes, screening of older children, parental notification of screening results, and availability of follow-up hearing clinics. According to LHD records, documentation of follow-up examination after an abnormal screen was low (hearing 27%, vision 25%). In contrast, most parents reported follow-up (74% hearing, 76% vision), and many reported that this resulted in treatment (50% hearing, 74% vision). In logistic regression modeling, the odds of follow-up after hearing or vision screening according to parents was not associated with income, health insurance status, or race/ethnicity. For hearing screening, the odds of follow-up decreased with school grade (p <0.001); however, the proportion who received treatment did not vary by grade. For vision screening, follow-up did not vary by grade, but the proportion who received treatment increased with grade (p =0.05). CONCLUSIONS: According to parent reports, most children had follow-up after an abnormal screen, and the majority of these children received treatment. Screening school-aged children for sensory impairment appears to be an important public health function.

Adolescent↗
PubMed2000

Prevalence of amblyopia among defaulters of preschool vision screening.

The prevalence of amblyopia among screening defaulters is an important determinant of the efficacy of amblyopia detection by preschool vision screening. A retrospective cohort study was therefore performed to assess an orthoptist-based preschool vision screening programme. The preschool vision screening status of children in the cohort was determined by reviewing their Community Child Health records. The prevalence of amblyopia among screening defaulters was determined by reviewing each child's school entry vision test (performed at 5.5 years of age), with retesting if a Snellen line acuity of 6/6 in each eye had not been documented. For comparison, the prevalence of amblyopia among screening attenders was also determined. The preschool vision screening status was known for 86.0% (772/898) of the cohort. The attendance rate at preschool vision screening was 79.2%. The prevalence of amblyopia among screening defaulters was 1.3% (95% CI 0.2% to 4.5%). The prevalence of amblyopia among screening attenders was 2.5% (95% CI 1.4% to 4.1%). There was no significant difference in the prevalence of amblyopia between screening defaulters and screening attenders (P=0.53). The efficacy of amblyopia detection by preschool vision screening is therefore highly dependent on its attendance rate. Preschool vision screening programmes with a low attendance rate will fail to detect a significant proportion of children with amblyopia.

Amblyopia↗
PubMed1988

Comprehensive vision screening program: Illinois' approach.

This article discusses a statewide vision screening program that utilizes trained and certified vision screening technicians under the auspices of the Department of Public Health. Public Act 81-174, the Child Vision and Hearing Test Act, mandates periodic vision screening of children using accepted and approved instruments and standards. The program receives consultation from the Children's Vision Services Advisory Committee, consisting of optometrists, ophthalmologists and others in health and education programs. Topics addressed include: training and certification of technicians; screening, referral and follow-up; program summary of statewide screening statistics of 1.2 million children for fiscal year 1985, etc.

Adolescent↗
PubMedDate not supplied

A survey of vision screening policy of preschool children in the United States.

A state-by-state survey regarding preschool vision screening guidelines, policies, and procedures was conducted. Currently 34 states provide vision screening guidelines and 15 states require vision screening of at least some of their preschool-aged children. The Department of Public Health administers the programs in 26 states, the Department of Education in 13. A wide range of professional and lay personnel conduct preschool vision screenings, and nurses participate in the screening process in 22 states. Visual acuity is assessed in 30 states, eye alignment in 24 states, refractive error in eight states, and color vision in 10 states. A combination of screening tests is recommended in 24 states. Currently, 45 states do not require screening of all preschool children. Thus, although laws, guidelines, and recommendations exist in most states, many preschool-age children do not have access to vision screening programs.

Child, Preschool↗
PubMed2003

Preschool vision screening frequency after an office-based training session for primary care staff.

OBJECTIVE: Although vision screening for preschool children is recommended for detecting amblyopia, many pediatric and family medicine practices do not screen preschool-aged children. The aim of this study was to determine the effect of a training program for primary care clinical staff on vision screening behavior and attitudes. METHODS: All local pediatric and family medicine practices were mailed invitations for free training sessions in preliterate eye chart vision screening. The clinical support staff at each participating practice location received a single training session. The lead ancillary medical employee of each practice location was surveyed immediately before and after training, and again 4 to 6 months later, to determine the effect of a single training session on screening behavior and attitudes. RESULTS: Twenty-nine (26%) of 110 practice locations received training in vision screening. Four to 6 months after training, reported screening frequency of 3-year-olds increased, but not of other ages. The reported comfort level with screening 3-year-olds and 4-year-olds was improved 4 to 6 months after training. Most practices responded that the training was beneficial and worthwhile, but lasting impact on practice behavior for the cohort was modest. CONCLUSIONS: Direct, practical training in preliterate eye chart vision screening may increase the number of 3-year-old children screened and improve clinical support staff comfort with screening preschool children. A single training session is not sufficient in itself, however, to achieve the goal of universal preschool vision screening in the primary care setting.

Adult↗
PubMed2003

Testability of preschoolers on stereotests used to screen vision disorders.

OBJECTIVE: The purpose was to determine whether preschool children aged 3 years 0 months through 3 years 6 months could be tested with the Random Dot E, Stereo Smile, and Randot Preschool stereoacuity tests, which are random dot stereotests marketed for use with preschoolers. METHODS: A total of 118 children from five Vision In Preschoolers Study Clinical Centers participated. Strabismic children, as determined by the cover test at distance and near, were excluded from this study. Stereopsis was tested on each child using each of the three tests in a variable, balanced order. A child's testability for each test was determined by the ability to complete the nonstereo task (pretest) and the gross stereo task for each stereotest. Proportions of children able to perform each test were compared using statistical methods accommodating multiple measurements per child. RESULTS: Testability of children on the pretest was greater for the Stereo Smile test (91%) than for the Random Dot E test (81%; p = 0.007) or the Randot Preschool test (71%; p < 0.0001) and greater for the Random Dot E test than for the Randot Preschool test (p = 0.02). For all children, testability on the gross stereo task was greater for the Stereo Smile (77%; p < 0.0001) and Random Dot E (74%; p = 0.005) tests than for the Randot Preschool test (56%) but did not differ significantly between the Stereo Smile and Random Dot E tests (p = 0.19). There were no significant differences among the proportion of children able to complete the gross stereo task among those who were testable on the pretest (p > 0.12, all comparisons). CONCLUSIONS: Among preschoolers aged 3 years 0 months through 3 years 6 months, testability differs significantly across the three commercially available random dot stereotests evaluated. The results suggest that two-choice procedures increase testability of young preschoolers.

Amblyopia↗
PubMed1989

Vision screening of school age children in Missouri.

In this report, vision screenings conducted by schools in the state of Missouri are reviewed. Data were generated by the 127 participating schools in 38 school districts that responded to four research questions. In general, many inadequacies exist in schools regarding vision screening. Recommendations include greater participation in the public school arena by vision specialists and the development of consistent criteria for vision screening in school districts.

Adolescent↗
PubMedDate not supplied

Stereopsis testing in a preschool vision screening program.

We conducted a preschool vision screening study using stereopsis testing with the Random Dot E and Lang stereotests as a complement to visual acuity measurement. Over 6000 children were screened. Stereopsis testing at a threshold of 600 seconds of arc was cognitively easier for the children than visual acuity measurement. At this threshold there was no effect on reducing the rate of visual acuity overreferrals, but ten children with abnormal binocular vision were detected who were not referred by visual acuity criteria. Though a large number of children passed only one of the two stereotests, there was no significant difference in their degree of difficulty. Stereopsis testing with these two stereotests may be a useful adjunct to preschool vision screening programs though further studies are required.

Child, Preschool↗
PubMed1994

Analysis of an older adult vision screening project.

BACKGROUND: The purpose of this study was to determine how a variety of reasonable vision screening criteria affected the results of vision screening previously performed on a community-dwelling older adult population. METHODS: The records of 201 previously performed vision screening evaluations of adults over the age of 65 were reanalyzed to determine failure rates using new theoretical criteria. Those criteria included screening by history alone, visual acuity alone, history in combination with visual acuity and a multiple test format with both 20/40 and 20/60 acuity criteria. RESULTS: Theoretical screening that would have taken place using visual acuity of less than 20/60 failed the fewest individuals; however, even using this minimal criteria 46 percent of those screened would have failed. Using a multiple test format the failure rate rises to almost 90 percent. The combination of historical criteria and visual acuity failed almost an identical population as would be failed by using an elaborate multiple test format. CONCLUSIONS: The prevalence of ocular abnormalities in this older adult populations was so high that vision screening done with even minimal criteria can be expected to fail very high numbers. Similar failure rates and composition can be achieved by using historical criteria in combination with visual acuity as are achieved using a more elaborate multiple-test format. Given the high prevalence of eye abnormalities in the older adult population the public health value of screening for the need for eye examination is questionable.

Aged↗
PubMedDate not supplied

Compliance with vision-screening guidelines among a national sample of pediatricians.

OBJECTIVE: The American Academy of Pediatrics (AAP) recommends vision screening from birth through adolescence, with visual acuity testing and binocular screening to begin at age 3 years. The 1996 AAP guidelines advised referral for visual acuity worse than 20/40 for children aged 3 to 5 years and worse than 20/30 for children aged 6 years and older. Our objective was to describe vision-screening and referral practices in a national sample of primary care pediatricians. METHODS: We mailed a survey to a random sample of US pediatricians. Initial nonresponders were mailed up to 3 additional surveys. All mailings occurred between May and October 1998. Analyses focused on primary care pediatricians and consisted of descriptive statistics and regression analyses. The main outcome measure was compliance with 1996 AAP recommendations for vision screening. RESULTS: Of the 1491 surveys mailed, 888 (60%) were returned, including 576 (65%) from primary care pediatricians. Vision-screening methods included visual acuity testing (92%), cover test (64%), red reflex test (95%), fundoscopic examinations (65%), and stereopsis testing (32%). Respondents routinely performed visual acuity testing at 3 years (37%), 4 years (79%), 5 years (91%), 6 years (80%), 7-12 years (82%), and 13-18 years (80%). Visual acuity thresholds for referring 3- and 4-year-olds were 20/40 (47%, 51%), 20/50 (36%, 32%), or worse than 20/50 (14%, 12%). The majority of pediatricians referred children aged 5 years and older at 20/40, although thresholds worse than 20/40 were reported commonly (18%-33%). Logistic regressions were done to identify factors associated with higher likelihood of performing specific screening tests. Although no factor was consistently associated with use of all screening tests, size of the practice was significant in several regression models. CONCLUSIONS: Many pediatricians do not follow AAP guidelines for vision screening and referral, especially in younger children. Two thirds of pediatricians do not begin visual acuity testing at age 3 years as recommended, and about one fifth do not test until age 5 years. In addition, one fourth do not perform cover tests or stereopsis testing at any age.

Adolescent↗
PubMed2003

Major review: The underutilization of vision screening (for amblyopia, optical anomalies and strabismus) among preschool age children.

BACKGROUND: Nearly 80% of preschool age children never get an eye examination (1). Many "back to school" physical exams do not test for common vision disorders. Untreated eye and vision problems can interfere with most life experiences. The prevalence of undetected vision problems among preschool age children is estimated to be 5% to 10% (2). Failure to detect visual impairment early may have a permanent effect on long term vision outcomes, education achievement, and self esteem (3). The most common vision disorders among children are strabismus, amblyopia and optical problems impairing visual acuity and depth perception. Various professional organizations, including the American Academy of Pediatrics (AAP), advise preschool vision screening to detect and correct vision problems before school entry. The AAP also recommends that children continue to receive periodic eye and vision examinations throughout childhood. However, resources for this level of care are rarely available. As such, only 21% of preschool age children receive vision screening and even fewer children get a comprehensive eye examination (1). PURPOSE: The purpose of this review is to determine, through a critical review of the literature, the social, economic, and political barriers which contribute to the underutilization of vision screening among preschool age children. A secondary aim is to identify gaps in the literature base that may be needed to complete a public policy response to this problem. METHOD: A comprehensive review and analysis of the pertinent available literature. RESULTS: A variety of barriers exist which prevent children from receiving proper vision screening. They include social, economic and even political problems. Social contextual barriers include ignorance, inconvenience, language, and a lack of providers. Financial barriers affect low income families. Political barriers reside in the disproportionately meager funding of preventative medicine. Moreover there are additional factors which put preventative medicine for vision at a disadvantage compared to other pediatric demands like immunizations, such as the danger to both the individual and society from the medical condition being prevented. CONCLUSION: Even considering large gaps in the literature concerning this topic, it is clear that low income, minority, uninsured families are at high risk of not utilizing vision screening. Ignorance remains a major problem at all levels so improvements in the distribution of information and education are needed and should yield improvement. Additional funding is necessary to pay for these remedies. Titration and direction of available resources to those at highest risk will create the greatest return on such efforts.

Amblyopia↗