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PubMed2003

Amblyopia treatment outcomes after preschool screening v school entry screening: observational data from a prospective cohort study.

BACKGROUND/AIMS: Preschool screening for amblyopia has controversially been abandoned in some localities within the United Kingdom, on the basis that there is no clear evidence of benefit to support its continuation. Data collected within a birth cohort study were used to examine visual outcomes at 7(1/2) years in children who did or did not receive preschool vision screening. METHODS: Monocular logMAR visual acuity with and without a pinhole was assessed by orthoptists. Contemporary records were used to identify children who had been offered and/or received preschool screening. RESULTS: Of 6081 children, 24.9% had been offered preschool screening and 16.7% had attended. The prevalence of amblyopia was approximately 45% lower in the children who received preschool screening than in those who did not (1.1% v 2.0%, p = 0.05). The mean acuity in the worse seeing eyes after patching treatment was better for amblyopic children who received preschool screening than for those who did not; 0.14 v 0.20 logMAR (p <0.001). These effects did not persist in an intention to screen analysis. CONCLUSIONS: Preschool screening at 37 months was associated with an improved treatment outcome for individuals with amblyopia. However, the improvement was clinically small and disappeared when considering all children offered screening rather than only those who received it. Further research is needed into improving the effectiveness of vision screening for preschool children, while in the interim these data do not conflict with current recommendations for school entry screening by orthoptists.

Age Factors↗
PubMedDate not supplied

Relationship between performance on tests of basic visual functions and visual-perceptual processing in persons after brain injury.

OBJECTIVE: In this correlational study of adults receiving occupational therapy who sustained a cerebrovascular accident (CVA), the relationship between basic visual functions (including acuity, visual field deficits, oculomotor skills, and visual attention or scanning) and higher level visual-perceptual processing skills (e.g., visual closure and figure-ground discrimination) was investigated. METHOD: Thirty adults who sustained CVA and 20 adults without a history of CVA were given a basic visual function screening and the Motor-Free Visual Perception Test (MVPT). Scores on the vision screening and the MVPT were correlated statistically. RESULTS: A Pearson product-moment correlation analysis produced a correlation of r = .75 between vision screening scores and scores from the MVPT. CONCLUSION: These results suggest that a positive relation exists between basic visual functions and visual-perceptual processing skills. Further, the results suggest that evaluation of visual-perceptual processing skills must begin with assessment of basic visual functions so that the influence of these basic visual functions on performance in more complex tests can be taken into consideration.

Accommodation, Ocular↗
PubMed2000

Relation of useful field of view and other screening tests to on-road driving performance.

The purpose of this study was to examine the value of a clinical driving assessment battery in predicting performance on an on-road driving test. 43 participants referred to the Bryn Mawr Rehab Adapted Driving Program for evaluation of driving ability underwent an evaluation consisting of a predriver screening and an on road driving test. The predriver screening included a vision screening, a reaction rime task, a split-attention task, the Hooper Visual Organization Test, verbal and symbolic sign recognition, and assessment of Useful Field of View. Logistic regression analyses were applied to identify which predriver screening variables could be used to predict outcome on the on road driving test (pass/fail); UFOV was that best single predictor. The addition of screening tests beyond UFOV alone did not increase predictive validity. These findings suggest that UFOV may serve as an indicator of the need for further driving assessment.

Age Factors↗
PubMedDate not supplied

The cost and yield of photoscreening: impact of photoscreening on overall pediatric ophthalmic costs.

BACKGROUND: Approximately 5% of preschool-age children suffer from amblyopia. Many of them have high or unequal hyperopia. Amblyogenic risk factors frequently can be detected by photoscreening. METHODS: Free photoscreening was offered to Alaskan children ages 1 to 5 from urban and rural screening hubs. Screened images were mailed to the Alaska Blind Child Discovery coordinating center for physician photoscreen interpretation, specifically seeking latent or anisometropic hyperopia. Parents and screeners then were mailed results and information about amblyopia. Follow-up examination data were tallied, and a cost-consequence analysis was developed for various vision screening paradigms and eye care. RESULTS: From 1996 through 2003, a total of 13,255 screenings were performed with a positive interpretation rate of 4.7%. Penetrance of screening was 22% in urban and 44% in rural communities. Positive predictive value was estimated to be more than 90%. Average cost to screen and inform an Alaskan preschooler was approximately 10.67 dollars, and cost to detect amblyogenic risk factors by photoscreening in an Alaskan was approximately 206 dollars. Compared to American Academy of Pediatrics (AAP) 1995 guidelines, implementing photoscreening added 9%, while mandating complete prekindergarten examination added 49% to overall eye care. CONCLUSIONS: MTI photoscreening achieved high community penetrance and high positive predictive value for latent hyperopia and other amblyogenic factors. When follow-up costs are considered, adding photoscreening to current AAP guidelines may add 112 dollars per child over 10 years, but probably would assist in the reduction of amblyopia. Penetrance of urban photoscreening likely will remain low unless pediatric vision screening guidelines and reimbursement are revised.

Alaska↗
PubMed2004

Vision status among foster children in NYC: a research note.

A summary of the results of research on the vision status of foster children. Results indicate that the vision screenings being provided at mandated annual physical examinations are not sufficiently identifying children's vision dysfunctions.

Child↗
PubMed2003

The efficacy of photoscreening for amblyopiagenic factors in a high risk population.

BACKGROUND: Amblyopia is the leading cause of monocular "legal" blindness in children and young adults, affecting 3% to 5% of the population. Factors producing amblyopia can be detected through a complete eye examination. Although it is important to treat children at risk for amblyopia as early as possible, appropriate screening methods for severely impaired individuals are lacking. The purpose of this study was to assess the ability of a photoscreening camera to detect amblyopiagenic factors (strabismus, unequal refractive error, and media opacities) in a group of disabled children, who were currently unscreenable with standard methodology. METHODS: Fifty-four high risk individuals, 6-20 years in age, were evaluated for amblyopiagenic factors using the MTI photoscreening camera, pre- and post-cycloplegia. The "gold standard" for comparison was a concurrent complete eye examination, including ocular health, visual acuity estimation, motility, ophthalmoscopy and clinical cycloplegic refractive error determination. Criteria for a "failure" on the clinical examination included myopia greater than -1.00 diopters (D), hyperopia greater than +3.00 D (2-6 years) and greater than +2 D (over 6 years), astigmatism greater than 1.5 D, unequal refractive error greater than 1.5 D, any strabismus, or any media opacity. RESULTS: Fifty- four individuals with disabilities, deemed untestable by standard vision screenings, were evaluated. The number of children with amblyopiagenic factors by complete cycloplegic ophthalmologic examination was 30 (55%) and by photoscreening was 25 (46%). Using the MTI photoscreener, the sensitivity was determined to be 83% with a specificity of 79%. The positive and negative predictive values of photoscreening were 83% and 79% respectively. CONCLUSIONS: The MTI photoscreener can detect such amblyopiagenic factors as high refractive error, strabismus, unequal refractive error, and significant media opacity. Photoscreening is an excellent way of obtaining valid vision screening with limited patient cooperation. Using photoscreening data, proper referrals can be made and prioritized for disabled individuals.

Adolescent↗
PubMed1997

Validity and reliability of the MTI photoscreener.

OBJECTIVES: The prevalence and necessity for early detection of vision problems illustrate the need for improved methods of vision screening in preschool children. This study assessed the validity and reliability of a new device, the MTI photoscreener in a cross-sectional field study. METHODS: An appropriate sample size (> 140) was calculated and recruited for the study. All children (N = 161) in a migrant workers summer education program were screened with the MTI Photoscreener. Simultaneously and in a masked design, disease status was determined by the Modified Clinic Technique, a well established method for diagnosing the conditions which the MTI screener was designed to detect. RESULTS: Validity measures revealed a sensitivity of 54%, specificity of 87%, phi coefficient of 0.40, and positive predictive value of 52%. Repeatability was assessed by the kappa coefficient, by a test for effect modification by examiner, and by comparison of sensitivity and specificity across 12 masked examiners. The kappa coefficient was 0.38. A test for effect modification suggested that differences existed among the examiners. Variability of sensitivity was high, but variability of specificity was low. CONCLUSIONS: Methods for vision screening in preschool children are limited. The MTI Photoscreener is an easy and efficient method, but the validity and reliability is a concern. Comparison of our results with other studies suggests future potential for this instrument provided protocols are refined and further field studies reveal efficacy.

Child↗
PubMed2006

The yield and challenges of charitable state-wide photoscreening.

INTRODUCTION: State-wide cooperative programs for pediatric vision screening utilizing the MTI photoscreener and centralized interpretation were established in Alaska (The Alaska Blind Child Discovery, ABCD) and in Tennessee (Tennessee Lions Outreach). METHODS: Details of setup, implementation and interpretation of the state-wide MTI photoscreening programs are compared through 2002. The absolute numbers of children screened and the breakdown in interpretation categories are presented. RESULTS: ABCD screened 14,000 children while Tennessee Lions screened 100,800. Similarities between ABCD and Tennessee programs were funded by Lions Clubs and other charitable and public health organizations, community screening and each had coordinated centralized image interpretation and notification. The programs differed by clinic focus (Tennessee Lions organized pre-schools while ABCD used village and community health fairs and schools), parent notification (Tennessee Lions communicated through pre- schools and ABCD mailed directly to parents), and image interpretation (Tennessee used VOIC age-based and pupil-size crescents while ABCD used "delta-center crescent"). Predictive value positive was 73% for Tennessee and 89% for ABCD. Tennessee achieved better followup on referrals after a specific coordinator was employed. Image interpretation breakdown for ABCD: Tennessee Lions Outreach were anisometropia (29%:34%), high hyperopia (33%:16%), astigmatism (18%:30%), strabismus (7%:15%), myopia (5%:2%), cataract (0.7%:0.2%). Two state-wide programs detected 3216 amblyopic children at a charity borne-cost of 1.5 million dollars. If the parents persisted with appropriate amblyopia therapy, the expected societal value was estimated at 17 million dollars. Lacking societal mandate and funding, these concerted charitable efforts only achieved a community penetration rate of 10% to 14%. CONCLUSION: National adoption of preschool vision screening by a method with similar or even better validity and cost effectiveness as MTI photoscreening, ideally in the pediatric medical home, is warranted.

Alaska↗
PubMed1992

A survey of the vision assessment of the developmentally disabled and multi-handicapped in University Affiliated Programs (UAPs).

In 1989 we conducted a survey to assess the availability of vision assessments (screening and complete eye/vision examinations) in University Affiliated Programs for Persons with Developmental Disabilities (UAPs). Analysis of the results suggests that although the UAPs are continuing to provide some services for eye/vision care, only 58 percent of these centers have facilities for the screening of vision problems. Ninety-six percent of the respondents, however, feel that vision screening is important. The developmentally disabled and multi-handicapped child is at high risk for vision/eye problems. Unless this difference between service availability and the perceived importance of vision services is addressed, there is an increased risk that the child may not reach his/her full potential. The UAPs need to increase the availability of eye/vision care within the UAPs and to expand training to providers in the community to deal with the developmentally disabled and multi-handicapped.

Child↗
PubMed1993

Survey of the accuracy of new pseudoisochromatic plates.

The accuracy of three new pseudoisochromatic tests for detecting red-green colour deficiency was assessed. These were the Ishihara plates, the Ishihara test for 'unlettered persons' and Ohkuma's test cards. We examined 500 subjects; 471 normal trichromats and 29 colour-deficient people. Results obtained for the 1989 edition of the Ishihara plates were compared with the 9th edition and the most efficient plates identified. Although normal trichromats may be expected to make several interpretive misreadings, the Ishihara plates were found to be superior to the 9th edition and to the Ohkuma test (1986) for colour vision screening. The new symbol designs of the Ishihara plates for 'unlettered persons' (1990) were found to be very effective for colour vision screening, and a further study with young children is proposed. The 38 plate 1989 edition of the Ishihara test is recommended for use in clinical practice. The designs included in the concise 24 plate edition and the new abbreviated 14 plate edition are not selected from the point of view of accuracy and more reliable results are obtained if the full test is given or if the practitioner shows only the most efficient designs.

Adolescent↗
PubMed1995

Visual characteristics of Missouri State Highway Patrol troopers.

BACKGROUND: The Missouri State Highway Patrol (MSHP) had 902 troopers on duty at the time of this study. The purpose of this study was to determine, for the first time, the visual characteristics of this group. METHODS: All 902 troopers were requested to be screened during early 1993 at their local MSHP troop headquarters. Vision screening was done by Department of Motor Vehicle Personnel using Keystone/Mast DVS II Driver Vision Screeners. The results, along with current prescriptions obtained from their eye care practitioners, were mailed to the author. RESULTS: A 94 percent response rate was achieved. The group's mean age was 38.7 years and most (98 percent) were male. Forty-seven percent wear an optical correction either some or all of the time and these were evenly divided between single vision and multifocal corrections. Seventy-four percent of eyes had uncorrected distance acuity of 20/20 increasing to 94 percent of eyes with 20/20 when corrections were worn. CONCLUSIONS: The results of this study will be used as a basis to update MSHP vision standards for acquisition and retention of troopers.

Adult↗
PubMedDate not supplied

Randot stereoacuity testing in young children.

OBJECTIVE: The Randot test is a commonly used stereoacuity test with child-friendly targets; however, little has been published about its use for young children. We sought to determine the completion rate of the Randot test among young children with normal vision and to calculate normative values. SUBJECTS AND METHODS: The Randot stereoacuity test was administered to 264 children whose ages ranged from 3 to 7 years. Because this was an investigation to determine the percentage of children who could complete the Randot test, children who failed a vision screening modified from the Modified Clinical Technique were excluded to minimize confounding factors (ie, a lack of measurable stereopsis due to vision problems rather than inability to understand the test). Completion rates and cumulative percentages were calculated by age. RESULTS: A completion rate of 98.5% was found. Median Randot stereoacuities were 100 seconds of arc for the 3-year-old children, 70 seconds of arc for the 4-year-old children, 50 seconds of arc for the 5-year-old children, 40 seconds of arc for the 6-year-old children, and 45 seconds of arc for the 7-year-old children. Kruskal-Wallis testing revealed a significant change in stereoacuity with age (chi-square, 35.55; df = 4; P < .001), and pairwise comparisons (alpha = 0.05) revealed that the 3- and 4-year-old children were significantly different from the 5-, 6-, and 7-year-old children. CONCLUSIONS: Randot stereoacuity can be assessed for most preschool children and all young school-aged children. In the absence of significant refractive error, strabismus, or reduced or unequal acuity, most 4-year-old children should have a Randot stereoacuity of 70 seconds of arc or better and most young school-aged children should have a Randot stereoacuity of 50 seconds of arc.

Child↗
PubMed1991

Factors associated with delay in diagnosis of childhood amblyopia.

The prevention of permanent visual impairment from amblyopia is an important goal of pediatric vision screening. Unfortunately, many cases of amblyopia are not diagnosed until the child is too old to benefit maximally from treatment. A review of patient records from the practice of a private pediatric ophthalmologist confirmed that late detection is a frequent occurrence among children with amblyopia who have had good access to health care. A case-control study was then used to identify factors associated with delayed diagnosis, in which children with an adverse outcome (diagnosed at or after 5 years of age) were compared with those with an optimal outcome (diagnosed before 5 years of age). The chart review identified 161 children with amblyopia who participated in this study; 75 had late diagnoses (case patients) and 86 served as control patients. Children with early diagnoses more often had the following characteristics: a positive family history of strabismus, greater degrees of strabismus (when strabismus was present), higher maternal educational level, greater parental suspicion that an eye problem existed, and an increased chance that the parents requested the eye examination that led to the diagnosis. The parents of children with late diagnoses expressed less concern over the seriousness of amblyopia but were more likely to report that their children had suffered adverse consequences of amblyopia. When diagnosed early, amblyopia was more often detected by the child's primary health care provider. Physicians of the children with early diagnoses more often reported compliance with both the American Academy of Pediatrics guidelines for vision screening in infancy and referral for vision problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Amblyopia↗
PubMed1986

Lessons from the Visual Acuity Impairment Survey pilot study.

The Visual Acuity Impairment Survey (VAIS) pilot study was carried out in three large metropolitan areas of the United States to determine whether it would be feasible to conduct a large two-stage survey of the prevalence of visual acuity impairment and its causes. The study was conducted in conjunction with the Health Interview Survey (HIS), performed by the National Center for Health Statistics and the Census Bureau. In the first stage, a simple vision screening test was administered to 1,868 adults in their homes by specially trained Census Bureau interviewers. All those who failed the test, and a sample of those who passed it, were invited to a local clinic for a check on the accuracy of the screen and a detailed eye examination to establish the cause of the impairment. About 89 per cent of the HIS interviewees took the vision screening test in the home and agreed to have the results released, making it possible for the clinic to invite them for an examination. The principal obstacle to the success of the feasibility study was a low rate (less than 50 per cent) of participation in the clinic examination by the target population. Such low participation would leave the survey open to a serious question about its representativeness. The methods and findings of the pilot study are presented because the lessons may be of value to those attempting similar studies in the future. Suggestions are made for methodological modifications that may enhance the chances for success.

Adult↗
PubMed2006

Accommodative insufficiency is the primary source of symptoms in children diagnosed with convergence insufficiency.

PURPOSE: Accommodative insufficiency (AI) and convergence insufficiency (CI) have been associated with similar symptomology and frequently present at the same time. The severity of symptomology in CI has been linked to the severity of the CI, suggesting a dose-dependent relationship. However, with increasing severity of CI also comes increased comorbidity of AI. AI alone has been shown to cause significant symptomology. We hypothesize that AI drives the symptoms in CI with a comorbid AI condition (CIwAI) and that it is the increased coincidence of AI, rather than increased severity of CI, which causes additional symptomology. METHODS: Elementary school children (n = 299) participated in a vision screening that included tests for CI and AI and the CISS-V15 symptom survey. They were categorized into four groups:1) normal binocular vision (NBV); 2) AI-only; 3) CI-only; and 4) CIwAI. One hundred seventy elementary school children fell into the categories of interest. RESULTS: Pairwise comparison of the group means on the symptom survey showed: 1) children with AI-only (mean = 19.7, p = 0.006) and children with CIwAI (mean = 22.8, p = 0.001) had significantly higher symptom scores than children with NBV (mean = 10.3); and 2) children with CI-only (mean = 12.9, p = 0.54) had a similar symptom score to children with NBV. Using a two-factor analysis of variance (AI and CI), the AI effect was significant (AI mean = 21.56; no AI mean = 11.56, p < 0.001), whereas neither the CI effect (p = 0.16) nor the CI by AI interaction effect (p = 0.66) were significant. CONCLUSION: CI is a separate and unique clinical condition and can occur without a comorbid AI condition, our CI-only group. Past reports of high symptom scores for children with CI are the result of the presence of AI, a common comorbid condition. When AI is factored out, and children with CI only are evaluated, they are not significantly more symptomatic than children with NBV.

Accommodation, Ocular↗
PubMed2003

Association of symptoms and convergence and accommodative insufficiency in school-age children.

BACKGROUND: The purpose of this article was to investigate the association between convergence insufficiency (CI) and accommodative insufficiency (AI) and symptoms in a group of school-aged children. METHODS: Children ages 8 to 15 years were recruited from two public and 2 private elementary schools in Southern California. The CI Symptom Survey (CISS) was administered to all children before a Modified Clinical Technique vision screening. Children with normal visual acuity, minimal uncorrected refractive error, and no strabismus were tested for CI and Al. RESULTS: Four hundred sixty nine children were initially screened and 392 participated in testing for CI and AI. Fifty-five percent of the children (218) were classified as having normal binocular vision (NBV), 4.6% (18) had three signs of CI, 12.7% (50) had two signs of CI, 10.5% (41) were classified as AI (with no signs of CI), and 16.6% (65) were classified as other. The symptom score was 3.78 for the NBV group, 4.6 for the two-sign CI group, 6.67 for the three-sign CI group, and 6.37 for the Al group. The three-sign CI and the Al groups scored significantly higher than the NBV group on the CISS (p < or = 0.001). CONCLUSION: CI and AI are common conditions in school-age children and are associated with increased symptoms.

Accommodation, Ocular↗
PubMed1999

Factors associated with the prevalence of myopia in 6-year-olds.

PURPOSE: To describe the frequency of and risk factors associated with myopia in grade one children. METHODS: Refractive error was measured by static retinoscopy, without cycloplegia, for 10,616 children in the first year of a province-wide vision-screening program. Information on factors that might be associated with myopia was collected from parents or guardians by self-administered questionnaires distributed before the vision screening. These factors were evaluated by a case-control method. RESULTS: The prevalence of myopia, greater than -0.25 D, was 6%. The estimated relative risk of myopia was increased significantly among children whose birth weight was <2500 g and whose mothers had a history of early spectacle use. CONCLUSIONS: Results suggest that the prevalence of myopia in 6-year-old children is associated with both hereditary and nonhereditary factors. In accord with prior work, the results argue that low birth weight has a permanent influence upon eye development.

Age Factors↗