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PubMed2004

Magnitude and determinants of refractive error in Omani school children.

OBJECTIVE: To estimate the magnitude and determinants of refractive error in school children, a study was undertaken to review the school screening and refraction data. METHODS: Trained physicians screened 416,157 students to evaluate their visual status and identified 28,765 students with defective vision. Refractionists refracted 25,733 (89.5%) of them, determined the refractive error and prescribed spectacles. Students with ocular co-morbidity and visual disability were re-examined and treated by the ophthalmologists. This study was conducted between June 2003 and December 2003 in the Ministry of Health, Muscat, Sultanate of Oman. RESULTS: The prevalence of myopia was 4.1% (95% confidence interval [CI] 4.06-4.18). It was higher among female than male students [rate ratio (RR) 1.69 (95% CI 1.64-1.74)]. The rate was more in students of higher age groups (chi2 = 11,179 degrees of freedom = 2 p<0.00001). Regional variation in myopic trend was marked. The prevalence of hypermetropia was 0.4% (95% CI 0.37-0.41). However, it could be an underestimation as presence of accommodative spasm was not taken into account. The risk of low vision disability was significantly higher in male students than female students. The prevalence of ambiopia was 0.3%. It was significantly higher in male than female students. First primary students had strabismus of 0.5%. CONCLUSION: The study enabled to understand trends of refractive error in Omani children (Arabic tribe) and demonstrated the importance of vision screening in providing timely eye care and identifying visually disabled school children.

Adolescent↗
PubMed2004

[Screening of the vision and hearing disorders in children from 0 to 3 years of age].

The screening of the visual and auditive sensory disorders is a significant stake of public health in France. Those are still too late and do not allow the assumption of responsibility early necessary. Between 0 and 3 years the issue is to avoid the two principal problems: irreversible amblyopia and language acquisition disorders by auditive deficit. It is thus advisable to find strategies which improve this situation. Pragmatic medical attitude and usual tests, usable in daily practice of the doctors who have really contact with the children, should be suggested.

Child, Preschool↗
PubMed1993

A clear policy: eyesight testing.

Like it or not employers are now required to provide employee eye and eyesight tests on request. Following last month's article on the Display Screen Equipment Regulations Hazel Montague looks at this specific duty and describes how one company has taken a proactive approach to setting up a vision screening programme.

Computer Terminals↗
PubMed1998

Screening for anisometropia in preschool children.

PURPOSE: A preschool vision screening program was reviewed to evaluate eccentric photoscreening (EP), visual acuity, and stereopsis in identifying anisometropia. METHODS: Patients referred by the screening were examined to assess efficacy of the three screening techniques in a population of preschool children. Testability and comparison of screening results to the classification of anisometropia (> or = 1 D) by retinoscopy obtained during a complete examination were evaluated. RESULTS: Although EP identified 94.5% of the anisometropic children as abnormal, only 27.8% were classified as anisometropic by EP. Of the anisometropic children, 36.1% failed acuity, but only 19.4% failed based on a 2 line or greater interocular acuity difference. Stereopsis correctly identified only 7.3% of anisometropes as abnormal. CONCLUSIONS: The sensitivity of EP in identifying anisometropic children as abnormal was superior to acuity and stereopsis, yet its ability to identify anisometropia specifically was poor. Anisometropia of low magnitude or that masked by the dead zone of the EP system was frequently classified as isometropic. Altering the EP referral criterion and/or taking photographs through adequate power plus lenses may improve the sensitivity for specifically identifying anisometropia. However, caution must be exercised when using EP to examine the prevalence of anisometropia in a population or if used to screen for only amblyogenic refractive errors (i.e., anisometropia), because many anisometropes will be missed, resulting in inaccurate prevalence data and significant underreferrals.

Anisometropia↗
PubMed2005

Screening for amblyopia in preverbal children with photoscreening photographs: IV. Interobserver variability in photograph grading: origin and method of reduction.

BACKGROUND: Earlier detection of childhood vision disorders is a prominent goal of vision screening. The Medical Technology and Innovation (MTI) PhotoScreener addresses this objective. Use of this camera does not require verbal feedback and may be administered early in a child's development. Decreasing the variability in photograph grading results will boost the utility of any photoscreening system. This report aims to understand and to decrease intra- and inter-observer variability in grading photoscreening photographs. METHODS: We dissected the photograph grading process and quantified the intra- and inter-observer agreement using intraclass plot correlation coefficients. We evaluated the outcome of a two grader verification system vs. adjudicated measurements with Receiver Operator Characteristic (ROC) curves. PARTICIPANTS: Data on 955 children under 5 years of age, normal except for refractive error, each with complete photoscreening and eye examination data, culled from two previous studies. MAIN OUTCOME MEASURES: Intra- and inter-observer agreement in measuring bright crescent dimensions and pupillary diameters. Sensitivity and specificity of detection of hyperopia. RESULTS: Measurements of bright crescents are associated with greater variability than are measurements of pupillary diameters. Recognition and omission of light "rim" measurements from photograph grading will result in superior inter-observer agreement. Photograph independent errors increase variability and may be corrected by remeasurement. A verification system in which the most discrepant 5% of measurements are redone results in ROC curves similar to adjudicated dimension. CONCLUSIONS: We conclude: 1) two novices grading photographs can do as well as one expert in most cases; 2) the proposed grading methodology has undergone statistical validation and can be used in other areas of ophthalmology and medicine; and 3) inter-observer variability, one of the limitations of photoscreening photograph grading, can be reduced. For 95% of the photographs, two novices achieve similar true positive and true negative values with or without adjudication.

Amblyopia↗
PubMed1989

Effects of ocular functioning and time upon reading proficiency.

We hypothesize that children with fusional and/or accommodative abnormalities will tend to tire more readily when reading than will children with normal vision and that, consequently, they will show a greater decrement in reading proficiency over time on a task requiring reading. Forty-five subjects who passed the New York State Optometric Association Vision Screening Battery and 32 who failed were given a "maze" reading test developed for the study. The abnormal vision group made significantly more errors than did the normal vision group on the reading test. The abnormal vision group also made progressively more errors than did the normal vision group at the end of each segment of the reading test. The differences, however, were not statistically significant. While the correlations between speed and accuracy reversed over time, the abnormal vision group began and ended at the most extreme levels, having undergone a significantly more radical shift in this regard.

Accommodation, Ocular↗
PubMed1998

Exercise Mountain Shield, Task Force 11, and visual readiness.

This report, in an effort to assist in the development of future operational and planning guidelines, presents data from a no-notice exercise involving an aviation brigade in Germany preparing for possible deployment to Bosnia. One hundred twenty-two soldiers (of 918) requested vision screening during predeployment processing. Twenty-four possessed 20/20 vision or better and simply required duplicate orders of needed eyewear. Ninety-eight required an updated refraction. The three battalion-level units provided equal numbers of soldiers requiring screening and examination. Although the lower enlisted grades presented in the greatest numbers, the distribution in terms of percentage was equivalent across all ranks. Myopes outnumbered hyperopes with a spherical distribution peak at -1.50 diopters, and a majority possessed 1.00 diopter of astigmatism or less. Assuming 40% of all soldiers are spectacle wearers (ametropic), this brigade of 518 soldiers had, then, roughly 210 ametropes, with 60% of them (122) requiring last-minute ordering of required eyewear, 98 of those after refractive examination. Possible solutions to this readiness issue have been developed but require sufficient command emphasis to be effective.

Bosnia and Herzegovina↗
PubMed2003

Assessment of colour vision as a screening test for sight threatening diabetic retinopathy before loss of vision.

AIM: To assess the effects of sight threatening diabetic retinopathy (STDR) on colour vision and to evaluate automated tritan contrast threshold (TCT) testing for STDR screening before significant visual loss. METHOD: Patients were recruited from a hospital based photographic screening clinic. All subjects underwent best corrected Snellen visual acuity (BCVA) and those with 20/30 vision or worse were excluded. Automated TCT was performed with a computer controlled, cathode ray tube based technique. The system produced a series of sinusoidal, standardised equiluminant chromatic gratings along a tritan confusion axis. Grading of diabetic retinopathy was made by one of the team of experienced ophthalmic registrars (SpR) using slit lamp biomicroscopy and a 78D lens; HbA(1c) and urine albumin were also tested. RESULTS: Patients with STDR had significantly worse TCT despite normal BCVA (p<0.0001). TCT yielded a sensitivity of 100% for detecting diabetic maculopathy and 94% for STDR with a specificity of 95%. Logistic regression analyses showed that TCT (p<0.001) and HbA(1c) (p<0.05) correlated significantly with the presence of STDR but duration of diabetes, urine albumin counts, and BCVA failed to show any significant correlation. No associations between TCT and duration of disease, TCT and HbA(1c), and TCT and urine albumin counts were found. CONCLUSION: Tritan colour vision deficiency was observed in patients with STDR despite their normal BCVA. These results indicate that automated TCT assessment is an effective and clinically viable technique for detecting STDR, particularly diabetic maculopathy, before visual loss.

Adolescent↗
PubMed2005

Mass community screening for diabetic retinopathy using a nonmydriatic camera with telemedicine.

BACKGROUND: Diabetic retinopathy is a leading cause of blindness. Studies have shown the value of screening and early, timely treatment. Our aim was to measure the effectiveness and degree of acceptance of community screening for diabetic retinopathy using telemedicine. METHODS: In this prospective, population-based cross-sectional study, diabetics recruited through a regional multimedia campaign were surveyed and screened for retinopathy using a nonmydriatic camera and evaluated through telemedical imaging. RESULTS: Of the 291 diabetics recruited over a 3-week period (37% by the regional diabetes association and 30% by the media), 49.4% reported having their most recent eye examination within 1 year, 30.7% between 1 to 2 years, 9.7% over 2 years, and 10.1% had never had an exam. 98.6% found our screening method acceptable, with 95.1% wanting to return for their next screening and 91.2% stating it would increase their compliance to annual screening. INTERPRETATION: Telemedicine provided a reliable and highly acceptable method for diabetic retinopathy screening. It can attract a significant number of people with diabetes and potentially recruit patients who would otherwise be missed by the current methods of vision screening.

Adolescent↗
PubMed2001

Screening for amblyopia in preschool children: results of a population-based, randomised controlled trial. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

INTRODUCTION: The rationale for preschool vision screening programmes has recently been questioned. Evidence about the effects of early treatment is needed, but it is not known how early the target conditions can reliably be detected. In this study, an intensive programme comprising several different screening methods, used at different ages up to 37 months, was compared with the usual practice of visual surveillance and ad hoc referrals. METHODS: Two groups were randomly selected from children in a population birth cohort study. The control group (n = 1461) received visual surveillance only. The intervention group (n = 2029) was offered in addition a programme of regular visual assessments by orthoptists testing visual acuity, ocular alignment, stereopsis and non-cycloplegic photorefraction. RESULTS: The intervention group programme yielded more children with amblyopia (1.6% vs. 0.5%, p < 0.01), and was more specific (95% vs. 92%, p < 0.01), than the control programme. The individual components of the intervention programme were compared. The cover test and visual acuity tests were poorly sensitive until the children were 37 months, but were always >99% specific. Photorefraction was more sensitive than acuity testing at all ages below 37 months, with specificity >95% at 31 and 37 months. CONCLUSIONS: Photorefraction would have detected more children less than 37 months of age with straight-eyed amblyopia than did visual acuity testing, but with more false positives. At 37 months, photorefraction plus a cover test would have been comparable in effectiveness to visual acuity testing plus a cover test.

Amblyopia↗
PubMed2000

Screening for amblyogenic factors using a volunteer lay network and the MTI photoscreener. Initial results from 15,000 preschool children in a statewide effort.

PURPOSE: To describe the results from a statewide preschool vision screening program using the MTI PhotoScreener (Medical Technology and Innovations, Inc., Cedar Falls, IA). DESIGN: Cross-sectional study. PARTICIPANTS: A total of 15,059 children aged 6 to 47 months enrolled in childcare and preschool settings throughout the state of Tennessee. METHODS: Volunteers from local Lions Clubs took photoscreening photographs of children in a statewide effort. Photographs were interpreted at the Vanderbilt Ophthalmic Photography Reading Center using predetermined criteria. Children who failed the screening were referred to community ophthalmologists or optometrists who performed a comprehensive evaluation and forwarded the results to the authors. MAIN OUTCOME MEASURES: Referral rate, unreadable rate, and predictive value positive (PVP). RESULTS: During the 2 years of the screening program, 15,059 children were screened in 850 screenings. The screening referred 1013 children (6.7%), and 704 photographs (4.7%) were unreadable. Children who failed the screening had a significant abnormality (strabismus, anisometropia, high hypermetropia, high astigmatism, or high myopia) in 320 of the 531 cases where adequate follow-up results were reported. The PVP ranged from 84% when a diagnosis of strabismus was suggested by the photoscreen reading to 41% for astigmatism. Despite intense attention to follow-up, many children who failed the screening never received a formal eye examination. CONCLUSIONS: The MTI PhotoScreener can be used by volunteers to screen preschool children and can have a high PVP in organized settings, provided that meticulous attention is paid to photograph interpretation and quality control. The PVP of the MTI PhotoScreener depends on the diagnosis suggested when the photograph is read. Significant obstacles exist in obtaining care for those who fail screening.

Amblyopia↗
PubMed2007

The results of screening frequency doubling technology perimetry in different locations of the community.

PURPOSE: To determine the effect of screening location on the frequency of abnormal test results with Frequency Doubling Technology (FDT) perimetry. DESIGN: Retrospective cross-sectional study. METHODS: The Vision Screening Outreach Project conducted FDT testing in community sites surrounding Portland, Oregon. The sites were separated into a specific location type: health care clinics, work sites, senior centers, festivals/fairs, food banks/shelters, and other locations. These locations were compared for differences in the proportion of screening failures. MAIN OUTCOME MEASURES: Screening failure (defined as a repeatable, abnormal FDT result in either eye). RESULTS: There were 9052 participants from 211 locations in Oregon and Washington. On initial FDT testing, the right and left eye had abnormal results in 18% (1654/9052) and 21% (1918/9052) of participants. Of those with abnormal FDT results, approximately 30% of eyes reverted to normal on repeat testing. Overall, 13% of participants were screening failures. Screening failure was highly associated with age (P<0.001). After controlling for age, participants at senior centers (P<0.001) were most likely to be screening failures and participants at work sites (P=0.006) were least likely to be screening failures when compared with health clinics. CONCLUSIONS: An investigator should repeat an initially abnormal FDT result when screening with FDT. Age and the location of testing influence the probability of a screening failure. Screening in senior centers is most likely to result in screening failure. However, only a randomized controlled trial can determine the true benefit of FDT screening in these locations.

Adolescent↗
PubMed1999

Working with school nurses: improving children's vision and building relationships.

The 45,000-plus school nurses in the U.S. have an astonishing array of responsibilities, and serve as important gatekeepers to the health care of millions of children. By building relationships with local school nurses, doctors of optometry can play an important part in improving children's vision care, and build their practices as well. We take a look at the challenges school nurses face, and an AOA program designed to reach out to them and improve the quality of vision screenings.

Child↗
PubMed2002

Economic evaluation of orthoptic screening: results of a field study in 121 German kindergartens.

PURPOSE: The purpose of this study was to analyze the cost-effectiveness of an orthoptic screening program in kindergarten children. METHODS: An empiric cost-effectiveness analysis was conducted as part of a field study of orthoptic screening. Three-year-old children (n = 1180) in 121 German kindergartens were screened by orthoptists. The number of newly diagnosed cases of amblyopia and amblyogenic factors (target conditions) was used as the measure of effectiveness. The direct costs of orthoptic screening were calculated from a third-party-payer perspective based on comprehensive measurement of working hours and material costs. RESULTS: The average cost of a single orthoptic screening examination was 12.58 Euro. This amount consisted of labor costs (10.99 Euro) and costs of materials and traveling (1.60 Euro). With 9.9 children screened on average per kindergarten, average labor time was 279 minutes per kindergarten, or 28 minutes per child. It consisted of time for organization (46%), traveling (16%), preparing the examination site (10%), and the orthoptic examination itself (28%). The total cost of the screening program in all 121 kindergartens (including ophthalmic examination, if required) was 21,253 Euro. Twenty-three new cases of the target conditions were detected. The cost-effectiveness ratio was 924 Euro per detected case. Sensitivity analysis showed that the prevalence and the specificity of orthoptic screening had substantial influence on the cost-effectiveness ratio. CONCLUSIONS: The data on the cost-effectiveness of orthoptic screening in kindergarten may be used by such third-party payers as health insurance or public health services when deciding about organizing and financing preschool vision-screening programs.

Amblyopia↗
PubMed1993

The prevalence of ocular disorders among Hispanic and Caucasian children screened by the UCLA Mobile Eye Clinic.

A cross-sectional study was performed to describe the prevalence of ocular abnormalities among six and seven year old children of Hispanic and Caucasian ancestry in Los Angeles County. Data were obtained from vision screenings of lower to middle income Hispanic and Caucasian children completed by the UCLA Mobile Eye Clinic at public neighborhood elementary schools and community centers between January and August of 1989, and January and March of 1990. Out of a total sample of 854 children, 64% were Hispanic; 36% were Caucasian; 51% were female and 49% were male. Ocular abnormalities observed were similar for both ethnic groups. Caucasians, however, showed non-significant, but consistently higher prevalences of most ocular abnormalities. Stronger associations between ethnicity and visual abnormalities were observed within the female subgroup. For example, hyperopia was found more commonly among female Caucasian children than among female Hispanic children (p < 0.01). This information can be used in planning for the eye care needs of communities with Caucasian and Hispanic components.

Child↗
PubMed1987

Evaluation of the Parsons Visual Acuity Test in screening exceptional children.

The Parsons Visual Acuity Test (PVAT) is a non-verbal picture based visual acuity test designed for the difficult-to-test preschool child, school age child and adult with handicapping conditions. It is designed primarily for vision screening of the exceptional child and adult with special needs. Since visual acuity measures are quite important in these populations, a comparative study between the PVAT and standard Snellen acuity were designed and completed. There was no significant difference in acuity measures at near, however, the validity of the distance PVAT visual acuity measure was not supported in this study. Implications of the findings and cautions for the use of this test in screening and clinical situations for exceptional children and adults are discussed.

Adolescent↗
PubMed1997

Vision profile of the athletes of the 1995 Special Olympics World Summer Games.

BACKGROUND: Special Olympics were organized in 1968 by Eunice Shriver as a program of physical fitness for individuals with mental handicaps. Numerous epidemiologic studies report an increase in visual problems in this population. METHODS: A comprehensive vision screening was conducted at the 1995 Special Olympic World Summer Games to identify the prevalence of visual anomalies in this select group. Testing included visual acuity, refractive error, ocular motor skills, stereopsis, color vision, contrast sensitivity, eye-hand coordination, eye-foot coordination, and an ocular health evaluation. RESULTS: Nine hundred five special athletes, ranging in age from 8 to 58 years, participated in the screening. More than 65% of the participants had not received eye care for more than 3 years. The most commonly reported symptom was difficulty in seeing. Other ocular health problems included refractive errors, poor distance monocular acuity, and strabismus. CONCLUSION: The results of the study indicate that Special Olympians have a high prevalence of vision anomalies that may go undetected. This population demonstrates a high prevalence of refractive errors, decreased visual acuity, ocular health problems, and strabismus. In addition, based on the number of individuals who have not received eye care within the last year, there is a need to increase the availability of vision care to these and other people with mental retardation.

Adolescent↗
PubMed1997

Visual impairment in school children in southern India.

This study was done to determine the prevalence of visual impairment due to refractive errors and ocular diseases in lower middle class school children of Hyderabad, India. A total of 4,029 children, which included 2,348 males and 1,681 females, in the age range of 3 to 18 years from 9 schools were screened with a detailed ocular examination protocol. Among 3,669 children in whom visual acuity could be recorded, on presentation 115 (3.1%) had visual acuity < 6/18 in the better eye (equivalent to visual impairment), while 41 (1.1%) had visual acuity < or = 6/60 [corrected] in the better eye (equivalent to legal blindness) out of which 18 (0.5%) had visual acuity < 6/60 in the better eye (equivalent to economic blindness). Of 115 children who presented with initial visual acuity < 6/18, vision improved to > or = 6/18 with refraction in 109 (94.8%). No child was legally or economically blind after refractive correction. Prevalence of hyperopia was 22.6%, myopia 8.6% and astigmatism 10.3%. The prevalence of myopia was significantly higher among children > or = 10 years of age (P < 0.001). The maximum, mean and median values for myopia were 10.00, 1.35 and 0.75 D in the better eye. For hyperopia these values were 8.50, 0.65 and 0.50 D. The major causes for best corrected visual acuity < 6/9 in the worse eye for 51 (1.4%) children included amblyopia in 40 (1.1%), corneal diseases in 5 (0.1%), cataract in 2 (0.05%) and others in 4 (0.1%). Out of the total, 30 (0.7%) children had strabismus. These data support the assumption that vision screening of school children in developing countries could be useful in detecting correctable causes of decreased vision, especially refractive errors, and in minimising long term permanent visual disability.

Adolescent↗