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The prevalence of ocular defects and the provision of eye care in adults with learning disabilities living in the community.

Most people with learning disabilities now live in the community rather than in institutions, and community services need to be targeted appropriately. Vision screening was carried out in community Day Care Centres for adults with learning disabilities. One hundred and fifty four subjects took part, and screening was successful in 148 subjects, using retinoscopy and standard acuity tests, including preferential looking. The previously reported high prevalence of refractive errors, strabismus and pathological defects amongst people with learning disabilities was confirmed. Over 60% of subjects had below-normal distance acuity, which in many cases was exacerbated by uncorrected refractive errors. In all, 41% of subjects could have benefited from distance spectacles, and 56% from spectacles for near tasks. The lack of adequate spectacles was particularly high amongst adults with more severe learning disabilities. The study highlights the current lack of adequate eye care for people with learning disabilities, and demonstrates that eye examinations are possible for the majority of individuals. There is a need for greater awareness amongst families/carers and amongst optometrists to address this important issue.

Adult↗

Development of phoria in children.

BACKGROUND: Although the prevalence of phoria in adults is well documented, data are scarce on phoria in children. We present results using modified clinical technique vision screening and data from the Orinda Longitudinal Study of Myopia on a large, population-based sample of nonstrabismic children to document the prevalence of phoria with age. METHODS: We collected cross-sectional (N = 1495) and longitudinal (N = 469) data. Phoria data were collected by cover tests administered by one observer who subjectively classified phoria as orthophoria, esophoria, or exophoria in 2 delta steps. RESULTS: Ninety-seven percent of the children were orthophoric at distance, and there were no significant changes with age. Near phoria showed a more normal distribution, with a 10.8% decrease in the prevalence of exophoria (from 31.8 to 21.0%) and a 5.5% increase in the prevalence of esophoria (from 6.7 to 12.2%) between kindergarten and fifth grade. CONCLUSIONS: Children are typically orthophoric or exophoric at near, but convergent shifts occur with age.

Child↗

Comparison of the handheld Retinomax K-Plus2 and on-table autokeratometers in children with and without cycloplegia.

PURPOSE: To compare the keratometry measurements in children by the handheld Nikon Retinomax K-Plus2 (Rmax) and the on-table Topcon KR8100 autokeratometers and evaluate the degree of agreement in the 2 instruments between children with and without cycloplegia. SETTING: Department of Ophthalmology, Kaohsiung Municipal United Hospital, and Chang-Gung Memorial Hospital, Kaohsiung, Taiwan. METHODS: The first cohort comprised 61 children who were consecutively collected in the pediatric ophthalmology clinic. The keratometry was measured under cycloplegia. The second cohort included 156 school children who received routine vision screening without cycloplegia. The horizontal and vertical keratometry data were measured by both instruments. The mean bias and agreement between the 2 types of measurements were evaluated. RESULTS: Both horizontal and vertical keratometry data from the Rmax were systemically and mildly lower than the data from the Topcon. The mean keratometric difference in the 2 types of instruments was minimal and clinically acceptable: 72% to 85% was within +/-0.5 diopter. The agreement of measured data in the children without cycloplegia was higher than that in the children with cycloplegia. CONCLUSIONS: The handheld Retinomax provided comparable data to that of the conventional on-table Topcon. It is useful in the clinic to measure keratometry in children and therefore may offer a convenient tool for assessing corneal curvature for fitting contact lenses or for implanting intraocular lenses in young children.

Child↗

A study of amblyopia in 18-19 year old males.

During a vision screening of 6,556 National Service pre-enlistees aged 18-19 years at the Medical Classification Centre of Central Manpower Base, 48 subjects were found to have visual acuity of 6/12 or less in one or both eyes in the absence of ocular pathology. The prevalence of amblyopia in this population is 0.73%. Amblyopia was due to anisometropia in 24 cases (50%), strabismus in 9 cases (18.7%), high astigmatism (meridional) in 7 cases (14.5%) and other causes or a combination of factors in 8 cases (16.7%). Strabismic amblyopia is most commonly associated with esotropia. There is a positive association between the severity of amblyopia and the degree of strabismus in strabismic amblyopes. Meridional amblyopia tends to be less severe than most other types of amblyopia. The amblyopes were detected late (average 7-10 years of age) and orthoptic treatment of a small minority of them upon diagnosis was unsuccessful.

Adolescent↗

Visual acuity, amblyopia, and ocular pathology in 12- to 13-year-old children in Northern Mexico.

PURPOSE: The aim of this study was to establish visual acuity (VA) and the prevalence of amblyopia and other ocular disorders in a population of 12- to 13-year-old children in Mexico who have not been vision screened. METHODS: A total of 1,035 12- to 13-year-old children were examined in a field study. The examination included VA, stereopsis, cover testing, refractive retinoscopy, and examination of the red reflex and posterior pole. In cases with unexplained subnormal VA, visually evoked potential/visually evoked response was also performed. RESULTS: A >or=20/20 in at least one eye was found in 93% of the subjects. Bilateral VA <or=20/40 was found in 0.3% of cases. None of the subjects had bilateral VA <20/60. Amblyopia (<or=20/40) was found in 26 subjects (2.5%). In 10 cases, the cause of subnormal VA was unexplained. Ocular albinism was found in 3 cases, whereas strabismus was found in 24 subjects (2.3%). There were very few ocular opacities or posterior pole abnormalities. CONCLUSIONS: The visual status in the Mexican 12- to 13-year-old children tested was good. The prevalence of amblyopia was similar to that in other unscreened populations.

Adolescent↗

The ocular and visual characteristics of an athletic population.

BACKGROUND: Nine hundred and thirty-nine athletes of various ages and from varying levels of competition were part of a sports vision epidemiology project conducted by the Sports Vision Service at the Illinois Eye Institute, Chicago, Illinois. METHODS: Data were collected from sports vision screenings conducted from 1992 to 1995. The population consisted of participants in the 1994 and 1995 AAU Junior Olympic Games, members of the DePaul, Elmhurst, Illinois and College of DuPage athletic departments, and members of two local high school basketball programs, DuSable and Dunbar. The data collected were analyzed to determine the use of eye care services and the visual characteristics present in these elite athletic populations. RESULTS: Analysis of the data showed that athletes competing at high levels of competition do have visual problems. Twenty five percent of our population had never had a complete eye examination, 29% had visual symptoms, and 28% had less than 20/25 acuity through their habitual sports prescription. CONCLUSIONS: The results of this study imply that the athletic populations at all levels are in need of eye care services. Protective eyewear is not often used in this athletic population. Comparing the results found in our population to other reported results in the general population indicate similar rates of refractive error.

Adolescent↗

Prevalence of myopia in local and international schools in Hong Kong.

PURPOSE: This study aims to investigate genetic and environmental influences on physiological myopia by studying the difference in myopia prevalence between local schools and international schools in Hong Kong. METHODS: Vision screening was carried out in local and international schools for students 13 to 15 years old. Types of refractive error were identified by visual acuity measurement, the presence of spectacles, a simple refraction, and the use of plus and minus ophthalmic lenses. RESULTS: Three local schools and six international schools participated in the study. Two hundred eighty-nine students were from the local schools, and 789 students were from the international schools. Prevalence of myopia at the local schools ranged from 85 to 88%, whereas it ranged from 60 to 66% in the international schools. Students in the international schools were subdivided into Chinese origin, white, mixed Chinese, and Asian. Prevalence of myopia was highest in the Chinese group (82.8%) and lowest in the white group (40.5%). There was no age or gender difference in the prevalence of myopia. CONCLUSIONS: Hong Kong Chinese students had a higher prevalence of myopia regardless of whether they studied in local or international schools when compared with other ethnic groups, such as whites. This further supports a genetic input into myopia development.

Adolescent↗

NYSOA K-D test.

An objective indirect method of evaluating saccadic performance is of interest to optometrists and non optometrists. A sample of 1202 children ages six to fourteen were screened using the New York State Optometric Association Vision Screening Battery. The NYSOA K-D Test was part of that battery. The test is quick, easy to score and can be administered by non eye care practitioners. The test is described and normative data is presented.

Adolescent↗

Does neonatal ocular misalignment predict later abnormality?

PURPOSE: A longitudinal prospective study was carried out to ascertain the significance of neonatal ocular misalignments. METHODS: Pre-school vision screening and hospital records were examined to determine the visual outcome of 1150 infants classified into 'often' (> 15% of waking hours), 'occasionally' (< 15%) or 'never' having an ocular misalignment (neonatal squint) in the first 8 weeks of life. Chi2 and Fisher's exact tests and ANOVA were used to analyse the data. RESULTS: When compared with infants who had squinted occasionally or never, frequent squinting in the neonatal period (which occurred in 7.7% of the subjects) was significantly associated with having been prescribed spectacles (p = 0.04), both for hypermetropia (p = 0.04) and for myopia (p = 0.05). Frequent squinters also had a higher incidence of significant esodeviation (p = 0.04) and were more likely to be > 21 days premature (p = 0.05). Small numbers of abnormalities made statistical analysis limited, but there were weak trends towards more myopic and oblique astigmatism in the 'never' group. The esotropias in the 'often' group were more frequently intermittent than those found in the other groups. CONCLUSIONS: Occasional squinting in the first 8 weeks of life appears to be normal neonatal behaviour. Frequent squinting trebles the chances of developing a significant esodeviation or refractive error severe enough to require spectacles before 5 years of age but incidence of abnormality still does not exceed 9%.

Analysis of Variance↗

An evaluation of techniques for measuring stereopsis in infants and young children.

Demonstrating stereopsis is valuable in vision screening of infants and toddlers, since its presence rules out the possibility of profound visual deficits. We assessed the performance of 55 infants and young children on three clinically available tests, the Lang, the Frisby and the TNO. The results were compared with those found using a computerized dynamic random dot stereogram. Most of the children tested were under 3 years of age and 10 were aged under 1 year. The Lang test was passed by 74%, including 50% of those under 1 year. The Frisby test was passed by 65%, but by only 20% of infants under 1 year. Forty-nine per cent passed the TNO test; none were under 1 year. The computerized stereogram was passed by 42.5% of those tested, including 100% of those over 3 years old. Both this test and the TNO presented difficulty in testing infants between 8 months and 2 years because of the increased likelihood that these children would reject the red/green glasses. We recommend that the most appropriate stereotest is largely based on whether the child will tolerate red/green glasses. We would use the dynamic random dot test for infants under 8 months of age, the Lang or Frisby stereotest for infants from 8 months to 30 months, and the TNO or dynamic random dot stereogram after this age.

Child, Preschool↗

Evaluation of a new color vision test: "color vision testing made easy".

PURPOSE: A new pseudoisochromatic color plate test, "Color Vision Testing Made Easy" (CVTMET) has recently been introduced. Said to be designed for all age groups, including pre-school children, it uses the identification of simple shapes and objects to detect red-green color deficiencies. We evaluated the CVTMET to determine if the test is suitable for color vision screening of young children. METHODS: Forty-one adults predetermined to be color normal (n = 20) or to have hereditary red-green color deficiency (n = 21), served as subjects. A battery of color vision tests including the Ishihara, Panel D-15, and the anomaloscope were used for diagnosis and color deficiency classification. Subjects were then tested with Part I and Part II of the CVTMET test and results were compared to the Ishihara, Panel D-15, and anomaloscope. In addition, the CVTMET was used to screen for color vision deficiency in 152 kindergarten children 5 to 7 years of age. RESULTS: The pass/fail results for the adult subjects were the same for Parts I and II and compared favorably with the anomaloscope. There were no false positives (100% specificity) and only a few (2 of 21) false negatives (90.5% sensitivity). The two color-deficient subjects who passed the CVTMET had the mildest color deficiencies (simple deuteranomaly) and also passed the Ishihara test. Testability of kindergarten children was found to be 100%. Color vision deficiency occurred in 5.06% of the boys, which is about the same frequency found in older boys of similar ethnic background. CONCLUSION: This preliminary study indicates that the CVTMET appears to be an excellent screening instrument for red-green color deficiency in adults and has been shown to be useful for examining color vision in children 5 to 7 years of age.

Adult↗

A model of the prevalence and incidence of low vision and blindness among adults in the U.S.

Population-based vision screening studies of the prevalence rate of low vision and blindness in the U.S. are reviewed to evaluate the sources of disagreement among studies. The major reasons that studies disagree on prevalence rate estimates are differences in best-corrected visual acuity criteria for low vision and differences in the age range of the oldest age category. When corrections are made for these differences, the results of all prevalence rate studies, except the Mud Creek Valley Study, fit the same prevalence rate vs. age function. The greater prevalence rate of low vision and blindness for each age category that was observed in the Mud Creek Valley Study can be attributed to the higher prevalence rate of cataract associated with a paucity of health care services in the Mud Creek Valley population. The time-derivative of the prevalence rate vs. age function fit to the data provided an estimate of the annual incidence rate of low vision and blindness vs. age. The estimated annual incidence agreed with estimates from unpublished 8-year incidence data of the Baltimore Eye Survey. The incidence rate of low vision and blindness for Americans aged 40 to 60 years is higher among blacks than among whites. For Americans greater than age 60 years, the incidence rate for whites exceeds that for blacks. This observation probably reflects the different natural histories of glaucoma, a leading cause of low vision and blindness among black Americans, and age-related macular degeneration, a leading cause of low vision and blindness among white Americans. Using the age-dependent models of prevalence rate of low vision and blindness for white and black populations, an estimated 1.5 million Americans over age 45 years have a best-corrected visual acuity in the better eye that is < or = 20/70. Based on the incidence rate estimates, approximately 240,000 new cases of low vision and blindness occur each year. With the aging of the U.S. population, that number is expected to double over the next 25 years.

Adult↗

Near stereoacuity: development in preschool children; normative values and screening for binocular vision abnormalities; a study of 115 children.

PURPOSE: Because of controversial results in previous reports, we wished to further evaluate stereoacuity development in children with normal binocular vision, and to investigate the reliability of stereoscopic tests for screening for abnormal binocular vision and amblyopia. MATERIALS AND METHODS: In a prospective study, 115 children, age 3 to 6 1/2 years, were first tested on the TNO and Titmus Stereotests, after which they received a more complete eye examination to determine the presence of ocular and vision abnormalities. Only specific quantitative stereotest results were tabulated for the development study. RESULTS: Binocular vision anomalies were detected by stereotesting in 3 of the 115 children. Testability was better on the TNO than the Titmus Stereotest. Using only the quantitative stereotest results, when segregated by age groups, there was a "statistically significant" change (improvement with age) on the TNO Test (p=.0001)(x2); whereas there was no such improvement found on the Titmus Stereotest Circles, p=.045, 0.72. CONCLUSIONS: The TNO Test is reliable for screening for binocular vision anomalies and amblyopia. Also, normal stereopsis and stereoacuity acuity improves "significantly" between age 4 and 5 1/2 years, and reaches adult-like level at 5 1/2 years on this test.

Aging↗

Screening for visual defects in preschoolchildren.

There is no evidence to support the suggestion that a widespread programme of vision screening at age 3 1/2 should be instituted. Some of the practical problems and defects of such a programme are outlined. If the issues raised are to be resolved by further research, identification of preschoolchildren who have visual problems will be facilitated by a screening procedure involving refraction and possibly a cover test.

Amblyopia↗

Validity of clinical color vision tests for air traffic control.

BACKGROUND: An experiment on the relationship between aeromedical color vision screening test performance and performance on color-dependent tasks of Air Traffic Control Specialists (ATCS) was replicated to expand the database supporting the job-related validity of 13 FAA-accepted screening tests. METHODS: The original experiment (10) (n = 108), and the replication (n = 136) involved a total of 121 normal trichromats, 31 simple and 44 extreme anomalous trichromats, and 48 dichromats; both protans and deutans were included. The simulations of ATCS color tasks which served as validation criteria were flight progress strips (en route centers), aircraft lights and the Aviation Signal Light indicator (ATC terminal operations), and color weather radar (flight service station and en route center facilities). RESULTS: The validities (Kappa) of aeromedical screening tests ranged from 0.44 to 0.91 for prediction of error-free performance on all color-dependent tasks. CONCLUSIONS: The aeromedical screening tests were generally acceptable in terms of selecting individuals who did not make errors on ATCS color tests, but several tests had high false alarm rates. High job-related validity, in the vicinity of 0.90, was confirmed for several aeromedical color vision tests used for ATCS screening.

Adult↗

Random Dot E stereotest: testability and reliability in 3- to 5-year-old children.

PURPOSE: To determine the proportion of preschoolers testable with the Random Dot E (RDE) stereotest and the between-tester reliability. METHODS: Subjects were 1257 3- to 5-year-olds who were participants in Head Start programs in five communities. The sample was over-weighted with children who failed the routine Head Start vision screening (58% failures; 42% nonfailures). Each child had stereotesting attempted by two licensed eye care professionals using the RDE test, first in a screening setting and later in a comprehensive eye examination. Pretesting was performed at 50 cm. Children who discriminated between the nonstereo E and blank cards on 4 of 4 or 4 of 5 presentations were considered testable. Stereotesting was conducted at 50, 100, and 150 cm corresponding to 504, 252, and 168 arcsec disparity). Extent of agreement beyond chance between the screening and examination test results was assessed using the kappa (kappa) and weighted kappa (kappa(w)) statistics. RESULTS: Testability increased with age at both the first (86% of 3-, 89% of 4-, and 93% of 5-year-olds; p = 0.02) and the second (90% of 3-, 94% of 4-, and 98% of 5-year-olds; p = 0.0001) sessions. Overall, stereopsis was better at the second session. Agreement between sessions was moderate (kappa(w) = 0.43; 59% identical scores). While identical scores increased with age (53% of 3-, 59% of 4-, and 63% of 5-year-olds), kappa(w) statistics did not differ with age (p = 0.49). CONCLUSIONS: Child testability on the RDE stereotest was significantly better for older than younger preschool-age children. Overall, test-retest agreement was moderate and did not differ according to age. Testability rates of 98% and higher have been achieved in the same population with other screening tests including another random dot stereotest.

Age Factors↗

A comparison of the Frisby, Random-Dot E, TNO, and Randot circles stereotests in screening and office use.

Three random-dot stereogram (RDS) tests, the Frisby, Random-Dot E (RDE), and TNO tests, and a stereotest with monocularly visible contours, the Randot circles test, were administered to two populations of 3- to 5-year-old children in vision screening settings and to a sample of patients with strabismus and amblyopia. The Frisby test missed (underreferred) cases of binocular dysfunction detected by the RDE and TNO tests, using a 250 seconds of arc (250") (Frisby and RDE) or 240" (TNO) thresholds as the pass-fail breakpoint. The TNO underreferred cases at 240" relative to the RDE, but underreferred none if the TNO's breakpoint was lowered to 120". The Randot circles test produced better-indicated stereoacuities than the RDS tests and was found able to reliably grade stereoacuity in patients with stereopsis too poor to be graded by RDS tests.

Adolescent↗

Simple retinoscopic screening.

A simplified retinoscopic technique to screen for refractive errors in children is presented. The technique described was assessed in 98 children and the results correlated with full retinoscopic refractions. All tests were done with cycloplegia. Orthoptists' results using the simple retinoscopy compared well with the full retinoscopic findings of the ophthalmologists, with an overall sensitivity of 90% and specificity of 74%. These results compare favourably with more technical refractive screening methods. This technique may be suitable as an adjunct to vision screening in pre-school children.

Child↗