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PubMed1994

Proposed protocol for a multi-centre study to compare clinical and trade tests of colour vision in firefighters.

Fire-brigade recruits in the UK have their colour vision screened using the Ishihara test. This is unsatisfactory because it rejects subjects with minor deficiencies in colour vision and does not test for blue defects. The Home Office is currently reviewing its recommendations on visual standards. This paper summarizes defects in colour vision, discusses alternative clinical and trade tests for the fire-brigade, and proposes a multi-centre study to collect data on the performance of fire-brigade recruits in clinical and trade tests.

Clinical Protocols↗
PubMed1995

Evaluation of vision services delivered by a mobile eye clinic in Costa Rica.

A number of private voluntary organizations provide mobile eye services to underserved populations in the developing world. This paper seeks to determine what segment of the population makes use of mobile vision clinics and whether the clinics are identifying significant eye conditions previously undetected by local eye care providers. The population studied were those attending the 1989 vision screening project conducted in rural Costa Rica by members of Volunteer Optometric Services to Humanity (VOSH). Sources of data include patient records of clinic attendees (N = 1530), patient interviews, and Costa Rican census data. Most of the clinic attendees were female (56.9%), over 35 years of age, and literate (71.1%). The three most commonly stated occupation categories were (1) housewife; (2) agriculture, forestry, or fishery worker; and (3) student. Over one-half reported having had a previous eye examination. Presbyopia and low hyperopia were the predominant refractive conditions encountered. Over one-third of patients presented with visual acuities 6/15 (20/50) or worse, and one-third of this group had never had an eye examination. Three-quarters of the patients required prescription lenses and over 20% had cataract. The dispensing of presbyopic corrections to first time patients is clearly the most valuable service provided by the clinics. Teaming up with mobile cataract camps may improve the access to surgical care for patients with cataract. It is important that mobile vision projects target future efforts toward those likely to be missed by conventional screenings.

Adolescent↗
PubMed2000

Motorist vision policy.

BACKGROUND: The primary purpose of public policy requiring vision testing for driver license renewal is to identify individuals with functional vision impairments and, when necessary, to restrict their driving. This is based on the presumption that poor vision is causally related to poor driving and traffic crashes. METHODS: The AOA Environmental and Occupational Vision Committee performed a synthesis of relevant empirical literature on policy-based research and developed potential options for enhancing traffic safety. RESULTS: Presently, some states require vision testing for driver's license renewal and some do not. Regional and nationwide studies report that vision-related license renewal policies are associated with enhanced traffic safety. However, contemporary vision screening tests may be of limited value in identifying individuals with functional vision impairments. CONCLUSION: The most cost-effective and valid method for identifying, treating and counseling visually impaired drivers is to require a comprehensive eye examination as a condition for driver license renewal for those with a high prevalence or high probability of vision impairment.

Accidents, Traffic↗
PubMed1983

The relationship between vision and juvenile delinquency.

Vision disorders can be contributing causes of juvenile delinquency. Previous research is cited that illustrates this relationship. The author also reports his results obtained during a series of recent vision screenings of juvenile delinquents in a major metropolitan area. The results indicate a relatively high incidence of vision problems most of which dealt with poor binocularity. Excessive exophorias at near viewing distances were the most frequent reasons for failing the screening.

Adolescent↗
PubMed2003

Test characteristics of orthoptic screening examination in 3 year old kindergarten children.

AIM: To analyse the test characteristics of orthoptic screening for amblyopia or amblyogenic risk factors (target conditions) in kindergarten. METHODS: 1180 three year old children were screened by orthoptists in 121 German kindergartens. Orthoptic screening consisted of cover tests, examination of eye motility and head posture, and monocular visual acuity testing with the Lea single optotype test. Children were re-examined in kindergarten by different orthoptists after 3-6 months using a more demanding pass threshold for visual acuity. All children with at least one positive orthoptic test result or an inconclusive re-examination were referred to an ophthalmologist for diagnosis. The gold standard was set positive if a target condition was diagnosed on ophthalmological examination. It was set negative if no target condition was found upon ophthalmological examination, or if a child who screened negative or inconclusive passed the orthoptic re-examination without any positive test result. RESULTS: The gold standard was ascertained in 1114 children. 26 (2.3%) children had a "positive" gold standard. In 10.8% of the children the initial screening was "inconclusive," mostly due to lack of collaboration. Screening test sensitivity (based on conclusive results only) was 90.9% and specificity was 93.8%. CONCLUSIONS: Orthoptic vision screening of 3 year olds in kindergarten is sensitive and specific. However, owing to a substantial proportion of inconclusive screening results, rescreening of non-cooperative 3 year old children should be considered.

Amblyopia↗
PubMed1977

Physical mass examinations in the school health service.

At 7 years of age, all 649 children in a school district underwent a physical examination, a vision screening and an auditory screening. The purpose of the present study was to analyse the value of the routine physical examination within the school health services. In 15% of the children functionally important health problems were found. Visual defects were most common, comprising 7.5%, then came physical health problems such as motor disturbances, obesity, bacteriuria in 6.5%, and hearing defects in 1%. About half of the important health problems were previously known. Most disorders of importance were detected by the nurse's screening examination and rather few by the doctor's physical examination. It seems advisable to introduce screening procedures in the hands of nurses also for the physical examination. The role of the school physician in the general health surveillance would then be mainly to control and verify specific observations or suspicions of disease or handicap noted by the school nurse. His time and attention could instead be directed towards important tasks, which are now often neglected, e.g. health education, and care of sick and handicapped children in the school setting.

Child↗
PubMed1997

Effects of changes in lighting level on performance with the AcuVision 1000.

BACKGROUND: The AcuVision 1000 Trainer is an instrument designed to assess and train eye-hand coordination in athletes. Variable environmental conditions are encountered when sports-vision screenings are performed. The effect of these factors on scores attained on sports-vision testing equipment is an important consideration when results for different populations are compared. METHODS: This study investigated the effect of different lighting levels on subject performance. Twenty-five subjects performed three trials at each of three lighting levels (day-light, dim room, and dark. The presentation order of lighting level was counterbalanced and subjects were randomly assigned to the various presentation orders. RESULTS: The results indicate a statistically significant difference in performance at the various levels. High lighting levels decreased scores significantly, whereas there was no significant difference between the two lower levels. CONCLUSIONS: This study emphasizes the effect lighting can have on performance, and illustrates the need to properly control environmental factors through well-defined testing protocols for the use of the AcuVision 1000.

Adult↗
PubMed1995

Effects of delayed visual information on the rate and amount of prism adaptation in the human.

Accurate reaching towards a visual target is initially disturbed when the visual field is displaced by prisms, but recovers with successive trials. To determine how the improvement depends on the visual error signals associated with the motor output, the time course of prism adaptation was studied with delayed visual information on the error. Subjects were trained to reach rapidly at a target on a tangent screen. Vision was always blocked during the movement, and allowed again only after the index finger touched the screen. One experiment consisted of three sets of 30 trials. In the first set, the subject wore no prisms and vision was allowed without delay. In the second, the visual field was displaced by prisms, and vision was available only after a delay period of 0-10,000 msec while the subjects maintained their final pointing position. Initially, the subject misreached the target by about the amount of visual displacement (60 mm). Errors decreased with trials by an amount proportional to the error in the preceding trial. The rate of decrease of error was generally largest when the delay was 0 msec, became significantly smaller when the delay was 50 msec, and showed only gradual change with longer delays. In the third set, the subject wore no prisms and vision was allowed without delay. Initial misreaching in the direction opposite to the visual displacement, reflecting the amount of adaptation in the second set, was generally largest with no delay (median of 46 mm) and significantly smaller with 50 msec and longer delays (17-33 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗
PubMed1979

Early and Periodic Screening, Diagnosis, and Treatment Program.

Preventive health care for children can have a significant impact on detecting and treating potential health problems. The Early and periodic screening, diagnosis, and Treatment Program (EPSDT) is a preventive health program under Medicaid designed to improve the health of indigent children. Since this program is the only federal Medicaid program which requires vision screening and treatment services, the opportunity exists for enormous benefits for detecting and treating an indigent child's vision problems, as well as general health problems. Even though the program has been slow in evolving, it is taking an expanding role in all phases of indigent child health care, including vision care.

Adolescent↗
PubMed2001

Is there an association between functional vision and learning to read?

Background: Controversy exists about the role of visual parameters and vision in learning to read. This study aims to determine whether ocular parameters or performance on a dynamic test of visual function differs for children of differing reading ability. Methods: Two hundred and eighty-four children (mean age 9.9 +/- 1.8 years) received a vision screening emphasising binocular anomalies associated with discomfort at near (distance and near visual acuity, distance vision challenged with binocular +1 D lenses, near heterophoria, near point of convergence, stereopsis and accommodative facility). Non-verbal mentation age and reading accuracy were assessed. One hundred and six children performed a computerised task of motion coherence detection. Children were classified as normal readers (n = 195), children with dyslexia (n = 49) or learning disabled children (n = 40) based on their mentation age and their reading age. Results: There were no statistically significant differences or correlations between visual parameters and reading performance. Over thirty per cent of the children had accommodative facilities below or equal to six cycles per minute. Children with learning disabilities performed worst on the motion coherence task but this was statistically significant only when compared to the performance of dyslexics. Discussion: The lack of association between ophthalmic parameters and poor reading ability supports the view of the Committee on Children with Disabilities. However, 39 per cent of the children might be expected to experience difficulty 'reading to learn', as suggested by the American Academy of Optometry, as they showed anomalies associated with visual discomfort with prolonged reading. The motion coherence test did not differentiate dyslexics from normal readers and was worst in children with learning disability. Accommodative facility testing remained the most useful predictor of potential visual discomfort.

Journal Article↗
PubMed2006

Clinical inquiries. What are appropriate screening tests for infants and children?

There is adequate evidence for screening neonates for hemoglobinopathies, congenital hypothyroidism, phenylketonuria (strength of recommendation [SOR]: A), and cystic fibrosis (SOR: B). Vision screening should be done for those younger than age 5 years (SOR: B). High-risk children should be tested for tuberculosis (TB) (SOR: B) and lead toxicity (SOR: B). Few data exist to guide frequency and timing of these screening tests, so the following timing recommendations are based on consensus opinion (SOR: C): test for visual acuity yearly starting at age 3 years; test for TB and lead once between the ages of 9 and 12 months, and repeat for high risk or exposure.

Child, Preschool↗
PubMed2003

Sports vision testing of selected athletic participants in the 1997 and 1998 AAU Junior Olympic Games.

BACKGROUND: Sports vision researchers have attempted to establish the need for vision care services for athletes and the relationship between visual skills and athletic success. METHODS: Data collected from sports vision screenings at the 1997 and 1998 Amateur Athletic Union AAU Junior Olympic Games was compiled for analysis. Four hundred forty-nine athletes, ranging in ages from 5 to 19 years old and representing 12 sports, were part of the sports vision epidemiology project conducted by the American Optometric Association Sports Vision Section. Protocols from the AOA Sports Vision Section were used to assess the visual systems of athletes participating in the games. The history included evaluation of the use of vision care services, refractive correction type, and symptomology. The screening assessed visual acuity, contrast sensitivity, ocular alignment, eye-hand dominance, handspeed, footspeed, speed of stereopsis, speed of recognition, eye movements, hand-eye coordination, anterior-segment health, and posterior-segment health. Performance testing was analyzed by age group and sport. RESULTS: In this population of athletes, eye care was under-utilized. The performance testing indicated an increase in performance with increasing age for most tests. With increasing age, there was a decrease in the number of fixation losses, an increase in footspeed, and a decrease in handspeed. The norms for the performance tests are reported by age group and by sport. CONCLUSIONS: The results of this study imply that athletic populations at all levels are in need of eye care services. The norms derived from this investigation act as a standard for the evaluation of vision performance using the AOA Sports Vision Testing Battery.

Adolescent↗
PubMed1986

Color vision tests to identify elevated digoxin levels.

The purpose of this study was to determine the usefulness of color vision screening in identifying patients with elevated digoxin levels (greater than or equal to 2.0 ng/ml). Test-retest color vision measurements were obtained on 56 subjects with elevated digoxin levels and 93 non-digoxin subjects. Two tests, the Ishihara and Sahlgren's Saturation Test (SST), identified digoxin levels of 2.9 ng/ml or more. These tests also yielded a high percentage of improved retest scores among subjects with elevated digoxin levels (greater than or equal to 2.7 ng/ml) of more than 4-days duration and a low percentage of improved retest scores among the non-digoxin group. The Ishihara, SST, and other bedside color vision tests may prove useful in the routine monitoring of patients on digoxin therapy, especially those with a high risk for toxicity.

Adult↗
PubMed1983

A survey of visual services available to the institutionalized mentally retarded.

Investigators have found a higher incidence of refractive error and eye disease in the mentally retarded population, so a study was needed to determine the extent of vision services available to this population. A survey requesting information on frequency of eye examinations and vision screenings was mailed to administrators of Illinois State and private residential facilities for the mentally retarded. The results indicate that vision services in these institutions are inadequate.

Adult↗
PubMed1985

[Detection of visual anomalies in children of 10 months, 2 and 4 years of age. Child health evaluation].

Ophthalmological examination is part of a comprehensive examination in children under 4 years of age. Screening priorities are: strabismus examination at 10 months and 2 years of age; assessment of distant visual acuity at 2 years of age; assessment of monocular far and near acuity in association with colored vision screening at 4 years of age. Out of 130 000 check ups carried out by ophthalmologists in the Bilan de Santé de l'Enfant: At 10 months and 2 years of age: one child out of five presented ophthalmological anomalies of various degrees; At 4 years of age, one child out of four. One anomaly out of five required immediate treatment. Strabismus was noted in one child out of 28 for all ages considered. In the first year of age, the risk factors for ophthalmological anomalies were: prematurity, dysmaturity, neo-natal pathology, a familial past history of ophthalmic anomalies. These children must be routinely examined prior to the age of 2 years by an ophthalmologist trained in the examination of young children. The decision to refer to the ophthalmologist is the pediatrician's responsibility.

Amblyopia↗
PubMed2002

A survey of the prevalence of refractive errors among children in lower primary schools in Kampala district.

BACKGROUND: Refractive errors are a known cause of visual impairment and may cause blindness worldwide. In children, refractive errors may prevent those afflicted from progressing with their studies. In Uganda, like in many developing countries, there is no established vision-screening programme for children on commencement of school, such that those with early onset of such errors will have many years of poor vision. Over all, there is limited information on refractive errors among children in Africa. OBJECTIVE: To determine the prevalence of refractive errors among school children attending lower primary in Kampala district; the frequency of the various types of refractive errors, and their relationship to sexuality and ethnicity. DESIGN: A cross-sectional descriptive study. SETTING: Kampala district, Uganda PATIENTS: A total of 623 children aged between 6 and 9 years had a visual acuity testing done at school using the same protocol; of these 301 (48.3%) were boys and 322 (51.7%) girls. RESULTS: Seventy-three children had a significant refractive error of +/-0.50 or worse in one or both eyes, giving a prevalence of 11.6% and the commonest single refractive error was astigmatism, which accounted for 52% of all errors. This was followed by hypermetropia, and myopia was the least common. CONCLUSION: Significant refractive errors occur among primary school children aged 6 to 9 years at a prevalence of approximately 12%. Therefore, there is a need to have regular and simple vision testing in primary school children at least at the commencement of school so as to defect those who may suffer from these disabilities.

Age Distribution↗
PubMed1994

Social deprivation and age at presentation in amblyopia.

BACKGROUND: Amblyopia is the most common visual disability in children. Early treatment is thought to be more effective, and therefore factors affecting the age at presentation are important. A relationship between social deprivation and access to health care and screening services is well known. We hypothesized that social deprivation might be associated with later presentation of amblyopia, particularly of anisometropic amblyopia which depends on vision screening for referral. METHODS: Data from a historical cohort of 897 children with amblyopia, from seven UK orthoptic clinics, were used to test this hypothesis. Social deprivation was measured by the Townsend score of the ward in which the child lived. RESULTS: A relationship between social deprivation and age at presentation was found in children with anisometropic amblyopia even after adjusting for differences between clinics (p = 0.01) but no similar association was evident in children with amblyopia associated with strabismus. There was a difference of 22 months in the average age at presentation between children with anisometropic amblyopia in the most deprived and least deprived areas of the study. CONCLUSIONS: If screening for anisometropic amblyopia is to be undertaken, priority should be given to screening children from areas of social deprivation.

Age Factors↗