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PubMed1990

Measuring visual acuity in children using preferential looking and sine wave cards.

Preferential looking using square waves is commonly used to measure visual acuity of infants. Since sine-wave gratings have the advantage of presenting only a single spatial frequency, we completed a study to develop and validate a set of acuity cards using sine waves. The subjects were 83 children (mean age = 41.5 months, range = 3 to 69 months). The sine-wave cards were compared with Teller cards. Identical visual acuity was determined in 83% of the cases. Wilcoxon non-parametric analysis provided no evidence to reject the null hypothesis of equal visual acuities between the two methods. We conclude that sine-wave cards may be used to measure the preferential looking acuity of children.

Child↗
PubMed1994

Early signs of myopia in Chinese schoolchildren.

We looked for the earliest signs of the onset of myopia in 194 emmetropic (-0.25 to +0.75 D) eyes by following them for 1 to more than 2 years. Visual acuity examination, cycloplegic retinoscopy, and A-scan ultrasonography were performed at intervals of 6 to 12 months. Of the 194 eyes 64 became myopic during the observation time. Our results show that during the progression from emmetropia to myopia the change in visual acuity is not a good indicator of the onset of myopia. When visual acuity decreased to below 6/6 (20/20) cycloplegic retinoscopy showed that most of the 64 eyes had become truly myopic and A-scan ultrasonography revealed a significant increase in vitreous chamber depth and axial length as compared to the non-myopic eyes. In the early stage of myopia development the anteroposterior diameter of the eye elongates. However, changes in anterior chamber depth and lens thickness did not differ between the myopic and non-myopic group. Our results suggest that routine ocular refraction should be conducted in addition to the school vision screening. For those who have visual acuity 6/6 (20/20) and ametropia of -0.25 D or more minus we would like to be able to prevent or at least retard the development of myopia.

Child↗
PubMed2003

Validity and reliability of the revised convergence insufficiency symptom survey in children aged 9 to 18 years.

PURPOSE: To assess the validity and reliability of the Convergence Insufficiency Symptom Survey (CISS) in children aged 9 to 18 years. The CISS is the primary outcome measure for a pilot study evaluating two different treatments for convergence insufficiency (CI). METHODS: Children with CI were given the CISS twice to assess reliability. CISS scores for the first administration were also compared with scores from children with normal binocular vision to assess the validity of the CISS. RESULTS: Forty-seven children with CI and 56 children with normal binocular vision participated in the study. Reliability was assessed using intraclass correlation and 95% limits of agreement for the children with CI. For children with CI, the intraclass correlation was 0.77 (95% confidence interval, 0.613 to 0.873), and the 95% limits of agreement were -10.2 to +12.1. The mean (+/-SD) CISS score was 30.8 +/- 8.4 for the children with CI and 8.4 +/- 6.4 for the children with normal binocular vision. These means were significantly different (p < 0.0001). Good discrimination (sensitivity, 96%; specificity, 88%) was obtained using a score of >/=16. CONCLUSIONS: Children with CI showed a significantly higher CISS symptom score than children with normal binocular vision. The results of the study indicate that the CISS is a valid and reliable instrument to use as an outcome measure for children aged 9 to 18 who are enrolled in clinical research concerning CI.

Adolescent↗
PubMed1998

Detection, prevention, and rehabilitation of amblyopia.

Although there is a continuing effort to develop effective measures for detecting amblyopia, the debate continues in many countries as to the real value of population-wide pediatric vision screening programs. Nevertheless, amblyopia still represents a significant and treatable clinical problem for the practicing ophthalmologist. In this past year's literature, we can find that many visual functions are abnormal in amblyopia, but only a few are measured to reach a diagnosis or monitor treatment. Unfortunately, the wide variety of the measurement methods and the lack of definition for a cure of amblyopia are the cause of serious criticism of our "scientific" literature on the subject. All the while, old methods of treatment are resurfacing again: optical and pharmacological penalizations. The search for a possible "pill" to either replace or at least complement conventional methods of treatment also has continued in 1997 and 1998. As well, there have been quite a few papers on the long-term management of amblyopia. Finally, this review would not be complete without reporting on the "controversy du jour:" a report that challenges the need to cure amblyopia before operating on esotropia.

Amblyopia↗
PubMed2001

Amblyopia: detection, prevention, and rehabilitation.

This year's literature on the detection, prevention, and rehabilitation of amblyopia is again somewhat dominated by the topic of vision screening, specifically photoscreening and also by the therapeutic challenges of compliance and late treatment. Basic scientists also have added to our knowledge and understanding of certain interesting and clinically significant characteristics of the visual perception of amblyopes.

Amblyopia↗
PubMed2006

Validation of the PowerRefractor for measuring human infant refraction.

PURPOSE: Eccentric photorefraction provides an opportunity to gather rapid and remote estimates of refraction and gaze position from infants. The technique has the potential for extensive use in vision screenings and studies of visual development. The goal of this study was to assess the refraction calibration of the PowerRefractor (Multichannel Systems) for use with uncyclopleged infants. METHODS: The defocus measurements from the instrument were compared with the results of simultaneous retinoscopy in one analysis and with known amounts of defocus induced with trial lenses in another. Data were collected from infants 1 to 6 months of age and adults. RESULTS: The PowerRefractor typically read < 1 D of myopia when the retinoscopy reflex was judged to be neutral at the same working distance in both infants and adults. The slopes of both infant and adult validation functions (trial lens power vs. measurement of induced defocus) were close to 1 over a 4D range. The infant slopes were significantly greater than those of the adults, however. CONCLUSIONS: The results suggest that the instrument is capable of detecting large amounts of defocus but needs individual calibration for detailed studies of accommodative accuracy and absolute levels of defocus, as has been recommended previously for adult subjects.

Accommodation, Ocular↗
PubMed2005

Retinal and intracranial arteriovenous malformations: Wyburn-Mason syndrome.

A 7-year-old girl who failed a vision screening examination was found to have a retinal arteriovenous malformation (AVM) in her right eye along with a small angioma of her right lower lip. Magnetic resonance imaging and cerebral angiography revealed a large AVM involving the thalamus and basal ganglia as well as a small AVM involving the right ophthalmic artery. The combination of retinal and intracranial AVMs is known as Wyburn-Mason syndrome. The retinal AVMs of this syndrome do not grow or bleed. Visual loss is usually the result of optic neuropathy from associated orbitocranial AVMs. The natural course of the intracranial AVMs of this syndrome is poorly documented. However, they tend to be extensive and inaccessible and therefore difficult to treat.

Cerebral Angiography↗
PubMed2006

Visual impairments in people with severe and profound multiple disabilities: an inventory of visual functioning.

BACKGROUND: The prevalence of visual impairments in people with severe and profound multiple disabilities (SPMD) is the subject of considerable debate and is difficult to assess. METHODS: In a typical Dutch care organization, all clients with SPMD (n = 76) participated in the study and specific instruments adapted to these clients (requiring a minimum of cooperation) were used to measure visual acuity, the visual field, binocular vision, contrast sensitivity, refractive errors and visual functioning behaviour. RESULTS: We found an unexpected 92% of clients with SPMD to have visual impairments. Previously, only 30% were known to have visual problems. None of the persons observed had normal visual acuity. Subnormal visual acuity was the best result. The severity of the visual impairment was related to the severity of the intellectual disability. In addition to the problem of acuity, impairments in the visual field, impaired contrast sensibility and impaired binocular functioning were found, as well as impaired visual attention, fixation and following. In 22% of the clients observed, refractive errors were found and glasses were advised. CONCLUSIONS: Consequences for caregiving and for modifications of the environment were discussed.

Adolescent↗
PubMed1984

Visual acuity in the primary school child aged four to twelve years: a review of amblyopia treatment in this age group at Princess Margaret Hospital.

A survey of the incidence in Western Australia of amblyopia assessed through the school vision screening programme and Princess Margaret Hospital (PMH) eye clinics shows the figure to be 0.12%, being new cases detected in primary school children each year. Occlusion methods of treatment for amblyopia acceptable in the younger age-group are much less tolerated by both parents and child in the school-age group. The PMH series involving 240 children between the ages of four and 12 years showed that an amblyopic eye with macula or paramacula fixation can be successfully treated up to the age of 10 years without constant occlusion. Also, eccentric fixation can be cured up to the 7th birthday, but no alternative has been found for the mandatory constant occlusion. Medical, developmental and behavioural problems can influence the management and response in the four to twelve-year-old child; if these are not recognized and the child treated as a whole during the critical stages of natural development of the visual system, these children can be left with an unnecessary visual disadvantage for the next 70 years of their life.

Age Factors↗
PubMed1995

Measures of acuity in primary-school children and their ability to detect minor errors of vision.

492 five to nine year old children participated in a study of the ability of three tests of linear acuity --the Sonksen-Silver Acuity System (SSAS), the Sheridan Gardiner 7-letter chart and the Keelers MK2 chart to identify children requiring specialist visual examination. The ability of the three tests to detect children with visual defects at 6m and of the SSAS in several test test conditions (3m and 6m, monocular and binocular) was investigated at two acuity levels for referral (3/4.5 or 6/9 and 3/6 or 6/12). Although specificity was very high for all tests and test conditions using a 3/6 or 6/12 cut-off for referral, the sensitivity and yield were disappointingly low; higher levels of the latter were achieved at the expense of a degree of specificity using a 3/4.5 or 6/9 cut off. Similarly, sensitivity and yield were greater for the monocular than binocular condition and for the 6m than 3m condition. A test of near vision (SSAS) did not detect any children not already identified by a distance measure. The optometric and developmental rationale behind the differences is discussed.

Animals↗
PubMed1988

Vision and visual acuity in an elderly population.

The data for this paper were collected during a two-year study of the elderly in the market town of Melton Mowbray. The data show that typically, persons aged 75 years and older have poor uncorrected vision (6/36 Snellen acuity), but good corrected acuity, 73.8 per cent gaining 6/12 binocular Snellen acuity or better. Over 88 per cent were able to read N8 typesize or better, under test conditions. Those with low uncorrected vision were the most likely to possess spectacles.

Aged↗
PubMed2005

Effect of training on attitudes and expertise of optometrists towards people with intellectual disabilities.

PURPOSE: To determine whether participation in an educational programme, which comprised both lectures and supervised patient contacts, did more to improve the attitudes, expertise, knowledge and confidence of optometrists and student optometrists towards people with intellectual disabilities (ID) compared with receiving didactic lectures only. METHODS: Optometrists and student optometrists were invited to take part in vision screening. A series of lectures were provided followed by supervised practice for a minimum of 2 days. A questionnaire was administered before the commencement of the training, and afterwards, in order to assess the impact of the training. The results were compared with a group of control subjects who received similar lectures without the clinical experience. RESULTS: For both groups there were statistically significant improvements in self-reported knowledge of ophthalmic complications of ID, confidence in working with people with ID, and there was a significantly reduced perceived need for further training after the courses. There was a significantly better result for the group experiencing patient contact particularly in respect of self-reported attitudes towards people with ID. Confidence in dealing with people with ID was related to the number of such patients seen over the last year. CONCLUSIONS: Training incorporating clinical experience, and using real patients, is particularly effective, although there is still benefit in providing lecture type courses. It is recommended that, whenever possible, courses are provided that offer hands-on experience with real patients. There is a need for further research using validated attitudinal scales to investigate the attitudes of optometrists to people with ID.

Attitude of Health Personnel↗
PubMed2006

Outcomes of low-vision services using optometric and multidisciplinary approaches: a non-randomized comparison.

Consecutive patients (n = 215) who were referred to optometric (55%) or multidisciplinary (45%) low-vision services and above 50 years of age were recruited from four hospitals in the Netherlands. They completed two vision-related quality of life questionnaires, the Vision Quality of Life Core Measure (VCM1) and the Low Vision Quality of Life Questionnaire (LVQOL), before their first visit with low-vision services and 1 year later. At follow-up, patients referred to multidisciplinary low-vision services had lower scores on the mobility subscale of the LVQOL than patients referred to optometric low-vision services [5.3 points; 95% confidence interval (CI): 0.2-10.5]. Paired sample t-tests for the two groups of patients taken together show improvement for the VCM1 (3.1 points; 95% CI: 0.6-5.6) and deterioration for the basic aspects of vision (3.5 points; 95% CI: 1.1-5.9) and the mobility (6.6 points; 95% CI: 3.7-9.5) subscales of the LVQOL. In conclusion, people referred to optometric services showed less deterioration in mobility than those referred to multidisciplinary services. No differences were observed for any of the other subscales of the LVQOL and the VCM1. Future research in this field should include randomized controlled designs comparing low-vision services with no treatment or placebo.

Aged↗
PubMed1986

Prediction of streptococcal pharyngitis: an option for school nurses?

In this article the authors address the dilemma confronting school nurses in determining whether or not to counsel parents about seeking medical care for a child with a sore throat. The use of a clinical scorecard in the school setting as an aid in predicting streptococcal pharyngitis is investigated. The authors conclude that the only valid solution to the dilemma is the availability of the throat culture to schools. Using the culture as an additional assessment tool augments those already proven over time--the stethoscope, scoliosis and vision screening, and the otoscope.

Adolescent↗
PubMed1986

Visual acuity in Danish school children.

The medical records of 8769 school children attending the 2nd-5th grades in the Municipality of Odense have been scrutinized with regard to visual acuity. 1216 children were subject to examination, of these 1034 were found to have reduced vision due to anomalies of refraction other causes. Bilateral reduction in vision of less than or equal to 6/18 was observed in 8 children corresponding to 0.09%. Unilateral reduction in sight of less than or equal to 6/12 (employed here as the definition of amblyopia) was seen in 1.07% of the children. This applied to 1.39% of the boys and 0.73% of the girls; the difference is statistically significant. The lower frequency of amblyopia as compared to earlier investigations is probably a consequence of better vision screening during preschool age.

Adolescent↗
PubMedDate not supplied

Birefringence-based eye fixation monitor with no moving parts.

For the purpose of vision screening, we develop an eye fixation monitor that detects the fovea by its unique radial orientation of birefringent Henle fibers. Polarized near-infrared light is reflected from the foveal area in a bow-tie pattern of polarization states, similar to the Haidinger brush phenomenon. In contrast to previous devices that used scanning systems, this instrument uses no moving parts. It rather utilizes four spots of linearly polarized light-two aligned with the "bright" arms and two aligned with the "dark" arms-of the bow-tie pattern surrounding the fovea. The light reflected from the fundus is imaged onto a quadrant photodetector, whereby the circular polarization component of the polarization state of each reflected patch of light is measured. The signals from the four photodetectors are amplified, digitized, and analyzed. A normalized differential signal is computed to detect central fixation. The algorithm is tested on a computer model, and the apparatus is tested on human subjects. This work demonstrates the feasibility of a fixation monitor with no moving parts.

Adult↗