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PubMedDate not supplied

Prevention of amblyopia and the concept of cure.

Amblyopia is used as a comprehensive term for unexplained reduction of visual acuity, usually unilateral. As long as the visual deficit is monocular the visual loss is more of a potential problem than an actual handicap. Amblyopia is one of the most common causes of visual deficit in childhood, and since it is treatable, at least in children, considerable efforts have been made to detect it as early in life as possible. Screening programmes for amblyopia among preschool and school children have been widely organized throughout the world, although questions remain about their utility. This study evaluated amblyopia screening, focussing on some essential points that need thorough consideration before a screening programme is started. We also try to demonstrate some of the pros and cons of a screening system.

Amblyopia↗
PubMed2003

[Well-child care today: an evidence-based view].

OBJECTIVES: Health promotion is one of the chief activities of pediatricians, although still lacking enough scientific bases. This article reviews the scientific support for the main preventive interventions, as well as who should make them, when and how they should be made. SOURCES: Systematic review of recent literature, through the search of Medline and Lilacs databases, using the terms well-child care, health supervision and health promotion (both in English and Portuguese); non-systematic review of reference lists of book chapters; non-systematic Internet search of organizations that make recommendations on health supervision; selection of classic articles within this field. SUMMARY OF THE FINDINGS: Pediatricians must seek integration with other professionals in providing preventive services, as well as in establishing effective partnerships with all community sectors. It is essential to improve communication skills. The ideal number of health supervision visits has never been established; interventions must be individually adapted according to family and community contextual risk factors. There is scientific evidence of the effectiveness of prenatal visits, preventive guidance, metabolic screening, immunization, and vision and hearing screening. Growth monitoring and development screening must be rationalized. The systematic repetition of complete physical examinations and laboratory tests is not warranted. CONCLUSIONS: Pediatricians play a fundamental role in child and adolescent health promotion, but their actions regarding well-child care must no longer be totally empirical. There are innumerous evidence-based resources to guide pediatricians as to the most effective interventions.

Child↗
PubMed1995

Impairments of reaching movements in patients without proprioception. II. Effects of visual information on accuracy.

1. The aim of this study was to determine how vision of a cursor indicating hand position on a computer screen or vision of the limb itself improves the accuracy of reaching movements in patients deprived of limb proprioception due to large-fiber sensory neuropathy. In particular, we wished to ascertain the contribution of such information to improved planning rather than to feedback corrections. We analyzed spatial errors and hand trajectories of reaching movements made by subjects moving a hand-held cursor on a digitizing tablet while viewing targets displayed on a computer screen. The errors made when movements were performed without vision of their arm or of a screen cursor were compared with errors made when this information was available concurrently or prior to movement. 2. Both monitoring the screen cursor and seeing their limb in peripheral vision during movement improved the accuracy of the patients' movements. Improvements produced by seeing the cursor during movement are attributable simply to feedback corrections. However, because the target was not present in the actual workspace, improvements associated with vision of the limb must involve more complex corrective mechanisms. 3. Significant improvements in performance also occurred in trials without vision that were performed after viewing the limb at rest or during movements. In particular, prior vision of the limb in motion improved the ability of patients to vary the duration of movements in different directions so as to compensate for the inertial anisotropy of the limb. In addition, there were significant reductions in directional errors, path curvature, and late secondary movements. Comparable improvements in extent, direction, and curvature were produced when subjects could see the screen cursor during alternate movements to targets in different directions. 4. The effects of viewing the limb were transient and decayed during a period of minutes once vision of the limb was no longer available. 5. It is proposed that the improvements in performance produced after vision of the limb were mediated by the visual updating of internal models of the limb. Vision of the limb at rest may provide configuration information while vision of the limb in motion provides additional dynamic information. Vision of the cursor and the resulting ability to correct ongoing movements, however, is considered primarily to provide information about the dynamic properties of the limb and its response to neural commands.

Adult↗
PubMed2004

Preventing and managing visual disability in primary care: clinical applications.

Clinicians in primary care settings are well positioned to participate in the prevention and management of visual disability. They can have a significant impact on their patients' visual health by screening for vision problems, aggressively controlling known risk factors for visual loss, ensuring adherence to ophthalmologic treatment and continuity of eye care, and by timely referral of specific patient populations to qualified eye care professionals (eg, ophthalmologists and optometrists). Using their knowledge about common ophthalmic medications, clinicians can detect adverse effects of these agents, including exacerbations of heart or lung disease. They can ensure that appropriate patients are screened for common serious eye diseases, such as glaucoma, and that patients with disabilities related to vision problems are assessed for treatable conditions, such as cataracts or refractive error. Finally, clinicians can direct patients with low vision from any cause to resources designed to help enhance patient function and emotional support.

Aged↗
PubMed2003

A clinical evaluation of ophthalmic assessment in children with sensori-neural deafness.

BACKGROUND: Since 1991, children with sensori-neural deafness and their families within Southern Derbyshire have been supported by a multiagency approach to their diagnosis and management. RESULTS: One hundred and twenty-two children were seen at the Child Development Centre for an holistic assessment, and 110 of these children have had an ophthalmic assessment, of whom 48 (43.6%) were found to have ophthalmic abnormalities. These included 43 children (39.1%) with refractive errors, ranging from mild to severe. Of 82 children with uncomplicated deafness, 26 (31.7%) had refractive errors. The prevalence of ophthalmic problems was higher than the prevalence in hearing school children in the literature and in local pre-school children. There were six cases of Usher syndrome. Twenty-one children had more than one eye defect. The findings indicate that deaf and hearing impaired children are two to three times more likely to develop ophthalmic abnormalities than their hearing peers, which makes early detection of paramount importance. An important local outcome has been the establishment of guidelines for ophthalmic assessment to include assessment of vision and screening for Usher syndrome by electro-physiological testing at aged 7 years and above. Screening has been completed to date in 78 children with congenital sensori-neural deafness. CONCLUSIONS: Sensitive and efficient ophthalmic assessment and management are essential for all deaf and hearing impaired children and national guidelines need to be established for both assessment of vision and screening for Usher syndrome, based on further evaluated research.

Child↗
PubMed2000

Distance stereopsis as a screening device.

PURPOSE: To determine the efficacy of distance stereotesting as a screening device. METHODS: Distance stereoacuity using the global Random Dot and contour Circle test of the Mentor BVAT II-SG computerized testing system was measured for 216 patients, ages 6 to 18 years, before the clinical examination. Patients were classified into pass/fail groups in the areas of refractive error change (REC), ocular deviation (DEV), visual acuity (VA), and all three together (EXAM). Legitimate cutoff scores were obtained when patients were classified as 'pass' as follows: REC if the change was 0.50 D or less in sphere or cylinder relative to the habitual correction or to emmetropia if no habitual correction; DEV if there was no heterophoria or strabismus at distance (criteria of heterophoria of < 6 prism diopters and heterophorias of any magnitude were also tested); VA if the acuity at distance was better than or equal to 20/25 in the poorer eye and better than or equal to 20/20 in the better eye; EXAM if they were pass in REC, DEV, and VA. Optimal pass/fail cutoff values for the stereopsis measurements were determined by finding the maximum chi2 value from contingency tables constructed using pass/fail levels for the screening test at each of the observed levels. RESULTS: The pass rates for REC, DEV, VA, and EXAM were 45%, 72%, 42%, and 24%, respectively. Patients passed the BVAT at the analytically determined optimal cutoff values of less than or equal to 120 sec arc for global and less than or equal to 30 sec arc for contour stereopsis. The sensitivity and specificity for global stereopsis were 0.90 and 0.40 for REC, 0.89 and 0.30 for DEV, 0.93 and 0.51 for VA, and 0.87 and 0.63 for EXAM. For contour stereopsis, the corresponding values were 0.85 and 0.42, 0.89 and 0.34, 0.91 and 0.53, and 0.84 and 0.62. CONCLUSION: Distance stereotesting is highly sensitive to small refractive error changes, heterophorias and strabismus, visual acuities < 20/25, or any of the three. Global stereopsis is only slightly better than contour stereopsis at classifying patients. Distance stereotesting has potential as an effective screening test.

Adolescent↗
PubMed1991

The Takagi Automatic Tangent Screen ATS-85 analyzer for the detection of glaucomatous patients.

The effectiveness of a new visual field analyzer, the Takagi Automatic Tangent Screen ATS-85, in detecting glaucomatous patients was studied. The study population consisted of three groups of subjects: normal healthy volunteers, glaucomatous patients with defective visual fields, and glaucomatous patients with early visual-field defects. Our results indicated that the screening program of the ATS-85 could be a useful instrument particularly for epidemiologic investigations.

Glaucoma↗
PubMed1997

Assessment of visual acuity in adult patients with strabismic amblyopia: a comparison between the preferential looking method and different acuity charts.

PURPOSE: Grating acuity values obtained with preferential looking techniques do not correspond to test results obtained with letter charts. The aim of the study was to investigate the agreement between grating acuity and other acuity tests. METHODS: Twenty-eight adult patients with strabismic amblyopia were assessed with the preferential looking-method and other linear and single letter and symbol tests. RESULTS: Assessment with preferential looking regularly led to an overestimation of the acuity values, but between preferential looking and single optotypes there was a much better agreement. This is most likely due to 'crowding' in strabismic amblyopia. A crowding ratio was calculated in the amblyopic eye, and crowding was found to be more prominent for comparisons of preferential looking with optotypes in rows, than for preferential looking and single optotypes. CONCLUSIONS: Strabismic amblyopia cannot be reliably identified with grating acuity. Preferential looking-testing is therefore of limited use as a screening method for the detection of amblyopia, but preferential looking could still be useful in the assessment and treatment.

Adult↗
PubMed2003

Diplopia after refractive surgery: occurrence and prevention.

OBJECTIVES: To report the occurrence of persistent diplopia manifesting after refractive surgery, to describe the different causes of this complication, to provide risk stratification for its occurrence, and to outline minimal screening techniques for its prevention. METHODS: A retrospective medical record review of patients seen in 2 private strabismus practices who experienced persistent diplopia after refractive surgery. RESULTS: A total of 28 patients were identified who met the inclusion criteria. The causes of postoperative diplopia could be traced to 1 of 5 mechanisms. These included technical problems, prior need of prisms, aniseikonia, iatrogenic monovision, and improper control of accommodation in patients with strabismus. The recommended screening techniques would have identified all patients in this series as being at risk for postoperative diplopia with the exception of those in whom technical problems were responsible. CONCLUSIONS: Diplopia can become manifest after refractive surgery. With proper attention paid to risk stratification and recommended screening criteria, the incidence of this complication can be minimized.

Adult↗
PubMed1991

Assessment of cycloplegic effects on the vistech contrast sensitivity test in Army aviator candidates.

This study was designed to provide information regarding two aspects of contrast sensitivity testing of aviator candidates: first to determine whether contrast sensitivity functions (CSF's) obtained with the Vistech Visual Contrast Test System (VCTS) are affected by cycloplegia and second to determine whether the VCTS provides useful CSF's under clinical screening conditions in a timely and simple manner. Contrast sensitivity thresholds were obtained at 5 spatial frequencies from 106 aviator candidates before and after administering a cycloplegic. CSF's obtained under cycloplegia were reduced by about 20%. The VCTS provided useful CSF's under military screening conditions, and added about 6 min to the time required for the standard flight physical.

Adult↗
PubMed2005

Accuracy of the Lang II stereotest in screening for binocular disorders in 6-year-old children.

PURPOSE: To assess the accuracy of the Lang II stereotest in screening for strabismus, amblyopia, and anisometropia in 6-year-old children. DESIGN: Cross-sectional population-based study. METHODS: The Sydney Myopia Study examined 1765 6-year-old children (78.9% of eligible) who were identified by random cluster sampling of 34 schools in Sydney, Australia. Sensitivity and specificity of the Lang II stereotest was determined by best stereoacuity. Cycloplegic autorefraction, assessment of visual acuity, and ocular motility were conducted. RESULTS: Test sensitivity ranged from 21.4% for anisometropia (> or =1.0 diopter) to 31.3% for amblyopia. The detection rate for new cases of amblyopia ranged from 20% to 40%; the detection rate for new cases of strabismus was 30%. Specificity was >98% in all three conditions. Children with false-negative results included newly diagnosed cases of strabismus (14 of 25 children) or amblyopia (5 of 12 children). CONCLUSION: The Lang II stereotest, when used alone, has very limited value as a screening test of binocular dysfunction.

Amblyopia↗