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PubMed1996

The flashlight test and van Herick's test are poor predictors for occludable angles.

OBJECTIVE: To determine the reliability and validity of the flashlight test and van Herick's test in detecting occludable anterior chamber angles. METHODS: The flashlight test, van Herick's test and gonioscopy were performed independently by two observers on 96 consecutive new patients in our outpatient clinic. Interobserver agreement was determined using the weighted Kappa statistic. Using the glaucoma specialist's assessment of occludability of the angle (assessed by gonioscopy) as a gold standard, the sensitivities and specificities of the two tests were calculated. RESULTS: All three tests showed good agreement (Kappa more than 0.75). The sensitivity and specificity on the flashlight test were 45.5% and 82.7% respectively. For the van Herick's test they were 61.9% and 89.3%. CONCLUSION: The flashlight test and van Herick's test are of limited use as screening tests for occludable angles.

Adolescent↗
PubMed2000

Screening for refractive errors with the Topcon PR2000 Pediatric Refractometer.

PURPOSE: The PR2000 (Topcon, Tokyo, Japan) is a photorefractor that has been used in a population study comparing different methods of screening preschool children. The present study was conducted to determine the accuracy of the device in a largely clinical population. METHODS: Two hundred twenty-two children less than 8 years of age were included. All children were examined by an orthoptist using the PR2000 without inducing cycloplegia. All children then underwent retinoscopy with cycloplegia by an examiner who was unaware of the results from the PR2000 examination. RESULTS: The PR2000 gave a numerical reading for 90% of the children's right eyes and the message "Out of range" for a further 5%. The readings underestimated the amount of hypermetropic or astigmatic refractive error found on retinoscopy by an amount proportional to the magnitude of the refractive error. Agreement with retinoscopy for the axis of astigmatism more than 0.75 D was moderately good (intraclass correlation coefficient [ICC] = 0.63). The PR2000 was more useful as a screener, especially for anisometropia for which it was 91% sensitive and 92% specific. The repeatability was good for sphere (ICC = 0.74), less so for astigmatism (ICC = 0.59), and better than the optometrist for anisometropia (ICC = 0.38). The presence of nonrefractive diagnoses and the age of the children examined made little difference in the screening results. CONCLUSIONS: The PR2000 underestimated hypermetropic refractive errors when used without cycloplegia. However, it was at least as good a screening device as other similar instruments, especially when judged by its ability to detect anisometropia and the repeatability of the results.

Child↗
PubMed2004

Reliability, normative data, and the effect of age-related macular disease on the Eger Macular Stressometer photostress recovery time.

PURPOSE: To assess repeatability and reproducibility, to determine normative data, and to investigate the effect of age-related macular disease, compared with normals, on photostress recovery time measured using the Eger Macular Stressometer (EMS). METHOD: The study population comprised 49 healthy eyes of 49 participants. Four EMS measurements were taken in two sessions separated by 1 h by two practitioners, with reversal of order in the second session. EMS readings were also taken from 17 age-related maculopathy (ARM), and 12 age-related macular degeneration (AMD), affected eyes. RESULTS: EMS readings are repeatable to within +/-7 s. There is a statistically significant difference between controls and ARM affected eyes (t = 2.169, p = 0.045), and AMD affected eyes (t = 2.817, p = 0.016). The EMS is highly specific, and demonstrates sensitivity of 29% for ARM, and 50% for AMD. CONCLUSIONS: The EMS may be a useful screening test for ARM, however, direct illumination of the macula of greater intensity and longer duration may yield less variable results.

Adolescent↗
PubMed2003

[A new objective test for random-dot stereopsis in preverbal children].

BACKGROUND: The Lang-Stereotest is at best half-objective in testing stereovision in preverbal children. We developed a new method which might objectively measure random-dot stereopsis in preverbal children. PATIENTS AND METHODS: We project two separate random-dot images into the left and right eye using a 3D-monitor. If both eyes are perfectly aligned and random stereopsis is present, the child perceives a stimulus. Four different stimulus positions are shown at random. An infrared oculography system objectively detects whether the stimuli are seen. By using a specific baby examination unit, testing is already feasible in infants. RESULTS: We present the plots of two children with a positive (normal) and two with a negative (pathologic) response to random-dot stimuli. CONCLUSIONS: This new examination technique allows an objective assessment of random-dot stereopsis in non-verbal children. It permits us for the first time to study the development of stereovision under natural conditions. In future, the method may also be used to screen preverbal children for visual abnormalities. Larger studies are required to determine the positive and negative predictive values of this new test.

Child, Preschool↗
PubMed2000

Managing eye disease in primary care. Part 1. How to screen for occult disease.

Proper eye screening is the first step in detection of occult eye disease in asymptomatic patients. Knowing which patients are at high risk and should be referred for a comprehensive eye examination is the key. In part 1 of this three-part article, Dr Shields explains how to identify high-risk patients and offers practical pointers for performing visual acuity measurements and other necessary testing in children. A list of resources on vision care for both patients and physicians is also included.

Adolescent↗
PubMed2002

Economic evaluation of different methods of screening for amblyopia in kindergarten.

OBJECTIVE: To compare the cost-effectiveness of 5 methods of screening for untreated amblyopia in kindergarten from a third-party-payer perspective: A) uncorrected monocular visual acuity testing with pass threshold > or =0.5 (20/40) and < or =1 line difference between eyes; B) same as A, but pass threshold > or =0.6 (20/32); C) same as A, plus cover tests and examination of eye motility and head posture; D) same as C, but pass threshold > or =0.6 (20/32); and E) refractive screening without cycloplegia using the Nikon Retinomax autorefractor. METHODS: A decision-analytic model was used with a time horizon until diagnostic examination. According to the model, all 3-year-old children were screened in kindergarten with 1 of the screening methods. Children with positive screening results were referred to an ophthalmologist for diagnostic examination. Children with inconclusive screening results were either referred to an ophthalmologist directly (option 1) or rescreened by the same method after 1 year and referred to an ophthalmologist if rescreening was positive or inconclusive (option 2). Screening test characteristics and costs were estimated on the basis of a field study in which 1180 3-year-old children were examined by orthoptists in 121 German kindergartens. RESULTS: Compared with methods A option 1 (A-1), B-1, C-1, C-2, E-1, and E-2, there was at least 1 other method that was both less costly and more effective. The average costs per detected case were lowest for method A-2 (878 Euro), followed by methods B-2 (886 Euro), D-2 (908 Euro), and D-1 (965 Euro). When these methods were compared with each other, the additional costs per extra case detected were 1058 Euro (B-2 vs A-2), 1359 Euro (D-2 vs B-2), and 13 448 Euro (D-1 vs D-2). CONCLUSIONS: Monocular visual acuity screening with rescreening of inconclusive results had a favorable cost-effectiveness. By adding additional test items, few more cases could be detected. Because of a great proportion of false-negative, false-positive, and inconclusive results, refractive screening was less effective with an unfavorable cost-effectiveness.

Amblyopia↗
PubMed2001

Detection of red reflex asymmetry by pediatric residents using the Brückner reflex versus the MTI photoscreener.

OBJECTIVE: To compare the ability of pediatric residents to differentiate an asymmetric from a symmetric red reflex in patients with anisometropia and microstrabismus using the Brückner reflex and the Medical Technology Innovations (MTI) photoscreener. METHODS: A prospective, masked, case-control study was performed. Twelve pediatric residents evaluated 10 study patients and 6 control subjects in a masked manner in 2 separate sessions, using the Brückner reflex or the MTI photoscreener, evaluating for asymmetric (abnormal) or symmetric (normal) red reflexes between the 2 eyes. Each study patient had asymmetric red reflexes and the amblyogenic risk factor of anisometropia or microstrabismus. Each control subject had symmetric red reflexes. RESULTS: The pediatric residents had a mean correct score of 82% (69%-100%) using the MTI photoscreener versus a mean correct score of 65% (44%-81%) using the Brückner reflex (McNemar test: alpha < 0.01). The sensitivity of the MTI photoscreener evaluation was 89% in comparison to 61% for the Brückner reflex. The specificities for the MTI photoscreener versus the Brückner reflex were similar at 69% and 71%, respectively. CONCLUSIONS: Pediatric residents were better at detecting asymmetric red reflexes in patients with anisometropia and microstrabismus when evaluating MTI photoscreener photographs than when evaluating the red reflexes by the Brückner reflex. The MTI photoscreener may be a more sensitive method than the Brückner reflex to screen for the common amblyogenic risk factors of anisometropia and microstrabismus by easier detection of red reflex asymmetry.

Adult↗
PubMedDate not supplied

The feasibility of introducing a visual screening test for children during vaccination campaigns.

PURPOSE: A visual screening test for children was prepared for the use of paramedics during vaccination campaigns. This test was used in a vaccination campaign in Taquaritinga, São Paulo, Brazil. METHODS: The campaign was carried out by two paramedics trained by ophthalmologists. The first 130 children vaccinated whose families showed interest in participating in the visual screening program were chosen. The program consisted of demographic information and eight questions, a visual screening test for children >4 years, and an external eye examination. After studying the data collected, the paramedic decided if the child needed a more thorough ophthalmologic examination. RESULTS: Of the 4505 children vaccinated, 130 children participated in the screening test. One (76.9%) hundred of the 130 children were reexamined by ophthalmologists. Of these, 38 (29.2%) were initially considered to have visual disorders. Ophthalmologic disorders were confirmed in 22 (57.9%) children; of these, 3 were already under ophthalmologic care. The paramedics correctly screened a total of 77 (77%) children. CONCLUSION: Visual screening during vaccination campaigns is simple and rapid, and provides the opportunity to identify children with visual disorders during the critical stage of visual development without the need of ophthalmologists.

Allied Health Personnel↗
PubMed1992

Results of photorefractometric screening for amblyogenic defects in children aged 20 months.

This report evaluates the validity of a preventive programme in a population which underwent refractometric screening at the ages of 20 months and 4 years. In 1987, 1,046 children born in 1985 in the territory of the Veneto National Health Unit No. 19 were invited to undergo screening for amblyogenic factors such as meridional hyperopia greater than or equal to +2.50 diopters (D), myopia less than or equal to -2.50 D, anisometropia greater than or equal to 2 D, opacity of the dioptric media and strabismus. The test method was non-cycloplegic photorefractometry (PhR). Seven hundred and ninety-five children were tested (76%); positive cases underwent subsequent cycloplegic autorefractometry (AR) and corrective lenses were prescribed as necessary. In 1989, an eye test was performed on 653 children who had taken part in the previous PhR screening and on 350 similar children who had not: the test included evaluation of visual acuity, stereopsis and AR. An eye with a corrected visual acuity of less than 0.7 was considered amblyopic. PhR demonstrated a sensitivity of 80%, a specificity of 96% and a positive prediction rating of 46% in the identification of amblyogenic factors. The prevalence of amblyopia at 4 years of age in the group which had undergone previous screening was 1.07% vs. 2.57% in the group which had not (P: not significant). The progress of the myopia was studied in a group with full optical correction used continuously (Group A) and in a control group under-corrected by at least 1.5 D (Group B).(ABSTRACT TRUNCATED AT 250 WORDS)

Amblyopia↗
PubMed2004

Screening for myopia and refractive errors using LogMAR visual acuity by optometrists and a simplified visual acuity chart by nurses.

PURPOSE: To compare the sensitivity and specificity of a widespread method of screening for refractive errors in Singapore schoolchildren using a simplified acuity screening chart with a more rigorous method using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. A secondary aim is to estimate the best cutoff values for the detection of refractive errors using these two methods. METHODS: This is a population-based study, involving 1779 schoolchildren from three schools in Singapore. Logarithm of the minimum angle of resolution (logMAR) visual acuity was recorded using a modified Bailey-Lovie chart by trained optometrists, and visual acuity measurement was also undertaken using a simplified 7-line visual acuity screening chart by school health nurses. The main outcome measures were the receiver-operating characteristics (ROC's) of logMAR and the simplified screening visual acuity to detect myopia or any refractive errors. The difference between measurements, simplified screening visual acuity--logMAR visual acuity, was calculated. RESULTS: The optimal threshold using the simplified screening visual acuity chart for the detection of myopia or any refractive error was 6/12 or worse. Using logMAR visual acuity, the most efficient threshold for the detection of myopia was 0.26, but this was 0.18 for the detection of any refractive error. The area under the ROC curves was significantly greater in the case of the logMAR visual acuity measurement compared with the simplified screening visual acuity measurement for the detection of myopia or any refractive errors. The 95% limits of agreement for the two methods (simplified screening--logMAR acuity) was -0.219 to +0.339. CONCLUSIONS: Bearing in mind that the visual acuity measurements were performed by two different groups of professionals, visual acuity screening using the ETDRS method appears to be more accurate than the simplified charts for the detection of myopia or any refractive errors in children.

Child↗
PubMed1994

The efficacy of a multimedia educational campaign to increase the use of eye care services.

PURPOSE: Effective eye care, both preventive and problem-directed, requires that patients actually see trained eye care providers. The authors examined the impact of a multimedia campaign on patient behavior in using eye care. METHODS: The authors surveyed 2000 individuals 1 year after they mailed in a contrast sensitivity screening card during a focused multimedia educational campaign. The response rate was 39%, allowing precision of estimates to +/- 4%. FINDINGS: Those who failed the screening test were much more likely to have had an eye examination in the year after the campaign and were much more likely to have seen an ophthalmologist for their care. Other important factors significantly related to using eye care services were: having had prior examinations, having a non-ophthalmologist physician, and having a history of cancer or macular degeneration. Importantly, 22% of those who failed the screening test thought they had had normal results when asked 1 year later. CONCLUSIONS: A focused multimedia campaign combined with interactive patient involvement can directly increase the use of eye care services. In addition, such care is much more likely to be delivered by ophthalmologist as opposed to other providers.

Contrast Sensitivity↗
PubMed1989

A normative study of step vergence in elementary schoolchildren.

The purpose of this study was to develop normative data for step vergence testing in children age 6-12. Such data are not currently available for this age group. Base-in and base-out step vergence testing with a prism bar was performed on 386 elementary schoolchildren who had all passed a modified clinical technique (MCT) screening. A new polarized target was developed which enabled us to detect suppression, as well as diplopia or blur. The findings suggest significant differences from normative data previously reported for adults. Because the data for 6-year-olds were different from the rest of the group, we suggest that lower norms be used for this age group. This study provides expected findings for step vergence testing outside the phoropter, which can be used clinically for the assessment of disparity vergence ranges in young children.

Child↗
PubMed1999

The utility of entoptic perimetry as a screening test for cytomegalovirus retinitis.

OBJECTIVE: To determine the sensitivity and specificity of entoptic perimetry as a noninvasive test for detecting retinal damage due to peripheral cytomegalovirus (CMV) retinitis. DESIGN: A masked study comparing entoptic perimetry with fundus photography under 4 experimental conditions (determined by increasing pixel sizes) on 2 separate testing sessions. SETTING: Acquired immunodeficiency syndrome Ocular Research Unit at the University of California, San Diego. PATIENTS: Twenty-four human immunodeficiency virus-positive and 8 human immunodeficiency virus-negative subjects; 21 eyes with documented CMV retinitis, and 26 eyes that were retinitis free. MEASUREMENTS: For each testing session, screening method, and condition, the presence of CMV retinitis was determined for each meridian (i.e., clock hour), each quadrant (consisting of 3 meridians), and each eye (consisting of all meridians); the amount of retinitis was defined as the percentage of meridians or quadrants with CMV retinitis. RESULTS: Entoptic perimetry was as sensitive and specific as fundus photography in determining the presence of CMV retinitis. Determination of the amount of CMV retinitis tended to be underestimated by perimetry for larger pixel sizes. CONCLUSION: Entoptic perimetry may be an effective and inexpensive alternative to fundus photography for CMV retinitis in hospitals and community clinics.

AIDS-Related Opportunistic Infections↗
PubMed2001

Poor correlation between "fix-follow-maintain" monocular/binocular fixation pattern evaluation and presence of functional amblyopia.

PURPOSE: To assess the reliability of visual screening with fix- follow-maintain (FFM) method in early detection of amblyopia in children who are not able to cooperate in testing with Allen Figures or Snellen E-chart. METHODS: Followup records of 89 patients that were examined in our pediatric ophthalmology department between May 1996 and May 1999 were evaluated retrospectively. The visual acuities that were measured with FFM method at the first visit were compared with the visual acuity levels that were measured with the Snellen E-chart at later followup visits. Functional amblyopia was defined as a difference of 2 or more Snellen lines between the two eyes. RESULTS: Amblyopia was later definitively diagnosed on the E-chart in only 17 (32.6%) of the 52 eyes that were estimated to have a significantly lower visual acuity than the fellow eye with the FFM method. Sensitivity of the FFM method in diagnosing amblyopia was found to be 53.1% and the specificity was 38.5%. CONCLUSIONS: The use of the FFM monocular/binocular fixation pattern to determine visual acuity and the possible presence of amblyopia is so insensitive, and so unspecific, that its reliability is very low and the results of such testing are therefore virtually useless, if not medically hazardous. There is, therefore, a need to make more universally available more sophisticated tests of vision (preferential looking, VEP); where they are not available, further emphasis should be placed on Snellen equivalent vision testing as with Allen Cards, Tumbling E, HOTV Test, Lea Figures etc. so as to obtain an accurate direct visual acuity at as young an age as possible. Amblyopia treatment should not be initiated solely on the basis of FFM testing.

Amblyopia↗
PubMed1996

Screening techniques for angle-closure glaucoma in rural Taiwan.

562 residents of Jin Shan aged 40 years and above underwent examinations to compare the sensitivity and specificity of oblique flashlight, peripheral slit beam and ultrasonographic evaluation of the anterior chamber depth to gonioscopy in detecting cases of PACG. Among 5441 eligible individuals aged 40 and above, 562 (10.3%) underwent screening for PACG, of whom 17 (3.02%) were defined as cases, and 10 (1.78%) as suspects. Home visits indicated that respondents for screening were similar to the population as a whole. Only 35% of PACG cases reported symptoms consistent with acute angle closure, and only 18% were previously diagnosed. When compared to gonioscopy, only ultrasonographic measurement of AC depth provided an adequate mix of sensitivity and specificity. Ultrasonography in combination with tonometry provided a sensitivity of 88% with a specificity of 92%. Sensitivity and specificity for ultrasonography in combination with refractive status were 84% and 83% respectively. Shallower AC depth (p = 0.0001), shorter axial globe length (p = 0.001), greater than 2D of hyperopia (p < 0.001), high grades of nuclear sclerotic cataract (p < 0.0001) and an increased cup-to-disc ratio (p = 0.002) were significantly correlated with a diagnosis of PACG.

Adult↗
PubMed2000

Normal emmetropization in infants with spectacle correction for hyperopia.

PURPOSE: The development of emmetropic refraction is known to be under visual control. Does partial spectacle correction of infants' refractive errors, which has been shown to have beneficial effects in reducing strabismus and amblyopia, impede emmetropization? The purpose of the present study was to perform the first longitudinal controlled trial to investigate this question in human subjects. METHODS: Children identified as having significant hyperopia in a population screening program at age 8 to 9 months were assigned to treated (partial spectacle correction) or untreated groups. A control group of infants with no significant refractive errors at screening was also recruited. Measurements of retinoscopic refraction under cycloplegia were taken at 4- to 6-month intervals up to the age of 36 months, and changes in refraction of 148 subjects were analyzed longitudinally. RESULTS: Refractive error decreased toward low hyperopic values between 9 and 36 months in both hyperopic groups. By 36 months, this reduction of hyperopia showed no overall difference between children who were treated with partial spectacle correction and those who were not. Despite the improvement, both hyperopic groups' mean refractive error at 36 months remained higher than that of the control group. When infants in all three groups were considered together, the rate of reduction of refractive error was, on average, a linear function of the initial level of hyperopia. CONCLUSIONS: The benefits of spectacle correction for infants with hyperopia can be achieved without impairing the normal developmental regulation of refraction.

Accommodation, Ocular↗