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[Proposal for a procedure for the detection of ophthalmic disorders in school children].
The proposal for a visual acuity test (A.V.) arose from a survey conducted among School Children of the "Ciclo Básico (C.B.)" i.é., the first two years of Elementary School in S. Carlos, S. Paulo State, Brazil. Nine schools participated in this study. The teachers were properly trained to apply the A. V. and squinting tests according to a standardized procedure. Of 2,025 children tested, 88.1% showed levels of A. V. higher than 0.8, and a squinting prevalence of 2.17%. When the application of the test was over, each school presented its proposals for the systematical application of such tests. These proposals had a common point: the test should be applied by the teachers themselves under the supervision of the coordinators of the C. B. The school nurse would be responsible for giving overall assistance to all the activities of the program at all levels.
A fundus camera dedicated to the screening of diabetic retinopathy in the primary-care physician's office.
PURPOSE: To increase the number of diabetic patients being screened for retinopathy, an instrument, the DigiScope, was specifically designed to operate in primary-care physicians' offices. The DigiScope is described and its automated functions are evaluated. METHODS: The DigiScope consists of a semiautomated optical head to acquire fundus images, evaluate visual acuity, and transmit the data to a remote reading center through telephone lines. Normal volunteers and 17 consecutive diabetic patients visiting their primary-care physician were recruited, and nonophthalmic staff performed the acquisition session. RESULTS: The pupil center and working distance were set automatically. Centering was achieved within 750 microm in less than 500 ms. The fundus was successfully focused by an automated algorithm, and an imaging session covering 71 degrees of the posterior pole of both eyes lasted 5.6 +/- 2.4 minutes. It was found that a file-compression ratio of 12 did not degrade the clinical information and allowed data transfer in less than 6 minutes. A pilot study in normal eyes showed that the DigiScope images yielded the same amount of details as conventional color fundus photographs obtained by an expert photographer. CONCLUSIONS: The DigiScope fulfills the instrumental requirements for a practical and cost-effective tool to acquire data needed to identify diabetic patients who must be referred to an eye-care specialist. Widespread screening with the DigiScope may help reduce the risk of vision loss in an estimated 4 million individuals in the United States alone, who currently do not undergo an annual eye examination.
Screening for primary open-angle glaucoma: a review.
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A simplified screening test for identifying people with low vision in developing countries.
Simple but effective tests have been produced for screening subjects with low vision in developing countries. These tests of distance and near vision, based on the E test, were evaluated and validated in trials with people aged 4-90 years, and have been field tested in the health, education and rehabilitation services in 32 developing countries. Their sensitivity and specificity as screening tools for low vision have been calculated; sensitivity of 85% and specificity of 96% for the distance vision test, and sensitivity of 100% and specificity of 84% for the near vision test. The content and format of the tests have been demonstrated to be appropriate for developing countries, and their effectiveness for screening for low vision has been confirmed.
Screening for amblyopia in childhood.
BACKGROUND: Amblyopia is a reversible deficit of vision that has to be treated within the sensitive period for visual development. Screening programmes have been set up to detect this largely asymptomatic condition and refer children for treatment while an improvement in vision is still possible. The value of such programmes and the optimum protocol for administering them remain controversial. OBJECTIVES: The objective of this review was to evaluate the effectiveness of vision screening in reducing the prevalence of amblyopia. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Group Trials Register, on The Cochrane Library Issue 2, 2005, MEDLINE (1966 to May 2005 week 1) and EMBASE (1980 to 2005 week 19). No language restrictions were placed on these searches. No handsearching was done. SELECTION CRITERIA: We planned to analyse data from randomised controlled trials and cluster-randomised trials comparing the prevalence of amblyopia in screened versus unscreened populations. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study abstracts identified by the electronic searches. Full text copies of appropriate studies were obtained and, where necessary, authors were contacted. No data were available for analysis and no meta-analysis was performed. MAIN RESULTS: Despite the large amount of literature available regarding vision screening no trials designed to compare the prevalence of amblyopia in screened versus unscreened populations were found. Data currently under preparation may be available for updates to the review. AUTHORS' CONCLUSIONS: The lack of data from randomised controlled trials makes it difficult to analyse the impact of existing screening programmes on the prevalence of amblyopia. The absence of such evidence cannot be taken to mean that vision screening is not beneficial; simply that this intervention has not yet been tested in robust trials. To facilitate such trials normative data on age-appropriate vision tests need to be available and a consensus reached regarding the definition of amblyopia. In addition, the consequences of living with untreated amblyopia have yet to be quantified and a cost-benefit analysis carried out.
Screening amblyopia of preschool children with uncorrected vision and stereopsis tests in Eastern Taiwan.
UNLABELLED: AIMS OR PURPOSE: Screening for amblyopia at earliest age is important for early treatment and better prognosis. This study aimed at evaluating the validity of uncorrected distant and near visual acuity and random dot stereopsis for screening amblyopia. METHODS; In Eastern Taiwan, population-based screen tests were performed for children at age from 3 to 6 years. The tests included uncorrected distant and near visions and random dot stereopsis (300 s) test. The screen performers were registered nurses of local public health service posts. The golden standards of the tests were the results of examination by the ophthalmologists. RESULTS: Including Hans and aboriginal Taiwanese, 5232 children were included. Screened by distance visual acuity with different cutoffs and near visual acuity, 10.3, 30.3 and 8.2% children were abnormal. Screened by random dot, only 2% children were abnormal. By a senior ophthalmologist, 115 amblyopic children were diagnosed amblyopic. The sensitivities of distance visual acuity with low/high cutoff and near visual acuity were 74.7/84.8 and 49.4%, whereas that of the NTU random dot stereogram was 20.5%. Simultaneous testing of either two of the three tests improved the sensitivity. CONCLUSION: Screening for amblyopia by the local nurses using the visual acuity tests or random dot stereopsis test alone does not display a high sensitivity. Simultaneous testing of distant visual acuity and stereopsis test elevate the sensitivity and preserve the specificity.
Visual field screening for glaucoma.
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The Allen vision test results of 2600 screenings.
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A national retinal screening programme for diabetes in Scotland.
The Health Technology Board Scotland (HTBS) have issued recommendations for eye screening in patients with diabetes. These are based on evidence-based clinical studies. Evidence-based studies do not answer all the practical issues, and some conclusions have thus been extrapolated from the known evidence base. Other factors such as patient issues, organizational issues and cost effectiveness have also been incorporated into the recommendations. HTBS recommend single-field digital retinal photography. Retinal photography best addresses the issues of adequate sensitivity and accountable quality assurance. Non-mydriatic photography is recommended, followed by immediate use of dilating eye drops if it is unsuccessful, followed by slit-lamp examination if both of these approaches fail. An independent grading scheme has been established, which is similar to the 'Global', and compatible with the National Screening Committee (NSC) grading scheme. The rationale for these recommendations, and debate behind some of the decisions, is laid out in this article.
Quality assurance for diabetic retinopathy telescreening.
AIMS: TOSCA was an EU-Commission supported international research project designed to develop telescreening services in diabetic retinopathy and glaucoma. This paper describes the quality assurance methods developed for the diabetic retinopathy telescreening service within the TOSCA project. SETTING: The study was performed in 1895 patients with diabetes between 2000 and 2002 at diabetic retinopathy screening sites in five European countries. Data were analysed centrally. METHODS: Patients attending each clinic's diabetic retinopathy screening service received standardized retinal photography. The images and associated data were transferred electronically to a remote location for grading. Each photographer uploading images and each grader downloading images for assessment was controlled by a systematic quality management approach. The quality assurance measures defined were image quality, intragrader reliability. A cockpit chart was developed for the management and presentation of relevant results and quality measures. For the intragrader reliability tests, 10% of the images were processed for a second grading. An algorithm for calculating differences between repeated gradings was developed. RESULTS: The assessment of image quality for the different sites showed that only 0-0.7% were unassessable. One hundred per cent agreement for both gradings was achieved in 50-85% of graded cases, depending on site and grader, and an agreement better than 95% in 71-100% of cases. CONCLUSIONS: A telemedicine-supported quality assurance process is practical and advantageous. The cockpit charts have proven to be useful tools when monitoring the performance of a telescreening service. Grader feedback showed high satisfaction with the quality assurance process.
An assessment tool for screening ROP in the preterm infant.
An increased incidence of retinopathy of prematurity (ROP) parallels the increased incidence of viable births at earlier gestational ages. However, advancements in laser therapy can treat ROP and ultimately prevent blindness. This paper describes the development, implementation, and evaluation of a tool that consistently documents ROP assessments by medical staff, as well as pertinent medical history necessary to safely manage this critical population. The assessment tool was designed for an outpatient ophthalmology clinic. The outpatient population included all infants delivered at or transferred to the neonatal intensive care unit of a large university hospital located in the Midwestern United States. The infants were considered at risk for ROP if they weighed less than 1500 grams or if they had a gestational age of less than or equal to 34 weeks. At any given time, the outpatient clinic manages from 50 to 70 infants. Implementation of the tool increased consistency in documentation by medical staff and guided the initial assessment for nursing and technical staff members.
[Development of postoperative motility in orbital floor, zygomatic and mid-face fractures].
A prospective study of was made on 100 patients with fractures of the orbital floor, the zygoma and/or midface who were surgically treated and investigated (before and 3 days, 7 days, 1 month and 6 months after surgery) with regard to their eye motility (Hess screen) and their double vision (Harms tangent screen). Stable results were obtained at least 30 days after surgery. Patients in whom early surgery was performed (within 7 days after trauma) showed better results (82% improvement) compared with those operated on in the second week after the trauma (50% improvement) or later (27% improvement). Young patients (less than 10 years of age) and patients with midface fractures (LeFort II and III) showed significantly poorer results with regard to eye motility.
[Screening of language disorders in the preschool period].
Between five and 20% of preschool age children have language problems. These can be related to the child's hearing, socioeconomic status, intellectual development, or a psychiatric disorder. Even when it is difficult to recommend a formal screening program, family physicians can interpret delays in speech and language as "indicators" of underlying disorders.
Screening for diabetic retinopathy.
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Fail-safe screening programme.
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A large-field screen with even texture for vision research.
Studies of the physiology of the central visual system and visual behavior frequently require large tangent screens, and it has been difficult to create a smooth surface with uniform illumination. We have developed a technique for holding drafting paper on a sheet of acrylic so that it can be used as a tangent screen for both front and rear projections. The process utilizes a vacuum system that holds the paper firmly and produces a uniformly smooth surface with good light diffusion; it is simple, flexible, and inexpensive and can be used for any size screens.