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An audit was carried out to clarify the dispute surrounding the vision screening test at 3.5 years. The uptake was 53.5%, sensitivity 77%, specificity 96%, and positive predictive value 50%. In particular the uptake was poor and the test needed a clear policy for the future.
OBJECTIVES: To assess to what extent the primary school vision screening programme was being carried out in the years 1993-94 and 1994-95, what the prevalence of eye defects was in the primary schools and how many children had a positive screening test. DESIGN: Summary sheets of the results of screening were returned by each school nurse. SETTING: All 315 mainstream primary schools served by Greater Glasgow Health Board. SUBJECTS: All school nurses working in these schools. RESULTS: Large numbers of tests were being performed but the screening programme was not fully carried out in 10% of schools in 1993-94 and in 68% in 1994-95, although the number of schools where some screening was performed did increase. The years were not directly comparable due to a change in the age groups screened. When a class was screened 94-96% of children were tested. The rate of positive screening varied from 4% to 15.6% and varied with age and locality. Fewer abnormalities were found at five years than in the older age groups (Primary 1-7.6%, Primary 4-11.4%, and Primary 7-9.7%) and fewer abnormalities were detected in the North-West area where a pre-school orthoptic screening programme was operating (4% in the North-West compared with 11% in the South where no pre-school screening was carried out). CONCLUSION: If the recommended programme is carried out, then 95% of children at age five years could be tested at a stage when amblyopia is still potentially treatable. The reasons for the programme not being completed require to be addressed. Variations between areas need to be confirmed and the reasons for them identified. Further evaluation of the programme is required, exploring the accuracy of it and the long-term outcomes.
OBJECTIVES: To undertake a systematic review of the effectiveness of preschool vision screening. To provide evidence on which decisions about the future provision of this service can be made. To indicate areas for further research. STUDY SELECTION: The Centre for Reviews and Dissemination guidelines for systematic reviews were used. The research questions were formulated using the Wilson and Jungner criteria for evaluating screening programmes. They concerned prevalence, natural history, disability, treatment and screening in relation to three target conditions: amblyopia, refractive errors and squints which are not cosmetically obvious. Studies were considered for inclusion according to pre-determined criteria for the age group studied, the outcomes measured and the study design. The following types of study design were considered: cross-sectional studies of prevalence, cohort studies of natural history, any type of study (e.g., cross-sectional surveys, case-series, qualitative studies) of disability attributable to a target condition, controlled trials, observational studies and audits of screening programmes, and prospective controlled trials of treatment. DATA SOURCES: The following electronic databases were searched: Biological Abstracts, CINAHL, Embase, ERIC, IAC Health Periodicals, IAPV, Medline, Psychlit, Science Citation Index, System for Information on Grey Literature in Europe, DHSS-Data, Faculty of Public Health Medicine Database of Dissertations, Index of Scientific and Technical Proceedings, Dissertation Abstracts, Index of Theses, NHS Research Register, Public Health Information Sharing Database. A limited amount of handsearching was undertaken. Reference lists were scanned to identify other relevant studies, and requests for unpublished data were made to people working in the field. DATA EXTRACTION: Data was extracted by the first author and then checked by the second. DATA SYNTHESIS: Quantitative analysis was undertaken where possible. Qualitative analysis was performed where studies were too heterogeneous for the data to be combined, or for research questions that were not suitable for quantitative synthesis. RESEARCH FINDINGS: The electronic search yielded over 5000 references, and over 500 abstracts were downloaded from the databases for further scrutiny. A total of 85 studies were included in the main analysis. PREVALENCE: No studies were found with the primary aim of establishing the prevalence of visual defects in preschool children. Data from studies of screening programmes report a range of yields for all the target conditions combined of 2.4-6.1%. NATURAL HISTORY: No studies designed with the intention of documenting the natural history of the target conditions in children aged 3 or 4 years were found. Other studies that provide some natural history data suggest that mild degrees of amblyopia may resolve spontaneously. In the absence of information about natural history it is impossible to estimate the effect of treatment from studies without a control group that was not treated. DISABILITY: A total of 21 studies exploring disability in relation to the target conditions were included. The literature provides a reasonable basis for generating plausible hypotheses about the ways in which the target conditions might disable people, but is insufficient to draw any firm conclusions about their impact on quality of life. The research to date is not sufficient to determine appropriate outcomes for controlled trials of treatment. TREATMENT: Five randomised controlled trials of treatment and six prospective controlleld trials without randomisation were found. No studies compared treatment with no treatment. Most of the studies were methodologically flawed.(ABSTRACT TRUNCATED)
The progress of 108 children who were identified by the vision screening programme in school as having defective vision (excluding those with puberty onset myopia) was reviewed. Treatment of these children resulted in improvement in visual acuity of the worst eye (two lines or better) for 16 children. Eighteen children had severe amblyopia (6/24 or worse). Among these the vision of only five was improved by treatment. Two thirds of the children had refractive errors in the better eye which required correction. It seems sensible to identify and treat children with bilateral refractive errors, but the need to treat children with lesser degrees of amblyopia is questioned.
Three- and 4-year-old children who obtain the minimum failing visual acuity result of one-line difference between eyes in preschool vision screening with isolated optotypes have a high rate of overreferral. We evaluated the Random Dot E Stereotest (RDES) to determine if a passing result at a high threshold on this test, as administered by lay screeners, could safely nullify referral for a minimum failing visual acuity test result. Fifty-eight children with a "one-line difference" result also had the RDES administered to them during screening at distances of 40 cm and 1.5 m. Upon subsequent ophthalmologic examination, 45 of these children were found to be normal, and 13 had abnormal findings. Thirty-nine of the children with normal examinations had correctly passed the RDES at 1.5 m. Seven of the 13 children with abnormal findings had correctly failed the RDES. Thus, the specificity of stereotesting was 87% and the sensitivity was 54%. Among the six children who falsely passed the stereopsis test during screening, best-corrected visual acuity was no worse than 20/40 and no child had greater than a one-line difference in acuity. Therefore, no amblyopia was missed. If a passing result on the stereotest at 1.5 m had been allowed to nullify a one-line difference referral, overreferral would have decreased 87% but underreferral would have increased 46%. We cannot yet recommend modifying current visual acuity referral criteria based on stereopsis testing results until the sensitivity of stereopsis screening by lay screeners at a sufficient threshold is improved.
This study is a sequel to an earlier report on a random vision screening of 651 prekindergarteners and compares the findings of the 35 children who failed this screening with the results and dispositions after retesting. Of the number failed, 32 (91.4%) were accounted for, of whom 28 (80%) were retested and 14 (40%) received no treatment; the other 4 (11.4%) were not retested. A discourse on probable discrepancies between screening and retesting results follows, along with corrective recommendations.
In Kuopio, Finland, vision screening for school children is done by school nurses once every 2 years. All children who have impaired vision, suspected strabismus or heterophoria, suspected eye disease or ocular discomfort, are sent for an eye examination to the ophthalmologist at the Community Health Centre, Kuopio. In 1977 the number of children referred for eye examination was 741 and 1134 in 1984. One hundred consecutive eye examinations were analysed both in 1977 and 1984. There were more girls than boys in both materials: 63 girls and 37 boys in 1977 and 60 girls and 40 boys in 1984. This difference between girls and boys was statistically highly significant in 1977 and significant in 1984. There was no significant difference in age distribution in 1977 and 1984. The largest age group was the 13-year-olds; in 1977 there were 13 and in 1984 22 children in this age group. In 1977, impaired vision (34 children) and in 1984 check-up on glasses (56 children) were the most common reasons for examination. The most usual finding in both years was myopic refraction; 52 cases in 1977 and 58 cases in 1984. It is noteworthy that in 1977 there were 16 children with normal eye examination but in 1984 there were only 6. This difference is almost significant. The cooperation between the ophthalmologist and the school nurses may account for this change.
This paper summarises the findings of a systematic review of research on preschool vision screening. The review concludes that the provision of such screening programmes should be reconsidered, if not abandoned.
We have reviewed the results of a pilot study of preschool screening by orthoptists for vision defects which was introduced in Newcastle in 1987. We have compared the visual outcomes, at age 7 years, of children who were screened at age 3 years by either orthoptists, health visitors or general practitioners in three matched, geographically defined cohorts. Manifest, large angle strabismus presented at the same age, and in roughly equal numbers in each cohort. Orthoptic screening detected many more cases of amblyopia associated with microtropia and anisometropia, but the b overall amblyopia prevalence at age 7 years was similar in each cohort. This study does not provide evidence to support the nationwide introduction of primary orthoptic preschool vision screening, and highlights the need for a prospective treatment trial of amblyopia associated with microtropia and anisometropia.
In August 1989, the Tokyo Metropolitan Government officially began a vision screening program for children aged 3 years 1 month. A 1988 pilot study of 1,303 children this age disclosed five cases (0.38%) of amblyopia. The home vision test, which uses picture cards of familiar figures, proved to be an efficient and inexpensive method of screening when incorporated into the existing health-check program for 3-year-old children. In the initial eight months of the program, 21,906 children were screened. Of these, 419 children (1.9%) were referred to an ophthalmologist for follow-up, and amblyopia was detected in 41 children (0.19%).
The validity of vision screening of children for amblyopia, squint and significant degrees of ametropia is reviewed. The suitability of the tests used in screening, the age at which they are applied and the personnel involved is assessed. Some suggestions for improvement are made with particular reference to the optometrist's role, especially in view of the proposed child health surveillance scheme to be undertaken by selected general medical practitioners.
OBJECTIVE: To see if there were differences in referral rates and abnormalities detected from two areas that were operating different preschool vision screening programmes. DESIGN: Cohort study using case notes of referrals. SETTING: Community based secondary referral centres in the county of Avon. PATIENTS: 263 referrals from a child population of 7105 in Southmead district, an area that used orthoptists as primary vision screeners; 111 referrals from a child population of 2977 in Weston-super-Mare, an area that used clinical medical officers for screening. MAIN OUTCOME MEASURES: Amblyopia and squint detection rates, together with false positive referral rates. RESULTS: The amblyopia detection rate in Southmead district was significantly higher than in Weston-super-Mare (11/1000 children v 5/1000), as was the detection rate of squint (11/1000 v 3/1000). However, the false positive referral rate from Southmead was significantly lower than that from Weston-super-Mare (9/1000 v 23/1000). CONCLUSION: Preschool vision screening using orthoptists as primary screeners offers a more effective method of detecting visual abnormalities than using clinical medical officers.
This article discusses the importance of providing vision screening services to students who are difficult-to-test and describes strategies for providing such services. Included in the discussion is an overview of various instruments that may be used to assess visual acuity. One of the instruments, the Parsons Visual Acuity Test, is described in detail as a tool for assessing visual acuity of the difficult-to-test. In addition, a discussion is presented which emphasizes the importance of providing follow-up services to those children who are referred for professional eye examinations. The authors delineate the vital role of the school nurse in assisting the difficult-to-test students to gain necessary vision care services through screening, referral, obtaining appropriate treatment and providing follow-up services.
We present the methodology of a population-based Randomised Controlled Trial, comparing an intensive programme of primary preschool vision screening by orthoptists with the usual non-specialist screening. The aims of the trial are to compare the effectiveness and costs of intensive orthoptic screening with non-specialist measures. The orthoptic screening programme will be evaluated both as a composite package and in terms of the screening value of the individual tests at specific ages. This trial is nested within a large population-based longitudinal study. Additional demographic and developmental data on the children in the trial are therefore available. The results of the trial will be used to help clarify which methods of preschool ophthalmic population screening are best in terms of disease detection and cost efficiency.
The Davidson and Hemmendinger (DH) color rule was evaluated for color vision screening of normal and congenital color-defective subjects. Ninety-eight normal and 14 color-defective subjects were tested on the color rule under Macbeth illumination of 5,400 K. The color-defective subjects were also tested on the Nagel anomaloscope, the Farnsworth D-15, and the H-R-R pseudoisochromatic plates. The DH color rule performed as accurately as the anomaloscope and was superior to the other two tests in detecting anomalous trichromats and in discriminating protanomalous subjects. The color rule also discriminated dichromats from anomalous trichromats. For severe color-defective subjects (dichromats, achromats), the color rule was more time-consuming than the other tests and discrimination was less certain. Response patterns on the DH color rule and response variability of the different classifications are reported.
This report describes the results of vision screening carried out by local health authorities on a national sample of 11-year-old schoolchildren using a standard Snellen chart. Of the 12 772 children tested, 78% had an unaided distant visual acuity of 6/6 or better in both eyes (optimal vision), 10% had a distant visual acuity of 6/9 in the worse or both eyes (near-optimal vision) and 12% had a visual acuity of 6/12 or worse in one or both eyes eyes (definite visual defect). In addition, near visual acuity was tested for 12 737 children and 5% were found to have defective near vision. Glasses had been prescribed for current use in 12% of children but a quarter of those prescribed glasses did not have them available at the time of the test. Testing revealed that 22% of children whose glasses were available had optimal or near-optimal unaided distant vision, the number increasing to 98% when retested wearing glasses. In contrast, 43% of the children who were without their glasses had optimal or near-optimal vision; 27% had a bilateral defect. Amongst the children for whom glasses had not been prescribed 4-6% had a visual defect. A higher proportion of children from non-manual family background than from manual family background had visual impairment and had been prescribed glasses, but there was no significant social class difference amongst the children with visual defects for whom no glasses had been prescribed. A defect of red/green colour vision was recorded in 6% of boys and 1% of girls. The proportion of children with poor visual acuity was similar in the group of children with defective colour vision and the group with normal colour vision.
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We examined 513 children (258 boys and 255 girls), between 3 and 11 years of age, with three pseudoisochromatic tests which involve different visual tasks. These were a selection of numeral designs from the Ishihara test, the Ishihara test for Unlettered Persons and the Velhagen Pfügertrident test. Eighteen children were found to be colour deficient. The symbol designs of the Unlettered Persons test were found to be the quickest and most effective method for examining children under 7 years of age. After 7 years of age the symbol designs of the Unlettered test and the numeral designs of Ishihara test were equally effective. The preferred numeral designs for screening children with the Ishihara plates are listed. Verbal identification always produced the most accurate results. Drawing over the figures or selecting replicas increased the viewing time and assisted children with normal colour vision to see both figures in transformation designs, especially pathway designs. The Velhagen Pfügertrident test was found to be unreliable for colour vision screening and younger children had difficulty performing the figure matching task.