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PubMedDate not supplied

Corneal sensitivity 10 years after epikeratoplasty.

PURPOSE: To assess corneal sensitivity in patients 10 or more years after epikeratoplasty for myopia, aphakia, hyperopia, and keratoconus. METHODS: A total of 45 eyes of 33 patients (age range at examination 33 to 55 yr) were included in the study. Corneal sensitivity thresholds using an electromagnetic aesthesiometer (Draeger) were measured at various locations on the lenticule and the recipient cornea. Measurements were evaluated regarding the corrective purpose, surgical technique, age, and gender of the patients and the area of measurements. RESULTS: The mean corneal sensitivity threshold in the center of the epikeratoplasty lenticule was significantly lower than on the peripheral recipient cornea (320.0 +/- 365.1 x 10(-5) N versus 0.1 +/- 0.5 x 10(-5) N). Corneal sensitivity at the 3 and 9 o'clock positions was significantly higher compared to the values at the 6 and 12 o'clock positions on the lenticule. No correlations of these values with age, gender, type, and primary indications for the surgery were observed. CONCLUSIONS: These results indicate a relative hypesthesia of the epikeratoplasty lenticule as compared to the peripheral host cornea, even 10 years after surgery. In our patients no clinically significant changes were observed that could be attributed to the reduced sensitivity over this follow-up period.

Adult↗
PubMedDate not supplied

First clinical results with the femtosecond neodynium-glass laser in refractive surgery.

PURPOSE: We evaluated four femtosecond laser intrastromal cutting procedures: creation of a corneal flap for laser in situ keratomileusis (LASIK), tunnel and entry cut for intracorneal ring, corneal flap and removable lens for keratomileusis, and intrastromal ablation for myopia and hyperopia. METHODS: A clinical trial using a femtosecond surgical laser (IntraLase Corporation) was performed in partially sighted eyes. Femto-LASIK treatment was performed on 46 eyes up to -14.00 D; 16 patients received intracorneal ring segments (Femto-ICRS); 5 patients each with one highly myopic eye had femtosecond laser keratomileusis (FLK), and 13 patients each with one myopic or hyperopic eye had intrastromal ablation (ISPRK). In Femto-LASIK, excimer laser ablation was done under the flap. In Femto-ICRS, ring segments were introduced into the laser-created channels. In femtosecond laser keratomileusis, a lens-shaped block of stroma was removed manually from under the flap. RESULTS: No difference was found between the results obtained with Femto-LASIK and a standard microkeratome. No refractive effects occurred when the created flap was not elevated. In cases of Femto-ICRS and conventional ICRS produced the same refractive results. With Femto-ICRS, no intraoperative complications occurred and visual acuity improved immediately after surgery. In femtosecond laser keratomileusis, high myopia was corrected without using excimer laser ablation; centralization of the treatment area was excellent. In intrastromal ablation, 1 to 2 hours after surgery the corneas were highly transparent; refractive results were stable. CONCLUSIONS: Femtosecond lasers can produce precise intrastromal cutting, offering significant safety and other advantages (no razor blades, corneal trauma, partial resections, or sterilization issues) over current techniques.

Adult↗
PubMedDate not supplied

Precision of flap measurements for laser in situ keratomileusis in 4428 eyes.

PURPOSE: To determine the factor(s) that influence the dimensions and predictability of the LASIK corneal flap with the Automated Corneal Shaper (ACS) or the Summit Krumeich Barraquer microkeratome (SKBM). METHODS: We performed a retrospective, comparative interventional case study of 4,428 eyes. Flap dimensions were measured using subtraction ultrasonic pachymetry during LASIK with one of two microkeratomes. RESULTS: Mean preoperative corneal thickness for all eyes was 555 +/- 35 microm. Corneal curvature and refractive astigmatism were inversely related to preoperative corneal thickness (P<.001). With an attempted flap thickness of 160 microm, the ACS flap thickness averaged 119.8 +/- 22.9 microm; SKBM flaps averaged 160.9 +/- 24.1 microm (P<.001). The coefficient of variation for central pachymetry compared to flap thickness was 6.4% vs. 22.1%. Flap thickness at enhancement was 10 to 17 microm thicker than at primary surgery. An increase in flap thickness was associated with thicker preoperative pachymetry (P<.001) and younger age for both instruments (P<.001) whereas increasing flap thickness was related to flatter preoperative mean keratometry for the ACS (P<.001) and steeper mean keratometry for the SKBM (P=.005). Less preoperative hyperopia or more myopia was related to an increase in flap thickness only for the SKBM (P<.001). CONCLUSIONS: Flap thickness varies significantly depending on the microkeratome used. Factors that influence flap thickness are primarily corneal thickness, patient age, preoperative keratometry, preoperative refraction including astigmatism, and corneal diameter. By understanding the factors that affect flap thickness, one can select a microkeratome system to allow maximum refractive correction while minimizing the risk of ectasia.

Adolescent↗
PubMedDate not supplied

Efficacy of phototherapeutic keratectomy in various superficial corneal pathologies.

PURPOSE: To study the use of phototherapeutic keratectomy in the treatment of various corneal pathologies. METHODS: We performed a nonrandomized consecutive study of patients who presented with superficial corneal diseases and poor vision. After slit-lamp microscopy, 31 eyes were included: corneal dystrophies, 20 eyes; pterygium, 1 eye; recurrent erosions, 3 eyes; superficial corneal opacities, 6 eyes; band-shaped keratopathy, 1 eye. All patients were treated with the Nidek EC-5000 excimer laser following manual epithelial debridement. A central 6.0 to 7.5-mm zone was treated with a surrounding 1-mm blend zone. Ablation zone diameter was determined by surgeon preference, presence of pannus, and overall corneal diameter. Follow-up ranged from 6 to 24 months, with a mean of 1 year. RESULTS: Epithelial healing occurred between 3 and 8 days in most eyes. Patients were followed for a minimum of 1 year. More than 50% of patients gained more than 2 Snellen lines; 12% for whom PTK was done for recurrent corneal erosions were symptomatically better. No eye was retreated. One patient with band keratopathy did not improve. Delayed epithelial healing occurred in three eyes. A trace to mild reticular subepithelial stromal haze was present in most eyes. Most patients showed a tendency to shift toward hyperopia. CONCLUSION: Phototherapeutic keratectomy may facilitate better visual acuity and reduced photophobia in eyes with various corneal pathology. Proper case selection is crucial.

Corneal Diseases↗
PubMedDate not supplied

US trends in refractive surgery: 2002 ISRS survey.

PURPOSE: To determine the latest trends in refractive surgery in the United States. METHODS: The full U.S. membership of the International Society of Refractive Surgery (ISRS) (approximately 900 members) was mailed the 2002 refractive surgery survey dealing with volumes, types, preferences of refractive surgery performed, and use of emerging technology. RESULTS: Questions regarding RK, AK, PRK, LASIK, LASEK, intracorneal ring segments (ICRS), laser thermal keratoplasty (LTK), conductive keratoplasty (CK), phakic intraocular lenses (PIOL), and clear lens extractions (CLE) were examined in the survey. Procedure preference for low, moderate, and high myopia, and hyperopia, were compared with the results from the surveys of the previous 5 years. Preference for unilateral versus bilateral same-day surgery, laser type, and microkeratome choice were also compared with the survey data from previous years. Incidence and frequency of co-management of refractive surgery patients were compared with 1999-2001 data. New questions regarding pupil measurement/documentation, wavefront aberrometry, and custom ablations were incorporated into the 2002 survey. CONCLUSIONS: As refractive surgery grows in the mainstream of ophthalmology, trends and changes in the United States continue to be elucidated by this professional organization survey. LASIK continues to dominate for refractive errors between -10.00 to +3.00 D. LASIK, LASEK, CLE, PIOL, and CK appear to have bright futures, whereas, RK, ICR, and LTK are on the decline. VISX continues to be utilized 2:1 over all other lasers combined, and instrumentation pupillometry is preferred 2:1 over pupil gauge cards. Currently, wavefront aberrometry and custom ablations are minimally employed but appear poised to be the wave of the future.

Adult↗
PubMedDate not supplied

Reasons for not performing LASIK in refractive surgery candidates.

PURPOSE: To analyze the reasons for which LASIK was rejected in eyes of patients who requested surgical correction of their refractive errors. METHODS: A retrospective study was performed in which data pertaining to refractive and ocular status of 338 patients who presented for refractive surgery at our LASIK facility between November 2002 and December 2003 were reviewed. The reasons for not performing LASIK in cases that were rejected were also noted. RESULTS: Among the 338 patients who requested refractive surgery, 223 (66%) underwent LASIK; surgery was not performed in 115 (34%) patients. The most common reason for rejecting LASIK was suboptimal central corneal thickness (55.1%). High myopia > -12.00 diopters (18.4%), keratoconus (9.6%), and hyperopia (5.9%) were other significant reasons. CONCLUSIONS: Suboptimal corneal thickness combined with a high amount of refractive error was found to be the leading cause of rejection of patients for LASIK in India.

Adolescent↗
PubMed2006

Wavefront-guided enhancements using the wavelight excimer laser in symptomatic eyes previously treated with LASIK.

PURPOSE: To describe our clinical experience in wavefront-guided LASIK enhancements using the WaveLight ALLEGRETTO system (WaveLight Technologie AG, Erlangen, Germany) for symptomatic eyes previously treated with standard LASIK. METHODS: Twenty-six eyes of 20 patients with residual myopia, hyperopia, or mixed astigmatism and/or night vision symptoms after primary standard LASIK were considered for wavefront-guided customized retreatment using the WaveLight ALLEGRETTO WAVE 200 Hz excimer laser system (model 106). Preoperative best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity, topography with the ALLEGRETTO Topolyzer, wavefront analysis using the ALLEGRETTO WAVE Tscherning Analyzer, and contrast sensitivity were compared to postoperative (enhancement) measurements. RESULTS: Twenty-two of the original 26 eyes underwent wavefront-guided enhancement, 4 were excluded because they did not meet wavefront-guided treatment inclusion guidelines of this study. Mean follow-up was 8 months (range: 6 to 13 months, standard deviation [SD] 2). All patients were within +/- 0.50 diopters (manifest refraction) of intended postoperative refraction. The mean preoperative BSCVA improved from 20/25 (SD +/- 0.12) to 20/18 (SD +/- 0.1) postoperatively. All patients gained at least one line of BSCVA, and a maximum of three lines. There was no loss of BSCVA in any patient. The total amount of high order aberrations (RMSH) decreased from an average of 1.04 (SD +/- 0.22) to 0.46 (SD +/- 0.14) microm. Patients also had a mean improvement in low contrast sensitivity of 59%. CONCLUSIONS: Based on this small series, customized wavefront-guided enhancements using the WaveLight ALLEGRETTO system in patients who underwent previous LASIK appear to be safe and effective in correcting residual refractive error, reducing high order aberrations, and improving visual symptoms when reliable and reproducible measurements are achieved.

Cornea↗
PubMed2006

Correction of presbyopia by technovision central multifocal LASIK (presbyLASIK).

PURPOSE: To investigate central multifocal presbyLASIK based on the creation of a central hyperpositive area. METHODS: Twenty-five patients (50 eyes) underwent presbyLASlK in an open-label, prospective, non-comparative pilot study. Mean patient age was 58 years (range: 51 to 68 years), mean preoperative spherical equivalent refraction was +1.6 +/- 0.63 diopters (D) (range: +0.50 to +3.00 D), and mean spectacle near addition was +2.27 +/- 0.37 D (range: +1.75 to +3.00 D). The ablation pattern was performed with proprietary software from Technovision using an H. Eye Tech. excimer laser platform. RESULTS: Mean postoperative spherical equivalent refraction was -0.37 +/- 0.55 D (range: -1.50 to + 1.00 D) and mean spectacle near addition was +1.72 +/- 0.34 D (range: +1.25 to +2.25 D). After 6 months, 16 (64%) patients achieved a distance uncorrected visual acuity (UCVA) of > or = 20/20 and 18 (72%) patients achieved a near UCVA of > or = 20/40. Seven (28%) patients lost a maximum of 2 lines of best spectacle-corrected visual acuity (BSCVA). The safety index for distance was 0.98 binocular and for near was 0.99 binocular. After 6 months, no significant change was noted in contrast sensitivity at 1.5 cycles/degree. A significant mean reduction was found at spatial frequencies of 3, 6, 12, and 18 cycles/degree (P<.001). There was a significant change in corneal aberrations after surgery. The coefficients for coma increased and the coefficients for spherical aberrations decreased. A significant decrease was noted in point spread function values (P=.0018). CONCLUSIONS: Central presbyLASIK may be used to provide improvement in functional near vision in patients with presbyopia associated with low and moderate hyperopia. However, factors involved in the loss of BSCVA in some cases and loss in vision quality should be further clarified prior to its general use.

Adult↗
PubMed2006

Customized LASIK treatment for myopia: relationship between preoperative higher order aberrations and refractive outcome.

PURPOSE: To analyze the effect of preoperative higher order aberrations on postoperative sphere and cylinder outcome. METHODS: Three hundred thirty myopic eyes (mean: -3.32 +/- 1.54 diopters [D], range: -1.0 to -7.0 D) treated with customized ablation using the Technolas 217z laser (Bausch & Lomb) were followed through 6 months after LASIK. Pre- and postoperative visual acuity, higher order root mean square (RMS), third order RMS, and spherical aberration were compared to study the safety and efficacy of the treatment. The relationship between preoperative higher order aberrations and manifest refraction after LASIK was analyzed. RESULTS: Following LASIK, 91.5% of eyes obtained an uncorrected visual acuity of > or = 20/20 and 70.3% of eyes obtained 20/16 without retreatment; 99% had a best spectacle-corrected visual acuity of > or = 20/20 (75.9% of eyes were within +/- 0.50 D). Mean value of significant increase in postoperative higher order aberrations was 0.12 +/- 0.18 microm (P<.0001). Increased spherical aberration was associated with increased myopia treatment (P<.0001). Greater positive spherical aberration after LASIK was significantly correlated to postoperative hyperopia (overcorrection). Change in third order RMS was significantly correlated to change in spherical equivalent refraction among eyes with postoperative astigmatism (P<.0001). CONCLUSIONS: With the Bausch & Lomb Technolas 217z Zyoptix software, treatment of higher order aberrations, especially third order (coma and trefoil) and spherical aberration, significantly improved postoperative refractive status.

Adult↗
PubMed1994

Neuro-ophthalmic aspects of vascular disease.

One of the most susceptible sites to vascular diseases is the optic nerve head. By innovative approaches using morphometry and in situ hybridization, vascular and extracellular characteristics of the human optic nerve head were examined. Nonarteritic ischemic optic neuropathy occurs due to vascular insufficiency within the optic nerve head. Various local and systemic risk factors have been proposed among which smoking and acute hypotension are now included. Anatomically abnormal discs such as the small optic disc, tilted disc, and optic nerve drusen are recognized as "disks at risk" and hyperopia may be an additional predisposing factor. Ocular, neurological, and vascular disorders due to giant cell arteritis were reviewed. Intravenous high-dose methylprednine should be administered in certain cases. Differentiating nonarteritic from arteritic ischemic optic neuropathy is sometimes difficult. Isolated choroidal ischemia or choroidal filling delay may be an indication of giant cell arteritis. Studies have been conducted on the vascular event, amaurosis fugax (transient monocular visual loss), and the results of some of these studies are discussed.

Blindness↗
PubMed1976

Culture and the development of vision.

Given Chinese ethnographic data, a model of a style of visual performance was predicted. The prediction was that the style would be "inwardizing". Inwardizing was related to individual styles of social behavior as observed in optometric offices. A complete 21-point optometric examination was performed on Chinese subjects and the results were compared to a control group of American subjects. Throughout the optometric examination the Chinese subjects displayed the predicted pattern of inwardizing visual performance. That physiologically measurable patterns of visual performance could be predicted on the basis of ethnographic data gives experimental support to the anthropological assumption of reciprocity between biology and culture. The discovery of a culturally determined pattern of visual performance beyond the work already done with various isolated refractive conditions and the observed relationship of this to patterns of social behavior pose interesting tasks for anthropology, optometry and other professions. First, there is need for further investigation of 1) the role of culture in determining visual performance and 2) the relationship of visual performance patterns to social behavior, beyond that which has already been done, for example, with myopia and hyperopia. Then there is need to incorporate these new areas of knowledge into all fields dealing with human behavior.

Adult↗
PubMed1999

Ocular predictors of the onset of juvenile myopia.

PURPOSE: The purpose of this study was to identify reliable predictors of the onset of juvenile myopia. METHODS: The data from 554 children enrolled in the Orinda Longitudinal Study of Myopia (OLSM) as nonmyopes with baseline data from the third grade were evaluated to develop a predictive profile for later onset of juvenile myopia. Myopia was defined as at least -0.75 D of myopia in the vertical and horizontal meridians of the right eye as measured by cycloplegic autorefraction (n = 45 children). Chosen predictors were refractive error and the ocular components: corneal power, Gullstrand crystalline lens power, and axial length. Sensitivity and specificity were calculated. Receiver operating characteristic (ROC) curves were generated to evaluate and compare these predictors singly and combined. RESULTS: Refractive error, axial length, Gullstrand lens and pod corneal power were all significant predictive factors for the onset of juvenile myopia. The best single predictor of future myopia onset in the right eye was the right eye's cycloplegic autorefraction spherical refractive error value (mean sphere across 10 readings) at baseline. For a cut point of less than +0.75 D hyperopia in the third grade, sensitivity was 86.7% and specificity was 73.3%. The area under the ROC curve for this mean sphere was 0.880. Producing a logistic model combining mean sphere, corneal power, Gullstrand lens power, and axial length results in a slight improvement in predictive ability (area under the ROC curve = 0.893). CONCLUSIONS: Onset of juvenile myopia can be predicted with moderate accuracy using the mean cycloplegic, spherical refractive error in the third grade. Measurement of other ocular components at this age improves predictive ability, albeit incrementally. Further improvements in the prediction of myopia onset will require the use of longitudinal data in addition to one-time measurement of refractive error and the ocular components.

Adolescent↗
PubMed1999

Refractive associations with cataract: the Blue Mountains Eye Study.

PURPOSE: To assess the relationship between myopia and age-related cataract in a defined older population. METHODS: A cross-sectional study of 3654 people aged 49 to 97 years was conducted in the Blue Mountains near Sydney, Australia, from 1992 through 1994. General medical, eye, and refractive history and information about confounders were collected by questionnaire. Participants had a detailed determination of refraction, and the spherical equivalent refraction of each eye was calculated. The Wisconsin Cataract Grading System was used in masked grading of slit lamp and retroillumination lens photographs, to assess presence and severity of nuclear, cortical, and posterior subcapsular (PSC) cataract. Data from both eyes were analyzed by the generalized estimating equation method, adjusting for cataract risk factors. RESULTS: Included in the analysis were 7308 eyes. A history of wearing distance glasses, excluding eyes with current hyperopic refraction, was used as a proxy for myopia. Subjects who had worn distance glasses were more likely to have nuclear cataract (odds ratio [OR] 1.3; confidence interval [CI] 1.0-2.1). After stratification by age at first wearing distance glasses, this relationship remained only for people who first wore distance glasses after age 40 years (OR 1.3; CI 1.0-1.8), which suggested a myopic refractive shift from developing nuclear opacity and was supported by the weak association found between current myopic refraction and nuclear cataract (OR 1.3; CI 1.0-1.6). Eyes with onset of myopia before age 20 years had the greatest PSC cataract risk (OR 3.9; CI 2.0-7.9). This was supported by the finding of an association between current myopic refraction and PSC cataract (OR 2.5; CI 1.6-4.1). PSC cataract was inversely associated with hyperopia (OR 0.6; CI 0.4-0.9). Refraction-related increasing odds were found between PSC cataract and myopia: low myopia (OR 2.1; CI 1.4-3.5), moderate myopia (OR 3.1; CI 1.6-5.7), and high myopia (OR 5.5; CI 2.8-10.9). High myopia was associated with PSC, cortical, and late nuclear cataract. CONCLUSIONS: Early-onset myopia (before age 20 years) may be a strong and independent risk factor for PSC cataract. The findings suggest the possibility of a dose response between levels of myopia and PSC cataract. Nuclear cataract was associated with presumed acquired myopia, whereas high myopia was associated with all three types of cataract.

Age Factors↗
PubMed2000

[Pigmentosum retinis and tubulo-interstitial nephronophtisis in Sensenbrenner syndrome: a case report].

PURPOSE: Sensenbrenner syndrome or cranio-ectodermal dysplasia is an extremely rare autosomal recessive condition (12 cases reported in literature). Our observation shows the possibility of both ocular and renal involvement associated with cranio-ectodermal abnormalities. PATIENTS: and method:We report the case of a girl who presented a typical cranio-ectodermal syndrome with dolicocephaly, short thorax, short limbs, short fingers and teeth abnormalities. At five years, she was found to have pigmentosum retinitis with amblyopy and moderate hyperopia. A chronic renal failure with uncontrollable hypertension underwent a cadaveric-donor transplantation at the age of six years. RESULTS: Two years later, the pigmentosum retinitis was stable. The kidney histology revealed a tubulo-interstitial nephronophtisis. The molecular analysis of the NPH 1 locus, which was associated with nephronophtisis, was negative. DISCUSSION: Our observation and two recent publications have in common ocular and renal abnormalities associated with cranio-ectodermal dysplasia. The underlying genetic defect would involve not only morphogenesis but also development and maturation of organs as eye and kidney. Sensenbrenner syndrome would thus be similar to certain disorders affecting the eye, kidney, skeleton and ectodermal structures such as the EEM, Senior-Loken, Mainzer-Saldino, and Jeune syndromes. CONCLUSION: The retinal dystrophy falls within the spectrum of clinical and genetic forms of pigmentosum retinitis. Our observation would confirm possible links between Sensenbrenner syndrome and oculorenal syndromes.

Abnormalities, Multiple↗
PubMed2000

[Refractive power evolution following cataract surgery].

A retrospective study was carried out to evaluate and quantify the refractive power evolution following cataract procedure. Three different intraocular lenses were compared: Corneal ACR6D (acrylic), Kelios 600 (silicone), Storz HM60 (hydrogel). Visual acuity and post-operative refraction were compared at one week and after two months. The spherical equivalent change after those follow-ups shows the refractive evolution. Refraction is stable with time for the Storz and Kelios lenses. However, post-operative hyperopia was found for monobloc Corneal implant.

Acrylic Resins↗
PubMed2000

Excimer laser phototherapeutic keratectomy for corneal diseases.

The efficacy and safety of excimer laser phototherapeutic keratectomy (PTK) for treatment of various corneal pathologies were determined. The preoperative indications included lattice dystrophies (10 eyes), Reis-Bücklers dystrophies (4 eyes), macular dystrophies (2 eye), and corneal scarring secondary to trauma (1 eye). Mean follow-up time was 9.9 months (range 6-18 months). Uncorrected visual acuity postoperatively improved in 15 eyes (88.2%); not improved in 1 eye (5.9%) and decreased in 1 eye (5.9%). Corneal clarity improved in 14 of 17 eyes (82.4%) which corresponded to the improvement of uncorrected visual acuity. Ocular discomfort improved in 16 eyes (94.1%), decreased in 1 eye (5.9%) which subsequently developed double vision. The complications included delayed reepithelialization (> 7 days) in 6 eyes (35.3%) and corneal scarring 1 eye (5.9%). Sixty four per cent had increased significant hyperopia (> 4 D) and 7.1 per cent had significant induced astigmatism (> 2 D). One eye (5.9%) needed retreatment due to remaining corneal opacity. One eye (5.9%) had double vision due to irregular astigmatism. Excimer laser PTK is effective and safe for treatment of various corneal pathologies. It thus appears to be an alternative to penetrating keratoplasty in some patients.

Adolescent↗
PubMed1999

[The therapeutic aspects in intermittent divergent strabismus].

PURPOSE: Is to evaluate the possibilities of treatment in intermittent divergent squint at children and young adults. MATERIALS AND METHOD: We studied an group of 66 patients treated in the University Clinic of Ophthalmology from Cluj-Napoca. RESULTS: The most frequent type of intermiTtent divergent squint (IDS) is the type of excess of divergency (25.76%). In 46.9% the onset was between 2-6 years. In 69.7% visual acuities were equal and stereopsis was present in 74.24%. Hyperopia +/- astigmatism was present in 69.7%. The treatment of intermittent exodeviation was conservative in 51.5% and surgical for first intention in 39.3%. CONCLUSIONS: 1. The most frequent type of intermittent exodeviation is by excess of divergency. 2. The treatment of exodeviation is an optical, orthoptic and surgical treatment. 3. The surgical technique depends on the type of intermittent exodeviation.

Adolescent↗
PubMed2000

Vision screening survey of all children starting primary school in 1998 in the Federal State of Saarland, Germany.

BACKGROUND: The excellent co-operation with the pediatric public health service of the local health authorities enables us to present the collected results of a vision screening survey of all children starting primary school in 1998 in the Federal State of Saarland. The aim is to analyze the prevalence of amblyopia, strabismus, reduced visual acuity, refractive errors and severe visual impairment in one complete grade of pre-schoolers. METHODS: The examination parameters had been determined in co-operation with the Department of Pediatric Ophthalmology at the University of Saarland and had been fitted to the needs and abilities of lay persons (health workers) doing a vision screening as part of a general health check-up. Parameters were: visual acuity (Rodenstock R21), color vision (Ishihara), stereopsis (Lang), and test for latent hyperopia. Referral to an ophthalmologist if: visual acuity < 0.7; difference in visual acuity in both eyes of more than one line, or any other pathological test result. A total of 12,192 children were screened. RESULTS: The preventive pediatric examinations were complete in 5756 children (56.4%), incomplete in 4449 children (43. 6%) and in 1987 children (16.3%) the degree of completion could not be determined. Eyes: pathological findings in 41.7%. Reduced visual acuity in 30.8%, color vision defects in 1.3%, severe visual impairment in 0.3%. Pathological findings in other organ systems: skeleton 33.5%, teeth 32.6%. For the urban confederacy of Saarbrücken: referrals to ophthalmologists: n=1108. No feedback information: 380; refractive correction: 226; recommendation for regular checks: 346; no pathological findings: 156. CONCLUSION. The high percentage of pathological findings in the vision screening of 12,192 pre-schoolers is an important confirmation that there is a need for a preventive ophthalmologic examination before the age of six. Only an area-wide ophthalmologic vision screening around the second or third year of life can effectively reduce the high prevalence of pathological findings at the time of starting primary school. To improve the present screening situation, networks between ophthalmologists and pediatricians would be beneficial.

Child↗