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Efficiency of the Ishihara test for identifying red-green colour deficiency.

The Ishihara test is the most widely used screening test for red-green colour deficiency. Results obtained by 401 people with red-green colour deficiency show that the combined sensitivity of the Transformation and Vanishing plates of the 38 plate Edition of the Ishihara plates is 95.5% on eight errors, 97.5% on six errors and 99.0% on three errors. The Hidden digit designs only identified approximately 50% of colour-deficient subjects. The protan/deutan classification plates were found to be more effective for deutans than for protans. No classification was obtained for 18% of protanopes and 3% of deuteranopes who saw neither figure on classification plates; 40% of protanomalous trichromats and 37.5% of deuteranomalous trichromats saw both classification figures and were classified on the relative luminance (clarity) of these figures. The specificity of the Ishihara test was determined in a previous study (Birch and McKeever, 1993) and the results combined with the present data to obtain the overall efficiency of the Ishihara plates for a representative cross section of colour-deficient subjects.

Adult↗

Screening for glaucomatous visual field loss. The effect of patient reliability.

Eighty-eight glaucoma patients and 252 normal subjects underwent C-30-2 testing on the Humphrey Field Analyzer. The effect of fixation losses, high false-positive and false-negative response rates on visual field test results was assessed using the mirror image method of detecting asymmetry across the horizontal meridian, and the Humphrey STATPAC pattern standard deviation (PSD) and mean deviation (MD). Glaucoma patients with poor fixation (greater than or equal to 20%) had less depressed fields and fewer localized defects than those with good fixation. Fixation loss did not affect measures of localized defects or generalized depression among normal subjects. High false-positive rates (greater than or equal to 10%) were associated with less-depressed visual fields among glaucoma patients and normal subjects. Visual fields were depressed by an average of 9 dB for glaucoma patients and 7 dB for normal subjects with high false-negative rates (greater than or equal to 33%), when compared with those with low false-negative rates. Apparent localized defects were observed among normal subjects with high false-negative rates. Most of these defects were located in the superior nasal and adjacent arcuate area.

Fixation, Ocular↗

[Noise field screening. Results of a television field study for detection of visual field defects].

White noise field campimetry is able to transform usually negative scotomas immediately into perceivable visual field defects. As this method needs a monitor, the obvious solution was to evaluate the suitability of the noise field stimulus broadcasted to home TV sets. Therefore, in cooperation with the "Süddeutscher Rundfunk" (SDR) as well as several health insurance companies ("AOK Baden-Württemberg" and other "RVO-Kassen"), approximately 300,000 viewers were invited to take this test after receiving brief information and instruction. There were 531 calls for questionnaires to document the subjects' findings and the results of a subsequent ophthalmological examination. In most cases this clarified the perceived noise field defect. Out of 127 evaluable questionnaires, 78 cases did not show any relevant ophthalmological pathology; this held true especially for lesions of the visual pathway. However, in 49 persons the ophthalmologists detected pathological findings; in 20 of these, the scotomas were previously unknown to the physicians. Glaucomatous optic neuropathy and macular degeneration were most frequently diagnosed as causing the white noise field defects. Finally, some preliminary estimates of the costs and benefit of this study are presented.

Adolescent↗

Efficiency of a video-autorefractometer used as a screening device for amblyogenic factors.

BACKGROUND: High ametropia is known as a risk factor in developing amblyopia. The aim of the study was to evaluate the efficiency of a commercially available infrared videorefractometer (PowerRefractor) in examining children, and to evaluate its effectiveness in detecting amblyogenic factors of the refraction. The influence of cycloplegia was of interest. METHODS: A total of 255 eyes (-28.25 D to +7.88 D spherical equivalent) of 128 patients (1-81 years) were examined by cycloplegic retinoscopy. All of them were measured with the PowerRefractor under cycloplegia. Fifty-four of these patients (108 eyes) were additionally measured without cycloplegia. The technique of the device is based on the eccentric photorefraction method. Both eyes can be measured simultaneously from a distance of 1 m. A video-analysis of each eye is computed in three meridians. The subject can be observed in real time on a screen, and the refraction is immediately available. RESULTS: Measurement of refraction was possible at all ages. More effort was required with young children who could not cooperate well with the procedure of conventional table-top autorefractometers. The mean sensitivity in detection of any amblyogenic ametropia was 80% with and without cycloplegia. The specificity was 61% with cycloplegia and 84% without. The rate of false-negative results in the detection of anisometropia, hyperopia and astigmatism ranged from 10% to 24%. In particular, high astigmatism and hyperopia remained undiscovered. CONCLUSIONS: The reliability of the photorefractor which was the subject of the evaluation in detecting amblyogenic ametropia was comparable to that of other devices described previously in the literature. The method is suitable for use in children, but anisometropia, high astigmatic and hyperopic ametropia remained undiscovered in several cases. Commercial interest: none.

Adolescent↗

Model simulation of the patient flow through a screening centre for diabetic retinopathy.

PURPOSE: To construct a quantitative, flexible and simplified mathematical model of the patient flow through the Eye Clinic at the Steno Diabetes Centre (SDC) in order to enable rational dimensioning and assess the effects of modifications. METHODS: Patient data were drawn from the Eye Care database at the SDC. A simple patient flow model was constructed, allowing simultaneous adjustments of all variables, and the model was tested. Two scenarios were simulated: (1) adjusting the algorithm that assigns the follow-up intervals, and (2) increasing the population size to include all patients with diabetes in Copenhagen County. RESULTS: The model can describe the patient flow under steady state conditions, but is less precise in predicting transient changes with the present set-up. Accordingly all simulations were run for a substantial number of iterations. The two scenarios illustrate the usefulness of the model by calculating the required photographic examination capacity for the specific population, thereby allowing better estimations of future dimensioning of the organization. CONCLUSION: The study presents a patient flow model that can be used to illustrate the effects of proposed changes prior to their implementation, specifically with respect to the capacity of the system.

Algorithms↗

A small number of older type 2 diabetic patients end up visually impaired despite regular photographic screening and laser treatment for diabetic retinopathy.

PURPOSE: The present study describes the prevalence of visual impairment and blindness in a geographically defined population 8 years after the introduction of a screening programme in 1987 for early detection of sight-threatening diabetic retinopathy. METHODS: Of 374 patients with diabetes, comprising 2.6% of the population in the study community, 72% were examined with fundus photography or biomicroscopy during 1994-95. These patients form the basis of this study. The screening programme was fulfilled by 93% of subjects, all of whom underwent ophthalmic examinations at least every other year. A total of 79 eyes in 52 patients received photocoagulation for macular oedema alone or in combination with severe non-proliferative or proliferative retinopathy. RESULTS: Eight years after the implementation of the programme, only three patients, all with type 2 diabetes (diabetes diagnosed at or after 30 years of age), had visual acuity < or = 0.1. The total number of eyes with visual acuity < or = 0.5 was higher in insulin-treated type 2 diabetic patients (n = 20) than in those on oral treatment (n = 5) or diet treatment only (n = 1) (p = 0.006 in both cases). The only independent risk factor for visual impairment in eyes with sight-threatening retinopathy was age. CONCLUSION: A small number of older type 2 diabetic patients end up with visual impairment due to unsuccessful photocoagulation of macular oedema.

Adolescent↗

Structural and functional outcome in infants treated with cryotherapy for threshold retinopathy between 1989 and 1999.

PURPOSE: To assess visual outcome, funduscopic appearance, and refraction for infants treated with cryotherapy for threshold retinopathy of prematurity (ROP) between 1989 and 1999. METHODS: Retrospective analysis of the medical records of premature infants with threshold ROP who were treated with cryotherapy. RESULTS: A total of 2,146 premature infants were screened for ROP during the study period. Of the 66 infants who were subsequently treated for threshold ROP with cryotherapy, 58 infants had at least 1 year of follow-up and comprised the study population. After correcting for improved survival, the overall incidence of treated infants with cryotherapy increased during the study period. Comparison of infants treated from 1989 through 1995 (group 1; n=26) and 1996 through 1999 (group 2; n=32) showed group 2 infants had improved visual outcome, better funduscopic anatomic appearance, and decreased myopia. CONCLUSION: Although the incidence of treated premature infants increased during the study period, visual outcome improved. The literature attributes improved visual and anatomical outcome to the use of the diode laser in the treatment of threshold ROP. In this study, the improved visual and anatomical results obtained with cryotherapy could be attributed in part to the development over the years of a milder type of retinopathy of prematurity and to earlier treatment of threshold ROP.

Cryosurgery↗

Visual field constriction as a cause of blindness or visual impairment.

Reported are the results of a study of onchocerciasis in communities mesoendemic for savanna onchocerciasis in Kaduna State, northern Nigeria. The study involved 6831 individuals aged > or = 5 years who underwent an extensive screening examination for visual function including Friedmann field analysis. A total of 185 (2.7%) were bilaterally blind by acuity and an additional 28 (0.4%) were blind by visual field constriction. Also 118 (1.7%) individuals were visually impaired by acuity criteria. No criteria for visual impairment by field constriction have been established, and we therefore investigated three potential criteria. As a result, a further 60 (0.9%) individuals were identified with significant visual impairment due to field loss by the various definitions. Small islands of remaining peripheral field occurred in 50 individuals, while 40 individuals had marked reduction of binocular visual field below the horizontal meridian. Concentric visual field constriction to < 20 degrees was found in seven individuals. The WHO definition of blindness currently includes visual field damage criteria for blindness but not for visual impairment. Visual field loss is recognized as a major disability. We hope that these findings stimulate international discussion leading to the development of satisfactory definitions for visual impairment by visual field constriction.

Adolescent↗

Threshold Amsler grid as a screening tool for asymptomatic patients on hydroxychloroquine therapy.

BACKGROUND/AIMS: Patients taking hydroxychloroquine (HCQ) are at risk of developing classic bull's eye maculopathy. Currently, the standard Amsler grid (AG) is one of the most useful methods to identify such lesions. However, AG is a suprathreshold target and may not detect relative central scotomas. The aim of this study was to determine if the threshold Amsler grid (TAG) test, which varies light transmission through two cross polarising filters, allows increased detection of scotomas caused by HCQ toxicity. METHODS: 56 rheumatological patients taking HCQ and 12 similar patients not taking HCQ were tested by AG, red Amsler grid (RAG), and TAG. RESULTS: No scotomas were observed in patients never treated with HCQ. Among patients who had been treated with HCQ, AG revealed scotomas in two of 56 (3.64%) patients; in contrast, six (10.7%) and 37 (66.1%) scotomas were identified by RAG and TAG testing respectively. Additionally, the average area of each scotoma detected by all three methods expanded from 34.5 square degrees of central field loss on AG testing to 71 square degrees on RAG and 117 on TAG. CONCLUSION: By decreasing the perceived luminance of the suprathreshold AG, TAG testing provides a novel alternative to detect shallow scotomas and areas of depressed retinal activity secondary to HCQ toxicity.

Adult↗

Ocular profile among hearing impaired children.

OBJECTIVE: To report ocular abnormalities among identified hearing impaired children and their prevalence in relation to normal hearing children. METHODS: A sample of 302 identified children with bilateral sensorineural hearing loss at King Abdul-Aziz University Hospital and Rehabilitation Medical Center of the Ministry of Health, Riyadh, Kingdom of Saudi Arabia, after full audiological assessment, aged below 15 years, were screened ophthalmologically during the period from December 1997 to December 2002. Visual testing and cycloplegic refraction using 1% Cyclogyl was performed followed by retinal examination using direct and indirect ophthalmoscopy. Electroretinography was recorded for those with retinal pigmentary changes. One hundred control normal hearing children were examined, and chi square test applied. RESULTS: A total of 302 hearing impaired children were examined, 199 (66%) were boys and 103 (34%) were girls, age ranged between 2-15 years. Hearing loss was bilateral severe to profound. One hundred and eighty-four (61%) have one or more ocular abnormalities, while 147 (48.7%) had one or more significant error of refraction. In the control cases, 23% had error of refraction with a chi square test of 20.2 (p<0.001), which is significant. CONCLUSION: Ocular anomalies are more commonly found among deaf children than those with normal hearing. Early ophthalmological assessment of hearing impairment is advisable to detect any ocular anomalies, followed by correction to help in the academic performance of these children.

Adolescent↗

Evaluation of the high specificity Screening Program (C-20-1) of the Frequency Doubling Technology (FDT) perimeter in clinical practice.

AIMS: To compare the efficacy of the high specificity Frequency Doubling Technology (FDT) Perimeter Screening Program (C-20-1) to standard threshold automated perimetry in the diagnosis of open-angle glaucoma. METHODS: A total of 100 consecutively presenting patients attending a glaucoma clinic who volunteered for the study (approximately 30% of whom were attending for an initial visit) were examined with the FDT C-20-1 Screening Program and with the Humphrey Field Analyzer (HFA) SITA Fast algorithm and Program 24-2. RESULTS: Of the patients, 17 were excluded due to unreliable visual field results or non-glaucomatous ocular abnormalities. In all, 10 patients were diagnosed as normal, 54 with open-angle glaucoma, eight with ocular hypertension, and 11 as glaucoma suspects. Of the 54 glaucomatous patients, 45 exhibited high-tension glaucoma and nine normal tension glaucoma. Perimetry with the HFA gave a sensitivity of 81.5% for the combined category of glaucoma and glaucoma suspect and a specificity of 83.3% for the combined category of normal and ocular hypertension. Perimetry with the FDT gave a sensitivity of 74.5% and a specificity of 85.2% compared to that of the HFA. CONCLUSION: In the detection of glaucoma, Program C-20-1 of the FDT perimeter exhibits high specificity. It exhibits low sensitivity for the detection of mild loss but high sensitivity for advanced field loss relative to Program 24-2 and the SITA Fast algorithm of the HFA.

Aged↗

Screening performance of functional and structural measurements of neural damage in open-angle glaucoma: a case-control study from the Baltimore Eye Survey.

PURPOSE: To compare the sensitivity and specificity of four approaches to glaucoma screening. METHODS: Case patients were persons with possible, probable, or definite glaucomatous optic nerve damage, as judged by a glaucoma specialist using Humphrey 24-2 threshold findings and clinical assessment of disc and nerve fiber layer, identified in the population-based Baltimore Eye Survey Follow-up Study. Control patients were participants in the same study, frequency-matched for age, without evidence of glaucomatous optic nerve damage. Participants underwent optic disc photography (Topcon ImageNet), disc imaging (GlaucomaScope), scanning laser polarimetry (Nerve Fiber Analyzer), and suprathreshold field testing (Dicon). RESULTS: A total of 100 case patients with open-angle glaucoma and 149 control patients were included. Objective imaging had the best screening performance. For the GlaucomaScope, a criterion of cup-to-disc ratio of -0.68 had a sensitivity of 72% and specificity of 82% for detecting eyes with definite or probable glaucomatous optic nerve damage. For the nerve fiber layer, a criterion of The Number as > or = 20 had a sensitivity of 69% and specificity of 77% for detecting eyes with definite or probable glaucomatous optic nerve damage. Usable data could be obtained in 93% of participants with the Dicon and the Nerve Fiber Analyzer and in 82% and 87% of participants with the GlaucomaScope and Topcon instruments, respectively. CONCLUSIONS: Vertical cup-to-disc ratio, as measured by the GlaucomaScope or Topcon instruments, and the Nerve Fiber Layer neural network Number had the best combination of sensitivity and specificity among the instruments tested. The Nerve Fiber Analyzer had the highest percentage of participants with usable data.

Aged↗

Screening relatives of patients with familial chronic open angle glaucoma.

PURPOSE: To describe the value and the results of screening of family members of individuals with familial chronic open-angle glaucoma (COAG) for the disease. DESIGN: Cross-sectional study of families with COAG. PARTICIPANTS: Eighty-six individuals from 15 families with COAG. TESTING: Complete ophthalmologic examinations, automated perimetry, and optic nerve photography. MAIN OUTCOME MEASURES: Disease status as glaucoma patient (at least two of three parameters abnormal: intraocular pressure, visual field, or disc appearance), glaucoma suspect (one of three parameters abnormal), or normal. RESULTS: Twenty-six relatives were diagnosed with COAG. The diagnosis was most frequently made on the basis of intraocular pressure readings and automated perimetry. Twenty-three relatives were classified as glaucoma suspects; automated perimetry was the most useful modality for the detection of abnormalities in these individuals. Siblings of COAG patients had the highest risk of COAG developing (64.7%) compared with children (13.2%) or other blood relatives (22.2%). CONCLUSIONS: When COAG is present in more than one family member, immediate and other relatives should be evaluated for glaucoma by means of clinical examination and automated perimetry.

Adult↗

Retinopathy screening in type 2 diabetes: reliability of wide angle fundus photography.

The purpose of the study was to assess the reliability of mydriatic 60 degrees fundus photography in a retinopathy screening programme for Type 2 diabetic patients in a primary health care setting. In 323 eligible consecutive Type 2 diabetic patients above 40 years of age, attending a regional shared care diabetes project, mydriatic wide angle fundus photography was compared with standardized fundoscopy in dilated pupils as the recommended test for the detection of diabetic retinopathy. Fundus photography included two black and white transparencies per eye visualizing the central and nasal retinal field. Fundoscopy findings and pictures were scored according to modified Wisconsin criteria. Fundoscopy revealed in 95/646 eyes (14.7%) some degree of diabetic retinopathy. Sensitivity and specificity of fundus photography (omitting ungradable transparencies) were 97% for the diagnosis of any diabetic retinopathy (DRP). All patients with moderate and severe DRP (Wisconsin grade 3 and worse) according to fundoscopy were detected by fundus photography. In conclusion, mydriatic wide angle 60 degrees fundus photography, making two pictures per eye, can be applied effectively and reliably in the detection of diabetic retinopathy in patients with Type 2 diabetes.

Adult↗

Ophthalmologic screening of deaf students in Oregon.

PURPOSE: To determine the frequency of Usher's syndrome and other ocular disease in students receiving special education services for the deaf in Oregon and to assess the amount of existing ophthalmologic surveillance of this population. A special emphasis was placed on screening for Usher's syndrome. METHODS: From 1980-1990, a prospective two-center visual screening program of 231 deaf students in schools throughout Oregon was conducted using an ophthalmic questionnaire, complete eye examinations, and electroretinography. Students were between the ages of 10 and 21 years and participated on a volunteer basis. Findings for etiology and severity of visual loss and the scope of ophthalmologic surveillance within this population were analyzed. RESULTS: Two hundred seventeen of the 231 students examined received electroretinograms. Significant ocular pathology was found in 111 (48%) of the students. The most common diagnoses were congenital rubella (21%), significant uncorrected ametropia (16%), and ocular hypertension (9%). Five students were diagnosed with Usher's syndrome. Of the students with significant ocular pathology, only 37% were actively followed by an ophthalmologist. CONCLUSION: Deaf students in Oregon's schools had a high frequency of eye disease. Early diagnosis and treatment of eye disease in this population could benefit the quality of life of these students. This study alerted the providers of special education services for the deaf and the ophthalmologic community in Oregon of the need for better eye care for these students.

Adolescent↗

Ophthalmological follow-up at 2 years of age of all children previously screened for retinopathy of prematurity: is it worthwhile?

PURPOSE: To evaluate the extent to which ophthalmological follow-up at 2 years of age of children born before 32 weeks gestation identifies obvious visual problems, strabismus and significant ametropia (target conditions). METHODS: Of 172 children born during a period of 2.5 years from January 2000, 142 underwent an ophthalmological examination at a median age of 2.33 years. This included evaluation of visual behaviour, cover testing and autorefractometry in cycloplegia. For children with the target conditions, we investigated whether the child had been followed in the eye clinic or referred before 2 years of age, or whether the abnormality was detected as a result of the follow-up examination. RESULTS: None of the target conditions were found in 117 children. None of four children with obviously abnormal visual behaviour, two of 10 children with strabismus and four of 11 with large refractive errors were detected in the follow-up examination. Thus the target conditions were detected at the follow-up examination in only six of 142 children (4.2%). CONCLUSIONS: Although ophthalmic abnormalities are common in children born prematurely, most of them are identified because high-risk children are followed regularly in eye clinics and because parents and primary health care personnel detect strabismus. Ophthalmological follow-up of all children born before 32 weeks appears not to be worthwhile and is therefore only recommended for high-risk children.

Child, Preschool↗

Social determinants of cataract surgery utilization in south India. The Operations Research Group.

A field trial was conducted to compare the effects of eight health education and economic incentive interventions on the awareness and acceptance of cataract surgery. Cataract screening and follow-up surgery were offered to more than 19,000 residents age 40 years and older in a probability sample of 90 villages in south India. Eight months after intervention, an evaluation was conducted to identify those in need of surgery who had been operated on. Two principal measures of program effectiveness are examined: awareness of cataract surgery and acceptance of the surgery. The type of intervention had a negligible effect on awareness of cataract surgery. A multiple logistic regression analysis revealed that individuals who were aware of surgery tended to be male, literate, and more affluent than those who were unaware of that option. Interventions that covered the complete costs of surgery had higher surgery acceptance rates. One health education strategy, house-to-house visits by a subject with aphakia, increased acceptance of the procedure more than others. In a multiple logistic regression analysis of acceptance rates, persons accepting surgery tended to be male; other factors were not important in explaining variation in acceptance rates.

Adult↗

Screening of amblyopic children and long-term follow-up.

A prospective study of amblyopic children was carried out in 1982-1992 in the ophthalmology unit of a community health center, a referral center for 14,000 preschool children. Five hundred and twenty-six children in 1982-1983 were referred to an ophthalmologist because of a suspicion of amblyopia, strabismus or other visual disorders. Amblyopia was diagnosed in 109 children. In 18 children amblyopia was on an organic basis and among them 4 children had X-chromosomal retinoschisis. Risk factors for functional amblyopia were convergent strabismus, spherical equivalent of the refractive error of 3.5 dioptres or more or anisometropia of 1.0 dioptres or more. The children with established functional amblyopia (91 children) were treated with a full-time occlusion, or, at the age of younger than 18 months, with 0.5% atropin, and, at the minimum of 6 years, with pleoptics when indicated. One hundred amblyopic children were followed for a minimum of 4 years, reinstituting the occlusion therapy if visual acuity deteriorated. Seventy-two children with functional amblyopia (79%) were available for a detailed ophthalmological examination 9.7 years, on the average, after the initial examination. Only three of these children (4%) had visual acuity of less than 0.4 at that time. Well-functioning child health centers and school health care, as well as the availability of ophthalmological services, are important for a good final visual result of amblyopic children.

Amblyopia↗