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PubMed1996

Preschool vision screening: outcome of children referred to the hospital eye service.

AIMS: To assess the outcome of children referred to the hospital eye service (HES) from an orthoptist based preschool vision screening programme. METHODS: A retrospective study was conducted of children referred from screening during a 2 year period. Children were screened by community orthoptists at 3 1/2 years of age. The main outcome measures were (1) HES findings for children referred from screening, and (2) visual outcome for amblyopic children after completion of treatment. RESULTS: The attendance rate at screening was 79.3% (6794 children): 348 children (5.1% of those screened) were referred to the HES. The HES findings were refractive error (32.9%), amblyopia (29.9%), false positive referral (20.1%), strabismus (13.2%), and other ocular disorders (3.9%). The positive predictive value of screening was 79.9%. Screening detected 48 children with straight eyed amblyopia and 43 children with strabismic amblyopia. A visual acuity of 6/9 or better in the amblyopic eye was achieved by 87.2% of straight eyed amblyopes and 64.3% of strabismic amblyopes (chi 2 = 5.27, p = 0.02). Residual amblyopia of 6/24 or worse occurred in only 5.6% of amblyopic children. CONCLUSION: Most amblyopic children detected by preschool vision screening achieve a good visual outcome with treatment. While treatment earlier in the sensitive period might be expected to give improved results, it remains to be demonstrated that preschool screening results in a better outcome than screening at school entry. Preschool vision screening also detects a significant number of children without amblyopia who have reduced vision due to refractive errors. This group of children must be included in any analysis of the cost effectiveness of preschool vision screening.

Amblyopia↗
PubMed1983

The significance of ocular morbidity in very-low-birthweight infants to the Australian health service.

The survival rate of very-low-birthweight (VLBW) infants has greatly increased due to the introduction of intensive-care methods to neonatal nurseries. It was feared that this would also cause an increase in the amount of ocular morbidity associated with prematurity. In order to estimate this, 111 very-low-birthweight infants (birthweights less than or equal to 1500 g) were reviewed at two years of age. They comprised 63% of the total number of long-term surviving babies born at, or transferred in the neonatal period to, the Royal Women's Hospital, Melbourne, in 1977 and 1978. In 33% a significant ocular problem was detected; 19% had strabismus, 17% had a significant refractive error, 10% had cicatricial retrolental fibroplasia (RLF), and 2.7% were blind, due to optic atrophy associated with cerebral palsy. Other studies have shown that 7% of VLBW infants develop severe (Stage III) RLF, and 18% of these (1.26% of VLBW infants) will be socially or totally blind. In order to estimate the significance of VLBW infants to the ophthalmic health services, and to the organisations for the care of the visually handicapped, these figures can be extrapolated. Based on 1980 figures, it would be expected that approximately 1105 VLBW infants would survive annually, and nine would become blind from RLF, while 110 would have been affected by RLF. Thirty-three children would be blind from optic atrophy associated with cerebral palsy, 210 would have strabismus, and at least 187 would have a significant refractive error. VLBW infants will contribute significantly to the number of children requiring ocular care, and because of the high incidence of ocular abnormalities, it is recommended that routine screening of all VLBW infants be carried out at one year and two years of age.

Australia↗
PubMed2006

Surgical outcome of primary developmental glaucoma: a single surgeon's long-term experience from a tertiary eye care centre in India.

PURPOSE: To determine the surgical outcome after initial surgery in children with primary developmental glaucoma (PDG). METHODS: Six hundred and twenty-four eyes of 360 consecutive patients who underwent primary combined trabeculotomy-trabeculectomy (CTT) for PDG from January 1990 to June 2004 were studied. The main outcome measures were pre- and postoperative intraocular pressures (IOPs), corneal clarity, visual acuities, refractive errors, success rate, time of surgical failure, complications, and factors associated with poor outcome. RESULTS: IOP reduced from 28.1+/-7.5 to 14.9+/-5.9 mmHg (P<0.0001). Probability of success (IOP<21 mmHg) was 85.2, 80.4, 77.2, 72.6, 66.2, and 57.5% at first, second, third, fourth, fifth, and sixth years, respectively (Kaplan-Meier analysis). The mean follow-up period was 20.3+/-25.6 months (median, 6 months). Preoperatively, 243 eyes (67.5%) had significant corneal oedema. Postoperatively, normal corneal transparency was achieved in 162 eyes (46.0%). Data on Snellen visual acuity were available in 100 patients (27.8%). At the final follow-up visit, 42 patients (42.0%) had normal visual acuity (>or=20/60). Myopia (mean spherical equivalent, 6.1 D) was the most common (75.0%) refractive error. In multivariate analyses, failure increased by three-fold in the presence of preoperative IOP>35 mmHg (hazards ratio (HR)=3.12; 95% confidence interval (CI), 1.4-6.7) and two-fold in cases with a history of prior glaucoma surgery (HR=2.57; 95% CI, 1.1-6.0). There were no major intraoperative complications, bleb-related infection, or endophthalmitis. CONCLUSIONS: This series shows that prolonged IOP control can be achieved in patients with PDG and 42% of the patients gained normal visual acuity.

Adolescent↗
PubMed2001

The ateliotic macula: a newly recognized developmental anomaly.

PURPOSE: We present a macular phenotype resulting from 1 or more abnormalities in the developmental pathway of the central retina. METHODS: We describe the clinical and genetic characteristics of 7 patients observed since shortly after birth with regard to visual acuity, refractive error, anterior segment status, retinal findings including foveal structure, and natural history. RESULTS: The patients varied in age from 18 months to 18 years. All patients were examined for the first time during their first year of life and by us at the age of 5 years or younger. The longest follow-up period was 16 years. The abnormal appearance of the macula consisted of thinning of the retina, rarefication of the pigment epithelium with excess visibility of the large choroidal vessels, and absence of the foveal reflex. The visual acuities varied from 20/20 in the better eye to light perception. A retinal detachment was noted in 1 patient at age 2 1/2 years. The refractive errors varied from -2.50 to -16.50 diopters of spherical equivalent. The disease was limited to the retina in 4 patients. In 2 patients, however, developmental abnormalities of the anterior segment were also present; they consisted of malformation of the iris in 1 patient and Peters' anomaly in the other. The electroretinogram (ERG) showed reduced but not absent photopic responses and some reduction in scotopic responses. CONCLUSION: The phenotype of ateliotic macula is being defined as characterized by an unfinished or primordial appearance. In the 7 patients studied, visual loss was noted shortly after birth. The visual outcome was variable with regard to visual acuity, but many patients showed improvement. There was no evidence of significant worsening of the disease with age except in 1 patient who had a retinal detachment. The ERG responses showed primarily photopic but also scotopic changes. The better-preserved ERG differentiates this disorder from Leber's congenital amaurosis.

Adolescent↗
PubMed2005

Ophthalmic sequelae of Crouzon syndrome.

PURPOSE: To document the frequency of ophthalmic sequelae in patients with Crouzon syndrome before the influence of craniofacial surgery. DESIGN: Retrospective observational case series. PARTICIPANTS: Seventy-one consecutive patients with a clinical diagnosis of Crouzon syndrome assessed before craniofacial or ophthalmic surgery at the Australian Craniofacial Unit between 1984 and 2000. METHODS: Review of clinical records with documentation of patient age, gender, visual acuity, refractive error, diagnosis of amblyopia, squint, eye movement dysfunction, nystagmus, fundus examination, examination of the anterior segment, interpupillary distance, and intercanthal distance. MAIN OUTCOME MEASURES: The frequency of ophthalmic signs and visual impairment, defined as a visual acuity of 6/12 or less. RESULTS: Visual impairment in at least 1 eye occurred in 35% of patients and was bilateral in 9%. The most common cause of visual impairment was amblyopia, which was present in 21% of patients, followed by optic atrophy in 7%. Ametropia occurred in 77% of patients; 57% had hypermetropia of > or =+2 diopters (D) and 20% had myopia of > or =-0.5 D. Strabismus occurred in 39% of patients. Although exposure keratopathy was observed in 15% of patients, this complication was well managed and caused no reduction in visual acuity. CONCLUSIONS: Early detection to reduce amblyopia by correction of refractive errors, timely treatment of strabismus, and patching should be a priority for ophthalmologists and a goal of the craniofacial teams managing patients with Crouzon syndrome. Optic atrophy remains an important cause of visual impairment in these patients before decompressive craniectomy.

Adolescent↗
PubMedDate not supplied

Anterior corneal optical aberrations induced by photorefractive keratectomy for hyperopia.

PURPOSE: Photorefractive keratectomy (PRK) for hyperopia requires both a steepening of the central cornea and a flattening of the mid-periphery to achieve its effect and is likely to affect the optical aberrations of the eye. METHODS: Nine patients underwent PRK to correct between +2.00 and +4.00 D of hyperopia (first eye treated for each patient) using the Summit Technology Apex Plus excimer laser. Anterior corneal aberrations for pupil diameters of 3, 5.5 and 7 mm were estimated from corneal topography data (TMS-1), assuming a uni-index, single surface cornea. Refractive error was assessed using retinoscopy and standard subjective tests. RESULTS: Apart from the intended change in refraction (mean spherical equivalent manifest refraction, +4.60 +/- 1.60 D before surgery and +0.70 +/- 1.60 D at 1 year after surgery), the most significant change was in spherical aberration. Anterior corneal spherical aberration was positive (+1.60 +/- 0.60 D for a 5.5-mm pupil) before surgery and became negative after surgery (-1.80 +/- 1.20 D at 1 year). The change in spherical aberration was related to the achieved change in refractive error. CONCLUSIONS: The large change (approximately 3.00 D) in spherical aberration (from positive to negative aberration) has implications for the optical performance of the whole eye, where the effects of lenticular aberration must also be considered.

Cornea↗
PubMed2006

[Astigmatism in ocular neuromuscular nystagmus].

BACKGROUND: Data on refraction of patients with congenital nystagmus are not available in the literature. PATIENTS AND METHODS: We have analysed the refractive errors in a cohort of 224 consecutive patients with congenital nystagmus, aged 1-57 years. RESULTS: Refractive errors, i. e., myopia, hyperopia (> 0.50 dioptres) and astigmatism (> 1.25 dioptres), were found in 179 patients (79.91 %). Of them 8 were myopic (4.46 %), 19 were hyperopic (10.61 %) and 152 were astigmatic (84.91 %). Mean astigmatism was of 2.44 dioptres for right eyes and 2.74 dioptres for left eyes. CONCLUSIONS: Astigmatism is extremely common in congenital nystagmus. Its presence is much higher than that found in normal populations. The amount of astigmatism found in nystagmus patients is noticeable. When considering he visual difficulties of patients with nystagmus, the astigmatic component should be taken in greatest consideration. Its presence should favour early surgery for anomalous head posture. Furthermore, refractive surgery should be considered as early as possible, for improving visual potential.

Adolescent↗
PubMedDate not supplied

Angle recess area decreases with age in normal Japanese.

PURPOSE: To investigate prospectively the relationships between anterior chamber angle configuration and refractive error, axial length, age, and body height in the Japanese. METHODS: We studied 65 eyes of 65 subjects (30 men, 35 women) who were either patients at the Ophthalmology Department of Mie University or volunteers. The 65 subjects underwent a complete eye examination, A-scan biometry, and ultrasound biomicroscopy. Images were exported to an IBM-compatible personal computer in PCX format. The angle recess area (ARA) was measured using a software program of our own design. RESULTS: The ARA decreased with age in all quadrants of all eyes. In older individuals, the angle in the superior quadrant was significantly narrower than in the other quadrants. The ARA correlated directly with anterior chamber depth (P < .001), axial length (P < .001), and body height (P = .003), and inversely with age (P < .001) and refractive error (P = .003) in pairwise analysis. Multivariate analysis revealed a significant association between ARA and anterior chamber depth (P < .001), axial length (P = .016), and younger age (P = .043). CONCLUSIONS: The anterior chamber area narrows with age, especially in the superior quadrant. Narrowing of the angle in Japanese is associated with older age, shorter axial length, and shallower anterior chamber depth. We hypothesize that because of the increasing prevalence of axial myopia in younger Japanese, angle-closure glaucoma could become less common in Japan in the future.

Adult↗
PubMed1994

Factors affecting light-adapted pupil size in normal human subjects.

PURPOSE: To investigate the effect of age, gender, refractive error, and iris color on light-adapted pupil size in humans. METHODS: Pupil diameters of 91 subjects (age range, 17 to 83 years) with normal, healthy eyes were measured using an objective infrared-based continuous recording technique. Five photopic ocular illuminance levels were used (2.15 to 1050 lumens m-2), and the accommodative status of each subject was precisely controlled at a constant level. RESULTS: Pupil size decreased linearly as a function of age at all illuminance levels. Even at the highest illuminance level, there was still a significant effect of age upon pupil size. The rate of change of pupil diameter with age decreased from 0.043 mm per year at the lowest illuminance level to 0.015 mm per year at the highest. In addition, the variability between pupil sizes of subjects of the same age decreased by a factor of approximately two as luminance was increased over the range investigated. Pupil size was found to be independent of gender, refractive error, or iris color (P > 0.1). CONCLUSIONS: Of the factors investigated, only chronologic age had a significant effect on the size of the pupil. The phenomenon of senile miosis is present over a wide range of ocular illuminance levels.

Accommodation, Ocular↗
PubMed2003

Variability of retinal steepness at the posterior pole in children 7-15 years of age.

PURPOSE: Considerable evidence suggests that both axial and peripheral refraction play important roles in eye growth control. The large variability in peripheral refraction seen in adults and children indicates that the peripheral retina is exposed to a wide range of refractive errors. The current lack of appropriate measurement techniques has hampered the determination of whether variability in peripheral refraction between individuals can be correlated with variability in retinal steepness. An Optical Low Coherence Reflectometer (OLCR) was developed to determine retinal steepness. METHODS: Retinal steepness was assessed in right eyes of 63 children 7-15 years of age by measuring eye length (EL) and spherical equivalent refraction (SER) axially and at 15 degrees temporally, nasally, inferiorly and superiorly with OLCR and Binocular Auto-Refractometry, respectively, during cycloplegia. At each peripheral location, relative peripheral EL and SER (i.e., the difference between peripheral and axial readings) were compared between myopic, emmetropic and hyperopic eyes, and the correlation between relative peripheral EL and SER was analyzed. RESULTS: Although the standard deviations were large, significant differences in relative peripheral EL and SER between refractive groups as well as a significant correlation between relative peripheral EL and SER were observed at several of the assessed locations. CONCLUSIONS. The results strongly suggest that peripheral refraction is correlated with retinal steepness and that previously observed variability in peripheral refraction chiefly reflects variability in retinal steepness. If peripheral refraction represents a determining parameter in the control of eye growth, the precise measurement of retinal steepness could be used not only to improve estimates of myopic progression, but also to identify children who are at high risk of developing myopia. It may lead to specialized clinical/optical treatments, e.g. the correction of not only axial but also peripheral refractive errors, which are more effective than current treatments in individuals who are at risk of myopia development or progression.

Adolescent↗
PubMed2006

Objective and subjective responses in patients refitted to daily-wear silicone hydrogel contact lenses.

PURPOSE: Silicone hydrogel (SiH) lenses offer many physiological advantages for daily wear (DW) in addition to the continuous-wear modality for which they were originally developed. The purpose of this study was to investigate the clinical performance and physiological responses in a group of successful long-term wearers of conventional hydrogel lenses when refitted with DW SiH contact lenses. METHODS: Eighty-seven successful soft lens wearers (8.4+/-4.7 years of prior lens wear) participated in this study. Bulbar and limbal hyperemia were subjectively graded and digitally photographed for subsequent masked objective evaluation. Subjective symptoms were scored using visual analog scales. In addition, refractive error, corneal curvature, and corneal thickness were measured. All subjects were refitted with Focus Night & Day (lotrafilcon A) SiH lenses; however, to reduce the potential for bias, they were informed that they were being randomly assigned to wear either low oxygen permeability (Dk) lenses or high Dk SiH lenses and were "masked" as to their lens assignment. Subjects returned after 1 week, 1 month, and 2 months of DW, at which time all gradings, photographs, and measurements were repeated. End-of-day subjective symptoms were also graded periodically during the study. RESULTS: Ninety-three percent of subjects were successfully refitted. Both objective and subjective evaluations showed that bulbar and limbal hyperemia decreased significantly in all quadrants during the study (p<0.001), particularly for those subjects with greater baseline hyperemia (p<0.001). Subjects reported a concurrent reduction in end-of-day dryness and improved end-of-day comfort compared with their habitual lenses (p<0.001). No significant changes in refractive error, tarsal papillary response, corneal curvature, or corneal thickness were found during the study. CONCLUSIONS: Hyperemia in contact lens wearers may be attributed to a number of factors, including hypoxia. Refitting existing low Dk lens wearers with SiH lenses on a DW basis can result in a decrease in hyperemia, which may be significant for some subjects and also results in improvements in symptoms of dryness and discomfort.

Adolescent↗
PubMed2006

Factors associated with spectacle-wear compliance in school-aged Mexican children.

PURPOSE: To study the prevalence and determinants of compliance with spectacle wear among school-age children in Oaxaca, Mexico, who were provided spectacles free of charge. METHODS: A cohort of 493 children aged 5 to 18 years chosen by random cluster sampling from primary and secondary schools in Oaxaca, Mexico, all of whom had received free spectacles through a local program, underwent unannounced, direct examination to determine compliance with spectacle wear within 18 months after initial provision of spectacles. Potential determinants of spectacle wear including age, gender, urban versus rural residence, presenting visual acuity, refractive error, and time since dispensing of the spectacles were examined in univariate and multivariate regression models. Children not currently wearing their spectacles were asked to select the reason from a list of possibilities, and reasons for noncompliance were analyzed within different demographic groups. RESULTS: Among this sample of children with a mean age of 10.4 +/- 2.6 years, the majority (74.5%) of whom were myopic (spherical equivalent [SE] < or = -0.50 D), 13.4% (66/493) were wearing their spectacles at the time of examination. An additional 34% (169/493) had the spectacles with them but were not wearing them. In regression models, the odds of spectacle wear were significantly higher among younger (OR = 1.19 per year of age; 95% CI, 1.05-1.33) rural (OR = 10.6; 95% CI, 5.3-21.0) children and those with myopia < or = -1.25 D (OR = 3.97; 95% CI, 1.98-7.94). The oldest children and children in urban-suburban areas were significantly more likely to list concerns about the appearance of the glasses or about being teased than were younger, rurally resident children. CONCLUSIONS: Compliance with spectacle wear may be very low, even when spectacles are provided free of charge, particularly among older, urban children, who have been shown in many populations to have the highest prevalence of myopia. As screening programs for refractive error become increasingly common throughout the world, new strategies are needed to improve compliance if program resources are to be maximized.

Adolescent↗
PubMed2005

Treated threshold stage 3 versus spontaneously regressed subthreshold stage 3 retinopathy of prematurity: a study of motility, refractive, and anatomical outcomes at 6 months and 36 months.

AIM: To compare the visual acuity (VA), spherical equivalent refractive error, motility, and anatomical outcomes in children with treated regressed threshold stage 3 retinopathy of prematurity (ROP) and those with spontaneously regressed subthreshold stage 3 ROP. METHOD: 6 month and 3 year data collected from infants examined between 1989 and 1999 with regressed stage 3 ROP, with or without treatment were retrospectively reviewed. RESULTS: 85 infants were included in this study. 40 eyes received cryotherapy, 81 eyes laser photocoagulation, and 34 eyes had spontaneously regressed subthreshold stage 3 ROP. Grating acuity score > or =2 cycles/degree (c/d) at 6 months was predictive of optotype acuity > or =6/9 in 69% of eyes and a score <2 c/d at 6 months was predictive of acuity < 6/9 in 88% of eyes. Eyes with subthreshold stage 3 ROP were twice as likely to have VA of 6/9 or better at 36 months than the treated eyes. The mean spherical equivalent refractive error at 36 months was -6.5 dioptres (D) (-21.5D to +1.38D) in cryotherapy treated eyes, -2.4D (-13D to +4D) in the laser group, and -0.22D (-9D to +2.25D) in the subthreshold group. Eyes within the treated groups were more myopic than the eyes within the spontaneously regressed group (p = 0.005). At 36 months, 42 out of the 85 infants (that is, 49%) had strabismus (44% in the cryotherapy group, 26% in the laser group, and 25% in the subthreshold group). There was a statistically significant association between the presence of strabismus and anisometropia (p = 0.016) and strabismus and intraventricular haemorrhage (IVH) (p = 0.005). There was a statistically significant difference in the incidence of strabismus between mild and moderate and severe grade IVH (p = 0.01). Eight out of 40 eyes in the cryotherapy group and six out of the 81 eyes in the laser group developed macular ectopia. None of the eyes in the spontaneously regressed group had macular dragging. CONCLUSIONS: In this study, the grating acuity at 6 months was a good predictor of the 3 year optotype acuity in all groups. Eyes with spontaneously regressed subthreshold stage 3 ROP were associated with better vision at 3 years of age and a lesser degree of myopia compared to the treated groups. Strabismus developed predominantly in the treated groups and was frequently associated with neurological damage and/or anisometropia. The spontaneously regressed subthreshold stage 3 group had a better anatomical outcome compared to the groups in which the retinopathy regressed following treatment.

Cryotherapy↗
PubMed2000

Distance stereopsis as a screening device.

PURPOSE: To determine the efficacy of distance stereotesting as a screening device. METHODS: Distance stereoacuity using the global Random Dot and contour Circle test of the Mentor BVAT II-SG computerized testing system was measured for 216 patients, ages 6 to 18 years, before the clinical examination. Patients were classified into pass/fail groups in the areas of refractive error change (REC), ocular deviation (DEV), visual acuity (VA), and all three together (EXAM). Legitimate cutoff scores were obtained when patients were classified as 'pass' as follows: REC if the change was 0.50 D or less in sphere or cylinder relative to the habitual correction or to emmetropia if no habitual correction; DEV if there was no heterophoria or strabismus at distance (criteria of heterophoria of < 6 prism diopters and heterophorias of any magnitude were also tested); VA if the acuity at distance was better than or equal to 20/25 in the poorer eye and better than or equal to 20/20 in the better eye; EXAM if they were pass in REC, DEV, and VA. Optimal pass/fail cutoff values for the stereopsis measurements were determined by finding the maximum chi2 value from contingency tables constructed using pass/fail levels for the screening test at each of the observed levels. RESULTS: The pass rates for REC, DEV, VA, and EXAM were 45%, 72%, 42%, and 24%, respectively. Patients passed the BVAT at the analytically determined optimal cutoff values of less than or equal to 120 sec arc for global and less than or equal to 30 sec arc for contour stereopsis. The sensitivity and specificity for global stereopsis were 0.90 and 0.40 for REC, 0.89 and 0.30 for DEV, 0.93 and 0.51 for VA, and 0.87 and 0.63 for EXAM. For contour stereopsis, the corresponding values were 0.85 and 0.42, 0.89 and 0.34, 0.91 and 0.53, and 0.84 and 0.62. CONCLUSION: Distance stereotesting is highly sensitive to small refractive error changes, heterophorias and strabismus, visual acuities < 20/25, or any of the three. Global stereopsis is only slightly better than contour stereopsis at classifying patients. Distance stereotesting has potential as an effective screening test.

Adolescent↗
PubMedDate not supplied

Screening of school-aged hearing impaired children.

Three hundred sixty hearing-impaired students were screened for visual problems, including Usher's syndrome, with a complete ophthalmologic exam and electroretinography (ERG). Over 25% were found to have a significant refractive error, and approximately 32% had one or more pathologic findings. Overall, 43% either had a significant refractive error or pathologic finding. The incidence of Usher's syndrome was estimated to be between 1.1% and 1.9% in the hearing impaired student population. The results emphasize the need for a complete ophthalmologic examination, and possible ERG testing, in the hearing impaired student population.

Adolescent↗
PubMed2001

Blindness in the Indian state of Andhra Pradesh.

PURPOSE: To determine the current prevalence and causes of blindness in the Indian state of Andhra Pradesh to assess if blindness has decreased since the last survey of 1986-1989. METHODS: A population-based epidemiology study, using a stratified, random, cluster, systematic sampling strategy, was conducted in the state of Andhra Pradesh in India. Participants of all ages (n = 10,293), 87.3% of the 11,786 eligible, from 94 clusters in one urban and three rural areas representative of the population of Andhra Pradesh, underwent interview and a detailed dilated ocular evaluation by trained professionals. Blindness was defined as presenting distance visual acuity < 6/60 or central visual field < 20(o) in the better eye. RESULTS: Two hundred seventy-five participants were blind, a prevalence of 1.84% (95% confidence interval, 1.49%-2.19%) when adjusted for the age, sex, and urban-rural distribution of the population in 2000. The causes of this blindness were easily treatable in 60.3% (cataract, 44%; refractive error, 16.3%). Preventable corneal disease, glaucoma, complications of cataract surgery, and amblyopia caused another 19% of the blindness. Blindness was more likely with increasing age and decreasing socioeconomic status, and in female subjects and in rural areas. Among the 76 million population of Andhra Pradesh, 714,400 are estimated to have cataract-related blindness (615,600 cataract, 53,200 cataract surgery-related complications, 45,600 aphakia), and 228,000 refractive error-related blindness (159,600 myopia, 22,800 hyperopia, 45,600 refractive error-related amblyopia). If 95% of the cataract and refractive error blindness in Andhra Pradesh had been treated effectively, 3.4 and 7.4 million blind-person-years, respectively, could have been prevented. If 90% of the blindness due to preventable corneal disease and glaucoma had been prevented, another 2.7 million blind-person-years could have been prevented. CONCLUSIONS: The prevalence of blindness in this Indian state has increased from 1.5% in the late 1980s to 1.84% currently, as against the target of the National Program for Control of Blindness to reduce the prevalence to 0.3% by 2000. The number of people with cataract-related blindness has not reduced even with the eye care policy focus on cataract. Reduction of blindness in India will require strategies that are more effective than those that have been pursued so far.

Adolescent↗
PubMed2004

Comparison of preschool vision screening tests as administered by licensed eye care professionals in the Vision In Preschoolers Study.

PURPOSE: To compare 11 preschool vision screening tests administered by licensed eye care professionals (LEPs; optometrists and pediatric ophthalmologists). DESIGN: Multicenter, cross-sectional study. PARTICIPANTS: A sample (N = 2588) of 3- to 5-year-old children enrolled in Head Start was selected to over-represent children with vision problems. METHODS: Certified LEPs administered 11 commonly used or commercially available screening tests. Results from a standardized comprehensive eye examination were used to classify children with respect to 4 targeted conditions: amblyopia, strabismus, significant refractive error, and unexplained reduced visual acuity (VA). MAIN OUTCOME MEASURES: Sensitivity for detecting children with > or =1 targeted conditions at selected levels of specificity was the primary outcome measure. Sensitivity also was calculated for detecting conditions grouped into 3 levels of importance. RESULTS: At 90% specificity, sensitivities of noncycloplegic retinoscopy (NCR) (64%), the Retinomax Autorefractor (63%), SureSight Vision Screener (63%), and Lea Symbols test (61%) were similar. Sensitivities of the Power Refractor II (54%) and HOTV VA test (54%) were similar to each other. Sensitivities of the Random Dot E stereoacuity (42%) and Stereo Smile II (44%) tests were similar to each other and lower (P<0.0001) than the sensitivities of NCR, the 2 autorefractors, and the Lea Symbols test. The cover-uncover test had very low sensitivity (16%) but very high specificity (98%). Sensitivity for conditions considered the most important to detect was 80% to 90% for the 2 autorefractors and NCR. Central interpretations for the MTI and iScreen photoscreeners each yielded 94% specificity and 37% sensitivity. At 94% specificity, the sensitivities were significantly better for NCR, the 2 autorefractors, and the Lea Symbols VA test than for the 2 photoscreeners for detecting > or =1 targeted conditions and for detecting the most important conditions. CONCLUSIONS: Screening tests administered by LEPs vary widely in performance. With 90% specificity, the best tests detected only two thirds of children having > or =1 targeted conditions, but nearly 90% of children with the most important conditions. The 2 tests that use static photorefractive technology were less accurate than 3 tests that assess refractive error in other ways. These results have important implications for screening preschool-aged children.

Amblyopia↗
PubMed2006

[The impact of some bad habits and environmental factors on the somatic status of male adolescents].

AIM: The aim of the study was to investigate whether some bad habits of sedentary lifestyle influence the occurrence of diagnoses in male adolescents, divided according to their environment into urban, rural and and island groups. PATIENTS AND METHODS: A total of 437 male adolescents underwent physical examination and functional diagnostic tests at Occupational Medicine Clinic in Rijeka, in order to evaluate their fitness for military service. The method of physical examination and anthropologic measurements was used. The results were analyzed by the Stat Soft, Statistics 6.0 software. Pearson chi-squared-test test and correlation matrices were used. RESULTS: The results showed obesity to be present in a relatively high percentage of subjects from urban area (10.94%) and rural area (13.19%), whereas asthenia was more pronounced in islanders (8.69%), yielding a statistically significant between-group difference (p<0.05). In contrast to asthenia, the islanders had the lowest percentage of flatfoot, with a significant difference from the two other groups (p<0.05). Refraction errors, primarily myopia, were not influenced by the place of residence. The incidence of myopia in all three groups was slightly over 20%. Contrary to our expectation, bronchial asthma was most common in the islanders (5.43%), however, there data could not be considered representative because of the rather big rate of migration from the inland to prevent relapses of respiratory diseases. The incidence of mild kyphoscoliosis ranged from 5.55% in the subjectss from rural settings up to 11.95% in the islanders, without a statistically significant between-group difference. DISCUSSION: It is difficult to identify the causes of differences in body weight among adolescents from urban, rural and island settings. It is not so easy to criticize the former for predominantly sedentary life, watching TV, video or Internet. Physical activity cannot be readily performed in towns because of the increasing presence of pollutants in the atmosphere. The prevalence of bronchial asthma was slightly higher than expected, which was explained by the permanent residence of atopics on the islands in order to prevent disease relapses. The lowest incidence of flatfoot among islanders was explained by their free lifestyle, barefoot walking along the rocky seaside, and high level of physical activity. Refraction errors including myopia as the leading diagnosis were equally present in the three groups, exceeding 20%. Besides heredity, the sight is influenced by intensified effects of ultraviolet radiation that causes changes of the eye structure. Also, neon signs and lights as well as too strong night streetlights lead to phototoxic vision damage in adolescents. Study results showed that male adolescents who lead physically inactive life should not to be blamed for the occurrence of the mentioned diagnoses. Like all of us they are daily affected by harmful pollutants that cause damage to the eyes, cardiovascular, respiratory and other organ systems. This study has helped identify the causes of the mentioned diseases in the group of male adolescents, emphasizing the role of occupational medicine. Specialists in occupational medicine should be involved in the monitoring of somatic and other parameters in adolescents from the early school age. In this period, it is still possible to reduce or and even prevent the occurrence of the mentioned diagnoses by examinations, education, exercises and diets. In this way, the candidates for military service would be healthier and fit.

Adolescent↗