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PubMed2000

Non-ophthalmologist screening for retinopathy of prematurity.

AIM: To determine if a non-ophthalmologist can accurately screen for retinopathy of prematurity (ROP) by evaluating the posterior pole blood vessels of the retina. ROP is a common ocular disorder of premature infants and may require multiple screening examinations by an ophthalmologist to allow for timely intervention. Since there is a strong correlation between posterior pole vascular abnormalities and vision threatening ROP, screening examinations performed by non-ophthalmologist may yield useful clinical information in high risk infants. METHODS: Infants born at the Medical University of South Carolina who met screening criteria (n = 142) were examined by a single non-ophthalmologist using a direct ophthalmoscope to evaluate the posterior pole blood vessels for abnormalities of the venules and/or arterioles. To determine the accuracy of the non-ophthalmologist's clinical observations, infants were also examined by an ophthalmologist, using an indirect ophthalmoscope, who graded the posterior pole vessels as normal, dilated venules, or dilated and tortuous venules and arterioles (including "plus disease"). RESULTS: There was significant correlation (p <0.001) between the non-ophthalmologist's and ophthalmologist's diagnoses of posterior pole vascular abnormalities. 47 infants had normal posterior pole blood vessels by the non-ophthalmologist examination. Of these, 31 (66%) were considered to have normal vessels and 16 (34%) to have dilated venules by the ophthalmologist. The non-ophthalmologist correctly identified abnormal posterior pole vessels in all 21 infants diagnosed with abnormal arterioles and venules by the ophthalmologist. No infants with clinically important ROP ("prethreshold" or worse) would have failed detection by this screening method. CONCLUSION: Using a direct ophthalmoscope, a non-ophthalmologist can screen premature infants at risk for ROP by evaluating the posterior pole blood vessels of the retina. While not necessarily recommended for routine clinical practice, this technique may nevertheless be of value to those situations where ophthalmological consultation is unavailable or difficult to obtain.

Humans↗
PubMed1997

Screening for depression in older persons with low vision. Somatic eye symptoms and the Geriatric Depression Scale.

The authors compared the sensitivity and specificity of a somatic eye symptoms question with the Geriatric Depression Scale (GDS) to detect depression in older patients with low vision. The sample was 70 patients (65+ years) attending a low-vision clinic. A geriatric nurse-practitioner examined all patients, diagnosed major depression by DSM-III-R criteria, and completed the GDS and an eye symptoms (ES) questionnaire. Twenty-seven patients (38.6%) met criteria for major depression. Although the sensitivity of the ES and GDS were identical (63%), the GDS was more specific (77% vs. 54%) and had higher positive predictive value (63% vs. 46%). Both measures identified patients who were more functionally disabled than patients without ES or depression, but with similar vision. Depression frequently accompanies visual impairment in this population. Inquiring about ES appears to be less specific than the GDS, although neither method is highly sensitive. However these screening tools identify distressed persons whose disability is high relative to the severity of their vision loss.

Aged↗
PubMed1989

Unsuspected infectious diseases and other medical diagnoses in the evaluation of internationally adopted children.

Seven simple screening tests--hepatitis B profile, urine culture for cytomegalovirus, Mantoux test for tuberculosis, stool examination for ova and parasites, VDRL, complete blood cell count, and vision and hearing screening--were used to evaluate 52 consecutive children at a pediatric clinic for international adoptees. In 63% of these children, unsuspected medical diagnoses were made by a combination of history, physical examination, and appropriate screening tests. When only those children previously examined by a physician in the United States were included in our analysis, the rate of unsuspected diagnosis remained high (67%). Omission of screening tests was the single most frequent cause of missed diagnoses, of which the majority were infectious diseases. More than 50% of our newly established diagnoses carried the potential for long-term sequelae without proper treatment. These data emphasize that internationally adopted children should receive a thorough screening evaluation for medical problems that may adversely affect their growth and development.

Adoption↗
PubMed1996

Evaluation of photoscreener instruments in a childhood population. 1. Otago photoscreener and Dortmans videophotorefractor.

OBJECTIVE: To evaluate two photoscreeners in a childhood population. STUDY DESIGN: Double-masked study. SUBJECTS AND METHOD: One hundred and thirteen children aged between 11 and 44 months with either normal vision or known visual disorders were photoscreened without cycloplegia by the Otago and Dortmans (prototype) photoscreeners. Each child had a full ophthalmological examination either on the day of screening or in the proceeding six months. Photoscreen images were reviewed by an independent observer for indicators of amblyopiogenic risk factors, and compared to the full ophthalmological examination to determine sensitivity and specificity for each instrument. RESULTS: The Otago photoscreener returned a sensitivity of 70% and specificity of 82% for the detection of amblyopiogenic risk factors. The Dortmans photoscreener returned a sensitivity of 70% and specificity of 90%. Both photoscreeners were portable and easily operated. CONCLUSION: Children can be screened successfully for amblyopiogenic risk factors with these photoscreening systems. Further evaluation is required to determine specificity in a normal population. This would also provide information on the potential usefulness of photoscreeners in a cost effective childhood vision screening program.

Amblyopia↗
PubMedDate not supplied

Color vision testing of healthcare personnel.

The purpose of the study was to identify and describe color vision testing of healthcare personnel who do glucose monitoring within a hospital. The subjects were 359 members of a nursing staff. Data were collected from nurses participating in a certification program for blood glucose monitoring. The lshihara plates were used to screen for a color vision deficiency. The results offered no evidence that screening of staff provided any benefit for patient care.

Blood Glucose Self-Monitoring↗
PubMed1999

Genetic, epidemiologic and social features of colour blindness.

Red-green colour blindness is an inherited defect which shows interesting epidemiologic and social features. Its mean frequency within the indigenous population of Calabria (Southern Italy) was found to be 5.25%, one of the highest in continental Italy, showing a decreasing trend from the province of Cosenza (Northern Calabria, 6.23%), to the province of Catanzaro (Central Calabria, 4.65%) and the province of Reggio Calabria (Southern Calabria, 3.43%). A similar trend has not been previously recognized, according to the recent literature, because no other region has been fully screened. The mean frequency (7.40%) of red-green colour blindness in the Albanian ethnic minority in Calabria is significantly different from that of the indigenous population, and this minority does not have the protanomalous phenotype. Screening showed that 96% of the colour-blind students attending middle school and 65% of the colour-blind university students are not aware of their anomalous vision status. Thus, screening during the school years would greatly help affected students to choose their future professional orientation.

Journal Article↗
PubMed1992

Functional blindness and visual impairment in older adults from three communities.

PURPOSE: The purpose of this study is to examine the association of sociodemographic factors with functional blindness and visual impairment in an aged population. METHODS: Three population-based cohorts (East Boston, MA; New Haven, CT; and Iowa and Washington Counties, IA) of persons aged 71 years and older were screened for bilateral functional near and distant vision during an in-home interview in 1988. RESULTS: Screening was completed by 5335 participants. The prevalence of functional blindness increased with age, from 1% at age 71 to 74 years to 17% in those 90 years of age and older. Functional visual impairment increased from 7% at age 71 to 74 years to 39% in those 90 years of age and older. In multivariate analyses, residence in a nursing home, older age, glaucoma, insulin-requiring diabetes at baseline, East Boston site, history of cataract, and lower 1982 income were independent and significantly associated with both functional blindness and visual impairment. Age and nursing home residence were significantly (P < 0.05) more strongly associated with blindness (odds ratios 4.8 and 6.1, respectively) than they were with visual impairment. CONCLUSION: Functional blindness and visual impairment are quite prevalent among the oldest old and the institutionalized. The number of affected individuals will increase as the population ages and life expectancy increases. Although visual problems are associated with aging, nursing home residence, health problems, and socioeconomic conditions, they may be readily remediable and may lead to immediate improvements in quality of life.

Aged↗
PubMed1975

Color vision testing in young children: a review.

It is often recommended that children be screened for possible color vision deficiencies as early as possible. This paper examines the validity of commercially-available color vision tests when used with young children (age three to seven years). It is concluded that with the possible exception of the anomaloscope, no test is entirely suited for children, in most cases because the test makes cognitive demands beyond the capability of the young child.

Adult↗
PubMed2003

Detecting chloroquine retinopathy: electro-oculogram versus colour vision.

AIM: To investigate the relative sensitivity and specificity of two tests of retinal function (the electro-oculogram (EOG) and a computerised colour vision test) in screening for ocular toxicity caused by chloroquine and hydroxychloroquine. METHODS: 93 patients with rheumatic diseases receiving long term chloroquine and hydroxychloroquine therapy were followed for an average of 2.6 years. Clinical examination, an EOG, and a quantitative test of colour vision were carried out every 6 months. RESULTS: Mild fundus changes were observed in 38 patients. Four patients developed typical bull's eye maculopathy, three of whom had received 250, 365, and 550 g total dose of chloroquine, and one 1500 g of hydroxychloroquine. Statistical analysis of all patients showed that for those with no fundus changes or stippled pigmentation a number showed elevation of tritan threshold, so that if macular stippling is a sign of mild retinopathy the test on tritan changes has a 64% sensitivity and 63% specificity for an upper threshold value of 7%. All four patients with bull's eye lesions showed a marked disturbance of tritan colour vision, with a threshold of 14.8%, a sensitivity of 75%, and a specificity of 94%. For protan colour vision a threshold of 10% gives 75% sensitivity and 91% specificity. By contrast, neither an absolute nor a relative EOG reduction was a valid criterion for early or late chloroquine retinopathy. In advanced retinopathy an Arden coefficient (AQ) <180% yields 50% sensitivity and 54% specificity. When AQ <160% is the threshold, sensitivity does not increase but specificity rises to 82%. Occurrence of marked corneal deposits on clinical examination yields 50% sensitivity and 90% specificity in this situation. CONCLUSION: Screening for chloroquine retinopathy can be improved by using a sensitive colour test. Disturbance of the tritan axis appears to occur first. A normal test result on computerised colour testing virtually excludes any retinopathy by antimalarials. The EOG is of little diagnostic value.

Aging↗
PubMedDate not supplied

Beyond three: MCH nurses' assessment leads to early interventions.

This study reports the results of a one year trial of a comprehensive developmental assessment, including vision and hearing screening, of three to four year olds in one municipality. Initial results indicated that over 50% of the 790 children assessed had no identifiable problems, this increased a further 15% after retesting. One hundred and eighty-seven children were referred to a variety of agencies, mainly for vision and audiological reassessment. One hundred and thirty-five referrals for further investigation were for children whose problems were confirmed and appropriately managed.

Child, Preschool↗
PubMed1996

Performance of color-dependent air traffic control tasks as a function of color vision deficiency.

BACKGROUND: This experiment was conducted to validate the requirement for normal color vision in Air Traffic Control Specialist (ATCS) personnel who work at en route center, terminal, and Flight Service Station (FSS) facilities. METHODS: A data base was developed involving 121 individuals with normal color vision, 31 simple and 44 extreme anomalous trichromats, and 48 dichromats; both protans and deutans were included. The performance of subjects with normal color vision was compared with the performance of individuals with various classifications of color vision deficiencies on a battery of color-dependent ATCS tasks. Simulations of the ATC color tasks concerned color coding in flight progress strips (at en route centers), aircraft lights and Aviation Signal Light indicator (in tower operations), and color weather radar (at FSS's). RESULTS: Errors were rare among normal trichromats. Mean errors were significantly higher at every level (degree) of color vision deficiency. Approximately 6% of color deficient subjects were able to perform ATC color tasks without error. The 6% were all from the simple anomalous trichromat category; all extreme anomalous trichromats and dichromats were prone to error on ATC tasks. CONCLUSIONS: We conclude that these findings provide support for the requirement of normal color vision in the initial medical screening of ATCS personnel.

Accidents, Aviation↗
PubMedDate not supplied

Colour vision loss among disabled workers with neuropsychological impairment.

Test performance on a neurobehavioural battery was examined with respect to acquired colour vision loss among patients with a history of neurotoxin exposure. The study group included 14 men and 7 women with clinically diagnosed neuropsychological impairment (mean age: 41.3 +/- 8.1 years; mean educational level: 13.4 +/- 1.4 years). Verbal and visual ability, memory and psychomotor function were assessed with the California Neuropsychological Screening Battery. Colour vision was assessed with the Lanthony D-15 desaturated colour arrangement panel. Acquired dyschromatopsia was present in 17 patients (80.9%), 11 of whom manifested patterns of Type II colour vision loss. Simple regression analysis of neuropsychological test performance with respect to colour vision loss, using age-adjusted Z-scores, revealed significant relationships (p less than or equal to 0.05) solely for tests which rely heavily on the visual system. Significant differences in visual task test scores were also observed with the type of dyschromatopsia (Kruskal-Wallis, p less than or equal to 0.05). These findings suggest that poor performance on visual tasks and colour vision loss may both result from damage to neuro-ophthalmic pathways or that loss of integrity of the peripheral visual pathways may affect visual task performance. The authors propose that visual testing should be incorporated into neurobehavioural test batteries.

Adult↗
PubMed1985

Nursing home glaucoma and visual acuity screening results in western Oklahoma.

Six hundred and four patients from 19 nursing homes in rural western Oklahoma underwent visual acuity and glaucoma screening. Thirty-seven percent (221/604) had corrected near visual acuity less than or equal to 20/200 in one or both eyes. Fourty-nine percent (298/604) had best distance visual acuity less than or equal to 20/200 in one or both eyes. Improvement of distance visual acuity of two or more lines of vision by the use of pinhole viewing (indicating a possible need for glasses lens change) was helpful in only 12% (36/298) of patients with distance visual acuity less than or equal to 20/200. Fifteen percent (50/316) had intraocular pressure (Schiotz tonometry) greater than or equal to 24 mm hg. The incidence of significant visual acuity impairments and borderline-elevated glaucoma testing in the nursing home population is significantly higher than for a comparable general community vision and glaucoma screening of a more mobile and youthful population (Table 7). Eleven percent (66/604) were determined to have had an eye examination (ophthalmological or optometric) within the previous two years. Because potentially severe visual loss caused by cataracts, glaucoma, some forms of macular degeneration, and diabetic retinopathy may be reduced by timely medical or surgical eye treatment, the study suggests that many nursing home patients who might benefit from ophthalmologic care are currently not receiving it. Consideration, therefore, should be given for similar future screenings at other nursing home populations.

Adolescent↗
PubMed1998

Care of the premature infant: Part I. Monitoring growth and development.

When monitoring growth and development in the premature infant, physicians should make adjustments for the estimated due date. With minor exceptions, administration of immunizations is based on the chronologic age. Administration of hepatitis B vaccine should be delayed until the infant weighs 2,000 g (4 lb, 5 oz). Administration of influenza vaccine should be considered in infants with chronic medical problems, and the pneumococcal vaccine may be beneficial at age two in children with chronic problems, especially pulmonary disease. Premature infants should also be monitored to assure appropriate nutrition. Breast-fed infants should probably receive vitamin supplements during the first year. Supplemental iron should be initiated at two weeks to two months after birth and continued for 12 to 15 months. Office care includes screening for problems that occur more frequently in premature infants, especially vision and hearing problems. Because many of these infants require care from multiple medical disciplines, coordination of care is another important role for the family physician. The goals of this care are to promote normal growth and development and minimize morbidity and mortality.

Deficiency Diseases↗
PubMed2003

Blindness and vision impairment in a rural south Indian population: the Aravind Comprehensive Eye Survey.

OBJECTIVE: To determine the prevalence of blindness and vision impairment in a rural population of southern India. DESIGN: A population-based cross-sectional study. PARTICIPANTS: A total of 17200 subjects aged 6 years or older, including 5150 subjects aged 40 years or older from 50 clusters representative of three southern districts of Tamil Nadu in southern India. METHODS: All participants had preliminary screenings consisting of vision using a LogMAR illiterate E chart and anterior segment hand light examinations at the village level. Subjects aged 40 years or older were offered comprehensive eye examinations at the base hospital, including visual acuity using LogMAR illiterate E charts and refraction, slit-lamp biomicroscopy, gonioscopy, applanation tonometry, dilated fundus examinations, and automated Humphrey central 24-2 full threshold perimetry; subjects younger than 40 years of age who had any signs or symptoms of ocular disease were also offered comparable examinations at the base hospital. MAIN OUTCOME MEASURES: Visual impairment was defined as best-corrected visual acuity <6/18, and blindness was defined using both Indian (<6/60) and World Health Organization (<3/60) definitions. RESULTS: Comprehensive examinations at the base hospital were performed on 5150 (96.5%) of 5337 persons 40 years of age or older. Among those 40 years of age and older, presenting visual acuity at the <3/60 level was present in 4.3% (95% confidence interval [CI]: 3.8, 4.9) and 11.4% (95% CI: 10.6, 12.3) at the <6/60 level. After best correction, the corresponding figures were 1.0% (95% CI: 0.79, 1.2) and 2.1% (95% CI: 1.7, 2.5). Over 70% of subjects improved their vision by at least one line, and nearly a third by three lines after refraction. Age-related cataract was the most common potentially reversible blinding disorder (72.0%) among eyes presenting with blindness. CONCLUSIONS: Blindness and vision impairment remain major public health problems in India that need to be addressed. Cataracts and refractive errors remain the major reversible causes for the burden of vision impairment in this rural population.

Adolescent↗
PubMed2004

Incorporating vision and hearing tests into aged care assessment: methods and the pilot study.

PURPOSE: Vision and hearing impairments are frequent in older people and may contribute to their reliance on aged care services. This study aims to assess whether incorporating vision and hearing screening into routine aged care assessments and provision of appropriate health care services will influence health outcomes of older individuals. METHODS: The proposed project is a 2 x 2 factorial design randomized controlled trial. The pilot study recruited 208 participants aged 65+ years attending an aged care assessment center at Westmead Hospital, Sydney, who were randomly allocated to one of four groups: vision and hearing tests, vision tests only, hearing tests only, or neither. Face-to-face interviews with all participants were conducted. Questionnaires included Activity of Daily Living (ADL), 36-item Short-Form health survey (SF-36), Mini-Mental State Exam (MMSE) and questions about use of health care and community support services. Participants will be re-examined after 12 months to assess changes over time in quality-of-life, physical and cognitive function, incident falls and use of health and community aged care services.

Aged↗
PubMed1988

Predicting problems in school performance from preschool health, developmental and behavioural assessments.

To determine the accuracy of various predictors of school problems, we conducted a 3-year prospective study of 1999 children who began school in the Niagara region of Ontario in 1980. During the year before school entry the parents gave a health, developmental and behavioural history during an interview with a community health nurse, and the children underwent vision and hearing screening tests and the Denver Developmental Screening Test (DDST). At the end of the 1980-81 school year the kindergarten teachers rated the children's learning problems. At the end of the 1982-83 school year the presence of school problems was ascertained, and the predictive accuracy of items from the preschool history and examination and of the kindergarten teachers' ratings was calculated. The health, developmental and behavioural history with or without the DDST was found to predict later school problems with acceptable accuracy. The kindergarten teachers' ratings gave slightly more accurate predictions. We conclude that in communities where prompt diagnostic evaluation and effective therapeutic or preventive help can be provided to children identified as being at high risk, health professionals may play a useful role in screening for future school problems.

Age Factors↗