Visual acuity testability and comparability in Australian preschool children: the Sydney Paediatric Eye Disease Study

Purpose

To establish standardised protocols for vision screening, testability and comparability of three different vision tests were examined in a population-based, cross-sectional sample of preschool children (Sydney Paediatric Eye Disease Study).

Methods

Measurement of presenting monocular distance visual acuity (VA) using the Amblyopia Treatment Study (ATS) HOTV protocol, was attempted by all (1774) children aged≥24 months. In addition, in children aged≥60 months (576), VA was also tested using the logMAR retro-illuminated HOTV or Early Treatment Diabetic Retinopathy Study (ETDRS) linear charts (CSV 1000). Children able to have both eyes tested monocularly were considered.

Results

Testability significantly increased with age for all VA tests. The ATS HOTV with an overall testability of 80% (females: 82%, males: 78%) was the most testable of the VA tests (P<0.0001). In children aged <3 years testability was low (≤47%) rising to≥80% in children aged≥3. In children≥60 months, testability was higher for the HOTV (94%) than the ETDRS (59%) chart. In those that did two VA tests, mean difference of the ATS HOTV compared with the HOTV(CSV) was −0.1, and compared with ETDRS was −0.12 (P<0.0001).

Conclusions

Children aged <3 years had poor VA testability, whereas those 3 years and above were highly testable using the ATS HOTV. The HOTV (CSV) retro-illuminated test was appropriate for children aged >5 years, and may be possible in younger children with early educational exposure. When comparing VA measures using these tests, the higher VA attained using the ATS HOTV, needs to be taken into account.     

免散瞳眼底照相技术在学龄前儿童眼底病筛查中的应用

目的：观察免散瞳眼底照相机在检查中所见的学龄前儿童眼底病变的发病情况,并与直接检影镜检查结果进行对比分析。方法：收集2012-04/2013-10来我院眼科门诊就诊的学龄前儿童3 896例7 760眼,采用日本 Topcon TRC-NW300彩色荧光眼底照相机拍照,图像及时保存,并进行直接检影镜检查。结果：免散瞳眼底照相技术的检出率较直接检影镜高。3 896例7 760眼患儿中,检出41眼（1.05%）眼底异常者。其中视网膜有髓鞘神经纤维（24.39%）、牵牛花综合征（21.95%）、视网膜色素变性（14.63%）、先天性视网膜劈裂（12.20%）; 而儿童眼病非单一发生,常伴有视力异常（68.30%）、屈光异常（63.41%）、斜视（19.51%）。结论：免散瞳眼底照相技术具有不用药物散瞳,学龄前儿童易于接受,图像结果即刻显示,能够直观、清晰显示眼底各种病变,对学龄前儿童眼病筛查有重要意义。     

儿童眼外伤分析

目的：研究儿童眼外伤及其有关特点。方法：对连续1265例儿童眼外伤进行常规临床检查诊断治疗和调查登记。每例选取临床资料数据80多项代码输入眼外伤数据库，用计算机管理系统分类统计分析。结果：儿童眼外伤有其特点；眼部伤情重，合并症多；致盲率高。治疗难度大；伤后单眼盲目率62.1%(714/1150眼）。双眼伤致盲率为60.0%(69/115例），单眼盲是双眼盲的10倍（外伤后）至22倍（治疗后）等等。结论：儿童眼外伤是主要致盲原因之一并终生痛苦。给个人家庭社会和国家造成的负担沉重，应作为防盲治盲的重点，本文提出3条临床医疗经验和预防措施设想。     

Amblyopia in astigmatic preschool children

Best-corrected acuity was measured for vertical and horizontal gratings and for recognition acuity optotypes (Lea Symbols) in a group of three- to five-year-old children with a high prevalence of astigmatism. Results showed meridional amblyopia (MA) among children with simple/compound myopic or mixed astigmatism, due to reduced acuity for horizontal gratings. Children with simple/compound hyperopic astigmatism showed no MA, but did show reduced acuity for both grating orientations. Reduced best-corrected recognition acuity was shown by both myopic/mixed and hyperopic astigmats. These results suggest that optical correction of astigmatism should be provided prior to age three to five years, to prevent development of amblyopia.     

Eye injuries in children: the current picture

AIMS: To investigate the current causes and outcomes of paediatric ocular trauma. METHODS: A prospective observational study of all children admitted to hospital with ocular trauma in Scotland over a 1 year period. RESULTS: The commonest mechanism of injury was blunt trauma, accounting for 65% of the total. 60% of the patients were admitted with a hyphaema. Injuries necessitating admission occurred most frequently at home (51%). Sporting activities were the commonest cause of injury in the 5-14 age group. There were no injuries caused by road traffic accidents or fireworks. Patients were admitted to hospital for a mean of 4.2 days (range 1-25 days). One (1%) child had an acuity in the "visually impaired" range (6/18-6/60) and one (1%) was "blind" (6/60) in the affected eye. No child was bilaterally blinded by injury and none required blind or partial sight registration. CONCLUSION: This study has shown that the incidence of eye injuries affecting children has fallen. The outcome of ocular trauma has improved significantly, and for the first time paediatric injuries appear to have a better prognosis than injuries affecting adults.     

Eye injuries in children.

We report a retrospective study of children's eye injuries treated during 1977 at Helsinki University Eye Hospital. There were 110 cases representing 34.5% of all eye injuries and 3% of all patients treated in 1977; 81.8% were boys and 18.2% girls. Half of the injuries were caused by another child, one-third were self-inflicted, and the rest were other accidents. The risk of eye injury in girls was low and stable at all ages, but in boys the risk grew markedly at the age of 8 years. The commonest cause of injury was a thrown missile. Other important causes were shots, hits, and sports accidents. Two-thirds of the injuries were concussions. The proportion of perforation was 8.9%, which is a much lower figure than in earlier reports, suggesting that the injuries have become milder. Some kind of complication was seen in 16% of concussions. No secondary bleeding was found among them. Permanent impairment of vision was seen in 2 cases: one had a visual acuity of 0.1 because of traumatic cataract and the other 0.6 because of corneal scars. Although the number of perforations was too low for statistical analysis, the final result in this group suggests that the prognosis of perforating eye injury is still as bad as it was during the 1950s.     

Keratoplasty for keratomalacia in preschool children

AIM: To study the results of surgical management of keratomalacia in children. METHODS: A clinical case series of all children with keratomalacia, admitted to an Indian centre during the period from June 2000 to June 2001 is presented. The parameters evaluated were demographic data, systemic associations, and results of medical and surgical intervention. RESULTS: 29 children with keratomalacia ranging from 2 months to 5 years of age (mean 1.8 (SD 1.4) years) were included in the study. All children belonged to families of lower socioeconomic status. 27 patients (93.1%) had not been immunised at all. The systemic diseases precipitating the onset of keratomalacia included measles (41.37%), pneumonia (31.03%), and acute diarrhoea (37.93%). 36 eyes (66.7%) had total corneal melting and 11 (20.3%) eyes had paracentral corneal melting. In 15 eyes (27.8%) an emergency tectonic penetrating keratoplasty was performed of which only five grafts (33.3%) remained clear at a mean follow up of 7.3 (6.8) months (range 3-24 months). Seven eyes underwent optical penetrating keratoplasty, of which four grafts (57.14%) remained clear at a mean follow up of 6.4 (3.6) months (range 3-12 months). None of these could achieve a visual acuity better than 6/60. CONCLUSIONS: Corneal grafting surgery in keratomalacia is associated with poor visual outcome.     

Use of interferometry in preschool children

Any procedure that can help to predict the outcome of treatment for a vision disorder is a desired clinical goal. Interferometry has shown such an ability for predicting the post-treatment visual acuities in amblyopia and other vision disorders. In this study, we investigated the effectiveness of using interferometry with preschool children, aged 3-5 years. We determined that they can be reliably tested in 5-10 minutes using a non-verbal, forced choice technique. Due to developmental differences, the 3-year-olds needed slightly more time to test and were more variable in their responses than the 4-years-olds. Overall, the prognostic value of interferometer visual acuity measures should be considered for use in preschool children with visual acuity disorders, e.g., amblyopia.     

学龄前儿童视觉发育的研究进展

了解学龄前儿童视觉发育特点及视功能检查方法，及时发现患儿视功能障碍，掌握最佳治疗时机。视功能检测大体可分为两类：一种为心理物理方法，另一种为客观检查法。①学龄前儿童视力检测分为定性和定量检查或电生理方法[如视觉诱发电位（visual evoked potential，VEP）]等。②对立体视的检查方法有Titmus偏振光立体图、颜少明立体视脸查图及随机点立体图、计算机立体觉检测和视差诱发电位（disparity evoked potentials，DEP）检测法等。③分析综述国内外常见眼病如斜视、弱视的最新动向和研究现状。学龄前儿童视觉发育具有规律性和特殊性，采用适合于各年龄段视觉功能检测手段进行筛查和检查，才能真正落实早期发现和早期干预，提高儿童眼病的防治水平。