MTI摄影筛查仪筛查婴幼儿斜视和屈光不正分析

目的 探讨MTI摄影筛查仪在眼科门诊对婴幼儿进行斜视和屈光不正筛查的价值。方法 对门诊的226例婴幼儿进行了筛查，阳性结果的病例再进行眼科常规检查，二者进行对比。结果 儿童合作率为100％，筛查结果异常率达22．84％，其中屈光不正占16．99％，斜视占5．75％。预测阳性率分别为斜视100％、远视100％、近视76．92％、散光88．88％、屈光参差87．50％。结论 MTI摄影筛查仪对婴幼儿斜视和屈光不正有很高的预测阳性率，它与眼科常规检查的结合可以提高防治弱视的效率。     

新生儿眼病筛查的技术探讨

目的研究新生儿眼病筛查模式,对新生儿眼病筛查技术进行探讨。方法通过对光刺激反应,外眼检查,红光反射及眼底检查对2002．03．04至2005．04．02济南市妇幼保健院出生的新生儿进行眼病筛查,初筛通过者进入正常儿童保健查体程序,未通过筛查,确诊有眼病的新生儿,对其进行干预或治疗,对于可疑病例进行复筛。结果共筛查了18478人,筛查率为88．8%,筛查总通过率84．5%,初筛眼病检出率11．9%,47例新生儿因病情比较复杂转入专业眼科治疗。结论新生儿眼病筛查的顺利开展需要合理的筛查程序及眼科、新生儿科和儿童保健知识的熟练掌握及有效配合。     

数码摄影验光法在儿童眼病与屈光异常普查中的应用

目的 探讨自行设计的数码摄影验光系统在儿童眼病和屈光异常诊治中的可行性和可靠性。方法 使用特殊光路设计的数码摄影系统对120例7个月到71个月的儿童进行视力筛查,使用计算机图像处理系统分析图片得出结果,与临床检查和阿托品眼膏散瞳验光结果对比,并以标准分析法进行评估。结果 数码摄影验光系统视力筛查在远视、近视、散光、屈光参差及斜视的灵敏度分别为87．62％、93．94％、80．77％、84．62％、91．67％;特异度分别为96．80％、97．46％、96．71％、99．07％、100％。结论 数码摄影验光系统视力筛查是一种安全、快速、经济、有效的儿童眼病筛查方法。较常规检查能更早地发现儿童眼病及屈光异常。     

儿童眼部肿瘤52例临床分析

儿童眼部肿瘤５２例临床分析朱英朱琴儿童眼部肿瘤有其特点，我院自１９７０年～１９９４年共收治儿童眼部肿瘤５２例，为同期眼科住院病人的０９７％，占眼部肿瘤患者中住院治疗的３７４１％，占儿童眼病住院病人的９０％。现将经手术及组织病理学证实的５２例病例...     

印度成人对于儿童眼保健的认识及贫困因素对其的影响

目的：探讨印度金奈地区成人对于儿童视力筛查的认识以及贫困因素对其的影响。
　　方法：此研究采用为期4wk的现况研究方法,于2012－12在印度金奈市及周边社会经济发展水平较低的地区,随机选取参加拓展营的个体作为研究对象。在接受了免费的视力筛查之后,与他们进行了一个简短的半结构性面谈。每隔两位选取一位受访者在一开始就被问及是否有儿童居住在他们住宅区,回答肯定者则纳入此项研究。
　　结果：本研究共纳入120人,其中38％（95％CI：30～47）的人指出在他们住宅区内至少有一名儿童先前接受过眼部检查（组1）,62％（95％CI：53～70）的参与者表示无儿童曾经接受过眼科检查（组2）。采用简单贫困记分卡方法测量两组贫困比分并无统计学差异。
　　结论：据不到半数的参与者回忆,他们的孩子之前曾接受过眼部检查。在贫困比分上,确认之前曾接受过眼部检查的参与者与没有接受过眼科检查的参与者之间无统计学差异。与孩子从未接受过眼科检查的参与者相比,那些孩子接受过眼部检查的参与者对该检查抱有更积极的态度。研究表明,成人对于孩子接受眼部检查重要性的认识不受贫困程度的影响,提高成人对于儿童接受眼部检查的认识可能需要更多的干预措施而不是扶贫。     

孟加拉吉大港区学龄前儿童眼病发生率研究

目的:研究吉大港区学龄前儿童的眼病发生率情况.方法:随机横断面抽样调查,研究孟加拉吉大港区学龄前儿童的眼病发生率.对60所托儿所4～6岁学龄前儿童进行记录,走访且检查眼睛.根据性别、年龄、视力障碍和眼部疾病的诱因,分析所获得的数据.结果:对60所托儿所共计900例学龄前儿童进行检查,其中男性儿童占52.6％,女性儿童占47.4％.年龄范围为4～6岁不等.平均年龄为5.47 ±0.64.在学龄前儿童中,眼病发生率为16.89％,通常疾病为7.66％儿童存在屈光不正,其次3.66％患结膜炎,2.77％患睑缘炎,1.66％患鼻泪管阻塞(NDO),0.88％患感染性结膜炎,0.33％患麦粒肿,0.44％患睑板腺囊肿.其中1.11％患弱视,0.77％患斜视,0.11％患发育性白内障,0.33％患角膜混浊,是一个值得关注的问题.结论:研究学龄前儿童的眼病发生率可以很容易地确定可持续视力筛查方案,如果及时采取治疗能够有效降低眼部疾病的患病率和视力障碍.目前的研究表明,未对屈光不正进行矫正是学龄前儿童视力障碍的主要原因.     

早产儿眼病的特征分析

目的分析早产儿眼病特征及其发病情况。方法以562例早产儿为筛查对象,筛查内容包括视觉评估、外眼检查、直接检眼镜和间接检眼镜检查,必要时行视觉诱发电位（VEP）、眼科B型超声、头颅MRI等辅助检查。结果在562例早产儿中,检出眼病11种,共93例（16．5％）,其中视网膜脉络膜病变52例（9．8％）,包括早产儿视网膜病变（ROP）51例（9．07％）和视网膜出血1例（0．18％）;视神经及视路病变16例（3．02％）,包括视盘缺损1例（0．18％）、视神经萎缩6例（1．1％）、视路及视皮质病变9例（1．6％）;眼前节疾病12例（2．14％）,包括先天性白内障8例（1．4％）、先天性青光眼2例（0．36％）、先天性虹膜缺损1例（0．18％）、淋球菌性结膜炎1例（0．18％）;外眼病变5例（0．9％）,包括新生儿泪囊炎3例（0．54％）、上睑下垂2例（0．36％）;原因不明的视力异常8例。B型超声提示ROP合并视网膜脱离者8例,玻璃体出血者1例。头颅MRI提示缺血缺氧性脑病138例、颅内出血21例、脑积水5例、蛛网膜下腔出血1例、先天性大脑发育不良1例。结论早产儿以ROP、视神经病变、视路及视皮质病变、先天性白内障为主,同时有多种散发的眼科病。常规的早期眼科筛查对早产儿眼病的防治十分必要。     

第六届全国儿童视觉发育与眼病防治新进展大会暨早产儿视网膜病变筛查实用技术学习班通知

为了更好地开展儿童眼病的早期筛查,提升儿童眼病防治的诊疗技术水平,贯彻落实国家在儿童眼保健领域的新举措,由中华预防医学会儿童保健分会视觉保健学组、中国斜视与小儿眼科杂志社联合主办,广州市儿童眼科学会与广州市妇女儿童医疗中心承办的“儿童眼病防治新进展研讨会与早产儿视网膜病变筛查实用技术学习班”将于2014年5月16～18日在美丽的羊城广州举办。     

千例儿童眼病中555例眼外伤分析

目的：探索儿童眼外伤发生、发展及转归的特殊规律。方法：统计眼科11年中3月至15入院儿童病例,并眼眼外伤病人进行.分批:和童眼病1106例,眼外伤555例占50．18％,主要为眼球穿孔伤257例占46．31％,外伤性白内障138例占24．86％,儿童白内障人工晶状体植入术后主要并发症为后囊浑浊及晶状体前纤维膜形成,发生率为19．51％,结论眼外伤居儿童眼病之首位,减少眼外伤是降低儿童眼病发病率的关键。儿童白内障人工晶状体植入术后葡萄膜炎症反就及纤维膜形成明显高于成人。     

全国儿童眼病防治新进展研讨会与早产儿视网膜病变筛查实用技术学习班通知（第一轮）

为了更好地开展弱视斜视等影响儿童视觉发育的眼病的早期筛查,提高弱视斜视等儿童眼病早期治疗水平,贯彻落实国家在儿童眼保健领域的新举措,由中华预防医学会儿童保健分会视觉保健学组、中国斜视与小儿眼科杂志联合主办,广州市儿童眼科学会与广州市妇女儿童医疗中心承办的“儿童眼病防治新进展研讨会与早产儿视网膜病变筛查实用技术学习班”将于;2014年5月中下旬在美丽的羊城广州举办。     

Time of onset of uveitis in children with juvenile rheumatoid arthritis

BACKGROUND: Recently, it has been advocated to decrease the frequency of eye examinations to screen for uveitis in children with juvenile rheumatoid arthritis (JRA) because of the low yield of positive findings after an initial normal eye examination.This study was undertaken to determine the time interval for the development of uveitis after the diagnosis of JRA and to further describe patients who develop uveitis related to JRA. METHODS: This was a retrospective chart review of all patients with JRA examined by either of 2 pediatric ophthalmologists from August 1984 to June 2001. All patients were also under the care of the Pediatric Rheumatology Division at Schneider Children's Hospital. Age of diagnosis of JRA, disease onset subtype of JRA, antinuclear antibody titers, age of diagnosis of uveitis, and complications from uveitis were recorded. RESULTS: One hundred fifty eight patients with JRA had eye examinations; 39 (25%) developed uveitis. Sixteen patients had uveitis on the initial eye examination, and 23 subsequently developed uveitis. When uveitis was absent at the initial eye examination, the mean time to develop it was 20 months (range, 4-81 months). CONCLUSIONS: A normal initial eye examination does not preclude the development of uveitis in patients with JRA. We recommend continuing the current standards of ophthalmologic examinations to screen for uveitis in children with JRA as prescribed by the Section on Rheumatology and Ophthalmology of the American Academy of Pediatrics.     

Early screening for amblyogenic risk factors lowers the prevalence and severity of amblyopia.

PURPOSE: To evaluate the efficacy of a mass screening program for amblyopia and amblyogenic risk factors in infants. METHODS: Since 1968, children between the ages of 1 and 2(1/2) years in the city of Haifa, Israel, have been systematically screened for amblyopia and amblyogenic risk factors. The screening is performed by the Ophthalmology Department of Bnai-Zion Medical Center (formerly known as Rothchild Hospital). In 1995, we compared the prevalence and severity of amblyopia in two populations of 8-year-old children in elementary school: one group was a cohort of 808 children from the city of Haifa and its vicinity, who had been screened in infancy (between 1988 and 1990); and the second group, the control group, was a cohort of 782 children from Hadera and its vicinity, where this early screening program is not conducted. Amblyopia was defined as corrected visual acuity of < or =5/10 (20/40), or >1 line difference in corrected visual acuity between the two eyes. Referral rate, treatment rate, sensitivity, specificity, and positive predictive value and negative predictive value of the screening test in detecting factors that later resulted in the development of amblyopia were examined. RESULTS: The prevalence of amblyopia in the 8-year-old population screened in infancy was found to be 1.0% compared with 2.6% in the 8-year-old population that had not been screened in infancy (P =.0098). The prevalence of amblyopia with visual acuity of < or =5/15 (20/60) in the amblyopic eye was 0.1% in the screened population compared with 1.7% in the non-screened population (P =.00026). In the screened infant population, 3.6% were referred from the screening examination to a confirmatory examination and 2.2% were treated. The screening examination had a sensitivity of 85.7% and a specificity of 98.6% for amblyopia. The positive predictive value of the screening examination was 62.1% and the negative predictive value was 99.6%. CONCLUSIONS: The screening program for amblyopia and amblyogenic risk factors in infants, followed by appropriate treatment, is effective in significantly reducing the prevalence and severity of amblyopia in children.     

Predictive value of photoscreening and traditional screening of preschool children.

PURPOSE: To compare the usefulness of traditional vision screening and photoscreening of 3- and 4-year-old children in the pediatrician's office. METHODS: Following training of pediatricians and office staff, six pediatric clinics used both the MTI PhotoScreener (Medical Technology Industries, LLC, Riviera Beach, FL) and traditional acuity and stereopsis screening materials (HOTV charts/Random Dot E tests as recommended by established AAP-MCHB-PUPVS guidelines) during well-child exams. Clinics used one testing method for a 6-month period and switched to the other for the following 6 months, in a randomized manner. Referred children received a complete eye examination with cycloplegic refraction by local ophthalmologists or optometrists who forwarded the results to Vanderbilt Ophthalmology Outreach Center. Amblyogenic factors were defined using standardized published criteria. RESULTS: Six hundred five children were screened with the photoscreener and 447 were screened with traditional techniques. Mean time for screening was less with the photoscreener: 2.5 versus 5.9 minutes ( P < 0.01). Untestable rates were similar (18% vs 10%, respectively P = NS), but higher with the photoscreener due to one clinic's 70% unreadable rate. Referral rates were also similar: 3.8% versus 4.5%. The positive predictive value (PPV) rate differed greatly. With follow-up results obtained from 56% of referred children, 73% of photoscreening referred children (8/11 examined) had amblyogenic factors confirmed on formal eye exams, whereas all children referred using traditional screening methods (10/10 examined) were normal. CONCLUSION: Photoscreening is more time efficient than traditional screening and has a significantly higher PPV in 3- and 4-year-old children. This study was unable to validate traditional screening techniques in this preschool age group. If these results can be replicated, support for traditional vision screening must undergo intense scrutiny, and attention should be turned toward making photoscreening feasible for widespread implementation.     

SpotTM视觉筛查仪在儿童斜视筛查中的应用

目的：探讨SpotTM在儿童斜视筛查中的可配合性及在斜视性弱视危险因素筛查中的筛查效率。方法：横断面研究。2015 年7-10 月在天津和平新世纪妇儿医院保健科体检的389 例儿童先后进行SpotTM及小儿眼科医师检查,依据SpotTM内设眼位异常推荐值确定出需要转诊的儿童,小儿眼科医师依据2013 年美国斜视与小儿眼科协会规定的视觉筛查转诊指南确定出具有斜视性弱视危险因素的儿童,最终评估SpotTM在斜视性弱视危险因素筛查中的敏感度、特异度、阳性预测值及阴性预测值。结果：389 例儿童入组,平均年龄（6.0±2.3）岁。97.4%的儿童能配合SpotTM检查,无法配合SpotTM检查直接转诊的10例儿童中7例患有眼部疾病。小儿眼科医师确定38例（9.8%）具有斜视性弱视危险因素;经SpotTM筛查,确定需转诊的眼位异常者49 例（12.6%）。SpotTM在斜视性弱视危险因素筛查中敏感度71.0%,特异度93.7%,阳性预测值55.3%,阴性预测值96.8%。结论：大多数儿童可配合SpotTM的检查,SpotTM在斜视性弱视危险因素的筛查中具有一定的临床应用价值。     

Validation of Peek Acuity application in pediatric screening programs in Paraguay

AIM: To validate the Peek Acuity mobile phone application in pediatric populations and compare its utility, both economic and diagnostic, against conventional screening methods using a pediatric ophthalmologist examination as the gold standard. METHODS: A cohort of 393 subjects from Fernando de la Mora, Paraguay (ages 6-16y) were enrolled in the study. Subjects were randomly assigned a starting screening modality among: Peek Acuity, a single line of tumbling E optotypes set at 20/40, and Spot Vision Screener. Once completing the first screening modality, the subjects completed the two remaining techniques. Referral criteria were established based on the most current American Association of Pediatric Ophthalmology and Strabismus (AAPOS) recommendations: 20/40 for Peek Acuity and the tumbling E, and refractive error detection for the Spot Vision Screener. Subjects that failed to achieve the cut-off for any of the three screening techniques or subjects that passed the screening but were randomly selected to perform a comprehensive eye exam to determine the false negative rate, were evaluated by a pediatric ophthalmologist. This evaluation was considered the gold standard, and included vision assessment by a Snellen chart, strabismus evaluation, and cycloplegic refraction with dilated fundoscopy. RESULTS: We obtained 48% sensitivity, 83% specificity, 43% positive predictive value, and 86% negative predictive value for Peek Acuity''s ability to refer compared to evaluation by a pediatric ophthalmologist, failing to achieve a desired sensitivity for implementation. Peek Acuity trended to overestimate the subject''s visual acuity, providing a higher visual acuity that would not indicate referral for a comprehensive eye examination. However, its high specificity accurately predicted a significant number of children who did not need further evaluation. When comparing the three screening methods, no single screening modality outperformed the others. Peek Acuity represented a technology that was economically feasible compared to other screening modalities in low income settings, due to the prevalence of cell phone use. CONCLUSION: Peek Acuity represents an efficient tool that has potential for implementation in school screenings with different strategies aimed at pediatric populations due to its low cost and high specificity. An increase in sensitivity would improve detection of children with refractive errors.     

Retcam3系统筛查ROP患儿检出情况及与眼压变化的关系

目的:探讨眼科广域数字成像系统(Retcam3)筛查早产儿视网膜病变(ROP)的能力及与眼压变化的关系。方法:选取2017-08/2019-08我院收治的80例符合筛查标准的早产儿为研究对象,分别采用双目间接检眼镜和Retcam3系统检查,以前者检查结果为金标准,统计Retcam3系统筛查的灵敏度、特异度、阳性和阴性预测值,同时比较筛查前后患儿眼压变化情况。结果:双目间接检眼镜检查ROP患儿37例69眼,Retcam3系统筛查ROP患儿35例65眼,Retcam3检查灵敏度为100%,特异度为95.8%,阳性预测值为94.2%,阴性预测值为100%。Retcam3筛查后左眼和右眼眼压均高于散瞳前(P<0.05)。结论:Retcam3系统能较为准确地筛查ROP患者,但筛查后可引起眼压升高。     

Screening for refractive errors in children: accuracy of the hand held refractor Retinomax to screen for astigmatism

AIMS: To assess the reliability of the hand held automated refractor Retinomax in measuring astigmatism in non-cycloplegic conditions. To assess the accuracy of Retinomax in diagnosing abnormal astigmatism in non-cycloplegic refractive screening of children between 9 and 36 months. METHODS: Among 1205 children undergoing a non-cycloplegic refractive screening with Retinomax, 299 (25%) had repeated non-cycloplegic measurements, 302 (25%) were refracted under cycloplegia using the same refractor, and 88 (7%) using retinoscopy or an automated on table refractor. The reproducibility of non-cycloplegic cylinder measurement was assessed by comparing the cylindrical power and axis values in the 299 repeated measurements without cycloplegia. The influence of the quick mode on cylinder measurement was analysed by comparing the cylinder and axis value in 93 repeated measurements without cycloplegia where normal mode was used in one measurement and quick mode in the other. Predictive values of the refractive screening were calculated for three different thresholds of manifest astigmatism (> or = 1.5, > or = 1.75, and > or = 2 D) considering as a true positive case an astigmatism > or = 2 D under cycloplegic condition (measured by retinoscopy, on table, or hand held refractor). RESULTS: The 95% limits of agreement between two repeated manifest cylinder measurements with Retinomax attained levels slightly less than plus or minus 1 D. The 95% limits of agreement for the axis were plus or minus 46 degrees. The comparison of non-cycloplegic measurements in the quick and normal mode showed no significant difference and 95% limits of agreement plus or minus 0.75 D. The mean difference between non-cycloplegic and cycloplegic cylinder values measured by Retinomax reached 0.17 D and was statistically significant. Manifest thresholds of > or = 1.5 D, > or = 1.75 D, > or = 2 D cylinder value diagnosed 2 D of astigmatism under cyclplegia respectively with 71-84%, 59-80%, 51-54% of sensitivity (right eye-left eye) and 90-92%, 95%, 98% of specificity. CONCLUSION: Without cycloplegia, Retinomax is able to measure cylinder power with the same reproducibility as cycloplegic retinoscopy. No significant difference was found in the cylinder values obtained with the quick and the normal modes. Therefore, the quick mode of measurement is recommended as it is more feasible in children. No difference, which is significant from a screening point of view, exists between the non-cycloplegic and the cycloplegic cylinder value (< 0.25 D). Retinomax diagnoses abnormal astigmatism (> or = 2 D) in a non-cycloplegic refractive screening at preschool ages with 51-84% sensitivity rates and 98-90% specificity rates, depending on the chosen threshold of manifest astigmatism. If 2 D of manifest astigmatism is chosen as a positive test, the positive predictive value of the screening reaches 81-84% and the negative predictive value 91-90% (right eye-left eye).     

Photoscreening for amblyogenic factors by public health personnel: the Eyecor Camera System

OBJECTIVES. This pilot study was designed to assess the ability of a photoscreening camera to detect amblyogenic factors such as high refractive error, anisometropia, media opacities and strabismus in children, compared to the standard vision screening techniques employed by the local state public health screening personnel. METHODS. Public health personnel in Illinois used the Eyecor prototype to the current commercially available MTI PS-100 photoscreening camera (manufactured by Medical Technology Inc.) to screen 127 non-dilated subjects, ages 7 months to 20 years (mean age, 6 years), for amblyogenic factors. All participants were concurrently subjected to the "standard" vision screening employed routinely by state public health personnel. The study participants included a group of normal inner-city children and one group of special-needs children. The normal children came from both a public school and a private school. The special-needs children included a group of children from a state-run school for the deaf and hard-of-hearing and a separate group of children attending a multi-disciplinary Easter Seals clinic. RESULTS. In the population of normal children, the mean sensitivity and specificity for the observers using the Eyecor Camera system was 81% and 83% with a mean positive predictive value of 83%, and a mean negative predictive value of 55%. Standard vision screening techniques employed by public health service certified vision screeners had a sensitivity of 88%, a specificity of 91%, a positive predictive value of 67% and a negative predictive value of 97% in the same subjects. In the population of special-needs children with hearing impairment and developmental delay, the mean sensitivity and specificity for the observers using the Eyecor Camera system was 74% and 82% with a mean positive predictive value of 69% and a mean negative predictive value of 85%. Standard vision screening techniques employed by public health service certified vision screeners had a sensitivity of 100%, a specificity of 55%, a positive predictive value of 62% and a negative predictive value of 100% in the same subjects. (See Table 1) CONCLUSIONS. This study shows that the Eyecor Photoscreening Camera is useful in screening normal children for amblyogenic factors. Photoscreening was at least as effective as standard screening methodologies performed by certified vision screeners as required by state public health policy. In addition, photoscreening is particularly useful in testing those children "unscreenable" by conventional vision screening procedures.     

Field evaluation of the Welch Allyn SureSight vision screener: incorporating the vision in preschoolers study recommendations.

INTRODUCTION: The prospective Vision in Preschoolers (VIP) study evaluated 11 methods of screening and proposed referral criteria for the Welch Allyn SureSight(trade mark) Vision Screener with 90% and 94% specificity. The SureSight had a higher sensitivity than most other screening techniques when these criteria were applied. We evaluated the usefulness of these criteria in a field study of healthy preschool children. METHODS: The SureSight software was altered to recommend referral using the VIP referral criteria with 90% specificity. Lions Club volunteers screened preschool children throughout Tennessee. Referred children underwent comprehensive eye examinations with cycloplegic refraction. Examination failure criteria were based upon published standards. Reanalysis using the 94% specificity criteria was then performed. Outcomes included referral rate and positive predictive value. RESULTS: The SureSight was used to screen 4,733 children, and screening was successful in 99.7% of children. The referral rate using the 90% specificity criteria was 12.2%. Most children (73%) were referred for suspected astigmatism. The positive predictive value was 30%. Using the 94% specificity criteria from the VIP study decreased the referral rate to 7.9% and substantially decreased over referral for suspected astigmatism; however, several anisometropes went undetected. Higher specificity was achieved by raising astigmatism referral criteria to 2.2 diopters while leaving the anisometropia criteria unchanged. CONCLUSIONS: The SureSight can be used successfully for preschool screening in the field provided that criteria with high specificity are incorporated into the instrument's software program. Higher rates of positive predictive value can be achieved without jeopardizing sensitivity by raising astigmatism referral criteria to 2.2 diopters.