Negative predictive value of a population-based preschool vision screening program.

BACKGROUND: The Enhanced Vision Screening Program is a population-based vision screening program that has, at present, examined 59,782 children. Its main goal is to detect amblyopia, strabismus, and high refractive errors. An average of 11,910 4 1/2- to 5 1/2-year-old children are screened yearly. The current study determines the negative predictive value of the screening program: For a subject having passed the vision screening test, what is the probability of not having amblyopia, strabismus, or high refractive errors? METHODS: Of the 11,734 subjects who passed the vision screening, 200 were randomly chosen to undergo a strictly defined gold standard examination by an orthoptist and an ophthalmologist. RESULTS: Of the 200 randomly chosen subjects, 157 underwent the gold standard evaluation. The negative predictive value of the Enhanced Vision Screening Program was 97.6% for any potentially vision-threatening ocular condition. It was 98.7% if we considered only the visually significant ocular problems that the test was designed to detect. CONCLUSION: Because the negative predictive value of the Enhanced Vision Screening Program is not 100%, some children with amblyopia, strabismus, or refractive errors are missed. Occasionally, a rare, potentially vision-threatening condition may go undetected. Parents should be made aware of this when they receive the results of the vision screening.     

674例3~6岁视力低常儿童屈光状态分析

目的分析3~6岁视力低常儿童的屈光状态分布并探讨不同屈光类型与弱视发生的关系。方法描述性研究。对674例（1 348眼）3~6岁裸眼视力低于正常（3岁≤20/40,4岁≤20/32,5岁及以上≤20/25）儿童进行阿托品散瞳后验光检查屈光状态及矫正视力。分析不同年龄段、弱视眼和非弱视眼的屈光状态分布,不同年龄段屈光参差分布以及屈光参差与弱视发生的关系。不同年龄段屈光分布的构成比及弱视发生率比较采用卡方检验。结果视力低常儿童中屈光分布以远视为主,近视发生率较低;随着年龄增加,远视所占比例逐渐降低,近视所占比例逐渐增加,差异有统计学意义（χ²=99.7,P＜0.001）。弱视眼和非弱视眼屈光分布差异有统计学意义（χ²=20.1,P=0.01）;弱视眼中前3位屈光类型分别为复性远视散光（59.4%）、单纯远视散光（17.8%）和混合性散光（15.8%）,而单纯近视眼中无弱视发生。双眼等效球镜度差值≥1 D时容易引起屈光参差性弱视,并且弱视发生率随屈光参差程度增大而升高（χ²=62.9,P＜0.001）。结论学龄前视力低常儿童的屈光状态分布以远视为主,远视性屈光不正、散光、屈光参差等屈光异常更容易引起弱视的发生。     

Referral outcomes from a vision screening program for school-aged children

ObjectiveTo assess ocular diagnoses and follow-up patterns of children referred for a comprehensive eye examination after a school-based vision screening program.DesignRetrospective chart review.ParticipantsStudents in grades K–5 from the School District of Philadelphia public schools screened by The Wills Eye Vision Screening Program for Children between January 2014 and June 2015.MethodsChildren with subnormal best-corrected visual acuity or other ocular conditions were referred to the Wills Eye pediatric ophthalmology service. A social worker assisted parents/guardians of referred children in scheduling an appointment and navigating insurance/payment issues. Measured outcomes included demographic information, ocular diagnoses, treatments, and follow-up patterns.ResultsOf 10 726 children screened, 509 (5%) were referred for a follow-up eye examination. Of these 509 children, only 127 (25%) completed a referral eye examination with parental consent. Most children (58%) were diagnosed with more than one eye condition, including refractive error (76%), amblyopia (43%), strabismus (16%), and anisometropia (13%). Other conditions included macular hypoplasia, ptosis, and other congenital anomalies.ConclusionsThis program discovered and addressed potentially vision-threatening conditions in underserved children susceptible to amblyopia by offering social worker services and financial support to enable referred children to complete an eye examination. Contact by the social worker required consent. Obtaining such consent proved to be a barrier to connecting children with the recommended consultation.     

北京市海淀区2～3岁幼儿视力和屈光状态筛查结果分析

目的研究北京市海淀区2～3岁儿童远视力、屈光参考范围及异常转诊标准。方法横断面调查研究。通过整群抽样,对随机抽取到的24所海淀区幼儿园托班和小班的3 804名2～3岁儿童进行远视力和屈光度检查。远视力检查使用图形视力表,屈光度检查使用SureSight手持式自动验光仪在自然状态下进行。用中位数和四分位数[M（P25,P75）]描述远视力、球镜度和柱镜度的分布特征。分别将球镜度以每1.00 D、柱镜度以每0.50 D为一个区间各分为7组,观察各组视力分布情况,比较不同度数球镜度组或柱镜度组视力分布是否存在差异。以视力低于0.4为视力异常,比较不同屈光度组视力异常的发生率差异。根据视力不同分为视力正常组（≥0.6）、视力低常组（=0.5）、视力异常组（≤0.4）3组,比较不同视力组屈光异常的发生率。不同屈光度组视力分布的比较使用秩和检验,视力和屈光异常的发生率的比较使用卡方检验。结果3 378例儿童（6 756眼）获得完整视力和屈光度资料。2岁儿童视力为0.6（0.6,0.6）,3岁儿童为0.6（0.6,0.8）,3岁儿童视力明显优于2岁儿童,差异具有统计学意义（Z=-10.10,P<0.01）。2岁和3岁儿童视力参考值下限P5值为0.5。2岁儿童与3岁儿童比较无论球镜度还是柱镜度分布差异均无统计学意义（Z=-2.48、-2.10,P>0.05）。不同球镜度组间视力差异具有统计学意义（χ²=89.22,P<0.01）;-0.25～+0.75 D组视力优于总体样本（Z=1.66,P<0.05）;+1.00～+2.75 D组视力与总体样本比较差异无统计学意义（Z=0.44,P>0.05）;而+3.00D～组的视力低于总体样本（Z=3.53,P<0.01）。不同柱镜度组间视力差异具有统计学意义（χ²=373.73,P<0.01）;0.00～-1.50 D组视力分布与总体样本比较差异无统计学意义（Z=1.02,P>0.05）;当柱镜度等于或超过-1.75D时视力低于总体水平, 并且视力水平随散光度增高而降低,差异具有统计学意义（Z=3.31、4.73、4.97,P<0.01）。远视球镜度等于或高于3.00 D,柱镜度值大于等于1.75 D时视力异常率明显增高（χ²=142.20,P<0.01）。视力异常组屈光异常率亦显著增高（χ²=240.82,P<0.01）。结论对2～3岁儿童的进行屈光筛查,有助于及早发现弱视。远视球镜度等于或高于3.00 D,柱镜度值大于等于1.75 D为屈光异常转诊标准。     

Analysis of a community vision screening program

For 3 consecutive years a community vision screening program has been conducted on-site at the Walker Eye Clinic of the Indiana University (IU) School of Optometry. A group of 490 screened patients, including 86 who returned for comprehensive evaluation, was retrospectively studied for a variety of characteristics. It was determined that the typical participant was likely to be an adult female who learned of the screening program through the written media. She was likely to have had a previous vision examination but it probably took place 3 or more years earlier. She usually failed the vision screening for reasons of reduced visual acuity, a problem with binocularity or asthenopia. If she returned to the Walker Eye Clinic for a comprehensive examination, she was likely to do so within 5 months and would be found to have been accurately identified as being in need of vision care. The organization and implementation of this vision screening program are described, and its value as an educational tool for students of optometry and its technician program is discussed.     

Lea图形与HOTV字母视力表对3～4.5岁儿童视力检查的比较

目的:比较分析Lea图形与HOTV字母视力表在3~4.5岁学龄前儿童视力检查中的适用情况及视力发育情况。方法:采用调查研究,以随机顺序先后应用两种视力表对广州地区两所幼儿园共133例266眼进行视力检查,视力值及其差异均用logM AR记录方法表示。结果:Lea视力较HOTV视力总体可测率高(96.24%vs92.48%),但差异无统计学意义(P>0.05)。儿童单眼两种视力差异均无统计学意义(右眼t=0.517,P=0.606;左眼t=-0.618,P=0.538)。儿童左右眼之间的视力差异均无统计学意义(Lea视力表:t=0.638,P=0.525;HOTV视力表:t=-0.897,P=0.372)。男性儿童的两种视力均优于女性儿童,但差异无统计学意义(均P>0.05)。3岁、3.5岁、4岁、4.5岁四个年龄组单眼的两种视力检查结果显示,儿童的视力随年龄增长逐渐提高,但四个年龄组间Lea视力差异无统计学意义(右眼:F=2.662,P=0.052;左眼:F=1.850,P=0.143),HOTV视力差异具有统计学意义(右眼:F=4.518,P=0.005;左眼:F=3.893,P=0.011)。结论:两种视力表都适合于3~4.5岁学龄前儿童的视力筛查;3~4.5岁儿童单眼的两种视力结果相似;视力发育与眼别、性别均无关;年龄大于3岁的儿童基本都可以接受主观视力检查,且在学龄前早期主观视力发育较快。     

3～6岁视力低下儿童眼球生物学参数研究

目的 探讨3～6岁视力低下儿童眼球生物学参数特征。方法 回顾性研究。纳入2016年6月至2021年9月于西北妇女儿童医院眼科门诊首次就诊的3～6岁轻度远视性屈光不正儿童197人(197眼),排除眼部器质性病变,按有无视力低下分两组：视力低下组与视力正常组。睫状肌麻痹后检影验光记录球镜屈光度、柱镜屈光度及轴向、等效球镜度(SE)和最佳矫正远视力(BCDVA)。A型超声生物测量仪测量前房深度(ACD)、晶状体厚度(LT)、玻璃体腔深度(VCD)及眼轴长度(AL)。角膜地形图测量角膜平均屈光力(Km),计算角膜曲率半径(CR)及轴率比(AL/CR)。采用SPSS 23.0对数据进行统计学分析。结果 两组儿童年龄、等效球镜度及柱镜屈光度差异均无统计学意义(均为P>0.05)。与视力正常组相比较,视力低下组儿童LT、Km较高,VCD、AL较低,差异均有统计学意义(均为P<0.05),两组间ACD、AL/CR差异均无统计学意义(均为P>0.05)。视力低下组儿童SE与AL、VCD、AL/CR均呈负相关(r=-0.468、-0.448、-0.341,均为P<0.05),与Km...     

Effectiveness of a photoscreener in identifying undiagnosed unilateral amblyopia at vision screening of 3-year-old children in Japan

Japanese Journal of Ophthalmology - In Japan a basic preparatory ophthalmic examination is routinely performed for 3-year-old children. This study aimed to determine the value of incorporating a...     

Results of cataract extraction with IOL implantation in children aged 17 months to 8 years old

PURPOSE: To evaluate anatomical and functional results of cataract extraction and IOL implantation, together with posterior capsulectomy and anterior vitrectomy in children. MATERIALS AND METHODS: Cataract extraction and IOL implantation with posterior capsulectomy and anterior vitrectomy was performed in 32 eyes of children between 17 months and 8 years old. Patients were followed up for a mean period 36 months (from 6 months to 5.5 years). RESULTS: Good anatomical results were achieved in all, except 2 cases. One eye required removal of opacifications located posterior to the IOL In the second eye membrane from the anterior surface of the lens were excised. Final postoperative visual acuity in eyes with bilateral cataract was 0.59, whereas in unilateral cataract 0.25. Half of the children with bilateral cataract has significantly worse BCVA in one eye. CONCLUSIONS: Cataract extraction and IOL implantation with posterior capsulectomy and anterior vitrectomy in young children gives good anatomical results. Functional results are better in bilateral congenital cataract, comparing to unilateral cases. To achieve good functional results, visual rehabilitation is necessary.     

A near-vision chart for children aged 3-5 years old:new designs and clinical applications

AIM:To introduce a new near-vision chart for children aged 3-5 years old and its clinical applications.METHODS:The new near-vision chart which combined the Bailey-Lovie layout with a newly devised set of symmetry symbols was designed based on Weber-Fechner law. It consists of 15 rows of symmetry symbols, corresponding to a visual acuity range from 1.3 to 0.1 logMAR. The optotypes were red against a white background and were specially shaped four basic geometric symbols:circle, square, triangle,and cross, which matched the preschool children's cognitive level. A regular geometric progression of the optotype sizes and distribution was employed to arrange in 15 lines. The progression rate of the optotype size between two lines was 1.2589 and two smaller groups of optotypes ranging from 0.7 to -0.1 logMAR were included for repetitive testing. A near visual acuity was recorded in logMAR or decimal, and the testing distance was 25 cm.RESULTS:This new near-vision chart with pediatric acuity test optotypes which consists of 4 different symbols (triangle, square, cross, and circle) met the national and international eye chart design guidelines. When performing the near visual acuity assessment in preschoolers (3-5 years old). It overcame an inability to recognize the letters of the alphabet and difficulties in designating the direction of black abstract symbols such as the tumbling 'E' or Landolt 'C', which the subjects were prone to lose interest in. Near vision may be recorded in different notations:decimal acuity and logMAR. These two notations can be easily converted each other in the new near-vision chart. The measurements of this new chart not only showed a significant correlation and a good consistency with the Chinese national standard logarithmic near-vision chart (r=0.932, P<0.01), but also indicated good test-retest reliability (89% of retest scores were within 0.1 logMAR units of the initial test score) and a high response rate.CONCLUSION:The results of this study support the validity and reliability of near visual acuity measurements using the new near-vision chart in children aged 3-5y over a wide range of visual acuities, and the new eye chart was especially suitable for the detection of amblyopia risk factors and low vision examination in children (3-5y of age). It can be applied in routine clinical practice.     

锦州市3～6周岁儿童屈光状态筛查及相关因素分析

目的：调查锦州市3～6周岁儿童的双眼屈光状态,分析相关影响因素,为屈光不正的防治提供依据。

方法：采用整群随机抽样法抽取锦州市30所幼儿园2 848名学龄前儿童,应用美国伟伦公司生产的SureSight视力筛查仪进行屈光检查,并向受检者家长发放问卷调查表进行相关因素的调查,对调查结果进行统计学分析。

结果：学龄前儿童2 848名参与调查,2 565人合格完成问卷调查表,完成率90.06%,整体屈光异常检出率为18.13%,屈光异常检出率四个年龄组分别为：11.84%,16.28%,20.72%,25.62%,趋势χ²检验(χ²=47.085,P<0.01),表明屈光异常检出率有随年龄增加而增高的趋势。屈光异常检出率男童21.83%、女童13.54%,差异有统计学意义(χ²=29.378,P<0.01)。经非条件Logistic回归分析,父、母文化程度、母亲生育年龄、早产、出生有窒息史、出生体质量、父亲屈光状态、近距离用眼时间、少吃蔬菜水果等因素的OR值分别为：2.638,2.380,2.316,5.891,9.675,3.146,2.079,1.241,6.731。

结论：随着年龄的增长,屈光异常检出率呈现增高趋势。男童的屈光异常检出率明显高于女童。父母低文化程度、高龄产妇、出生有窒息史、早产、体质量低于2 000g或高于4 000g、父亲屈光异常、长时间近距离用眼、少食蔬菜水果是屈光异常的危险因素。     

Ophthalmological findings in a sample of Swedish children aged 4-15 years

AIMS: To characterize ophthalmological findings in a sample of Swedish children aged 4-15 years. METHODS: A prospective cross-sectional comprehensive ophthalmological investigation was performed on a sample of 143 children (67 girls, 76 boys) aged 4-15 years. RESULTS: Visual acuity (VA) in the better eye >or=1.0 (0.3 logMAR). Amblyopia was found in 0.7% of subjects. A total of 68% of the children had no refractive errors. Hyperopia (>or=2.0 dioptres [D] in spherical equivalent [SE]) was found in 9% and myopia (>or=0.5 D SE) in 6% of children. Astigmatism (>or=0.75 D) was recorded in 22% and anisometropia (>or=1.0 D SE) in 3%. A total of 8% were optically corrected. Strabismus was recorded in 3.5%. Signs of visuoperceptual problems were reported in 3% of the children. CONCLUSION: This sample of Swedish children may serve as a comparison group regarding ophthalmological findings in children aged 4-15 years.     

Visual acuity screening of children 6 months to 3 years of age

The operant preferential looking (OPL) procedure allows a behavioral estimate of visual acuity to be obtained from children 6 mo to 3 yr of age. In clinical settings, there is often too little time available to obtain an acuity estimate with the standard OPL procedure. The goal of this study was to identify specific spatial frequencies, termed diagnostic grating frequencies, that could enable the OPL technique to be used as a screening procedure under conditions where completion of acuity estimation was not possible. One hundred eighty presumptively normal children, 6, 12, 18, 24, 30, and 36 mo of age, were each tested with up to 20 trials of a potential diagnostic grating frequency to determine the highest spatial frequency grating that could be resolved by 90% of children at each age. For all ages except 18 mo, there existed a spatial frequency that produced uniformly high OPL performance within the age group; this spatial frequency was separated by one-half to one octave from a higher spatial frequency that more than 30% of children at that age failed to detect. These results suggest that at all ages except 18 mo, it should be possible to use the OPL procedure as a vision screening tool by testing individual children with the diagnostic grating frequency appropriate for their age.