Use of a noncycloplegic autorefractor to perform vision screening in preschools

Early detection and treatment of vision disorders in children are important to avoid lifelong visual impairment; however, preschool vision-screening rates are low. Traditional methods of screening lack the precision of objective tests and are difficult to administer in preschoolers. This study adopted a method using school nurses to conduct vision screening in preschoolers with a portable autorefractor. In addition, the effectiveness of the school nurse in conducting follow-up was evaluated. In a sample of 600 children, more than 98% completed the screening, and 7% were referred for follow-up evaluation. Seventeen percent of parents had plans to follow-up after receiving a brochure indicating that their child would benefit from a comprehensive eye exam. However, after a conversation with the school nurse, 86% had plans to schedule an evaluation with an eye care professional. Of the 15 students with known follow-up, 10 received glasses. The described method is effective in identifying young children with potential vision problems and facilitating their correction after contact made by the school nurse.     

Managing eye disease in primary care. Part 1. How to screen for occult disease

Proper eye screening is the first step in detection of occult eye disease in asymptomatic patients. Knowing which patients are at high risk and should be referred for a comprehensive eye examination is the key. In part 1 of this three-part article, Dr Shields explains how to identify high-risk patients and offers practical pointers for performing visual acuity measurements and other necessary testing in children. A list of resources on vision care for both patients and physicians is also included.     

Outcomes of an elementary school-based vision screening program in North Carolina

School nurses can play a key role in the detection of significant refractive error. The purpose of this study was to assess the impact of a statewide school nurse vision screening program by evaluating the outcomes of screening among first, third, and fifth graders in 10 schools in North Carolina during the 2009-2010 school year. Of the 2,726 children who were screened, 7.7% (n = 209) were abnormal, of which 89% (n = 186) were placed into a comprehensive database for follow-up. No documentation of any follow-up was available for 35% (n = 65) of these children. Of the 106 with complete eye examination data available, 54.7% (n = 58) had myopia, 22.6% (n = 24) had hyperopia, 11.3% (n = 12) had astigmatism, 1.9% (n = 2) had anisometropia, and 9.4% (n = 10) were normal. Even with incomplete follow-up, this screening activity led to identification of 3 cases for every 100 children screened, underscoring the importance of high-quality school-based vision screening programs.     

儿童眼病筛查法在群体儿童眼保健中的应用效果

目的探究儿童眼病筛查法在群体儿童眼保健中的应用效果。方法回顾性分析我院2018年5月至2020年5月的167例儿童眼病筛查病例资料,全部儿童均接受了常规观察及眼病筛查,比较两种眼病筛查方法的异常检出率、漏诊率、误诊率、阴性预测值、阳性预测值、特异度、灵敏度。结果纳入儿童共167例,经过OCT检查后,正常儿童135例(80.84%),结果异常儿童32例(19.16%)。眼病筛查法的异常检出率显著高于常规观察法,差异具有统计学意义(P<0.05)。眼病筛查法的漏诊率显著低于常规观察法,差异具有统计学意义(P<0.05)。眼病筛查法的阴性预测值及灵敏度均高于常规观察法(P<0.05)。结论眼病筛查法应用于群体儿童眼保健中具有着较低的漏诊率,同时表现出了较高的灵敏度,对于提高儿童眼保健效果具有积极意义。     

When should children have their eyes checked?

Timely screening for the early detection of eye and vision problems in children is vital to avoid lifelong visual impairment. Early detection provides the best opportunity for effective treatment. Organizations devoted to the health and well-being of children have issued recommendations or policy statements regarding the timing of eye screenings and examinations. The American Academy of Pediatrics (AAP), American Association of Pediatric Ophthalmology and Strabismus (AAPOS), American Academy of Ophthalmology (AAO), American Association of Certified Orthoptists (AACO), and the American Academy of Family Physicians (AAFP) recommend screening at birth and all well-child visits. The American Optometric Association (AOA) recommends that vision examinations begin at 6 months of age. All children found to have an ocular abnormality or who fail vision assessment should be referred to an eye care specialist trained to treat pediatric patients.     

Amblyopia

Amblyopia, a decrease in visual acuity, is a major public health problem with a prevalence of 1 to 4 percent in the United States. It is thought to develop early in life during the critical period of visual development. Early recognition of amblyogenic risk factors such as strabismus, refractive errors, and anatomic obstructions can facilitate early treatment and increase the chance for recovery of visual acuity. Multiple medical organizations endorse screening for visual abnormalities in children and young adults, yet only 20 percent of school-age children have routine vision screening examinations. Any child with a visual acuity in either eye of 20/40 or worse at age three to five years or 20/30 or worse at age six years or older, or a two-line difference in acuity between eyes, should be referred to an ophthalmologist for further evaluation and definitive therapy. Treatment is started at the time of diagnosis and depends on the etiology. Treatment options for children with strabismus include patching and atropine drops. Children with refractive errors should be prescribed corrective lenses. Corneal lesions, cataracts, and ptosis require surgery. The success of therapy is highly dependent on treatment compliance. Patients and their parents should be educated about the need for regular follow-up and the risk of permanent vision loss.     

Preschool vision screening using the MTI-Photoscreener

Amblyopia is a condition that, if detected and treated early, can improve vision for most children. Thus, both pediatric and ophthalmologic groups have acknowledged the need for preschool vision screening. However, vision screening is the exception rather than the rule for preschoolers, since traditional methods of vision screening are often inappropriate for the preschool population and almost impossible for those children who are preverbal or nonverbal, developmentally delayed, and/or have chronic illnesses or disabilities. This study evaluated the use of a photoscreener to detect vision problems in a preschool population. Fifty-one children ages 3 to 5 years were evaluated using the MTI Photoscreener. Results were compared with a complete ophthalmologic examination, including cycloplegia. The sensitivity and specificity calculated for this study was 83% and 68%, respectively. Findings conclude that the MTI Photoscreener detected a broad range of vision problems, seemed to require less time, and seemed more acceptable to preschoolers when compared with the traditional vision screening methods performed by registered nurses. Although the sensitivity and specificity rates for this study were less than desired, it is likely that both could be improved with additional photo interpretation training.     

Routine ultrasonography in utero and subsequent vision and hearing at primary school age.

The study was performed to investigate any associations between routine ultrasonography during pregnancy and subsequent reduced vision and/or hearing among children. A follow-up was carried out of primary school children born to women who took part in two randomized, controlled trials of routine ultrasonography during pregnancy. Of 2428 eligible singletons, 2161 (89%) were followed up with a parental questionnaire and with information from maternal and child health centers.Parents assessed vision and hearing in their children and reported their observations in questionnaires. At the age of 7 years, the children were also screened with bilateral visual acuity tests and pure tone audiometry at public maternal and child health centers. No significant differences between ultrasound-screened children and their controls were found in the parental assessment of vision or hearing. The objective tests did not show any significant differences between children in the two groups with regard to visual acuity or hearing.The risk of reduced vision or hearing was no greater for children of mothers who had been offered routine ultrasonography during pregnancy than for those whose mothers had not received that offer.     

Commonly missed diagnoses in the childhood eye examination

Early and accurate detection of eye disorders in children can present a challenge for family physicians. Visual acuity screening, preferably performed before four years of age, is essential for diagnosing amblyopia. Cover testing may disclose small-angle or intermittent strabismus. Leukocoria, which is detected with an ophthalmoscope, may indicate retinoblastoma or cataract. Children with glaucoma may have light sensitivity and enlargement of the cornea, and conjunctivitis that does not respond quickly to treatment may reflect more serious ocular inflammation. Children with serious eye injuries often present to the primary care physician. Nystagmus and many systemic conditions are associated with specific eye findings.     

Randomized field study of the etiology of strabismus concomitans]

After an introduction to the problems of binocular vision and an overview of the literature, the authors report on the reasons for undertaking this study and on its practical implications. Up to now, no other randomized study has been undertaken to our knowledge on children of this age group in such a large city as Vienna. All children in primary 3 classes in 20 out of the 256 elementary schools were examined ophthalmologically and orthoptically. It was found that hereditary factors are of statistically significant importance. Especially important for the ophthalmologist is also the statistically significant relation between the diagnosis poor range of fusion, poor fixation, incorrect Worth test for distance and/or proximity, and poor or lacking stereoscopic vision with the occurrence of strabism. The authors were astonished to find a remarkably high percentage of exophoria (58%), in contrast to esophoria (16%). It is interesting for prophylaxis and therapy that children originating from families where spectacles are worn, acted more cooperatively and tended to take the orders of the physician more seriously than those coming from families without eye problems. The promotion of genetic research related to squint and more counselling for couples wishing to have children or confronted with risk factor problems would be desirable, as well as the inclusion of more obligatory ophthalmological examinations in the mother-child medical "passport".     

Two-field photography can identify patients with vision-threatening diabetic retinopathy: a screening approach in the primary care setting.

OBJECTIVE: To compare the effectiveness of two 45 degrees photographic fields per eye in the screening for diabetic retinopathy with the routine ophthalmologist's examination and to study the effectiveness of visual acuity measurement in the detection of diabetic macular edema. RESEARCH DESIGN AND METHODS: Type 1 and 2 diabetic patients without a known history of more than minimal retinopathy (n = 469) had a routine examination by an ophthalmologist, including visual acuity measurement, indirect retinoscopy, and biomicroscopy. At the same time, two-field nonstereoscopic retinal photographs were made of both eyes and assessed in a masked fashion by a retinal specialist. The results were compared. RESULTS: The prevalence was 4.3% for vision-threatening retinopathy and 24% for any retinopathy. The sensitivity of two-field photography in identifying diabetic patients with sight-threatening retinopathy was 95% (specificity 99%) and sensitivity for detecting any retinopathy was 83% (specificity 88%). The percentage of referrals to an ophthalmologist was 6.2%. All patients with macular edema detected by biomicroscopy were classified as having vision-threatening retinopathy on the photographs. CONCLUSIONS: Two-field retinal photography is a promising alternative to the routine ophthalmologist's examination in the screening for diabetic retinopathy. Visual acuity measurement is not a sensitive tool for the detection of macular edema. Screening for diabetic retinopathy using two-field retinal photography is feasible in a primary care setting and can substantially lower the number of ophthalmic referrals.     

Screening for pediatric eye disease.

The majority of preschool children in the United States are not screened for visual problems. To avoid permanent visual loss, standardized screening should be incorporated into well-child examinations so that treatment can be initiated promptly. Newborns should be checked for the red reflex, pupillary responses and any constant eye deviation. Infants six months old should be checked for these responses and for "fixation and following" and ocular alignment. Visual acuity should be tested in three- to four-year-old children using the "tumbling E" test, Allen pictures or the HOTV chart.     

Continuing nursing education (CNE) article Detection and treatment of strabismus

Strabismus, a misalignment of the eyes, is one of the most common eye problems in children. Reduced vision in a weaker eye is called amblyopia, occurring in about 50% of children with strabismus. Determining the presence of strabismus can lead to referrals for appropriate treatment. The importance of early detection is stressed, because permanent irreversible vision loss may occur if the condition is not treated by 6 years of age. Methods of detection, common types, and treatment modalities are reviewed. The informed nurse can reiterate instructions and explanations to parents and family members; patient education can enhance treatment and compliance.     

Lack of follow-up exams after failed school vision screenings: an investigation of contributing factors.

Programs to facilitate professional eye exams after failed school vision screenings often are based on the assumption that funding and access to services are major obstacles to care. Despite such programs, many children do not receive professional exams. The purpose of this study was to identify additional barriers to follow-up eye care. School nurses in an urban, midwestern public school district identified elementary school students who had not received follow-up eye exams after failed school vision screenings. Parents of these students were interviewed during the summer to determine financial, logistical, social/family, and perceptual barriers to care. Family issues, parental perceptions of vision problems, and difficulty planning ahead were found to be significant factors. Strategies to increase follow-up compliance and recommendations for overcoming barriers to care were also identified.     

Contrast sensitivity vision testing: new screening technology for family physicians.

Contrast sensitivity vision testing is the new technology in visual screening. Easy to administer and quick to perform, contrast sensitivity vision testing appears to be cost-effective for use by family physicians. It is a more sensitive indicator of ocular disease than traditional Snellen acuity testing and may detect ocular pathology at an early stage when Snellen acuity is still normal.     

Hörscreening an Kindergärten: Ergebnisse einer Evaluierungsstudie

OBJECTIVE: This study aimed to evaluate the hearing screening of pre-school children at nursery schools in Tyrol, Austria. METHODS AND SAMPLE: 47 nursery schools with a total of 2199 enrolled children participated in the study. At the screening, the children were presented a series of tones at frequencies 0.5 kHz (25dB), 1 kHz, 2 kHz, 3 kHz, and 4 kHz (20 dB each) from portable audiometers. The tones were presented over headphones for each ear separately and at irregular intervals. Failure to respond to any of the frequencies was considered failure of the screening. Parents were then advised in written form to have the child examined by an ENT-specialist. RESULTS: 1832 individuals were screened (coverage: 83% of nursery school children; corresponding to at least 63% of all Tyrolean children aged 3 to 5 years). Of these, 390 failed the test (referral rate: 21% of all screened). Examination through an ENT-specialist occurred with 217 children, and this confirmed the positive test in 139 children (hit rate: 64%). In most cases, a temporary conductive hearing loss due to external or middle ear problems (glue ear, tube dysfunction, cerumen, otitis media) was diagnosed. A sensorineural hearing loss was found in 4 children (in 3 of them bilateral). The need for therapy was recognized in 81 children (4% of all screened). CONCLUSION: Pre-school hearing screening identifies children with ear and hearing problems that need therapeutical intervention. Although the hearing problems are mostly of a temporary nature, some may require monitoring over some period. Also some children with permanent sensorineural hearing loss may be detected through this measure. Hearing screening is an efficient means of assessing ear and hearing problems in pre-school children. However, the follow-up rate needs to be improved for optimizing the efficacy.     

916例应届高考生视力状况调查分析

目的：调查应届高考生的视力状况以及对眼卫生保健知识的认识。方法：采用问卷调查和由专人对学生裸眼宙力按常规进行测定。结果：应届高考生近视发生率为82．4％,近视发生率随年龄增长呈上升趋势。结论：对青少年的眼卫生保健知识的教育迫在眉睫,各医疗机构、学校、家庭等应重视和积极开展健康咨询教育,提高青少年身体素质。     

基于视觉相关理论设计的视知觉检测系统——理解弱视视觉缺陷特征：弱视筛查新途径

背景：既往的研究揭示,与正常人相比,弱视患者存在多种视觉缺陷。通过工程化的视知觉系统对人的视觉系统进行相关检测就能够发现弱视患者。目的：通过检测弱视患者的多项视知觉功能,从中筛选出敏感性强的指标用于弱视筛查,并由此建立起一种基于互联网的弱视筛查方法。设计、时间及地点：随机、盲法、对照试验,于 2008-09/11 在广西壮族自治区人民医院视光科完成。对象：从广西壮族自治区人民医院视光科接受视知觉功能检测的志愿者中随机抽取 80人,年龄 4~19 岁,在排除眼部器质性疾病的前提下,按照矫正视力是否达 4.9 以上将其分成正常组和弱视组,其中正常组 40 人,弱视组 40 人。方法：运用视知觉检测系统对每位受试者的多项视知觉功能指标进行检测,将采集到的单眼和双眼数据进行 Fishher 判别分析,从中筛选出敏感性指标并建立判别方程用于弱视筛查。主要观察指标：受试者的年龄、视觉噪声、位置辨别和轮廓整合等功能。结果：判别结果显示,年龄、视觉噪声、位置辨别和轮廓整合等指标意义较大,交互验证法显示判别正确率达 92.5%,具备临床应用价值。弱视的判别函数式为 ：Y1=1.175X1＋0.786X2＋0.928X3＋1.061X4- 0.225X5＋2.547X6＋1.313X7-18.651;正常的判别函数式为：Y2=1.369 X1＋1.728 X2＋ 1.779 X3＋1.549 X4-1.912 X5＋2.665 X6＋0.387 X7 -26.640。结论：视知觉检测系统中的视觉噪声、位置辨别和轮廓整合程序可用于儿童弱视筛查,并可借助互联网发挥更加积极而深远的作用。     

Does encouragement boost visual acuity testing results?

AIM: To investigate the hypothesis: 'Patients who receive encouragement during visual acuity testing achieve better scores than patients who receive no encouragement'. METHOD: Fifty patients were randomly selected from general eye clinics with five exclusions. A quasi-experimental, non-equivalent comparison before/after design was used to consider the way patients' vision is tested using the Snellen visual acuity chart in the eye department at Kettering General Hospital. RESULTS: The results were significant (t = 5.78 df=49 p < 0.001) and supported the initial hypothesis that 'patients who receive encouragement during visual acuity testing achieve better scores than patients who receive no encouragement'. CONCLUSION: The results of the study suggest that the subjects did get better visual acuity scores when encouragement was used and recommendations were made to change the clinic protocol.     

Preschool vision screening in primary care after a legislative mandate for diagnostic eye examinations

BACKGROUND: Kentucky legislation now requires that children entering public school receive a diagnostic eye examination. METHODS: Mail survey of randomly selected office-based primary care pediatricians (PDs, n = 221) and family physicians (FPs, n = 207) in Kentucky to assess the impact of the mandated eye examination. RESULTS: The response rate was 71% PDs and 51% FPs. Most offer preschool vision screening (PD 86%; FP 79%; P = 0.16), but many report they will be less likely to offer it in the future because of the mandated diagnostic eye examination (PD 61%; FP 50%; P = 0.09). Perceived barriers to the diagnostic eye examination include lack of parental knowledge about the requirement, belief by parents that they will need to pay, difficulty in getting an appointment, and lack of endorsement by primary care physicians. CONCLUSION: Most primary care physicians in Kentucky offer preschool vision screening, but many now are likely to reduce their screening effort. Until more data are available regarding the impact of the required eye examination, primary care providers should not change their screening practices.