Photo Screening Around the World: Lions Club International Foundation Experience

Purpose: To describe the use of photoscreening for preschool vision screening in several diverse locations throughout the world. Methods: The MTI photo screener was used to screen pre-verbal children; photographs were interpreted using standard criteria. Results: The Tennessee vision screening program remains successful, screening over 200,000 children during the past 8 years. Similar programs modeled across the United States have screened an additional 500,000 children. A pilot demonstration project in Hong Kong, Beijing, and Brazil screened over 5000 additional children with good success and appropriately low referral rates. Conclusion: Photoscreening can be an appropriate technique for widespread vision screening of preschool children throughout the world.     

计算机折射摄影与小瞳检影在儿童弱视筛查的比较

目的 确定计算机折射摄影法与小瞳检影在对９～５０ｍｏ的婴幼儿进行弱视危险因素筛查中的敏感性和特异性。方法 应用计算机折射摄影法与小瞳检影在３００例９～５０ｍｏ的婴幼儿中进行弱视危险因素筛查。采用临床标准化双盲法,对此２种技术所得出的结果进行比较评比,由２位技术人员对电脑荧光屏的图象作出判断,以确定受检儿童眼部是否存在弱视的危险因素。同时与眼部的详细检查作比较。结果 在检测弱视危险因素包括远视（＋２．７５Ｄ以上）、近视（－１．５０Ｄ以上）、散光（１．２５Ｄ以上）、屈光参差（２．００Ｄ以上）、眼位偏斜（５度以上）以及屈光间质混浊（１．５ｍｍ以上）;计算机折射摄影的敏感性为９４．２％,特异性为９０．１％;而小瞳检影的敏感性为８５．７％,特异性为８１．１％。结论 计算机折射摄影对于早期发现婴幼儿和学龄前儿童的视力障碍提     

The Problems of Screening Children's Vision

ABSTRACT It is widely agreed that screening of vision at schools is desirable since the prevalence of visual disorders among children is high and in a good proportion of instances adequate care would not be sought unless the disorder is uncovered by a screening programme. There is less agreement on what methods are most appropriate for school vision screening bearing in mind the need for the screening method to be efficient, easy to administer and inexpensive. The Orinda Study showed that the modified clinical technique (MCT) was efficient and not unduly expensive and that screening instruments had very high under- and over-referral rates. The present study evaluated the Mavis vision screener, an instrument which has a number of features that are appropriate to the screening of children's vision. Despite careful training of the teacher operators who were highly motivated and very conscientious, the instrument had a high over-referral rate most likely due to proximal accommodation. Although the MCT to which the instrument was compared was not infallible, it seems that this is the preferable method of school screening especially for younger children. Since myopia is the principal visual disorder to emerge during the school years, screening with the Snellen chart by lay persons in the later years at school may be an acceptable procedure provided optometrists or ophthalmologists are used for a thorough vision screening of kindergarten and year one children.     

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。     

Validity of Teacher-Based Vision Screening and Factors Associated with the Accuracy of Vision Screening in Vietnamese Children

Purpose: To assess validity of teacher-based vision screening and elicit factors associated with accuracy of vision screening in Vietnam.

Methods: After brief training, teachers independently measured visual acuity (VA) in 555 children aged 12–15 years in Ba Ria – Vung Tau Province. Teacher VA measurements were compared to those of refractionists. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for uncorrected VA (UVA) and presenting VA (PVA) 20/40 or worse in either eye. Chi-square, Fisher’s exact test and multivariate logistic regression were used to assess factors associated with accuracy of vision screening. Level of significance was set at 5%.

Results: Trained teachers in Vietnam demonstrated 86.7% sensitivity, 95.7% specificity, 86.7% positive predictive value and 95.7% negative predictive value in identifying children with visual impairment using the UVA measurement. PVA measurement revealed low accuracy for teachers, which was significantly associated with child’s age, sex, spectacle wear and myopic status, but UVA measurement showed no such associations.

Conclusions: Better accuracy was achieved in measurement of VA and identification of children with visual impairment using UVA measurement compared to PVA. UVA measurement is recommended for teacher-based vision screening programs.     

A Vision Screening Report of a Teacher-selected Primary School Population

ABSTRACT Ninety-six children, teacher-selected as below their expected achievement levels and displaying behaviour indicative of visual anomalies, were screened using a form of Modified Clinical Technique. Eleven tests of visual function were measured. Eighty-seven per cent of children failed one or more tests, and fifty-eight percent required referral based on the clinical intuition of the author. Unconventionally, tests of accommodation, vergences and visual motor skills were attempted within the context of a screening.     

School-entry Vision Screening in the United Kingdom: Practical Aspects and Outcomes

Purpose: To describe and assess an orthoptist-led vision screening service for school-entry (reception class) children, and report outcomes from one healthcare trust in the UK.

Methods: A total of 3721 children (aged 4–5 years) in reception class primary school (155 state, 3 private) underwent orthoptist-conducted vision screening. Children who failed to meet the screening criteria were referred to hospital-based eye services for re-testing and final diagnosis.

Results: The screening take-up rate was 96.41%; the remaining 3.59% refused/failed to consent to screening. The screening capture rate of participating children was 99.7%. A total of 11.14% of screened children failed to meet the screening criteria and were referred elsewhere; no abnormalities were found in 14% (false referral rate) of these children. Of the referred children, 53% had refractive errors requiring glasses and 42% had squints. The estimated percentages of common visual problems in screened children were 9.15% for refractive error and 3.81% for squint.

Conclusion: An orthoptist-led, time-of-school-entry vision screening service is ideal for successful childhood vision screening and is, thus, a valuable source of information regarding the prevalence of common visual problems among children.     

学龄前儿童弱视的早期筛查

弱视是一种由视觉敏感期异常视觉经验引起的以神经系统发育异常为主、无眼部器质性病变的疾病。视力检查是儿童弱视筛查与诊断中的重要组成部分,但对于不能言语表达的低龄儿童,视力检查受到限制。而屈光不正和屈光参差是引起弱视的最常见危险因素,近年来,对弱视的早期筛查不断延伸至对弱视相关危险因素的早期筛查,针对屈光状态的筛查方法与技术也在不断更新发展。本文试对视力检查方法和屈光性质筛查方法进行综述。     

Parental Home Vision Testing of Children During Covid-19 Pandemic

Background:The Covid-19 pandemic necessitated social distancing restrictions, which placed limitations on access to ophthalmic care to only those who had an imminent risk of sight loss. All other face-to-face consultations were converted to telephone consultations or were postponed. We investigated whether parents were able to test their child’s vision using available home vision testing applications, with an aim to aid decision making during a telephone consultation.Methods:Families with follow-up consultations at Birmingham Children’s Hospital were asked to test their child’s vision at home. Instructions for the use of Peek acuity, or iSight Pro, were emailed to a parent. Parents chose to use a particular app based on available devices at home. Parents were asked to test uniocular visual acuity twice. Home versus hospital acuity was correlated. Home acuity test-retest reliability was acquired. Parental feedback was obtained through questionnaires.Results:One hundred and three families were contacted, 15 families completed home vision testing. Ten families used Peek acuity, five families used iSight Pro. Uniocular visual acuity test-retest reliability was 0.03 LogMAR. Home-hospital acuity testing had a bias of 0.14 LogMAR, hospital acuity yielding a lower LogMAR score. Most families who completed testing found it easy to do; however, some struggled, and 81 families did not undertake home vision testing.Conclusions:Uptake of home vision testing was limited by parental engagement, most likely influenced by the current pandemic. Most families who undertook home vision testing were able to generate results that could be used for clinical decision making. Extending the impact of parental vision testing will require education by clinicians and further study to increase sample sizes and to improve confidence.     

Vision Screening in Children Entering School: Eskisehir,Turkey

Abstract

Purpose: To report vision screening results among school children in Eskisehir, Turkey.

Methods: Vision screening was performed in 7- to 8-year-old school children in November and December 2011. Best-corrected visual acuity (BCVA) assessment, cover test, and autorefractometer measurement under cycloplegia were performed. Spherical equivalent ≤?0.50 diopters (D) was considered to be myopic, while spherical equivalent >0.75?D was considered to be hypermetropic. Astigmatism was defined as a cylinder power ≥0.75?D. Regression analysis was used to determine the likelihood of having BCVA ≤0.8 Snellen (versus having BCVA >0.8 Snellen) in the presence of independent variables.

Results: A total of 709 children were included. The prevalence rates of myopia, hypermetropia, and astigmatism were 22.6%, 10.6%, and 11.0%, respectively. Overall, 145 children (20.4%) needed spectacles, but only 65 of these were wearing them. The prevalence of children who required spectacles for myopia ≤?3.00?D and spectacles for hypermetropia ≥3.00?D were 0.8% and 1.0%, respectively. The prevalence of BCVA?≤?0.8 Snellen was 56/709 (7.9%). In 39/709 (5.5%) of children, amblyopia was present; strabismus (14/56), isometropia (14/56), and anisometropia (11/56) were the etiologies. Strabismus was diagnosed in 18 children (2.5%). Anisometropia, strabismus, hypermetropia, and astigmatism were associated with BCVA?≤?0.8 Snellen (odds ratio, OR, 6.32, 39.18, 5.47, 5.17, respectively; p?=?0.0001 for all ORs).

Conclusions: Myopia and amblyopia rates in Eskisehir were high among school children. The need for a national large-scale vision screening program for children that includes diverse regions of Turkey is apparent.     

PRE-SCHOOL VISION SCREENING–A PILOT STUDY

The importance of early vision screening in children is well known, but also are the difficulties of choosing a satisfactory programme and its implementation. This paper describes the reasons for the programme being implemented and discusses the method of examination and the co-operation required to carry it out. More than 10,000 children were screened by more than 350 voluntary family doctors. The examinations were carried out throughout Queensland in pre-school centres. The family doctors were fundamental in the success of the programme, as they had the considerable task of examining the children. The scheme was made possible by the co-operation of the family doctors through the help of the Royal Australian College of General Practitioners, The Family Medicine Programme and the Australian Medical Association. These organisations, together with the Division of School Health, Queensland, and The Royal Australian College of Ophthalmologists were responsible for the organisation of the scheme. The results of the Pilot Study and the requirements for an on-going programme are discussed.     

The Prevalence of Anisometropia,Amblyopia and Strabismus in Schoolchildren of Shiraz,Iran

Purpose: To determine the prevalence of amblyopia, anisometropia, and strabismus in schoolchildren of Shiraz, Iran.

Materials and Methods: A random cluster sampling was used in a cross-sectional study on schoolchildren in Shiraz. Cycloplegic refraction was performed in elementary and middle school children and high school students had non-cylcoplegic refraction. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded for each participant. Anisometropia was defined as spherical equivalent (SE) refraction difference 1.00D or more between two eyes. Amblyopia was distinguished as a reduction of BCVA to 20/30 or less in one eye or 2-line interocular optotype acuity differences in the absence of pathological causes. Cover test was performed for investigating of strabismus.

Results: Mean age of 2638 schoolchildren was 12.5 years (response rate?=?86.06%). Prevalence of anisometropia was 2.31% (95% confidence interval [CI], 1.45 to 3.16). 2.29% of schoolchildren (95% CI, 1.46 to 3.14) were amblyopic. The prevalence of amblyopia in boys and girls was 2.32% and 2.26%, respectively (p?=?0.945). Anisometropic amblyopia was found in 58.1% of the amblyopic subjects. The strabismus prevalence was 2.02% (95% CI, 1.18 to 2.85). The prevalence of exotropia and esotropia was 1.30% and 0.59%, respectively.

Conclusions: Results of this study showed that the prevalence of anisometropia, amblyopia, and strabismus are in the mid range. The etiology of amblyopia was often refractive, mostly astigmatic, and non-strabismic. Exotropia prevalence increased with age and was the most common strabismus type.     

Outcomes of a Vision Screening Program for Underserved Populations in the United States

ABSTRACT

Purpose: To evaluate which components of a vision screening process are most effective in identifying individuals who need eye care services.

Methods: Subjects visiting a free health clinic were screened using visual acuity and a questionnaire. Persons who failed screening were referred for a professional eye examination.

Results: A total of 1380 of 3004 screened persons (46%) screened positive on question(s) or distance visual acuity; 81% of screened positives were referred for an eye exam, <50% of the positives attended the examination, and one-third had ≥1 problem requiring intervention or monitoring. The most common problem was distance refractive error that, once corrected, improved vision by two or more lines, followed by glaucoma or glaucoma suspect (8.9%), visually significant cataract (7.2%), and diabetic retinopathy (2.5%). Ninety-four subjects who screened negative (“normal”) were examined; nearly half of these had 2+ lines of visual acuity improvement with refraction (from 20/40 or 20/32 to 20/20). Sensitivity for detecting specific eye conditions varied substantially, ranging from 0–83% for individual screening questions. Time since last exam and distance acuity <20/50 were the most sensitive questions for visually significant cataract; however, their specificity was low. No combination of questions and acuity testing had both high sensitivity and specificity.

Conclusions: Vision problems requiring intervention were common among this relatively young population, but no combination of screening questions and vision testing proved effective for screening. More than half of those who screened positive never showed for an examination, indicating that on-site eye exams might be more effective.     

The Portsea Lord Mayor's Children's Camp Vision Screening: A Rationale and Protocol for Op to metric Screening

ABSTRACT The development of a new screening protocol, The Portsea Modified Clinical Technique (PMCT), is described. This screening technique was designed for use with children in the eight to fourteen years age group and includes such measures as ocular motility, fusional vergence, accommodation, stereopsis and colour vision in addition to the traditional modified clinical test battery. Some six thousand children have been examined using this protocol which requires a screening time of five to six minutes. Referral criteria are given as guidelines only, with the clinician retaining the responsibility for classification on the basis of the whole clinical profile. It is argued that the Orinda MCT criteria can no longer be regarded as inclusive of all the most relevant parameters. Details of the screening administration and instrumentation are outlined.     

SPOT屈光筛查仪在6岁以下儿童视力筛查的转诊标准研究

目的：基于2021版美国斜视与小儿眼科协会(AAPOS)《儿童视力筛查指南》,修订SPOT屈光筛查仪在6岁以下儿童的转诊标准,并评估其准确性。

方法：纳入2022-01/2023-04在南京市雨花台区妇幼保健所就诊的儿童,进行SPOT屈光筛查仪、睫状肌麻痹检影验光等检查,并根据AAPOS指南定义具有弱视危险因素(ARFs)及有临床意义屈光不正(VSRE)的目标人群。使用受试者工作曲线计算最佳转诊标准,并与厂商标准、吴标准、Peterseim标准进行对比。

结果：共有959名儿童接受检查,其中<4岁组342人,≥4岁组617人。<4岁组的最佳转诊标准为：近视≤-2.75D、远视≥+2.25D、散光≤-2.75D、屈光参差≥1.00D; ≥4岁组为近视≤-1.75D、远视≥+2.00D、散光≤-2.25D、屈光参差≥1.00D; 其约登指数分别为0.38与0.52,均高于其他标准。

结论：采用新的6岁以下儿童屈光筛查转诊标准,其准确性较高,优于既往其他标准,能为儿童眼保健工作提供有益参考。     

Vision screening of older people

A recent systematic review found that between 20% and 50% of older people in the UK have undetected reduced vision and in most cases this is caused by refractive error or cataracts, and is correctable. Two approaches to improve the detection of these problems are to better publicise optometric services and to carry out community‐based vision screening of older people. Screening programmes should pass the Wilson criteria and a consideration of these highlights three inter‐related questions: ‘Is vision screening effective at detecting correctable low vision in older people?’; ‘Which tests should be included?’ and ‘Which venues are most appropriate?’ We carried out a systematic review to investigate these questions. For the first question, only one study was found which met our selection criteria. The ‘gold standard’ eye examination in this study lacked several important components, and the vision screening method that was used was not found to be very effective. The review revealed other studies, which, although not meeting our selection criteria, included relevant information. The screening studies highlight the lack of agreement on the content of a gold standard eye examination and of the test(s) that should be used to screen vision. Visual function in older people is not adequately described by high contrast visual acuity (VA), nor by self‐reports of visual difficulties. Other tests that may be relevant include visual field testing, low contrast VA, contrast sensitivity and stereo‐acuity. The pinhole test has often been used in attempts to detect uncorrected refractive errors, but results from this test can be problematic and possible reasons for this are discussed. Appropriate venues for vision screening are contingent upon the format of the vision screening programme. There is still uncertainty over the battery of vision tests that are most appropriate. This, and optimum venues for screening, require further research before it can be fully determined whether vision screening of older people meets the Wilson criteria. If a vision screening programme using a battery of vision tests, perhaps computerised, can be established, then this should be tested to determine the sensitivity and specificity for detecting the target conditions. Ultimately, longitudinal studies are necessary to determine whether such a screening programme will lead to improved visual performance and quality of life in older people.     

Review of preschool vision screening referrals in South Auckland, New Zealand

Background: Limited data are available on the causes of visual impairment in preschool children in New Zealand. We aimed to review demographic and visual parameters in children referred to the Ophthalmology Department, Manukau Super Clinic from vision screening programs in South Auckland. Methods: Retrospective medical record review of 131 children, aged three to five years, referred from community‐based vision screening programs to the Ophthalmology Department for further assessment. Medical records were reviewed to determine: the reason for referral; findings from ophthalmic assessments; treatment received; and visual acuity at the final visit. The main outcome measures were the cause of visual impairment in children referred from preschool vision screening and the visual acuity at the final follow‐up visit. Results: Thirty‐eight (29.0 per cent) children were discharged after their initial assessment as false positive referrals. Almost half (45.5 per cent) of the children were prescribed glasses for the correction of refractive error, amblyopia or strabismus. Twenty‐nine (22.1 per cent) children were diagnosed with amblyopia with an average follow‐up period of 17.5 ± 2.7 months. In general, compliance with therapy for amblyopia was poor with 48.3 per cent non‐compliant with their prescribed treatment regimen. Despite this, visual outcomes were good with an average final visual acuity in the amblyopic eye of 0.294 ± 0.231 logMAR (Snellen 6/12). Conclusions: The ‘positive predictive value’ for the Counties‐Manukau preschool vision screening program was 47.4 per cent, suggesting that the visual acuity measurements alone produce a significant number of false positive results. In children diagnosed with amblyopia, early detection and intervention showed significant improvement in vision in the amblyopic eye, with many children also showing improved binocular function.     

温州市区小学生弱视的筛选及屈光状态分析

目的 研究弱视在小学生中的发病率、屈光状态分布和主要影响因素。方法 在全市视力 小学生中,用列镜筛选,再用扩瞳检影验光进行屈光测定,选择矫正视力≤４．９;眼科检查无器质性病变的弱视患者,分别检查注视性质,眼位、单视功能及询问填写调查表。并分别作统计学处理。结果 在受检６３６００眼中,确诊弱视１２０５人,２２６６只眼,患病为３．７８％;以屈光不正弱视为主,其中远视性弱视最高。弱视程度与屈光度、注视性