Paediatric Low Vision – A Survey

ABSTRACT This paper reports the results of a survey conducted at a paediatric low vision clinic, of all children examined in the eight year period 1974 to 1981. The data provide a unique opportunity to identify the ophthalmic characteristics of children with low vision. The major cause of low vision in these children has been identified, examined and compared with the results of similar studies. Other characteristics studied are distance and near vision, the type of low vision aids used and the nature of primary education undertaken by the children. The results are discussed to provide information to improve paediatric low vision care.     

Developing an integrated paediatric low vision service.

A survey of usage of low vision aids (LVAs) by 56 children with visual impairment, who were attending mainstream schools in Wirral, was undertaken. A total of 25% of children owned an LVA and 5% were using these on a regular basis. These low levels of ownership and usage led to the development of a low vision service involving the collaboration of education and health care. This paper describes the development of that service, its elements and implementation. The results from the new service show that of the 29 children issued with an LVA, 82.7% are using them on a regular basis. Having an integrated service is shown to significantly improve LVA usage in the group of children seen so far. The service results are discussed with suggestions for future service development.     

Spectrum of ocular disease in children aged between 0 and 3 years at an Australian paediatric tertiary hospital

Background

Childhood ocular disease can be a significant health burden to the child, family and society. Previous studies have examined the spectrum of paediatric ocular disease presenting to tertiary hospitals; however, these studies have broader age ranges, smaller sample sizes, and are largely based in developing countries. This study aims to assess the spectrum of ocular disease in the first 3 years of life presenting to the eye department of an Australian tertiary paediatric hospital.

Methods

The records of 3337 children who had their initial presentation at the eye clinic between the age of 0 and 36 months were reviewed, spanning 6.5 years from 1st July 2012 to 31st December 2018.

Results

The most common primary diagnoses overall were strabismic amblyopia (6.0%), retinopathy of prematurity (5.0%) and nasolacrimal duct obstruction (4.5%). Bilateral visual impairment was more common in younger children, while unilateral visual impairment was more common in older children. The proportion of all children presenting with visual impairment was 10.3%, with 5.7% of all children presenting with bilateral visual impairment and 4.6% presenting with unilateral visual impairment. In children with visual impairment, the most common sites of primary abnormality were lens (21.4%), retina (17.3%), and cerebral and visual pathways (12.1%). The most common primary diagnoses in children with visual impairment were cataract (21.4%), strabismic amblyopia (9.3%) and retinoblastoma (6.5%).

Conclusions

The spectrum of eye disease and vision impairment presenting in the first 3 years of life facilitates health care planning, greater community education about vision impairment and importance of early intervention, and guidance for appropriate resource allocation. Health systems can apply these findings to aid in early identification and intervention to reduce preventable blindness and institute appropriate rehabilitation services.     

Reading performance in children with low vision

Purpose: While educators and optometrists are concerned with reading efficiency in children with low vision, in most low vision assessments, children's reading performance is assessed only by a brief evaluation of reading fluency. We examined the relationships between clinical vision measures and reading performance in children with low vision. Methods: Subjects were 71 students with low vision, aged seven to 18 years. The vision and reading performance measures were: high contrast distance visual acuity, contrast sensitivity using both the Pelli‐Robson and LH symbol charts, near text visual acuity and reading rates on a range of print sizes. Results: Most children achieved maximum reading rate at print sizes between 2.5 and seven times larger than threshold print size. Maximum reading rate increased significantly with age and near visual acuity. There was no significant relationship between reading rate and contrast sensitivity. Conclusions: The majority of children with low vision can achieve near normal reading rates with magnification. Age is the strongest predictor of reading rate in children with low vision. They need print sizes well above threshold to achieve maximum reading rate. Routine contrast sensitivity testing of visually impaired students is not indicated for reading assessment.     

Paediatric Vision and Optometry

ABSTRACT Until recent times remarkably little attention has been paid to the visual problems of children. Few children seek professional eye care, and vision screening services provided by the school health authorities have been shown to be inadequate. National Children's Vision Week (NCVW) in 1979 was the first stage of an AOA programme to inform the public, particularly teachers, of optometrists' unique role in paediatric eye care and the importance of early intervention. The paper presents information resulting from optometry's participation in NCVW, and suggests strongly that all optometrists should be informed as to their responsibilities in paediatric eye care.     

A practical guide to low vision management of patients with diabetes

Diabetic retinopathy is the leading cause of low vision and blindness in developed countries.^1,2 Optometrists have an important role in the detection of diabetic‐related eye disease. They are also well‐placed to manage patients with reduced vision due to diabetes. In 1998, visual rehabilitation information was analysed from 590 visually impaired patients attending the multidisciplinary Low Vision Clinic at Kooyong in Melbourne, Australia. Diabetes was the primary cause of vision loss in 43 (7.3 per cent) of the patients. This paper investigates the characteristics of these 43 patients and the strategies employed to assist them. In doing so we hope to assist practitioners in managing patients with low vision due to diabetes.     

Perspectives on low vision service in Canada: a pilot study

BACKGROUND: A review of the literature and current practice patterns for vision rehabilitation care in Canada provide a basis for this pilot study, which was undertaken to explore related issues from the perspectives of older adults and low vision service providers. The pilot study was overseen by a number of collaborators whose names are listed at the end of this paper. METHODS: Thirty people aged 60 years or older who had vision impairments and were clients of the Canadian National Institute for the Blind were surveyed by telephone. Ophthalmologists, optometrists, and opticians completed a mail questionnaire. Vision rehabilitation practitioners and nurses, ophthalmic technicians, and service providers for low vision technical aids were surveyed by e-mail. RESULTS: Ophthalmologists are a primary source of referrals to low vision services, but low functional vision does not always trigger such referrals, nor are referrals always timely. Optometrists are primary providers of low vision services, including dispensing of low vision aids, but such aids are expensive, and inadequate training in their use may contribute to noncompliance. Costs associated with providing low vision assessments and services are higher than compensation to vision service providers, whose capacity to meet increasing demand is limited. In addition, there are disparities between rural and urban areas and among provinces in the availability of, and funding for, services and aids. INTERPRETATION: On the basis of the findings, an emergent theory is proposed on the consequences resulting from lack of planning and standards for vision rehabilitation care. The implications of this study form the basis for further research.     

The Developmental History and an Evaluation of the Queensland Low Vision Care Centre

ABSTRACT: The decisive shift in attitute from partial blindness and conservation of residual vision towards partial sightedness and maximal use of residual vision in the last fifteen years has resulted in low vision care being a relatively new field of particular concern to health care professionals. In Australia, the first multi-disciplinary clinic providing a comprehensive low vision service was established at the Association for the Blind, Kooyong, Victoria in 1972. Since then, a number of low vision clinics in a variety of locations have developed throughout Australia, with the establishment of the Low Vision Care Centre in Brisbane, Queensland occurring in 1979. This paper describes the developmental history of this service and evaluates the comprehensive low vision care which this clinic provides to the Queensland population. The effectiveness and future considerations of this service are also discussed.     

助视器在低视力儿童中的应用

目的探讨自行来院就诊低视力儿童的病因及低视力康复疗效,方法对门诊筛查视力低常儿童进行散瞳验光、眼底等检查,诊断为低视力者,应用远用、近用助视器进行视力康复训练;结果在25例低视力儿童中,(1)病因以先天性眼球震颤合并屈光不正多见,占76.00%;(2)20例选择康复远视力,最佳矫正远视力在0.1～<0.3,用4X、6X单筒近距远距观察镜康复远视力达到≥1.0,脱残率100%;(3)5例选择康复近视力,最佳矫正近视力<0.3~0.1,经过使用2.5X、3X、4X直柄放大镜和2.5X木马放大镜康复近视力≥0.5,近视力康复有效率100%。结论应用助视器能有效提高低视力儿童的远、近视力和视觉质量,让患儿有机会具备接受正常教育的用眼条件,因此,早发现、早诊断、早矫正、早康复,对低视力儿童的身心健康、拓宽知识领域、升学、就业具有积极地意义。     

Low vision in young New Zealanders: a survey of Homai College

The records of 809 students attending Homai College in New Zealand were reviewed. The three major causes of vision loss were congenital cataract (11.0 percent), optic atrophy (9.1 per cent) and albinism (8.8 per cent). The percentage of Homai students with vision loss due to cataract, optic atrophy and retinopathy of prematurity (ROP) was lower than that reported in 1978. Males (59.3 per cent) were more commonly affected than females. The three most commonly used visual appliances were spectacles (39 per cent), distance telescopes (25 per cent) and stand magnifiers (9 per cent). The data are compared with other reports from young visually impaired populations. A future role for optometry in the detection of vision loss in New Zealand children is suggested. Further investigation into the aetiology and racial distribution of vision loss in New Zealand children is needed.     

Usefulness of post-assessment reports in a paediatric low vision clinic: a questionnaire survey of parents and education professionals.

This survey aimed to evaluate how helpful parents and those working in the educational setting found written low vision assessment reports. A questionnaire survey was sent to 25 parents and to the corresponding and relevant member of the educational team for each of the 25 children. All were satisfied with the level of information contained in the report and agreed that the report was easy to understand and that the level of explanations given regarding visual function were clear. The main disparities between parents and teaching professionals were concerning the amount of medical terminology used in the report, with only 7% (n = 1) of those from the educational setting, but 30% (n = 6) of parents feeling there was too much. Adaptations were also more likely to have been implemented in the educational setting [82% (n = 11)] as compared with 62% (n = 16) in the home. Eighty-three per cent (n = 43) of respondents reported that low vision aids were used at either home or school on at least a weekly basis.     

矫正屈光不正对儿童低视力康复的意义

目的 探讨有屈光不正的低视力儿童戴矫正眼镜后对应用助视器提高视的效果。方法 经散瞳验光 后视力有提高或改善者,予以配镜。然后再应用远用双筒与单筒望镜式助视器。结果 ３５０例中有９００例（占２５％）经验光配镜后视力均有一定程度的提高与改善,在这９０例中不戴镜直接用助视器时,其脱残率（视力提高到０．３以上）为５４．４％,而在戴镜基础上再应用助视器,则脱残率为８３．３％,两者之间差异有着非常显著性意义（     

中国大陆三级医疗机构低视力服务专业人员配置和服务提供情况分析

目的：统计分析我国三级医疗机构低视力服务专业人员配置和服务提供情况，为进一步推进我国低视力医疗康复工作提供参考依据。方法：描述性研究。于2015 年开始对全国提供眼科服务的三级医疗机构通过网上填报的方式进行普查，采用描述性统计方法和χ2检验，对我国三级医疗机构低视力服务专业人员配置和服务提供情况进行系统整理和统计分析。结果：本次调查覆盖全国1 508 家三级医疗机构，其中提供低视力诊疗康复服务的有559 家（37.07%），未提供服务的有949 家（62.93%），各级医疗机构在是否开展低视力康复服务方面差异有统计学意义（χ2=61.94，P<0.001）。在提供服务的机构中，已设立低视力专业门诊的有338家（60.47%），低视力年平均门诊量为964例。从事低视力医疗康复服务专业人员2 993 人，平均每家三级医疗机构有低视力专业医师1.98 人、护士0.46 人、技师0.41 人、辅助人员0.22 人。三级医疗机构以儿童功能性视力康复训练、低视力社区教育宣传和助视器验配为主要低视力服务类型。结论：我国三级医疗机构低视力学科建设亟待加强，专业人员总量偏低、人才梯队建设不完善，服务质量低、服务类型单一，无法满足我国低视力患者全方位的服务需求。     

A survey of paediatric visual assessment by optometrists in New South Wales

Background: The importance of early vision care in the prevention and treatment of amblyopia is clear from an abundance of literature on visual development. Optometrists possess the necessary skills to detect and manage amblyogenic factors and thus have an important role to play in paediatric visual assessment and management. The present study investigates the role that optometrists in New South Wales are taking in paediatric vision care and the methods and strategies used in this role. Methods: Questionnaires were sent to 400 optometrists practising in New South Wales; 179 completed questionnaires were returned. Resulte and Discussion: Our findings reveal a number of associations between practice characteristics (such as location) and the management of paediatric patients. In general, practitioners in rural locations, in full‐time practice or self‐employed were more likely to treat patients and less likely to refer them elsewhere than those in city locations, in part‐time practice or employed by others. In addition, our findings suggest the possibility of a changing pattern of collaboration between optometrists and ophthalmologists in the management of paediatric patients.     

A review of paediatric vision screening protocols and guidelines

Vision screening plays an important role in the early detection of children who have or probably are predisposed to have specific visual problems. The validity and reliability of the screening batteries in relation to the age group to be screened, and the person administering the test as well as the referral and follow-up criteria contribute to the overall outcome of the vision screening. Despite the long history of vision screening and significant improvement in the development of screening protocols, no agreement exists concerning the age at which children should be screened, the exact test batteries that should be included and who should conduct the screening. This review highlights some important aspects of the history of paediatric vision screening and available evidence in support of their use to detect visual conditions in children. It also examines some of the barriers against the development of paediatric vision screening models especially in low and medium income countries.     

A holistic model of low vision care for improving vision-related quality of life

Vision impairment can have a significant impact on the wellbeing and quality of life of an individual. Vision rehabilitation has the potential to improve these areas; however, four in five patients with vision impairment are not being referred to the appropriate services. Barriers to on-referral include, but are not limited to: (1) misunderstandings by both practitioners and patients alike regarding which individuals with vision impairment might benefit or qualify for low vision services; (2) lack of awareness of available services; (3) unfamiliarity with practice guidelines; (4) miscommunication between practitioners and patients; (5) required patient travel or limitations in access; and (6) the perceived costs of goods and services. Further, current referral patterns do not represent a holistic patient-centric approach. Vision-related quality of life questionnaires are tools which can assist health professionals in providing optimal individualised care. This review explores current evidence regarding low vision service delivery within Australia and globally, the impact of vision impairment on activities of daily living, the instruments used for the assessment of vision-related quality of life (VRQOL), competing priorities of individual needs in low vision services and rehabilitation, and provides recommendations for a more patient-centred model of care.     

The interface of education, psychological and visual services in pediatric optometry

Optometrists cannot effectively serve children with learning problems in isolation. Through integrated input from multidisciplinary sources, the optometrist can develop an appropriate vision care program for these children.     

Low vision device requirements among children from two schools for the blind in Tamil Nadu

Purpose:To identify children with low vision from two local schools for the blind, to provide low vision devices (LVD) to those who may benefit from it, and to encourage them to learn print.Methods:A prospective study was conducted among children from two local schools for the blind. Best-corrected visual acuity (BCVA) was done using the Snellen chart. Children with BCVA of counting finger (CF) 1/2 meter or more in the better eye underwent low vision assessment. Distant vision was assessed using the Feinbloom chart and near vision was assessed using the Lea symbol chart. Low vision devices (LVD) were prescribed as required.Results:Among 185 children enrolled, 31 children had BCVA of >CF ½ meter. Using a telescope, distant vision was better than 3/36 in 48.4%, 3/36–3/12 in 16.2%, and 3/9.5 to 3/3 in 35.4%. Among 23 children who read 1M at <10 cm, 22.6% could read 0.6–0.8M, and 25.8% could read 1M using LVD.Conclusion:Regular screening of children in schools for the blind could identify children who might benefit from LVD. A review of protocols for the entry of children in schools for the blind by screening these children by a specialist team prior to admission should be made mandatory.     

助视器提升低视力患者生活质量

目的：调查低视力助视器（LVAs）在提高低视力患者生活质量方面的有效性。方法：前瞻性临床研究。选取2017年1月至2018年2月在温州医科大学附属眼视光医院就诊的符合低视力诊断标准的患者55例，给患者验配远用、近用助视器。在低视力患者配戴LVAs前和配戴30 d后采用中文版低视力患者生活质量量表（CLVQOL）评估低视力患者的生活质量，问卷内容涉及远视力、移动和光感，心 理调节能力，阅读和精细工作能力及日常生活能力。对各组LVQOL评分结果进行配对t检验，对影 响因素进行回归分析。结果：55例低视力患者中，44例完成了基线和随访时的生活质量问卷调查。经过低视力助视器等辅助后，生活质量评分从77.8±19.0上升到82.3±22.5，差异具有统计学意义（t=4.56，P=0.001）。性别、识字率、学习状况和视力等因素不影响低视力患者生活质量。结论：低视力助视器可以提高不同年龄段、不同性别的低视力人群的生活质量。