Ocular findings in individuals with intellectual disability

BACKGROUND: The purpose of the study was to assess refractive errors and ocular abnormalities in intellectually disabled (ID) children and adults. METHODS: In this study, a random sample of 180 participants with ages ranging from 9 to 50 were recruited and examined between January and April 2006. Refractive errors were measured by photorefractometer. The ophthalmologic examination consisted of a structural observation of the external eye, anterior and posterior segment evaluation, and examinations for strabismus. RESULTS: A refractive error was the leading ocular diagnosis, found in 56 of 166 patients. Strabismus was the second most frequent ocular abnormality. Eyelid abnormalities were detected in 30 patients. Cataract was the fourth most frequent ocular pathology and also most frequent intraocular one. Overall, 28 patients (16.9%) had anterior segment findings, of whom 18 had congenital lens opacity. Posterior segment findings were detected in 23 of 166 patients. INTERPRETATION: Ocular problems are common in ID individuals and are frequently correctable. We suggest that professionals provide early ophthalmologic examination and regular follow-up of young ID individuals. This would ensure that the required treatment of possible ocular disorders is received and would improve quality of life and social accommodation in this population.     

对比度视力检查在视感知觉学习治疗前后的临床应用研究

目的：评估屈光不正患儿视感知觉学习治疗前后的对比度视力变化,探讨视觉质量及视功能的临床意义。方法对视感知觉学习治疗的屈光不正患者50名（100眼）,随机分为两组采用电子视力测量仪检查对比度视力,评估视功能。结果所有患者视感知觉学习训练后对比度视力较国际标准视力改善明显,其中低屈光度数患者改善更明显;治疗后国际标准视力无改善的患者,对比度视力的低亮、标低仍有改善,P〈0.05。结论对比度视力能全面的反应明视力及暗视力,同时视感知觉学习训练对提高屈光不正患者对比敏感度及视力有效,值得推广。     

小学一、五年级学生视力及屈光状态构成对比分析

目的了解小学一、五年级学生视力及屈光状态的构成情况,为儿童近视的预防矫治工作提供参考。方法对上海市川沙学区小学一年级学生447人,共计894只眼,五年级学生269人,共计538只眼进行眼科普查,先检查其裸眼视力、最佳矫正视力及小瞳屈光状态,后给予睫状肌麻痹剂散瞳,检查其基础屈光状态。结果近视是小学生视力低常的主要原因。小学五年级学生的视力低常率(54.3%)和近视患病率(53.2%)明显高于一年级(7.4%,6.2%),一年级的散光患病率(64.7%)高于五年级(59.5%)。两个年级各种屈光状态构成存在差异;五年级整体屈光状态偏近视,一年级偏远视。两个年级男女生屈光发育存在显著性差异。结论小学五年期间,是儿童屈光发育变化较快的年龄阶段,也是儿童屈光异常预防矫治的关键时期,应该作为儿童近视预防的重要阶段。     

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.     

中国眼科医生对智障者视觉健康的认识调查

目的了解中国眼科医生对智障者视觉健康的认识和诊疗技能的现状,为制定针对性的教育和培训方案提供依据,更好地为世界特奥会提供健康诊疗服务。方法采用随机方法,对来自中国31个城市和地区的1351位(男性629位,女性722位)参加第十届全国眼科大会的医生代表进行问卷调查。调查内容包括对被调查医生的个人信息(如省市、年龄、职称、学历、医院等级、工作地点)及其对特奥和智障者的认知情况。对问卷调查表的各项内容进行分类汇总统计。结果被调查医生中80.48%对特奥概念理解不正确,85.44%没有参与过特奥眼科健康项目,95.56%表示愿意参与特奥眼科健康项目,72.19%认为智障者的视觉健康被忽视,需要改善。经过特奥培训的中国眼科医生(如温州地区)对智障者视觉健康的认知和参与情况显著高于国内平均水平。结论目前中国眼科医生对保障智障者眼睛和视觉健康重要性的认识不足,但绝大部分的医疗机构和眼科医生都对特奥事业充满热情。特奥事业在中国的进一步发展有着扎实的基础,通过特奥视觉健康项目可以有效促进眼科医生对智障者视觉健康的认识和诊疗技能。     

眼科门诊50岁以上部分人群屈光矫正前后视力分析

目的: 了解本院眼科门诊50岁以上部分人群屈光状态及视力矫正前后状况,探讨视力损害的相关影响因素。方法: 选取该组人群149例298眼,使用电脑验光联合视网膜检影进行屈光矫正,并以问卷方式了解患者年龄、文化水平、经济状况及居住地。结果: 该组人群149例298眼中,屈光不正281眼(98.6%)。其中近视性屈光不正有119眼(42.3%),远视性屈光不正有94眼(33.5%),混合性散光有68眼(24.2%)。验光矫正前后平均视力分别为0.42±0.21和0.63±0.32,可矫正的视力损害为186眼(65.3%)。低教育程度、低收入、居住在农村是视力损害的危险因素。结论: 未矫正的屈光不正是视力损害的重要因素,通过矫正可使大部分人脱离视力损害的范围。应加强老年人群特别是贫困地区、低教育程度及低收入人群的视力保健和相关知识的普及。     

Vision assessment in persons with intellectual disabilities

Purpose

To investigate the degree of visual acuity in workers with intellectual disabilities and the impact of vision on their working conditions.

Methods

We recruited 224 workers (mean age 43.77 years, SD ± 12.96; range, 19–72 years) from a workshop for those with intellectual disabilities, to participate in a vision examination program. The assessment consisted of objective refraction, visual acuity, ocular motility, near‐point of convergence, cover/uncover test, stereo acuity and colour perception. Individuals with vision deficits were fitted with spectacles following the screening program.

Results

Within the past three years, 38.9 per cent of the participants received eye care, 14.3 per cent of participants had not received eye care in more than three years, and 6.7 per cent had not received any eye care. As many as 39.7 per cent of participants did not know whether they had ever received eye care. Entering visual acuity for far vision was 0.52 dec (?0.29 logMAR) and 0.42 dec (?0.38 logMAR) for near vision. Only 14.9 per cent, 11 of all participants aged ≥50 years, owned spectacles for near vision before the examination. After subjective determination of refraction, best corrected visual acuity for far vision was 0.61 dec (?0.22 logMAR) and 0.56 dec (?0.25 logMAR) for near vision (in both cases with p < 0.001). After the examination, 44.6 per cent (33) of all workers aged ≥50 years received a recommendation for reading or bifocal spectacles. In 46 per cent of workers, the threshold of stereopsis was higher than 63 arc seconds, and some form of colour vision deficiency was measured in 12.5 per cent of participants.

Conclusions

Workers with intellectual disabilities are often unaware of their visual deficits. We found that some of their abnormalities can be solved by appropriate optical means and that they could benefit from regular eye care. These workers should be encouraged to be tested and to improve their vision with appropriate lenses.

     

郑州市金水区小学生视力状况调查

目的　调查郑州市金水区７～１２岁小学生视力状况及屈光不正的患病情况,为小学生视力保健工作提供科学依据。方法　横断面调查研究,分层整群抽样方法,以学校为单位,随机抽取郑州市金水区３所小学,对抽样学校内的１～６年级在校学生进行普查,共调查７８４５名学生。眼部检查包括裸眼视力、矫正视力、眼前节、眼底、眼压及眼位检查,并对任意一眼或双眼裸眼视力＜１．０且眼压正常的儿童进行睫状肌麻痹验光。结果　实际受检学生７６８１名,应答率为９７．９１％。裸眼视力在７～８岁呈现逐年增加趋势,两两比较差异有显著统计学意义（Ｐ＜０．０１）;９～１２岁时裸眼视力视力呈现逐年下降趋势,两两比较差异有显著统计学意义（Ｐ＜０．０１）。任一眼裸眼视力≤０．５者占总人数３７．３９％,并且随着年龄增长,视力低下人群所占比例逐渐加大（７岁１５．２５％、８岁１８．３５％、９岁３１．６７％、１０岁４２．９６％、１１岁５１．７３％、１２岁６０．０３％）。接受睫状肌麻痹后验光的小学生中,近视的总患病率为３８．５８％,远视的总患病率为４．８４％。Ｌｏｇｉｓｔｉｃ回归分析显示,近视眼的等效球镜度与年龄呈显著正相关（ｒ＝１．７６９,Ｐ＜０．０１）;远视眼的等效球镜度与年龄呈显著负相关（ｒ＝－０．９２３,Ｐ＜０．０１）。受检的视力损伤者中屈光不正占８６．４０％,弱视占１２．４０％,沙眼导致的角膜混浊占０．０３％,其他原因导致的角膜混浊占０．３１％,白内障占０．４４％,视网膜疾病占０．１９％,其他致病原因占０．２５％。结论　郑州市金水区７～１２岁小学生视力损害的主要原因是近视,９岁是正视向近视转变的高敏年龄。     

北京市怀柔城区和郊区学龄前儿童视觉调查

目的对2009年北京市怀柔区25个幼儿园(其中区中心15个,郊区10个)4～6岁学龄前儿童进行视觉状况的普查,比较城区和郊区儿童视觉状况及相关因素。方法分别对城区2150例儿童和郊区1679例儿童进行了视力检测,包括远近视力(裸眼和戴镜视力)、外眼检查、眼位及眼球运动。对视力低于0.8进行散瞳验光。结果怀柔区城区和郊区儿童视力低常率有显著性差异。视力低常率:城区占13.02%,其中4岁占9.39%,5岁15.29%,6岁14.95%;郊区占9.17%,其中4岁占7.59%,5岁13.16%,6岁8.08%。各年龄组视力低常率有统计学意义,(P<0.01)。视力低常率与年龄相关。视力低常儿童中,其中疾病包括屈光不正;斜视;先天眼病(先天上睑下垂和先天眼球震颤);眼外伤。视力低常屈光不正占96.31%。屈光不正分布:远视74.16%,其中4岁占75.22%,5岁84.47%,6岁51.51%;近视10.77%,其中4岁占4.42%,5岁4.85%,6岁30.30%;混合散光15.07%,其中4岁占20.35%,5岁10.67%,6岁18.18%。弱视患病率4.3%;对弱视相关因素调查显示,屈光参差性占36.36%,轻度65.00%,中度31.67%,重度3.33%;斜视性占15.15%,轻度28.00%,中度60.00%,重度12.00%;形觉剥夺性占2.43%,轻度0%,中度50.50%,重度50.50%。结论学龄前儿童视力低常率和地域有一定的关系。低常率随年龄增加而降低,表明视功能发育逐渐成熟。屈光不正中各组比例提示远视是4～6岁学龄前儿童视力低下的主要原因。近视、斜视、弱视等因素所占比例提示普查手段十分重要,可以早发现早治疗。     

Development of Pocket Vision Screener and its effectiveness at screening visual acuity deficits

Aim:The aim was to construct a visual acuity chart and find its effectiveness at screening visual acuity deficits.Results:The mean age of the subjects was 43 ± 17 years. Subjects were classified as normal or deficient based on the logMAR visual acuity measurement. The screener was found to have 81% sensitivity, 94% specificity. The positive and negative predictive values were found to be 91% and 87%, respectively. A significant difference (P < 0.001) was found in the time taken to record visual acuity using both the charts.Conclusion:The Pocket Vision Screener can be used as a quick and accurate tool to screen subjects for visual acuity deficits, being highly sensitive, specific, and cost-effective.     

Myopia and visual acuity impairment: a comparative study of Greek and Bulgarian school children

Purpose:  To compare the proportions of school children with myopia and impaired visual acuity in Greece and Bulgaria.
Methods:  A sample of 898 children, aged 10–15 years, was selected from two primary and two secondary schools in a Greek city (Heraklion), and one primary and secondary school in a Bulgarian city (Stara Zagora). Five hundred and eighty eight children were Greek (65.5%, mean age 12.5 ± 0.08 years) and 310 Bulgarian (34.5%, age 12.4 ± 0.07 years). VA was assessed with the habitual refractive correction. Refractive error was measured in the absence of cycloplegia using an auto-refractor.
Results:  The percentage of children, tested with their habitual refractive correction, with decimal VA <0.5 in at least one eye was 11.7% (95% CI 9.1–14.3%) for Greek and 5.2% (95% CI 2.7–7.6%) for Bulgarian pupils. The percentage of myopic children also differed between the two countries with the proportion with myopic refractive error ≤−0.75 D and decimal VA <0.8 at primary school level being 14.1% and 28.9% in Stara Zagora and Heraklion respectively and 13.0% and 46.9% (95% CI 18.2–29.2%, p  < 0.0001) at secondary school level. Among the myopic pupils only 35.8% used corrective spectacles in Stara Zagora, compared to 70.7% of the children in Heraklion. Finally, myopia appeared more prevalent in female adolescents with the effect being statistically significant only for Greek children (55% vs 40% of males, p  = 0.015).
Conclusions:  The increased proportion of myopic children in Heraklion, compared to Stara Zagora, may arise from a number of environmental and socio-economic factors, which need to be further investigated in order to understand the differences observed among European populations.     

连续性功能性视力在眼科的应用进展

连续性功能性视力（FVA）被认为是一种可以较好体现自然状态下视功能的功能性视力检查方法,它的概念与测量方法随着技术的进步得到了不断的更新.FVA检查最初应用于干眼患者的评估,并在屈光不正、白内障、眼底病变、药物使用效果评估等领域逐渐得到推广,为一些眼病的早期诊断、治疗效果评价等提供了理论依据.就FVA的概念与方法、FVA的测量系统以及FVA在干眼、屈光不正、白内障和眼底病变患者中的应用和研究进展进行综述.     

智障儿童眼部筛查结果与分析

目的 通过对温州地区特殊学校就读的智障儿童进行眼部健康筛查,了解智障儿童的眼部健康问题,分析相关因素,以提供相应的视觉矫正和治疗措施,及探索如何为智障儿童的眼部健康提供有效的服务.方法 调查研究.对在温州地区特殊学校就读的342名智障儿童进行眼部健康筛查,内容包括：一般信息、视力检查、眼位检查、色觉检查、眼前段检查、内眼检查以及屈光不正检查.采用Excel软件对数据进行整理、归纳和求百分比.并针对存在的视觉问题作出相应的分析和医学处理.结果 筛查患儿智力残疾为轻度至中度,心理与情绪等适应能力轻度或中度障碍,能参与部分社区活动.眼科检查发现,正视眼占46.6%,屈光不正均以低度屈光不正状态为主,大部分能通过眼镜矫正达到5.0 眼位检查显示正位眼占67.2%,隐斜视占12.9% 色觉正常者占81.9%,色觉存在明显异常者占6.4% 外眼及眼前段检查未发现明显异常者占92.7% 内眼检查未发现明显异常者占81.1%.这些患儿眼部的异常主要是眼球震颤（占50.0%）和白内障（占28.3%）.结论 智障儿童的眼部问题现患率比普通儿童高,但还是以屈光不正、眼球震颤、白内障等为主,大多为可矫正和可康复的,可以通过眼镜、手术或视觉康复等提高视功能.     

不同手术切口对白内障术后视力和屈光力的影响

目的　评价白内障不同的手术切口对术后视力恢复的影响。方法　对１８６ 只眼老年性、并发性、发育性和无角膜瘢痕的外伤性白内障行ＥＣＣＥ（ＣＣＣ） 加ＩＯＬ。切口为１１ ｍ ｍ ,隧道６ ｍ ｍ 及反眉状５ ．５ ｍ ｍ 巩膜切口,手术后１ ｗｋ ,１ ｍ ｏ ,３ ｍ ｏ 进行视力和屈光检查与比较。结果　随着手术切口的缩小和手术切口的改进,角膜散光明显减少,视力明显提高。结论　提示反眉状隧道式白内障摘出术ＩＯＬ 术具有有效控制术后散光,全面重建视功能的优点     

视觉诱发电位技术与视力客观评估

对视觉诱发电位技术及其发展历史、现状进行了必要介绍,并结合分析临床法医实践中眼损伤的特点对视觉诱发电位技术在视力评估中的应用进行了综述。     

Temporal visual field defects are associated with monocular inattention in chiasmal pathology

Purpose: Chiasmal lesions have been shown to give rise occasionally to uni‐ocular temporal inattention, which cannot be compensated for by volitional eye movement. This article describes the assessments of 46 such patients with chiasmal pathology. It aims to determine the clinical spectrum of this disorder, including interference with reading. Methods: Retrospective consecutive observational clinical case study over a 7‐year period comprising 46 patients with chiasmal field loss of varying degrees. Observation of reading behaviour during monocular visual acuity testing ascertained from consecutive patients who appeared unable to read optotypes on the temporal side of the chart. Visual fields were evaluated by kinetic (Goldmann) and static (Octopus) techniques. Five patients who clearly manifested this condition are presented in more detail. The results of visual field testing were related to absence or presence of uni‐ocular visual inattentive behaviour for distance visual acuity testing and/or reading printed text. Results: Despite normal eye movements, the 46 patients making up the clinical series perceived only optotypes in the nasal part of the chart, in one eye or in both, when tested for each eye in turn. The temporal optotypes were ignored, and this behaviour persisted despite instruction to search for any additional letters temporal to those, which had been seen. This phenomenon of unilateral visual inattention held for both eyes in 18 and was unilateral in the remaining 28 patients. Partial or full reversibility after treatment was recorded in 21 of the 39 for whom reliable follow‐up data were available. Reading a text was affected in 24 individuals, and permanently so in six. Conclusion: A neglect‐like spatial unawareness and a lack of cognitive compensation for varying degrees of temporal visual field loss were present in all the patients observed. Not only is visual field loss a feature of chiasmal pathology, but the higher visual function of affording attention within the temporal visual field by means of using conscious thought to invoke appropriate compensatory eye movement was also absent. This suggests the possibility of ‘trans‐synaptic dysfunction’ caused by loss of visual input to higher visual centres. When inattention to the temporal side is manifest on monocular visual testing it should raise the suspicion of chiasmal pathology.     

Correctable visual impairment in older people: a major unmet need

This review seeks to determine the prevalence of correctable visual impairment (VI) in older people in the UK, to discover what proportion of these cases are undetected, to suggest reasons for the poor detection and to make recommendations for improving the detection. To establish the context of these issues, the review will also touch on the general prevalence and causes of VI in older people in developed countries and on the impact of VI in older people. Typically, studies suggest that VI affects about 10% of people aged 65-75, and 20% of those aged 75 or older. There is a strong relationship between impaired vision in older people and both reduced quality of life and increased risk of accidents, particularly falls. The literature suggests that those with low vision are about two times more likely to have falls than fully sighted people, and the annual UK cost of treating falls directly attributable to VI is pound 128 million. The literature on the prevalence of undetected reduced vision in older people reveals that between 20 and 50% of older people have undetected reduced vision. The majority of these people have correctable visual problems (refractive errors or cataract). It is particularly startling that, in 'developed countries', between 7 and 34% of older people have VI that could simply be cured by appropriate spectacles. The reasons why so many cases of treatable VI remain untreated are discussed, and suggestions are made for improving the detection of these cases. We conclude that there should be better publicity encouraging older people to attend for regular optometric eye examinations. A complementary approach is annual visual screening of the elderly, possibly as part of GPs annual health check on people aged 75 years and older. Recommendations are made for evaluating new approaches to screening and for improving the management of cases detected by screening.