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Leat SJ, Saraf A, Rose K, Christian LW, Irving EL, Jones D, McCulloch DL. Measuring recognition visual acuity in young children - testability with the Waterloo Differential Acuity Test (WatDAT). Clin Exp Optom 2023; 106:883-889. [PMID: 36403264 DOI: 10.1080/08164622.2022.2141101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/24/2022] [Indexed: 11/21/2022] Open
Abstract
CLINICAL RELEVANCE Visual acuity measurement is important for the detection and monitoring of eye disorders. Developing accurate and sensitive visual acuity tests suitable for young children is therefore desirable. BACKGROUND Recognition or form visual acuity (VA), which is measured with matching in children aged 3 years and up, is more sensitive for detecting visual deficits compared to resolution VA. The Waterloo Differential Acuity Test (WatDAT) is a proposed recognition VA test using the concept of identifying the "odd one out" among distractors. The WatDAT is expected to be cognitively easier than matching tests and therefore may be used in younger children. The purpose of this study is to investigate the testability of the WatDAT paradigm in children aged 12-36 months, and to determine the optimum format and number of distractors. METHODS Fifty-one typically-developing children aged 12-36 months participated in the study. Data for Patti Pics (PP) and Face targets (FT) were collected for formats with 3, 4 and 5 distractors. The targets were presented binocularly on a computer touch screen at 30 cm. The task was to touch the face among identical non-faces or a house among circles. Following initial training, there were 5 presentations for each distractor format. Testability was defined as correctly identifying at least 4/5 presentations and was also determined for uncrowded PP symbols using matching. RESULTS Of participants aged 18-36 months, 87% could perform the WatDAT PP targets with 3 distractors compared to 68% for the FT, while 48% could perform matching with PP. The testability for FT increased to 85% for children ≥22 months. Younger children showed lower testability. For the 3 distractor format, PP targets gave 9% testability in children 12 to <18 months, and FT gave a testability of 16% in children 12 to <22 months. CONCLUSION WatDAT testability is higher than matching VA tests. This indicates that the newly developed WatDAT has potential for measuring recognition VA in children 18 months and older.
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Affiliation(s)
- Susan J Leat
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Aashi Saraf
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Kalpana Rose
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Lisa W Christian
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Elizabeth L Irving
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Deborah Jones
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Daphne L McCulloch
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
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Wang P, Bianchet S, Carter M, Hopman W, Law C. Utilization and barriers to eye care following school-wide pediatric vision screening. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:465-471. [PMID: 35525265 DOI: 10.1016/j.jcjo.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/27/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE In August 2018, Ontario introduced the Child Visual Health and Vision Screening Protocol outlining school-based senior kindergarten (aged 4-6 years) vision screening. We determine the prevalence of children at risk based on screening in an Ontario community and follow up to determine resource utilization after screening. METHODS Vision screening data (HOTV, Randot, Autorefractor) from 41 schools (1127 children) were collected for the 2018-2019 and 2019-2020 school years. Phone follow-up was conducted 1-1.5 years after screening to determine whether an optometry visit occurred, if glasses were prescribed, and potential barriers to accessing eye care. Independent t tests were used to compare time to follow-up between groups, and χ2 testing was used for associations between material and social deprivation. RESULTS Overall screening resulted in a 32.2% referral rate within our region. Of the referred children who responded, the rate of seeking out eye care was 69.9% (n = 64), and 65.2% of these visits were prompted specifically by vision screening, and 34.4% of referred children respondents were prescribed glasses. There was a significant relationship between receiving a referral and living in a more materially deprived (p = 0.001) and a more socially deprived area (p = 0.006). The most frequently reported barriers were related to insufficient insurance coverage for eye care or glasses, COVID-19-related difficulties, and scheduling conflicts. CONCLUSION Our vision screening program identified and referred more than one third of children screened for follow-up eye examinations, with children in more deprived neighbourhoods being more frequently referred. Around two thirds of referred children sought care, and one third were prescribed glasses in the follow-up sample.
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Affiliation(s)
- Patrick Wang
- Department of Ophthalmology, School of Medicine, Queen's University, Kingston, Ont
| | - Sonya Bianchet
- Department of Public Health Sciences, Kingston, Frontenac, Lennox, and Addington Public Health, Kingston, Ont
| | - Megan Carter
- Department of Public Health Sciences, Kingston, Frontenac, Lennox, and Addington Public Health, Kingston, Ont.; Department of Public Health Sciences, Queen's University, Kingston, Ont
| | - Wilma Hopman
- KGH Research Institute and Department of Public Health Sciences, Queen's University, Kingston, Ont
| | - Christine Law
- Department of Ophthalmology, Queen's University, Kingston, Ont..
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Mutlu D, Bayram N. Morphological changes of the retinal layers in the central macula in children with anisometropic amblyopia. J Fr Ophtalmol 2023; 46:363-368. [PMID: 36759245 DOI: 10.1016/j.jfo.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 02/10/2023]
Abstract
PURPOSE The goal of this study was to evaluate the morphological characteristics of the retinal layers in the central macula in children with anisometropic amblyopia. METHODS This comparative, observational, prospective study included 28 patients who were diagnosed with anisometropic amblyopia and 30 age- and sex-matched healthy controls. All children were evaluated using the automatic calculation software system available on spectral-domain optical coherence tomography (SD-OCT) for automated segmentation of the macula. RESULTS Of the included patients, 18 (64.3%) were male and 10 (35.7%) were female, with a mean age of 10.3±3.4 years. Mean spherical equivalent and best-corrected visual acuity (BCVA) were 4.13±1.95 diopters and 0.707±0.36 logMAR, respectively. The mean axial length was significantly lower in amblyopic eyes compared to fellow eyes (22.1±0.34mm vs. 23.3±0.42mm, P<0.0001), and control eyes (22.1±0.34mm vs. 23.1±0.40mm, P<0.0001). The mean thickness of the outer nuclear layer was significantly lower in amblyopic eyes compared to fellow eyes (79.8±11.9μm vs. 86.8±7.9μm, P=0.007), and healthy controls (79.8±11.9μm vs. 87.4±10.5μm, P=0.012). CONCLUSION The results of this study showed that there are quantitative differences in retinal microstructures of the macula in eyes with anisometropic amblyopia compared to fellow eyes and healthy controls. These findings suggest that anisometropic amblyopia may result in abnormal development of macular structure in the inner retinal layer. A detailed analysis of retinal layers may be able to provide a guide to the depth of amblyopia and visual prognosis.
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Affiliation(s)
- D Mutlu
- Department of Ophthalmology, Kayseri City Training and Research Hospital, University of Health Science, 30080 Kocasinan Kayseri, Turkey.
| | - N Bayram
- Department of Ophthalmology, Kayseri City Training and Research Hospital, University of Health Science, 30080 Kocasinan Kayseri, Turkey
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Wang H, Qiu K, Yin S, Du Y, Chen B, Jiang J, Deng D, Zhang M. Prevalence of Visual Impairment in Preschool Children in Southern China. Front Public Health 2022; 10:755407. [PMID: 35444981 PMCID: PMC9013812 DOI: 10.3389/fpubh.2022.755407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The goal of this study is to assess the prevalence and distribution of visual impairment in preschool children in southern China. METHODS Preschool children aged 36-83 months were enrolled in a vision screening program in Shantou City. Visual acuity test and non-cycloplegic refraction were conducted. According to the American Academy of Ophthalmology (AAO) guidelines, visual impairment was defined as uncorrected visual acuity (UCVA) in either eye <20/50, 20/40, and 20/32 in children aged 36-47, 48-59, and 60-83 months, respectively, as well as an interocular difference (IOD) of ≥ two lines of UCVA. RESULTS The UCVA test was successfully performed on 7,880 children (94.6% of the enrolled population). A total of 938 (11.9%; 95% CI 11.2-12.6) children were found to have reduced UCVA in the worse eye, and 393 (5%; 95% CI 4.5-5.5) of the children had an IOD of two or more lines. Combining the reduced UCVA with the IOD criteria identified 1,032 (13.1%; 95% CI 12.4-13.8) children with visual impairment. UCVA in preschool children improves with age naturally and boys have slightly better age-adjusted UCVA than girls. Causes of reduced visual acuity included uncorrected refractive error, amblyopia, congenital cataract, and others. The cylindrical diopter in the right eye of children with reduced vison was higher than that of children with normal vision (1.19 ± 1.05 vs. 0.52 ± 0.49, P < 0.001). A total of 146 (1.9%, 95% CI 1.6-2.2) of the preschool children wore spectacles. The proportion of wearing spectacles increased with age (χ2 = 35.714, P < 0.001), but with IOD increasing by.1 logMAR, the odds of wearing spectacles decreased by 44.8%. CONCLUSION This study provided data on the prevalence of visual impairment in preschool children in China by large-scale school-based vision screening. Further studies should be conducted to verify the benefit from vision screening.
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Affiliation(s)
- Hongxi Wang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | | | | | | | | | | | | | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
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Hou C. A novel method for utilizing dichoptic attention tasks in amblyopic training. MethodsX 2022; 9:101829. [PMID: 36081490 PMCID: PMC9445385 DOI: 10.1016/j.mex.2022.101829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022] Open
Abstract
There is converging evidence of attention deficits in individuals with amblyopia. It has been reported that selective visual attention is allocated preferentially toward the non-amblyopic fellow eye in strabismic ambloypes. This attention allocation bias between the eyes is found related to visual suppression in amblyopia. In this study, I introduced a novel method, which uses dichoptic attention tasks to train individuals with amblyopia and has been demonstrated alleviating visual suppression and improving visual functions while reducing interocular attention bias in adults with amblyopia. The method consists of the following components:The training tasks include three attention factors (searching, counting and cueing) to implement selective visual attention to the amblyopic eye dichoptically. With a dichoptic approach, the targets are presented to the amblyopic eye while the distractors are simultaneously presented to the fellow eye. The tasks are to search and count the targets that are presented to the cued eye among the distractors. The training stimuli avoid typical contrast sensitivity-based tasks, and the targets are highly visible allowing them to be seen by the amblyopic eye with poor visual acuity.
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Cui J, Fu J, Li L, Chen W, Meng Z, Su H, Yao Y, Dai W. Prevalence and pattern of refractive error and visual impairment among schoolchildren: the Lhasa childhood eye study. BMC Ophthalmol 2021; 21:363. [PMID: 34641830 PMCID: PMC8513166 DOI: 10.1186/s12886-021-02134-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background Early and effective ocular screening may help to eliminate treatable eye disorders. The Lhasa Childhood Eye Study (LCES) revealed the particular prevalence of refractive error and visual impairment in grade one schoolchildren (starting age of 6 years old) in Lhasa. Methods This is a cross-sectional part of school-based cohort study. One thousand nine hundred forty-three children were enrolled (median age, 6.78 years, range, 5.89 to 10.32). Each child underwent general and ocular examinations, including logarithm of the minimum angle of resolution (logMAR) visual acuity, cycloplegic autorefraction, and slit-lamp biomicroscopy evaluation. Multivariate and correlation analyses were performed to evaluate the association between refractive error with gender and ethnics. Results The prevalence of visual impairment (logMAR visual acuity ≥0.3 in the better-seeing eye) of uncorrected, presenting and best-corrected visual acuity (BCVA) was 12.2, 11.7 and 2.7%, respectively. Refractive error presented in 177 (78.0%) out of 227 children with bilateral visual impairment. Myopia (spherical equivalent refractor [SER] ≤ − 0.50 diopter [D] in either eye) was present in 4.7% children when measured after cycloplegic autorefraction. Hyperopia (SER ≥ + 2.00 D) affected 12.1% children. Hyperopia was significantly associated with female gender (P<0.001). Astigmatism (cylinder value ≤ − 0.75 D) was present in 44.8% children. In multivariate regression and correlation analysis, SER had no significant difference between ethnic groups. Conclusion The Lhasa Childhood Eye Study is the first school-based cohort study to reveal the prevalence and pattern of refractive error and visual impairment in Lhasa. Effective strategies such as corrective spectacles should be considered to alleviate treatable visual impairment.
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Affiliation(s)
- Jiantao Cui
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Jing Fu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China.
| | - Lei Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Weiwei Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China.,Beijing Institute of Ophthalmology, Beijing, China
| | - Zhaojun Meng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Han Su
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Yao Yao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
| | - Wei Dai
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology & Visual Sciences, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, China
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Wang S, Wen W, Zhu W, Liu Y, Zou L, Tian T, Lin J, Liu R, Liu H. Effect of Combined Atropine and Patching vs Patching Alone for Treatment of Severe Amblyopia in Children Aged 3 to 12 Years: A Randomized Clinical Trial. JAMA Ophthalmol 2021; 139:990-996. [PMID: 34264296 DOI: 10.1001/jamaophthalmol.2021.2413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Patching is often less effective for severe amblyopia because of poor adherence. For the treatment of severe amblyopia, although combined atropine and patching therapy (CAPT) has been found to be efficacious, it is currently unknown whether CAPT is more efficacious than patching alone. Objective To compare the efficacy of CAPT vs patching alone in children aged 3 to 12 years with severe amblyopia. Design, Setting, and Participants This single-center randomized clinical trial was conducted from November 2018 to May 2020. The visual acuity (VA) examiner was masked to the treatment groups. The follow-up visits were at 3 months and 6 months. Participants aged 3 to 12 years with severe amblyopia (20/100 to 20/500) resulting from strabismus, anisometropia, or both were randomly assigned to CAPT or patching therapy. Interventions CAPT or patching alone for 6 months. Main Outcomes and Measures Change of the amblyopic eye VA from baseline to 6 months. Results Among 108 participants, the mean (SD) age was 5.2 (1.8) years, and 54 (50%) were female. Overall, 53 participants (49%) were randomized to CAPT and 55 (51%) were randomized to patching therapy. At baseline, the mean (SD) amblyopic eye VA was 0.95 (0.22) logMAR (approximately 20/200 [2.2 lines]). At 6 months, the CAPT group's mean improvement in amblyopic eye VA was 0.72 logMAR (7.2 lines) compared with 0.58 logMAR (5.8 lines) in the patching alone group (difference, 0.14 logMAR [1.4 lines] greater in the CAPT group; 95% CI, 0.05-0.22 logMAR [0.5-2.2 lines]; P = .002). The amblyopic eye VA improvement in the CAPT group also was greater than that in the patching alone group at 3 months (difference in the means, 0.13 logMAR [1.3 lines]; 95% CI, 0.04-0.22 logMAR [0.4-2.2 lines]; P = .004). No participants were withdrawn because of adverse effects. Conclusions and Relevance CAPT resulted in more mean improvement of amblyopic eye VA than patching alone among participants enrolled in this trial, although the clinical relevance of this relatively small VA difference cannot be determined from this trial. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR1800018663.
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Affiliation(s)
- Shu Wang
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Wen Wen
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Wenqing Zhu
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yan Liu
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Leilei Zou
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Tian Tian
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jing Lin
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Rui Liu
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Hong Liu
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,Department of Ophthalmology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Anstice N, Spink J, Abdul‐rahman A. Review of preschool vision screening referrals in South Auckland, New Zealand. Clin Exp Optom 2021; 95:442-8. [DOI: 10.1111/j.1444-0938.2012.00713.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nicola Anstice
- Department of Ophthalmology, Manukau Super Clinic, Auckland, New Zealand
- Department of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand. E‐mail:
| | - Jennifer Spink
- Department of Ophthalmology, Manukau Super Clinic, Auckland, New Zealand
| | - Anmar Abdul‐rahman
- Department of Ophthalmology, Manukau Super Clinic, Auckland, New Zealand
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Anstice NS, Thompson B. The measurement of visual acuity in children: an evidence‐based update. Clin Exp Optom 2021; 97:3-11. [DOI: 10.1111/cxo.12086] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/02/2013] [Accepted: 04/16/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Nicola S Anstice
- Department of Optometry and Vision Science, University of Auckland, Auckland, New Zealand,
| | - Benjamin Thompson
- Department of Optometry and Vision Science, University of Auckland, Auckland, New Zealand,
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10
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Pang Y, Allen M, Robinson J, Frantz KA. Contrast sensitivity of amblyopic eyes in children with myopic anisometropia. Clin Exp Optom 2021; 102:57-62. [PMID: 30054940 DOI: 10.1111/cxo.12817] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/15/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Yi Pang
- Illinois College of Optometry, Chicago, Illinois, USA
| | - Megan Allen
- Illinois College of Optometry, Chicago, Illinois, USA
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Alem KD, Gebru EA. A cross-sectional analysis of refractive error prevalence and associated factors among elementary school children in Hawassa, Ethiopia. J Int Med Res 2021; 49:300060521998894. [PMID: 33752506 PMCID: PMC8013717 DOI: 10.1177/0300060521998894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This study assessed the prevalence of refractive error (RE) and its
associated factors among elementary school children in Hawassa,
Ethiopia. Methods In this school-based cross-sectional study, a random selection technique with
proportional allocation was used to ensure a representative sample of
students. Survey questionnaires were used to collect sociodemographic,
environmental, and family history data. Clinical examinations were performed
to assess RE and ocular health. Associations between dependent and
independent variables were computed using adjusted odds ratios (AORs) and
95% confidence intervals (CIs). Results Overall, 529 children participated in this study, with a response rate of
95.5% (529/554). Most participants were aged ≥12 years (337 [63.7%]), in
grade levels 5 to 8 (307 [58%]), and attended public schools (366 [69.2%]).
RE prevalence was 12.9% (95% CI: 10.0–16.1). Higher grade level (AOR=3.18,
95% CI: 1.68–5.97), positive family history of RE (AOR=3.69, 95% CI:
1.57–8.67), lack of paternal formal education (AOR=3.25, 95% CI: 1.20–8.77),
and public school attendance (AOR=3.33, 95% CI: 1.52–7.27) were factors
significantly associated with RE. Conclusions RE prevalence among elementary school children in Hawassa was higher than in
previous reports. Grade level, family history, paternal education level, and
school type significantly influenced RE status.
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Affiliation(s)
- Kindie Desta Alem
- Department of Ophthalmology and Optometry, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Elias Abera Gebru
- Department of Ophthalmology and Optometry, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Thicknesses of Macular Inner Retinal Layers in Children with Anisometropic Amblyopia. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6853258. [PMID: 33134383 PMCID: PMC7591976 DOI: 10.1155/2020/6853258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/13/2020] [Accepted: 10/04/2020] [Indexed: 11/17/2022]
Abstract
Objective To investigate the thicknesses of macular inner retinal layers in children with anisometropic amblyopia using spectral domain optical coherence tomography (SD-OCT). Methods Thirty-seven children with anisometropic amblyopia and fifty-seven children with normal vision were recruited in the study. Both eyes of children with anisometropic amblyopia and the right eyes of normal controls underwent scanning with the Spectralis OCT. The segmentation of retinal layers was performed automatically to measure individual inner retinal layers in the five sectors of the macular. An independent sample t-test was applied to compare the mean layer thicknesses of anisometropic eyes and fellow eyes with those of control eyes. Results There was no significant difference in the total macular thickness between amblyopic and control eyes. However, in the peripheral macular area, three of the four quadrants of both the ganglion cell layer (GCL) and the inner plexiform layer (IPL) thicknesses were significantly reduced in amblyopic eyes compared to control eyes. Moreover, two of the four quadrants of the GCL thickness and three of the four quadrants of the IPL thickness in the peripheral macular area were significantly reduced in fellow eyes than in control eyes. Conclusion The SD-OCT data revealed differences in the thicknesses of some macular inner retinal layers in both eyes of children with anisometropic amblyopia compared with those with emmetropia, indicating that structural changes might exist in the retina of children with amblyopia.
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Ravindran M, Pawar N, Renagappa R, Ravilla T, Khadse R. Identifying barriers to referrals in preschool-age ocular screening in Southern India. Indian J Ophthalmol 2020; 68:2179-2184. [PMID: 32971635 PMCID: PMC7728044 DOI: 10.4103/ijo.ijo_1603_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: The aim of this study was to identify barriers to follow-up among children aged 0–5 years who failed ocular screening. Methods: A cross-sectional, descriptive study was conducted for screening children aged 0–5 years, covering three districts of South India from January 2012 to December 2012. Screening was performed under Lavelle Paediatric Eye Care Project, included under Integrated Child Development Services (ICDS) program. A survey was conducted within 60 days of the screening, with the parents of children who failed to follow up at base hospital. Family demographics, parental awareness of childhood eye diseases and eye care for children, and barriers to follow up eye care were assessed. Results: A total of 19,408 children were screened. Among them, 913 (4.7%) failed screening and were referred. 319 (35%) of those referred attended the base hospital, of which 133 (41.6%) had no abnormality on detailed examination. 111 (34.7%) had refractive errors, 10 (3%)) had strabismus, and three (1%) had amblyopia. 62 (19.4%) had other ocular conditions. Parents of 324/594 (65%) children who did not attend the base hospital were traced and completed the questionnaire. Low level of education, low income, types of occupation, and distance factors were the main barriers to follow-up of referral in preschool children. Factors such as cost of time taking off from work and monthly family income were statistically significant (P < 0.001). Conclusion: Education, financial status, and distance factors were the main barriers to follow up of referral in preschool children. Identification of these barriers to follow up and improving the referral services could help in detecting visual problem effectively.
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Affiliation(s)
- Meenakshi Ravindran
- Department of Pediatric Ophthalmology and Squint Services, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Neelam Pawar
- Department of Pediatric Ophthalmology and Squint Services, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Ramakrishnan Renagappa
- Department of Pediatric Ophthalmology and Squint Services, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Thulsiraj Ravilla
- Department of Pediatric Ophthalmology and Squint Services, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Ruthika Khadse
- Department of Pediatric Ophthalmology and Squint Services, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
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Ashrafi E, Jamali S, Mohammadi SF, Mehdipoor P. National and sub national prevalence of Amblyopia and its trends from 1990 to 2018 in Iran. JOURNAL OF OPTOMETRY 2020; 13:113-119. [PMID: 32321688 PMCID: PMC7182781 DOI: 10.1016/j.optom.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/13/2019] [Accepted: 12/06/2019] [Indexed: 06/11/2023]
Abstract
PURPOSE To determine the national and subnational prevalence of amblyopia and the respective provincial distribution and trend during 1990-2018 in Iran. METHODS Amblyopia data retrieved from 26 original studies, systematic reviews, Data has been cleaned by STATA and a linear mixed effect spatio-temporal model was used to calculate Gaussian process regression mean functions. Using a Bayesian approach, by pooling empirical data based on the assumed prior, a posterior distribution obtained for age and sex specific prevalence prediction nationally during the study time and provincially. RESULTS The overall age-adjusted prevalence of Amblyopia was 0.03 (95% CI, 0.022-0.035). The prevalence was comparable in boys and girls (p = 0.85), highest prevalence was in >30 years old (p = 0.038). Our extrapolation revealed a stable trend of prevalence of Amblyopia in Iran during 1990-2018 (national screening program has been active from 1990 onwards). While Amblyopia prevalence suggested a declining trend in three provinces of Hormozgan, Qom and Tehran and it went up in 13 other provinces. CONCLUSION Amblyopia prevalence seems unchanged despite the concurrent screening program. It is noteworthy that the coverage of the program has been improved and has reached more than 85% in 2018. Our finding mandates a formal evaluation on the program.
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Affiliation(s)
- Elham Ashrafi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Jamali
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Farzad Mohammadi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parinaz Mehdipoor
- Non-communiacable diseases research center, Tehran University of Medical Science, Tehran, Iran
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Liu CF, Tseng CH, Huang CY, Sun CC, Yang ML, Chen WY, Yeung L. Correlation between higher-order aberrations and visual acuity recovery (CoHORT) after spectacles treatment for pediatric refractive amblyopia: A pilot study using iDesign measurement. PLoS One 2020; 15:e0228922. [PMID: 32059018 PMCID: PMC7021302 DOI: 10.1371/journal.pone.0228922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 01/26/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose To determine the correlation between higher-order aberrations (HOAs) and best-corrected visual acuity (BCVA) recovery speed after spectacles treatment using iDesign measurements in refractive amblyopic children. Methods This is a prospective case series. Children aged from 3 to 7 years with refractive amblyopia (Landolt C equivalent < 0.8) were recruited. All participants were followed for at least 6 months after full correction of the refraction error by spectacles. The HOAs were measured using iDesign before and after cycloplegia at first visit and at 3-month intervals. Then correlation between BCVA recovery after treatment for 6 months and HOAs was determined. Results We analyzed 24 eyes of 12 children (mean age, 4.5 years). Baseline mean BCVA was logarithm of minimal angle of resolution (logMAR) 0.335 (Landolt C equivalent 0.46), which improved to logMAR 0.193 (Landolt C equivalent 0.64) after treatment with full-correction spectacles for 6 months. The amblyopic eye BCVA recovery was negatively correlated with tetrafoil with/without cycloplegia (P = 0.006 and 0.022, respectively) and trefoil with cycloplegia (P = 0.049). Conclusions trefoil and tetrafoil measured with iDesign negatively correlates with the BCVA recovery speed of refractive amblyopic eyes after spectacles treatment in this pilot study. The current study results may aid in further investigation for diagnosis and treatment of refractory refractive and idiopathic amblyopia.
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Affiliation(s)
- Chun-Fu Liu
- Program in Molecular Medicine, National Yang Ming University, Taipei, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Hsin Tseng
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chung-Ying Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linckou, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Meng-Ling Yang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linckou, Taiwan
| | - Wei-Yi Chen
- Program in Molecular Medicine, National Yang Ming University, Taipei, Taiwan
- Institute of Biochemistry and Molecular Biology, National Yang-Ming University, Taipei, Taiwan
- * E-mail: (LY); (WYC)
| | - Ling Yeung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail: (LY); (WYC)
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Chen H, Lin Z, Chen J, Li X, Zhao L, Chen W, Lin H. The impact of an interactive, multifaceted education approach for congenital cataract on parental anxiety, knowledge and satisfaction: A randomized, controlled trial. PATIENT EDUCATION AND COUNSELING 2020; 103:321-327. [PMID: 31522896 DOI: 10.1016/j.pec.2019.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of our research was to examine the impact of a patient education program for parents of children with congenital cataract on parental stress, comprehension of disease information and parental satisfaction. METHODS This prospective study included 177 parents of children with congenital cataract. The children were randomized into the following groups: the health education program with a multifaceted, interactive approach and conventional follow-up. Self-administered questionnaires were used for parental evaluation before and after the education program. The anxiety level, parental satisfaction and comprehension of the information were evaluated at each time point. RESULTS A multifaceted, interactive approach to education significantly reduced parental levels of anxiety compared with the conventional group (effect sizes: Parenting Stress Index, ƞ2 = 0.285; Ocular Treatment Index, ƞ2 = 0.346). This approach also improved comprehension-memorization scores (effect sizes: ƞ2 = 0.303) and parental satisfaction (p < 0.001). The impact of this new intervention was maintained for 6 and 12 months after the course. CONCLUSION The interactive, multifaceted education approach could efficiently improve the comprehension of disease-related information and parental satisfaction, resulting in significantly decreased parental anxiety. PRACTICE IMPLICATIONS This new patient education approach had a significant impact on congenital cataracts and may be generalized to other pediatric diseases.
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Affiliation(s)
- Hui Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhuoling Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jingjing Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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Gurnani B, Kaur K, Kannusamy V, Mouttapa F, Venkatesh R, Khadia A. To assess the accuracy of Plusoptix S12-C photoscreener in detecting amblyogenic risk factors in children aged 6 months to 6 years in remote areas of South India. Indian J Ophthalmol 2020; 68:2186-2189. [PMID: 32971637 PMCID: PMC7727995 DOI: 10.4103/ijo.ijo_2046_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To assess the screening accuracy of a novel fourth generation, handheld Plusoptix S12 C photo screener in detecting amblyogenic risk factors in children aged 6 months to 6 years in remote areas of South India. Methods: In this cross sectional study, 381 children aged 6 months to 6 years were screened by a trained fieldworker in Anganwadis and schools using the Plusoptix photoscreener. This was followed by complete ophthalmic evaluation including retinoscopy, subjective refraction, and strabismus evaluation by an optometrist and an orthoptist. All children further underwent complete ocular examination by the senior pediatric ophthalmologist for validation of the results. Results: A total of 367 children were included in the study. The sensitivity and specificity of the photo screener were found to be 86.76% and 82.27%, respectively. Positive Predictive Value, Negative Predictive Value, and Receiver Operative Characteristics were 52.67%, 96.47%, and 83.11%, respectively. In subgroup younger than 3 years, sensitivity and specificity was 89.19% and 81.18%, respectively. Myopic astigmatism was the most common amblyogenic risk factor in our study group. Conclusion: In India, with a lack of adequate healthcare professionals and poor health-seeking behavior; photo screeners can play an important role. We recommend the use of photo screeners for screening children as young as 6 months, especially in remote low-resource settings. This will help in expanding reliable eye care services to previously underserved areas.
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Assessment of stereovision with digital testing in adults and children with normal and impaired binocularity. Vision Res 2019; 164:69-82. [DOI: 10.1016/j.visres.2019.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 07/10/2019] [Accepted: 07/24/2019] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Amblyopia is defined as impaired visual acuity in one or both eyes without demonstrable abnormality of the visual pathway, and is not immediately resolved by wearing glasses. OBJECTIVES In performing this systematic review, we aimed to synthesize the best available evidence regarding the effectiveness and safety of conventional occlusion therapy compared to atropine penalization in treating amblyopia. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 8); Ovid MEDLINE; Ovid Embase; LILACS BIREME; ClinicalTrials.gov; ISRCTN; and the WHO ICTRP on 7 September 2018. SELECTION CRITERIA We included randomized/quasi-randomized controlled trials comparing conventional occlusion to atropine penalization for amblyopia. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts and full-text articles, abstracted data, and assessed risk of bias. MAIN RESULTS We included seven trials (five randomized controlled trials and two quasi-randomized controlled trials) conducted in six countries (China, India, Iran, Ireland, Spain, and the United States) with a total of 1177 amblyopic eyes. Three of these seven trials were from the original 2009 version of the review. We assessed two trials as having a low risk of bias across all domains, and the remaining five trials as having unclear or high risk of bias for some domains.As different occlusion modalities, atropine penalization regimens, and populations were used across the included trials, we did not conduct any meta-analysis due to clinical and statistical heterogeneity. Evidence from six trials (two at low risk of bias) suggests that atropine penalization is as effective as conventional occlusion in improving visual acuity. Similar improvement in visual acuity was reported at all time points at which it was assessed, ranging from five weeks (improvement of 1 line) to 10 years (improvement of greater than 3 lines). At six months, although most participants (363/522) come from a trial rated as at low risk of bias with a precise estimate (mean difference (MD) 0.03, 95% confidence interval (CI) 0.00 to 0.06), two other trials rated as at high risk of bias produced inconsistent estimates and wide confidence intervals (MD -0.02, 95% CI -0.11 to 0.07 and MD -0.14, 95% CI -0.23 to -0.05; moderate-certainty evidence). At 24 months, additional improvement was found in both groups, but there continued to be no meaningful difference between those receiving occlusion and those receiving atropine therapies (moderate-certainty evidence).We did not find any difference in ocular alignment, stereo acuity, or sound eye visual acuity between occlusion and atropine penalization groups (moderate-certainty evidence). Both treatments were well tolerated. Atropine was associated with better adherence (moderate-certainty evidence) and quality of life (moderate-certainty evidence), but also a higher reported risk of adverse events in terms of mild reduction in the visual acuity of the sound eye not requiring treatment and light sensitivity (high-certainty evidence). Skin, lid, or conjunctival irritation were more common among participants receiving patching than those receiving atropine (high-certainty evidence). Atropine penalization costs less than conventional occlusion. AUTHORS' CONCLUSIONS Both conventional occlusion and atropine penalization produce visual acuity improvement in the amblyopic eye. Atropine penalization appears to be as effective as conventional occlusion, although the magnitude of improvement differed among the trials we analyzed.
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Affiliation(s)
- Tianjing Li
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 North Wolfe Street, E6011BaltimoreMarylandUSA21205
| | - Riaz Qureshi
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 North Wolfe Street, E6011BaltimoreMarylandUSA21205
| | - Kate Taylor
- Royal Victoria InfirmaryDepartment of OphthalmologyClaremont WingQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
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Vagge A, Shields CL, Shields JA, Pointdujour-Lim R, Schnall B. Visual improvement in amblyopic eye following treatment-induced vision loss in dominant eye with uveal melanoma. Br J Ophthalmol 2019; 104:202-207. [PMID: 31097438 DOI: 10.1136/bjophthalmol-2018-313505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/11/2019] [Accepted: 04/13/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the frequency and amount of visual improvement in amblyopic eyes of adults following visual loss in the dominant eye resulting from treatment of uveal melanoma. METHODS AND ANALYSIS Retrospective case series of adult patients with amblyopia and dominant eye visual loss resulting from treatment of uveal melanoma. Review of best-corrected visual acuity (BCVA) in each eye (amblyopia eye vs melanoma eye) at date first seen and over time following treatment of uveal melanoma. BCVA in each eye was graded as improved (>2 logarithm of minimal angle of resolution (logMAR) lines) or unimproved (<2 logMAR lines). RESULTS Twenty-one patients that met the inclusion criteria. Mean age at presentation was 56 years (range 39-73 years). Following treatment of the uveal melanoma and decline of BCVA in the dominant, the BCVA in the amblyopic eye improved in 11/21 (52%; 95% CI 30% to 74 %) patients. The degree of visual loss in the melanoma eye was to the level of the amblyopic eye or worse in 14 patients. In this group, BCVA improved in the amblyopic eye in 9/14 (64%; 95% CI 35% to 87 %) patients. Of these nine with improved eyes, the mean starting visual acuity was logMAR 0.6 (20/80) with mean improvement of logMAR 0.4 (4 lines±0.13 (range 0.2-0.6). Eight of nine eyes achieved a BCVA of 20/25 (n=3) or 20/20 (n=5). CONCLUSION Visual acuity in the amblyopic eye of adults can improve following visual loss in the contralateral dominant eye associated with treatment for uveal melanoma.
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Affiliation(s)
- Aldo Vagge
- Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania, USA .,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University Eye Clinic, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | | | - Bruce Schnall
- Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Advocare Schnall Pediatric Ophthalmology, Voorhees, New Jersey, USA
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Ugurbas SC, Kucuk N, Isik I, Alpay A, Buyukuysal C, Ugurbas SH. Objective vision screening using PlusoptiX for children aged 3-11 years in rural Turkey. BMC Ophthalmol 2019; 19:73. [PMID: 30871506 PMCID: PMC6419461 DOI: 10.1186/s12886-019-1080-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 03/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background This population based cross sectional study was conducted to detect amblyopia risk factors and myopia in a rural district of Northwestern Turkey by using PlusoptiX S12R (Photoscreener PlusoptiX Inc., Nuremberg, Germany). Methods Children from 38 rural schools in Caycuma district of Zonguldak Turkey underwent vision screening in their school using PlusoptiX S12 photoscreener. Data were analyzed using the factory default level 5 referral criteria targeting 80% sensitivity and 95% specificity. Referral, unable readings, and positive predictive value (PPV) were reported. Results Data from 2846 children were analyzed. Mean age was 7.9 years (±0.8) (range 36 months to 11 years). Three hundred ten (11%) were referred of whom 32% were read as ‘unable’. 150 children (48% of the referred) received a gold standard examination. Positive predictive value of PlusoptiX was 69%. PPV was 83% when unable readings were excluded. 93 children with amblyopia risk factors were identified. Only 26% (n = 25) had received glasses priorly. 49 children had amblyopia of whom 33 were newly diagnosed. Conclusions PlusoptiX showed a reasonable level of positive predictive value in community setting and the device could be a useful tool for vision screening in preschoolers and schoolers. We found most of the amblyogenic refractive errors were underdiagnosed in rural school children leading to a call for action on vision screening.
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Affiliation(s)
- Silay Canturk Ugurbas
- Department of Ophthalmology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Esenkoy-Kozlu, 67600, Zonguldak, Turkey.
| | - Numan Kucuk
- Department of Ophthalmology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Esenkoy-Kozlu, 67600, Zonguldak, Turkey
| | - Irem Isik
- Department of Ophthalmology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Esenkoy-Kozlu, 67600, Zonguldak, Turkey
| | - Atilla Alpay
- Department of Ophthalmology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Esenkoy-Kozlu, 67600, Zonguldak, Turkey
| | - Cagatay Buyukuysal
- Department of Biostatistics, Faculty of Medicine, Zonguldak Bulent Ecevit University, Esenkoy-Kozlu, Zonguldak, 67600, Turkey
| | - Suat Hayri Ugurbas
- Department of Ophthalmology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Esenkoy-Kozlu, 67600, Zonguldak, Turkey
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Chen AM, Manh V, Candy TR. Longitudinal Evaluation of Accommodation During Treatment for Unilateral Amblyopia. Invest Ophthalmol Vis Sci 2019; 59:2187-2196. [PMID: 29801152 PMCID: PMC5916545 DOI: 10.1167/iovs.17-22990] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Retinal image quality is dependent on accommodative performance. This longitudinal observational study of children with unilateral amblyopia evaluated the accommodative performance of the amblyopic eye during treatment. Methods Twenty-six participants with unilateral amblyopia and 10 participants with typical vision aged 3 to 10 years participated. Accommodative response was measured using modified Nott retinoscopy in monocular and binocular viewing conditions for target distances of 50, 33, and 25 cm, at enrollment and each follow-up visit. Results Participants with amblyopia accommodated less accurately when viewing with their amblyopic eye in monocular than in binocular conditions. Over the course of amblyopia treatment, accommodative performance improved with amblyopic eye visual acuity (VA) improvement, although this was not consistent across individual participants. A linear mixed model showed that accommodative error worsened with increasing depth of amblyopia for monocular viewing with the amblyopic eye (0.14 diopter [D] per line of acuity loss, P = 0.001), with an interaction between VA and stimulus demand (0.09 D of additional lag per diopter of stimulus, per line of acuity loss, P < 0.001). Participant age, patching duration, length of time in the study, history of strabismus, and stereoacuity were not significant predictors of accommodative performance. Conclusions Overall, poor monocular accommodative performance of the amblyopic eye was associated with worse amblyopia and improved simultaneously with VA improvement, although there was variability across the study cohort. Further research is needed to determine the causal relationship between amblyopic eye VA and accommodation and its impact on amblyopia treatment.
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Affiliation(s)
- Angela M Chen
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California, United States
| | - Vivian Manh
- Seattle Children's Hospital, Seattle, Washington, United States
| | - T Rowan Candy
- Indiana University School of Optometry, Bloomington, Indiana, United States
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Nanda KD, Blaha B, Churchfield WT, Fulwylie CR, Medsinge A, Nischal KK. Induced Tropia Test and Visual Acuity Testing in Nonverbal Children. J Binocul Vis Ocul Motil 2018; 68:134-136. [PMID: 30332333 DOI: 10.1080/2576117x.2018.1525235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The objective of our study was to compare the Cardiff Acuity Card© test (CAC test) (Kay Pictures Ltd) with the induced tropia test (ITT) in nonverbal children for the detection of monocular vision deficit. This is a retrospective case note review of 34 nonverbal children, aged 12-48 months, attending the pediatric ophthalmology clinic at Children's Hospital of Pittsburgh of UPMC between October 2014 and January 2015. 30/34 were included for analysis. Binocular visual acuity and monocular visual acuity were tested at 50cm in 30 and 17 patients, respectively. At 100cm, binocular visual acuity and monocular visual acuity were tested in 16 and 11 patients, respectively. All 30 children had successful induced tropia testing; 21 had no fixation preference and 9 had a fixation preference. Of those that had no difference on monocular visual acuity, five had a fixation preference at 50cm and three at 100cm. Out of 21 that had no fixation preference, 3 had a monocular visual acuity difference, but of only one line. Our study suggests that to obtain as much information as possible without losing the interest or cooperation of the child, it may be more beneficial to perform the CAC test with both eyes open, followed by ITT, before attempting monocular visual acuity testing with the CAC test. Obtaining visual information using ITT was much more attainable compared to monocular CAC testing. The sensitivity using CAC test to find a visual acuity discrepancy is 40% using ITT as the standard, and the specificity is 63%. If one loses the interest of the child after the ITT, at least some information will have been gleaned rather than none about monocular visual behavior. This provides a more complete, attainable approach to gathering visual information.
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Affiliation(s)
- Kaajal D Nanda
- a Eye Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bianca Blaha
- a Eye Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Anagha Medsinge
- a Eye Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ken K Nischal
- a Eye Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.,b School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Goyal S, Phillips PH, Rettiganti M, Gossett JM, Lowery RS. Comparison of the Effect of Cycloplegia on Astigmatism Measurements in a Pediatric Amblyopic Population: A Prospective Study. J Pediatr Ophthalmol Strabismus 2018; 55:293-298. [PMID: 29913022 DOI: 10.3928/01913913-20180410-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 09/28/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To study the effect of cycloplegia on astigmatism measurements in pediatric patients with amblyopia. METHODS This was a prospective comparative clinical study. Participants 4 to 17 years old were recruited from the patient population at the Arkansas Children's Hospital eye clinic after informed consent was obtained. Autorefractor measurements were used to obtain values of refractive error in amblyopic and non-amblyopic patients before and after cycloplegia. The groups were subdivided into myopia and hyperopia and with and without underlying amblyopia. The refractive error was expressed as sphere, cylinder, axis of astigmatism, and spherical equivalent. The treatment effect was summarized as the mean difference (95% confidence interval) for each outcome. RESULTS No statistically significant difference was found on the axis and power of astigmatism before and after cycloplegia in the patients with amblyopia (P = .28 and .99, respectively). CONCLUSIONS Non-cycloplegic autorefraction measurements may be considered safe for refining astigmatism power and axis in pediatric patients with amblyopia. [J Pediatr Ophthalmol Strabismus. 2018;55(5):293-298.].
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Morya AK. Commentary on: "Tribal Odisha Eye Disease Study # 4: Accuracy and utility of photorefraction for refractive error correction in tribal Odisha (India) school screening". Indian J Ophthalmol 2018; 66:934. [PMID: 29941734 PMCID: PMC6032731 DOI: 10.4103/ijo.ijo_812_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Arvind K Morya
- Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Haschke M, Kinberg H, Morgan LA, Suh DW. Assessment of an Advanced Vision Screener in the Detection of Amblyopia in the Nebraska Pediatric Population. J Pediatr Ophthalmol Strabismus 2018; 55:189-193. [PMID: 29257184 DOI: 10.3928/01913913-20171205-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 08/08/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the validity of the OPTEC 5500 vision screener (Stereo Optical Co., Inc., Chicago, IL) in assessing visual acuity and amblyopia in pediatric patients between the ages of 3 and 17 years by comparing it statistically to gold standard comprehensive ophthalmic examinations. METHODS A cross-sectional study was conducted of 64 patients between the ages of 3 and 17 years who underwent a vision screening test at a pediatric ophthalmology office using the OPTEC 5500 vision screener, followed by traditional visual acuity testing via the Snellen or Lea optotypes. After data were collected, the results of the OPTEC 5500 vision screener were compared to the Snellen and Lea visual acuity tests and statistical analysis was subsequently performed for the right and left eyes separately. Patients were considered to have risk factors for amblyopia based on the American Association for Pediatric Ophthalmology and Strabismus referral criteria guidelines. RESULTS The results of the OPTEC 5500 vision screener for the right eye of participants of all ages were a sensitivity of 77.4%, specificity of 100.0%, positive predictive value of 100.0%, negative predictive value of 50.0%, and accuracy of 81.5%. Results for the left eye were a sensitivity of 81.0%, specificity of 87.0%, positive predictive value of 91.9%, negative predictive value of 71.4%, and accuracy of 83.1%. CONCLUSIONS Although the specificity and positive predictive value were acceptable, the sensitivity and negative predictive value of the OPTEC 5500 vision screener were below average when compared to other available devices, exhibiting some of the weaknesses of the device. Additional studies of the OPTEC 5500 vision screener with a larger population are necessary to assess the device in the general pediatric population, such as in general pediatric clinics and public schools. Additionally, other options for pediatric vision screening devices should be explored. [J Pediatr Ophthalmol Strabismus. 2018;55(3):189-193.].
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Williams T, Morgan LA, High R, Suh DW. Critical Assessment of an Ocular Photoscreener. J Pediatr Ophthalmol Strabismus 2018; 55:194-199. [PMID: 29257181 DOI: 10.3928/01913913-20170703-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/07/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the accuracy of the PlusoptiX A12 photoscreener (PlusoptiX, Inc., Atlanta, GA) in detecting amblyopia or ambylogenic risk factors in pediatric patients in Nebraska. METHODS Using the PlusoptiX A12 photoscreener, data were collected from pediatric patients seen at a single pediatric ophthalmology practice. Each patient was screened using the device and also received a comprehensive ophthalmic examination. The results of the PlusoptiX A12 photoscreener were compared to the gold standard, comprehensive ophthalmic examination findings. The assessment of amblyopia or amblyogenic risk factors in the patients was based on the updated American Association for Pediatric Ophthalmology and Strabismus (AAPOS) referral criteria guidelines. RESULTS Data were collected from 219 consecutive pediatric patients (438 eyes) during the 3-month study period. Among the patients, 87 (40%) children were determined to have amblyopia or ambylogenic risk factors after the comprehensive pediatric ophthalmology examination based on the AAPOS guidelines. The PlusoptiX A12 photoscreener was found to have a sensitivity of 93.02%, specificity of 84.96%, false-positive rate of 9.13%, false-negative rate of 2.74%, positive predictive value of 80.00%, and negative predictive value of 94.96%. CONCLUSIONS The PlusoptiX A12 photoscreener is viable and comparable to various commercially available devices in the detection of refractive amblyogenic risk factors based on the Nebraska pediatric patient population. Future studies may show increased sensitivity by combining the use of the PlusoptiX A12 photoscreener with an alternate cover test. [J Pediatr Ophthalmol Strabismus. 2018;55(3):194-199.].
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Kinori M, Molina I, Hernandez EO, Robbins SL, Granet DB, Coleman AL, Brown SI. The PlusoptiX Photoscreener and the Retinomax Autorefractor as Community-based Screening Devices for Preschool Children. Curr Eye Res 2018; 43:654-658. [PMID: 29424565 DOI: 10.1080/02713683.2018.1437453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the performance of the PlusoptiX S12 mobile photoscreener and the Retinomax K+3 Autorefractor as screening devices in preschool children. METHODS Children ranging from 3 to 5 years of age from 11 San Diego County preschools underwent vision screening in their schools where ambient light could not always be controlled using both the Retinomax and the PlusoptiX. Cycloplegic refraction on the consented children was subsequently performed on the UCSD EyeMobile for children on-site at the school locations. RESULTS A total of 321 children were screened with the PlusoptiX and Retinomax. The PlusoptiX referred 22% of children, of whom 70% of the referrals were read as "unable". The Retinomax referred 13% and there were no "unables". Similar results occurred in the cycloplegic-refracted 182 consented children-64% of the PlusoptiX referrals were read as "unable" . Only one third of these "unables" required glasses. Both devices referred the four children with amblyopia and one case of strabismus. However, PlusoptiX's 3 false negatives had amblyopia risk factors (ARFs) while the one Retinomax's false negative did not have ARFs. The Retinomax screening had 95% sensitivity and 94% specificity. The PlusoptiX screening had 86% sensitivity and 84% specificity. CONCLUSION In this preschool population and environment, the PlusoptiX referred 63% more than the Retinomax in addition to a lower specificity and sensitivity. Adjusting PlusoptiX referral criteria might not substantially improve the specificity of the PlusoptiX due to the high numbers of "unables".
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Affiliation(s)
- Michael Kinori
- a The Goldschleger Eye Institute, Sheba Medical Center, Tel HaShomer, affiliated to the Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Iliana Molina
- b Department of Ophthalmology, Shiley Eye Center, School of Medicine , University of California-San Diego , La Jolla , CA , USA
| | - Eric O Hernandez
- b Department of Ophthalmology, Shiley Eye Center, School of Medicine , University of California-San Diego , La Jolla , CA , USA
| | - Shira L Robbins
- b Department of Ophthalmology, Shiley Eye Center, School of Medicine , University of California-San Diego , La Jolla , CA , USA
| | - David B Granet
- b Department of Ophthalmology, Shiley Eye Center, School of Medicine , University of California-San Diego , La Jolla , CA , USA
| | - Anne L Coleman
- c Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA , University of California, Los Angeles , Los Angeles , CA , USA
| | - Stuart I Brown
- b Department of Ophthalmology, Shiley Eye Center, School of Medicine , University of California-San Diego , La Jolla , CA , USA
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Kothari M, Kosumbkar S. Ultra-rapid School Vision Screening in Developing Nations Using the Brückner Test. ACTA ACUST UNITED AC 2017; 60:82-6. [DOI: 10.3368/aoj.60.1.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kothari MT, Turakhia JK, Vijayalakshmi P, Karthika A, Nirmalan PK. Can the Brückner Test be Used as a Rapid Screening Test to Detect Amblyogenic Factors in Developing Countries? ACTA ACUST UNITED AC 2017; 53:121-6. [DOI: 10.3368/aoj.53.1.121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Mihir T. Kothari
- Department of Paediatric Ophthalmology and Strabismus, Aravind Eye Center System, Madurai, India
| | - Jinesh K. Turakhia
- Department of Paediatric Ophthalmology and Strabismus, Aravind Eye Center System, Madurai, India
| | | | - Arumugam Karthika
- Lions Aravind Institute of Community Ophthalmology (LAICO), Aravind Eye Care System, Madurai, India
| | - Praveen K. Nirmalan
- Lions Aravind Institute of Community Ophthalmology (LAICO), Aravind Eye Care System, Madurai, India
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Le TD, Raashid RA, Colpa L, Noble J, Ali A, Wong A. Paediatric vision screening in the primary care setting in Ontario. Paediatr Child Health 2017; 23:e33-e39. [PMID: 29769813 DOI: 10.1093/pch/pxx148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives Early intervention is critical to prevent treatable causes of vision loss in children. The objectives of the current study are: (1) to assess how well primary care physicians in Ontario follow the vision screening guidelines for children as recommended by the Canadian Paediatric Society and the Rourke Baby Record and (2) to identify barriers to vision screening in the primary care setting. Design Cross-sectional survey. Methods A 19-question survey was mailed out to 1000 randomly selected family physicians (family MDs), 1000 general practitioners (GPs) and 1000 paediatricians in Ontario as listed in the 2013 Canadian Medical Directory. Results A total of 719 completed surveys were included in the analysis (449 from family MDs/GPs and 270 from paediatricians). Vision screening was reported to be performed by 65% of family MDs/GPs and 52% of general paediatricians at every well child visit. While red reflex was reported to be checked by 94% of all physicians in children under 3, it was only performed by 25% of respondents for children over 3. Thirty seven percent of all physicians reported never performing a visual acuity test in any age group. When asked about the obstacles preventing them from performing vision screening, lack of training (family MDs/GPs: 50%, paediatricians: 42%), time constraints (family MDs/GPs: 42%; paediatricians: 40%) and inadequate reimbursement (family MDs/GPs: 17%; paediatricians: 15%) were the most commonly cited reasons. Conclusions Strategies to improve vision screening are necessary given that early intervention is crucial to prevent treatable causes of vision loss in children.
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Affiliation(s)
- Tran D Le
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario
| | - Rana Arham Raashid
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Ontario
| | - Linda Colpa
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Ontario
| | - Jason Noble
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario
| | - Asim Ali
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario.,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario
| | - Agnes Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario.,Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Ontario.,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario
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Hull S, Tailor V, Balduzzi S, Rahi J, Schmucker C, Virgili G, Dahlmann‐Noor A. Tests for detecting strabismus in children aged 1 to 6 years in the community. Cochrane Database Syst Rev 2017; 11:CD011221. [PMID: 29105728 PMCID: PMC6486041 DOI: 10.1002/14651858.cd011221.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Strabismus (misalignment of the eyes) is a risk factor for impaired visual development both of visual acuity and of stereopsis. Detection of strabismus in the community by non-expert examiners may be performed using a number of different index tests that include direct measures of misalignment (corneal or fundus reflex tests), or indirect measures such as stereopsis and visual acuity. The reference test to detect strabismus by trained professionals is the cover‒uncover test. OBJECTIVES To assess and compare the accuracy of tests, alone or in combination, for detection of strabismus in children aged 1 to 6 years, in a community setting by non-expert screeners or primary care professionals to inform healthcare commissioners setting up childhood screening programmes.Secondary objectives were to investigate sources of heterogeneity of diagnostic accuracy. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 12) (which contains the Cochrane Eyes and Vision Trials Register) in the Cochrane Library, the Health Technology Assessment Database (HTAD) in the Cochrane Library (2016, Issue 4), MEDLINE Ovid (1946 to 5 January 2017), Embase Ovid (1947 to 5 January 2017), CINAHL (January 1937 to 5 January 2017), Web of Science Conference Proceedings Citation Index-Science (CPCI-S) (January 1990 to 5 January 2017), BIOSIS Previews (January 1969 to 5 January 2017), MEDION (to 18 August 2014), the Aggressive Research Intelligence Facility database (ARIF) (to 5 January 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 5 January 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 5 January 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 5 January 2017. We did not use any date or language restrictions in the electronic searches for trials. In addition, orthoptic journals and conference proceedings without electronic listings were searched. SELECTION CRITERIA All prospective or retrospective population-based test accuracy studies of consecutive participants were included. Studies compared a single or combination of index tests with the reference test. Only those studies with sufficient data for analysis were included specifically to calculate sensitivity and specificity and determine diagnostic accuracy.Participants were aged 1 to 6 years. Studies reporting participants outside this range were included if subgroup data were available.Permitted settings included population-based vision screening programmes or opportunistic screening programmes, such as those performed in schools. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. In brief, two review authors independently assessed titles and abstracts for eligibility and extracted the data, with a third senior author resolving any disagreement. We analysed data primarily for specificity and sensitivity. MAIN RESULTS One study from a total of 1236 papers, abstracts and trials was eligible for inclusion with a total number of participants of 335 of which 271 completed both the screening test and the gold standard test. The screening test using an automated photoscreener had a sensitivity of 0.46 (95% confidence interval (CI) 0.19 to 0.75) and specificity of 0.97 (CI 0.94 to 0.99). The overall number affected by strabismus was low at 13 (4.8%). AUTHORS' CONCLUSIONS There is very limited data in the literature to ascertain the accuracy of tests for detecting strabismus in the community as performed by non-expert screeners. A large prospective study to compare methods would be required to determine which tests have the greatest accuracy.
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Affiliation(s)
- Sarah Hull
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
| | - Vijay Tailor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
| | - Sara Balduzzi
- University of Modena and Reggio EmiliaCochrane Italy, Department of Diagnostic, Clinical and Public Health MedicineVia del Pozzo 71ModenaItaly41124
| | - Jugnoo Rahi
- UCL Institute of Child Health and UCL Institute of OphthalmologyDepartment of EpidemiologyLondonUK
| | - Christine Schmucker
- Medical Center – Univ. of Freiburg, Faculty of Medicine, Univ. of FreiburgCochrane GermanyBreisacher Straße 153FreiburgGermany79110
| | - Gianni Virgili
- University of FlorenceDepartment of Translational Surgery and Medicine, Eye ClinicLargo Brambilla, 3FlorenceItaly50134
| | - Annegret Dahlmann‐Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
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Leman R, Clausen MM, Bates J, Stark L, Arnold KK, Arnold RW. A Comparison of Patched HOTV Visual Acuity and Photoscreening. J Sch Nurs 2016; 22:237-43. [PMID: 16856779 DOI: 10.1177/10598405050220040901] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Early detection of significant vision problems in children is a high priority for pediatricians and school nurses. Routine vision screening is a necessary part of that detection and has traditionally involved acuity charts. However, photoscreening in which “red eye” is elicited to show whether each eye is focusing may outperform routine acuity testing in pediatric offices and schools. This study compares portable acuity testing with photoscreening of preschoolers, kindergarteners, and 1st-graders in 21 elementary schools. School nurses performed enhanced patched acuity testing and two types of photoscreening in a portable tent. Nearly 1,700 children were screened during spring semester 2004, and 14% had confirmatory exams by community eye care professionals. The results indicate that one form of photoscreening using a Gateway DV-S20 digital camera is significantly more sensitive to children with significant vision problems, as well as being the most cost effective (85% specificity and only $0.11 per child). This suggests that the adaptation of photoscreening into a routine vision screening protocol would be beneficial for efficiently detecting vision problems that could lead to amblyopia.
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Affiliation(s)
- Rachel Leman
- University of Alaska-Anchorage, Anchorage, AK, USA
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Struble RD, House RR, Trower J, Lawrence LM. Efficacy of a vision-screening tool for birth to 3 years early intervention programs. J AAPOS 2016; 20:431-434. [PMID: 27647112 DOI: 10.1016/j.jaapos.2016.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To validate a screening tool used to detect unsuspected visual pathway pathology in preschool children under 3 years of age with developmental disabilities enrolled in an early intervention program using guidelines from the Kansas Department of Health and Environment (KDHE). METHODS The records of 300 consecutive children screened at a birth to 3 early intervention program from 2011 to 2014 were reviewed retrospectively. Inclusion criteria were documented KDHE vision screening examinations performed by trained early interventionist and full ophthalmic evaluations by a general ophthalmologist. The evaluation was only considered a pass if it was recorded on the chart and the child did not have any known risk factors. The visual pathway pathology status was determined after comprehensive ophthalmic examination, with the ophthalmologist masked to the vision screening results. RESULTS A total of 216 children met inclusion criteria, of whom 137 were referred. The sensitivity was 95.3% (95% CI, 90.8-99.8); specificity, 57.25% (95% CI, 48.3-65.7); positive predictive value, 59.1% (95% CI, 50.4-67.3); negative predictive value, 94.9% (95% CI, 86.8-98.4); and negative likelihood ratio, 0.082 (95% CI, 0.031-0.22). A Pearson χ2 test for fit yielded an approximate P value of <0.0001. CONCLUSIONS In this study population, good sensitivity and negative predictive value were demonstrated by the inexpensive screening examination coupled with associated risk factors for the 0-3 population of children with developmental disabilities.
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Affiliation(s)
- Roger D Struble
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Ryan R House
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Joyce Trower
- Donna Vanier Children's Center, Department of Infant Child Development, Salina Regional Health Center, Salina, Kansas
| | - Linda M Lawrence
- Donna Vanier Children's Center, Department of Infant Child Development, Salina Regional Health Center, Salina, Kansas.
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Rajavi Z, Sabbaghi H, Amini Sharifi E, Behradfar N, Yaseri M. The role of Interactive Binocular Treatment system in amblyopia therapy. J Curr Ophthalmol 2016; 28:217-222. [PMID: 27830207 PMCID: PMC5093783 DOI: 10.1016/j.joco.2016.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/14/2016] [Accepted: 07/17/2016] [Indexed: 11/26/2022] Open
Abstract
Purpose To determine the role of Interactive Binocular Treatment (I-BiT™) as a complementary method of patching in amblyopia therapy. Methods In this randomized clinical trial study, 50 unilateral amblyopic children (25 male/25 female) between 3 and 10 years with either best corrected visual acuity (BCVA) ≤20/30 in the amblyopic eye or a difference of BCVA ≥ 2 lines between the two eyes were included. They were randomly classified into the case and control groups (25 in each). Patching was recommended in both groups, and cases also received I-BiT™. Cases were asked to play I-BiT™ games through appropriate glasses with conjugate colored filters. Moving and fixed targets were shown to the amblyopic and non-amblyopic eyes, respectively. Playing games was continued 20 min in each session for 5 days a week within one month (total time: 6.6 h). Patching was continued for one month more in both groups to evaluate the continuous effect of I-BiT™. BCVA was measured at baseline, one month after beginning I-BiT™, and one month after cessation of I-BiT™. Results BCVA of amblyopic eyes in cases and controls were 0.34 ± 0.14 and 0.33 ± 0.17LogMAR at baseline which improved to 0.17 ± 0.14 and 0.26 ± 0.17 at one month, respectively. The difference was significant in each group (p < 0.001 for cases and p = 0.024 for controls) with more improvement in the case group (p < 0.001). One month after cessation of I-BiT™, BCVA difference between the two groups was not statistically significant. There was no case with recurrence of amblyopia. Conclusion Based on our results, I-BiT™ seems to be effective in amblyopia therapy accompanied with patching. We recommend comparing I-BiT™ alone with patching in further studies. ClinicalTrials.gov Identifier: NCT02740725.
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Affiliation(s)
- Zhale Rajavi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding author. Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, 23 Paidar Fard, Bostan 9, Pasdaran Ave., Tehran, 16666, Iran.Ophthalmic Research CenterShahid Beheshti University of Medical Sciences23 Paidar FardBostan 9Pasdaran Ave.Tehran16666Iran
| | - Ebrahim Amini Sharifi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Behradfar
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
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Won JY, Shin HY, Kim SY, Lee YC. A comparison of the Plusoptix S09 with an autorefractometer of noncycloplegics and cycloplegics in children. Medicine (Baltimore) 2016; 95:e4596. [PMID: 27583875 PMCID: PMC5008559 DOI: 10.1097/md.0000000000004596] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study is to compare outcome measures of refractive error obtained using the Plusoptix S09 photorefractor and an autorefractometer of noncycloplegics and cycloplegics in children.We reviewed the medical records of 40 patients (77 eyes) who were classified using 2 methods. The patients were first assigned to 2 groups consisting of 11 eyes with ≥+3.0 D and 66 eyes with <+3.0 D, and then to 2 groups of 12 and 65 eyes with cycloplegic and noncycloplegic refraction of spherical powers ≥+2.0 D and <+2.0 D, respectively. We compared the outcome measures of refractive error using the Plusoptix S09 photorefractor and an autorefractometer of noncycloplegics and cycloplegics.There was no statistically significant difference between the Plusoptix S09 photorefractor and cycloplegic autorefractometer in the spherical power and spherical equivalent. In contrast, there was a statistically significant difference between the Plusoptix S09 photorefractor and noncycloplegic autorefractometer (P < 0.001). There was a statistically significant difference between the spherical equivalent of the Plusoptix S09 photorefractor and cycloplegic autorefractometer in children with hyperopia ≥+3.0D and with cycloplegic and noncycloplegic refraction of spherical power ≥+2.0 D. We also found a significant difference between the outcomes of the Plusoptix S09 photorefractor and cycloplegic autorefractometer in the spherical power and spherical equivalent for children with hyperopia ≥+3.0 D.The refractive error of the Plusoptix S09 photorefractor was similar to that of the cycloplegic autorefractometer, in contrast to the noncycloplegic autorefractometer. However, the Plusoptix S09 photorefractor is an inaccurate tool to estimate the refractive errors of children with moderate hyperopia.
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Affiliation(s)
- Jae Yon Won
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital
| | - Hye Young Shin
- Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Su Young Kim
- Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Chun Lee
- Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Correspondence: Young Chun Lee, Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Cheonbo-Ro, Uijeongbu-si, Gyeonggi-do, Republic of Korea (e-mail: )
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Rajavi Z, Sabbaghi H, Baghini AS, Yaseri M, Moein H, Akbarian S, Behradfar N, Hosseini S, Rabei HM, Sheibani K. Prevalence of Amblyopia and Refractive Errors Among Primary School Children. J Ophthalmic Vis Res 2016; 10:408-16. [PMID: 27051485 PMCID: PMC4795390 DOI: 10.4103/2008-322x.176909] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To determine the prevalence of amblyopia and refractive errors among 7 to 12-year-old primary school children in Tehran, Iran. Methods: This population-based cross-sectional study included 2,410 randomly selected students. Visual acuity was tested using an E-chart on Yang vision tester. Refractive errors were measured by photorefractometry and cycloautorefraction. Strabismus was checked using cover test. Direct ophthalmoscopy was used to assess the anterior segment, lens opacities, red reflex and fundus. Functional amblyopia was defined as best corrected visual acuity ≤20/40 in one or both eyes with no anatomical problems. Results: Amblyopia was present in 2.3% (95% CI: 1.8% to 2.9%) of participants with no difference between the genders. Amblyopic subjects were significantly younger than non-amblyopic children (P=0.004). Overall, 15.9% of hyperopic and 5.9% of myopic cases had amblyopia. The prevalence of hyperopia ≥+2.00D, myopia ≤-0.50D, astigmatism ≥0.75D, and anisometropia (≥1.00D) was 3.5%, 4.9%, 22.6%, and 3.9%, respectively. With increasing age, the prevalence of myopia increased (P<0.001), that of hyperopia decreased (P=0.007), but astigmatism showed no change. Strabismus was found in 2.3% of cases. Strabismus (OR=17.9) and refractive errors, especially anisometropia (OR=12.87) and hyperopia (OR=11.87), were important amblyogenic risk factors. Conclusion: The high prevalence of amblyopia in our subjects in comparison to developed countries reveals the necessity of timely and sensitive screening methods. Due to the high prevalence of amblyopia among children with refractive errors, particularly high hyperopia and anisometropia, provision of glasses should be specifically attended by parents and supported by the Ministry of Health and insurance organizations.
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Affiliation(s)
- Zhale Rajavi
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran; Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Moein
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Akbarian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Behradfar
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Simin Hosseini
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Mohammad Rabei
- Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran; Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kourosh Sheibani
- Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran
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Rewri P, Nagar CK, Gupta V. Vision Screening of Younger School Children by School Teachers: A Pilot Study in Udaipur City, Western India. J Ophthalmic Vis Res 2016; 11:198-203. [PMID: 27413502 PMCID: PMC4926569 DOI: 10.4103/2008-322x.183920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 01/16/2016] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To assess the reliability of school teachers for vision screening of younger school children and to study the pattern of vision problems. METHODS In this cross-sectional study, trained school teachers screened 5,938 school children aged 3 to 8 years for vision and ocular disorders. Children were cross screened by professionals to assess the reliability of the teachers in vision screening and detecting ocular disorders in these children. The pattern of visual acuity, ametropia and ocular disorders was studied. RESULTS Sensitivity and specificity of the vision screening by school teachers was 69.2% (95% CI: 66.8-71.5%) and 95.3% (95% CI: 94.5-95.8%), respectively. The positive predictive value was 83.5% (95% CI: 81.4-85.6%) and negative predictive value was 89.8% (95% CI: 88.8-90.6%). The kappa statistic was 0.68 (95% CI: 0.66-0.7). CONCLUSION School teachers could effectively screen younger school children for vision assessment and ocular disorders.
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Affiliation(s)
- Parveen Rewri
- Department of Ophthalmology, Maharaja Agrasen Medical College, Hisar, Haryana, India
- Department of Ophthalmology, Ravinder Nath Tagore Medical College, Udaipur, Rajasthan, India
| | - Chandra Kant Nagar
- Department of Ophthalmology, Ravinder Nath Tagore Medical College, Udaipur, Rajasthan, India
- Department of Ophthalmology, Geetanjali Medical College, Udaipur, Rajasthan, India
| | - Vijay Gupta
- Department of Ophthalmology, Ravinder Nath Tagore Medical College, Udaipur, Rajasthan, India
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Demirci G, Tanrıverdio C, Erdur SK, Ozsutcu M, Gulkilik G, Eliacik M. Case of extremely high refractive error misdiagnosed as normal by PlusoptiX S09 photoscreener. Clin Exp Optom 2015; 98:385-6. [DOI: 10.1111/cxo.12252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 10/16/2014] [Accepted: 10/23/2014] [Indexed: 10/23/2022] Open
Affiliation(s)
- Goktug Demirci
- Department of Ophthalmology, Medipol University Hospital, Istanbul, Turkey
| | - Cafer Tanrıverdio
- Department of Ophthalmology, Medipol University Hospital, Istanbul, Turkey
| | | | - Mustafa Ozsutcu
- Department of Ophthalmology, Medipol University Hospital, Istanbul, Turkey
| | - Gokhan Gulkilik
- Department of Ophthalmology, Medipol University Hospital, Istanbul, Turkey
| | - Mustafa Eliacik
- Department of Ophthalmology, Medipol University Hospital, Istanbul, Turkey
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Kuhli-Hattenbach C, Koss MJ, Kohnen T, Fronius M. A morphological study of amblyopic eyes in children failing to achieve normal visual acuity after electronically monitored long-term occlusion treatment. Graefes Arch Clin Exp Ophthalmol 2015; 253:2021-8. [PMID: 26100453 DOI: 10.1007/s00417-015-3085-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/03/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To search for morphological abnormalities in compliant unilaterally amblyopic children with poor occlusion treatment outcomes, for the first time with electronically recorded patching dosage. We included school children with remaining interocular logMAR (logarithm of the minimum angle of resolution) difference ≥ 0.3 after patching time of more than 22 months and 1300 h total in a previous prospective study. METHODS Six patients with a mean age of 11.19 years were included. Four patients had anisometropic amblyopia and two patients had a mixed strabismic and anisometropic amblyopia. Best-corrected visual acuity, cycloplegic refraction, dilated fundus examination, optic disc morphology and macular thickness using optical coherence tomography (OCT), retinal visual acuity, color perception, and the presence of a relative afferent pupillary defect (RAPD) were assessed. Paired t tests were performed to compare optic disc values and macular thickness of the amblyopic eyes to those of the fellow eyes. RESULTS Average (± SD) logMAR VA in the amblyopic eyes was 0.42 (±0.23) with a remaining average interocular difference (IOD) of 0.51 (± 0.23), despite electronically monitored occlusion treatment of more than 1300 h. All patients presented with hyperopia and a significantly different mean spherical equivalent of + 4.73 (± 2.73) D in the amblyopic eye compared with the fellow eye (p = 0.02). A statistically significant difference in macular thickness was found between amblyopic and fellow eyes, with amblyopic eyes having an increased average thickness (p = 0.0062) and total volume (p = 0.0091) of the macula. One patient had familial hereditary primary macrodisc in both eyes. CONCLUSIONS Our results provide evidence that average macular thickness and total macular volume tended to be increased among these compliant amblyopic children with unsatisfactory occlusion treatment outcomes. Further studies are warranted to evaluate whether morphological changes may have an impact on the effectiveness of amblyopia treatment. Moreover, our findings suggest that greater magnitude of hyperopia and anisometropia as well as older age may be risk factors associated with a poor visual acuity outcome among compliant amblyopic children.
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Affiliation(s)
- Claudia Kuhli-Hattenbach
- Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Michael Janusz Koss
- Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Thomas Kohnen
- Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Maria Fronius
- Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Yan XR, Jiao WZ, Li ZW, Xu WW, Li FJ, Wang LH. Performance of the Plusoptix A09 photoscreener in detecting amblyopia risk factors in Chinese children attending an eye clinic. PLoS One 2015; 10:e0126052. [PMID: 26030210 PMCID: PMC4452218 DOI: 10.1371/journal.pone.0126052] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/28/2015] [Indexed: 12/03/2022] Open
Abstract
Purpose To assess the accuracy of the Plusoptix A09 photoscreener in detecting amblyopia risk factors in children and determine referral criteria when using Plusoptix A09 for a large-scale vision screening. Methods Pediatric patients attending our eye clinic underwent a comprehensive ophthalmic examination that included photorefraction, orthoptic examination, anterior segment assessment, fundus examination and cycloplegic retinoscopy. The measurements were collected for statistical analyses. Results One hundred and seventy-eight children (mean age ± SD: 6.2±2.4 years, range: 2.2 to 14.1 years) were included in the study. The mean spherical equivalent (SE) obtained using Plusoptix A09 (PSE) was 0.57 D lower than that obtained from cycloplegic retinoscopy (CRSE) (P = 0.00). However, there was no statistically significant difference of Jackson cross cylinder J0 and J45 between Plusoptix A09 (PJ) and cycloplegic retinoscopy (CRJ) (P = 0.14, P = 0.26). The relationship of SE obtained from Plusoptix A09 and SE obtained from cycloplegic retinoscopy was presented as the equation: CRSE = 0.358 + 0.776 PSE + 0.064 PSE2 + 0.011 PSE3. Based on the Receiver Operating Characteristic (ROC) curve, the Plusoptix A09 had an overall sensitivity of 94.9% and specificity of 67.5% for detecting refractive amblyopia risk factors. The sensitivity and specificity of the Plusoptix A09 for detection of strabismus were 40.7% and 98.3%, respectively; detection of amblyopia and/or strabismus was 84.7% and 63.2%, respectively. Conclusions The Plusoptix A09 photoscreener underestimated hyperopia and overestimated myopia according to SE when compared with cycloplegic retinoscopy. The accuracy of the Plusoptix A09 in detecting amblyopia risk factors in children could be improved by the regression equation and optimized criteria for refractive amblyopia risk factors developed in the present study. Moreover, the Plusoptix A09 photoscreener is not suitable for a large-scale strabismus screening when it is applied solely.
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Affiliation(s)
- Xiao-Ran Yan
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Wan-Zhen Jiao
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Zhi-Wei Li
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Wen-Wen Xu
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Feng-Jiao Li
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Li-Hua Wang
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
- * E-mail:
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Ogbuehi KC, Almaliki WH, AlQarni A, Osuagwu UL. Reliability and Reproducibility of a Handheld Videorefractor. Optom Vis Sci 2015; 92:632-41. [DOI: 10.1097/opx.0000000000000566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kodjebacheva GD, Maliski S, Coleman AL. Use of Eyeglasses among Children in Elementary School: Perceptions, Behaviors, and Interventions Discussed by Parents, School Nurses, and Teachers during Focus Groups. Am J Health Promot 2015; 29:324-31. [DOI: 10.4278/ajhp.120315-qual-140] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To investigate the perceptions, behaviors, and recommendations that parents, school nurses, and teachers have regarding children's use of eyeglasses. Approach. Focus groups with parents, school nurses, and teachers were conducted. Setting. The study took place in one Southern California school district. Participants. There were 39 participants, including 24 parents, seven school nurses, and eight teachers. Method. An experienced moderator guided the focus group discussions. Transcripts were analyzed using grounded theory techniques. Results. Participants perceive visual impairment as a serious problem in the development of children. The lack of eyeglasses may lead to problems such as tiredness, headaches, inability to focus on school work, and decreased reading speed. Participants experienced disappointment, unhappiness, worry, and concern when they realized they needed eyeglasses at a young age. Negative societal perceptions toward eyeglasses, lack of eye doctors in minority communities, parental perceptions that children do not need eyeglasses, and peer bullying of children wearing eyeglasses are key obstacles to children's use of eyeglasses. Participants suggest school and national campaigns featuring respected public figures who wear eyeglasses to promote positive attitudes toward eyeglasses. Conclusion. Parents and teachers who closely follow the academic development of children have observed that visual impairment has negative consequences for the scholastic achievement of children. They recommend interventions to promote the attractiveness of eyeglasses in society. The participants discuss the need for a national preventative message for eye care similar to the message for dental care. The public health message should emphasize the importance of embracing and respecting differences among individuals.
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Wallace DK, Lazar EL, Repka MX, Holmes JM, Kraker RT, Hoover DL, Weise KK, Waters AL, Rice ML, Peters RJ. A randomized trial of adding a plano lens to atropine for amblyopia. J AAPOS 2015; 19:42-8. [PMID: 25727586 PMCID: PMC4354879 DOI: 10.1016/j.jaapos.2014.10.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 10/10/2014] [Accepted: 10/14/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Some children have residual amblyopia after treatment with atropine eyedrops for amblyopia due to strabismus and/or anisometropia. We conducted a randomized clinical trial to evaluate the effectiveness of augmenting the effect of atropine by changing the lens over the fellow eye to plano in children with residual amblyopia. METHODS A total of 73 children 3 to <8 years of age (mean, 5.8 years) with stable residual amblyopia (range, 20/32 to 20/160, mean 20/63(+1)) were enrolled after at least 12 weeks of atropine treatment of the fellow eye. Participants were randomly assigned to continuing weekend atropine alone or wearing a plano lens over the fellow eye (while continuing atropine). The primary outcome was assessed at 10 weeks, and participants were followed until improvement ceased. RESULTS At the 10-week primary outcome visit, amblyopic-eye visual acuity had improved an average of 1.1 lines with the plano lens and 0.6 lines with atropine only (difference adjusted for baseline visual acuity = + 0.5 line; 95% CI, -0.1 to +1.2). At the primary outcome or later visit when the best-measured visual acuity was observed, the mean amblyopic-eye improvement from baseline was 1.9 lines with the plano lens and 0.8 lines with atropine only. CONCLUSIONS When amblyopic-eye visual acuity stops improving with atropine treatment, there may be a small benefit to augmenting atropine therapy with a plano lens over the fellow eye. However, the effect was not statistically significant, and the large confidence interval raises the possibility of no benefit or a benefit larger than we observed. A larger study would be necessary to get a more precise estimate of the treatment effect.
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Longmuir SQ, Pfeifer W, Shah SS, Olson R. Validity of a layperson-administered Web-based vision screening test. J AAPOS 2015; 19:29-32. [PMID: 25727583 DOI: 10.1016/j.jaapos.2014.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 09/28/2014] [Accepted: 10/06/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the sensitivity and specificity of the Web-based vision-screening test (WBT) VisionForKids.org when administered by an untrained layperson in a controlled environment. METHODS Visual acuities were obtained by an untrained layperson using the WBT under observation and by an ophthalmic professional using the Electronic Visual Acuity (EVA) Tester. Subjects were randomized to which method was used first. Subjects were considered to have failed by the following criteria: in children <48 months, 20/50 vision; in children between 48 and 59 months, 20/40 or worse; in children ≥60 months, 20/30 or worse. The results of the vision examinations by the WBT and the EVA Tester were compared; sensitivity and specificity of the WBT and the correlation coefficient to detect normal and abnormal vision compared to EVA testing were determined. RESULTS Visual acuities were obtained on 203 children between ages 3 and 12 years (average age, 7.4 years). Sensitivity of the WBT was 78.7% (95% CI, 66.0%-87.7%), specificity was 89.4% (95% CI, 82.9%-93.8%). The correlation coefficient of EVA testing with the WBT was 0.89 (P < 0.001). CONCLUSIONS This layperson-administered WBT, VisionForKids.org, is valid for identifying amblyopia in a controlled environment, making it possible for cost-effective and easily accessible vision screening to be performed by laypersons.
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Affiliation(s)
- Susannah Q Longmuir
- Departments of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa.
| | - Wanda Pfeifer
- Departments of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
| | - Shaival S Shah
- Departments of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
| | - Richard Olson
- Departments of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
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Kim M, Choi MY. Comparison of Results after Daily Patching and Alternate-Day Patching to Treat Amblyopia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.2.254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Moses Kim
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Mi Young Choi
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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Kim MS, Kim WJ, Kim MM. A Case of Reverse Amblyopia of the Dominant Eye that was Refractory to Treatment. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.2.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Min Seok Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Won Jae Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Myung Mi Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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Lança C, Serra H, Prista J. Strabismus, Visual Acuity, and Uncorrected Refractive Error in Portuguese Children Aged 6 to 11 Years. Strabismus 2014; 22:115-9. [DOI: 10.3109/09273972.2014.932395] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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49
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Lança C. Reply to letter to the Editor: Expert Opinion on Best Practice Guidelines and Competency Framework for Visual Screening in Children. Strabismus 2014; 22:88-9. [DOI: 10.3109/09273972.2014.905123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Song S, Levi DM, Pelli DG. A double dissociation of the acuity and crowding limits to letter identification, and the promise of improved visual screening. J Vis 2014; 14:3. [PMID: 24799622 PMCID: PMC4021854 DOI: 10.1167/14.5.3] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 02/14/2014] [Indexed: 11/24/2022] Open
Abstract
Here, we systematically explore the size and spacing requirements for identifying a letter among other letters. We measure acuity for flanked and unflanked letters, centrally and peripherally, in normals and amblyopes. We find that acuity, overlap masking, and crowding each demand a minimum size or spacing for readable text. Just measuring flanked and unflanked acuity is enough for our proposed model to predict the observer's threshold size and spacing for letters at any eccentricity. We also find that amblyopia in adults retains the character of the childhood condition that caused it. Amblyopia is a developmental neural deficit that can occur as a result of either strabismus or anisometropia in childhood. Peripheral viewing during childhood due to strabismus results in amblyopia that is crowding limited, like peripheral vision. Optical blur of one eye during childhood due to anisometropia without strabismus results in amblyopia that is acuity limited, like blurred vision. Furthermore, we find that the spacing:acuity ratio of flanked and unflanked acuity can distinguish strabismic amblyopia from purely anisometropic amblyopia in nearly perfect agreement with lack of stereopsis. A scatter diagram of threshold spacing versus acuity, one point per patient, for several diagnostic groups, reveals the diagnostic power of flanked acuity testing. These results and two demonstrations indicate that the sensitivity of visual screening tests can be improved by using flankers that are more tightly spaced and letter like. Finally, in concert with Strappini, Pelli, Di Pace, and Martelli (submitted), we jointly report a double dissociation between acuity and crowding. Two clinical conditions-anisometropic amblyopia and apperceptive agnosia-each selectively impair either acuity A or the spacing:acuity ratio S/A, not both. Furthermore, when we specifically estimate crowding, we find a double dissociation between acuity and crowding. Models of human object recognition will need to accommodate this newly discovered independence of acuity and crowding.
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Affiliation(s)
- Shuang Song
- Vision Science, School of Optometry, UC Berkeley, Berkeley, CA, USA
| | - Dennis M. Levi
- School of Optometry and Helen Wills Neuroscience, Institute, UC Berkeley, Berkeley, CA, USA
| | - Denis G. Pelli
- Psychology & Neural Science, New York University, New York, NY, USA
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