Infant vision screening predicts failures on motor and cognitive tests up to school age

Evaluation of Portable, Low-Cost Autorefractor in School Students with Limited Eye Care Access in Northeastern Brazil

This study compared the refraction measurements of the ClickCheck™ device (CCD), Topcon KR-8000, and subjective clinical refractometry (SCR) in Brazilian public school students with limited access to eye care. Eighty-seven eyes of healthy students aged 7 to 17 underwent refractometry using the CCD, Topcon KR-8000, and SCR methods under cycloplegia, with only the right-eye data analyzed. For comparison, the measurements were converted into spherical equivalents (SEs) and vector magnitudes. The mean SE difference between CCD and Topcon KR-8000 was -0.27 ± 0.58 (p < 0.0001), while the vector magnitudes at the 90° and 135° meridians were -0.23 ± 0.55 (p = 0.0001) and +0.04 ± 0.47 (p = 0.2246), respectively, demonstrating no clinical relevance. Similarly, the mean SE difference between CCD and SCR was -0.18 ± 0.58 (p = 0.065), with vector magnitudes of -0.20 ± 0.50 (p = 0.0003) at 90° and +0.03 ± 0.46 (p = 0.3730) at 135°, also lacking clinical relevance. Despite statistically significant differences between the methods, the findings confirm strong agreement, validating CCD as an effective refractive assessment tool for children in low-resource settings. These methods can enhance access to refraction services in underserved populations.

The Impact of Socioeconomic Status on Visual Acuity Changes in Schoolchildren: A One-Year Follow-Up

(1) Background: Visual acuity (VA) is essential for children's quality of life, and its relationship with socioeconomic status (SES) highlights disparities in healthcare. This study investigated the influence of SES on changes in schoolchildren's VA over one year. (2) Methods: Initial examinations were conducted on 1822 children (8-10 years). Follow-up was performed on 804 of these children a year later. Uncorrected (UCVA) and presenting (PVA) distance VA were measured monocularly using a decimal Snellen chart. Very reduced UCVA (<0.5) was considered a proxy of myopia. (3) Results: The prevalence of initially very reduced UCVA (myopia) was similar in children with low and high SES (12.6% vs. 12.4%) (χ2; p = 0.153). After one year, the prevalence of very reduced UCVA increased to 14.1% in children with a low SES compared with 11.1% in children with a high SES (p = 0.001). Significant disparities related to SES were also found in PVA so that children with a low SES exhibited a greater reduction in PVA than children with a high SES (5.2% vs. 3.5%) (χ2; p = 0.004). (4) Conclusions: Children with a low SES showed an increase in reduced UCVA values over one year and a higher number of children with very reduced PVA compared with those with a high SES.

Prevalence of Comprehensive Eye Examination in Preschool Children With Eye Conditions

Introduction

The purpose of this study is to assess the prevalence of comprehensive eye examinations in multiethnic preschool children, including children with visually significant eye conditions, and identify factors associated with comprehensive eye examinations.

Methods

A sample of 9,197 African American, Hispanic, Asian American, and non-Hispanic White children aged 6-72 months was recruited for the Multi-Ethnic Pediatric Eye Disease Study from 2003 to 2011. Logistic regression performed in 2022 identified independent factors associated with parent-reported history of comprehensive eye examinations. The proportion of children with previous comprehensive eye examinations and the proportion with undetected amblyopia or strabismus were measured.

Results

The prevalence of comprehensive eye examinations was 6.3% overall and 38.3%, 24.8%, 19.1%, 15.1%, and 9.8% among children with strabismus, amblyopia, significant anisometropia, hyperopia, and astigmatism, respectively. Children without prior comprehensive eye examinations were more likely to have undetected amblyopia or strabismus than those with comprehensive eye examination history (ps<0.001). The prevalence of comprehensive eye examinations was higher among older children. Prevalence varied by race/ethnicity, with 8.1%, 7.9%, 6.3%, and 4.9% of non-Hispanic White, Asian American, African American, and Hispanic children having had prior comprehensive eye examinations, respectively; however, the differences did not remain after adjusting for other associated factors. Older age, a primary caregiver with a college/university degree or higher, having vision insurance, gestational age <33 weeks, neurodevelopmental disorder diagnosis, strabismus, and ocular disease history were all statistically significantly associated with a relatively higher prevalence of comprehensive eye examinations in multivariable analyses.

Conclusions

Comprehensive eye examinations were uncommon among preschool children, including those with treatable vision disorders. Interventions, such as parent education and vision insurance, are needed to imaprove comprehensive eye examination access and utilization for at-risk preschool children.

Does an integrated school eye health delivery model perform better than a vertical model in a real-world setting? A non-randomised interventional comparative implementation study in Zanzibar

BACKGROUND

Few studies on school eye health programmes have shown they were cost-effective. We compared the performance (Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM)) between an integrated model (IM) and a vertical model (VM) of school eye health delivery in Zanzibar.

METHODS

The set of RE-AIM performance indicators of the IM (n=9) and VM (n=10) cohorts was compared. The VM implemented only the eye health interventions, while the IM had the eye health interventions conducted within the school feeding programme. Semistructured interviews were conducted with 36 stakeholders to understand the challenges and outcomes experienced when implementing both models.

RESULTS

The IM achieved higher screening coverage, voluntary follow-up rate, screening validity and spectacle compliance than VM. This was due to effective coordination between implementers, motivated teachers to prevent vision problems and related negative impacts in children, and activities implemented timeously post-training. Both models recorded low wearing compliance. All schools in the IM cohort completed screening activities, but two schools in the VM cohort did not. Both models ceased activities after the funding stopped. Local stakeholders emphasised that evidence from this study can be used to advocate for more resources for children's eye health.

CONCLUSIONS

The IM cohort achieved better reach, effectiveness, adoption rate and implementation performance than the VM cohort. The poor maintenance performance indicators in both arms postfunding call for improvement to the implementation strategy to ensure the sustainability of school eye health. In the optics of scaling up, an integrated approach is recommended.

Contextual factors affecting integration of eye health into school health programme in Zanzibar: a qualitative health system research

BACKGROUND

Short-term school eye health programmes supported by external funders have sustainability issues. This study aimed to understand the contextual factors affecting integrating eye health into the school health programme.

METHODS

We elicited responses from 83 respondents, purposefully selected from the Ministry of Health (n = 7), Ministry of Education and Vocational Training (n = 7), hospitals/eye centres (n = 5), master trainers (4) and schools (n = 60) who participated in in-depth interviews. Their responses were analysed and grouped into contextual factors according to the WHO Consolidated Framework for Implementation Research: stakeholders/political, institutional, physical, cultural, delivery system and others. Themes were then generated, and quotations were presented to illustrate the findings.

RESULTS

The six contextual factors affecting the integration of eye health into the school eye health programme were i) Stakeholders/political (Good ministry coordination, defined departmental roles and resource mobilisation from multiple stakeholders; Good stakeholder synergies and address current gaps); ii) Institutional (Institutional coordination and adequate clinic space; Securing human and financial resources; Strategic advocacy for institutional resources); iii) Physical (Long travel distance to service points); vi) Cultural (low eye health awareness among parents, teachers and children); iv) Delivery system (Practical approach to increase screening coverage using teachers as screeners; Balance teachers' workload, increase screening sensitivity and follow up and; v) Others (Comprehensive training material and effective training delivery; Improved curriculum, teacher selection and supervision and incentives).

CONCLUSION

Integrated school eye health delivery is generally well-received by stakeholders in Zanzibar, with the caveat that investment is required to address the six contextual factors identified in the study.

Laboured reading and musculoskeletal pain in school children - the role of lifestyle behaviour and eye wear: a cross-sectional study

Background

Lifestyle behaviour in children and adolescents has become increasingly sedentary and occupied with digital work. Concurrently, there has been an increase in the prevalence of headache, neck- and low back pain, which are leading causes of disability globally. Extensive near work and use of digital devices are demanding for both the visual system and the upper body head-stabilizing musculature. Uncorrected vision problems are present in up to 40% of Nordic school children, and a lack of corrective eye wear may cause eyestrain, musculoskeletal pain and headache. The aim of this study was to investigate associations between laboured reading, musculoskeletal pain, uncorrected vision, and lifestyle behaviours in children and adolescents.

Methods

This was a cross-sectional study with a total of 192 Norwegian school children aged 10–11 and 15–16 years. As a part of a school vision testing program, the children completed an online questionnaire about general and ocular health, socioeconomic status, academic ambition, near work and related symptoms, upper body musculoskeletal pain, and physical and outdoor activities.

Results

The 15–16-year-olds had a more indoor, sedentary, digital-based lifestyle with higher academic demands, compared with the 10–11-year-olds. Concurrently, reading became more laboured and upper body musculoskeletal pain increased with age. Girls reported more symptoms, higher academic ambitions, and more time spent on schoolwork and reading, compared with boys. Non-compliance in wearing prescribed eye wear (glasses or contact lenses), increased use of near digital devices, and experiencing visual stress (glare) were positively associated with laboured reading and upper body musculoskeletal pain.

Conclusions

A screen-based lifestyle with high academic demands challenges the ability to sustain long hours of static, intensive near work. Extensive near work tires the visual system and upper body musculature and provokes laboured reading and musculoskeletal pain symptoms. This study emphasizes the importance of regular eye examinations in school children, and the need to raise awareness among children, parents, and school- and health personnel about the importance of optimal vision and visual environment for academic performance and health.

Associations among co-occurring medical conditions and cognition, language, and behavior in Down syndrome

BACKGROUND

Specific medical conditions are more prevalent in Down syndrome (DS) compared to the general population. Medical heterogeneity has also been hypothesized to contribute to variability in outcomes in DS.

AIMS

This project aimed to examine the association between medical conditions (i.e., gastrointestinal issues, hearing loss, vision problems, and congenital heart defects) and cognition, language, and behavior in children and adolescents with DS.

METHODS AND PROCEDURES

Participants were 73 children and adolescents with DS, ages 6-17 years (M = 12.67, SD = 3.16). Caregivers reported on participants' medical conditions, social behaviors, maladaptive behaviors, and executive function. Child cognitive abilities were also assessed.

OUTCOMES AND RESULTS

Of the 73 participants, 34.2% had gastrointestinal issues, 12.3% had uncorrected hearing loss, 26.0% had uncorrected vision problems, and 31.5% had congenital heart defects. Participants with gastrointestinal issues had significantly more challenges with social behaviors, maladaptive behaviors, and executive function compared to those without gastrointestinal issues.

CONCLUSIONS AND IMPLICATIONS

The associations identified between gastrointestinal issues and caregiver-reported behavioral characteristics in youth with DS contributes to our understanding of the interrelation between co-occurring medical conditions and child outcomes and has implications for approaches to care for individuals with DS.

EEG Measurement for Suppression in Refractive Amblyopia and Push-pull Perception Efficacy

In order to evaluate refractive amblyopia suppression and understand the neural mechanism of amblyopia suppression and push-pull perception training, we recorded the EEG of refractive amblyopia children before, during, and after push-pull perception training. We compared the brain activity in different states through the steady-state visual evoked potentials (SSVEPs) response and power topography and compared them with normal children. We found that amblyopic and fellow eyes have different performances in fundamental and harmonic frequency responses. They also show different characteristics when be masked. Push-pull perception training improved the SSVEP performance of amblyopia children by reducing the SSVEP response difference between eyes and improving the intermodulation frequency response. The result of topography showed that push-pull perception reduced the alpha power of occipital and temporal lobes, which was conducive to improving binocular function. The changes of intermodulation response and occipital alpha power were significantly correlated with the clinical indicator. Thus, EEG is a potential method to measure amblyopia suppression and the efficacy of push-pull perception.

Development of Visual Acuity in Children: Assessing the Contributions of Cognition and Age in LEA Chart Acuity Readings

SIGNIFICANCE

The development of visual acuity has often been looked upon as a function of age. This study considers whether cognition might also be a predictor of acuity in children. The results indicate that cognition is a predictor of acuity and therefore should play a role in vision evaluations and developmental research.

PURPOSE

Prior studies have shown that changes in visual acuity in typically developing children occur beyond primary school age. However, these studies almost exclusively use chronological age as the sole predictor for visual development. Because many of the tasks used to measure acuity have a cognitive demand, it is possible that age is not the best predictor for changes in this function. The aims of this study were to explore the effect of cognition on the development of visual acuity and to compare this predictor with age.

METHODS

The predictive ability of chronological age and cognition on acuity was assessed in a group of 81 typical children between 5 and 11 years old.

RESULTS

Analysis of resulting trajectories showed that, although age indeed was a good predictor, development of visual acuity was equally well predicted by cognition. Moreover, partial correlations showed a strong correlation between cognition and acuity when controlling for age but no significant correlation between age and acuity when controlling for cognition.

CONCLUSIONS

These results suggest that age alone is not the optimal determinant for the development of visual acuity in typical school-aged children, as cognition was also found to be an important predictor.

The prevalence and correlates of vision impairment and glasses ownership among ethnic minority and Han schoolchildren in rural China

PURPOSE

To determine the prevalence of visual impairment and glasses ownership among Han Chinese and Hui minority junior high school children in Ningxia Hui Autonomous Region, China.

DESIGN

Population-based cross-sectional study.

METHODS

Vision screening was conducted on 20,376 children (age 12-15 years) in all 124 rural junior high schools in Ningxia. Personal and family characteristics, glasses ownership, and academic performance were assessed through a survey questionnaire and standardized mathematics test, respectively.

RESULTS

The prevalence of visual acuity (VA) ≤6/12 in either eye was significantly higher among Han (54.5%) than Hui (45.2%) children (P<0.001), and was significantly positively associated with age, female sex, Han ethnicity, parental outmigration for work, shorter time spent outside during recess, shorter time spent watching television and higher time spent studying. Among children with VA≤6/12 in both eyes, only 56.8% of Han and 41.5% of Hui children had glasses (P<0.001). Glasses ownership was significantly associated with worse vision, greater family wealth, female sex, higher test scores, age, parental outmigration for work, understanding of myopia and glasses, higher time spent studying and Han ethnicity.

CONCLUSION

One of the first of its kind, this report on Han and Hui ethnic schoolchildren confirms a high prevalence of visual impairment among both populations, but slightly higher among the Han. Both groups, especially the Hui, have low rates of glasses ownership. Future interventions and policies designed to improve glasses usage should focus on populations with lower incomes and seek to correct erroneous beliefs about the safety of glasses and efficacy of traditional eye exercises.

Refractive Error and Visual Impairment Among School Children: Result of a South-Eastern Nigerian Regional Survey

PURPOSE

To determine the prevalence refractive errors and causes of visual impairment in school children in the south-eastern region of Nigeria.

METHODS

School-based cross-sectional samples of children 5 to 15 of age in both urban and rural areas were profiled through cluster sampling. The main outcome measures were presenting, uncorrected, and best-corrected visual acuity using the Refractive Error in School-age Children (RESC) protocol.

RESULTS

A total of 5723 children were examined during the study period comprising 2686 (46.9%) males and 3037 (53.1%) females; (M:F ratio 0.9:1) and aged 10.49±2.74SD of mean (range, 5 to 15 years). The age group 12 to <13 accounted for the highest 776 (13.6%) number of the study participants. The uncorrected visual acuity (VA) of <20/40 (6/12) was seen in 188 (3.4%) of the study participants while the presenting and best-corrected visual acuity of <20/40 (6/12) were noted in 182 (3.4%) children and 14 (0.2%) children, respectively. Refractive error was the principal cause of visual impairment.

CONCLUSION

Prevalence of refractive error is low. Myopia is the principal cause of refractive error occurring more in females and in urban schools. The main cause of visual impairment is refractive error, and most children that need spectacle correction did not have them. Program to identify children with refractive error in addition to providing free or affordable optical services remains the key to preventing visual impairment from refractive error particularly in resource-poor settings.

Risk factors of ocular morbidity among under-five years old children in Khartoum State- Sudan- 2020

BACKGROUND AND AIMS

Visual impairment in early childhood can significantly affect the development of visual, motor, and cognitive function and potentially lead to long-term adverse psychosocial consequences. This study aimed to identify the risk factors of ocular morbidity among under 5-year old children in Khartoum State, Sudan.

METHODS

A cross-sectional study was conducted in three tertiary eye care hospitals in Khartoum State, Sudan. The study included 391 children under the age of 5 years. The parent(s) were interviewed using a precoded, pretested, closed-ended questionnaire that included questions regarding socio-demographic profile and possible risk factors. Data were analyzed using Statistical Package for the Social Sciences (version 21.0). A P-value of less than .05 was regarded as significant.

RESULTS

There was a significant association between participants with diabetes mellitus and poor vision (P-value <.001). Two-thirds of participants (57%) with visual impairment had mothers, who reportedly attended antenatal care services regularly (P-value .001), revealing a significant statistical association. Maternal diseases, specifically diabetes, was identified as a risk factor for poor visual acuity in their offspring (P-value <.001). A significant relation was revealed between family history of eye disease and the degree of relationship to the affected participant (P-value <.001). There was an association between watching TV and current visual acuity (P-value <.001); as well as using mobile phones and current visual acuity (P-value <.001). Multilinear analysis revealed the stronger influence of TV watching rather than the use of mobile phones (P-value <.001).

CONCLUSIONS

Diabetes, diabetic mothers, a family history of ocular morbidity, watching television, and using mobile phones emerged as significant risk factors of ocular morbidity among children under the age of 5 years in this study. Many of these risk factors are either modifiable or controllable ocular morbidities among under-five children can be reduced with suitable interventions.

Effects of Vision Health Education and Free Eyeglasses on Knowledge of Vision and Usage of Spectacles Among Primary School Students: Evidence from Gansu and Shaanxi Provinces in China

Background

In rural China, children’s vision problems are very common, with many who would benefit from refractive correction not getting the care they need. This study examines whether a health information campaign that involves vision health education and a free trial of health product with free eyeglasses is effective at raising students’ awareness of myopia and promoting students’ eyeglasses usage.

Methods

We conducted an in-the-field randomized controlled experiment of a program providing vision health education and subsidized free eyeglasses to myopic children from 168 primary schools in rural Northwestern China in 2012.

Results

A total of 2189 students, mean age 10.5 years (49.3% male), participated in the baseline survey. At the baseline, the average correct response rate for visual knowledge among the sample students was 30.1%, and only 15% who needed eyeglasses used them. Seven months after intervention, the average correct response rate for vision knowledge were 48.5% and 48.3% in the education group and the education plus free eyeglasses group respectively, significantly higher than that of the control group. The rate of eyeglasses usage was 36% and 43% in the free eyeglasses group and the education plus free eyeglasses group respectively, significantly higher than that of the control group. The rate of eyeglasses compliance in the free eyeglasses group and the education plus free eyeglasses group was 19% and 26%, which also were significantly higher than the control group.

Conclusion

The information campaign combined with subsidized eyeglasses had a better effect both on vision knowledge and eyeglasses usage. The information campaign improved knowledge by providing the right information, and free eyeglasses changed the perceived utility and experience by the students using the product and getting benefits. Information and the free eyeglasses (subsidized) are complements.

Preschool Vision Screening Collaborative: Successful Uptake of Guidelines in Primary Care

Preschool vision screening rates in primary care are suboptimal and poorly standardized. The purpose of this project was to evaluate pediatric primary care adherence to and improvement in preschool vision screening guidelines through a learning collaborative environment.

Validity of the Spot Vision Screener in detecting vision disorders in children 6 months to 36 months of age

PURPOSE

To evaluate the Spot Vision Screener in detecting targeted vision disorders compared to cycloplegic retinoscopy in children <3 years of age.

METHODS

Children, ages 6 months to 36 months underwent vision screening using the Spot Vision Screener. Results were compared to results of comprehensive eye examinations. Validity of the Spot was evaluated by calculating the area under the curve (AUC); the receiver operating characteristics (ROC) were used to determine optimal sensitivity and specificity for detection of targeted vision disorders.

RESULTS

A total of 249 children were included. The AUC for detecting targeted vision disorders as defined by the study specific criteria using the Spot was 0.790. Compared to cycloplegic retinoscopy, the Spot underestimated hyperopia by 1.02 D (95% CI, 0.86-1.17 D). For hyperopia ≥4.5 D spherical equivalent (n = 10), the mean difference between the Spot and cycloplegic retinoscopy was 3.46 D (95% CI, 1.95-4.98 D). In contrast, the Spot overestimated astigmatism compared to cycloplegic retinoscopy (-1.00 D vs -0.48 D; P < 0.001) by -0.52 D (95% CI, 0.43-0.62 D).

CONCLUSIONS

The Spot Vision Screener showed good overall validity in detecting targeted vision disorders. It was within 0.5 D and 1 D of cycloplegic retinoscopy with regard to low hyperopia and astigmatism. Higher hyperopic spherical equivalent refractive errors showed larger differences in mean values between the Spot and cycloplegic retinoscopy.

Evidence-based preschool-age vision screening: health policy considerations

Background

There are many causes of visual impairment, and even blindness, which are treatable or at least preventable. Two such conditions are strabismus (crossed-eye, squint) and refractive error (visual image not focused on the most sensitive part of the retina). If these are not detected and corrected at an early age, they can lead to an irreversible impairment known as amblyopia (lazy eye). Pediatric vision screening and subsequent treatment for amblyopia and amblyogenic risk factors are thus key to preventing vision loss. Furthermore, vision screening can detect moderate to high hyperopia, which has been found to be associated with poor school readiness.

Evidence-based recommendations call for screening children at 3–5 years of age; they are old enough to cooperate, but still within the window of effective intervention. However, these recommendations have yet to be universally implemented as the standard of care.

Methods

This paper integrates a review of the literature and the international experience of preschool vision screening with the findings from a preliminary feasibility study of expanded screening in Israel to formulate a discussion of the current health policy challenge in Israel and the options for addressing it. The advantages and disadvantages of various venues for vision screening are discussed.

Findings

Screening by optometrists in Mother and Child Health Centers, as implemented in a recent pilot project in the Jerusalem District, would allow the most comprehensive testing. Photo-screening in preschools would reach the most children, but at the cost of missing hyperopia (farsightedness). Either approach would probably constitute improvements over the current situation. The relative strengths of the two approaches depends in part on the ability to purchase automatic screening equipment (and the efficacy of that equipment) vs. the ongoing cost of paying trained personnel.

Conclusions

Further research should be conducted in Israel to determine the prevalence of refractive errors, so that best practices can be established for Israel’s population and social needs. In the interim, the Ministry of Health should promptly implement the inclusion of preschool visions screening for children in the approved “basket of services” covered by the National Health Insurance Laws, using photo-screening, including collection of the clinical data.

Electronic supplementary material

The online version of this article (10.1186/s13584-019-0339-z) contains supplementary material, which is available to authorized users.

Impact of Cognitive Demand during Sustained Near Tasks in Children and Adults

SIGNIFICANCE

These results demonstrate that accommodation in children is more accurate and less variable when performing a sustained near task with increased cognitive demand. In addition, children with increased uncorrected hyperopia have less stable accommodative responses, which may have visual implications during sustained near tasks.

PURPOSE

This study investigated accommodative accuracy (lag) and variability during sustained viewing for passive and active tasks in children and adults with emmetropia and uncorrected hyperopia.

METHODS

Lag and variability (root mean square [RMS] and low-frequency component) were measured in 54 children aged 3 to younger than 10 years with mean spherical equivalent of +1.31 ± 1.05 diopters (D) (range, -0.37 to +4.58 D) and 8 adults aged 22 to 32 years with mean spherical equivalent +0.65 ± 0.62 D (range, -0.13 to +1.15 D). Subjects viewed 20/50 stimuli at 33 cm during both a 10-minute passive and active task. Group 1 (<6 years or nonreaders) viewed shapes; group 2 (≥6 years and reading) and adults read passages.

RESULTS

Groups 1 and 2 had larger lags, RMS, and low-frequency component for passive versus active tasks (P < .001). Lag and RMS did not differ between tasks in adults (P > .05), but low-frequency component was larger during passive viewing (P = .04). Group 1 had significantly higher RMS and low-frequency component than group 2 and the adults in the passive condition had greater low-frequency component in the active condition. In children, hyperopia was independently associated with RMS and low-frequency component under passive (RMS 95% confidence interval [CI], 0.04 to 0.15; low-frequency component 95% CI, 0.00011 to 0.00065) and active (RMS 95% CI, 0.001 to 0.06; 95% CI, 0.000014 to 0.00023) viewing.

CONCLUSIONS

Accommodation is more accurate and less variable when children are engaged in the task. Children also have more variable accommodation than adults. In addition, children with greater hyperopia have more variable accommodation during sustained near tasks.

Association of visual acuity with educational outcomes: a prospective cohort study

BACKGROUND/AIM

To quantify the impact of baseline presenting visual acuity (VA), refractive error and spectacles wear on subsequent academic performance among Chinese middle school children.

METHODS

A prospective, longitudinal, school-based study on grade 7 Chinese children (age, mean±SD, 12.7±0.5 years, range=11.1-15.9) at four randomly selected middle schools in Anyang, China. Comprehensive eye examinations including cycloplegic autorefraction were performed at baseline, and information on demographic characteristics, known risk factors for myopia and spectacle wear was collected. Academic test scores for all subjects in the curriculum were obtained from the local Bureau of Education. Main outcome measure was total test scores for five subjects at the end of grade 9, adjusted for total scored at the beginning of grade 7.

RESULTS

Among 2363 eligible children, 73.1% (1728/2363) had seventh grade test scores available. 93.9% (1623/1728) completed eye examinations, and 98.5% (1599/1623) of these had ninth grade test scores. Adjusting only for baseline test score, the following were significantly associated with higher ninth grade scores: younger age, male sex, less time outdoors, better baseline presenting VA, higher parental education and income and parental myopia, but refractive error and spectacle wear were not. In the full multivariate model, baseline test score (p<0.001), presenting VA (p<0.01), age (p<0.001), quality of life (p<0.05) and parental education (p<0.001) and myopia (either: p<0.05; both: p<0.05) remained significantly associated with better ninth grade scores.

CONCLUSIONS

In this longitudinal study, better presenting VA, but not cycloplegic refractive error or spectacle wear, was significantly associated with subsequent academic performance.

The feasibility of fundamental movement skill assessments for pre-school aged children

Fundamental movement skill (FMS) assessment in preschools allows for early intervention; however it is unclear what assessments are feasible. The purpose of this review is to systematically review the feasibility of FMS assessments for pre-school aged children. The search was conducted across four databases, MEDLINE, Scopus, ERIC and SportsDiscus. Search terms included synonyms of "fundamental movement skills" and "pre-school children". Inclusion criteria were: (i) FMS assessment; (ii) feasibility data; (iii) assessment of children aged three to six years; (iv) assessment of typically developing children; and (v) peer reviewed full text publications in English. Feasibility concepts (administration time, equipment, space, assessment type, item, training, qualification) were each coded as 'poor = 1', 'average = 2' and 'good = 3'; potential total of 21. A total of 330 full text articles were considered but a quarter (n = 86) were excluded due to no feasibility data. Sixty-five studies using 13 different FMS assessments were included. The Athletic Skills Track and DEMOST-PRE assessments were most feasible (18/21) and the Test of Gross Motor Development and Movement Assessment Battery for Children were common but among the least feasible (12-14/21). This review allows pre-school staff to choose a FMS assessment based on feasibility. Future studies need to present feasibility of assessments.

Cortical correlates of amblyopia

There are many levels of disorder in amblyopic vision, from basic acuity and contrast sensitivity loss to abnormal binocular vision and global perception of motion and form. Amblyopia treatment via patching to restore acuity often leaves other aspects of vision deficient. The source for these additional deficits is unclear. Neural correlates of poor binocular function and acuity loss are found in V1 and V2. However, they are generally not sufficient to account for behaviorally measured vision loss. This review summarizes the known cortical correlates of visual deficits found in association with amblyopia, particularly those relevant to binocular vision and higher-order visual processing, in striate and extrastriate cortex. Recommendations for future research address open questions on the role of suppression and oculomotor abnormalities in amblyopic vision, and underexplored mechanisms such as top-down influences on information transmission in the amblyopic brain.

Early diagnosis of amblyopia

Amblyopia can be improved or eliminated more easily when treated early in life. Because amblyopia in older children is generally less responsive to treatment (Holmes et al., 2011), there is a premium on the early identification of amblyopia and its risk factors and the subsequent treatment thereof. Clinical preference is to institute treatment in children before 7 years of age when an optimal visual outcome is typically easier to obtain.

Attention and Visual Motor Integration in Young Children with Uncorrected Hyperopia

SIGNIFICANCE

Among 4- and 5-year-old children, deficits in measures of attention, visual-motor integration (VMI) and visual perception (VP) are associated with moderate, uncorrected hyperopia (3 to 6 diopters [D]) accompanied by reduced near visual function (near visual acuity worse than 20/40 or stereoacuity worse than 240 seconds of arc).

PURPOSE

To compare attention, visual motor, and visual perceptual skills in uncorrected hyperopes and emmetropes attending preschool or kindergarten and evaluate their associations with visual function.

METHODS

Participants were 4 and 5 years of age with either hyperopia (≥3 to ≤6 D, astigmatism ≤1.5 D, anisometropia ≤1 D) or emmetropia (hyperopia ≤1 D; astigmatism, anisometropia, and myopia each <1 D), without amblyopia or strabismus. Examiners masked to refractive status administered tests of attention (sustained, receptive, and expressive), VMI, and VP. Binocular visual acuity, stereoacuity, and accommodative accuracy were also assessed at near. Analyses were adjusted for age, sex, race/ethnicity, and parent's/caregiver's education.

RESULTS

Two hundred forty-four hyperopes (mean, +3.8 ± [SD] 0.8 D) and 248 emmetropes (+0.5 ± 0.5 D) completed testing. Mean sustained attention score was worse in hyperopes compared with emmetropes (mean difference, -4.1; P < .001 for 3 to 6 D). Mean Receptive Attention score was worse in 4 to 6 D hyperopes compared with emmetropes (by -2.6, P = .01). Hyperopes with reduced near visual acuity (20/40 or worse) had worse scores than emmetropes (-6.4, P < .001 for sustained attention; -3.0, P = .004 for Receptive Attention; -0.7, P = .006 for VMI; -1.3, P = .008 for VP). Hyperopes with stereoacuity of 240 seconds of arc or worse scored significantly worse than emmetropes (-6.7, P < .001 for sustained attention; -3.4, P = .03 for Expressive Attention; -2.2, P = .03 for Receptive Attention; -0.7, P = .01 for VMI; -1.7, P < .001 for VP). Overall, hyperopes with better near visual function generally performed similarly to emmetropes.

CONCLUSIONS

Moderately hyperopic children were found to have deficits in measures of attention. Hyperopic children with reduced near visual function also had lower scores on VMI and VP than emmetropic children.

Spatial and temporal postural analysis in children born prematurely

The aim of this study was to compare postural stability in a group of preterm-born children aged 4-6 years old and in a group of age-matched full-term control children by exploring both spatial and temporal analysis of the Center of Pressure (CoP). Twenty-nine children born prematurely (mean age: 5.38±0.17) and twenty-nine age-matched full-term control children participated in this study. Postural control was tested on both a stable and an unstable platform (from Framiral^®) in three different visual conditions: eyes open fixating a target, eyes closed, and with vision perturbed by optokinetic stimulation. We observed a significant increase of both surface area and mean velocity of the CoP in pre-term children compared to full-term control children, particularly in an unstable postural condition. The spectral power indices increased significantly in pre-term children with respect to full-term control children, while the cancelling time was not different between the two groups of children tested. We suggested that poor postural stability observed in preterm children could be due to immaturity of the cortical processes (the occipital parietal prefrontal cortex) involved in motor control. Preterm children could have an inappropriate compensation of sensory inputs when they are tested in difficult postural and/or visual conditions.

Visual Impairment in Preschool Children in the United States: Demographic and Geographic Variations From 2015 to 2060

Importance

Visual impairment (VI) in early childhood can significantly impair development.

Objective

To determine demographic and geographic variations in VI in children aged 3 to 5 years in the United States in 2015 and to estimate projected prevalence through 2060.

Design, Setting, and Participants

Descriptive study reporting statistics estimated based on prevalence data from 2 major population-based studies conducted in the United States between 2003 and 2011. Using US census projections, prevalence of VI and cause-specific VI in the better eye were reported by race/ethnicity, state and region, and per capita prevalence of VI by state. The study included preschool children in the United States. Analyses for this study were conducted between February 2016 and March 2017.

Main Outcomes and Measures

Prevalence of VI among children aged 3 to 5 years in the United States.

Results

In 2015, more than 174 000 children aged 3 to 5 years in the United States were visually impaired. Almost 121 000 of these cases (69%) arose from simple uncorrected refractive error, and 43 000 (25%) from bilateral amblyopia. By 2060, the number of children aged 3 to 5 years with VI is projected to increase by 26%. In 2015, Hispanic white children accounted for the highest number of VI cases (66 000); this group will remain the most affected through 2060, with an increasingly large proportion of cases (37.7% in 2015 and 43.6% in 2060). The racial/ethnic group with the second most VI is projected to shift from non-Hispanic white children (26.3% in 2015 decreasing to 16.5% in 2060) to African American children (24.5% in 2015 and 22.0% in 2060). From 2015 to 2060, the states projected to have the most children with VI are California (26 600 in 2015 and 38 000 in 2060), Texas (21 500 in 2015 and 29 100 in 2060), and Florida (10 900 in 2015 and 13 900 in 2060).

Conclusions and Relevance

These data suggest that the number of preschool children with VI is projected to increase disproportionally, especially among minority populations. Vision screening for refractive error and related eye diseases may prevent a high proportion of preschool children from experiencing unnecessary VI and associated developmental delays.

Interrater and Test-Retest Reliability of the Beery Visual-Motor Integration in Schoolchildren

PURPOSE

To assess interrater and test-retest reliability of the 6th Edition Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI) and test-retest reliability of the VMI Visual Perception Supplemental Test (VMIp) in school-age children.

METHODS

Subjects were 163 Native American third- to eighth-grade students with no significant refractive error (astigmatism <1.00 D, myopia <0.75 D, hyperopia <2.50 D, anisometropia <1.50 D) or ocular abnormalities. The VMI and VMIp were administered twice, on separate days. All VMI tests were scored by two trained scorers, and a subset of 50 tests was also scored by an experienced scorer. Scorers strictly applied objective scoring criteria. Analyses included interrater and test-retest assessments of bias, 95% limits of agreement, and intraclass correlation analysis.

RESULTS

Trained scorers had no significant scoring bias compared with the experienced scorer. One of the two trained scorers tended to provide higher scores than the other (mean difference in standardized scores = 1.54). Interrater correlations were strong (0.75 to 0.88). VMI and VMIp test-retest comparisons indicated no significant bias (subjects did not tend to score better on retest). Test-retest correlations were moderate (0.54 to 0.58). The 95% limits of agreement for the VMI were -24.14 to 24.67 (scorer 1) and -26.06 to 26.58 (scorer 2), and the 95% limits of agreement for the VMIp were -27.11 to 27.34.

CONCLUSIONS

The 95% limit of agreement for test-retest differences will be useful for determining if the VMI and VMIp have sufficient sensitivity for detecting change with treatment in both clinical and research settings. Further research on test-retest reliability reporting 95% limits of agreement for children across different age ranges is recommended, particularly if the test is to be used to detect changes due to intervention or treatment.

Visual Motor and Perceptual Task Performance in Astigmatic Students

Purpose. To determine if spectacle corrected and uncorrected astigmats show reduced performance on visual motor and perceptual tasks. Methods. Third through 8th grade students were assigned to the low refractive error control group (astigmatism < 1.00 D, myopia < 0.75 D, hyperopia < 2.50 D, and anisometropia < 1.50 D) or bilateral astigmatism group (right and left eye ≥ 1.00 D) based on cycloplegic refraction. Students completed the Beery-Buktenica Developmental Test of Visual Motor Integration (VMI) and Visual Perception (VMIp). Astigmats were randomly assigned to testing with/without correction and control group was tested uncorrected. Analyses compared VMI and VMIp scores for corrected and uncorrected astigmats to the control group. Results. The sample included 333 students (control group 170, astigmats tested with correction 75, and astigmats tested uncorrected 88). Mean VMI score in corrected astigmats did not differ from the control group (p = 0.829). Uncorrected astigmats had lower VMI scores than the control group (p = 0.038) and corrected astigmats (p = 0.007). Mean VMIp scores for uncorrected (p = 0.209) and corrected astigmats (p = 0.124) did not differ from the control group. Uncorrected astigmats had lower mean scores than the corrected astigmats (p = 0.003). Conclusions. Uncorrected astigmatism influences visual motor and perceptual task performance. Previously spectacle treated astigmats do not show developmental deficits on visual motor or perceptual tasks when tested with correction.

The Davida Teller Award Lecture, 2016: Visual Brain Development: A review of "Dorsal Stream Vulnerability"-motion, mathematics, amblyopia, actions, and attention

Research in the Visual Development Unit on "dorsal stream vulnerability' (DSV) arose from research in two somewhat different areas. In the first, using cortical milestones for local and global processing from our neurobiological model, we identified cerebral visual impairment in infants in the first year of life. In the second, using photo/videorefraction in population refractive screening programs, we showed that infant spectacle wear could reduce the incidence of strabismus and amblyopia, but many preschool children, who had been significantly hyperopic earlier, showed visuo-motor and attentional deficits. This led us to compare developing dorsal and ventral streams, using sensitivity to global motion and form as signatures, finding deficits in motion sensitivity relative to form in children with Williams syndrome, or perinatal brain injury in hemiplegia or preterm birth. Later research showed that this "DSV" was common across many disorders, both genetic and acquired, from autism to amblyopia. Here, we extend DSV to be a cluster of problems, common to many disorders, including poor motion sensitivity, visuo-motor spatial integration for planning actions, attention, and number skills. In current research, we find that individual differences in motion coherence sensitivity in typically developing children are correlated with MRI measures of area variations in parietal lobe, fractional anisotropy (from TBSS) of the superior longitudinal fasciculus, and performance on tasks of mathematics and visuo-motor integration. These findings suggest that individual differences in motion sensitivity reflect decision making and attentional control rather than integration in MT/V5 or V3A. Its neural underpinnings may be related to Duncan's "multiple-demand" (MD) system.

Motor skills of children with unilateral visual impairment in the Infant Aphakia Treatment Study

AIM

To assess motor functioning in children aged 4 years 6 months enrolled in the Infant Aphakia Treatment Study, and to determine contributions of visual acuity and stereopsis to measured motor skills.

METHOD

One hundred and four children (53% female) with unilateral aphakia randomized to intraocular lens or contact lens treatment were evaluated at 4 years 6 months (age range 4y 6mo-4y 11mo) for monocular recognition visual acuity, motor skills, and stereopsis by a traveling examiner masked to treatment condition. Motor skills were assessed with the Movement Assessment Battery for Children--Second Edition (MABC-2). Visual acuity was operationalized as log10 of the minimum angle of resolution (logMAR) value for treated eye, best logMAR value for either eye, and intraocular logMAR difference.

RESULTS

Student's t-tests showed no significant differences in MABC-2 scores between the intraocular lens and contact lens groups. The mean total score was low (6.43; 18th centile) compared with the normative reference group. Motor functioning was not related to visual acuity in the treated eye or to intraocular logMAR difference, but was predicted in a regression model by the better visual acuity of either eye (usually the fellow eye), even after accounting for the influence of age at surgery, examiner, orthotropic ocular alignment, and stereopsis.

INTERPRETATION

Children with unilateral congenital cataract may have delayed motor functioning at 4 years 6 months, which may adversely affect their social and academic functioning.

Kulp MT, Ciner E, Maguire M, Moore B, Pentimonti J, Pistilli M, Cyert L, Candy TR, Quinn G, Ying GS. Uncorrected Hyperopia and Preschool Early Literacy: Results of the Vision in Preschoolers-Hyperopia in Preschoolers (VIP-HIP) Study

PURPOSE

To compare early literacy of 4- and 5-year-old uncorrected hyperopic children with that of emmetropic children.

DESIGN

Cross-sectional.

PARTICIPANTS

Children attending preschool or kindergarten who had not previously worn refractive correction.

METHODS

Cycloplegic refraction was used to identify hyperopia (≥3.0 to ≤6.0 diopters [D] in most hyperopic meridian of at least 1 eye, astigmatism ≤1.5 D, anisometropia ≤1.0 D) or emmetropia (hyperopia ≤1.0 D; astigmatism, anisometropia, and myopia <1.0 D). Threshold visual acuity (VA) and cover testing ruled out amblyopia or strabismus. Accommodative response, binocular near VA, and near stereoacuity were measured.

MAIN OUTCOME MEASURES

Trained examiners administered the Test of Preschool Early Literacy (TOPEL), composed of Print Knowledge, Definitional Vocabulary, and Phonological Awareness subtests.

RESULTS

A total of 492 children (244 hyperopes and 248 emmetropes) participated (mean age, 58 months; mean ± standard deviation of the most hyperopic meridian, +3.78±0.81 D in hyperopes and +0.51±0.48 D in emmetropes). After adjustment for age, race/ethnicity, and parent/caregiver's education, the mean difference between hyperopes and emmetropes was -4.3 (P = 0.01) for TOPEL overall, -2.4 (P = 0.007) for Print Knowledge, -1.6 (P = 0.07) for Definitional Vocabulary, and -0.3 (P = 0.39) for Phonological Awareness. Greater deficits in TOPEL scores were observed in hyperopic children with ≥4.0 D than in emmetropes (-6.8, P = 0.01 for total score; -4.0, P = 0.003 for Print Knowledge). The largest deficits in TOPEL scores were observed in hyperopic children with binocular near VA of 20/40 or worse (-8.5, P = 0.002 for total score; -4.5, P = 0.001 for Print Knowledge; -3.1, P = 0.04 for Definitional Vocabulary) or near stereoacuity of 240 seconds of arc or worse (-8.6, P < 0.001 for total score; -5.3, P < 0.001 for Print Knowledge) compared with emmetropic children.

CONCLUSIONS

Uncorrected hyperopia ≥4.0 D or hyperopia ≥3.0 to ≤6.0 D associated with reduced binocular near VA (20/40 or worse) or reduced near stereoacuity (240 seconds of arc or worse) in 4- and 5-year-old children enrolled in preschool or kindergarten is associated with significantly worse performance on a test of early literacy.

Vision screening for children 36 to <72 months: recommended practices

PURPOSE

This article provides recommendations for screening children aged 36 to younger than 72 months for eye and visual system disorders. The recommendations were developed by the National Expert Panel to the National Center for Children's Vision and Eye Health, sponsored by Prevent Blindness, and funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration, United States Department of Health and Human Services. The recommendations describe both best and acceptable practice standards. Targeted vision disorders for screening are primarily amblyopia, strabismus, significant refractive error, and associated risk factors. The recommended screening tests are intended for use by lay screeners, nurses, and other personnel who screen children in educational, community, public health, or primary health care settings. Characteristics of children who should be examined by an optometrist or ophthalmologist rather than undergo vision screening are also described.

RESULTS

There are two current best practice vision screening methods for children aged 36 to younger than 72 months: (1) monocular visual acuity testing using single HOTV letters or LEA Symbols surrounded by crowding bars at a 5-ft (1.5 m) test distance, with the child responding by either matching or naming, or (2) instrument-based testing using the Retinomax autorefractor or the SureSight Vision Screener with the Vision in Preschoolers Study data software installed (version 2.24 or 2.25 set to minus cylinder form). Using the Plusoptix Photoscreener is acceptable practice, as is adding stereoacuity testing using the PASS (Preschool Assessment of Stereopsis with a Smile) stereotest as a supplemental procedure to visual acuity testing or autorefraction.

CONCLUSIONS

The National Expert Panel recommends that children aged 36 to younger than 72 months be screened annually (best practice) or at least once (accepted minimum standard) using one of the best practice approaches. Technological updates will be maintained at http://nationalcenter.preventblindness.org.

Effect of providing free glasses on children's educational outcomes in China: cluster randomized controlled trial

OBJECTIVE

To assess the effect of provision of free glasses on academic performance in rural Chinese children with myopia.

DESIGN

Cluster randomized, investigator masked, controlled trial.

SETTING

252 primary schools in two prefectures in western China, 2012-13.

PARTICIPANTS

3177 of 19,934 children in fourth and fifth grades (mean age 10.5 years) with visual acuity <6/12 in either eye without glasses correctable to >6/12 with glasses. 3052 (96.0%) completed the study.

INTERVENTIONS

Children were randomized by school (84 schools per arm) to one of three interventions at the beginning of the school year: prescription for glasses only (control group), vouchers for free glasses at a local facility, or free glasses provided in class.

MAIN OUTCOME MEASURES

Spectacle wear at endline examination and end of year score on a specially designed mathematics test, adjusted for baseline score and expressed in standard deviations.

RESULTS

Among 3177 eligible children, 1036 (32.6%) were randomized to control, 988 (31.1%) to vouchers, and 1153 (36.3%) to free glasses in class. All eligible children would benefit from glasses, but only 15% wore them at baseline. At closeout glasses wear was 41% (observed) and 68% (self reported) in the free glasses group, and 26% (observed) and 37% (self reported) in the controls. Effect on test score was 0.11 SD (95% confidence interval 0.01 to 0.21) when the free glasses group was compared with the control group. The adjusted effect of providing free glasses (0.10, 0.002 to 0.19) was greater than parental education (0.03, -0.04 to 0.09) or family wealth (0.01, -0.06 to 0.08). This difference between groups was significant, but was smaller than the prespecified 0.20 SD difference that the study was powered to detect.

CONCLUSIONS

The provision of free glasses to Chinese children with myopia improves children's performance on mathematics testing to a statistically significant degree, despite imperfect compliance, although the observed difference between groups was smaller than the study was originally designed to detect. Myopia is common and rarely corrected in this setting.Trial Registration Current Controlled Trials ISRCTN03252665.

Associations between hyperopia and other vision and refractive error characteristics

PURPOSE

To investigate the association of hyperopia greater than +3.25 diopters (D) with amblyopia, strabismus, anisometropia, astigmatism, and reduced stereoacuity in preschoolers.

METHODS

Three- to five-year-old Head Start preschoolers (N = 4040) underwent vision examination including monocular visual acuity (VA), cover testing, and cycloplegic refraction during the Vision in Preschoolers Study. Visual acuity was tested with habitual correction and was retested with full cycloplegic correction when VA was reduced below age norms in the presence of significant refractive error. Stereoacuity testing (Stereo Smile II) was performed on 2898 children during study years 2 and 3. Hyperopia was classified into three levels of severity (based on the most positive meridian on cycloplegic refraction): group 1: greater than or equal to +5.00 D, group 2: greater than +3.25 D to less than +5.00 D with interocular difference in spherical equivalent greater than or equal to 0.50 D, and group 3: greater than +3.25 D to less than +5.00 D with interocular difference in spherical equivalent less than 0.50 D. "Without" hyperopia was defined as refractive error of +3.25 D or less in the most positive meridian in both eyes. Standard definitions were applied for amblyopia, strabismus, anisometropia, and astigmatism.

RESULTS

Relative to children without hyperopia, children with hyperopia greater than +3.25 D (n = 472, groups 1, 2, and 3) had a higher proportion of amblyopia (34.5 vs. 2.8%, p < 0.0001) and strabismus (17.0 vs. 2.2%, p < 0.0001). More severe levels of hyperopia were associated with higher proportions of amblyopia (51.5% in group 1 vs. 13.2% in group 3) and strabismus (32.9% in group 1 vs. 8.4% in group 3; trend p < 0.0001 for both). The presence of hyperopia greater than +3.25 D was also associated with a higher proportion of anisometropia (26.9 vs. 5.1%, p < 0.0001) and astigmatism (29.4 vs. 10.3%, p < 0.0001). Median stereoacuity of nonstrabismic, nonamblyopic children with hyperopia (n = 206) (120 arcsec) was worse than that of children without hyperopia (60 arcsec) (p < 0.0001), and more severe levels of hyperopia were associated with worse stereoacuity (480 arcsec for group 1 and 120 arcsec for groups 2 and 3, p < 0.0001).

CONCLUSIONS

The presence and magnitude of hyperopia among preschoolers were associated with higher proportions of amblyopia, strabismus, anisometropia, and astigmatism and with worse stereoacuity even among nonstrabismic, nonamblyopic children.

Spectacles may improve reading speed in children with hyperopia

PURPOSE

The purpose of this study was to investigate the role of (hyperopic or myopic) spectacle correction in reading speed of 9- to 10-year-old children.

METHODS

Subjects were recruited at their schools. Initial selection was based on reduced distance acuity and/or a positive blur test. Final inclusion depended on cycloplegic refraction. Forty-three myopes were prescribed glasses. Sixty-five hyperopes were randomized to three groups: (1) no glasses, (2) +0.5DS for both eyes, and (3) full correction. Before and 4 to 6 months after prescription of glasses, reading speed was tested: One-Minute Test (reading speed of genuine words) and the Klepel (reading speed of nonwords). Data for this second reading test were obtained in 34 myopes and 48 hyperopes.

RESULTS

At baseline, myopes had about 11% higher One-Minute scores (p = 0.005) and about 9% higher Klepel scores (p = 0.066) than hyperopes. At follow-up, the hyperopia-full correction group improved its One-Minute score by about 13% more than both the no-glasses group (p = 0.012) and +0.5DS group (p = 0.019). Spectacles did not, or only slightly, improve reading scores of myopes (One-Minute scores, p = 0.068; Klepel scores, p = 0.021).

CONCLUSIONS

Correction of hyperopia may increase speed of reading (as reflected by the One-Minute score). The fact that reading speed of nonwords does not increase after correction suggests that hyperopia affects speed of recognition but not decoding per se.

Childhood clumsiness and peer victimization: a case-control study of psychiatric patients

BACKGROUND

Poor motor and social skills as well as peer victimization are commonly reported in both ADHD and autism spectrum disorder. Positive relationships between poor motor and poor social skills, and between poor social skills and peer victimization, are well documented, but the relationship between poor motor skills and peer victimization has not been studied in psychiatric populations.

METHOD

277 patients (133 males, 144 females), mean age 31 years, investigated for ADHD or autism spectrum disorder in adulthood and with normal intelligence, were interviewed about childhood peer victimization and examined for gross motor skills. The parents completed a comprehensive questionnaire on childhood problems, the Five to Fifteen. The Five to Fifteen is a validated questionnaire with 181 statements that covers various symptoms in childhood across eight different domains, one of them targeting motor skills. Regression models were used to evaluate the relationship between motor skills and the risk and duration of peer victimization, adjusted for sex and diagnosis.

RESULTS

Victims were described as more clumsy in childhood than their non-victimized counterparts. A significant independent association was found between reportedly poor childhood gross motor skills and peer victimization (adjusted odds ratio: 2.97 [95% confidence interval: 1.46-6.07], n = 235, p = 0.003). In adulthood, the victimized group performed worse on vertical jumps, a gross motor task, and were lonelier. Other factors that were expected to be associated with peer victimization were not found in this highly selected group.

CONCLUSION

Poor gross motor skills constitute a strong and independent risk factor for peer victimization in childhood, regardless of sex, childhood psychiatric care and diagnosis.

Development of human visual function

By 1985 newly devised behavioral and electrophysiological techniques had been used to track development of infants' acuity, contrast sensitivity and binocularity, and for clinical evaluation of developing visual function. This review focus on advances in the development and assessment of infant vision in the following 25 years. Infants' visual cortical function has been studied through selectivity for orientation, directional motion and binocular disparity, and the control of subcortical oculomotor mechanisms in fixation shifts and optokinetic nystagmus, leading to a model of increasing cortical dominance over subcortical pathways. Neonatal face processing remains a challenge for this model. Recent research has focused on development of integrative processing (hyperacuity, texture segmentation, and sensitivity to global form and motion coherence) in extra-striate visual areas, including signatures of dorsal and ventral stream processing. Asynchronies in development of these two streams may be related to their differential vulnerability in both acquired and genetic disorders. New methods and approaches to clinical disorders are reviewed, in particular the increasing focus on paediatric neurology as well as ophthalmology. Visual measures in early infancy in high-risk children are allowing measures not only of existing deficits in infancy but prediction of later visual and cognitive outcome. Work with early cataract and later recovery from blinding disorders has thrown new light on the plasticity of the visual system and its limitations. The review concludes with a forward look to future opportunities provided by studies of development post infancy, new imaging and eye tracking methods, and sampling infants' visual ecology.

Child development and refractive errors in preschool children

PURPOSE

Many parents are concerned about their child's development. The purpose of this study is to determine whether parental concerns about overall development are associated with significant refractive errors among urban preschool children.

METHODS

A cross-sectional population-based study was conducted to evaluate the prevalence of ocular disorders in white and African American children aged 6 through 71 months in Baltimore, Maryland. A comprehensive eye examination with cycloplegic refraction was performed. Parental concerns about development were measured with the Parents' Evaluation of Developmental Status screening tool. Of 2546 eligible children 2381 (93.5%), completed the refraction and the parental interview.

RESULTS

Parental concerns about development were present in 510 of the 2381 children evaluated [21.4%; 95% confidence intervals (CI): 9.8 to 23.1]. The adjusted odds ratios [OR] of parental concerns with hyperopia [≥3.00 diopters (D)] was 1.26 (95% CI: 0.90 to 1.74), with myopia (≥1.00 D) was 1.29 (95% CI: 0.83 to 2.03), with astigmatism (≥1.50 D) was 1.44 (95% CI: 1.08 to 1.93) irrespective of the type of astigmatism, and with anisometropia (≥2.00 D) was 2.61 (95% CI: 1.07 to 6.34). The odds of parental concerns about development significantly increased in children older than 36 months with hyperopia ≥3.00 D, astigmatism ≥1.50 D, or anisometropia ≥2.00 D.

CONCLUSIONS

Parental concerns about general developmental problems were associated with some types of refractive error, astigmatism ≥1.50 D and anisometropia ≥2.00 D, in children aged 6 to 71 months. Parental concerns were also more likely in children older than 36 months with hypermetropia, astigmatism, or anisometropia. Parental concerns were not associated with myopia. Because of the potential consequences of uncorrected refractive errors, children whose parents have expressed concerns regarding development should be referred for an eye examination with cycloplegic refraction to rule out significant refractive errors.

Hypo-accommodation responses in hypermetropic infants and children

AIMS

Accommodation to overcome hypermetropia is implicated in emmetropisation. This study recorded accommodation responses in a wide range of emmetropising infants and older children with clinically significant hypermetropia to assess common characteristics and differences.

METHODS

A PlusoptiXSO4 photorefractor in a laboratory setting was used to collect binocular accommodation data from participants viewing a detailed picture target moving between 33 cm and 2 m. 38 typically developing infants were studied between 6 and 26 weeks of age and were compared with cross-sectional data from children 5-9 y of age with clinically significant hypermetropia (n = 15), corrected fully accommodative strabismus (n=14) and 27 age-matched controls.

RESULTS

Hypermetropes of all ages under-accommodated compared to controls at all distances, whether corrected or not (p < 0.00001) and lag related to manifest refraction. Emmetropising infants under-accommodated most in the distance, while the hypermetropic patient groups under-accommodated most for near.

CONCLUSIONS

Better accommodation for near than distance is demonstrated in those hypermetropic children who go on to emmetropise. This supports the approach of avoiding refractive correction in such children. In contrast, hypermetropic children referred for treatment for reduced distance visual acuity are not likely to habitually accommodate to overcome residual hypermetropia left by an under-correction.

A review of the evidence on the effectiveness of children's vision screening

Screening programmes enable health conditions to be identified so that effective interventions can be offered. The aim of this review was to determine: (1) the effectiveness of children's vision screening programmes; (2) at what age children should attend vision screening; and (3) what form vision screening programmes should take to be most effective. A literature review on the effectiveness of vision screening programmes in children aged 0-16 years was undertaken. Eligible studies/reviews were identified through clinical databases, hand searches and consultation with expert reviewers. The methodological quality of papers was rated using National Health and Medical Research Council (NHMRC) guidelines. Screening of children 18 months to 5 years, and subsequent early treatment, led to improved visual outcomes. The benefit was primarily through treatment of amblyopia, with improved visual acuity of the amblyopic eye. However, the overall quality of the evidence was low. The implication of improved visual acuity (e.g. any potential impact on quality of life) was not considered. Without consideration of 'quality of life' values, such as loss of vision in one eye or possibility of future bilateral vision loss, the cost-effectiveness of screening is questionable. Screening and treating children with uncorrected refractive error can improve educational outcomes. Evidence suggested that screening occur in the preschool years. Orthoptists were favoured as screening personnel; however, nurses could achieve high sensitivity and specificity with appropriate training. Further research is required to assess the effectiveness of neonatal screening. Most studies suggested that children's vision screening was beneficial, although programme components varied widely (e.g. tests used, screening personnel and age at testing). Research is required to clearly define any improvements to quality of life and any related economic benefits resulting from childhood vision screening. The evidence could be used to guide optimization of existing programmes.

Defining Amblyopia: The Need for a Joint Classification

Recent years have shown an impressive rise in high quality research on amblyopia. Unfortunately, the condition is not sufficiently defined, and consequently different studies have been used different definitions of amblyopia. Aspects in need of consideration include the degree of visual acuity reduction, magnitude of interocular difference in acuity, method of visual acuity testing used, the effect of refractive adaption, the presence of amblyogenic factors, the absence of organic cause and the treat ability of the deficit. Vision scientists worldwide are encouraged to jointly decide on what is, and what is not, amblyopia.

Does visual impairment lead to additional disability in adults with intellectual disabilities?

BACKGROUND

This study addresses the question to what extent visual impairment leads to additional disability in adults with intellectual disabilities (ID).

METHOD

In a multi-centre cross-sectional study of 269 adults with mild to profound ID, social and behavioural functioning was assessed with observant-based questionnaires, prior to expert assessment of visual function. With linear regression analysis the percentage of variance, explained by levels of visual function, was calculated for the total population and per ID level.

RESULTS

A total of 107/269 participants were visually impaired or blind (WHO criteria). On top of the decrease by ID visual impairment significantly decreased daily living skills, communication & language, recognition/communication. Visual impairment did not cause more self-absorbed and withdrawn behaviour or anxiety. Peculiar looking habits correlated with visual impairment and not with ID. In the groups with moderate and severe ID this effect seems stronger than in the group with profound ID.

CONCLUSION

Although ID alone impairs daily functioning, visual impairment diminishes the daily functioning even more. Timely detection and treatment or rehabilitation of visual impairment may positively influence daily functioning, language development, initiative and persistence, social skills, communication skills and insecure movement.

Long term ophthalmic sequelae of prematurity

There are numerous reports of an increase in refractive errors and amblyogenic factors in the low birth weight population relative to children born at full term. This raises the question of whether additional long term ophthalmic screening is required. The current provision of follow up care for preterm infants in the UK is haphazard and varies in terms of its availability, the type of assessment, age at assessment and age at discharge. This issue needs to be addressed to provide the best care for these children however there are different possible methodologies. One key aspect of a screening programme is the age at testing as this dictates the possible tests used which impacts on the efficacy. However, although the prevalence of strabismus and refractive errors is well documented the development of these conditions is poorly understood so for this and other reasons it is difficult to devise the most effective screening programme.

Hyperopia and emergent literacy of young children: pilot study

PURPOSE

To compare emergent literacy skills in uncorrected hyperopic and emmetropic children.

METHODS

"Hyperopes" (>or=2.00 D sphere along the most hyperopic meridian; n=13; aged 67+/-13 mo) and "emmetropes" (<or=1.50 D sphere along the most hyperopic meridian; n=19; aged 58+/-12 mo) were tested for visual acuity (VA) and assessed for their emergent literacy skills [three standard tests (letter/word reading skills, receptive vocabulary and phonological awareness) and an experimental test of emergent orthography]. Parents completed a survey of family demographics, health/developmental concerns and home literacy experiences. Visual motor and visual perceptual skills tests were used to assess any visual cognitive differences.

RESULTS

There were no differences in single letter VA for hyperopes and emmetropes and crowded letters for the right eye. Crowding effects were significantly greater in the left eye for hyperopes (t (30)=-2.74, p=0.01), with two of the hyperopes showing abnormal crowding. Hyperopes lagged behind emmetropes in letter and word recognition ability (Mann-Whitney U=72, p=0.049), receptive vocabulary (F(1,30)=9.64, p=0.004), and emergent orthography (F(1,29)=5.43, p=0.03). The groups did not differ in phonological awareness skills (F(1,29)=0.39, p=0.54). No statistically significant differences between the two groups were found for visual motor or visual perceptual skills, age, and some family variables known to contribute to emergent literacy skills.

CONCLUSIONS

In this pilot study, uncorrected hyperopic children, ages 4 to 7 years, show reduced performance on tests of letter and word recognition, receptive vocabulary, and emergent orthography and crowded VA, despite no difference in phonological awareness skills, visual cognitive skills, and other family variables known to affect the acquisition of literacy skills. The relationship between hyperopia and the poorer progress in emergent literacy is complex, and it is not clear if the relationship is causal, and whether the hyperopes will catch up to the emmetropes with time.