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Yin Y, Li L, Wang T, Lin S, Wang J, Wang H, Jiang M, Ma Y, Zhu J. Establishment of noncycloplegic methods for screening myopia and pre-myopia in preschool children. Front Med (Lausanne) 2023; 10:1291387. [PMID: 38173941 PMCID: PMC10764102 DOI: 10.3389/fmed.2023.1291387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose Pre-myopia, a non-myopic refractive state, is a key concern for myopia prevention because of its association with a significantly higher risk of myopia in children under 3 years of age. Amid the myopia pandemic, its onset at younger ages is increasing, yet research on screening methods for myopia and pre-myopia in preschool children remains limited. This study aimed to establish effective noncycloplegic screening methods for myopia and pre-myopia in preschool children. Methods This cross-sectional study included 16 kindergartens in Shanghai, China. Uncorrected distance visual acuity (UDVA) was recorded using a logMAR visual acuity chart. Pre- and post-cycloplegic refractions were obtained using an auto-refractor (TopconKR-800). Noncycloplegic axial length (AL) and corneal curvature radius (CR) were measured using the IOL Master-700. Logistic regression models were developed to establish accurate noncycloplegic screening methods for myopia and pre-myopia. Results A total of 1,308 children with a mean age of 4.3 ± 0.9 years were included; among them 640 (48.9%) were girls. The myopia prevalence rate was 2.8% (n = 36), and the prevalence of pre-myopia was 21.9% (n = 286). Pre-myopia screening (cycloplegic spherical equivalent [SE] ≤ -0.5 < SE ≤0.75 diopters [D]) using UDVA exhibited an area under the receiver operating curve (AUC) of 0.52, noncycloplegic SE had an AUC of 0.70 and AL had an AUC of 0.63. The accuracy of combining the SE and AL/CR ratio was among the best with the least number of checks used, and the AUC was 0.74 for pre-myopia screening and 0.94 for myopia screening (cycloplegic SE ≤ -0.5 D). The addition of UDVA did not further improve the accuracy. Conclusion Using UDVA alone did not achieve good accuracy in pre-myopia or myopia screening of young children. Under non-cycloplegic conditions, the combination of AL/CR and SE demonstrated favorable results for pre-myopia and myopia screening of preschool children.
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Affiliation(s)
- Yao Yin
- Department of Ophthalmology, Fengcheng Hospital, Fengxian District, Shanghai, China
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Liping Li
- Disease Control and Prevention Center in HongKou District, Shanghai, China
| | - Ting Wang
- Department of Eye Disease Prevention and Treatment, Shanghai Yangpu District Kongjiang Hospital, Shanghai, China
| | - Senlin Lin
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Jia Wang
- Department of Eye Disease Prevention and Treatment, Shanghai Yangpu District Kongjiang Hospital, Shanghai, China
| | - Hong Wang
- Department of Eye Disease Prevention and Treatment, Shanghai Yangpu District Kongjiang Hospital, Shanghai, China
| | - Minmin Jiang
- Department of Eye Disease Prevention and Treatment, Shanghai Yangpu District Kongjiang Hospital, Shanghai, China
| | - Yingyan Ma
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Fundus Diseases, National Clinical Research Center for Eye Diseases, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Jianfeng Zhu
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
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Li Y, Duffy S, Wilks S, Keel R, Beswick R, Dai S. Positive predictive value of dual-modality vision screening in school children 4-7 years of age-a retrospective review in Queensland, Australia. J AAPOS 2023; 27:22.e1-22.e5. [PMID: 36565950 DOI: 10.1016/j.jaapos.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/08/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To report the outcomes and positive predictive value (PPV) of vision screening in schoolchildren 4-7 years of age through the Primary School Nurse Health Readiness Program (PSNHRP) in Queensland, Australia. METHODS A retrospective review of schoolchildren who underwent vision screening between January 2017 and December 2020 was conducted. Vision screening was performed through a dual-examination method, using the Parr 4m letter-matching vision test with crowding bars and the Spot photoscreener. Children were referred to an optometrist or ophthalmologist for review as required and if they failed either screening modality. PPVs were calculated based on whether a visual abnormality was confirmed by an ophthalmologist or optometrist. RESULTS Of 185,685 eligible children, 176,164 (94.9%) consented to vision screening, 164,890 (93.6%) consented children underwent vision screening, and of those 12,148 (7.4%) were referred for an eye assessment. Of the 8,659 children with a known outcome (71.3% of referred), 6,011 (69.4% of known outcomes) had a confirmed visual abnormality and 2,648 (30.6%) children did not. The PPV was 0.73 when a referral was indicated by the photoscreener result, 0.76 when indicated by visual acuity testing, and 0.91 when indicated by both the photoscreener and visual acuity testing. CONCLUSIONS The PSNHRP vision screening program showed a high uptake, and the dual screening method was effective in identifying visual abnormalities, with higher PPV when both visual acuity and photoscreener results indicated a need for referral.
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Affiliation(s)
- Ye Li
- Department of Ophthalmology, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Shelley Duffy
- Child and Youth Community Health Services, Children's Health Queensland, Brisbane Australia
| | - Sagen Wilks
- Child and Youth Community Health Services, Children's Health Queensland, Brisbane Australia
| | - Rachel Keel
- Child and Youth Community Health Services, Children's Health Queensland, Brisbane Australia
| | - Rachael Beswick
- Child and Youth Community Health Services, Children's Health Queensland, Brisbane Australia
| | - Shuan Dai
- Department of Ophthalmology, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia.
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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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Zeng LF, Tang ZD, Gu J, Wang CQ, Zhang HL. Incidence of congenital heart diseases in Chinese children with non-syndromic congenital blepharoptosis: a prospective observational study of 1053 patients. World J Pediatr 2020; 16:411-415. [PMID: 31267383 DOI: 10.1007/s12519-019-00282-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Congenital blepharoptosis (CBP) may be part of a large spectrum of birth defects presenting with other ocular or systemic conditions. Therefore, the aim of the study was to investigate the incidence of congenital heart diseases (CHD) in CBP children not associated with specific syndromes. METHODS A total of 1053 Chinese children diagnosed with non-syndromic CBP were consecutively enrolled and their cardiac structure was evaluated by echocardiography. RESULTS Forty children were identified with CHD. Twenty-four children had one type of structural malformation (simple CHD). Sixteen children had two or more types of structural malformation (complex CHD). CHD and complex CHD were more prevalent in patients with severe or bilateral ptosis. Multivariate analysis revealed that presence of severe ptosis and bilateral ptosis was independently associated with CHD occurrence. CONCLUSIONS We found an increased frequency of CHD in CBP children, suggesting a clinical need for routine echocardiography evaluation in CBP, especially in children with severe or bilateral ptosis.
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Affiliation(s)
- Le-Feng Zeng
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Zheng-De Tang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Jun Gu
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Chang-Qian Wang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Hui-Li Zhang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
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Zhao L, Stinnett SS, Prakalapakorn SG. Visual Acuity Assessment and Vision Screening Using a Novel Smartphone Application. J Pediatr 2019; 213:203-210.e1. [PMID: 31326117 DOI: 10.1016/j.jpeds.2019.06.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/30/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate a smartphone-based application's (Peek Acuity) ability to assess visual acuity and screen for ocular conditions in children, we compared visual acuity assessment between Peek Acuity and the pediatric ophthalmology examination and evaluated Peek Acuity's ability to identify children with referable ocular conditions. STUDY DESIGN We prospectively recruited 111 children age 3-17 years, presenting to a pediatric ophthalmology clinic, who could follow instructions. Monocular visual acuity assessments by Peek Acuity and standard clinical methods were performed in randomized order. We compared visual acuity assessments between methods using intraclass correlation coefficient (ICC) and evaluated Peek Acuity's ability to identify children with referable ocular conditions. RESULTS ICC comparing visual acuity assessed between methods was 0.88 (95% CI 0.83-0.92) for first and 0.85 (95% CI 0.78-0.89) for second eyes examined. ICC among 3 to 5-year-olds (preschool-age children) was 0.88 (95% CI 0.77-0.94) for first and 0.45 (95% CI 0.13-0.68) for second eyes examined. Peek Acuity had a sensitivity of 83%-86% for decreased vision and 69%-83% for referable ocular disease. Sensitivity was highest among 3 to 5-year-olds with decreased vision, 93%-100%. CONCLUSIONS Overall, Peek Acuity visual acuity assessment correlated well with visual acuity assessed by standard clinical methods, though preschool-age children appeared more susceptible to examination fatigue. Peek Acuity performed adequately as a screening tool and had the greatest sensitivity among those with decreased vision and preschool-age children. TRIAL REGISTRATION ClinicalTrials.gov: NCT03212222.
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Affiliation(s)
- Lloyd Zhao
- School of Medicine, Duke University, Durham, NC
| | - Sandra S Stinnett
- Department of Ophthalmology, Duke University, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - S Grace Prakalapakorn
- Department of Ophthalmology, Duke University, Durham, NC; Department of Pediatrics, Duke University, Durham, NC.
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Prevalence of ophthalmological abnormalities in children and adolescents with CHD: systematic review and meta-analysis of observational studies. Cardiol Young 2016; 26:477-84. [PMID: 25904230 DOI: 10.1017/s104795111500044x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND CHDs form a complex and heterogeneous group of clinical entities, with high morbidity and mortality. With the advancement of surgical and invasive techniques and clinical treatment, the survival of these patients has increased significantly, and there are reports of a high prevalence of ocular abnormalities in this group. The objective of this study was to estimate the prevalence of ocular findings in children and adolescents diagnosed with CHD. METHODS A systematic search was conducted in the following databases: MEDLINE (via PubMed), EMBASE, and Cochrane CENTRAL, in addition to a manual search on studies published on the patient, from inception until August, 2014. Observational studies assessing the prevalence of ocular abnormalities in children and adolescents with CHDs were included. RESULTS Of the 2413 articles identified, eight were included, comprising a total of 1061 patients. Among them, the lowest and highest prevalences observed were 6.3 and 65%, respectively. The weighted average prevalence of ocular abnormalities was 32.5% (CI95% 19.3-49.3). Strabismus, cataracts, and retinopathy were the most frequently observed alterations. CONCLUSION The prevalence of ocular abnormalities in children and adolescents with CHDs was 32.5%, demonstrating that ocular consequences are not uncommon in this population and may have relevant clinical impact. These results reinforce the need for ophthalmological evaluation of patients with CHDs.
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Langeslag-Smith MA, Vandal AC, Briane V, Thompson B, Anstice NS. Preschool children's vision screening in New Zealand: a retrospective evaluation of referral accuracy. BMJ Open 2015; 5:e009207. [PMID: 26614622 PMCID: PMC4663450 DOI: 10.1136/bmjopen-2015-009207] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess the accuracy of preschool vision screening in a large, ethnically diverse, urban population in South Auckland, New Zealand. DESIGN Retrospective longitudinal study. METHODS B4 School Check vision screening records (n=5572) were compared with hospital eye department data for children referred from screening due to impaired acuity in one or both eyes who attended a referral appointment (n=556). False positive screens were identified by comparing screening data from the eyes that failed screening with hospital data. Estimation of false negative screening rates relied on data from eyes that passed screening. Data were analysed using logistic regression modelling accounting for the high correlation between results for the two eyes of each child. PRIMARY OUTCOME MEASURE Positive predictive value of the preschool vision screening programme. RESULTS Screening produced high numbers of false positive referrals, resulting in poor positive predictive value (PPV=31%, 95% CI 26% to 38%). High estimated negative predictive value (NPV=92%, 95% CI 88% to 95%) suggested most children with a vision disorder were identified at screening. Relaxing the referral criteria for acuity from worse than 6/9 to worse than 6/12 improved PPV without adversely affecting NPV. CONCLUSIONS The B4 School Check generated numerous false positive referrals and consequently had a low PPV. There is scope for reducing costs by altering the visual acuity criterion for referral.
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Affiliation(s)
| | - Alain C Vandal
- Ko Awatea, Counties Manukau District Health Board, Auckland, New Zealand Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Vincent Briane
- Ko Awatea, Counties Manukau District Health Board, Auckland, New Zealand
| | - Benjamin Thompson
- Department of Optometry and Vision Science, The University of Waterloo, Waterloo, Ontario, Canada School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Nicola S Anstice
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
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Abstract
Amblyopia is a neurodevelopmental disorder of vision associated with decreased visual acuity, poor or absent stereopsis, and suppression of information from one eye.(1,2) Amblyopia may be caused by strabismus (strabismic amblyopia), refractive error (anisometropic amblyopia), or deprivation from obstructed vision (deprivation amblyopia). 1 In the developed world, amblyopia is the most common cause of childhood visual impairment, 3 which reduces quality of life 4 and also almost doubles the lifetime risk of legal blindness.(5, 6) Successful treatment of amblyopia greatly depends on early detection and treatment of predisposing disorders such as congenital cataract, which is the most common cause of deprivational amblyopia. Understanding the genetic causes of congenital cataract leads to more effective screening tests, early detection and treatment of infants and children who are at high risk for hereditary congenital cataract.
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Affiliation(s)
- Behzad Mansouri
- Mass Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston , Massachusetts , USA and
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Hopkins S, Sampson GP, Hendicott P, Wood JM. Review of guidelines for children's vision screenings. Clin Exp Optom 2013; 96:443-9. [PMID: 23432116 DOI: 10.1111/cxo.12029] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 10/23/2012] [Accepted: 11/02/2012] [Indexed: 11/28/2022] Open
Abstract
The aim of children's vision screenings is to detect visual problems that are common in this age category through valid and reliable tests. Nevertheless, the cost effectiveness of paediatric vision screenings, the nature of the tests included in the screening batteries and the ideal screening age has been the cause of much debate in Australia and worldwide. Therefore, the purpose of this review is to report on the current practice of children's vision screenings in Australia and other countries, as well as to evaluate the evidence for and against the provision of such screenings. This was undertaken through a detailed investigation of peer-reviewed publications on this topic. The current review demonstrates that there is no agreed vision screening protocol for children in Australia. This appears to be a result of the lack of strong evidence supporting the benefit of such screenings. While amblyopia, strabismus and, to a lesser extent refractive error, are targeted by many screening programs during pre-school and at school entry, there is less agreement regarding the value of screening for other visual conditions, such as binocular vision disorders, ocular health problems and refractive errors that are less likely to reduce distance visual acuity. In addition, in Australia, little agreement exists in the frequency and coverage of screening programs between states and territories and the screening programs that are offered are ad hoc and poorly documented. Australian children stand to benefit from improved cohesion and communication between jurisdictions and health professionals to enable an equitable provision of validated vision screening services that have the best chance of early detection and intervention for a range of paediatric visual problems.
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Affiliation(s)
- Shelley Hopkins
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Geoff P Sampson
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter Hendicott
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Joanne M Wood
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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