Should amblyopia be treated?

Eye care in young children: a parent survey exploring access and barriers

BACKGROUND

A questionnaire was designed to investigate the attitudes of parents toward eye care for their young children (4-6-year-olds) and possible barriers to accessing eye care for this age group. An exploration was undertaken to determine whether these beliefs and barriers are influenced by certain demographic factors such as ethnicity, level of parental income, level of parental education, confidence with speaking English and a reported family history of eye problems.

METHODS

A total of 1,317 questionnaires (hard copies) were distributed to parents of children in primary school reception and year one classes (ages four to six) from 14 schools across five London boroughs. Ninety online surveys were sent to parents at two further London schools. All questionnaires were anonymous.

RESULTS

A total of 384 completed questionnaires were analysed (27 per cent response rate). Three hundred and thirty-eight parents (24 per cent) completed the 'parental knowledge' section of the questionnaire. Of all responses, 65 per cent (n = 249) were from parents whose children attended a school where a program of school entry vision screening took place. Of these, 15 per cent (n = 36) of parents reported that they were aware of the screening program. Barriers to accessing eye care for their children were reported by 38 per cent (n = 153) of parents/carers who responded. Twelve per cent (n = 47) reported not knowing how to access an eye test for their child and 12 per cent (n = 47) reported that they were concerned their child would be given glasses that were not needed. When compared to parents from White ethnic groups, parents from African/Afro-Caribbean ethnic groups were more likely to report not knowing how to access an age-appropriate eye test for their child (p = 0.001). Parents of African/Afro-Caribbean ethnic origins were statistically more likely to report barriers to eye care (p = 0.001).

CONCLUSION

The study provides evidence of some parental misconceptions around eye care for young children and some barriers to access. Possible solutions to this are discussed.

Crowded letter and crowded picture logMAR acuity in children with amblyopia: a quantitative comparison

Aims

Clinically, picture acuity tests are thought to overestimate visual acuity (VA) compared with letter tests, but this has not been systematically investigated in children with amblyopia. This study compared VA measurements with the LogMAR Crowded Kay Picture test to the LogMAR Crowded Keeler Letter acuity test in a group of young children with amblyopia.

Methods

58 children (34 male) with amblyopia (22 anisometropic, 18 strabismic and 18 with both strabismic/anisometropic amblyopia) aged 4–6 years (mean=68.7, range=48–83 months) underwent VA measurements. VA chart testing order was randomised, but the amblyopic eye was tested before the fellow eye. All participants wore up-to-date refractive correction.

Results

The Kay Picture test significantly overestimated VA by 0.098 logMAR (95% limits of agreement (LOA), 0.13) in the amblyopic eye and 0.088 logMAR (95% LOA, 0.13) in the fellow eye, respectively (p<0.001). No interactions were found from occlusion therapy, refractive correction or type of amblyopia on VA results (p>0.23). For both the amblyopic and fellow eyes, Bland-Altman plots demonstrated a systematic and predictable difference between Kay Picture and Keeler Letter charts across the range of acuities tested (Keeler acuity: amblyopic eye 0.75 to −0.05 logMAR; fellow eye 0.45 to −0.15 logMAR). Linear regression analysis (p<0.00001) and also slope values close to one (amblyopic 0.98, fellow 0.86) demonstrate that there is no proportional bias.

Conclusions

The Kay Picture test consistently overestimated VA by approximately 0.10 logMAR when compared with the Keeler Letter test in young children with amblyopia. Due to the predictable difference found between both crowded logMAR acuity tests, it is reasonable to adjust Kay Picture acuity thresholds by +0.10 logMAR to compute expected Keeler Letter acuity scores.