Current Challenges Supporting School-Aged Children with Vision Problems: A Rapid Review

Visual Acuity Among Portuguese School-Aged Population

Background/Objectives: Visual acuity (VA) screening is highly valid in school-aged children for detecting visual impairments. This study aims to provide a comprehensive profile of VA among school-aged children (6-17 years old) from Lisbon, Portugal. Specifically, it focuses on estimating the prevalence of abnormal VA (VA < 0.8 in the worst eye) and establishing age-specific normative reference values (percentiles) for monocular and binocular VA within this urban sample. Methods: We performed an observational, descriptive, and cross-sectional study that included healthy children aged 6 to 17 years. Convenience sampling was used in three educational centers in Lisbon. Retinoscopy and monocular VA (right eye, left eye, and the eye with the lowest) and binocular VA were assessed using the Herman Snellen optotype. Descriptive statistics, prevalence of abnormal VA (worst-eye VA < 0.8), and monocular and binocular VA percentiles were calculated for the whole cohort and by age. Results: The sample consisted of 2215 children (49.6% of males; and 9.4 ± 2.6 years old). Binocular VA, right-eye VA, left-eye VA, and VA worst eye in the study cohort showed ranges of 0.92-1.00, 0.90-0.95, 0.89-0.97, and 0.85-0.94, respectively, for ages 6-17 years. In total, 86.8% of the study population had a normal VA (≥0.8). VA deficit was mild (0.8 < AV ≥ 0.3), moderate (0.3 < AV ≥ 0.125), and severe (VA < 0.125) in 10.5%, 1.1%, and 1.6% of children, respectively. Conclusions: Our study provides both age-specific normative reference values for visual acuity in Portuguese children and prevalence estimates for visual acuity deficits. These findings offer critical data to support early detection strategies and the development of age-adjusted vision-screening protocols in school-aged populations.

Comparison of the 1-year efficacy of epithelium-off and transepithelial accelerated corneal collagen crosslinking in adolescent keratoconus

OBJECTIVES

To compare the clinical efficacy of epithelium-off and transepithelial accelerated corneal collagen crosslinking (ACXL) in adolescent keratoconus.

METHODS

In this prospective observational study with a 1-year follow-up, 60 patients aged 16-26 years (60 eyes) with keratoconus were assigned to two groups: the epithelium-off ACXL group (30 patients, 30 eyes) and the transepithelial ACXL group (30 patients, 30 eyes). Patients were evaluated preoperatively and at 7 days, 1 month, 3 months, 6 months, and 12 months post-treatment. The measurements included visual acuity, corneal parameters, and corneal endothelium parameters. Baseline data and treatment effect were compared using the t-test or Wilcoxon rank-sum test for continuous variables and the chi-square test for categorical variables. Within-group comparisons used paired t-tests or paired rank-sum tests.

RESULTS

At 12 months postoperatively, the treatment groups showed statistically significant differences in central corneal thickness (IOLMaster), thinnest point corneal thickness (topography), thickness (topography), central corneal thickness, corneal thickness on optical coherence tomography, deformation amplitude (DA), first applanation time, first applanation velocity, second applanation time, second applanation velocity, peak distance (PD), high-contrast acuity, stiffness parameter at the first applanation, and comprehensive refraction (p < 0.001). No differences were observed between the groups in any other parameters before or after treatment.

CONCLUSIONS

Both epithelium-off and transepithelial ACXL effectively treat keratoconus. Transepithelial ACXL is slightly inferior to epithelium-off ACXL in maximum corneal curvature but superior in improving corneal thickness and DA parameters. Further studies are necessary to verify the efficacy, safety, and long-term stability of transepithelial ACXL in treating keratoconus.

Prevalence of Vision Problems Among School-Entering Children and Association with Socio-Demographic Characteristics: An Iranian Population-Based Cross-Sectional Study

PURPOSE

Early detection of visual disorders in children and related factors is important to minimize future problems in academic performance and social life. The present study aimed to determine the prevalence of vision problems among school-entering children, and their association with socio-demographic characteristics.

METHODS

A population-based cross-sectional study was conducted in Qazvin province between June and November 2023. The research participants were school-entering children and their parents recruited using random quota multi-stage sampling. Data were collected by interviewing parents including demographic characteristics, children's vision status, family history of vision problems, and daily hours of using the internet and/or playing videogames by children. Data were analyzed using multivariate multi-nominal logistic regression.

RESULTS

A total of 5141 parents of school-entering children participated. The prevalence of wearing glasses and suspected visual impairment was 2.2% and 6.7%, respectively. The odds of using eyeglasses among boys was 38% lower than among girls (p = 0.014). The odds of using eyeglasses was 3.5 times higher if there was a history of vision disorders in other children in the family (p < 0.001) and 90% more likely if there was a history of vision disorders among the parents (p = 0.002). The odds of using eyeglasses increased 5% with each unit increase in children's BMI. The odds of suspected vision problems increased by 39% and 3% with each year of age of the child and their mother (p = 0.001 and p = 0.034 respectively). The odds of suspected visual problems was 90% higher among urban vs. rural children (p < 0.001) and 58% higher if there was a history of vision disorders among other children in the family (p = 0.029).

CONCLUSION

The present study identified socio-demographic predictors of having vision disorder among school-entering children based on information provided by their parents. Although vision health screening is carried out as part of the health assessment program for children upon entering school in Iran, high-risk individuals should not to postpone their children's vision examinations until they enter school and should have eye examinations at a younger age.

Pediatric and School-Age Vision Screening in the United States: Rationale, Components, and Future Directions

Pediatric vision screening detects children at risk for visual conditions with the goal of connecting those in need with an eye care provider for evaluation and treatment. The primary aim for vision screening in younger children is the detection of those at risk for amblyopia, which can result in irreversible vision loss if left untreated. In older children, screening goals broaden to include the detection of risk for uncorrected refractive error. In the United States, professional organization guidelines and state-mandated requirements for vision screening vary widely across both the timing and components of screening. In this article, we describe the goals and components of pediatric vision screenings, current challenges, novel approaches to providing follow-up services through school-based vision programs, and future directions.

Research Directions of Applied Cognitive Sciences

Cognitive science is an interdisciplinary field of investigation of the mind and intelligence [...]