Strabismus and Amblyopia

Strabismus is a misalignment of the eye which can cause a permanent visual problem if not corrected early in life. Amblyopia, lazy eye, occurs when one eye is weaker than the other and the child shows preference for the stronger eye. Several screening devices including external examination of the eye, ability to track, a cover test, acuity tests, and stereoscopic tests can detect strabismus and amblyopia at an early age. Treatment for strabismus and amblyopia include patching therapy, use of glasses, surgery, orthoptics, CAM vision stimulator, or a combination of these techniques.

An analysis of vision screening data from New York City public schools

OBJECTIVE

This study compares different vision screening batteries and documents the failure rates of different vision tests in children who receive periodic vision screenings.

METHODS

Vision screenings were conducted on 1,992 preschool through fifth grade children attending schools in lower socioeconomic areas in New York City. The screening battery incorporated visual acuity, retinoscopy, cover test, stereopsis, near point of convergence, ocular motility, accommodation, color vision, and ocular health.

RESULTS

Slightly less than one third (30%) of the children screened failed the State University of New York (SUNY) battery and were referred for a comprehensive examination, of which 249 (41%) children actually passed distance visual acuities. The referral rate for distance visual acuity alone was 19%. The referral rate for the Modified Clinical Technique (MCT) was 22%. A greater percentage (33%) of the children in grades kindergarten through fifth were referred compared with the preschoolers (20%). Only a small percentage (8%) of the children wore corrective lenses at the time of testing. There was a significant increase in the prevalence of binocular vision problems found in children from grades kindergarten through 5.

CONCLUSIONS

Poor visual acuity and binocular vision problems exist in schoolchildren despite ongoing vision screenings. The results provide evidence for the necessity of periodic rescreening starting in kindergarten and the importance of screening for hyperopia and binocular vision problems in addition to distance visual acuities.

Vision Health Care Providers?? Attitudes and Experiences with Preschool Vision Screening in Ontario

PURPOSE

The validity of preschool vision screening has been questioned in the light of the World Health Organization's criteria for determining the validity of screening programs. However, recommendations toward preschool screening have been made by a number of organizations. Given the contrasting views of screening, the purpose of this study was to examine visual health care provider experiences and attitudes toward preschool screening.

METHOD

Optometrists, public health administrators, pediatric ophthalmologists, and orthoptists were surveyed about opinions of, recommendations for, and experiences with preschool vision screening in Ontario. The survey focused on four areas, including general opinion of preschool screening, screening standards and practices, provider experience with preschool screening, and barriers to preschool screening. In addition, survey responses were broken down by regional access to health care.

RESULTS

Overall, strong support for preschool vision screening and movement toward standardization of screening practice was found among all surveyed groups. Although support for vision screening in low health care access areas was strong, providers estimated that parent compliance to screening was weaker in low access areas. Providers also reported considerable variability in vision screening practices. In addition, although the majority of providers had been involved in a screening program, the majority was no longer involved because of lack of program organization, structure, and funding. Lack of sufficient funding, public education, organization of screening, training, and government support were listed as barriers to preschool vision screening.

CONCLUSION

Providers are interested in the development of structured screening programs. However, although screening may be a way to offer some level of vision care service to low health care access areas, a number of factors need to be addressed in discussions of vision screening program standards or screening best practice. In general, preschool screening programs need to be structured, be supported, have quality control, and be evaluated.