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Pentland L, Conway ML. Prevalence of presenting bilateral visual impairment associated with refractive error - findings from the See4School, pre-school vision screening programme in NHS Scotland. Eye (Lond) 2024; 38:1941-1946. [PMID: 38600359 PMCID: PMC11226424 DOI: 10.1038/s41433-024-03047-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND/OBJECTIVES The See4School programme in Scotland is a pre-school vision screening initiative delivered by orthoptists on a national scale. The primary objective of any vision screening programme is to identify amblyopia, given the common understanding that this condition is unlikely to be detected either at home or through conventional healthcare channels. The target condition is not bilateral visual impairment, as it is believed that most children will be identified within the first year of life either through observations at home or as part of the diagnosis of another related disorder. This belief persists even though bilateral visual impairment is likely to have a more detrimental impact on a child's day-to-day life, including their education. If this hypothesis were accurate, the occurrence of bilateral visual impairment detected through the Scottish vision screening programme would be minimal as children already under the hospital eye service are not invited for testing. The overarching aim of this study was therefore to determine the prevalence of presenting bilateral visual impairment associated with refractive error detected via the Scottish preschool screening programme. SUBJECTS/METHODS Retrospective anonymised data from vision screening referrals in Scotland from 2013-2016 were collected. Children underwent an assessment using a crowded logMAR vision test and a small number of orthoptic tests. RESULTS During the 3-year period, out of 165,489 eligible children, 141,237 (85.35%) received the vision screening assessment. Among them, 27,010 (19.12%) failed at least one part of the screening and were subsequently referred into the diagnostic pathway, where they received a full sight test. The prevalence of bilateral visual impairment associated with refractive error and detected via the vision screening programme (≥ 0.3LogMAR) was reported to range between 1.47% (1.37-1.59) and 2.42% (2.29-2.57). CONCLUSIONS It is estimated that up to 2.42% (2.29-2.57) of children living Scotland have poorer than driving standard of vision (6/12) in their pre-school year, primarily due to undetected refractive error. Reduced vision has the potential to impact a child's their day-to-day life including their future educational, health and social outcomes.
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Wang YL, Wang JJ, Lou XC, Zou H, Zhao YE. Clinical usefulness of the baby vision test in young children and its correlation with the Snellen chart. Int J Ophthalmol 2024; 17:348-352. [PMID: 38371254 PMCID: PMC10827630 DOI: 10.18240/ijo.2024.02.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/17/2023] [Indexed: 02/20/2024] Open
Abstract
AIM To investigate the efficacy of a new visual acuity (VA) screening method, the baby vision test for young children. METHODS A total 105 eyes of 65 children aged 2-8y were included in the study. Acuity testing was conducted using a standardized recognition acuity chart (Snellen visual chart: at 3 m) and the baby vision model assessment. The baby vision device includes a screen, a near infrared camera and a computer. Children were seated at a measured distance of 33-40 cm from a display for testing. VA was estimated according to the highest resolution the children could follow. Decimal VA data were converted to logarithm of the minimum angle of resolution (logMAR) for statistical analysis. The VA results for each child were recorded and analyzed for consistency. RESULTS The mean VA measured using the Snellen visual chart was 0.62±0.32, and that assessed using the baby vision test was 0.66±0.27. The 95% limit of agreement was -0.609 to 0.695, with 95.2% (100/105) plots within the 95% limits of agreement. VA values of the baby vision test were significantly correlated with those of the Snellen chart (R=0.274, P=0.005). CONCLUSION The baby vision test can be used as a relatively reliable method for estimating VA in young children. This new acuity assessment might be a valid predictor of optotype-measured acuity later in preverbal children.
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Affiliation(s)
- Ya-Lan Wang
- The Eye Hospital of Wenzhou Medical University, Hangzhou 310000, Zhejiang Province, China
- National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Jia-Jun Wang
- The Eye Hospital of Wenzhou Medical University, Hangzhou 310000, Zhejiang Province, China
- National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Xi-Cong Lou
- The Eye Hospital of Wenzhou Medical University, Hangzhou 310000, Zhejiang Province, China
- National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Han Zou
- The Eye Hospital of Wenzhou Medical University, Hangzhou 310000, Zhejiang Province, China
- National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Yun-E Zhao
- The Eye Hospital of Wenzhou Medical University, Hangzhou 310000, Zhejiang Province, China
- National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
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Sil A, Aggarwal P, Sil S, Mitra A, Jain E, Sheeladevi S, Murthy G. Design and delivery of the Refractive Errors Among Children (REACH) school-based eye health programme in India. Clin Exp Optom 2023; 106:859-868. [PMID: 37914536 DOI: 10.1080/08164622.2022.2125793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
CLINICAL RELEVANCE Optimisation of vision screening programmes can result the detection of refractive anomalies in a high proportion of school children. BACKGROUND The Refractive Errors Among Children (REACH) programme aims to optimise outcomes of school-based vision screening in India by collaborating with hospitals and monitoring eye care throughout school attendance. METHODS REACH delivers school vision screening using pocket vision screeners (cards presenting rows of seven 0.2 logMAR Sloan letters at a 3 m viewing distance) in five states across India. Children who fail screening are referred for detailed evaluation including refraction, those requiring cycloplegic refraction are referred to partner hospitals. Spectacles are dispensed as needed and compliance is assessed. All data are recorded electronically. RESULTS Out of 2,240,805 children aged 5 to 18 (mean 11.5; SD ±3.3) years, 2,024,053 have undergone REACH screening in 10,309 schools predominantly in rural locations (78.7%) and government-funded (76%). Of those screened, 174,706 (8.6%) underwent detailed evaluation. A higher proportion of children in private or urban schools (11.8% and 10.4% respectively) were referred for detailed evaluation than those in government-funded or rural schools (5.9% and 7.2%, respectively; p < 0.001). The proportion referred for detailed evaluation differed by state (p < 0.001), from 4.0% in West Bengal to 14.4% in Kerala. CONCLUSION The REACH programme screened a high proportion of school children, providing further care and follow-up to optimise visual outcomes.
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Affiliation(s)
- Asim Sil
- Community Eye Care, Vivekananda Mission Ashram Netra Nirmay Niketan, West Bengal, India
| | | | - Subhra Sil
- Community Eye Care, Vivekananda Mission Ashram Netra Nirmay Niketan, West Bengal, India
| | - Ankita Mitra
- Community Eye Care, Vivekananda Mission Ashram Netra Nirmay Niketan, West Bengal, India
| | - Elesh Jain
- Department of Community Ophthalmology, Sadguru Netra Chikitsalaya, Madhya Pradesh, India
| | | | - Gvs Murthy
- Department of Public Health, Indian Institute of Public Health, Telangana, India
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Oke I, Slopen N, Hunter DG, Wu AC. Vision Testing for Adolescents in the US. JAMA Ophthalmol 2023; 141:1068-1072. [PMID: 37824151 PMCID: PMC10570910 DOI: 10.1001/jamaophthalmol.2023.4475] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/19/2023] [Indexed: 10/13/2023]
Abstract
Importance Untreated refractive error contributes to the racial, ethnic, and socioeconomic disparities in visual function of adolescent children in the US. Objective To describe patterns in vision testing as a function of age among US adolescents and identify sociodemographic factors associated with vision testing. Design, Setting, and Participants This cross-sectional study used data from the National Survey of Children's Health (2018-2019), a nationally representative survey of the noninstitutionalized US pediatric population. A total of 24 752 adolescent children (aged 12 to <18 years) were included. Data were analyzed from March 22 to August 11, 2023. Main Outcomes and Measures The primary outcome was the caregiver report of vision testing within the last 12 months. Linear regression was used to describe the patterns in reported vision testing as a function of participant age. Logistic regression was used to describe the association of sociodemographic factors with the report of vision testing in each setting. Results Among 24 752 adolescents, the median (IQR) age was 14 (13-16) years; 12 918 (weighted, 51%) were male. Vision testing in any setting within the previous year was reported by caregivers of 18 621 adolescents (weighted, 74%). Vision testing was reported to have occurred at an eye clinic in 13 323 participants (weighted, 51%), at a primary care clinic in 5230 participants (weighted, 22%), at a school in 2594 participants (weighted, 11%), and at a health center in 635 participants (weighted, 4%). The percentage of adolescents reported to have vision tested decreased with age (-1.3% per year; 95% CI, -2.5% to 0% per year) due to a decrease in testing in primary care and school settings. After adjusting for age and sex, there were lower odds of vision testing reported for adolescents who were uninsured vs insured (adjusted odds ratio [AOR], 0.81; 95% CI, 0.76-0.87), had caregivers with less than vs greater than high school education (AOR, 0.89; 95% CI, 0.84-0.95), and were from a family born outside vs inside the US (AOR, 0.90; 95% CI, 0.82-0.98). Conclusions and Relevance In this cross-sectional study, vision testing in adolescents decreased as a function of age due to fewer reported tests performed in primary care and school-based settings. Relative to children in socioeconomically advantaged families, those from disadvantaged families were less likely to report receiving vision testing in clinical settings. Efforts to expand the role of school-based vision testing for older adolescents from disadvantaged backgrounds may enable opportunities to address disparities in untreated refractive error.
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
| | - David G. Hunter
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ann Chen Wu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Ramírez-Ortiz MA, Amato-Almanza M, Romero-Bautista I, Klunder-Klunder M, Aguirre-Luna O, Kuzhda I, Resnikoff S, Eckert KA, Lansingh VC. A large-scale analysis of refractive errors in students attending public primary schools in Mexico. Sci Rep 2023; 13:13509. [PMID: 37598286 PMCID: PMC10439951 DOI: 10.1038/s41598-023-40810-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023] Open
Abstract
A cross-sectional, retrospective study was conducted from September 2013 through July 2014 to determine the prevalence of refractive errors among students attending public primary schools in Mexico. Among 3,861,156 students at 14,566 public primary schools in all 32 states of Mexico, teachers identified reduced visual acuity in 1,253,589 (32.5%) using visual acuity measurement. Optometrists confirmed 391,498 [31.2%, mean (SD) age: 8.8 (1.9) years; 204,110 girls (52.9%)] had refractive errors using visual acuity measurement and noncycloplegic static retinoscopy. Among 288,537 (72.4%) of children with previous eyeglasses usage data reported, 241,505 (83.7%) had uncorrected refractive errors. Before prescription eyeglasses were provided, 281,891 students (72%) had logMAR visual acuity ≤ 0.2; eyeglasses corrected vision loss in 85.6% (n = 241,352) of them. Simple myopic astigmatism was the most frequent refractive error (25.7%, n = 100,545). Astigmatism > - 1.00 diopters was present in 54.6% of all students with ametropia. The anisometropia rate based on spherical equivalent difference between right and left eye ≥ 1.50 diopters was 3.9% (n = 15,402). Uncorrected refractive errors are an important issue in primary school students in Mexico. An updated study is needed to analyze the evolving trends over the past decade.
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Affiliation(s)
| | - Mónica Amato-Almanza
- Ophthalmology Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | | | - Oswaldo Aguirre-Luna
- Ophthalmology Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Iryna Kuzhda
- Ophthalmology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, NSW, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
| | | | - Van Charles Lansingh
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
- HelpMeSee, New York, NY, USA.
- See Better to Learn Better Foundation, Mexico City, Mexico.
- Instituto Mexicano de Oftalmología, Av. Armando Birlain Shaffler S/N, Centro Sur, 76090, Santiago de Querétaro, QRO, Mexico.
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Pirindhavellie GP, Yong AC, Mashige KP, Naidoo KS, Chan VF. The impact of spectacle correction on the well-being of children with vision impairment due to uncorrected refractive error: a systematic review. BMC Public Health 2023; 23:1575. [PMID: 37596579 PMCID: PMC10436410 DOI: 10.1186/s12889-023-16484-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Despite being easily corrected with eyeglasses, over two-thirds of the world's child population presents with vision impairment (VI) due to uncorrected refractive errors. While systematic reviews have shown that VI can significantly impact children's depression and anxiety, none have reviewed the existing literature on the association between spectacle correction and well-being. This review aims to address this knowledge gap. MAIN OUTCOME MEASURES The main outcome measures were i) cognitive and education well-being which included mathematics and english literacy, reading fluency, school function, academic performance and grades; ii) psychological and mental health well-being which included physical anxiety, learning anxiety and mental health test scores and iii) quality of life. METHODS We searched eight databases for articles published between 1999 to 2021 that assessed the associations between spectacle correction and children's (0 to 18 years) well-being. There were no restrictions on language or geographic location. Two reviewers independently screened all publications using validated quality checklists. The findings of the review were analysed using narrative synthesis. [PROSPERO CRD42020196847]. RESULTS Of 692 records found in the databases, six randomised control trials, one cohort, one cross-sectional and one qualitative study (N = 9, 1.3%) were eligible for analysis. Data were collected from 25 522 children, 20 parents and 25 teachers across the nine studies. Seven were rated as good quality (67 to 100% of quality criteria fulfilled), and two were satisfactory (33 to 66% of quality criteria fulfilled). Spectacle correction was found to improve children's educational well-being (n = 4 very strong evidence; n = 2 strong evidence), quality of life (n = 1, very strong evidence) and decrease anxiety and increase mental health scores (n = 1, strong evidence). CONCLUSION Evidence suggests that spectacle correction improves children's cognitive and educational well-being, psychological well-being, mental health, and quality of life. More research is needed, given the paucity of published literature and the focus on only three aspects of well-being.
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Affiliation(s)
| | - Ai Chee Yong
- Queens University Belfast, University Rd, Belfast, BT7 1NN, UK
| | | | - Kovin S Naidoo
- University of KwaZulu Natal, College of Health Sciences, Private Bag X54001, Durban, 4000, South Africa
| | - Ving Fai Chan
- University of KwaZulu Natal, College of Health Sciences, Private Bag X54001, Durban, 4000, South Africa.
- Queens University Belfast, University Rd, Belfast, BT7 1NN, UK.
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7
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Black JM, Collins AV, Ramke J, Phillips G, Giurgiu A, Morar V, Watene R, Dakin SC. Vision Bus Aotearoa: a platform for strengthening eye health teaching, research and community partnership. Clin Exp Optom 2023; 106:165-170. [PMID: 36403253 DOI: 10.1080/08164622.2022.2146483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
CLINICAL RELEVANCE Vision Bus Aotearoa is a fully equipped mobile eye health clinic designed to provide a novel platform for undergraduate optometry clinical training, community eye health research and deliver services to underserved communities. BACKGROUND Aotearoa New Zealand has inequitable access to eye health care. Vision Bus Aotearoa aims to work in partnership with communities to provide comprehensive mobile primary eye health care services while training optometry students, and integrating community eye health research. METHODS A description is provided of the governance model which has been involved throughout the project. RESULTS The process of vehicle manufacture, clinical set-up, funding models and service delivery are described. The aims of the project are detailed in terms of optometry teaching, clinical services in partnership with communities, and research integration and implementation. CONCLUSION Vision Bus Aotearoa represents a valuable opportunity to deliver mobile eye health care to historically underserved communities, enhance undergraduate optometry teaching and to provide a unique platform for community eye health research.
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Affiliation(s)
- Joanna M Black
- School of Optometry & Vision Science, The University of Auckland, Auckland, New Zealand
| | - Andrew V Collins
- School of Optometry & Vision Science, The University of Auckland, Auckland, New Zealand
| | - Jacqueline Ramke
- School of Optometry & Vision Science, The University of Auckland, Auckland, New Zealand
| | - Geraint Phillips
- School of Optometry & Vision Science, The University of Auckland, Auckland, New Zealand
| | - Adina Giurgiu
- School of Optometry & Vision Science, The University of Auckland, Auckland, New Zealand
| | - Veeran Morar
- School of Optometry & Vision Science, The University of Auckland, Auckland, New Zealand
| | - Renata Watene
- School of Optometry & Vision Science, The University of Auckland, Auckland, New Zealand
| | - Steven C Dakin
- School of Optometry & Vision Science, The University of Auckland, Auckland, New Zealand
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Hutchinson AK, Morse CL, Hercinovic A, Cruz OA, Sprunger DT, Repka MX, Lambert SR, Wallace DK. Pediatric Eye Evaluations Preferred Practice Pattern. Ophthalmology 2023; 130:P222-P270. [PMID: 36543602 PMCID: PMC10680450 DOI: 10.1016/j.ophtha.2022.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Amy K Hutchinson
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Oscar A Cruz
- Department of Ophthalmology and Department of Pediatrics, Saint Louis University Medical Center, Saint Louis, Missouri
| | - Derek T Sprunger
- Indiana University Health Physicians, Midwest Eye Institute, Indianapolis, Indiana
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - David K Wallace
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
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Evans JR, Lawrenson JG, Ramke J, Virgili G, Gordon I, Lingham G, Yasmin S, Keel S. Identification and critical appraisal of evidence for interventions for refractive error to support the development of the WHO package of eye care interventions: a systematic review of clinical practice guidelines. Ophthalmic Physiol Opt 2022; 42:526-533. [PMID: 35191063 PMCID: PMC9306966 DOI: 10.1111/opo.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 11/30/2022]
Abstract
Purpose The World Health Organization is developing a Package of Eye Care Interventions (PECI) to support the integration of eye health care into national health programmes. Interventions included in the PECI should be based on robust evidence where available. Refractive error is a leading cause of blindness and vision impairment and is a PECI priority condition. The aim of this study was to provide high‐quality evidence to support the development of the PECI by identifying and critically appraising clinical practice guidelines (CPGs), and extracting recommendations for refractive error interventions. Methods We searched for CPGs on refractive error published in the last 10 years. We conducted the searches initially in February and March 2019 and repeated them in March 2020. We evaluated the quality of potentially relevant guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Results We identified 12 high‐quality CPGs relevant to refractive error, written by six organisations from three high‐income countries. Organisations used a variety of frameworks to assess the strength of recommendations based on available evidence, with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) being most common. Vision screening for children aged 3 to 5 years was recommended consistently. Evidence for screening and eye evaluations at other ages was weaker, although ophthalmic professional organisations consistently recommended regular evaluations. Recommendations on optical and laser correction of refractive error were limited and did not consider implications for low resource settings. Interventions for slowing myopia progression in children were recommended, but these will need regular updating as new evidence emerges. Conclusions Current high‐quality guidelines on refractive error have been formulated in high‐income countries. Recommendations focused on prevention and treatment of refractive error in low‐and middle‐income countries are lacking. Regular updating of systematic reviews and CPGs is essential to ensure that robust evidence is promptly appraised and incorporated into recommendations for eye health care practitioners.
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Affiliation(s)
- Jennifer R Evans
- Centre for Public Health, Queen's University, Belfast, UK.,International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - John G Lawrenson
- Division of Optometry and Vision Science, City, University of London, London, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.,School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Gianni Virgili
- Centre for Public Health, Queen's University, Belfast, UK
| | - Iris Gordon
- Centre for Public Health, Queen's University, Belfast, UK
| | - Gareth Lingham
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Australia
| | | | - Stuart Keel
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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10
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Asare AO, Wong AMF, Maurer D, Kulandaivelu Y, Saunders N, Ungar WJ. Economic evaluations of vision screening to detect amblyopia and refractive errors in children: a systematic review. Canadian Journal of Public Health 2021; 113:297-311. [PMID: 34755325 PMCID: PMC8577413 DOI: 10.17269/s41997-021-00572-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/20/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To synthesize and appraise economic evaluations of vision screening to detect vision impairment in children. METHODS Literature searches were conducted on seven electronic databases, grey literature, and websites of agencies conducting health technology assessments. Studies were included if they (1) were full, comparative economic evaluations that used cost-utility, cost-benefit, cost-effectiveness, cost-consequence, or cost-analysis methods; (2) described screening services designed to detect amblyopia, strabismus, or uncorrected refractive errors in children under 6 years of age; and (3) published after 1994. High-quality studies were synthesized descriptively. Currencies were reported in 2019 Canadian dollars. Quality was assessed with the Pediatric Quality Appraisal Questionnaire (PQAQ). RESULTS Vision screening services were conducted by paid staff, volunteers, or health care professionals in schools or clinics. Thirteen studies were published from five countries: China (n = 1), United States (n = 4), United Kingdom (n = 1), Canada (n = 1), and Germany (n = 6). Analytical techniques included cost-utility/cost-effectiveness combination (n = 2), cost-effectiveness analysis (n = 7), cost-utility analysis (n = 1), cost-benefit analysis (n = 1), cost-consequence analysis (n = 1), and cost analysis (n = 1). Incremental cost-effectiveness ratios ranged from C$1,056 to C$151,274 per additional case detected/prevented and from C$9,429 to C$30,254,703 per additional QALY gained, depending on the type of screening service and comparator. Six studies were determined to be of high quality. CONCLUSION Vision screening to detect amblyopia for young children may be cost-effective compared with no screening if amblyopia reduced quality of life. Studies varied significantly in the type of screening services and comparators used. Methodological limitations were common. Future studies would be aided immensely by prospective studies on the impact of amblyopia on the health-related quality of life of young children and guidelines on the effective conduct of vision screening.
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Affiliation(s)
- Afua O Asare
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Agnes M F Wong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Daphne Maurer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,McMaster University, Hamilton, ON, Canada
| | - Yalinie Kulandaivelu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Natasha Saunders
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,The Hospital for Sick Children, Toronto, ON, Canada. .,ICES, Toronto, ON, Canada. .,Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, 686 Bay St., Toronto, ON, M5G 0A4, Canada.
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11
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Current Challenges Supporting School-Aged Children with Vision Problems: A Rapid Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11209673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many children have undetected vision problems or insufficient visual information processing that may be a factor in lower academic outcomes. The aim of this paper is to contribute to a better understanding of the importance of vision screening for school-aged children, and to investigate the possibilities of how eye-tracking (ET) technologies can support this. While there are indications that these technologies can support vision screening, a broad understanding of how to apply them and by whom, and if it is possible to utilize them at schools, is lacking. We review interdisciplinary research on performing vision investigations, and discuss current challenges for technology support. The focus is on exploring the possibilities of ET technologies to better support screening and handling of vision disorders, especially by non-vision experts. The data orginate from a literature survey of peer-reviewed journals and conference articles complemented by secondary sources, following a rapid review methodology. We highlight current trends in supportive technologies for vision screening, and identify the involved stakeholders and the research studies that discuss how to develop more supportive ET technologies for vision screening and training by non-experts.
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12
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Abstract
Evidence-based practice in health care requires that treatment decisions be supported by high-quality clinical evidence, preferably involving well-designed large-scale clinical trials of the various treatment options. How does this relate to everyday primary-care optometry? This article provides a background to the emergence of the 'evidence-based' movement and investigates areas where the efficacy of clinical optometry might be improved by an evidence-based approach. It is argued that evidence-based practice is appropriate for all aspects of optometry but it may be most useful in the selection of treatments with topical therapeutic agents and in optometry's growing public health role in the detection and management of sight-threatening disease.
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Affiliation(s)
- Philip J Anderton
- School of Optometry and Vision Science, The University of New South Wales, Australia.
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13
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Abstract
Several children struggle with vision difficulties caused by problematic coordination between their left and right eye muscles, i.e., oculomotor dysfunction (OMD). Many OMDs can be improved by training the eyes via physical exercises defined and supervised by vision experts. The aim of this paper is to investigate the feasibility of utilizing Serious Games (SGs) and eye-tracking technologies (ETs) for training the eyes of children having OMD. Via these activities, a trainee can, with her eye gaze, follow objects which are moving, change their directions and speed, or pop up on the screen. The results present mapping the current physical training goals to activities for SGs using input from ETs, and illustrate this correspondence for designing and developing six games. The games’ feasibility evaluation is done via semistructured interviews and evaluating user experiences. Three vision teachers (VTs) were involved in design and development, ensuring achievement of training goals, and five VT students in evaluations. The findings demonstrate the potential of using SGs and ETs to train OMD and point to future needs for improvements.
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Morjaria P, Bastawrous A, Murthy GVS, Evans J, Sagar MJ, Pallepogula DR, Viswanath K, Gilbert C. Effectiveness of a novel mobile health (Peek) and education intervention on spectacle wear amongst children in India: Results from a randomized superiority trial in India. EClinicalMedicine 2020; 28:100594. [PMID: 33294811 PMCID: PMC7700898 DOI: 10.1016/j.eclinm.2020.100594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Uncorrected refractive errors can be corrected by spectacles which improve visual functioning, academic performance and quality of life. However, spectacle wear can be low due to teasing/bullying, parental disapproval and no perceived benefit.Hypothesis: higher proportion of children with uncorrected refractive errors in the schools allocated to the intervention will wear their spectacles 3-4 months after they are dispensed. METHODS A superiority, cluster-randomised controlled trial was undertaken in 50 government schools in Hyderabad, India using a superiority margin of 20%. Schools were the unit of randomization. Schools were randomized to intervention or a standard school programme. The same clinical procedures were followed in both arms and free spectacles were delivered to schools. Children 11-15 years with a presenting Snellen visual acuity of <6/9.5 in one or both eyes whose binocular acuity improved by ≥2 lines were recruited.In the intervention arm, classroom health education was delivered before vision screening using printed images which mimic the visual blur of uncorrected refractive error (PeekSim). Children requiring spectacles selected one image to give their parents who were also sent automated voice messages in the local language through Peek. The primary outcome was spectacle wear at 3-4 months, assessed by masked field workers at unannounced school visits. www.controlled-trials.com ISRCTN78134921 Registered on 29 June 2016. FINDINGS 701 children were prescribed spectacles (intervention arm: 376, control arm: 325). 535/701 (80%) were assessed at 3-4 months: intervention arm: 291/352 (82.7%); standard arm: 244/314 (77.7%). Spectacle wear was 156/291 (53.6%) in the intervention arm and 129/244 (52.9%) in the standard arm, a difference of 0.7% (95% confidence interval (CI), -0.08, 0.09). amongst the 291 (78%) parents contacted, only 13.9% had received the child delivered PeekSim image, 70.3% received the voice messages and 97.2% understood them. INTERPRETATION Spectacle wear was similar in both arms of the trial, one explanation being that health education for parents was not fully received. Health education messages to create behaviour change need to be targeted at the recipient and influencers in an appropriate, acceptable and accessible medium. FUNDING USAID (Childhood Blindness Programme), Seeing is Believing Innovation Fund and the Vision Impact Institute.
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Affiliation(s)
- Priya Morjaria
- Faculty of Infectious and Tropical Diseases, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
- Corresponding author.
| | - Andrew Bastawrous
- Faculty of Infectious and Tropical Diseases, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Gudlavalleti Venkata Satyanarayana Murthy
- Faculty of Infectious and Tropical Diseases, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
- Indian Institute of Public Health, Plot No #1, A.N.V. Arcade, Amar Co-op Society, Kavuri Hills, Madhapur, Hyderabad 500033, India
| | - Jennifer Evans
- Faculty of Infectious and Tropical Diseases, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Mekala Jayanthi Sagar
- Indian Institute of Public Health, Plot No #1, A.N.V. Arcade, Amar Co-op Society, Kavuri Hills, Madhapur, Hyderabad 500033, India
| | | | - Kalluri Viswanath
- Pushpagiri Vitreo Retina Institute, Plot No 241, Uma Plaza, 9, West Marredpally, Secunderabad, Telangana 500026, India
| | - Clare Gilbert
- Faculty of Infectious and Tropical Diseases, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
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15
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García García M, Breher K, Ohlendorf A, Wahl S. To Correct or Not Correct? Actual Evidence, Controversy and the Questions That Remain Open. J Clin Med 2020; 9:jcm9061975. [PMID: 32599775 PMCID: PMC7356996 DOI: 10.3390/jcm9061975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 12/31/2022] Open
Abstract
Clinical studies and basic research have attempted to establish a relationship between myopia progression and single vision spectacle wear, albeit with unclear results. Single vision spectacle lenses are continuously used as the control group in myopia control trials. Hence, it is a matter of high relevance to investigate further whether they yield any shift on the refractive state, which could have been masked by being used as a control. In this review, eye development in relation to eyes fully corrected versus those under-corrected is discussed, and new guidelines are provided for the analysis of structural eye changes due to optical treatments. These guidelines are tested and optimised, while ethical implications are revisited. This newly described methodology can be translated to larger clinical trials, finally exerting the real effect of full correction via single vision spectacle lens wear on eye growth and myopia progression.
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Affiliation(s)
- Miguel García García
- Carl Zeiss Vision International GmbH, ZEISS Group, Turnstrasse 27, 73430 Aalen, Germany; (A.O.); (S.W.)
- Ophthalmic Research Institute, Elfriede-Aulhorn-Straße 7, 72076 Tuebingen, Germany;
- Correspondence:
| | - Katharina Breher
- Ophthalmic Research Institute, Elfriede-Aulhorn-Straße 7, 72076 Tuebingen, Germany;
| | - Arne Ohlendorf
- Carl Zeiss Vision International GmbH, ZEISS Group, Turnstrasse 27, 73430 Aalen, Germany; (A.O.); (S.W.)
- Ophthalmic Research Institute, Elfriede-Aulhorn-Straße 7, 72076 Tuebingen, Germany;
| | - Siegfried Wahl
- Carl Zeiss Vision International GmbH, ZEISS Group, Turnstrasse 27, 73430 Aalen, Germany; (A.O.); (S.W.)
- Ophthalmic Research Institute, Elfriede-Aulhorn-Straße 7, 72076 Tuebingen, Germany;
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16
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Comparison of the pediatric vision screening program in 18 countries across five continents. J Curr Ophthalmol 2019; 31:357-365. [PMID: 31844783 PMCID: PMC6896448 DOI: 10.1016/j.joco.2019.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/12/2019] [Accepted: 07/24/2019] [Indexed: 01/25/2023] Open
Abstract
Purpose Incorporating mass pediatric vision screening programs as part of a national agenda can be challenging. This review assessed the implementation strategy of the existing pediatric vision screening program. Methods A search was performed on PubMed, EBSCO host MEDLINE Complete, and Scopus databases encompassing the past ten years for mass pediatric screening practice patterns that met the selection criteria regarding their objectives and implementation. Results were analyzed from 18 countries across five continents. Results Eight countries (44%) offered screening for distance visual acuity only, where the majority of the countries (88%) used either Snellen or Tumbling E chart. High-income countries initiated screening earlier and applied a more comprehensive approach, targeting conditions other than reduced vision only, compared with middle-income countries. Chart-based testing was most commonly performed, with only three countries incorporating an instrument-based approach. Lack of eyecare and healthcare practitioners frequently necessitated the involvement of non-eyecare personnel (94%) as a vision screener including parent, trained staff, and nurse. Conclusions Implementation of a vision screening program was diverse within countries preceded by limited resources issues. Lack of professional eyecare practitioners implied the need to engage a lay screener. The limitation of existing tests to detect a broader range of visual problems at affordable cost advocated the urgent need for the development of an inexpensive and comprehensive screening tool.
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Falkenberg HK, Langaas T, Svarverud E. Vision status of children aged 7-15 years referred from school vision screening in Norway during 2003-2013: a retrospective study. BMC Ophthalmol 2019; 19:180. [PMID: 31409305 PMCID: PMC6693216 DOI: 10.1186/s12886-019-1178-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 07/24/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Undetected vision problems is an important cause of reduced academic achievement, performance in everyday life and self-esteem. This receives little attention in national health care services in Norway even though most of these vision problems are easily correctable. There are no published data on how many Norwegian schoolchildren are affected by correctable vision problems. This study aims to determine the vision status in primary and secondary schoolchildren referred from vision screening during the 10 year period of 2003-2013. METHODS Of the 1126 children (15%) aged 7-15 years referred to the university eye clinic by the school screening program, all 782 who attended the eye clinic were included in the study. Patient records were retrospectively reviewed with regard to symptoms, refractive error, best corrected visual acuity (BCVA) of logMAR, binocular vision, ocular health and management outcomes. RESULTS Previously undetected vision problems were confirmed in 650 (83%) of the children. The most frequent outcomes were glasses (346) or follow-up (209), but types of treatment modalities varied with age. Mean refractive errors were hyperopic for all age groups but reduced with age (ANOVA, p < 0.001). Overall, 51% were hyperopic, 32% emmetropic and 17% myopic. Refractive errors did not change across the decade (linear regression, all p > 0.05). Mean logMAR BCVAs were better than 0.0 and improved with age (ANOVA, p < 0.001). The most prevalent symptoms were headaches (171), near vision problems (149) and reduced distance vision (107). CONCLUSIONS The vision screening identified children with previously undetected visual problems. This study shows that the types of visual problems varied with age and that most problems could be solved with glasses. Our results stress the importance of regular eye examinations and that vision examinations should be included in primary health care services. Furthermore, there is a need for raised awareness among parents and teaching staff regarding vision problems in children.
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Affiliation(s)
- Helle K Falkenberg
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway.
| | - Trine Langaas
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway
| | - Ellen Svarverud
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway
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Levinson J, Kohl K, Baltag V, Ross DA. Investigating the effectiveness of school health services delivered by a health provider: A systematic review of systematic reviews. PLoS One 2019; 14:e0212603. [PMID: 31188826 PMCID: PMC6561551 DOI: 10.1371/journal.pone.0212603] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/27/2019] [Indexed: 01/08/2023] Open
Abstract
Schools are the only institution regularly reaching the majority of school-age children and adolescents across the globe. Although at least 102 countries have school health services, there is no rigorous, evidence-based guidance on which school health services are effective and should be implemented in schools. To investigate the effectiveness of school health services for improving the health of school-age children and adolescents, a systematic review of systematic reviews (overview) was conducted. Five databases were searched through June 2018. Systematic reviews of intervention studies that evaluated school-based or school-linked health services delivered by a health provider were included. Review quality was assessed using a modified Ballard and Montgomery four-item checklist. 1654 references were screened and 20 systematic reviews containing 270 primary studies were assessed narratively. Interventions with evidence for effectiveness addressed autism, depression, anxiety, obesity, dental caries, visual acuity, asthma, and sleep. No review evaluated the effectiveness of a multi-component school health services intervention addressing multiple health areas. From the limited amount of information available in existing systematic reviews, the strongest evidence supports implementation of anxiety prevention programs, indicated asthma education, and vision screening with provision of free spectacles. Additional systematic reviews are needed that analyze the effectiveness of comprehensive school health services, and specific services for under-researched health areas relevant for this population.
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Affiliation(s)
- Julia Levinson
- Institute for Medical Informatics, Biometrics and Epidemiology, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Bavaria, Germany
| | - Kid Kohl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Valentina Baltag
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - David Anthony Ross
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Donaldson LA, Karas M, O'Brien D, Woodhouse JM. Findings from an opt-in eye examination service in English special schools. Is vision screening effective for this population? PLoS One 2019; 14:e0212733. [PMID: 30856194 PMCID: PMC6411105 DOI: 10.1371/journal.pone.0212733] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 02/10/2019] [Indexed: 12/04/2022] Open
Abstract
Our objective was to present the findings of an opt-in, school-based eye care service for children attending 11 special schools in England and use these findings to determine whether a vision screening programme would be appropriate for this population. Data from eye examinations provided to 949 pupils (mean age 10.7 years) was analysed to determine the prevalence and aetiology of visual deficiencies and reported eye care history. For 46.2% (n = 438) of pupils, a visual deficiency was recorded. 12.5% of all the children seen (n = 119) had a visual deficiency that was previously undiagnosed. Referral for a medical opinion was made for 3.1% (n = 29) of pupils seen by the service. Spectacle correction was needed for 31.5% (n = 299) of pupils; for 12.9% (122) these were prescribed for the first time. 3.7% (n = 11) of parents/carers of pupils needing spectacles chose not to use the spectacle dispensing service offered in school. Eye care history was available for 847 pupils (89.3%). Of the pupils for whom an eye care history was available, 44% (n = 373) reported no history of any previous eye care and10.7% (n = 91) reported a history of attending a community optical practice/opticians. Only one pupil from the school entry 4–5 age group (0.6% of age group n = 156) would have passed vision screening using current Public Health England screening guidelines. Children with a diagnosis of autism were significantly less likely to be able to provide a reliable measurement of visual acuity. This study supports previously published evidence of a very high prevalence of visual problems in children with the most complex needs and a significant unmet need in this group. It demonstrates routine school entry vision screening using current Public Health England guidelines is not appropriate for this group of children and very low uptake of community primary eye care services.
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Affiliation(s)
| | | | | | - J Margaret Woodhouse
- School of Optometry & Vision Sciences, Cardiff University, Cardiff, United Kingdom
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Dhanesha U, Polack S, Bastawrous A, Banks LM. Prevalence and causes of visual impairment among schoolchildren in Mekelle, Ethiopia. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2018.1554832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Usha Dhanesha
- International Centre for Eye Health LSHTM, London, UK
| | - Sarah Polack
- International Centre for Evidence in Disability, LSHTM, London, UK
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