Refractive errors and ocular findings in children with intellectual disability: a controlled study

Ophthalmic health care needs of children with disabilities

BACKGROUNDS

Although vision care is crucial for pediatric eye health, research on vision care utilization by children with disabilities remains limited. Furthermore, no study has investigated the variations among various disability types and the interaction between disability status and age.

METHODS

All children with disabilities listed in the Taiwan National Disability Registry during the study period (2015-2019) were matched by age and sex at a 1:4 ratio with children without disabilities. Vision care needs were measured on the basis of (1) the number of outpatient ophthalmology visits, (2) total medical costs associated with outpatient ophthalmology visits, and (3) whether ophthalmic care was provided. Generalized estimating equation models were estimated to determine the relationships between utilization, disability status, and age.

RESULTS

Significant differences in needs between various disability types were identified. Other than children with visual disability, children with facial disability and balance abnormalities also had considerable needs. Children with intellectual disabilities, which constituted the most common disability type (29.4% in 2019), had fewer visits (mean = 1.38, SD = 2.12) and lower medical costs, compared with the averages for all children with disabilities. Care utilization shared an inverted U-shaped relationship with age.

CONCLUSIONS

Children with disabilities have higher vision care needs, which vary by disability type and age. Such needs are greater at younger ages and decreases after the ages of 9-10 years. Policies should be specific to disability type and age to ensure vision care needs are met.

Trends in the prevalence of common ocular conditions and comparison of ophthalmic outpatient utilisation related to these conditions in children with and without various types of disabilities: analysis of nationwide population-based data from Taiwan, 2014-2019

OBJECTIVE

The study objectives were to investigate trends in the prevalence of common ocular conditions among children with and without disabilities; to compare the prevalence of these conditions in children with various disabilities; and to compare ophthalmic outpatient utilisation related to these ocular conditions in children with and without disabilities.

DESIGN

Repeated cross-sectional nationwide population-based study.

SETTING

Nationwide analysis in Taiwan based on National Health Insurance (NHI) claims data and the National Disability Registry, from 2014 to 2019.

PARTICIPANTS

All children (aged under 18 years) with a disability in any given year between 2014 and 2019 were included in our analysis. All children with a disability (experimental group) were matched 1:1 with a child of the same age without a disability (control group). Data regarding the children's disability type and status and ocular conditions were obtained from the National Disability Registry and NHI database of Taiwan.

OUTCOME MEASURES

(1) The prevalence of myopia, strabismus, astigmatism, amblyopia and hyperopia over time; (2) the prevalence of myopia, strabismus, astigmatism, amblyopia and hyperopia in children with various disabilities; and (3) the association between disability and the use of outpatient vision care. All outcome measures were assessed using data from 2014 to 2019.

RESULTS

Among children with disability, the prevalence of myopia increased from 15.97% in 2014 to 18.07% in 2019. The prevalence of strabismus (2.06-3.90%), astigmatism (8.25-9.24%), amblyopia (4.13-4.95%) and hyperopia (3.36-4.58%) also increased over the study period in children with disabilities. The prevalence of strabismus, astigmatism, amblyopia and hyperopia was significantly higher in children with disabilities than in those without disabilities in all years. For example, in 2019, the prevalence values for strabismus, astigmatism, amblyopia and hyperopia were 3.90%, 9.24%, 4.95% and 4.58%, respectively, among children with disabilities, and 0.67%, 5.84%, 1.33% and 1.70%, respectively, for those without disabilities. The prevalence of these conditions varied considerably across disability types. For example, in 2019, the prevalence of strabismus was highest in children with visual disabilities (10.66%; p<0.001); these children also exhibited a high prevalence of amblyopia (24.34%; p<0.001). The prevalence of myopia was high in children with autism (24.77%), but the prevalence of other ocular conditions was not elevated in this group. Regression results indicated that for myopia, children with disability had 0.48 fewer outpatient clinic visits than those without disability (p<0.001).

CONCLUSIONS

The prevalence of common ocular conditions and the corresponding vision care required vary across types of disabilities among children. Healthcare policies must account for children at high risk of various ocular conditions, including those with less common disabilities.

Ocular abnormalities in children with developmental delay

Purpose

To describe the presence of ocular abnormalities in children with developmental delay (DD) and compare with normal children; to analyze associated risk factors, systemic problems, and the possible treatment that can be delivered.

Methods

This was a cross sectional, observational study. We included children between one and 18 years, diagnosed as developmental delay in DD group, and next immediate age- and sex-matched children without developmental delay on the same day or during the same period in the control group. Detailed history and neuroimaging findings were noted. Uncorrected visual acuity, best-corrected visual acuity for distance and near, cycloplegic refraction, anterior, and posterior segment examination was carried out. Various ocular problems, delayed visual maturation (DVM), and cortical visual impairment (CVI) were diagnosed based on examination. Data were analyzed statistically, and P value <0.05 was considered as statistically significant.

Results

Ninety-four children were included in each group. Mean age was 4.97 ± 3.84 years, and 64.89% were males. In DD group: Most common abnormal neuroimaging finding was gliotic changes; systemic associations: 39 children; 83 children had ocular problems: refractive error-70, strabismus-39, cataract-five, amblyopia-16; DVM-13; CVI-13 children; glasses and vision stimulation were advised in 39 and 65 children, respectively; whereas, in control group: refractive error-36, strabismus-15, cataract-two; amblyopia-20 children.

Conclusion

88.29% of developmental delay children had ocular abnormalities, commonest was refractive error (74.47%); these values were higher than in control group; common risk factors were low birthweight and consanguineous marriage; epilepsy was the most common systemic association.

Ophthalmologic diagnoses in youths with autism spectrum disorder: Prevalence and clinical correlates

Autism spectrum disorder (ASD) is associated with a high prevalence of visual dysfunction. This study aimed to investigate the rates of amblyopia, refractive errors, and strabismus, as well as their clinical correlates in ASD. This population-based matched-cohort study used data from the Taiwan National Health Insurance Research Database. A total of 3,551 youths with ASD and 35,510 non-autistic control participants matched by age and sex were included. All the participants were followed-up until they were 18 years old. The prevalence of amblyopia, refractive errors, and strabismus was compared between the ASD and control groups. Effect modifiers, including sex, ASD subgroup, and co-diagnosis of intelligence disability, were examined. Compared to the control group, youths with ASD had a significantly increased risk of amblyopia (adjusted odds ratio [aOR] = 1.75), anisometropia (aOR = 1.66), astigmatism (aOR = 1.51), hypermetropia (aOR = 2.08), exotropia (aOR = 2.86), and esotropia (aOR = 2.63), but a comparable likelihood of myopia according to age. Males with ASD had a significantly lower likelihood of exotropia, but a higher likelihood of myopia than females with ASD. The autism subgroup had a higher OR for hypermetropia, but a lower OR for myopia than the other ASD subgroups. ASD youths with intelligence disabilities demonstrated significantly higher ORs for amblyopia, hypermetropia, and all types of strabismus and lower OR for myopia than those without intelligence disabilities. In conclusion, the rates of amblyopia, refractive errors, and strabismus were higher in youths with ASD. Ocular abnormalities in youths with ASD require a comprehensive assessment and management.

A brief history of MECP2 duplication syndrome: 20-years of clinical understanding

MECP2 duplication syndrome (MDS) is a rare, X-linked, neurodevelopmental disorder caused by a duplication of the methyl-CpG-binding protein 2 (MECP2) gene-a gene in which loss-of-function mutations lead to Rett syndrome (RTT). MDS has an estimated live birth prevalence in males of 1/150,000. The key features of MDS include intellectual disability, developmental delay, hypotonia, seizures, recurrent respiratory infections, gastrointestinal problems, behavioural features of autism and dysmorphic features-although these comorbidities are not yet understood with sufficient granularity. This review has covered the past two decades of MDS case studies and series since the discovery of the disorder in 1999. After comprehensively reviewing the reported characteristics, this review has identified areas of limited knowledge that we recommend may be addressed by better phenotyping this disorder through an international data collection. This endeavour would also serve to delineate the clinical overlap between MDS and RTT.

Ocular findings in 22q11.2 deletion syndrome: A systematic literature review and results of a Dutch multicenter study

The 22q11.2 deletion syndrome (22q11.2DS) is a multisystem disorder with an estimated prevalence of 1:3000 live births. Manifestations show a marked variability in expression and include speech‐ and language delay, intellectual disability, and neuropsychiatric disorders. We aim to provide an overview of ocular findings in 22q11.2DS in order to optimize recommendations for ophthalmic screening. We combined results from a systematic literature review with results from a multicenter cross‐sectional study of patients with 22q11.2DS who were assessed by an ophthalmologist. Our systematic literature search yielded four articles, describing 270 patients. We included 132 patients in our cross‐sectional study (median age 8.9 [range 0–56] years). Most reported ocular findings were retinal vascular tortuosity (32%–78%), posterior embryotoxon (22%–50%), eye lid hooding (20%–67%), strabismus (12%–36%), amblyopia (2%–11%), ptosis (4%–6%), and refractive errors, of which hyperopia (6%–48%) and astigmatism (3%–23%) were most common. Visual acuity was (near) normal in most patients (91%–94%). Refractive errors, strabismus, and amblyopia are treatable conditions that are frequently present in patients with 22q11.2DS and should be corrected at an early stage. Therefore, in 22q11.2DS, we recommend ophthalmic and orthoptic screening at the age of 3 years or at diagnosis, and a low‐threshold referral in adults.

Ocular manifestations in children with developmental delay at a tertiary center in South India

PURPOSE:

Developmental delay occurs when a child exhibits a significant delay in the acquisition of milestones, in one or more domains of development. This study was planned to determine the distribution of ocular disorders and to assess the correlation between ocular findings and systemic co morbidity, antenatal and postnatal factors, and perinatal history.

METHODS:

This cross-sectional study included children with developmental delay <16 years of age. All children underwent complete ophthalmological evaluation including full cycloplegic refraction. Vision assessment was done as appropriate for age. Spearman's correlation test was used to analyze the correlation between ocular findings and causes for developmental delay and antenatal, perinatal, and postnatal history.

RESULTS:

A total of 128 children were evaluated. Mean age of the study group was 5.59 ± 2.12 years, 64.8% were males, and 76.6% of children were from rural area. Ocular findings were seen in 110 (85.93%) children, refractive error being the most common finding seen in 87 children (astigmatism n = 47, hypermetropia n = 28, and myopia n = 12). Strabismus was seen in 65 children, esotropia being the most common (n = 36). Vision impairment was present in 39.84% of children. Other ocular findings included disc pallor, cataract, ptosis, amblyopia, keratoconus, telecanthus, lagophthalmos, blepharitis, retinitis pigmentosa, and morning glory syndrome. Spearman's correlation showed no statistical association between ocular findings and various causes for developmental delay. There was a weak negative correlation between antenatal history, mode of delivery, gestational age, and ocular findings.

CONCLUSION:

More than three-fourths of children with developmental delay had ocular findings which necessitates the need for ocular evaluation.

Evaluation of the PlusoptiX photoscreener in the examination of children with intellectual disabilities

PURPOSE:

This study aimed to determine whether the plusoptiX vision screener (PVS) can be used to detect amblyogenic risk factors (ARFs) as defined by the American Association for Paediatric Ophthalmology and Strabismus Vision Screening Committee guidelines (2013) for automated vision screening devices.

METHODS:

In this cross-sectional study, children attending a special needs school underwent screening with the PVS and complete ophthalmologic examinations. Ophthalmologic examinations were used as the gold standard to compute the prevalence, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and testability.

RESULTS:

Forty-four children with special needs (mean age, 8.5 years; range, 4–18 years) were included. The PVS recommended referral of 31 cases (referral rate 70%). Thirty-nine of the 44 children (89%) met the referral-positive threshold for strabismus, reduced vision and/or amblyogenic factors on examination. The plusoptiX had a sensitivity of 40% (confidence interval [CI] 7%–83%), specificity of 78% (CI 55%–85%), PPV of 15% (CI 3%–46%), and NPV of 90.3% (CI 73%–97%). The PVS underestimated refractive errors by 0.67 to 0.71 D in the right (P < 0.001) and left eyes (P = 0.002). Testability was relatively low, with the PVS at 75% compared to the gold standard examination at 100%.

CONCLUSION:

We found that although the plusoptiX photoscreener might be a useful tool in pediatric vision screening, it might not perform as well in children with intellectual disabilities. Utilization of the PVS as a single screening device may fail to identify a considerable proportion of young children with ARFs or amblyopia.

Visual Status in a Portuguese Population with Intellectual Disability

BACKGROUND

Neurosensory deprivation associated with vision is a well-known fact in people with intellectual disability (ID). This work aims to report the visual status of a population with ID in Portugal.

METHODS

A vision screening protocol was conducted during two Special Olympics events. The vision protocol included personal medical history, ocular health evaluation, and clinical measures, such as visual acuity (VA), binocular vision, colour vision, refractive error, and intraocular pressure. This protocol was administered to 134 subjects.

RESULTS

Half of the subjects reported that they had never attended or they did not remember having attended a previous eye exam. Additionally, 10% of them had not attended an eye exam in the immediate past three years. Half the subjects failed the VA test and 13% presented moderate Visual Impairment (VI) (VA worse than 0.5 logMAR in the best eye). Manifest ocular deviation was found in 25% of the subjects and the most common ocular health dysfunction conditions were conjunctiva hyperaemia, meibomian gland dysfunction, and lens anomalies. Refractive error correction allowed a reduction in the level of moderate VI to 3.7%.

CONCLUSIONS

The population analysed showed a poor eye care attendance rate and vision-related conditions are in agreement with previous reports. The development of national strategies to promote the awareness for routine eye care in people with ID and improving accessibility to eye care services may mitigate many of the most prevalent conditions encountered.

Evidence-Based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination

Republished with written permission granted from the American Optometric Association, October 2, 2020.

Strabismus in Children With Intellectual Disability: Part of a Broader Motor Control Phenotype?

PURPOSE

Intellectual disability (ID) results from a heterogeneous group of disorders and affects 1% to 2% of children. ID frequently occurs in association with other clinical features such as seizures or malformations. We suspected that strabismus might also be unusually frequent in this population and that it might be associated with ID groups affecting motor control.

METHODS

We reviewed phenotypic descriptors, extracted from medical records, for a heterogeneous series of 222 probands with ID who had been enrolled in a study of clinical application of exome sequencing. We estimated the frequency of strabismus and other common clinical features and explored statistical associations between them. Data from Population Data British Columbia and Online Mendelian Inheritance in Man were also examined for confirmation of our observations.

RESULTS

Strabismus had a higher prevalence among probands with ID than in the general population (odds ratio = 5.46). Moreover, probands with both ID and strabismus were more likely to have problems affecting motor control than those with ID and no strabismus (odds ratio = 2.84). Hypotonia was one of the most common motor control subgroups affecting the ID probands, and a frequent co-occurrence of strabismus and hypotonia was also observed (odds ratio = 2.51) and supported by related gene literature review. There was no evidence for associations between strabismus and other frequent clinical features.

CONCLUSION

Strabismus is a frequent feature in individuals with ID. The frequent co-occurrence of strabismus and motor control phenotypes, in particular hypotonia, suggests that a common cerebellar mechanism or pathway may underlie these phenotypes.

Refractive error and ocular findings among infants and young children with severe problem behavior and developmental disabilities

The prevalence of refractive error and ocular disorders among infants and young children with severe behavioral problems and developmental disorders is not well defined, particularly in developing countries. We performed a retrospective review of ophthalmic examinations performed during a National Institutes of Health-funded cohort study of very young children in Peru with behavioral problems and at risk for developmental disorders. 222 children between the ages of 0 and 4 years (mean 2.2 ± 0.9 years) were examined and 100 (45.0%) had an abnormal ocular exam. Overall, the prevalence of refractive error was 33.3%, nystagmus was 12.2%, and strabismus was 10.9%. Among children with Down syndrome, refractive error ranged from 46.2% at age 2 to 85.7% at age 4. Refractive error and ocular disorders are highly prevalent even at a young age in children with behavioral problems and developmental disorders. Much of the visual impairment in this population is treatable; early identification and intervention can have a lifelong positive impact on neurodevelopment.

Vision in children with autism spectrum disorder: a critical review

Autism spectrum disorder (ASD) is a common neurodevelopmental condition with approximately 1-2 per cent prevalence in the population. The condition has lifelong effects for the individual and family, and early intervention and management helps maximise quality of life and outcomes. Many studies of vision in ASD have attempted to link the behavioural and sensory deficits in ASD with underlying visual processing. From this work, it is clear that individuals with ASD 'see' and process the world differently, but there remain gaps in our understanding. This review will summarise our current knowledge of key aspects of visual functions and the optometric profile of ASD. This includes findings regarding visual acuity and contrast sensitivity, refractive error, eye movements, binocular vision, near visual functions and retinal structure in ASD. From this, a pattern of knowledge emerges for children with ASD: we should expect normal visual acuity; there will likely be atypical eye movements and susceptibility for subtle visuo-motor deficits, there is an increased prevalence of strabismus; an increased likelihood of astigmatism and possibly other refractive errors; attention, crowding and task complexity will likely be problematic; and retinal structure and function may be compromised. Bringing this together, these findings highlight that further work is necessary, not only to understand how higher-level functions link to behaviours, but also to ensure there is a sound understanding of the building-blocks of vision to fully grasp the profile of visual processing as a whole in ASD. This review will give a translational viewpoint for clinicians, and underline the benefits of comprehensive vision care in ASD.

Vision assessment in persons with intellectual disabilities

PURPOSE

To investigate the degree of visual acuity in workers with intellectual disabilities and the impact of vision on their working conditions.

METHODS

We recruited 224 workers (mean age 43.77 years, SD ± 12.96; range, 19-72 years) from a workshop for those with intellectual disabilities, to participate in a vision examination program. The assessment consisted of objective refraction, visual acuity, ocular motility, near-point of convergence, cover/uncover test, stereo acuity and colour perception. Individuals with vision deficits were fitted with spectacles following the screening program.

RESULTS

Within the past three years, 38.9 per cent of the participants received eye care, 14.3 per cent of participants had not received eye care in more than three years, and 6.7 per cent had not received any eye care. As many as 39.7 per cent of participants did not know whether they had ever received eye care. Entering visual acuity for far vision was 0.52 dec (-0.29 logMAR) and 0.42 dec (-0.38 logMAR) for near vision. Only 14.9 per cent, 11 of all participants aged ≥50 years, owned spectacles for near vision before the examination. After subjective determination of refraction, best corrected visual acuity for far vision was 0.61 dec (-0.22 logMAR) and 0.56 dec (-0.25 logMAR) for near vision (in both cases with p < 0.001). After the examination, 44.6 per cent (33) of all workers aged ≥50 years received a recommendation for reading or bifocal spectacles. In 46 per cent of workers, the threshold of stereopsis was higher than 63 arc seconds, and some form of colour vision deficiency was measured in 12.5 per cent of participants.

CONCLUSIONS

Workers with intellectual disabilities are often unaware of their visual deficits. We found that some of their abnormalities can be solved by appropriate optical means and that they could benefit from regular eye care. These workers should be encouraged to be tested and to improve their vision with appropriate lenses.

Behavior disorders in children with significant refractive errors

Purpose

To evaluate the frequency of behavioral disorders in children with significant refractive error and to compare the results with those of emmetropic children.

Methods

In this prospective, comparative study from January to September 2013, refractive errors of all 5–12-year-old children who referred to a general eye clinic were recorded. A validated Persian version of the Rutter A scale was filled out by the parents for the evaluation of the child's behavioral disorders. The Rutter A scale scores of children with significant refractive error were compared with those of emmetropic eyes. Student t test, Chi square test, and Fisher's exact test were used for analysis. Differences with a P value less than 0.05 were considered significant.

Results

One hundred eighty-three patients, including 101 patients with significant refractive error and 82 emmetropic subjects, were studied. Overall, 44 patients (24%) had behavioral disorders, according to the Rutter A scale scores. Thirty patients (29.7%) with significant refractive error and 14 emmetropic subjects (16.9%) had behavioral disorders (P = 0.043). The prevalence of behavioral disorders were 37.5% in hyperopia, 35.7% in hyperopia-astigmatism, 21.4% in simple astigmatism, 16.7% in myopia-astigmatism, and 14.3% in myopia. Compared with emmetropic subjects, the prevalence of behavioral disorders was statistically significantly higher only in patients with hyperopia and hyperopia-astigmatism (P = 0.019 and P = 0.040).

Conclusion

The prevalence of behavioral disorders is higher in children with hyperopia and hyperopia-astigmatism.

Comparing Intelligence Quotient (IQ)among 3 to 7-year-old strabismic and nonstrabismic children in an Iranian population

This study was designed to compare the Intelligence Quotient (IQ) among 3 to 7-year-old strabismic and nonstrabismic children in an Iranian population.

In this cross-sectional study, 108 preschool children with equal numbers of strabismic/non-strabismic disorder (age 3–7 years) were randomly selected from exceptional strabismus clinics of Ahvaz and were evaluated with the preschool and primary scale of intelligence versions of Wechsler (WPPSI).

In the current study, 108 children were evaluated. In strabismic patients the mean performance, verbal and total IQ were 89.46±19.79, 89.57±21.57 and 91.54±22.08 respectively. These mean scores in normal children were 91.89±47.53, 87.56±15.6 and 89.96±17.62consecuently. The results showed that these three different IQ subscales were not significantly different among 3 to 7 years old strabismic and nonstrabismic children ((P>0.05 for all comparisons). There was no significant difference in IQ between two sexes (P>0.05) while Persian tribe children had greater IQ score compared to other tribes (P<0.05). Also, higher paternal educational status of children related to higher IQ score. IQ score was better in combined deviations and was higher in exotropes than esotropes; however, these differences were not statistically significant (P>0.05).

In this evaluation, we did not found a significant negative interference of strabismus on IQ score of preschool children. It can be concluded that paternal educational level and tribe have a significant effect on intelligent quotient, while this is not the case on sex and ocular deviation.

Brief report: incidence of ophthalmologic disorders in children with autism

PURPOSE

To determine the incidence of ophthalmologic disorders in children with autism and related disorders.

DESIGN

Retrospective chart review. Four hundred and seven children diagnosed with autism or a related disorder between 1998 and 2006. one hundred and fifty-four of these children completed a comprehensive ophthalmology exam by a pediatric ophthalmologist.

RESULTS

Ophthalmologic pathology was found in 40% of patients with autism or a related disorder with 29% having significant refractive errors, 21% demonstrating strabismus, and 10% having amblyopia.

CONCLUSIONS

Children with autism or a related disorder will frequently have an ophthalmologic abnormality. Since cooperation with vision screening is understandably limited in these children, a comprehensive eye examination by a pediatric ophthalmologist is recommended for all such children.

Intelligence Quotient (IQ) in Congenital Strabismus

PURPOSE

To evaluate intelligence quotient (IQ) in patients with congenital strabismus.

METHODS

All patients with congenital strabismus scheduled for surgery were enrolled consecutively over a one year period in a cross-sectional study and were evaluated for verbal, performance and total IQ scores, and compared to the mean normal IQ of 100±15.

RESULTS

During the study period, 109 patients with mean age of 18.4±10.5 (range, 4-63) years were included. Educational status in most patients (80%) was less than high-school. Most patients (80%) lived in urban areas and 46 patients (42.2%) had some degrees of unilateral or bilateral amblyopia. Mean verbal IQ was 87.2±19.6 (range, 45-127), performance IQ was 81±15.5 (range, 44-111) and total IQ was 83.5±18.3 (range, 40-120). Total IQ was significantly lower in comparison to the normal population (P<0.01) and significantly higher in urban as compared to rural residents (85.1±19.5 versus 77.3±10.8 respectively, P=0.02). Patients with coexisting amblyopia and alternate deviation had lower IQ levels. Verbal IQ was insignificantly higher in myopes than emmetropes and hyperopes. IQ was better with vertical deviations and was higher in esotropes than exotropes; however, these differences were not statistically significant (P>0.05 for all comparisons).

CONCLUSION

Patients with congenital strabismus in this study had lower mean IQ scores than the normal population which may be due to genetic background or acquired causes secondary to strabismus.

Changes in causes of low vision between 1988 and 2009 in a Dutch population of children

PURPOSE

Causes of low vision in the Netherlands may have changed over time. The purpose of this study is to assess trends over the last two decades.

METHODS

Socio-demographic and medical data, including ophthalmic diagnosis and inheritance patterns for 2843 children with low vision (0-21 years; 50% representation) referred to a Dutch institute for low vision (Bartiméus) over a 21-year period between 1988 and 2009, were included in the analysis. For the 19 most common diagnoses, inheritance and presence of mental impairment, trend analyses were performed with logistic regression models; odds ratios (OR) for a 10-year time span were reported.

RESULTS

Cerebral visual impairment (CVI) was found in 27.2% (97% mental impairment), albinism in 8.0%. Over time, nystagmus (6.6%; OR = 1.42), retinitis pigmentosa (2.9%; OR = 1.61), cone-rod dystrophy (2.6%; OR = 1.98) and hyperopia (2.0%; OR = 3.66) increased significantly. Cataract (4.9%; OR = 0.64), aniridia (1.6%; OR = 0.42) and retinopathy of prematurity (ROP; 2.0%; OR = 0.45) decreased significantly. There was a significant increase in genetic disorders (41.0%; OR = 1.49) and in co-occurrence of mental impairment (52.2% OR = 1.16).

CONCLUSION

In the last two decades, treatable or preventable disorders (such as cataract and ROP) have become a less common cause of low vision in children. However, the prevalence of complex (genetic) and untreatable disorders (CVI) has taken its place, as a result of increased survival of preterm and low birth weight children and improved diagnostic possibilities. Knowledge of the prevalence of low vision, its causes and trends over time may help policy makers to define effective intervention strategies and to monitor its impact.

Validation of plusoptiX S04 photoscreener as a vision screening tool in children with intellectual disability

PURPOSE

Intellectual disability (ID) is a major public health issue, affecting more than 1% of children worldwide. Pediatric vision screening using standard eye charts may be challenging for children with ID, who may benefit from a quick noninvasive vision screening tool. This study evaluated the accuracy of plusoptiX S04 (Plusoptix Gmbh, Nuremberg, Germany) in detecting amblyopia risk factors in children with ID.

METHODS

Children diagnosed with ID according to age-appropriate psychological tests were examined consecutively. Vision screening was performed using the plusoptiX S04 prior to complete ophthalmological examination, including cycloplegic refraction. Pass/refer screening results was compared with findings of ophthalmological examination. Amblyogenic risk factors were defined according to American Association for Pediatric Ophthalmology and Strabismus referral criteria.

RESULTS

A total of 182 infants and children were examined. Only 3% of children were uncooperative for screening. Ophthalmological examination detected amblyogenic risk factors in 32% of patients. The sensitivity of plusoptiX S04 was 95% (95% CI, 85.6%-98.9%), and specificity was 50% (95% CI, 40.8%-59.1%). The positive predictive value was 47% (95% CI, 37.7%-56.4%) and the negative predictive value was 95.4% (95% CI, 87.1%-99.1%).

CONCLUSIONS

High sensitivity and negative predictive values suggest that the plusoptiX S04 will detect most children with ID who have amblyogenic risk factors, but one-half of all children referred will have no risk factors.

Overview of diagnosis and management of paediatric headache. Part I: diagnosis

Headache is the most common somatic complaint in children and adolescents. The evaluation should include detailed history of children and adolescents completed by detailed general and neurological examinations. Moreover, the possible role of psychological factors, life events and excessively stressful lifestyle in influencing recurrent headache need to be checked. The choice of laboratory tests rests on the differential diagnosis suggested by the history, the character and temporal pattern of the headache, and the physical and neurological examinations. Subjects who have any signs or symptoms of focal/progressive neurological disturbances should be investigated by neuroimaging techniques. The electroencephalogram and other neurophysiological examinations are of limited value in the routine evaluation of headaches. In a primary headache disorder, headache itself is the illness and headache is not attributed to any other disorder (e.g. migraine, tension-type headache, cluster headache and other trigeminal autonomic cephalgias). In secondary headache disorders, headache is the symptom of identifiable structural, metabolic or other abnormality. Red flags include the first or worst headache ever in the life, recent headache onset, increasing severity or frequency, occipital location, awakening from sleep because of headache, headache occurring exclusively in the morning associated with severe vomiting and headache associated with straining. Thus, the differential diagnosis between primary and secondary headaches rests mainly on clinical criteria. A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment, bearing in mind that children with headache are more likely to experience psychosocial adversity and to grow up with an excess of both headache and other physical and psychiatric symptoms and this creates an important healthcare problem for their future life.