Evidence-based clinical practice guidelines for the periodic eye examination in children aged 0-5 years in Canada

Continued care and provision of glasses are necessary to improve visual and academic outcomes in children: Experience from a cluster-randomized controlled trial of school-based vision screening

OBJECTIVE

To assess the effectiveness of a kindergarten vision screening program by randomly assigning schools to receive or not receive vision screening, then following up 1.5 years later.

METHODS

Fifty high-needs elementary schools were randomly assigned to participate or not in a vision screening program for children in senior kindergarten (SK; age 5‒6 years). When the children were in Grade 2 (age 6‒7 years), vision screening was conducted at all 50 schools.

RESULTS

Contrary to expectations, screened and non-screened schools did not differ in the prevalence of suspected amblyopia in Grade 2 (8.6% vs. 7.5%, p = 0.10), nor prevalence of other visual problems such as astigmatism (45.1% vs. 47.1%, p = 0.51). There was also no difference between screened and non-screened schools in academic outcomes such as the proportion of children below grade level in reading (33% vs. 29%) or math (44% vs. 38%) (p = 0.86). However, more children were wearing glasses in screened than in non-screened schools (10.2% vs. 7.8%, p = 0.05), and more children reported their glasses as missing or broken (8.3% vs. 4.7%, p = 0.01), suggesting that SK screening had identified successfully those in need of glasses. Examination of individual results revealed that 72% of children diagnosed and treated for amblyopia in SK no longer had amblyopia in Grade 2.

CONCLUSION

The prevalence of amblyopia and other visual problems was not reduced in Grade 2 by our SK vision screening program, perhaps because of poor treatment compliance and high attrition. The results suggest that a single screening intervention is insufficient to reduce visual problems among young children. However, the data from individuals with amblyopia suggest that continuing vision care and access to glasses benefits children, especially children from lower socioeconomic class.

Knowledge, Attitude, and Practice Regarding Vision and Eye Screening of Preschool Children Among Primary Health Center Staff in the Qassim Region, Saudi Arabia

Purpose To study the knowledge, attitude, and practice (KAP) regarding vision and eye screening of preschool children among primary health center (PHC) staff in Qassim, Saudi Arabia.  Methods A survey of PHC staff was conducted in 2023. The questionnaire included knowledge (10), attitude (five), and practice (five)-related questions associated with preschool vision and eye screening. A five-graded Likert scale was used for responses. Cronbach's alpha score of the questionnaire was 0.776. The KAP score was correlated with the demographic variables of participants. The current and desired sources of information were also collected.  Results We surveyed 101 health staff (66 doctors and 35 nurses). The median (interquartile range) knowledge, attitude, and practice scores of participants were 4.1 (3.8; 4.3), 4.2 (4.0; 4.6), and 3.6 (3.0; 4.0), respectively. The doctors had better knowledge (Mann-Whitney U test (MW), P = 0.016) and attitude (MW, P = 0.019) than the nurses. Staff above 40 years had better knowledge (Kruskal-Wallis H test (KW), P = 0.035), attitude (KW, P = 0.017), and practice (KW, P < 0.001). The primary source of information about preschool vision screening was their medical education (51%). Other sources were eye care professionals (11.9%), Google and computers (12.9%), and social media (14.9%). Their preferred sources of information were medical journals (25.7%), eyecare training (22.8%), and eye professionals (33.7%). Conclusions Knowledge and attitude for eye and vision screening of preschool children was high, but practices were less among PHC staff. Providing information through their preferred mode could further strengthen eye care for preschool children.

Socioeconomic Status and Vision Care Services in Ontario, Canada: A Population-Based Cohort Study

OBJECTIVE

To test the association of material deprivation and the utilization of vision care services for young children.

STUDY DESIGN

We conducted a population-based, repeated measures cohort study using linked health and administrative datasets. All children born in Ontario in 2010 eligible for provincial health insurance were followed from birth until their seventh birthday. The main exposure was neighborhood-level material deprivation quintile, a proxy for socioeconomic status. The primary outcome was receipt of a comprehensive eye examination (not to include a vision screening) by age 7 years from an eye care professional, or family physician.

RESULTS

Of 128 091 children included, female children represented 48.7% of the cohort, 74.4% lived in major urban areas, and 16.2% lived in families receiving income assistance. Only 65% (n = 82 833) had at least 1 comprehensive eye examination, with the lowest uptake (56.9%; n = 31 911) in the most deprived and the highest uptake (70.5%; n =19 860) in the least deprived quintiles. After adjusting for clinical and demographic variables, children living in the least materially deprived quintile had a higher odds of receiving a comprehensive eye examination (aOR 1.43; 95% CI 1.36, 1.51) compared with children in the most materially deprived areas.

CONCLUSIONS

Uptake of comprehensive eye examinations is poor, especially for children living in the most materially deprived neighborhoods. Strategies to improve uptake and reduce inequities are warranted.

A Systematic Review of Clinical Practice Guidelines for Infectious and Non-infectious Conjunctivitis

PURPOSE

To systematically review and critically appraise clinical practice guidelines (CPGs) and summarise the recommendations for non-infectious and infectious conjunctivitis.

METHODS

CPGs published on non-infectious and infectious conjunctivitis between 2010 and March 2020 were reviewed, evaluated, and selected using nine items from the Appraisal of Guidelines for Research and Evaluation II tool (4, 7, 8, 10, 12, 13, 15, 22 and 23). CPGs with an average score for items 4, 7, 8, 12, or 22 below 3 and/or a sum of the two researchers' average score for all nine items less than 45 were excluded. Two authors independently extracted and validated the data using standardised forms.

RESULTS

Fifteen CPGs from five sources remained for data extraction. CPGs consistently recommended non-pharmacological interventions (artificial tears, cold compress, avoidance or removal of allergens) for non-infectious conjunctivitis and pharmacological interventions (topical anti-histamine, mast-cell stabiliser and dual-acting agent) for allergy types. Observation without treatment was strongly recommended for non-herpetic viral and bacterial infections. Systemic and topical anti-viral was consistently recommended for herpetic viral conjunctivitis, while systemic and topical antibiotics were recommended for chlamydial and gonorrhoeal conjunctivitis. The methods used to assess the level of evidence and the strength of recommendation varied among CPGs.

CONCLUSIONS

There are a number of high-quality CPGs for non-infectious and infectious conjunctivitis. While there were a number of consistencies in the recommendations provided within these CPGs, several inconsistencies were also identified. Many of which related to the scope of practise of the targeted end-user of the particular guideline.

Visual Health and Academic Performance in School-Aged Children

BACKGROUND

Academic performance at different educational levels has become a very important subject of study in local, national and international institutions. A visual system working properly is critical to improving academic performance. It is important to check children's vision during the different stages of elementary school.

METHODS

A visual screening was carried out in elementary school children, aged between 6 and 12, across Spain. The screening included: the collection of demographic data, surveys of children and families about their vision habits and a basic optometric screening to detect visual problems.

RESULTS

Children with bad academic performance had worse visual health than those with good academic performance.

CONCLUSIONS

It would be highly recommendable to introduce policies that ensure the early detection of visual disorders in schools and primary care in order to improve the academic performance of elementary students.