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Musa M, Enaholo E, Bale BI, Salati C, Spadea L, Zeppieri M. Retinoscopes: Past and present. World J Methodol 2024; 14:91497. [DOI: 10.5662/wjm.v14.i3.91497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Retinoscopy is arguably the most important method in the eye clinic for diagnosing and managing refractive errors. Advantages of retinoscopy include its non-invasive nature, ability to assess patients of all ages, and usefulness in patients with limited cooperation or communication skills.
AIM To discuss the history of retinoscopes and examine current literature on the subject.
METHODS A search was conducted on the PubMed and with the reference citation analysis (https://www.referencecitationanalysis.com) database using the term “Retinoscopy,” with a range restricted to the last 10 years (2013-2023). The search string algorithm was: "Retinoscopy" (MeSH Terms) OR "Retinoscopy" (All Fields) OR "Retinoscopes" (All Fields) AND [(All Fields) AND 2013: 2023 (pdat)].
RESULTS This systematic review included a total of 286 records. Publications reviewed iterations of the retinoscope into autorefractors, infrared photo retinoscope, television retinoscopy, and the Wifi enabled digital retinoscope.
CONCLUSION The retinoscope has evolved significantly since its discovery, with a significant improvement in its diagnostic capabilities. While it has advantages such as non-invasiveness and broad applicability, limitations exist, and the need for skilled interpretation remains. With ongoing research, including the integration of artificial intelligence, retinoscopy is expected to continue advancing and playing a vital role in eye care.
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Affiliation(s)
- Mutali Musa
- Department of Optometry, University of Benin, Benin 300283, Nigeria
- Department of Ophthalmology, Africa Eye Laser Centre, Benin 300105, Nigeria
| | - Ehimare Enaholo
- Department of Ophthalmology, Africa Eye Laser Centre, Benin 300105, Nigeria
- Department of Ophthalmology, Centre for Sight Africa, Nkpor 434101, Nigeria
| | | | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, "Sapienza" University of Rome, Rome 00142, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
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Nitzan I, Akavian I, Shmueli O, Erdinest N, Hanina Y, Twig G, Safir M. Body mass index and astigmatism: A nationwide study. Clin Exp Ophthalmol 2024; 52:616-626. [PMID: 38803147 DOI: 10.1111/ceo.14406] [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: 03/01/2024] [Revised: 04/12/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Existing research on the relationship between body mass index (BMI) and astigmatism yields inconsistent results. This study analyses this association in a nationally representative sample of adolescents. METHODS This retrospective, cross-sectional study included Israeli adolescents who underwent medical assessments before mandatory military service between 2011 and 2022. BMI was categorised based on the US age- and sex-matched percentiles. Astigmatism was categorised by magnitude [low-moderate: 0.75 to <3.00 diopters (D), high: ≥3.00 D], and axis orientation [with-the-rule (WTR), against-the-rule (ATR), or oblique (OBL)]. Sex-stratified regression models adjusted for sociodemographic variables were used. RESULTS Of 935 989 adolescents evaluated, 887 325 were included [511 465 (57.6%) males, mean age 17.2 years]. Astigmatism was diagnosed in 123 675 (13.9%) adolescents, of whom 117 081 (13.2%) had low-moderate and 6594 (0.7%) had high astigmatism. WTR astigmatism was the most prevalent (8.2%), followed by ATR (4.1%) and OBL (1.6%) types. Compared with low-normal BMI (5th to 50th percentile), the adjusted ORs for total astigmatism increased with increasing BMI, peaking at 1.65 (1.57-1.74) in males and 1.74 (1.64-1.86) in females with severe obesity. ORs were accentuated for high astigmatism, reaching 3.51 (3.01-4.09) in males, and 3.45 (2.83-4.22) in females with severe obesity. WTR astigmatism demonstrated the strongest association with BMI, with ORs reaching 2.26 (2.13-2.40) in males and 2.04 (1.90-2.20) in females with severe obesity. The results persisted in a series of subgroup analyses. CONCLUSIONS Obesity is associated with higher odds of astigmatism in adolescence. Further investigation into the role of weight management in astigmatism development is warranted.
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Affiliation(s)
- Itay Nitzan
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Israel
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Inbal Akavian
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Israel
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Or Shmueli
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nir Erdinest
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yair Hanina
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Gilad Twig
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Israel
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Department of Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Margarita Safir
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Israel
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
- Department of Ophthalmology, Shamir Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Nishimura M, Wong A, Maurer D. 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. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:688-698. [PMID: 38691337 PMCID: PMC11303613 DOI: 10.17269/s41997-024-00884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/21/2024] [Indexed: 05/03/2024]
Abstract
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.
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Affiliation(s)
- Mayu Nishimura
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada.
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Agnes Wong
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Daphne Maurer
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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He T, Yin L, Zheng Q, He B, Xu Z, Hu T, Wu Y, Chen H, Yu J, Shen T. Survey on pattern of myopia in school children in Hangzhou after the COVID-19 pandemic: a school-based vision screening study. BMC Public Health 2024; 24:1850. [PMID: 38992612 PMCID: PMC11238354 DOI: 10.1186/s12889-024-19338-4] [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: 06/26/2023] [Accepted: 07/02/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Myopia is a major health issue around the world. Myopia in children has increased significantly during the COVID-19 pandemic in China, but reports are scarce on the prevalence of myopia following the pandemic. This study collected vision screening data of school children in China for five consecutive years to observe the changes in myopia after the pandemic and compare the observed prevalence of myopia before and after the pandemic. METHODS A school-based vision screening study used stratified samplings to collect the vision screening data in school children aged 6-13 from 45 primary schools in Hangzhou. Vision screening data including uncorrected visual acuity(UCVA) and spherical equivalent refraction(SER). Calculating the mean of SER and the prevalence of myopia and hyperopia from 2019 to 2023. RESULTS A total of 79,068 screening results (158,136 eyes) were included in the analysis. A substantial myopic shift (approximately -0.30 diopters [D] on average) was found in 2020 and 2021 compared with 2019 in all age groups and a substantial myopic shift (approximately 0.4 D on average) was found in 2022 compared with 2021. A slight myopic shift (approximately -0.14 D on average) was found in 2023 compared with 2022. The prevalence of myopia in all age groups was the highest for five years in 2020 or 2021, which was 31.3% for 6-year-olds, 43.0% for 7-year-olds, and 53.7% for 8-year-olds. A positive change in the prevalence rate of myopia was found at 6 years old (0.59%, 0.12%, 0.36%, 0.25%, p < 0.001). The change in prevalence rate in myopia was shifted slightly in children aged 10-13 years. Children aged 8 to 13 years had a slight increase in myopia prevalence from 2022 to 2023. The prevalence of hyperopia was low and stable in all grade groups, ranging from 0.7% to 2.2% over five years. CONCLUSION Myopia in children has increased rapidly during the COVID-19 pandemic. After the pandemic, the prevalence of myopia in children gradually decreased temporarily and then rebounded. Myopic shift was more apparent in younger children. Myopic shift in children may be related to the reduction of outdoor time, less light, and near work habits, and further research is needed.
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Affiliation(s)
- Ting He
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, CN, China
| | - Lei Yin
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, CN, China
| | - Qingqing Zheng
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, CN, China
| | - Bei He
- Hangzhou Xiaoshan Liuliqiao Hospital, Hangzhou, Zhejiang, CN, China
| | - Zhizi Xu
- Hangzhou Xiaoshan Liuliqiao Hospital, Hangzhou, Zhejiang, CN, China
| | - Tingting Hu
- Hangzhou Xiaoshan Liuliqiao Hospital, Hangzhou, Zhejiang, CN, China
| | - Yuanpeng Wu
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, CN, China
| | - Hu Chen
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, CN, China
| | - Jie Yu
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, CN, China
| | - Ting Shen
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, CN, China.
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Luo R, Wang Z, Li Z, Xie R, Zhang Y, Ye G, Chen J, Xiao Y, Zhan J, Zhu Y, Zhuo Y. Quantitative assessment of colour fundus photography in hyperopia children based on artificial intelligence. BMJ Open Ophthalmol 2024; 9:e001520. [PMID: 38969362 PMCID: PMC11227822 DOI: 10.1136/bmjophth-2023-001520] [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: 10/03/2023] [Accepted: 05/14/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVES This study aimed to quantitatively evaluate optic nerve head and retinal vascular parameters in children with hyperopia in relation to age and spherical equivalent refraction (SER) using artificial intelligence (AI)-based analysis of colour fundus photographs (CFP). METHODS AND ANALYSIS This cross-sectional study included 324 children with hyperopia aged 3-12 years. Participants were divided into low hyperopia (SER+0.5 D to+2.0 D) and moderate-to-high hyperopia (SER≥+2.0 D) groups. Fundus parameters, such as optic disc area and mean vessel diameter, were automatically and quantitatively detected using AI. Significant variables (p<0.05) in the univariate analysis were included in a stepwise multiple linear regression. RESULTS Overall, 324 children were included, 172 with low and 152 with moderate-to-high hyperopia. The median optic disc area and vessel diameter were 1.42 mm2 and 65.09 µm, respectively. Children with high hyperopia had larger superior neuroretinal rim (NRR) width and larger vessel diameter than those with low and moderate hyperopia. In the univariate analysis, axial length was significantly associated with smaller superior NRR width (β=-3.030, p<0.001), smaller temporal NRR width (β=-1.469, p=0.020) and smaller vessel diameter (β=-0.076, p<0.001). A mild inverse correlation was observed between the optic disc area and vertical disc diameter with age. CONCLUSION AI-based CFP analysis showed that children with high hyperopia had larger mean vessel diameter but smaller vertical cup-to-disc ratio than those with low hyperopia. This suggests that AI can provide quantitative data on fundus parameters in children with hyperopia.
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Affiliation(s)
- Ruiyu Luo
- Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan, Guangzhou, Guangdong, China
| | - Zhirong Wang
- Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan, Guangzhou, Guangdong, China
- Foshan Women and Children's Hospital, Foshan, Guangdong, China
| | - Zhidong Li
- Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan, Guangzhou, Guangdong, China
| | - Rui Xie
- Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan, Guangzhou, Guangdong, China
| | - Yuan Zhang
- Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan, Guangzhou, Guangdong, China
| | - Guitong Ye
- Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan, Guangzhou, Guangdong, China
| | - Jianqi Chen
- Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan, Guangzhou, Guangdong, China
| | - Yue Xiao
- Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan, Guangzhou, Guangdong, China
| | - Jinan Zhan
- Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan, Guangzhou, Guangdong, China
| | - Yingting Zhu
- Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan, Guangzhou, Guangdong, China
| | - Yehong Zhuo
- Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan, Guangzhou, Guangdong, China
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Bjeloš M, Bušić M, Rak B, Ćurić A, Kuzmanović Elabjer B. Unveiling Visual Acuity in 58,712 Four-Year-Olds: Standardized Assessment Defined Normative Visual Acuity Threshold. Vision (Basel) 2024; 8:39. [PMID: 38922184 PMCID: PMC11209505 DOI: 10.3390/vision8020039] [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: 05/07/2024] [Revised: 06/03/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
The purpose was to define the threshold of normal visual acuity (VA), mean monocular and binocular VA, and interocular difference in the uniform cohort of healthy four-year-old children. All the children were recruited from the Croatian National Registry of Early Amblyopia Detection database. LEA Symbols® inline optotypes were used for VA testing at near and distance, binocularly and monocularly. The pass cut-off level was set to ≤0.1 logMAR. The final sample consisted of 58,712 four-year-old children. In total, 83.78% of the children had unremarkable results, and 16.22% of the children were referred to examination. Of those, 92% of the children were referred due to binocular, and 8% of the children due to monocular causes. The children referred due to binocular causes demonstrated a VA of 0.3 ± 0.24, while the children referred due to monocular causes 0.6 ± 0.21. The ROC curve analysis defined the uniform cut-off value for a normative VA of 0.78. We analyzed the largest uniform cohort of 58,712 children, and have determined normative data for binocular and monocular VA tested with gold standard logMAR chart in four-year-old children. The results presented here established no reasoning to further utilize historical protocols in testing VA in preschool children aged ≥ 4 years.
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Affiliation(s)
- Mirjana Bjeloš
- University Eye Department, Reference Center of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, Reference Center of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies, University Hospital “Sveti Duh”, 10000 Zagreb, Croatia; (M.B.); (B.R.); (A.Ć.); (B.K.E.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Mladen Bušić
- University Eye Department, Reference Center of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, Reference Center of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies, University Hospital “Sveti Duh”, 10000 Zagreb, Croatia; (M.B.); (B.R.); (A.Ć.); (B.K.E.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Benedict Rak
- University Eye Department, Reference Center of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, Reference Center of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies, University Hospital “Sveti Duh”, 10000 Zagreb, Croatia; (M.B.); (B.R.); (A.Ć.); (B.K.E.)
| | - Ana Ćurić
- University Eye Department, Reference Center of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, Reference Center of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies, University Hospital “Sveti Duh”, 10000 Zagreb, Croatia; (M.B.); (B.R.); (A.Ć.); (B.K.E.)
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Biljana Kuzmanović Elabjer
- University Eye Department, Reference Center of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, Reference Center of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies, University Hospital “Sveti Duh”, 10000 Zagreb, Croatia; (M.B.); (B.R.); (A.Ć.); (B.K.E.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Hong JD, Choi EH, Suh S, Bui JH, Storch AM, Walker KR, Shahraki K, Yanez C, Torres D, Espinoza J, Molina I, Suh DW. UCI EyeMobile Exam Findings from School Children Following on-Site Screening. Clin Ophthalmol 2024; 18:1667-1678. [PMID: 38860118 PMCID: PMC11164085 DOI: 10.2147/opth.s460879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/30/2024] [Indexed: 06/12/2024] Open
Abstract
Purpose Uncorrected refractive errors (REs) and amblyopia can lead to visual impairment with deleterious effects on quality of life and academic performance. Early detection and treatment by community vision care programs, such as the UCI EyeMobile for Children, can aid in addressing preventable vision loss. Methods A total of 5074 children between the ages of 3 and 10 years were screened at 153 locations, including preschools, head start programs, and elementary schools within Orange County (OC), California (CA). Subsequently, 1024 children presented for comprehensive eye examinations. A retrospective analysis of all examined children was conducted, determining the frequency and severity of REs and amblyopia and the spectacle prescription rate by age. Propensity score matching analysis evaluated the effect of median household income on RE and amblyopia frequency. Results Among those who failed initial screening and were subsequently examined, significant rates of REs and amblyopia were detected: myopia (24.4%), hyperopia (35.4%), astigmatism (71.8%), anisometropia (8.9%), amblyopia (7.0%), and amblyopia risk (14.4%). A majority (65.0%) of those examined received prescription spectacles from UCI EyeMobile, with around a third requiring a new or updated prescription. The frequency of REs and amblyopia and the spectacle prescription rate were uniform across OC congressional districts. Myopia and amblyopia risk was positively and negatively associated with household income, respectively. Conclusion The UCI EyeMobile for Children serves as a vital vision care program, providing free vision screening, comprehensive eye examinations, and spectacles. A significant number of children required examination, and a high frequency of REs and amblyopia were detected in examined children, with subsequent provision of prescription spectacles to most children.
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Affiliation(s)
- John D Hong
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Elliot H Choi
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Susie Suh
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Joseph H Bui
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Annabelle M Storch
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Kimberly R Walker
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Kourosh Shahraki
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Carolina Yanez
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Diana Torres
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Jennifer Espinoza
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Iliana Molina
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, CA, USA
| | - Donny W Suh
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
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Mavi S, Massie J, Chan VF, Morjaria P. Hyperopia: a practical introduction. COMMUNITY EYE HEALTH 2024; 37:12-13. [PMID: 38827973 PMCID: PMC11141126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Affiliation(s)
- Sonia Mavi
- PhD student and Optometrist: Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - Jessica Massie
- Freelance Global Eye Health Consultant and Public Health Optometrist, Australia
| | - Ving Fai Chan
- Senior Lecturer and Public Health Optometrist: Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - Priya Morjaria
- Assistant Professor and Public Health Optometrist: London School of Hygiene & Tropical Medicine and Head of Global Programme Design: Peek Vision, UK
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Wang J, Jost RM, Birch EE. Ocular Biometric Components in Hyperopic Children and a Machine Learning-Based Model to Predict Axial Length. Transl Vis Sci Technol 2024; 13:25. [PMID: 38809529 PMCID: PMC11146039 DOI: 10.1167/tvst.13.5.25] [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] [Accepted: 04/29/2024] [Indexed: 05/30/2024] Open
Abstract
Purpose The purpose of this study was to investigate the development of optical biometric components in children with hyperopia, and apply a machine-learning model to predict axial length. Methods Children with hyperopia (+1 diopters [D] to +10 D) in 3 age groups: 3 to 5 years (n = 74), 6 to 8 years (n = 102), and 9 to 11 years (n = 36) were included. Axial length, anterior chamber depth, lens thickness, central corneal thickness, and corneal power were measured; all participants had cycloplegic refraction within 6 months. Spherical equivalent (SEQ) was calculated. A mixed-effects model was used to compare sex and age groups and adjust for interocular correlation. A classification and regression tree (CART) analysis was used to predict axial length and compared with the linear regression. Results Mean SEQ for all 3 age groups were similar but the 9 to 11 year old group had 0.49 D less hyperopia than the 3 to 5 year old group (P < 0.001). With the exception of corneal thickness, all other ocular components had a significant sex difference (P < 0.05). The 3 to 5 year group had significantly shorter axial length and anterior chamber depth and higher corneal power than older groups (P < 0.001). Using SEQ, age, and sex, axial length can be predicted with a CART model, resulting in lower mean absolute error of 0.60 than the linear regression model (0.76). Conclusions Despite similar values of refractive errors, ocular biometric parameters changed with age in hyperopic children, whereby axial length growth is offset by reductions in corneal power. Translational Relevance We provide references for optical components in children with hyperopia, and a machine-learning model for convenient axial length estimation based on SEQ, age, and sex.
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Affiliation(s)
- Jingyun Wang
- State University of New York College of Optometry, New York, NY, USA
| | - Reed M. Jost
- Retina Foundation of the Southwest, Dallas, TX, USA
| | - Eileen E. Birch
- Retina Foundation of the Southwest, Dallas, TX, USA
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, USA
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England L, O’Connor A. Do Socioeconomic Inequalities Exist Within Ophthalmology and Orthoptics in the UK?: A Scoping Review. Br Ir Orthopt J 2024; 20:31-47. [PMID: 38250169 PMCID: PMC10798172 DOI: 10.22599/bioj.338] [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: 09/06/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction It is well documented that socioeconomic disadvantage adversely affects general health and ocular health worldwide. Within orthoptics, while clinicians recognise a relationship between socioeconomic situation and treatment outcome, no previous literature review was found to address this issue. Neither was a UK-specific literature review found to address the same issue for ophthalmology as a whole. Aim This literature review evaluates evidence for an association between socioeconomic situation and ophthalmic/orthoptic conditions and their treatment outcomes, specifically within the UK. Methods Keyword searches were conducted on Google Scholar and the University of Liverpool library catalogue. Results for the main analyses were limited to full papers, specific to the UK, written in English. Literature was only included from pre-2000 if more recent evidence was insufficient. Results There is evidence of socioeconomic disadvantage being associated with the following: reduced visual acuity; reduced attendance at diabetic retinopathy screening appointments; and delayed presentation of glaucoma, cataracts, and diabetic retinopathy. However, evidence linking socioeconomic disadvantage to AMD is mixed. There is limited evidence of the increased prevalence of amblyopia and subsequent barriers to its treatment for socioeconomically underserved children. There is also evidence of a reduction in quality of life for socioeconomically underserved adults with strabismus. Conclusions Health inequalities within ophthalmology and orthoptics are reported, but with confounding results for some conditions. Further research should explore the reasons behind the inequalities that are found and identify methods of reducing them.
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11
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Wei X, Li L, Jiang L, Lu H, Huang H, Zhong D, Pan L, Wei D, Han Y, Lin H, Chen Q. Comparison of the new self-contained darkroom refractive screener versus table-top autorefractor and cycloplegia retinoscopy in detecting refractive error. BMC Ophthalmol 2023; 23:487. [PMID: 38012552 PMCID: PMC10680182 DOI: 10.1186/s12886-023-03231-6] [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: 08/05/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE By comparing the results of the new self-contained darkroom refractive screener (YD-SX-A) versus table-top autorefractor and cycloplegic retinoscopy, to evaluate the performance of the YD-SX-A in detecting refractive error in children and adolescents and then judge whether it can be used in refractive screening. METHODS Cross-sectional study. 1000 participants between the ages of 6 and 18 who visited the Optometry Center of the People's Hospital of Guangxi Zhuang Autonomous Region from June to December 2022 were selected. First, participants were instructed to measure their diopter with a table-top autorefractor (Topcon KR8800) and YD-SX-A in a noncycloplegic setting. After cycloplegia, they were retinoscopy by a professional optometrist. The results measured by three methods were collected respectively. To avoid deviation, only the right eye (1000 eyes) data were used in the statistical analysis. The Bland-Altman plots were used to evaluate the agreement of diopters measured by the three methods. The receiver operating characteristic (ROC) curves was used to analysis effectiveness of detecting refractive error of YD-SX-A. RESULTS The average age of participants was 10.77 ± 3.00 years, including 504 boys (50.4%) and 496 girls (49.6%). When YD-SX-A and cycloplegia retinoscopy (CR) were compared in the myopia group, there was no statistical difference in spherical equivalent (SE) (P > 0.05), but there was a statistical difference in diopter spherical (DS) and diopter cylinder (DC) (P < 0.05). Comparing the diopter results of Topcon KR8800 and CR, the difference between each test value in the myopia group was statistically significant (P < 0.05). In the hyperopia group, the comparison between YD-SX-A and CR showed no statistically significant differences in the DC (P > 0.05), but there were significant differences in the SE and DS (P < 0.05). In the astigmatism group, the SE, DS, and DC were statistically different, and the DC of YD-SX-A was lower than that of CR and Topcon KR8800. Bland-Altman plots indicated that YD-SX-A has a moderate agreement with CR and Topcon KR8800. The sensitivity and specificity of YD-SX-A for detecting myopia, hyperopia and astigmatism were 90.17% and 90.32%, 97.78% and 87.88%, 84.08% and 74.26%, respectively. CONCLUSION This study has identified that YD-SX-A has shown good performance in both agreement and effectiveness in detecting refractive error when compared with Topcon KR8800 and CR. YD-SX-A could be a useful tool for large-scale population refractive screening.
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Affiliation(s)
- Xianxian Wei
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
- Guilin Medical University, Guilin, China
| | - Lili Li
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Li Jiang
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Haiyan Lu
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Huiyao Huang
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Dedong Zhong
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Liang Pan
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Diefeng Wei
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Yun Han
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Hong Lin
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China
| | - Qi Chen
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, China.
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12
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Antonio-Aguirre B, Ambrosino CM, Dai X, Collins ME. Addressing Health Disparities in Pediatric Eye Care for School-Age Children: A Call to Action. Transl Vis Sci Technol 2023; 12:17. [PMID: 37962540 PMCID: PMC10653256 DOI: 10.1167/tvst.12.11.17] [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: 06/30/2023] [Accepted: 09/25/2023] [Indexed: 11/15/2023] Open
Abstract
Disparities in access to pediatric eye care among school-age children pose significant challenges to their health and well-being; addressing these disparities will necessitate coordination across multiple systems. Although vision screenings are mandated in most US states, differences persist in terms of who receives screenings and subsequent follow-up care. Racial, ethnic, and socioeconomic factors exacerbate the issue, with potential ramifications of unaddressed eye problems on learning performance and the risk of widening preexisting educational disparities. To address these challenges, various initiatives and strategic plans have emphasized the need to improve access, enhance diversity in the workforce, and promote health literacy. School-based vision programs (SBVPs) have shown promise in improving access to care and academic outcomes, but issues with integration into the health care system exist. This article explores opportunities to address structural barriers, establish resilient and equitable systems for delivering pediatric eye care to school-age children, and leverage the success of SBVPs to build stronger connections with community providers. Proposed strategies include developing standardized guidelines; establishing referral mechanisms; fostering communication with parents, teachers, and community providers; and promoting eye health literacy across the school community. Collectively, these measures aim to improve health outcomes, address social determinants of health, and reduce disparities in access to care.
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Affiliation(s)
| | | | - Xi Dai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Megan E. Collins
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
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13
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Fukasaku H, Meguro A, Takeuchi M, Mizuki N, Ota M, Funakoshi K. Association of PDGFRA polymorphisms with the risk of corneal astigmatism in a Japanese population. Sci Rep 2023; 13:16075. [PMID: 37752244 PMCID: PMC10522672 DOI: 10.1038/s41598-023-43333-1] [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: 06/02/2023] [Accepted: 09/22/2023] [Indexed: 09/28/2023] Open
Abstract
Corneal astigmatism is reportedly associated with polymorphisms of the platelet-derived growth factor receptor alpha (PDGFRA) gene region in Asian populations of Chinese, Malay, and Indian ancestry and populations of European ancestry. In this study, we investigated whether these PDGFRA polymorphisms are associated with corneal astigmatism in a Japanese population. We recruited 1,535 cases with corneal astigmatism (mean corneal cylinder power across both eyes: ≤ - 0.75 diopters [D]) and 842 controls (> - 0.75 D) to genotype 13 single-nucleotide polymorphisms (SNPs) in the PDGFRA gene region. We also performed imputation analysis in the region, with 179 imputed SNPs included in the statistical analyses. The PDGFRA SNPs were not significantly associated with the cases with corneal astigmatism ≤ - 0.75 D. However, the odds ratios (ORs) of the minor alleles of SNPs in the upstream region of PDGFRA, including rs7673984, rs4864857, and rs11133315, tended to increase according to the degree of corneal astigmatism, and these SNPs were significantly associated with the cases with corneal astigmatism ≤ - 1.25 D or ≤ - 1.50 D (Pc < 0.05, OR = 1.34-1.39). These results suggest that PDGFRA SNPs play a potential role in the development of greater corneal astigmatism.
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Affiliation(s)
- Hideharu Fukasaku
- Department of Neuroanatomy, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
- Fukasaku Eye Institute, Yokohama, Kanagawa, 220-0003, Japan
| | - Akira Meguro
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan.
- Department of Advanced Medicine for Ocular Diseases, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan.
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
- Department of Advanced Medicine for Ocular Diseases, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
- Department of Advanced Medicine for Ocular Diseases, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
| | - Masao Ota
- Department of Advanced Medicine for Ocular Diseases, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
- Department of Medicine, Division of Hepatology and Gastroenterology, Shinshu University School of Medicine, Matsumoto, Nagano, 390-8621, Japan
| | - Kengo Funakoshi
- Department of Neuroanatomy, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, 236-0004, Japan
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Morrison AM, Kulp MT, Ciner EB, Mitchell GL, McDaniel CE, Hertle RW, Candy TR, Roberts TL, Peterseim MM, Granet DB, Robbins SL, Srinivasan G, Allison CL, Ying GS, Orel-Bixler D, Block SS, Moore BR. Prescribing patterns for paediatric hyperopia among paediatric eye care providers. Ophthalmic Physiol Opt 2023; 43:972-984. [PMID: 37334937 DOI: 10.1111/opo.13184] [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: 04/03/2023] [Revised: 05/18/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE To survey paediatric eye care providers to identify current patterns of prescribing for hyperopia. METHODS Paediatric eye care providers were invited, via email, to participate in a survey to evaluate current age-based refractive error prescribing practices. Questions were designed to determine which factors may influence the survey participant's prescribing pattern (e.g., patient's age, magnitude of hyperopia, patient's symptoms, heterophoria and stereopsis) and if the providers were to prescribe, how much hyperopic correction would they prescribe (e.g., full or partial prescription). The response distributions by profession (optometry and ophthalmology) were compared using the Kolmogorov-Smirnov cumulative distribution function test. RESULTS Responses were submitted by 738 participants regarding how they prescribe for their hyperopic patients. Most providers within each profession considered similar clinical factors when prescribing. The percentages of optometrists and ophthalmologists who reported considering the factor often differed significantly. Factors considered similarly by both optometrists and ophthalmologists were the presence of symptoms (98.0%, p = 0.14), presence of astigmatism and/or anisometropia (97.5%, p = 0.06) and the possibility of teasing (8.3%, p = 0.49). A wide range of prescribing was observed within each profession, with some providers reporting that they would prescribe for low levels of hyperopia while others reported that they would never prescribe. When prescribing for bilateral hyperopia in children with age-normal visual acuity and no manifest deviation or symptoms, the threshold for prescribing decreased with age for both professions, with ophthalmologists typically prescribing 1.5-2 D less than optometrists. The threshold for prescribing also decreased for both optometrists and ophthalmologists when children had associated clinical factors (e.g., esophoria or reduced near visual function). Optometrists and ophthalmologists most commonly prescribed based on cycloplegic refraction, although optometrists most commonly prescribed based on both the manifest and cycloplegic refraction for children ≥7 years. CONCLUSION Prescribing patterns for paediatric hyperopia vary significantly among eye care providers.
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Affiliation(s)
- Ann M Morrison
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | - Marjean T Kulp
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | - Elise B Ciner
- Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania, USA
| | - G Lynn Mitchell
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | | | | | - T Rowan Candy
- Indiana University Bloomington, Bloomington, Indiana, USA
| | - Tawna L Roberts
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, USA
| | - M Millicent Peterseim
- Medical University of South Carolina Albert Florens Storm Eye Institute, Charleston, South Carolina, USA
| | - David B Granet
- Viterbi Family Department of Ophthalmology, Ratner Children's Eye Center, University of California San Diego, La Jolla, California, USA
| | - Shira L Robbins
- Viterbi Family Department of Ophthalmology, Ratner Children's Eye Center, University of California San Diego, La Jolla, California, USA
| | - Gayathri Srinivasan
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, USA
| | | | - Gui-Shuang Ying
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Deborah Orel-Bixler
- Berkeley School of Optometry, University of California, Berkeley, California, USA
| | | | - Bruce R Moore
- New England College of Optometry, Boston, Massachusetts, USA
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15
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Hozumi K, Yagasaki T, Yokoyama Y, Yagasaki A, Haga Y, Eboshita R. Relationship Between Suppression Scotomas and Stereoacuity in Anisometropic Amblyopia With Successfully Treated Visual Acuity. Invest Ophthalmol Vis Sci 2023; 64:16. [PMID: 37561448 PMCID: PMC10424799 DOI: 10.1167/iovs.64.11.16] [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: 12/02/2022] [Accepted: 07/23/2023] [Indexed: 08/11/2023] Open
Abstract
Purpose The purpose of this study was to investigate the relationship among suppression scotoma size, stereoacuity, and four-prism base-out test (4ΔBOT) results in anisometropic amblyopia with successfully treated visual acuity. Methods We included 103 cases of anisometropic amblyopia successfully treated for visual acuity without strabismus. Stereoacuity was measured using a Randot Stereotest. The size of the suppression scotomas was measured using a new device, the polarized four dot (P4D) test. This is a modification of the Worth 4 dot test (W4D) device. The patients were divided into three groups based on the 4ΔBOT results: normal (group A = 29 cases), subnormal (group B = 48 cases), and abnormal (group C = 26 cases) response groups. The horizontal diameter of the suppression scotomas and stereoacuity in logarithmic values with a base of 20 seconds of arc (″) were compared among the 3 groups. Results The mean age at P4D testing was 8.4 ± 2.1 years. The average horizontal diameters of the suppression scotomas were 0.35 ± 0.79Δ, 2.01 ± 0.82Δ, and 5.50 ± 2.72Δ in groups A, B, and C, respectively, showing significant differences (A versus B: P < 0.0001, A versus C: P < 0.0001, and B versus C: P < 0.0001; 1-way ANOVA). The average logarithmic stereoacuity were 1.07 (24.95″), 1.22 (38.84″), and 1.47 (82.79″) in groups A, B, and C, respectively, thereby showing significant differences between the groups (A versus B: P < 0.0001, A versus C: P < 0.0001, and B versus C: P < 0.0001; 1-way ANOVA). Stereoacuity and horizontal diameter of the suppression scotoma were strongly correlated (r = 0.732, P < 0.0001). Conclusions The suppression scotoma size measured using P4D correlated significantly with stereoacuity and the 4ΔBOT results.
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Affiliation(s)
- Kenta Hozumi
- Department of Ophthalmology, Japan Community Health Care Organization Chukyo Hospital, Minamiku, Nagoya, Aichi, Japan
| | - Teiji Yagasaki
- Department of Ophthalmology, Japan Community Health Care Organization Chukyo Hospital, Minamiku, Nagoya, Aichi, Japan
- Yagasaki Eye Clinic, Ichinomiya, Aichi, Japan
| | - Yoshimi Yokoyama
- Department of Ophthalmology, Japan Community Health Care Organization Chukyo Hospital, Minamiku, Nagoya, Aichi, Japan
| | - Ayaka Yagasaki
- Yagasaki Eye Clinic, Ichinomiya, Aichi, Japan
- Department of Ophthalmology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Yayoi Haga
- Yagasaki Eye Clinic, Ichinomiya, Aichi, Japan
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16
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Morrison AM, Mutti DO. Evaluation of a Pilot Protocol for Detecting Infant Hyperopia. Optom Vis Sci 2023; 100:304-311. [PMID: 36951871 DOI: 10.1097/opx.0000000000002011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
SIGNIFICANCE Highly hyperopic children are at greater risk for developing conditions such as strabismus, amblyopia, and early literacy and reading problems. High hyperopia is a common finding in infants in a pediatric medical practice, and early detection can be done effectively in that setting with tropicamide autorefraction. PURPOSE This study aimed to evaluate the effectiveness of a pilot screening program to detect high hyperopia in 2-month-old infants in a pediatric medical practice in Columbus, Ohio. METHODS Cycloplegic refractive error (1% tropicamide) was measured by retinoscopy and autorefraction with the Welch Allyn SureSight (Welch Allyn/Hillrom, Skaneateles Falls, NY) in 473 infants (55.4% female) who were undergoing their 2-month well-baby visit at their pediatrician's medical practice. Cycloplegic retinoscopy (1% cyclopentolate) was repeated at a subsequent visit in 35 infants with ≥+5.00 D hyperopia in the most hyperopic meridian during the screening. RESULTS Twenty-eight infants (5.9%) had high hyperopia (spherical equivalent, ≥+5.00 D), and 61 (12.9%) had high hyperopia (≥+5.00 D in at least one meridian of at least one eye) by retinoscopy with 1% tropicamide. The mean ± standard deviation spherical equivalent tropicamide cycloplegic refractive error measured with retinoscopy was +2.54 ± 1.54 D (range, -3.25 to +7.00 D) and with SureSight was +2.29 ± 1.64 D (range, -2.90 to +7.53 D). Retinoscopy done using 1% cyclopentolate was 0.44 ± 0.54 D more hyperopic in spherical equivalent than with 1% tropicamide ( P < .001). CONCLUSIONS High hyperopia was a common finding in 2-month-old infants in a pediatric medical setting that could be detected effectively by cycloplegic autorefraction using tropicamide. Greater cooperation between pediatric primary vision and medical care could lead to effective vision screenings designed to detect high hyperopia in infants.
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Affiliation(s)
| | - Donald O Mutti
- The Ohio State University College of Optometry, Columbus, Ohio
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17
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Kam KW, Chee ASH, Tang RCY, Zhang Y, Zhang XJ, Wang YM, Li SL, Chen LJ, Young AL, Tham CC, Pang CP, Yam JC. Differential compensatory role of internal astigmatism in school children and adults: The Hong Kong Children Eye Study. Eye (Lond) 2023; 37:1107-1113. [PMID: 35473966 PMCID: PMC10102244 DOI: 10.1038/s41433-022-02072-9] [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: 09/14/2021] [Revised: 03/30/2022] [Accepted: 04/08/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To compare the prevalence of refractive (RA), corneal (CA), and internal astigmatism (IA) in Hong Kong children and adults and evaluate the role of IA in compensating for total astigmatism and its relations to myopic traits. METHODS The Hong Kong Children Eye Study is a population-based cross-sectional study. Totally 3704 school children (mean age 7.5 ± 1.0 years) and 5577 adults (mean age 41.1 ± 7.5 years), who were their parents, were recruited. Cycloplegic and non-cycloplegic refractive cylinders were obtained from children and adults, respectively. Spearman correlation was applied to detect associations between astigmatism, ocular biometrics, refraction, and lens power. Astigmatism compensation factor (CF) was derived from the power vector analysis J0 and J45. RESULTS The prevalence of RA (≤-1.0 D), CA (≥+1.0 D) and IA (≥+1.0 D) was 21.9%, 63.9%, and 9.9% in children, and 30.9%, 39.5%, and 23.7% in adults respectively. The mean RA, CA and IA values in children and adults were -0.69 ± 0.66 D, +1.14 ± 0.61 D, +0.62 ± 0.32 D, and -0.80 ± 0.74 D, +0.97 ± 0.69 D, and +0.76 ± 0.43 D, respectively. In adults and children, IA was negatively correlated with axial length (p < 0.0001), but positively correlated with spherical values and equivalent (p < 0.0001), suggesting an association of astigmatism with myopic traits. A greater proportion of children exhibited compensation by IA than adults in J0 (86.6% vs. 66.0%, p < 0.0001) and J45 components (55.5% vs. 41.7%, p < 0.0001). CONCLUSIONS Chinese children in Hong Kong exhibit a higher prevalence of RA and CA than in other cities. Children displayed a greater compensation by IA than adults, suggesting an age-related attenuation of IA compensation. IA is associated with myopic traits.
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Affiliation(s)
- Ka Wai Kam
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Arnold Shau Hei Chee
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Rex Chin Yung Tang
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuzhou Zhang
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiu Juan Zhang
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Yu Meng Wang
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Sophia Ling Li
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Alvin L Young
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Clement C Tham
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong, China
| | - Chi Pui Pang
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason C Yam
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.
- Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital, Hong Kong, China.
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.
- Hong Kong Eye Hospital, Hong Kong, China.
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong, China.
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18
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Shah R, Edgar DF, Evans BJW. Worsening vision at age 4-5 in England post-COVID: Evidence from a large database of vision screening data. Ophthalmic Physiol Opt 2023; 43:454-465. [PMID: 36866712 DOI: 10.1111/opo.13112] [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: 09/28/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Myopia prevalence has increased in the UK at age 10-16y, but little is known about younger children. We hypothesise that if the 'myopia epidemic' is affecting young children, then there will be increasing rates of bilateral reduced unaided vision (V) at vision screenings of children 4-5 years of age. METHODS Retrospective anonymised data from computerised vision screening at age 4-5 years were analysed from serial cross-sectional data. Refractive error is not assessed in UK vision screening, so vision was investigated. Data were only included from schools that screened every year from 2015/16 to 2021/22. The criterion used was unaided monocular logMAR (automated letter-by-letter scoring) vision >0.20 in both the right and left eyes, so as to maximise the chances of detecting bilateral, moderate myopia rather than amblyopia. RESULTS Anonymised raw data were obtained for 359,634 screening episodes from 2075 schools. Once schools were excluded where data were not available for every year and data were cleaned, the final database comprised 110,076 episodes. The proportion (percentage and 95% CI) failing the criterion from 2015/16 to 2021/22 were 7.6 (7.2-8.0), 8.5 (8.1-8.9), 7.5 (7.1-7.9), 7.8 (7.4-8.2), 8.7 (8.1-9.2), 8.5 (7.9-9.0) and 9.3 (8.8-9.7), respectively. The slope of the regression line showed a trend for increasing rates of reduced bilateral unaided vision, consistent with increasing frequency of myopia (p = 0.06). A decreasing linear trendline was noted for children 'Under Professional Care'. CONCLUSIONS For children 4-5 years of age, there were signs of reduced vision over the last 7 years in England. Consideration of the most likely causes support the hypothesis of increasing myopia. The increase in screening failures highlights the importance of eye care in this young population.
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Affiliation(s)
- Rakhee Shah
- Institute of Optometry, London, UK.,Centre for Applied Vision Research, City, University of London, London, UK
| | - David F Edgar
- Institute of Optometry, London, UK.,Centre for Applied Vision Research, City, University of London, London, UK
| | - Bruce J W Evans
- Institute of Optometry, London, UK.,Centre for Applied Vision Research, City, University of London, London, UK
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Gordon-Shaag A, Ben-Eli H, Sztrigler Cohen O, Toledano M, Benyamin A, Stein-Zamir C. Adherence to referrals from preschool vision screening and identification of barriers for non-adherence in Israel. Clin Exp Optom 2023; 106:202-210. [PMID: 35970195 DOI: 10.1080/08164622.2022.2107891] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
CLINICAL RELEVANCE Preschool vision screening is essential for the early detection and treatment of eye and vision problems. BACKGROUND The rate of parental adherence to referrals for comprehensive examination was assessed and factors and potential barriers associated with adherence were identified. METHODS In a prospective cohort study design, parents were offered to bring their 3-6 year old aged children to free-of-charge vision screening tests at community-based Mother Child Health Centers. Children with abnormal findings were referred to an ophthalmologist examination. Parents were interviewed three to six months after the referral to evaluate adherence and barriers. Barriers were organised into a conceptual framework of parental predisposing and health system factors. Adherence and barriers were assessed by sex, age, ethnic group and socio-economic-status. RESULTS Altogether 1283 children (mean age 4.5 ± 0.6 years, 47.8% girls) were screened in the Jerusalem district, Israel. The ethnic groups, Jewish (ultra-Orthodox 51.4%, secular/religious 33.2%) and Arab (15.4%), were similar by age and sex, but not by socio-economic status. The overall referral rate was 23.0% (N = 295). Referral rate was not associated with demographic factors. Overall, 54.3% (N = 160) of parents adhered to the referral to bring the child for a full eye examination. Adherence did not differ with sex, ethnicity or socio-economic-status. Parents of 5-6-year-old children were significantly more likely to adhere than parents of younger children. Of parents who did not adhere, 79.3% were attributed to predisposing factors, 16.3% to system factors and 4.4% to other reasons. CONCLUSIONS Only half the parents proceeded with the recommended full eye examination. Parents of older children were more likely to adhere to referral. In contrast with vaccinations provided by Mother Child Health Centers, adherence to vision screening did not vary based on ethnicity or socio-economic factors. Since most barriers were associated with predisposing factors of parents, interventions to improve adherence should include parental education.
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Affiliation(s)
- Ariela Gordon-Shaag
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
| | - Hadas Ben-Eli
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
| | - Orit Sztrigler Cohen
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
| | - Monique Toledano
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Aviya Benyamin
- Department of Ophthalmology, Hadassah Medical Organization, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Chen Stein-Zamir
- Braun School of Public and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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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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21
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Peterseim MMW, Trivedi RH, Monahan SR, Smith SM, Bowsher JD, Alex A, Wilson ME, Wolf BJ. Effectiveness of the Spot Vision Screener using updated 2021 AAPOS guidelines. J AAPOS 2023; 27:24.e1-24.e7. [PMID: 36642243 PMCID: PMC10251219 DOI: 10.1016/j.jaapos.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate the Spot Vision Screener according to updated 2021 AAPOS Vision Screening Committee guidelines for instrument-based pediatric vision screen validation. METHODS As part of an IRB-approved ongoing prospective study, children were screened with the Spot prior to a complete examination. RESULTS Spot screening was successful in 1,036 of 1,090 children (95%). Forty-eight percent of participants were referred for further screening using the Spot manufacturer guidelines, and 40% of all children were found to have a 2021 amblyopia risk factor or visually significant refractive error by gold standard examination. The Spot recommendation compared reasonably well to the 2021 criteria, with an overall sensitivity of 0.88 and a specificity of 0.78. Applying updated guidelines to the Spot for hyperopia, anisometropia, and astigmatism yielded moderate-to-poor sensitivity (0.27-0.77) but excellent specificity (>0.9). The area under the curve of the receiver operating characteristic analysis demonstrates overall good prediction performance for the Spot for each diagnosis-myopia, hyperopia, astigmatism, anisometropia (range, 0.87-0.97). Results of our study suggest increasing the instrument referral criterion for astigmatism from 1.5 D (manufacturer thresholds of the screener used in this study) to 2 D in older children. Decreasing the anisometropia cut-off from 1 D to 0.75 D would improve sensitivity from 0.59 to >0.8. CONCLUSIONS In our study population, the overall predictive ability of the Spot is good, with a sensitivity of 0.88 and a specificity of 0.78. We recommend specific device refractive referral criteria to maximize screening effectiveness using the updated AAPOS guidelines.
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Affiliation(s)
| | - Rupal H Trivedi
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Samantha M Smith
- Medical University of South Carolina, Charleston, South Carolina
| | - James D Bowsher
- Medical University of South Carolina, Charleston, South Carolina
| | - Anastasia Alex
- Medical University of South Carolina, Charleston, South Carolina
| | - M Edward Wilson
- Medical University of South Carolina, Charleston, South Carolina
| | - Bethany J Wolf
- Medical University of South Carolina, Charleston, South Carolina
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22
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Asare AO, Maurer D, Wong AMF, Saunders N, Ungar WJ. Cost-effectiveness of Universal School- and Community-Based Vision Testing Strategies to Detect Amblyopia in Children in Ontario, Canada. JAMA Netw Open 2023; 6:e2249384. [PMID: 36598785 PMCID: PMC9857467 DOI: 10.1001/jamanetworkopen.2022.49384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Screening for amblyopia in primary care visits is recommended for young children, yet screening rates are poor. Although the prevalence of amblyopia is low (3%-5%) among young children, universal screening in schools and mandatory optometric examinations may improve vision care, but the cost-effectiveness of these vision testing strategies compared with the standard in primary care is unknown. OBJECTIVE To evaluate the relative cost-effectiveness of universal school screening and mandated optometric examinations compared with standard care vision screening in primary care visits in Toronto, Canada, with the aim of detecting and facilitating treatment of amblyopia and amblyopia risk factors from the Ontario government's perspective. DESIGN, SETTING, AND PARTICIPANTS An economic evaluation was conducted from July 2019 to May 2021 using a Markov model to compare 15-year costs and quality-adjusted life-years (QALYs) between school screening and optometric examination compared with primary care screening in Toronto, Canada. Parameters were derived from published literature, the Ontario Schedule of Benefits and Fees, and the Kindergarten Vision Testing Program. A hypothetical cohort of 25 000 children aged 3 to 5 years was simulated. It was assumed that children in the cohort had irreversible vision impairment if not diagnosed by an optometrist. In addition, incremental costs and outcomes of 0 were adjusted to favor the reference strategy. Vision testing programs were designed to detect amblyopia and amblyopia risk factors. MAIN OUTCOMES AND MEASURES For each strategy, the mean costs per child included the costs of screening, optometric examinations, and treatment. The mean health benefits (QALYs) gained were informed by the presence of vision impairment and the benefits of treatment. Incremental cost-effectiveness ratios were calculated for each alternative strategy relative to the standard primary care screening strategy as the additional cost required to achieve an additional QALY at a willingness-to-pay threshold of $50 000 Canadian dollars (CAD) ($37 690) per QALY gained. RESULTS School screening relative to primary care screening yielded cost savings of CAD $84.09 (95% CI, CAD $82.22-$85.95) (US $63.38 [95% CI, US $61.97-$64.78]) per child and an incremental gain of 0.0004 (95% CI, -0.0047 to 0.0055) QALYs per child. Optometric examinations relative to primary care screening yielded cost savings of CAD $74.47 (95% CI, CAD $72.90-$76.03) (US $56.13 [95% CI, $54.95-$57.30]) per child and an incremental gain of 0.0508 (95% CI, 0.0455-0.0561) QALYs per child. At a willingness-to-pay threshold of CAD $50 000 (US $37 690) per QALY gained, school screening and optometric examinations were cost-effective relative to primary care screening in only 20% and 29% of iterations, respectively. CONCLUSIONS AND RELEVANCE In this study, because amblyopia prevalence is low among young children and most children in the hypothetical cohort had healthy vision, universal school screening and optometric examinations were not cost-effective relative to primary care screening for detecting amblyopia in young children in Toronto, Canada. The mean added health benefits of school screening and optometric examinations compared with primary care screening did not warrant the resources used.
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Affiliation(s)
- Afua Oteng Asare
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Program of Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- John Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City
| | - Daphne Maurer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Agnes M. F. Wong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Program of Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Saunders
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Wendy J. Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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23
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Kam KW, Chee ASH, Zhang Y, Tang RCY, Chan JTC, Zhang XJ, Wang YM, Chan RCF, Chu WK, Ip P, Young AL, Tham CC, Pang CP, Chen LJ, Yam JC. Association of Maternal and Paternal Astigmatism With Child Astigmatism in the Hong Kong Children Eye Study. JAMA Netw Open 2022; 5:e2247795. [PMID: 36542383 PMCID: PMC9856878 DOI: 10.1001/jamanetworkopen.2022.47795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Parental astigmatism is a factor associated with risk for development of child astigmatism; however, the magnitude of the association has not been determined. OBJECTIVE To determine the association between parental and child astigmatism. DESIGN, SETTING, AND PARTICIPANTS This population-based, cross-sectional study included participants from familial trios, each comprising a child aged 6 to 8 years and both parents, recruited from the Hong Kong Children Eye Study. No restriction criteria were set on the children in terms of refractive status. Data were analyzed from February to June 2022. EXPOSURES Cycloplegic autorefraction and autokeratometry were conducted on the children, whereas noncycloplegic autorefraction and autokeratometry were conducted on their parents. The children were categorized into 6 groups on the basis of the severity of astigmatism of both parents. Information on parental education, family income, and children's outdoor and near work time were obtained by questionnaires. MAIN OUTCOMES AND MEASURES The primary outcome was the odds of child astigmatism among the 6 categories of children. Associations of factors with child astigmatism were evaluated by logistic regression analyses. RESULTS A total of 17 124 participants from 5708 trios (2964 boys and 2754 girls) at a mean (SD) age of 7.32 (0.87) years, and 11 416 parents were examined. Astigmatism of 1.0 D or greater in both parents was associated with greater odds of refractive astigmatism (RA) (odds ratio [OR], 1.62; 95% CI, 1.15-2.26) and corneal astigmatism (CA) (OR, 1.94; 95% CI, 1.50-2.50) in the child. The respective ORs increased to 3.10 (95% CI, 1.34-7.21) and 4.31 (95% CI, 1.76-10.55) when both parents had astigmatism 2.0 D or greater. Higher parental astigmatism conferred higher risks for both RA and CA in children (P for trend <.001). Parental astigmatism was significantly associated with greater odds of corresponding child astigmatism (maternal RA: OR, 0.76; 95% CI, 0.68-0.84; paternal RA: OR, 0.82; 95% CI, 0.74-0.91; maternal CA: OR, 1.70; 95% CI, 1.51-1.93; paternal CA: OR, 1.33; 95% CI, 1.19-1.49). CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study suggest that parental astigmatism may confer an independent and dose-dependent association with child astigmatism. Children with parents with astigmatism should have early eye examinations for timely detection of astigmatism to facilitate age-appropriate vision correction and visual development.
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Affiliation(s)
- Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Arnold S. H. Chee
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Rex C. Y. Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Jason T. C. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Yu Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Ryan C. F. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China
| | - Wai Kit Chu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Alvin L. Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Clement C. Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C. Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong SAR, China
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Genetic causal inference between amblyopia and perinatal factors. Sci Rep 2022; 12:18050. [PMID: 36302817 PMCID: PMC9613760 DOI: 10.1038/s41598-022-22121-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/10/2022] [Indexed: 01/24/2023] Open
Abstract
Amblyopia is a common visual disorder that causes significant vision problems globally. Most non-ocular risk factors for amblyopia are closely related to the intrauterine environment, and are strongly influenced by parent-origin effects. Parent-origin perinatal factors may have a direct causal inference on amblyopia development; therefore, we investigated the causal association between perinatal factors and amblyopia risk using a one-sample Mendelian Randomization (MR) with data from the UK Biobank Cohort Data (UKBB). Four distinct MR methods were employed to analyze the association between three perinatal factors (birth weight [BW], maternal smoking, and breastfeeding) and amblyopia risk, based on the summary statistics of genome-wide association studies in the European population. The inverse variance weighting method showed an inverse causal association between BW and amblyopia risk (odds ratio, 0.48 [95% CI, 0.29-0.80]; p = 0.004). Maternal smoking and breastfeeding were not causally associated with amblyopia risk. Our findings provided a possible evidence of a significant genetic causal association between low BW and increased amblyopia risk. This evidence may highlight the potential of BW as a predictive factor for visual maldevelopment and the need for careful management of amblyopia risk in patients with low BW.
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Morjaria P, Massie J, Bastawrous A. A School Eye Health Rapid Assessment (SEHRA) planning tool: Module to survey the magnitude and nature of local needs. BMC Public Health 2022; 22:1665. [PMID: 36056322 PMCID: PMC9437397 DOI: 10.1186/s12889-022-13927-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/01/2022] [Indexed: 01/09/2023] Open
Abstract
Background Eye conditions in children can have negative consequences on visual functioning and quality of life. There is a lack of data on the magnitude of children with eye conditions who need services for effective planning of school eye health programmes. To address this, the School Eye Health Rapid Assessment (SEHRA) tool is being developed to collect data to support school eye health programme planning. Methods The module, ‘the magnitude and nature of local needs in school children’ is the first of six modules in the SEHRA tool. The module outlines a school-based cluster survey designed to determine the magnitude of eye health needs in children. This paper outlines the survey sampling strategy, and sample size calculations. Results The requirements for the SEHRA survey indicate that in regions where a larger sample size is required, or where fewer schools are recruited to the survey, confidence in the accuracy of the data will be lower. Conclusions The SEHRA survey module ‘the magnitude and nature of local needs in school children’ can be applied in any context. In certain circumstances, the confidence in the survey data will be reduced. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13927-x.
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Affiliation(s)
- Priya Morjaria
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK. .,Peek Vision, London, UK.
| | - Jessica Massie
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.,Peek Vision, London, UK
| | - Andrew Bastawrous
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.,Peek Vision, London, UK
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Stoll N, Di Foggia E, Speeg-Schatz C, Meunier H, Rimele A, Ancé P, Moreau PH, Sauer A. Development and validation of a new method for visual acuity assesment on tablet in pediatric population: eMOVA test. BMC Ophthalmol 2022; 22:180. [PMID: 35439959 PMCID: PMC9020062 DOI: 10.1186/s12886-022-02360-8] [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: 03/19/2020] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Amblyopia is a major public health concern. Its screening and management require reliable methods of visual acuity assessment. New technologies offer nowadays many tests available on different app stores for smartphone or tablet but most of them often lack of scientific validation for a medical use. The aim of our study was to attempt validating a tablet-based near visual acuity test adapted to the pediatric population: the eMOVA test (electronic Measurement Of Visual Acuity) by comparing visual acuity measured with more conventional test. METHODS A cohort of 100 children aged 3 to 8 attending the ophthalmic-pediatric for eye examination between September 2016 and June 2017 were included in the study. Near visual acuity was assessed on participants using both the eMOVA test and a Standard test (Rossano-Weiss test). Duration of each test, its comprehension, its acceptability and the attention of the child during the test was also investigated. RESULTS The eMOVA test overestimated near visual acuity by 0.06 logMAR. This difference, statistically significant, was not clinically relevant. The duration of the eMOVA test was longer than the reference test, but less discomfort and preferred by children and their parents compared to standard tests. CONCLUSION The eMOVA test appears as a reliable test to assess near visual acuity in children. By its portability and efficiency, this application proved to be a relevant tool to be used for children eye examination in daily routine at the hospital.
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Affiliation(s)
- Noémie Stoll
- Three borders ophthalmologic center, 76 rue de Battenheim, 68170, Rixheim, France.
| | - Elsa Di Foggia
- Colmar Civil Hospitals, 39 avenue de la Liberté, 68000, Colmar, France
| | - Claude Speeg-Schatz
- University professor, University hospitals of Strasbourg, 1 quai Louis Pasteur, 67000, Strasbourg, France
| | - Hélène Meunier
- Cognitive and Adaptative Neuroscience Laboratory, Strasbourg University, 67000, Strasbourg, Alsace, France
| | - Adam Rimele
- SILABE Platform, Strasbourg University, Fort Foch, 67207, Niederhausbergen, France
| | - Pascal Ancé
- SILABE Platform, Strasbourg University, Fort Foch, 67207, Niederhausbergen, France
| | - Pierre-Henri Moreau
- SILABE Platform, Strasbourg University, Fort Foch, 67207, Niederhausbergen, France
| | - Arnaud Sauer
- University professor, University hospitals of Strasbourg, 1 quai Louis Pasteur, 67000, Strasbourg, France
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Moore M, Loughman J, Butler JS, Ohlendorf A, Wahl S, Flitcroft DI. The Refractive Error and Vision Impairment Estimation with Spectacle Data Study. OPHTHALMOLOGY SCIENCE 2022; 2:100092. [PMID: 36246180 PMCID: PMC9562346 DOI: 10.1016/j.xops.2021.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/23/2021] [Accepted: 12/13/2021] [Indexed: 11/08/2022]
Abstract
Purpose To investigate whether spectacle lens sales data can be used to estimate the population distribution of refractive error among patients with ametropia and hence to estimate the current and future risk of vision impairment. Design Cross-sectional study. Participants A total of 141 547 436 spectacle lens sales records from an international European lens manufacturer between 1998 and 2016. Methods Anonymized patient spectacle lens sales data, including refractive error information, was provided by a major European spectacle lens manufacturer. Data from the Gutenberg Health Survey was digitized to allow comparison of a representative, population-based sample with the spectacle lens sales data. A bootstrap analysis was completed to assess the comparability of both datasets. The expected level of vision impairment resulting from myopia at 75 years of age was calculated for both datasets using a previously published risk estimation equation combined with a saturation function. Main Outcome Measures Comparability of spectacle lens sales data on refractive error with typical population surveys of refractive error and its potential usefulness to predict vision impairment resulting from refractive error. Results Equivalent estimates of the population distribution of spherical equivalent refraction can be provided from spectacle lens data within limits. For myopia, the population distribution was equivalent to the Gutenberg Health Survey (≤ 5% deviation) for levels of –2.0 diopters (D) or less, whereas for hyperopia, the distribution was equivalent (≤ 5% deviation) for levels of +3.0 D or more. The estimated rates of vision impairment resulting from myopia were not statistically significantly different (chi-square, 182; degrees of freedom, 169; P = 0.234) between the spectacle lens dataset and Gutenberg Health Survey dataset. Conclusions The distribution of refractive error and hence the risk of vision impairment resulting from refractive error within a population can be determined using spectacle lens sales data. Pooling this type of data from multiple industry sources could provide a cost-effective, timely, and globally representative mechanism for monitoring the evolving epidemiologic features of refractive error and associated vision impairment.
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Maguire MG, Ying GS, Ciner EB, Kulp MT, Candy TR, Moore B. Detection of Significant Hyperopia in Preschool Children Using Two Automated Vision Screeners. Optom Vis Sci 2022; 99:114-120. [PMID: 34889862 PMCID: PMC8816853 DOI: 10.1097/opx.0000000000001837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
SIGNIFICANCE Moderate to high uncorrected hyperopia in preschool children is associated with amblyopia, strabismus, reduced visual function, and reduced literacy. Detecting significant hyperopia during screening is important to allow children to be followed for development of amblyopia or strabismus and implementation of any needed ophthalmic or educational interventions. PURPOSE This study aimed to compare the sensitivity and specificity of two automated screening devices to identify preschool children with moderate to high hyperopia. METHODS Children in the Vision in Preschoolers (VIP) study were screened with the Retinomax Autorefractor (Nikon, Inc., Melville, NY) and Plusoptix Power Refractor II (Plusoptix, Nuremberg, Germany) and examined by masked eye care professionals to detect the targeted conditions of amblyopia, strabismus, or significant refractive error, and reduced visual acuity. Significant hyperopia (American Association for Pediatric Ophthalmology and Strabismus definition of hyperopia as an amblyopia risk factor), based on cycloplegic retinoscopy, was >4.00 D for age 36 to 48 months and >3.50 D for age older than 48 months. Referral criteria from VIP for each device and from a distributor (PediaVision) for the Power Refractor II were applied to screening results. RESULTS Among 1430 children, 132 children had significant hyperopia in at least one eye. Using the VIP referral criteria, sensitivities for significant hyperopia were 80.3% for the Retinomax and 69.7% for the Power Refractor II (difference, 10.6%; 95% confidence interval, 7.0 to 20.5%; P = .04); specificities relative to any targeted condition were 89.9 and 89.1%, respectively. Using the PediaVision referral criteria for the Power Refractor, sensitivity for significant hyperopia was 84.9%; however, specificity relative to any targeted condition was 78.3%, 11.6% lower than the specificity for the Retinomax. Analyses using the VIP definition of significant hyperopia yielded results similar to when the American Association for Pediatric Ophthalmology and Strabismus definition was used. DISCUSSION When implementing vision screening programs for preschool children, the potential for automated devices that use eccentric photorefraction to either miss detecting significant hyperopia or increase false-positive referrals must be taken into consideration.
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Affiliation(s)
| | - Gui-Shuang Ying
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elise B Ciner
- Pennsylvania College of Optometry at Salus University, Elkins Park, Pennsylvania
| | | | - T Rowan Candy
- Indiana University School of Optometry, Bloomington, Indiana
| | - Bruce Moore
- New England College of Optometry, Boston, Massachusetts
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Mdala S, Zungu T, Manda C, Namate C, Fernando E, Twabi HS, Msukwa G, Kayange PC. Profile of primary childhood glaucoma at a child eye health tertiary facility in Malawi. BMC Ophthalmol 2022; 22:45. [PMID: 35101025 PMCID: PMC8805399 DOI: 10.1186/s12886-022-02279-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To describe the clinical characteristics and treatment of primary childhood glaucoma at Queen Elizabeth Central Hospital in Blantyre, Malawi. METHODS A retrospective case notes review was undertaken of all medical records of patients aged less than 16 years with a diagnosis of primary glaucoma according to the Childhood Glaucoma Research Network Classification (CGRN) who presented from January 2016 to December 2018. The parameters extracted from the case files included age at presentation, sex, type of glaucoma, presenting complaints, laterality of ocular involvement, examination findings and the treatment modality instituted. The Mann-Whitney test was used to investigate factors associated with the intraocular pressure (IOP) in eyes that had a higher presenting IOP value compared to contralateral eyes. RESULTS A total of 45 subjects (80 eyes) were identified, 42 with primary congenital glaucoma (PCG) and 3 with juvenile open angle glaucoma (JOAG). The mean age for the population was 2.6 years (S.D ± 3.7) and most of the patients were male, with a male-female ratio of 2:1. The majority of patients had bilateral disease (n = 35, 77.8%) with the commonest presenting complaint being a whitish appearance of the eye (57.5%). The eyes studied had a mean IOP of 30.1 mmHg (CI 27.4-32.9), a mean horizontal corneal diameter (HCD) of 13.6 mm (CI 13.1-14.2) and a mean cup-disc-ratio `(CDR) of 0.73 (CI 0.66-0.79). In addition, 62 eyes (77.5%) had corneal haze on examination. Most patients (n = 59, 73.8%) underwent a combined trabeculotomy - trabeculectomy surgery within the study period. The median presenting IOP was significantly higher with JOAG compared to PCG (P = 0.02). CONCLUSION PCG was the most common primary childhood glaucoma at Queen Elizabeth Central Hospital and most patients presented with bilateral eye involvement. Most of the eyes had corneal haze and JOAG was associated with a higher presenting IOP compared to PCG. Further studies to investigate the outcomes of combined trabeculotomy - trabeculectomy surgery in primary childhood glaucoma in Malawi are recommended.
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Affiliation(s)
- Shaffi Mdala
- Kamuzu University of Health Sciences, Blantyre, Malawi. .,Queen Elizabeth Central Hospital, Blantyre, Malawi.
| | - Thokozani Zungu
- Kamuzu University of Health Sciences, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Chatonda Manda
- Kamuzu University of Health Sciences, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Chinsisi Namate
- Kamuzu University of Health Sciences, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | | | | | - Petros Cyrus Kayange
- Kamuzu University of Health Sciences, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Blantyre, Malawi
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Kulp MT, Ciner E, Ying GS, Candy TR, Moore BD, Orel-Bixler D. Vision Screening, Vision Disorders, and Impacts of Hyperopia in Young Children: Outcomes of the Vision in Preschoolers (VIP) and Vision in Preschoolers - Hyperopia in Preschoolers (VIP-HIP) Studies. Asia Pac J Ophthalmol (Phila) 2022; 11:52-58. [PMID: 35044337 PMCID: PMC8813881 DOI: 10.1097/apo.0000000000000483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT This review summarizes clinically relevant outcomes from the Vision in Preschoolers (VIP) and VIP-Hyperopia in Preschoolers (VIP-HIP) studies. In VIP, refraction tests (retinoscopy, Retinomax, SureSight) and Lea Symbols Visual Acuity performed best in identifying children with vision disorders. For lay screeners, Lea Symbols single, crowded visual acuity (VA) testing (VIP, 5-foot) was significantly better than linear, crowded testing (10-foot). Children unable to perform the tests (<2%) were more likely to have vision disorders than children who passed and should be referred for vision evaluation. Among racial/ethnic groups, the prevalence of amblyopia and strabismus was similar while that of hyperopia, astigmatism, and anisometropia varied. The presence of strabismus and significant refractive errors were risk factors for unilateral amblyopia, while bilateral astigmatism and bilateral hyperopia were risk factors for bilateral amblyopia. A greater risk of astigmatism was associated with Hispanic, African American, and Asian race, and myopic and hyperopic refractive error. The presence and severity of hyperopia were associated with higher rates of amblyopia, strabismus, and other associated refractive error. In the VIP-HIP study, compared to emmetropes, meaningful deficits in early literacy were observed in uncorrected hyperopic 4- and 5-year-olds [≥+4.0 diopter (D) or ≥+3.0 D to ≤+6.0 D associated with reduced near visual function (near VA 20/40 or worse; stereoacuity worse than 240")]. Hyperopia with reduced near visual function also was associated with attention deficits. Compared to emmetropic children, VA (distance, near), accommodative accuracy, and stereoacuity were significantly reduced in moderate hyperopes, with the greatest risk in those with higher hyperopia. Increasing hyperopia was associated with decreasing visual function.
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Affiliation(s)
| | - Elise Ciner
- Pennsylvania College of Optometry at Salus University, Elkins Park, PA, US
| | | | - T Rowan Candy
- Indiana University School of Optometry, Bloomington, IN, US
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Hu B, Liu Z, Zhao J, Zeng L, Hao G, Shui D, Mao K. The Global Prevalence of Amblyopia in Children: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:819998. [PMID: 35601430 PMCID: PMC9114436 DOI: 10.3389/fped.2022.819998] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/15/2022] [Indexed: 01/15/2023] Open
Abstract
Epidemiological data about the prevalence of amblyopia around the world vary widely among regions and periods. This meta-analysis aimed to determine the global prevalence of amblyopia in children. PubMed, Embase, and the Cochrane Library were searched for prevalence studies published up to 5 November 2021. The outcome was the prevalence of amblyopia, analyzed as pooled estimates with 95% confidence intervals (CI). A total of 97 studies were included, including 4,645,274 children and 7,706 patients with amblyopia. The overall worldwide pooled prevalence of amblyopia was 1.36% (95%CI: 1.27-1.46%). The prevalence of amblyopia was higher in males (1.40%, 95%CI: 1.10-1.70%) than in females (1.24%, 95%CI: 0.94-1.54%) (OR = 0.885, 95%CI: 0.795-0.985, P = 0.025). The results of the meta-regression analysis showed that there were no significant associations between the prevalence of amblyopia and geographical area, publication year, age, sample size, and whether it was carried out in a developed or developing country (all P > 0.05). Begg's test (P = 0.065) and Egger's test (P < 0.001) showed that there was a significant publication bias in the prevalence of amblyopia. In conclusion, amblyopia is a significant vision problem worldwide, and public health strategies of early screening, treatment, and management are important.
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Affiliation(s)
- Budan Hu
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, China
| | - Zongshun Liu
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, China
| | - Jiao Zhao
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, China
| | - Li Zeng
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, China
| | - Gengsheng Hao
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, China
| | - Dan Shui
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, China
| | - Ke Mao
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, China
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Zhang XJ, Wong PPY, Wong ES, Kam KW, Yip BHK, Zhang Y, Zhang W, Young AL, Chen LJ, Ip P, Tham CC, Pang CP, Yam JC. Delayed Diagnosis of Amblyopia in Children of Lower Socioeconomic Families: The Hong Kong Children Eye Study. Ophthalmic Epidemiol 2021; 29:621-628. [PMID: 34620042 DOI: 10.1080/09286586.2021.1986551] [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: 10/20/2022]
Abstract
AIMS To determine the prevalence of amblyopia and the factors associated with delayed diagnosis among school-aged children in Hong Kong. METHODS Completed comprehensive ophthalmoscopic examinations were conducted among 4.273 children aged 6-8 years in the population-based Hong Kong Children Eye Study. New and previous diagnoses of amblyopia were identified. Socioeconomic status was surveyed through questionnaires. RESULTS According to criteria from the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS), amblyopia was present in 43 out of 4,273 children (1.01%; 95% CI, 0.71-1.31). Among them, 33 (0.77%) were newly detected cases that were more likely from families living in Public Rental Housing or subdivided flats (OR, 4.22; P = .012), with lower paternal (OR 6.68, P = .008) and maternal education levels (OR, 4.38; P = .039). Multivariate analysis revealed associations of amblyopia with hyperopia (≥+2.00D; OR, 6.23; 95% CI, 2.86-13.56, P < .001), astigmatism (≥+2.00D; OR, 24.88; 95% CI, 10.69-57.91, P < .001) and anisometropia (≥2.00D; OR, 14.49; 95% CI, 5.93-37.63, P < .001). CONCLUSION These children with delayed diagnoses of amblyopia were more likely to come from lower socioeconomic backgrounds. Public education aimed at increasing awareness and utilization of child vision screening among such families is needed.
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Affiliation(s)
- Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Tianjin Eye Hospital, Tianjin, China
| | - Posey Po-Yin Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Emily S Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Benjamin Hon Kei Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Wei Zhang
- Tianjin Eye Hospital, Tianjin, China
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Lks Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Tianjin Eye Hospital, Tianjin, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Kowloon, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
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33
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Poole KJ, Derouin A, Yap TL, Thompson JA. Implementation of Photoscreening to Improve the Preschool Vision Screening Process. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kapoor V, Shah SP, Beckman T, Gole G. Community based vision screening in preschool children; performance of the Spot Vision Screener and optotype testing. Ophthalmic Epidemiol 2021; 29:417-425. [PMID: 34423736 DOI: 10.1080/09286586.2021.1962918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Children's vision screening children commonly uses optotype-based visual acuity or instrument-based methods measuring amblyogenic risk factors (ARFs). OBJECTIVE To compare the performance of the Spot Vision Screener (SVS) (PediaVision, Welch Allyn, NY) and a nurse-administered visual acuity screen (NVAS) in identifying ARFs and decreased visual acuity. METHODS A prospective, cross-sectional population-based study of preschool children in South-East Queensland, Australia. Eligible participants had both forms of screening by trained community nurses. All children with an abnormal result by either method as well as a cohort of randomly selected children who passed both assessments were assessed at a tertiary paediatric ophthalmology clinic. RESULTS Over a 10 month period, 2237 children (mean age; 64.4 ± 4.0 months) were screened from 38 schools. 6.4% of children failed SVS and 8.3% failed NVAS (with 3.8% overlap, failing both). The positive predictive value (PPV) in identifying either ARFs and/or reduced VA for the SVS and NVAS was 70.4% (95% Confidence Interval (CI): 61.6%-78.2%) and 60.5% (95% CI: 52.6%-67.9%) respectively. Highest PPV to detect either ARFs and/or reduced VA was achieved by a 'hybrid' method by combining failed NVAS and failed SVS: 91.0% (95% CI: 82.4 to 96.3) but this would risk children with sight impairment being missed in the community. CONCLUSION To our knowledge, this is the first population-based study providing detailed comparative measures of diagnostic accuracy for NVAS and SVS in preschool children. One in ten preschool children failed one or both screens. A number of children who required ophthalmic intervention were missed if only one screening method was utilized.
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Affiliation(s)
- Vishal Kapoor
- Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Australia.,Department of Paediatric Medicine, QLD Children's Hospital, Brisbane, Australia
| | - Shaheen P Shah
- Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Australia.,Department of Ophthalmology, QLD Children's Hospital, Brisbane, Australia
| | - Timothy Beckman
- Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Australia.,Department of Ophthalmology, QLD Children's Hospital, Brisbane, Australia
| | - Glen Gole
- Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Australia.,Department of Ophthalmology, QLD Children's Hospital, Brisbane, Australia
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Shi T, Zhang W, Chen S, Xia H, Chen H. Reduced Photoreceptor Outer Segment Layer Thickness and Association with Vision in Amblyopic Children and Adolescents with Unilateral High Myopia. Curr Eye Res 2021; 46:1892-1899. [PMID: 34112034 DOI: 10.1080/02713683.2021.1942072] [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: 10/21/2022]
Abstract
PURPOSE To quantitatively compare reflectivity and other morphological changes of the photoreceptors of normal eyes with amblyopic eyes using the longitudinal reflectance profile (LRP) on swept-source optical coherence tomography (SS-OCT) images in children and adolescents with unilateral high myopia. The relationships between OCT parameters and visual acuity were investigated. METHOD Twenty-six amblyopes with unilateral high myopia and 34 age-, axial length- and spherical equivalent-matched normal controls were recruited. All participants underwent SS-OCT and detailed ophthalmic investigations. The reflectivity of the outer retinal and photoreceptor outer segment layer thickness were quantified by LRP using ImageJ software. All parameters were measured at three selected regions: at the fovea, 1 mm nasal to the fovea and 1 mm temporal to the fovea. Differences between the groups were evaluated. RESULTS The mean choroidal thickness was thinner in amblyopic eyes compared with controls (165.19 ± 59.02 μm vs 214.97 ± 66.41 μm at the fovea; 128.77 ± 57.06 μm vs 161.54 ± 57.37 μm at 1 mm nasal to the fovea; 188.13 ± 59.51 μm vs 219.87 ± 61.78 μm at 1 mm temporal to the fovea, P < .05). The amblyopic eyes had higher reflectivity of the ellipsoid zone at 1 mm nasal to the fovea only (85.41 ± 25.78 vs 70.76 ± 18.69, P = .02). The mean length of the photoreceptor outer segment (OS) layer was significantly greater in the control eyes than in the amblyopic eyes at all three regions (20.19 ± 1.89 vs 18.70 ± 2.23 at the fovea, P = .006; 16.06 ± 1.47 vs 15.07 ± 1.30 at 1 mm nasal to the fovea, P = .008; 15.81 ± 1.58 vs 14.56 ± 1.87 at 1 mm temporal to the fovea, P = .006). The shortened OS length was associated with poorer visual acuity. CONCLUSION The results of this study revealed that the amblyopes with unilateral high myopia had thinner choroidal thickness and shortened OS thickness compared to normal controls. The findings indicate that abnormal anatomic changes in the amblyopic children and adolescents with unilateral high myopia were not only due to high myopia but more likely due to a combination of high myopia and amblyopia.
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Affiliation(s)
- Tingkun Shi
- Joint Shantou International Eye Center, Shantou University & the Chinese University of Hong Kong, Shantou, China
| | - Wenli Zhang
- Joint Shantou International Eye Center, Shantou University & the Chinese University of Hong Kong, Shantou, China
| | - Shirong Chen
- Joint Shantou International Eye Center, Shantou University & the Chinese University of Hong Kong, Shantou, China
| | - Honghe Xia
- Joint Shantou International Eye Center, Shantou University & the Chinese University of Hong Kong, Shantou, China
| | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University & the Chinese University of Hong Kong, Shantou, China
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Rafique Ali AA, Ismail F, May May C, Mohd Abdullah AA, Khaliddin N, Hariri F, Abdul Rahman ZA, Iqbal T. Ophthalmic features of craniosynostosis: A Malaysian experience. Eur J Ophthalmol 2021; 32:1417-1423. [PMID: 34219491 DOI: 10.1177/11206721211030093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aims to collect local Malaysian data regarding the ophthalmic features and complications in craniosynostosis patients who attended the Combined Craniofacial Clinic (CFC) in University Malaya Medical Centre (UMMC). METHODS Retrospective study of medical notes of craniosynostosis patients who attended the CFC in UMMC from 2014 to December 2020. RESULTS Out of 37 patients, 29 had syndromic craniosynostosis, and 8 had non-syndromic craniosynostosis. Visual impairment was present in 32.1% of patients. Causes for visual impairment were as follows - amblyopia (25.0%), exposure keratopathy (3.6%), and optic atrophy (3.6%). Hypermetropia and myopia were each seen in 20.6% of patients. Astigmatism was seen in 47.1% of patients, and 29.1% had anisometropia. Proptosis was present in 78.6% and lagophthalmos in 53.3% of patients. Strabismus in primary position occurred in 51.7% of patients. Thirty-one percent of the patients had exposure keratopathy. Optic disc atrophy was seen in 13.7% of patients, and 8.3% had optic disc swelling. Optic disc swelling was resolved in all patients who underwent craniofacial surgery. CONCLUSION Our experience in Malaysia was consistent with previously reported data on ophthalmic features of craniosynostosis patients. Additionally, we found that non-syndromic craniosynostosis patients are also at risk of ocular complications just as much as syndromic patients. Appropriate treatment of amblyogenic risk factors, ocular complications, and timely detection of papilledema, and prompt surgical intervention are crucial in preserving long-term visual function in these patients.
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Affiliation(s)
- Abdullah Ashraf Rafique Ali
- University Malaya Eye Research Centre, Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia.,Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Ophthalmology Department, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Fazliana Ismail
- University Malaya Eye Research Centre, Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia.,Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Choo May May
- University Malaya Eye Research Centre, Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia.,Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Azlindarita Aisyah Mohd Abdullah
- MSU Medical Centre, Universiti Drive, Off Persiaran Olahraga, Shah Alam, Selangor, Malaysia.,MSU Clinical Centre of Exellence, Management and Science University, Shah Alam, Selangor, Malaysia
| | - Nurliza Khaliddin
- University Malaya Eye Research Centre, Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia.,Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Firdaus Hariri
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Zainal Ariff Abdul Rahman
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Tajunisah Iqbal
- University Malaya Eye Research Centre, Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia.,Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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37
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Huang L, Schmid KL, Zhang J, Yang GY, Wu J, Yin XN, He G, Ruan Z, Jiang XQ, Wu CA, Chen WQ. Association between greater residential greenness and decreased risk of preschool myopia and astigmatism. ENVIRONMENTAL RESEARCH 2021; 196:110976. [PMID: 33684414 DOI: 10.1016/j.envres.2021.110976] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/26/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Rapid urbanization has led to reduced greenness in many areas, this has been linked to adverse health outcomes. The aim was to determine the association between residential greenness experienced during very early childhood with preschool myopia and astigmatism and to explore the potential mediating role of screen time on any associations. METHOD Information regarding socio-demographic characteristics, home address, screen time during early childhood, and refraction data from vision screenings of 53,575 preschoolers from Longhua Child Cohort Study were collected via questionnaires. Residential greenness was calculated as the average of satellite-derived Normalized Difference Vegetation Index in buffers of 100, 250, and 500 m around each child's home address. Logistic and linear regression models were used to examine the relationships between residential greenness, screen time, and preschool myopia and astigmatism. RESULT The mean (SD) age of the 53,575 preschoolers was 5.0 (0.7) years, and 24,849 (46.4%) were girls. A total of 1236 (2.3%) preschoolers had myopia and 5347 (10.0%) had astigmatism. In the adjusted model, a higher neighborhood greenness level within 100 m buffers around the home address was associated with decreased risk of myopia (adjusted odds ratios (AOR): 0.62, 95% confidence interval (CI): 0.38-0.99), and higher neighborhood greenness levels within 100, 250, and 500 m decreased the risk of astigmatism, and their AORs (95% CIs) were 0.55 (0.43-0.70) for 100 m, 0.59 (0.41-0.83) for 250 m, 0.61 (0.42-0.90) for 500 m, respectively. Greater screen time during early childhood increased the risk of myopia (AOR = 1.33) and astigmatism (AOR = 1.23). Reduction in screen time fully mediated the benefits of greater residential greenness on preschool myopia, but partially mediated that on preschool astigmatism (p < 0.05). CONCLUSION Higher residential greenness reduces the risk of preschool myopia and astigmatism; the benefits of residential greenness were mediated through reduced daily screen time.
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Affiliation(s)
- Lihua Huang
- Department of Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, China.
| | - Katrina L Schmid
- Centre for Eye and Vision Research, School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Brisbane, 4059, QLD, Australia.
| | - Jingyu Zhang
- Longhua District Maternal and Child Health Hospital, 518109, Shenzhen, China
| | - Gui-You Yang
- Department of Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, China
| | - Jianbo Wu
- Department of Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, China; Longhua District Maternal and Child Health Hospital, 518109, Shenzhen, China
| | - Xiao-Na Yin
- Longhua District Maternal and Child Health Hospital, 518109, Shenzhen, China
| | - Guanhao He
- Department of Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, China
| | - Zengliang Ruan
- Department of Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, China
| | - Xiao-Qin Jiang
- Longhua District Maternal and Child Health Hospital, 518109, Shenzhen, China
| | - Chuan-An Wu
- Longhua District Maternal and Child Health Hospital, 518109, Shenzhen, China.
| | - Wei-Qing Chen
- Department of Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, China; Department of Information Management, Xinhua College of Sun Yat-sen University, 510080, Guangzhou, China.
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Webber AL, Camuglia JE. A pragmatic approach to amblyopia diagnosis: evidence into practice. Clin Exp Optom 2021; 101:451-459. [DOI: 10.1111/cxo.12662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 01/15/2023] Open
Affiliation(s)
- Ann L Webber
- School of Optometry and Vision Science, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia,
| | - Jayne E Camuglia
- Department of Ophthalmology, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia,
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia,
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Efficacy of Toric Intraocular Lens and Prevention of Axis Misalignment by Optic Capture in Pediatric Cataract Surgery. J Cataract Refract Surg 2021; 47:1417-1422. [PMID: 33797870 DOI: 10.1097/j.jcrs.0000000000000643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the outcomes of intraocular lens (IOL) implantation using toric (T)-IOL and non-toric (N)-IOL in pediatric cataract patients with astigmatism, and to examine the effect of optic capture (OC) on the axis misalignment (AM) of the T-IOLs. SETTING Department of Ophthalmology, Kindai University Hospital, Osaka, Japan. DESIGN Interventional, comparative case study. METHODS Consecutive pediatric patients implanted with T-IOLs or N-IOLs were retrospectively reviewed. In the T-IOL group, the preoperative and postoperative corrected distance visual acuity (CDVA) and AM were compared in patients with and without OC. RESULTS The T-IOL group included 14 eyes of 11 patients, while the N-IOL group included 22 eyes of 15 patients. One year after surgery, the mean ocular cylinder (1.38 ± 0.80 D) was significantly smaller than the average corneal cylinder (3.33 ± 1.24 D) in the T-IOL group (P = .00012, Wilcoxon signed-rank test). The mean preoperative and 1-year postoperative CDVA (logMAR) were 0.57/0.003 (T-IOL) and 0.71/0.09 (N-IOL), respectively. The AM at 1 week and 1 year after surgery was 2.6° ± 3.7° and 4.4° ± 3.1° for the OC group, and 13.3° ± 8.8° and 18.5° ± 14.8°, for the non-OC group, respectively. The AM was significantly smaller in the OC group than that in non-OC group (P = .009, Mann-Whitney U test) at postoperative 1 week. CONCLUSION T-IOL implantation is effective in correcting astigmatism in pediatric cataract patients with astigmatism, and the OC technique is likely to achieve lower AM of the T-IOL.
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Thomas J, Rajashekar B, Kamath A, Gogate P. Comparison between Plusoptix A09 and gold standard cycloplegic refraction in preschool children and agreement to detect refractive amblyogenic risk factors. Oman J Ophthalmol 2021; 14:14-19. [PMID: 34084029 PMCID: PMC8095298 DOI: 10.4103/ojo.ojo_284_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 09/06/2020] [Accepted: 10/06/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: The preschool children hardly complain about their vision problems. It is of paramount importance to screen them with an objective tool and compare with the gold standard technique. AIM: To compare the values obtained with Plusoptix A09 and cycloplegic refraction in 3–6 years children and agreement to detect refractive amblyogenic risk factors. SUBJECTS AND METHODS: A cross-sectional study was conducted in the Outpatient Department of Ophthalmology in a tertiary care hospital. Informed consent from parents and verbal assent from children were obtained. Each subject had monocular vision assessment with Lea symbol chart, stereo acuity measurement with Frisby, refractive screening with Plusoptix A09, squint assessment, and anterior segment evaluation before administering Homatropine hydrobromide (homide) 2% eye drops. Cycloplegic refraction and posterior segment evaluation were performed for final diagnosis. STATISTICAL ANALYSIS: Descriptive statistics were used to summarize the data. Spearman correlation coefficient and kappa statistics were also employed. RESULTS: In total, data of 94 children were analyzed. The correlation values obtained between plusoptix and cyclorefraction values for spherical, cylindrical, spherical equivalent were 0.508 (P < 0.0001), 0.779 (P < 0.0001), and 0.407 (P < 0.0001), respectively. Refractive errors were seen in 32% and amblyopia in 17% of eyes. Kappa value was κ = 0.974 in detecting refractive amblyogenic risk factors. CONCLUSION: Good correlation was found between the plusoptix and cyclorefraction values. Cylindrical values showed a better correlation. Refractive errors and amblyopia were the major ocular disorders observed. There was significant agreement between the refractive techniques in detecting amblyogenic risk factors.
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Affiliation(s)
- Jyothi Thomas
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - B Rajashekar
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Asha Kamath
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Parikshit Gogate
- Department of Ophthalmology, Dr. D. Y. Patil Medical College Hospital, Pune, Maharashtra, India.,Community Eye Care Foundation, Dr. Gogate's Eye Clinic, Pune, Maharashtra, India
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Oke I, VanderVeen D. Machine Learning Applications in Pediatric Ophthalmology. Semin Ophthalmol 2021; 36:210-217. [PMID: 33641598 DOI: 10.1080/08820538.2021.1890151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To describe emerging applications of machine learning (ML) in pediatric ophthalmology with an emphasis on the diagnosis and treatment of disorders affecting visual development. Methods: Literature review of studies applying ML algorithms to problems in pediatric ophthalmology. Results: At present, the ML literature emphasizes applications in retinopathy of prematurity. However, there are increasing efforts to apply ML techniques in the diagnosis of amblyogenic conditions such as pediatric cataracts, strabismus, and high refractive error. Conclusions: A greater understanding of the principles governing ML will enable pediatric eye care providers to apply the methodology to unexplored challenges within the subspecialty.
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Deborah VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Guimaraes S, Soares A, Freitas C, Barros P, Leite RD, Costa PS, Silva ED. Amblyopia screening effectiveness at 3-4 years old: a cohort study. BMJ Open Ophthalmol 2021; 6:e000599. [PMID: 33437872 PMCID: PMC7783520 DOI: 10.1136/bmjophth-2020-000599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 11/04/2022] Open
Abstract
Objective To study the effectiveness of amblyopia screening at ages 3-4. Methods and Analysis From a population with no previous screening, a cohort of 2300 children with 3-4 years old attending school (91% of children this age attend school in Portugal), were submitted to a complete ophthalmological evaluation. Amblyopia was diagnosed, treated and followed. Amblyopia prevalence, treatment effectiveness, absolute risk reduction (ARR), number needed to screen (NNS) and relative risk reduction (RRR) were estimated. Results Past/present history of amblyopia was higher than 3.1%-4.2%, depending on amblyopia definition normatives. Screening at age 3-4, had estimated ARR=2.09% (95% CI 1.50% to 2.68%) with a reduced risk of amblyopia in adulthood of 87% (RRR). NNS was 47.8 (95% CI 37.3 to 66.7). Treatment effectiveness of new diagnosis was 88% (83% if we include children already followed). 91% of new amblyopia diagnoses were refractive (of which 100% surpassed amblyopia Multi-Ethnic Pediatric Eye Disease Study criteria after treatment), while most strabismic amblyopias were already treated or undertreatment. Only 30% of children with refractive amblyopia risk factors that were not followed by an ophthalmologist, ended up having amblyopia at age 3-4. Eye patch was needed equally in new-diagnosis versus treated-earlier refractive amblyopia. Conclusions Screening amblyopia in a whole-population setting at age 3-4 is highly effective. For each 48 children screened at age 3-4, one amblyopia is estimated to be prevented in the future (NNS). Screening earlier may lead to overdiagnosis and overtreatments: Treating all new diagnosis before age 3-4 would have a maximal difference in ARR of 0.3%, with the possible burden of as much as 70% children being unnecessary treated before age 3-4.Involving primary care, with policies for timely referral of suspicious/high-risk preverbal children, plus whole screening at age 3-4 seems a rational/effective way of controlling amblyopia.
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Affiliation(s)
- Sandra Guimaraes
- Ophthalmology, Hospital-Escola da Universidade Fernando Pessoa, Gondomar, Porto, Portugal.,Ophthalmology, Hospital de Braga, Braga, Portugal
| | - Andreia Soares
- Ophthalmology, Hospital-Escola da Universidade Fernando Pessoa, Gondomar, Porto, Portugal.,Ophthalmology, Hospital de Braga, Braga, Portugal
| | | | - Pedro Barros
- Ophthalmology, Hospital de Braga, Braga, Portugal
| | | | - Patrício Soares Costa
- School Of Medicine - University Of Minho, Universidade do Minho Instituto de Investigacao em Ciencias da Vida e Saude, Braga, Braga, Portugal.,School Of Medicine - University Of Minho, ICVS 3B's Associate Laboratory, Braga, Braga, Portugal
| | - Eduardo D Silva
- Ophthalmology, Centro Cirurgico de Coimbra, Coimbra, Portugal
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Kleinstein RN, Mutti DO, Sinnott LT, Jones-Jordan LA, Cotter SA, Manny RE, Twelker JD, Zadnik K. Uncorrected Refractive Error and Distance Visual Acuity in Children Aged 6 to 14 Years. Optom Vis Sci 2021; 98:3-12. [PMID: 33394925 PMCID: PMC7789395 DOI: 10.1097/opx.0000000000001630] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE This study presents the relationship between distance visual acuity and a range of uncorrected refractive errors, a complex association that is fundamental to clinical eye care and the identification of children needing refractive correction. PURPOSE This study aimed to analyze data from the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study to describe the relationship between distance uncorrected refractive error and visual acuity in children. METHODS Subjects were 2212 children (51.2% female) 6 to 14 years of age (mean ± standard deviation, 10.2 ± 2.1 years) participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study between 2000 and 2010. Uncorrected distance visual acuity was measured using a high-contrast projected logMAR chart. Cycloplegic refractive error was measured using the Grand Seiko WR-5100K autorefractor. The ability of logMAR acuity to detect various categories of refractive error was examined using receiver operating characteristic curves. RESULTS Isoacuity curves show that increasing myopic spherical refractive errors, increasing astigmatic refractive errors, or a combination of both reduces distance visual acuity. Visual acuity was reduced by approximately 0.5 minutes of MAR per 0.30 to 0.40 D of spherical refractive error and by approximately 0.5 minutes of MAR per 0.60 to 0.90 D of astigmatism. Higher uncorrected hyperopic refractive error had little effect on distance visual acuity. Receiver operating characteristic curve analysis suggests that a logMAR distance acuity of 0.20 to 0.32 provides the best balance between sensitivity and specificity for detecting refractive errors other than hyperopia. Distance acuity alone was ineffective for detecting hyperopic refractive errors. CONCLUSIONS Higher myopic and/or astigmatic refractive errors were associated with predictable reductions in uncorrected distance visual acuity. The reduction in acuity per diopter of cylindrical error was about half that for spherical myopic error. Although distance acuity may be a useful adjunct to the detection of myopic spherocylindrical refractive errors, accommodation presumably prevents acuity from assisting in the detection of hyperopia. Alternate procedures need to be used to detect hyperopia.
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Affiliation(s)
- Robert N Kleinstein
- Department of Optometry and Vision Science, School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Donald O Mutti
- College of Optometry, The Ohio State University, Columbus, Ohio
| | | | | | - Susan A Cotter
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California
| | - Ruth E Manny
- College of Optometry, University of Houston, Houston, Texas
| | - J Daniel Twelker
- Department of Ophthalmology and Vision Science, University of Arizona, Tucson, Arizona
| | - Karla Zadnik
- College of Optometry, The Ohio State University, Columbus, Ohio
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Scope and costs of autorefraction and photoscreening for childhood amblyopia-a systematic narrative review in relation to the EUSCREEN project data. Eye (Lond) 2020; 35:739-752. [PMID: 33257800 PMCID: PMC8026636 DOI: 10.1038/s41433-020-01261-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 09/26/2020] [Accepted: 10/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background Amblyopia screening can target reduced visual acuity (VA), its refractive risk factors, or both. VA testing is imprecise under 4 years of age, so automated risk-factor photoscreening appears an attractive option. This review considers photoscreening used in community services, focusing on costs, cost-effectiveness and scope of use, compared with EUSCREEN project Country Reports describing how photo- and automated screening is used internationally. Methods A systematic narrative review was carried out of all English language photoscreening literature to September 10th 2018, using publicly available search terms. Where costs were considered, a CASP economic evaluation checklist was used to assess data quality. Results Of 370 abstracts reviewed, 55 reported large-scale community photoscreening projects. Five addressed cost-effectiveness specifically, without original data. Photoscreening was a stand-alone, single, test event in 71% of projects. In contrast, 25 of 45 EUSCREEN Country Reports showed that if adopted, photoscreening often supplements other tests in established programmes and is rarely used as a stand-alone test. Reported costs varied widely and evidence of cost-effectiveness was sparse in the literature, or in international practice. Only eight (13%) papers compared the diagnostic accuracy or cost-effectiveness of photoscreening and VA testing, and when they did, cost-effectiveness of photoscreening compared unfavourably. Discussion Evidence that photoscreening reduces amblyopia or strabismus prevalence or improves overall outcomes is weak, as is evidence of cost-effectiveness, compared to later VA screening. Currently, the most cost-effective option seems to be a later, expert VA screening with the opportunity for a re-test before referral.
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Agarwala R, Leube A, Wahl S. Utilizing minicomputer technology for low-cost photorefraction: a feasibility study. BIOMEDICAL OPTICS EXPRESS 2020; 11:6108-6121. [PMID: 33282478 PMCID: PMC7687974 DOI: 10.1364/boe.400720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/03/2020] [Accepted: 09/13/2020] [Indexed: 06/12/2023]
Abstract
Eccentric photorefraction is an objective technique to determine the refractive errors of the eye. To address the rise in prevalence of visual impairment, especially in rural areas, a minicomputer-based low-cost infrared photorefractor was developed using off-the-shelf hardware components. Clinical validation revealed that the developed infrared photorefractor demonstrated a linear working range between +4.0 D and -6.0 D at 50 cm. Further, measurement of astigmatism from human eye showed absolute error for cylinder of 0.3 D and high correlation for axis assessment. To conclude, feasibility was shown for a low-cost, portable and low-power driven stand-alone device to objectively determine refractive errors, showing potential for screening applications. The developed photorefractor creates a new avenue for telemedicine for ophthalmic measurements.
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Affiliation(s)
- Rajat Agarwala
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, Tuebingen, 72076, Germany
| | - Alexander Leube
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, Tuebingen, 72076, Germany
- Carl Zeiss Vision International GmbH, Turnstr. 27, Aalen, 73430, Germany
| | - Siegfried Wahl
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, Tuebingen, 72076, Germany
- Carl Zeiss Vision International GmbH, Turnstr. 27, Aalen, 73430, Germany
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Amblyopia Outcomes Through Clinical Trials and Practice Measurement: Room for Improvement: The LXXVII Edward Jackson Memorial Lecture. Am J Ophthalmol 2020; 219:A1-A26. [PMID: 32777377 DOI: 10.1016/j.ajo.2020.07.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe amblyopia prevalence and outcomes using results from randomized studies and a clinical registry. DESIGN Review of published studies, analysis of data in Intelligent Research in Sight (IRIS) Registry from 2013 to 2019, personal perspective. METHODS Literature review, analysis of IRIS Registry data and IRIS-50, a visual acuity quality measure. RESULTS Clinical trials have reduced the treatment burden of amblyopia by reducing hours of patching and frequency of atropine eye drops with clinical success of about 83%. There is no appreciable age effect if treatment is started before 5 years of age, outcomes are stable to at least 15 years of age, and treatment can be somewhat effective until 12 years of age. The IRIS Registry identified 1,760,066 individuals with amblyopia for a prevalence of 2.47%. Refractive error alone accounted for 68.9% of childhood cases. Mean amblyopic eye visual acuity improved 1.8 lines for children 3-6 years of age and 0.8 lines for 7-12 years, but mean residual amblyopia was more than 2 lines. Among 18,841 children aged 3-7 years eligible for IRIS-50, 77.3% were successful. The odds ratios for success were significantly lower for African-American (0.67; 95% confidence interval [CI] = 0.58 to 0.78) and Hispanic or Latino (0.84; 95% CI = 0.75 to 0.94) children compared with white children. CONCLUSIONS Clinical trials provided evidence of a beneficial effect from several treatments, with substantially reduced doses than previously recommended. Registry data from clinical practice found residual visual acuity impairment among all ages and races, especially among minorities.
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Abstract
Republished with written permission granted from the American Optometric Association, October 2, 2020.
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48
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A dichoptic feedback-based oculomotor training method to manipulate interocular alignment. Sci Rep 2020; 10:15634. [PMID: 32973252 PMCID: PMC7515870 DOI: 10.1038/s41598-020-72561-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/24/2020] [Indexed: 11/15/2022] Open
Abstract
Strabismus is a prevalent impairment of binocular alignment that is associated with a spectrum of perceptual deficits and social disadvantages. Current treatments for strabismus involve ocular alignment through surgical or optical methods and may include vision therapy exercises. In the present study, we explore the potential of real-time dichoptic visual feedback that may be used to quantify and manipulate interocular alignment. A gaze-contingent ring was presented independently to each eye of 11 normally-sighted observers as they fixated a target dot presented only to their dominant eye. Their task was to center the rings within 2° of the target for at least 1 s, with feedback provided by the sizes of the rings. By offsetting the ring in the non-dominant eye temporally or nasally, this task required convergence or divergence, respectively, of the non-dominant eye. Eight of 11 observers attained 5° asymmetric convergence and 3 of 11 attained 3° asymmetric divergence. The results suggest that real-time gaze-contingent feedback may be used to quantify and transiently simulate strabismus and holds promise as a method to augment existing therapies for oculomotor alignment disorders.
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49
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Yap TP, Luu CD, Suttle C, Chia A, Boon MY. Effect of Stimulus Orientation on Visual Function in Children with Refractive Amblyopia. Invest Ophthalmol Vis Sci 2020; 61:5. [PMID: 32392311 PMCID: PMC7405838 DOI: 10.1167/iovs.61.5.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose We investigated and characterized the patterns of meridional anisotropies in newly diagnosed refractive amblyopes using pattern onset–offset visual evoked potentials (POVEPs) and psychophysical grating acuity (GA). Methods Twenty-five refractive amblyopes were recruited and compared with non-amblyopic controls from our previous study. Monocular POVEPs were recorded in response to sinewave 4 cycles per degree (cpd) grating stimuli oriented along each individual participants' principal astigmatic meridians, which were approximately horizontal (meridian 1) and vertical (meridian 2). Binocular POVEPs in response to the same stimuli, but oriented at 45°, 90°, 135°, and 180°, were recorded. Psychophysical GAs were assessed along the same meridians using a two-alternative non-forced-choice technique. The C3 amplitudes and peak latencies of the POVEPs and GAs were compared across meridians for both groups (refractive amblyopes and controls) using linear mixed models (monocular) and ANOVA (binocular), and post hoc analysis was conducted to determine if meridional anisotropies in this cohort of amblyopes were related to low (≤1.50 diopters [D]), moderate (1.75–2.75 D) and high (≥3.00 D) astigmatism. Results In the newly diagnosed refractive amblyopes, there were no significant meridional anisotropies across all outcome measures, but the post hoc analysis demonstrated that C3 amplitude was significantly higher in those with low (P = 0.02) and moderate (P = 0.004) astigmatism compared to those with high astigmatism. Refractive amblyopes had poorer GA and C3 amplitudes compared to controls by approximately two lines on the logMAR chart (monocular: P = 0.013; binocular: P = 0.014) and approximately 6 µV (monocular: P = 0.009; binocular: P = 0.027), respectively. Conclusions Deleterious effects of high astigmatism was evident in newly diagnosed refractive amblyopes, but the neural deficits do not seem to be orientation-specific for the stimulus parameters investigated.
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50
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Yam JC, Tang SM, Kam KW, Chen LJ, Yu M, Law AK, Yip BH, Wang YM, Cheung CYL, Ng DSC, Young AL, Tham CC, Pang CP. High prevalence of myopia in children and their parents in Hong Kong Chinese Population: the Hong Kong Children Eye Study. Acta Ophthalmol 2020; 98:e639-e648. [PMID: 31981300 DOI: 10.1111/aos.14350] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/20/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To determine the myopia prevalence in Hong Kong Chinese children and their parents. METHODS It was a population-based cross-sectional study. A total of 4257 children aged 6-8 years, and 5880 parents were recruited in the Hong Kong Children Eye Study. Cycloplegic autorefraction was measured for children; and non-cycloplegic autorefraction for parents. Parental educational level, children's outdoor time, and near work were collected by validated questionnaires. RESULTS In children aged 6-8 years, 25.0% were myopic, and among them, 12.7% for the 6-year-olds, 24.4% for the 7-year-olds and 36.1% for the 8-year-old. About 0.7% of children aged 8 years were high myopia. In all age groups, boys (their myopia rate: 13.9% at 6 years, 26.7% at 7 years, and 38.3% at 8 years) were more myopic than girls (11.3% at 6 years, 22.0% at 7 years, 33.4% at 8 years). Among parents, 72.2% were myopic (mother, 73.2%; father, 70.7%) and 13.5% high myopia (mother, 12.8%; father, 14.5%). It was observed that prevalence decreased with ages and increased with education level. CONCLUSION There is a strikingly high prevalence of myopia in Hong Kong children aged 6-8, much higher than that of other regions of China. Of note, the prevalence of children was similar to that in 15 years ago. Furthermore, the myopia prevalence of parents is high, and it had already increased in this cohort. Prevention of childhood myopia is important, likewise for visual complications from high myopia in adults.
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Affiliation(s)
- Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong.,Hong Kong Eye Hospital, Hong Kong, Hong Kong
| | - Shu Min Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong.,Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Kowloon, Hong Kong
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Kowloon, Hong Kong
| | - Marco Yu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Antony K Law
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Benjamin H Yip
- The Jockey Club School of Public Health and Primary Care Faculty of Medicine, The Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Yu Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Carol Y L Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Danny S C Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Kowloon, Hong Kong
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
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