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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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Pentland L, Conway ML. Prevalence of presenting bilateral visual impairment associated with refractive error - findings from the See4School, pre-school vision screening programme in NHS Scotland. Eye (Lond) 2024; 38:1941-1946. [PMID: 38600359 PMCID: PMC11226424 DOI: 10.1038/s41433-024-03047-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND/OBJECTIVES The See4School programme in Scotland is a pre-school vision screening initiative delivered by orthoptists on a national scale. The primary objective of any vision screening programme is to identify amblyopia, given the common understanding that this condition is unlikely to be detected either at home or through conventional healthcare channels. The target condition is not bilateral visual impairment, as it is believed that most children will be identified within the first year of life either through observations at home or as part of the diagnosis of another related disorder. This belief persists even though bilateral visual impairment is likely to have a more detrimental impact on a child's day-to-day life, including their education. If this hypothesis were accurate, the occurrence of bilateral visual impairment detected through the Scottish vision screening programme would be minimal as children already under the hospital eye service are not invited for testing. The overarching aim of this study was therefore to determine the prevalence of presenting bilateral visual impairment associated with refractive error detected via the Scottish preschool screening programme. SUBJECTS/METHODS Retrospective anonymised data from vision screening referrals in Scotland from 2013-2016 were collected. Children underwent an assessment using a crowded logMAR vision test and a small number of orthoptic tests. RESULTS During the 3-year period, out of 165,489 eligible children, 141,237 (85.35%) received the vision screening assessment. Among them, 27,010 (19.12%) failed at least one part of the screening and were subsequently referred into the diagnostic pathway, where they received a full sight test. The prevalence of bilateral visual impairment associated with refractive error and detected via the vision screening programme (≥ 0.3LogMAR) was reported to range between 1.47% (1.37-1.59) and 2.42% (2.29-2.57). CONCLUSIONS It is estimated that up to 2.42% (2.29-2.57) of children living Scotland have poorer than driving standard of vision (6/12) in their pre-school year, primarily due to undetected refractive error. Reduced vision has the potential to impact a child's their day-to-day life including their future educational, health and social outcomes.
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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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Lin CW, Zheng CM, Chen YC, Lin FG, Chen CL, Chang YH, Chen JT, Zheng JQ, Tai MC, Huang YH, Lin YF, Lin HT. Effect of spectacle correction on hyperopic children. Int J Med Sci 2024; 21:1302-1306. [PMID: 38818474 PMCID: PMC11134591 DOI: 10.7150/ijms.93822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/03/2024] [Indexed: 06/01/2024] Open
Abstract
Background: Hyperopia is a significant refractive error in children, often leading to vision impairment. This study aimed to investigate whether partial or full spectacle correction is benefit for hyperopia in preschool-aged children. Methods: A retrospective study was conducted on hyperopic children visited to teaching medical center outpatient clinic between October 2011 and October 2018, and were categorized into three groups: full correction, overcorrection, and undercorrection. The study was approved by the institutional ethical committee of Tri-Service General Hospital. Results: Following a minimum of one-year follow-up period, no statistically significant differences were observed in best-corrected visual acuity (BCVA) among children receiving full, over, or under spectacle correction. Notably, the overcorrection group exhibited a significant reduction in spherical equivalent (SE) compared to both the full and under correction groups, indicating a better SE with spectacle overcorrection. Conclusions: Spectacle overcorrection may offer potential benefits for enhancing SE in preschool children with hyperopia. Nevertheless, further investigation through randomized controlled trials is warranted to establish the validity of this approach and its impact on visual outcomes in this hyperopic pediatric population.
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Affiliation(s)
- Chia-Wei Lin
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Urology, Tri-Service General Hospital, National Defense Medical Center
| | - Cai-Mei Zheng
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Yo-Chang Chen
- Beauty-Bright Eye Clinics, Zhubei City, Hsinchu County, Taiwan
| | - Fu-Gong Lin
- Department of Optometry, University of Kang Ning, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Long Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yun-Hsiang Chang
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Jing-Quan Zheng
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Han Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yuh-Feng Lin
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Ting Lin
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
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Zhang F, Li Y, Liu L, Liu Y, Wang P, Biswal BB. Corticostriatal causality analysis in children and adolescents with attention-deficit/hyperactivity disorder. Psychiatry Clin Neurosci 2024; 78:291-299. [PMID: 38444215 DOI: 10.1111/pcn.13650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024]
Abstract
AIM The effective connectivity between the striatum and cerebral cortex has not been fully investigated in attention-deficit/hyperactivity disorder (ADHD). Our objective was to explore the interaction effects between diagnosis and age on disrupted corticostriatal effective connectivity and to represent the modulation function of altered connectivity pathways in children and adolescents with ADHD. METHODS We performed Granger causality analysis on 300 participants from a publicly available Attention-Deficit/Hyperactivity Disorder-200 dataset. By computing the correlation coefficients between causal connections between striatal subregions and other cortical regions, we estimated the striatal inflow and outflow connection to represent intermodulation mechanisms in corticostriatal pathways. RESULTS Interactions between diagnosis and age were detected in the superior occipital gyrus within the visual network, medial prefrontal cortex, posterior cingulate gyrus, and inferior parietal lobule within the default mode network, which is positively correlated with hyperactivity/impulsivity severity in ADHD. Main effect of diagnosis exhibited a general higher cortico-striatal causal connectivity involving default mode network, frontoparietal network and somatomotor network in ADHD compared with comparisons. Results from high-order effective connectivity exhibited a disrupted information pathway involving the default mode-striatum-somatomotor-striatum-frontoparietal networks in ADHD. CONCLUSION The interactions detected in the visual-striatum-default mode networks pathway appears to be related to the potential distraction caused by long-term abnormal information input from the retina in ADHD. Higher causal connectivity and weakened intermodulation may indicate the pathophysiological process that distractions lead to the impairment of motion planning function and the inhibition/control of this unplanned motion signals in ADHD.
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Affiliation(s)
- Fanyu Zhang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yilu Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Lin Liu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yefen Liu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Pan Wang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Bharat B Biswal
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
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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 2024:10.17269/s41997-024-00884-8. [PMID: 38691337 DOI: 10.17269/s41997-024-00884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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Yu VK, Tarczy-Hornoch K, Cotter SA, Torres M, Jiang X, Varma R. Prevalence of Comprehensive Eye Examination in Preschool Children With Eye Conditions. AJPM FOCUS 2024; 3:100184. [PMID: 38283739 PMCID: PMC10818075 DOI: 10.1016/j.focus.2024.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Introduction The purpose of this study is to assess the prevalence of comprehensive eye examinations in multiethnic preschool children, including children with visually significant eye conditions, and identify factors associated with comprehensive eye examinations. Methods A sample of 9,197 African American, Hispanic, Asian American, and non-Hispanic White children aged 6-72 months was recruited for the Multi-Ethnic Pediatric Eye Disease Study from 2003 to 2011. Logistic regression performed in 2022 identified independent factors associated with parent-reported history of comprehensive eye examinations. The proportion of children with previous comprehensive eye examinations and the proportion with undetected amblyopia or strabismus were measured. Results The prevalence of comprehensive eye examinations was 6.3% overall and 38.3%, 24.8%, 19.1%, 15.1%, and 9.8% among children with strabismus, amblyopia, significant anisometropia, hyperopia, and astigmatism, respectively. Children without prior comprehensive eye examinations were more likely to have undetected amblyopia or strabismus than those with comprehensive eye examination history (ps<0.001). The prevalence of comprehensive eye examinations was higher among older children. Prevalence varied by race/ethnicity, with 8.1%, 7.9%, 6.3%, and 4.9% of non-Hispanic White, Asian American, African American, and Hispanic children having had prior comprehensive eye examinations, respectively; however, the differences did not remain after adjusting for other associated factors. Older age, a primary caregiver with a college/university degree or higher, having vision insurance, gestational age <33 weeks, neurodevelopmental disorder diagnosis, strabismus, and ocular disease history were all statistically significantly associated with a relatively higher prevalence of comprehensive eye examinations in multivariable analyses. Conclusions Comprehensive eye examinations were uncommon among preschool children, including those with treatable vision disorders. Interventions, such as parent education and vision insurance, are needed to imaprove comprehensive eye examination access and utilization for at-risk preschool children.
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Affiliation(s)
- Victoria K. Yu
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle, Washington
- Seattle Children's Hospital, Seattle, Washington
| | - Susan A. Cotter
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California
| | - Mina Torres
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California
| | - Xuejuan Jiang
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, California
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California
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Hopkins S, Read SA, Cox RA, Oduro BA, Strang N, Wood JM. Hyperopia in schoolchildren: Investigating the impact on vision and determining appropriate methods for screening. Ophthalmic Physiol Opt 2024; 44:42-51. [PMID: 37787443 DOI: 10.1111/opo.13236] [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: 06/13/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Hyperopia is associated with reduced vision and educational outcomes in schoolchildren. This study explored the impact of clinically significant hyperopia (≥+2.00 D) on visual function in schoolchildren and compared the ability of different screening tests (alone and in combination) to detect this level of hyperopia. METHODS Vision testing including monocular logMAR visual acuity (VA) measured to threshold (distance [DVA], near [NVA] and DVA through a plus lens [+2.50 D]), stereoacuity and cycloplegic autorefraction (tropicamide 1%) were undertaken on 263 schoolchildren (mean age: 11.76 years ± 3.38) in Queensland, Australia. Vision measures were compared between children with clinically significant hyperopia in at least one meridian (≥+2.00 D) and emmetropia/low hyperopia (>0.00 and <+2.00 D). Receiver operating curve (ROC) analysis was performed to identify optimal pass/fail criteria for each test and the diagnostic accuracy of individual and combinations of tests. RESULTS Thirty-two children had clinically significant hyperopia and 225 had emmetropia/low hyperopia. DVA and NVA were worse (p < 0.01), while the difference in DVA through a plus lens was less in children with clinically significant hyperopia (p < 0.01). ROC analysis for individual tests resulted in areas under the curve (AUCs) ranging from 0.65 to 0.85. Combining screening tests revealed that failing one or more of the following tests was most effective for detecting hyperopia: DVA, NVA and difference in DVA through a plus lens, resulting in a sensitivity and specificity of 72% and 81%, respectively. CONCLUSION Significant differences in visual function existed between schoolchildren with clinically significant hyperopia and emmetropia/low hyperopia. Combining measures of DVA and NVA and the difference in DVA through a plus lens demonstrated good discriminative ability for detecting clinically significant hyperopia in this population.
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Affiliation(s)
- Shelley Hopkins
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Scott A Read
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Rebecca A Cox
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bright A Oduro
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Niall Strang
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Joanne M Wood
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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Joseph E, Ck M, Kumar R, Sebastian M, Suttle CM, Congdon N, Sethu S, Murthy GV. Prevalence of refractive errors among school-going children in a multistate study in India. Br J Ophthalmol 2023; 108:143-151. [PMID: 36562766 PMCID: PMC10804007 DOI: 10.1136/bjo-2022-322123] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
AIM Much existing data on childhood refractive error prevalence in India were gathered in local studies, many now dated. The aim of this study was to estimate the prevalence, severity and determinants of refractive errors among school-going children participating in a multistate vision screening programme across India. METHODS In this cross-sectional study, vision screening was conducted in children aged 5-18 years at schools in five states using a pocket vision screener. Refractive error was measured using retinoscopy, and subjective refraction and was defined both by spherical equivalent (SE) and spherical ametropia, as myopia ≤-0.5 diopters (D), hyperopia ≥+1.0 D and/or astigmatism as >0.5 D. Data from the eye with less refractive error were used to determine prevalence. RESULTS Among 2 240 804 children (50.9% boys, mean age 11.5 years, SD ±3.3), the prevalence of SE myopia was 1.57% (95% CI 1.54% to 1.60%) at 5-9 years, 3.13% (95% CI 3.09% to 3.16%) at 10-14 years and 4.8% (95% CI 4.73% to 4.86%) at 15-18 years. Hyperopia prevalence was 0.59% (95% CI 0.57% to 0.61%), 0.54% (95% CI 0.53% to 0.56%) and 0.39% (95% CI 0.37% to 0.41%), respectively. When defined by spherical ametropia, these values for myopia were 0.84%, 2.50% and 4.24%, and those for hyperopia were 2.11%, 2.41% and 2.07%, respectively.Myopia was associated with older age, female gender, private school attendance, urban location and state. The latter appeared to be driven by higher literacy rates. CONCLUSIONS Refractive error, especially myopia, is common in India. Differences in prevalence between states appear to be driven by literacy rates, suggesting that the burden of myopia may rise as literacy increases.
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Affiliation(s)
- Elizabeth Joseph
- Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India
| | - Meena Ck
- Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India
| | - Rahul Kumar
- Orbis India Country office, ORBIS International, Gurugram, Haryana, India
| | - Mary Sebastian
- Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India
| | | | | | - Sheeladevi Sethu
- Orbis India Country office, ORBIS International, Gurugram, Haryana, India
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Sil A, Aggarwal P, Sil S, Mitra A, Jain E, Sheeladevi S, Murthy G. Design and delivery of the Refractive Errors Among Children (REACH) school-based eye health programme in India. Clin Exp Optom 2023; 106:859-868. [PMID: 37914536 DOI: 10.1080/08164622.2022.2125793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
CLINICAL RELEVANCE Optimisation of vision screening programmes can result the detection of refractive anomalies in a high proportion of school children. BACKGROUND The Refractive Errors Among Children (REACH) programme aims to optimise outcomes of school-based vision screening in India by collaborating with hospitals and monitoring eye care throughout school attendance. METHODS REACH delivers school vision screening using pocket vision screeners (cards presenting rows of seven 0.2 logMAR Sloan letters at a 3 m viewing distance) in five states across India. Children who fail screening are referred for detailed evaluation including refraction, those requiring cycloplegic refraction are referred to partner hospitals. Spectacles are dispensed as needed and compliance is assessed. All data are recorded electronically. RESULTS Out of 2,240,805 children aged 5 to 18 (mean 11.5; SD ±3.3) years, 2,024,053 have undergone REACH screening in 10,309 schools predominantly in rural locations (78.7%) and government-funded (76%). Of those screened, 174,706 (8.6%) underwent detailed evaluation. A higher proportion of children in private or urban schools (11.8% and 10.4% respectively) were referred for detailed evaluation than those in government-funded or rural schools (5.9% and 7.2%, respectively; p < 0.001). The proportion referred for detailed evaluation differed by state (p < 0.001), from 4.0% in West Bengal to 14.4% in Kerala. CONCLUSION The REACH programme screened a high proportion of school children, providing further care and follow-up to optimise visual outcomes.
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Affiliation(s)
- Asim Sil
- Community Eye Care, Vivekananda Mission Ashram Netra Nirmay Niketan, West Bengal, India
| | | | - Subhra Sil
- Community Eye Care, Vivekananda Mission Ashram Netra Nirmay Niketan, West Bengal, India
| | - Ankita Mitra
- Community Eye Care, Vivekananda Mission Ashram Netra Nirmay Niketan, West Bengal, India
| | - Elesh Jain
- Department of Community Ophthalmology, Sadguru Netra Chikitsalaya, Madhya Pradesh, India
| | | | - Gvs Murthy
- Department of Public Health, Indian Institute of Public Health, Telangana, India
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11
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Neupane S, Sreenivasan V, Wu Y, Mestre C, Connolly K, Lyon DW, Candy TR. How Do Most Young Moderate Hyperopes Avoid Strabismus? Invest Ophthalmol Vis Sci 2023; 64:17. [PMID: 37962529 PMCID: PMC10655831 DOI: 10.1167/iovs.64.14.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
Purpose Uncorrected hyperopic children must overcome an apparent conflict between accommodation and vergence demands to focus and align their retinal images. This study tested hypotheses about simultaneous accommodation and vergence performance of young hyperopes to gain insight into ocular motor strategies used to maintain eye alignment. Methods Simultaneous eccentric photorefraction and Purkinje image tracking were used to assess accommodative and vergence responses of 26 adult emmetropes (AE) and 94 children (0-13 years) viewing cartoons. Children were habitually uncorrected (CU) (spherical equivalent refractive error [SE] -0.5 to +4 D), corrected and aligned (CCA), or corrected with a history of refractive esotropia (CCS). Accommodative and vergence accuracy, dissociated heterophoria, and vergence/accommodation ratios in the absence of retinal disparity cues were measured for 33- and 80-cm viewing distances. Results In binocular viewing, median accommodative lags for 33 cm were 1.0 D (AE), 1.33 D (CU), 1.25 D (CCA), and 1.0 D (CCS). Median exophorias at 80 and 33 cm were 1.2 and 4.5 pd (AE), 0.8 and 2.5 pd (CU), and 0 and 1.2 pd (CCA), respectively. Without disparity cues, most response vergence/accommodation ratios were between 1 and 2 meter angle/D (∼5-10 pd/D) (69% of AE, 44% of CU, 60% of CCA, and 50% of CCS). Conclusions Despite apparent conflict in motor coupling, uncorrected hyperopes were typically exophoric and achieved adultlike accuracy of both vergence and accommodation simultaneously, indicating ability to compensate for conflicting demands rather than bias to accurate vergence while tolerating inaccurate accommodation. Large lags and esophoria are therefore atypical. This analysis provides normative guidelines for clinicians and a deeper mechanistic understanding of how hyperopes avoid strabismus.
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Affiliation(s)
- Sonisha Neupane
- Indiana University School of Optometry, Bloomington, Indiana, United States
| | | | - Yifei Wu
- Indiana University School of Optometry, Bloomington, Indiana, United States
| | - Clara Mestre
- Indiana University School of Optometry, Bloomington, Indiana, United States
| | - Katie Connolly
- Indiana University School of Optometry, Bloomington, Indiana, United States
| | - Don W. Lyon
- Indiana University School of Optometry, Bloomington, Indiana, United States
| | - T. Rowan Candy
- Indiana University School of Optometry, Bloomington, Indiana, United States
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12
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Chan SCY, Shah PR, Tan K, Ford B, Webber A, Keay L. Integration of hospital and community care for paediatric ophthalmology: A mixed-methods study. Ophthalmic Physiol Opt 2023; 43:997-1006. [PMID: 37150970 DOI: 10.1111/opo.13160] [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: 01/02/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND To explore collaborative care models for paediatric eye care that integrate hospital and community-based care to address access blocks. METHODS Sequential referrals to a tertiary paediatric ophthalmology clinic between April and October 2019 and subsequent encounters up until July 2020 at a major metropolitan public children's hospital in Sydney, Australia, were reviewed to identify those cases suitable for community care. Semi-structured phone interviews were conducted with eye health service providers, including ophthalmologists, orthoptists and optometrists, as well as service users to explore their perspectives on potential changes to service delivery. Qualitative data were analysed deductively using the Levesque model for access to healthcare and Consolidated Framework for Implementation Research (CFIR) to inform implementation strategies for future models of care. RESULTS One-third of the 439 audited referrals (30.5%; 134/439) were identified as suitable for community management. Interviews revealed five themes relating to potential models of care, which would support and promote access: integrated health systems, standardised quality of care, interprofessional trust, multidisciplinary governance and patient-centred care. Key recommendations for future implementation included: (i) identifying and preparing clinical champions, (ii) conducting educational meetings, (iii) conducting local needs assessments and (iv) informing local opinion leaders. CONCLUSIONS This audit highlights access blocks and poor targeting of referrals to tertiary paediatric ophthalmology services in a metropolitan hospital. Integration with community practitioners was identified as an acceptable way to streamline services, and strategies that may support successful implementation in this setting were identified.
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Affiliation(s)
- Stephen C Y Chan
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Parth R Shah
- Department of Paediatric Ophthalmology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Kimberley Tan
- Department of Paediatric Ophthalmology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Belinda Ford
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ann Webber
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- School of Optometry & Vision Science, Queensland University of Technology, Brisbane City, Queensland, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Ntodie M, Saunders K, Little JA. Accuracy and stability of accommodation and vergence responses during sustained near tasks in uncorrected hyperopes. Sci Rep 2023; 13:14389. [PMID: 37658084 PMCID: PMC10474059 DOI: 10.1038/s41598-023-41244-9] [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: 05/29/2022] [Accepted: 08/23/2023] [Indexed: 09/03/2023] Open
Abstract
This study investigated the accuracy and stability of accommodative and vergence functions in children with and without hyperopia while engaged in two sustained near tasks. The sustained accommodative and vergence characteristics of participants without refractive correction (n = 92, aged 5-10 years) with and without hyperopia (defined as cycloplegic retinoscopy ≥ + 1.00D and less than + 5.00D) were measured using eccentric infrared photorefraction (PowerRef 3; PlusOptix, Germany). Binocular measures of accommodation and eye position were recorded while participants engaged in 2 tasks at 25 cm for 15 min each: (1) reading small print on an Amazon Kindle and (2) watching an animated movie on liquid crystal display screen. Comprehensive visual assessment, including measurement of presenting visual acuity, amplitude of accommodation, and stereoacuity was conducted. The magnitude of accommodative and vergence responses was not related to refractive error (P > 0.05). However, there were inter-task differences in the accuracy and stability of the accommodative responses across refractive groups (P < 0.05). The relationship between accommodation and vergence was not significant in both tasks (P > 0.05). However, increased accommodative and vergence instabilities were associated with total accommodative response (P < 0.05). Despite having greater accommodative demand, uncorrected hyperopes accommodate comparably to emmetropic controls. However, uncorrected hyperopes have increased instabilities in their accommodative and vergence responses, which may adversely impact their visual experience.
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Affiliation(s)
- Michael Ntodie
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK.
| | - Kathryn Saunders
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Julie-Anne Little
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
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14
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Ravid-Saffir A, Sella S, Ben-Eli H. Development and validation of a questionnaire for assessing parents' health literacy regarding vision screening for children: a Delphi study. Sci Rep 2023; 13:13887. [PMID: 37620666 PMCID: PMC10449776 DOI: 10.1038/s41598-023-41006-7] [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: 03/19/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023] Open
Abstract
Preschool vision screening is recommended to reduce the incidence of amblyopia that persists into adulthood. However, parent's perceptions regarding the importance of screening and early intervention may constitute a significant barrier to seeking vision exams and pursuing treatment. The aim of this study is to develop and validate a questionnaire for assessing parent's awareness, perception and health literacy of children's vision tests. The questionnaire was developed using the Delphi method with experts from the fields of pediatric ophthalmology, optometry, orthoptics, pediatric medicine, social sciences and Mother and Child Health Care centers. Experts were provided with drafts of the questions iteratively in three rounds until a consensus was reached independently on the relevant items, coherently language and redundancies. For the first, second and third stages of the Delphi process, 17, 15 and 13 experts participated in the panel respectively. Validity was achieved by wide consensus among the panel on the relevance of each question, of 75%, 85% and 90%, for the three rounds respectively. Here we describe the final questionnaire, EYES: Evaluating Young-Children Eye health Survey, which includes 31 questions regarding demographics, ocular history, parental health literacy, and perceptions of vision and vison exams.
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Affiliation(s)
- Ahuva Ravid-Saffir
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Shulamit Sella
- 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.
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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15
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Ly VV, Elhusseiny AM, Cannon TC, Brown CC. Race, poverty, and the lack of follow-up for Arkansas students that fail vision screenings: a cross-sectional study over 7 years. J AAPOS 2023; 27:129.e1-129.e6. [PMID: 37150435 DOI: 10.1016/j.jaapos.2023.02.005] [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] [Received: 12/04/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To analyze rates of follow-up eye care for students that failed school vision screenings over a 7-year period in 238 Arkansas school districts. METHODS In this cross-sectional study, vision screening, demographic, socioeconomic, academic, and eye care provider data were collected. The main outcomes were referral rates, rates of follow-up eye care for students with failed vision screenings, and estimated associations between the rate of follow-up and school district and county-level characteristics, such as race, poverty, insurance coverage, academic achievement, and the number of eye care providers. RESULTS A total of 1,744,805 vision screenings over 7 academic years (2013-2020) were included. The average screening rate was 35.4% across the study years. The screening failure rate ranged from 8.0% to 9.4%. Two-thirds of districts had a follow-up rate between 20% and 50%. 91% had follow-up rates of <60%. School districts with higher concentrations of White students (P < 0.001), higher graduation rates (P = 0.024), higher percentages of students on government-assisted insurance (P = 0.035), and higher standardized scores (P < 0.001) had higher rates of follow-up. There were no statistically significant relationships between the rate of follow-up eye care and the number of school nurses per school district or the number of ophthalmologists or optometrists per county. CONCLUSIONS Arkansas children in our study cohort that failed vision screenings had inadequate follow-up eye care. Follow-up rates were associated with several key indicators of socioeconomic status.
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Affiliation(s)
- Victoria V Ly
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas; Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Thomas C Cannon
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Clare C Brown
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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16
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Babu L, Kumaran SL, Gupta D. Comparison of Self Refraction accuracy with Cycloplegic Subjective Refraction in Young Adults. Niger Med J 2023; 64:365-372. [PMID: 38974062 PMCID: PMC11223018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background Uncorrected refractive error is one of the major causes of blindness. Self-refraction methods are currently practiced to correct refractive error. Self-adjustable eyeglasses are available easily in the present online buying era. Hence this study aimed to compare the visual and refractive outcomes between Self-refraction (SR) eyeglasses and Cycloplegic subjective Refraction (CSR). Methodology This observational cross-sectional study included 59 participants (21 males and 38 females) within the age of 18 to 30yearsand refractive error between +3.00D to -6.00D took part in this study. Subjects with a previous history of non-strabismic binocular vision anomaly, astigmatic error, pathological eye problems, ocular surgery or trauma were excluded from the study. The subjects were allowed to estimate their refractive error with DialVision eyeglasses followed by CSR, which was performed by a single examiner. The visual and refractive outcomes of SR and CSR were collected and analyzed. Result The study participants mean age was 22(2) years.The comparison of visual acuity and duochrome between SR and CSR using Paired T test showed a statistically significant difference (P<0.01). Visual acuity attained from SR resulted in a mean acuity of 0.14(0.05) logMAR compared to CSR 0.002(0.007) logMAR. Duochrome test identified 92% of participants being under corrected with SR. No statistically significant difference was observed in contrast sensitivity and cover test (P>0.01). Conclusion Visual acuity with SR was acceptable but wasn't better than CSR. Appreciable under correction of refractive error with SR raises concern. Encouraging a patient to correct their own refractive error without a comprehensive eye examination can lead to various adverse effects. Even though SR might bring a brief relief towards the burden of uncorrected refractive error, dispensing spectacle based on standard refraction procedure is imperative for good visual performance.
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Affiliation(s)
- Logesh Babu
- Department of Optometry, UIAHS Chandigarh University, Punjab, India
| | - Samuel Livingstone Kumaran
- Department of Optometry, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Tamil Nadu, India
| | - Deepak Gupta
- Department of Optometry, NIMS College of Paramedical Technology, NIMS University, Rajasthan, India
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Ibrahim MKM, Wolvaardt JE, Elnimeiri MKM, Ibrahim HKM, Mohamed ASA. Proportion and patterns of ocular disorders among under-five children in Khartoum State, Sudan: A cross-sectional study. Health Sci Rep 2023; 6:e1273. [PMID: 37216054 PMCID: PMC10193645 DOI: 10.1002/hsr2.1273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/24/2023] [Accepted: 05/07/2023] [Indexed: 05/24/2023] Open
Affiliation(s)
- Mohanad K. M. Ibrahim
- Department of Community Medicine, Faculty of MedicineIbn Sina UniversityKhartoumSudan
| | - Jacqueline E. Wolvaardt
- Faculty of Health Sciences, School of Health Systems and Public HealthUniversity of PretoriaPretoriaSouth Africa
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18
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Banashefski B, Rhee MK, Lema GMC. High Myopia Prevalence across Racial Groups in the United States: A Systematic Scoping Review. J Clin Med 2023; 12:jcm12083045. [PMID: 37109381 PMCID: PMC10144975 DOI: 10.3390/jcm12083045] [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: 02/09/2023] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
High myopia is a significant public health issue globally and in the United States (US), where it affects ~4% of the population or 13 million people. This is a potentially blinding condition, but complications can be prevented with early intervention in childhood. Several countries have developed robust data on high myopia, but the United States' data on high myopia remains lacking. Further, underrepresented populations are at particular risk of complications due to reduced access to optometric and ophthalmic care. We performed a systematic scoping review of population-based studies that investigated the prevalence of high myopia across racial and ethnic groups in the US to identify the impact of high myopia on underrepresented communities. Only four studies were identified that met inclusion criteria, which highlights the need to further investigate the topic in the United States. The prevalence of high myopia ranged from a low of 1.8% among Hispanic populations to a high of 11.8% among Chinese populations. Our study demonstrated a paucity of high myopia data in the United States and variable rates of high myopia depending on the time and location of each study. More complete prevalence data will help identify opportunities for community-based interventions to prevent debilitating and blinding complications of high myopia.
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Affiliation(s)
- Bryana Banashefski
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Michelle K Rhee
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Gareth M C Lema
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- John J. Peters VA Medical Center, Bronx, NY 10468, USA
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Read SA, Hopkins S, Black AA, Bentley SA, Scott J, Wood JM. Prevalence of vision conditions in children in a very remote Australian community. Clin Exp Optom 2023; 106:195-201. [PMID: 36442517 DOI: 10.1080/08164622.2022.2133597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
CLINICAL RELEVANCE Understanding the prevalence of vision conditions in a population is critical for determining the most appropriate strategies for detecting and correcting eye conditions in a community. This is particularly important in very remote regions where access to vision testing services is limited. BACKGROUND Although recent studies have provided detailed analyses of the prevalence of vision conditions in Aboriginal and/or Torres Strait Islander children in urban and regional areas of Australia, there is a paucity of research examining vision conditions in children in remote regions. Importantly, a significant proportion of the population in remote and very remote regions identify as Aboriginal and/or Torres Strait Islander people. METHODS Comprehensive eye examinations were provided to 193 primary school children in a very remote Australian region. Ninety eight percent of children identified as Aboriginal and/or Torres Strait Islander. The eye examination included measures of visual acuity, cycloplegic autorefraction, binocular vision and accommodative function, ocular health and colour vision. Previous history of eye examinations and refractive correction were assessed through parental questionnaire. RESULTS Although the average unaided vision in the population was good (mean: 0.02 ± 0.13 logMAR) and the prevalence of reduced unaided visual acuity (>0.3 logMAR in either eye) was low (4%), vision conditions were detected in 32% of children. The most common conditions were clinically significant refractive errors (18% of children) and binocular vision or accommodative disorders (16%). Of the total population of children tested, 10% had previously had an eye examination, and 2% were reported to have previously been prescribed spectacles. CONCLUSIONS In this population of children in a very remote Australian region, up to 1 in 3 children had a vision condition, with many of these conditions being uncorrected and undetected. These findings highlight the important need for additional resources to be made available to very remote communities for the detection and correction of vision conditions in childhood.
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Affiliation(s)
- Scott A Read
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Shelley Hopkins
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Alex A Black
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Sharon A Bentley
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - John Scott
- Centre for Justice, School of Justice, Faculty of Creative Industries, Education and Social Justice, Queensland University of Technology, Brisbane, Australia
| | - Joanne M Wood
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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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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Santiago HC, Rullán M, Ortiz K, Rivera A, Nieves M, Piña J, Torres Z, Mercado Y. Prevalence of refractive errors in children of Puerto Rico. Int J Ophthalmol 2023; 16:434-441. [PMID: 36935800 PMCID: PMC10009595 DOI: 10.18240/ijo.2023.03.15] [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: 08/19/2022] [Accepted: 01/05/2023] [Indexed: 03/06/2023] Open
Abstract
AIM To determine the prevalence of refractive error in 5- to 17-year-old schoolchildren in Puerto Rico. METHODS A quantitative descriptive study of 2867 children aged 5 to 17y from all seven educational regions of Puerto Rico was conducted from 2016-2019. Refractive error was determined via static and subjective refraction. Children with distance acuity ≤20/40 or near visual acuity ≤20/32 had a cycloplegic refraction. Data analysis included descriptive statistics, correlation coefficient, Kruskal-Wallis, Chi-square, and t test calculations. RESULTS Twenty percent of the children had a spherical equivalent refractive error ≤ -0.50 D, 3.2% had a spherical equivalent ≥ +2.00 D, and 10.4% had astigmatism ≥1 D. There was a statistically (but non-clinically) significant myopic change in spherical equivalent refractive error with age (P<0.001). The prevalence of myopia increased with age (P<0.001) but not hyperopia (P=0.59) or astigmatism (P=0.51). Males had a significantly higher hyperopic spherical equivalent than females (P<0.001). Females had a higher prevalence of myopia (P<0.001) than males, but there was no difference in the hyperopia (P=0.74) or astigmatism prevalence (P=0.87). CONCLUSION The prevalence of a spherical equivalent equal to or less than -0.50 D (myopia, 20.7%) is one of the highest among similar-aged children worldwide. Further studies should explore the rate of myopia progression in children in Puerto Rico. Individual children must be monitored to examine the need for treatment of myopia progression.
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Affiliation(s)
- Héctor C Santiago
- Inter American University of Puerto Rico, School of Optometry, 500 John Will Harris, Bayamón, Puerto Rico 00957, USA
| | - Mayra Rullán
- Inter American University of Puerto Rico, School of Optometry, 500 John Will Harris, Bayamón, Puerto Rico 00957, USA
| | - Katerin Ortiz
- Inter American University of Puerto Rico, School of Optometry, 500 John Will Harris, Bayamón, Puerto Rico 00957, USA
| | - Andrés Rivera
- Inter American University of Puerto Rico, School of Optometry, 500 John Will Harris, Bayamón, Puerto Rico 00957, USA
| | - Mónica Nieves
- Inter American University of Puerto Rico, School of Optometry, 500 John Will Harris, Bayamón, Puerto Rico 00957, USA
| | - José Piña
- Inter American University of Puerto Rico, School of Optometry, 500 John Will Harris, Bayamón, Puerto Rico 00957, USA
| | - Zulmaris Torres
- Inter American University of Puerto Rico, School of Optometry, 500 John Will Harris, Bayamón, Puerto Rico 00957, USA
| | - Yvette Mercado
- Inter American University of Puerto Rico, School of Optometry, 500 John Will Harris, Bayamón, Puerto Rico 00957, USA
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Association between ADHD and vision problems. A systematic review and meta-analysis. Mol Psychiatry 2023; 28:410-422. [PMID: 35931758 PMCID: PMC9812778 DOI: 10.1038/s41380-022-01699-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/23/2022] [Accepted: 07/01/2022] [Indexed: 01/11/2023]
Abstract
AIM To conduct the first systematic review and meta-analysis assessing whether attention-deficit/hyperactivity disorder (ADHD) is associated with disorders of the eye, and/or altered measures of visual function. METHOD Based on a pre-registered protocol (PROSPERO: CRD42021256352), we searched PubMed, Web of Knowledge/Science, Ovid Medline, Embase and APA PsycINFO up to 16th November 2021, with no language/type of document restrictions. We included observational studies reporting at least one measure of vision in people of any age meeting DSM/ICD criteria for ADHD and in people without ADHD; or the prevalence of ADHD in people with and without vision disorders. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS). Random effects meta-analyses were used for data synthesis. RESULTS We included 42 studies in the narrative synthesis and 35 studies in the meta-analyses (3,250,905 participants). We found meta-analytic evidence of increased risk of astigmatism (OR = 1.79 [CI: 1.50, 2.14]), hyperopia and hypermetropia (OR = 1.79 [CI: 1.66, 1.94]), strabismus (OR = 1.93 [CI: 1.75, 2.12]), unspecified vision problems (OR = 1.94 [CI: 1.38, 2.73]) and reduced near point of convergence (OR = 5.02 [CI: 1.78, 14.11]); increased lag (Hedge's g = 0.63 [CI: 0.30, 0.96]) and variability (Hedge's g = 0.40 [CI: 0.17, 0.64]) of the accommodative response; and increased self-reported vision problems (Hedge's g = 0.63 [CI: 0.44, 0.82]) in people with ADHD compared to those without ADHD (with no significant heterogeneity). We also found meta-analytic evidence of no differences between people with and without ADHD on retinal nerve fiber layer thickness (Hedge's g = -0.19 [CI: -0.41, 0.02]) and refractive error (Hedge's g = 0.08 [CI: -0.26, 0.42]) (with no significant heterogeneity). DISCUSSION ADHD is associated with some self-reported and objectively ascertained functional vision problems, but not with structural alterations of the eye. Further studies should clarify the causal relationship, if any, between ADHD and problems of vision. TRIAL REGISTRATION PROSPERO registration: CRD42021256352.
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Gehring AM, Haensel JX, Curtiss MK, Roberts TL. Validation of the PowerRef 3 for Measuring Accommodation: Comparison With the Grand Seiko WAM-5500A Autorefractor. Transl Vis Sci Technol 2022; 11:25. [PMID: 36255360 PMCID: PMC9587467 DOI: 10.1167/tvst.11.10.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose This validation study examines the PowerRef 3 as a method for measuring accommodation objectively. We assess agreement with refractive measurements obtained simultaneously by the Grand Seiko WAM-5500A autorefractor. Methods Refractive measurements were recorded simultaneously using the PowerRef 3 and WAM-5500A in 32 noncyclopleged participants aged 15 to 46 years. Accommodative states were recorded for 10 seconds at six accommodative demands (5 diopters [D], 4 D, 3 D, 2.5 D, 2 D, and 0 D) while participants fixated a high-contrast Maltese cross. WAM-5500A measurements were converted to power in the vertical meridian for comparison with PowerRef 3 data. Dioptric difference values were computed, and agreement was assessed using Bland-Altman plots with 95% limits of agreement (LOA) and intraclass correlation coefficient analyses. Results The mean absolute dioptric differences measured 0.14 D or less across accommodative demands. Analyses showed an excellent intraclass correlation coefficient across the tested demands (0.93). Bland-Altman plots indicated a bias of -0.02 D with 95% LOA of -1.03 D to 0.99 D. The 95% LOA was smallest for the 3 D demand (-0.71 D to 0.64 D), and largest at 5 D demand (-1.51 D to 1.30 D). Conclusions The mean dioptric differences between the PowerRef 3 and WAM-5500A autorefractor were small and not clinically significant. While some variability in agreement was observed depending on the tested demand, the PowerRef 3 demonstrated good agreement with the WAM-5500A. Translational Relevance The PowerRef 3 may be used to obtain objective measures of accommodation both monocularly and binocularly and provides a more flexible method, especially in pediatric populations.
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Affiliation(s)
| | - Jennifer X. Haensel
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
| | - Molly K. Curtiss
- Children's Vision Center, Akron Children's Hospital, Akron, OH, USA
| | - Tawna L. Roberts
- Children's Vision Center, Akron Children's Hospital, Akron, OH, USA
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
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Gerena Arévalo VA, Ruiz-Moreno JM. Choroidal Thickness in a Hyperopic Pediatric Population. Diagnostics (Basel) 2022; 12:diagnostics12102330. [PMID: 36292018 PMCID: PMC9600784 DOI: 10.3390/diagnostics12102330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/21/2022] [Accepted: 09/24/2022] [Indexed: 11/16/2022] Open
Abstract
Aims: To evaluate the choroidal thickness (CT) in hyperopic and emmetropic children using swept-source optical coherence tomography (SS-OCT). Methods: This was a prospective, cross-sectional comparative study. Macular choroidal thickness and axial length of 62 eyes from hyperopic pediatric patients were studied. CT was determined at nine different macular locations. The results were compared to 66 eyes of healthy pediatric patients. Results: Study groups were classified as a hyperopic group (SE ≥ 2D) and an emmetropic group (SE < 2D). The hyperopic group have shorter AL than the emmetropic group (p < 0.001). The mean CT is greater in the hyperopic group (p = 0.039), and there are no significant differences between CT and gender (p = 0.389). Study participants were also classified by age (2−5 years old and 6−18 years old), and we observe differences in CT, but these differences are only significant for the 6−18 years old group (p < 0.05). Conclusions: CT in hyperopic pediatric populations is statistically thicker than in healthy pediatric patients. AL and SE have statistically significant correlations with CT values, and those correlations are seen in children in the ocular slow-growing phase (6−18 years old), and not in the early years (2−5 years old).
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Affiliation(s)
- Vanessa Antonia Gerena Arévalo
- Department of Ophthalmology, Puerta de Hierro-Majadahonda University Hospital, 28222 Madrid, Spain
- Sanitas La Moraleja University Hospital, 28050 Madrid, Spain
- Correspondence:
| | - Jose Maria Ruiz-Moreno
- Department of Ophthalmology, Puerta de Hierro-Majadahonda University Hospital, 28222 Madrid, Spain
- Department of Ophthalmology, Castilla de la Mancha University, 13001 Ciudad Real, Spain
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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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26
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Wait, what are we screening for again? J AAPOS 2022; 26:55-57. [PMID: 35314314 DOI: 10.1016/j.jaapos.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 03/12/2022] [Indexed: 11/22/2022]
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Guillon-Rolf R, Grammatico-Guillon L, Leveziel N, Pelen F, Durbant E, Chammas J, Khanna RK. Refractive errors in a large dataset of French children: the ANJO study. Sci Rep 2022; 12:4069. [PMID: 35260753 PMCID: PMC8904779 DOI: 10.1038/s41598-022-08149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
Undetected refractive errors (REs) in children can lead to irreversible vision loss. This study aimed to show the proportions of REs in French children using cycloplegic refraction. Multicentre cross-sectional retrospective study including children with cycloplegic refraction and without associated ocular conditions from 2015 to 2018 in French eye clinics. The following data were collected: age, symptoms of eye strain, best-corrected visual acuity (BCVA), cycloplegic refraction. The analysis included 48,163 children (mean age: 7.75 years, range: 2 to 12 years). The proportion of each RE was as follows: emmetropia (− 0.50 < Spherical Equivalent (SE) ≤ + 2.0; 58.3%), hyperopia (+ 2.0 \documentclass[12pt]{minimal}
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\begin{document}$$\le$$\end{document}≤ SE \documentclass[12pt]{minimal}
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\begin{document}$$\le$$\end{document}≤− 0.50; 15.5%), high myopia (SE < − 6; 0.5%), high hyperopia (SE > + 5; 3.6%), mixed astigmatism (4.9%). Anisometropia (SE difference ≥ 1.5) was found in 5.0%. Functional amblyopia in children attending primary school (aged over 6 years) was encountered in 2.7%. Symptoms of eye strain were frequent (70%) but not specific to any RE. REs are frequently found in French children and may remain undetected in the absence of symptoms of eye strain. Few studies have investigated REs in children using cycloplegic refraction, which has been shown to be the gold standard for RE assessment.
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Affiliation(s)
- Rébecca Guillon-Rolf
- Department of Ophthalmology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,ANJO, Association Nationale Des Jeunes Ophtalmologistes, Centre Hospitalier National des 15-20, 28, Rue de Charenton, 75012, Paris, France
| | - Leslie Grammatico-Guillon
- Department of Medical Information, Centre Hospitalier Régional Universitaire, Bretonneau Hospital, Tours, France
| | - Nicolas Leveziel
- Department of Ophthalmology, Centre Hospitalier Universitaire, Poitiers, France
| | | | - Eve Durbant
- ANJO, Association Nationale Des Jeunes Ophtalmologistes, Centre Hospitalier National des 15-20, 28, Rue de Charenton, 75012, Paris, France.,Department of Ophthalmology, Centre Hospitalier Universitaire, Reims, France
| | - Jimmy Chammas
- ANJO, Association Nationale Des Jeunes Ophtalmologistes, Centre Hospitalier National des 15-20, 28, Rue de Charenton, 75012, Paris, France.,Department of Ophthalmology, Centre Hospitalier Universitaire, Reims, France
| | - Raoul K Khanna
- ANJO, Association Nationale Des Jeunes Ophtalmologistes, Centre Hospitalier National des 15-20, 28, Rue de Charenton, 75012, Paris, France. .,Neurogénétique et Physiopathologie Neuronale, iBrain, INSERM, U1253, Université de Tours, Tours, France. .,Department of Ophthalmology, Centre Hospitalier Régional Universitaire, Bretonneau Hospital, Tours, France.
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Asare AO, Maurer D, Wong AMF, Ungar WJ, Saunders N. Socioeconomic Status and Vision Care Services in Ontario, Canada: A Population-Based Cohort Study. J Pediatr 2022; 241:212-220.e2. [PMID: 34687692 DOI: 10.1016/j.jpeds.2021.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/08/2021] [Accepted: 10/15/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To test the association of material deprivation and the utilization of vision care services for young children. STUDY DESIGN We conducted a population-based, repeated measures cohort study using linked health and administrative datasets. All children born in Ontario in 2010 eligible for provincial health insurance were followed from birth until their seventh birthday. The main exposure was neighborhood-level material deprivation quintile, a proxy for socioeconomic status. The primary outcome was receipt of a comprehensive eye examination (not to include a vision screening) by age 7 years from an eye care professional, or family physician. RESULTS Of 128 091 children included, female children represented 48.7% of the cohort, 74.4% lived in major urban areas, and 16.2% lived in families receiving income assistance. Only 65% (n = 82 833) had at least 1 comprehensive eye examination, with the lowest uptake (56.9%; n = 31 911) in the most deprived and the highest uptake (70.5%; n =19 860) in the least deprived quintiles. After adjusting for clinical and demographic variables, children living in the least materially deprived quintile had a higher odds of receiving a comprehensive eye examination (aOR 1.43; 95% CI 1.36, 1.51) compared with children in the most materially deprived areas. CONCLUSIONS Uptake of comprehensive eye examinations is poor, especially for children living in the most materially deprived neighborhoods. Strategies to improve uptake and reduce inequities are warranted.
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Affiliation(s)
- Afua Oteng Asare
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; The Hospital for Sick Children, Toronto, Canada
| | - Daphne Maurer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Psychology, Neuroscience, and Behavior, McMaster University, Hamilton, Canada
| | - Agnes M F Wong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada; ICES, Toronto, Canada
| | - Natasha Saunders
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; The Hospital for Sick Children, Toronto, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada; ICES, Toronto, Canada; Department of Pediatrics, University of Toronto, Toronto, Canada.
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Mavi S, Chan VF, Virgili G, Biagini I, Congdon N, Piyasena P, Yong AC, Ciner EB, Kulp MT, Candy TR, Collins M, Bastawrous A, Morjaria P, Watts E, Masiwa LE, Kumora C, Moore B, Little JA. The Impact of Hyperopia on Academic Performance Among Children: A Systematic Review. Asia Pac J Ophthalmol (Phila) 2022; 11:36-51. [PMID: 35066525 DOI: 10.1097/apo.0000000000000492] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the impact of uncorrected hyperopia and hyperopic spectacle correction on children's academic performance. DESIGN Systematic review and meta-analysis. METHODS We searched 9 electronic databases from inception to July 26, 2021, for studies assessing associations between hyperopia and academic performance. There were no restrictions on language, publication date, or geographic location. A quality checklist was applied. Random-effects models estimated pooled effect size as a standardized mean difference (SMD) in 4 outcome domains: cognitive skills, educational performance, reading skills, and reading speed. (PROSPERO registration: CRD-42021268972). RESULTS Twenty-five studies (21 observational and 4 interventional) out of 3415 met the inclusion criteria. No full-scale randomized trials were identified. Meta-analyses of the 5 studies revealed a small but significant adverse effect on educational performance in uncorrected hyperopic compared to emmetropic children {SMD -0.18 [95% confidence interval (CI), -0.27 to -0.09]; P < 0.001, 4 studies} and a moderate negative effect on reading skills in uncorrected hyperopic compared to emmetropic children [SMD -0.46 (95% CI, -0.90 to -0.03); P = 0.036, 3 studies]. Reading skills were significantly worse in hyperopic than myopic children [SMD -0.29 (95% CI, -0.43 to -0.15); P < 0.001, 1 study]. Qualitative analysis on 10 (52.6%) of 19 studies excluded from meta-analysis found a significant (P < 0.05) association between uncorrected hyperopia and impaired academic performance. Two interventional studies found hyperopic spectacle correction significantly improved reading speed (P < 0.05). CONCLUSIONS Evidence indicates that uncorrected hyperopia is associated with poor academic performance. Given the limitations of current methodologies, further research is needed to evaluate the impact on academic performance of providing hyperopic correction.
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Affiliation(s)
- Sonia Mavi
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Ving Fai Chan
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Gianni Virgili
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
- Department NEUROFARBA, University of Florence, Florence, Italy
| | - Ilaria Biagini
- Department NEUROFARBA, University of Florence, Florence, Italy
| | - Nathan Congdon
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
- Orbis International, New York, NY, US
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Prabhath Piyasena
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Ai Chee Yong
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Elise B Ciner
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA, US
| | | | - T Rowan Candy
- School of Optometry, Indiana University, Bloomington, IN, US
| | - Megan Collins
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Andrew Bastawrous
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Peek Vision, London, UK
| | - Priya Morjaria
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Peek Vision, London, UK
| | - Elanor Watts
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Lynett Erita Masiwa
- Optometry Unit, Department of Primary Health Care, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Bruce Moore
- New England College of Optometry, Boston, MA, US
| | - Julie-Anne Little
- Centre for Optometry and Vision Science, School of Biomedical Sciences, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
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30
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MacKenzie GE, Morgan IG, Baraas RC, Little JA, Congdon N, Chan VF, Moore B, Bundy D. Recognizing Eye Health as an Integral Part of Children's School Health Throughout the World. Asia Pac J Ophthalmol (Phila) 2022; 11:3-5. [PMID: 35044338 DOI: 10.1097/apo.0000000000000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Graeme E MacKenzie
- Riemann Limited, London, United Kingdom
- Clearly Initiatives, London, United Kingdom
| | - Ian G Morgan
- Research School of Biology, Australian National University, Canberra, ACT, Australia
| | - Rigmor C Baraas
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway
| | - Julie-Anne Little
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Nathan Congdon
- Ulverscroft Chair for Global Eye Health, Department School of Medicine, Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
- Orbis International, Lenexa, Kansas, US
| | - Ving Fai Chan
- School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Centre for Public Health, Royal Victoria Hospital, United Kingdom
- School of Optometry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bruce Moore
- New England College of Optometry, Boston, Massachusetts, US
| | - Donald Bundy
- Global Research Consortium for School Health and Nutrition, Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine
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31
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Little JA, Moore B, Congdon N. The Impact of Near Vision Impairment on Activities of Daily Living Across the Life Course. Asia Pac J Ophthalmol (Phila) 2022; 11:1-2. [PMID: 35044340 PMCID: PMC7612327 DOI: 10.1097/apo.0000000000000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Julie-Anne Little
- Centre for Optomtry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Bruce Moore
- New England College of Optometry Boston, MA, US
| | - Nathan Congdon
- School of Medicine Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK Orbis International, New York, US Zhongshan Ophthalmic Center; and Sun Yat-sen University, Guangzhou, China
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Plotnikov D, Sheehan NA, Williams C, Atan D, Guggenheim JA. Hyperopia Is Not Causally Associated With a Major Deficit in Educational Attainment. Transl Vis Sci Technol 2021; 10:34. [PMID: 34709397 PMCID: PMC8556559 DOI: 10.1167/tvst.10.12.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Hyperopia (farsightedness) has been associated with a deficit in children's educational attainment in some studies. We aimed to investigate the causality of the relationship between refractive error and educational attainment. Methods Mendelian randomization (MR) analysis in 74,463 UK Biobank participants was used to estimate the causal effect of refractive error on years spent in full-time education, which was taken as a measure of educational attainment. A polygenic score for refractive error derived from 129 genetic variants was used as the instrumental variable. Both linear and nonlinear (allowing for a nonlinear relationship between refractive error and educational attainment) MR analyses were performed. Results Assuming a linear relationship between refractive error and educational attainment, the causal effect of refractive error on years spent in full-time education was estimated as -0.01 yr/D (95% confidence interval, -0.04 to +0.02; P = 0.52), suggesting minimal evidence for a non-zero causal effect. Nonlinear MR supported the hypothesis of the nonlinearity of the relationship (I2 = 80.3%; Cochran's Q = 28.2; P = 8.8e-05) but did not suggest that hyperopia was associated with a major deficit in years spent in education. Conclusions This work suggested that the causal relationship between refractive error and educational attainment was nonlinear but found no evidence that moderate hyperopia caused a major deficit in educational attainment. Importantly, however, because statistical power was limited and some participants with moderate hyperopia would have worn spectacles as children, modest adverse effects may have gone undetected. Translational Relevance These findings suggest that moderate hyperopia does not cause a major deficit in educational attainment.
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Affiliation(s)
- Denis Plotnikov
- School of Optometry & Vision Sciences, Cardiff University, Cardiff, UK.,Kazan State Medical University, Kazan, Russia
| | - Nuala A Sheehan
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Cathy Williams
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Denize Atan
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Sun Y, Fu J, Li L, Chen W, Meng Z, Su H, Yao Y, Dai W. Stereoacuity and its determinants in 7-year-old children: the Lhasa Childhood Eye Study. Graefes Arch Clin Exp Ophthalmol 2021; 260:599-608. [PMID: 34499245 DOI: 10.1007/s00417-021-05390-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/01/2021] [Accepted: 08/13/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To explore the distribution of stereoacuity and to examine its determinants in school-age children in Tibetan plateau, Southwest China. METHODS This is the cross-sectional part of a school-based cohort study of 7-year-old children in Lhasa, Tibet Autonomous Region, Southwest China. Children in first year of primary school were invited to undergo a comprehensive examination, including height, weight, visual acuity, cycloplegic autorefraction (1% cyclopentolate), anterior segment, cover and uncover test, and stereoacuity (Titmus Stereo Test). RESULTS A total of 1833 eligible subjects were included, with a mean age of 6.82 ± 0.46 years. Mean stereoacuity was 1.78 ± 0.21 in log units (median: 60 arcsec). Children with stereoacuity equal to 40 arcsec and stereoacuity worse than 100 arcsec accounted for 29.24% and 8.18% of the cohort, respectively. Tibetan ethnicity (OR = 1.98; 95%CI, 1.30-3.03), astigmatism (OR = 1.65; 95%CI, 1.26-2.17), strabismus (OR = 2.92; 95%CI, 1.38-6.18), and amblyopia (OR = 3.77; 95%CI, 1.14-12.49) were risk factors for normal stereoacuity (= 40 arcsec). Shorter height, younger age, strabismus, and worse BCVA (P < 0.05 for all) were both related to lower stereoacuity in Spearman correlation analysis and associated with lower stereoacuity in multivariate regression analysis. CONCLUSION Stereoacuity maturation does not appear fully completed in 7-year-old children, while few children present stereoacuity worse than 100 arcsec (8.18%). Lower stereoacuity was associated with younger age, shorter height, strabismus, and lower best-corrected visual acuity.
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Affiliation(s)
- Yunyun Sun
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China
| | - Jing Fu
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China. .,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.
| | - Lei Li
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China
| | - Weiwei Chen
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China
| | - Zhaojun Meng
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China
| | - Han Su
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China
| | - Yao Yao
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China
| | - Wei Dai
- Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, 100730, Beijing, China
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Ibrahim MKM, Wolvaardt JE, Elnimeiri MKM. Risk factors of ocular morbidity among under-five years old children in Khartoum State- Sudan- 2020. Health Sci Rep 2021; 4:e279. [PMID: 33977161 PMCID: PMC8093856 DOI: 10.1002/hsr2.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND AIMS Visual impairment in early childhood can significantly affect the development of visual, motor, and cognitive function and potentially lead to long-term adverse psychosocial consequences. This study aimed to identify the risk factors of ocular morbidity among under 5-year old children in Khartoum State, Sudan. METHODS A cross-sectional study was conducted in three tertiary eye care hospitals in Khartoum State, Sudan. The study included 391 children under the age of 5 years. The parent(s) were interviewed using a precoded, pretested, closed-ended questionnaire that included questions regarding socio-demographic profile and possible risk factors. Data were analyzed using Statistical Package for the Social Sciences (version 21.0). A P-value of less than .05 was regarded as significant. RESULTS There was a significant association between participants with diabetes mellitus and poor vision (P-value <.001). Two-thirds of participants (57%) with visual impairment had mothers, who reportedly attended antenatal care services regularly (P-value .001), revealing a significant statistical association. Maternal diseases, specifically diabetes, was identified as a risk factor for poor visual acuity in their offspring (P-value <.001). A significant relation was revealed between family history of eye disease and the degree of relationship to the affected participant (P-value <.001). There was an association between watching TV and current visual acuity (P-value <.001); as well as using mobile phones and current visual acuity (P-value <.001). Multilinear analysis revealed the stronger influence of TV watching rather than the use of mobile phones (P-value <.001). CONCLUSIONS Diabetes, diabetic mothers, a family history of ocular morbidity, watching television, and using mobile phones emerged as significant risk factors of ocular morbidity among children under the age of 5 years in this study. Many of these risk factors are either modifiable or controllable ocular morbidities among under-five children can be reduced with suitable interventions.
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Hopkins S, Narayanasamy S, Vincent SJ, Sampson GP, Wood JM. Do reduced visual acuity and refractive error affect classroom performance? Clin Exp Optom 2021; 103:278-289. [DOI: 10.1111/cxo.12953] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Shelley Hopkins
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia,
| | - Sumithira Narayanasamy
- Programme of Optometry & Vision Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia,
| | - Stephen J Vincent
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia,
| | - Geoff P Sampson
- School of Medicine (Optometry), Faculty of Health, Deakin University, Geelong, Australia,
| | - Joanne M Wood
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia,
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Ntodie M, Saunders KJ, Little JA. Correction of Low-Moderate Hyperopia Improves Accommodative Function for Some Hyperopic Children During Sustained Near Work. Invest Ophthalmol Vis Sci 2021; 62:6. [PMID: 33821881 PMCID: PMC8039472 DOI: 10.1167/iovs.62.4.6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose This study investigated whether refractive correction improved accommodative function of hyperopic children while engaged in two sustained near activities. Methods Sustained accommodative function of 63 participants (aged 5–10 years) with varying levels of uncorrected hyperopia (>/= +1.00 D and < + 5.00 D spherical equivalent in the least hyperopic eye) was measured using eccentric infrared photorefraction (PowerRef 3; PlusOptix, Germany). Binocular accommodation measures were recorded while participants engaged in 2 tasks at 25 cm for 15 minutes each: an “active” task (reading small print on an Amazon Kindle), and a “passive” task (watching an animated movie on liquid crystal display [LCD] screen). Participants also underwent a comprehensive visual assessment, including measurement of presenting visual acuity, prism cover test, and stereoacuity. Reading speed was assessed with and without hyperopic correction. Refractive error was determined by cycloplegic retinoscopy. Results Hyperopic refractive correction significantly improved accuracy of accommodative responses in both task (pairwise comparisons: t = −3.70, P = 0.001, and t = −4.93, P < 0.001 for reading and movie tasks, respectively). Accommodative microfluctuations increased with refractive correction in the reading task (F(1,61) = 25.77, P < 0.001) but decreased in the movie task (F(1,59) = 4.44, P = 0.04). Reading speed also significantly increased with refractive correction (F(1,48) = 66.32, P < 0.001). Conclusions Correcting low-moderate levels of hyperopia has a positive impact on accommodative performance during sustained near activity in some schoolchildren. For these children, prescribing hyperopic correction may benefit performance in near vision tasks.
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Affiliation(s)
- Michael Ntodie
- Optometry and Vision Science Department, School of Allied Health Sciences, College of Health, University of Cape Coast, Cape Coast, Ghana.,Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, United Kingdom
| | - Kathryn J Saunders
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, United Kingdom
| | - Julie-Anne Little
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, United Kingdom
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Ciner EB, Kulp MT, Pistilli M, Ying G, Maguire M, Candy TR, Moore B, Quinn G. Associations between visual function and magnitude of refractive error for emmetropic to moderately hyperopic 4‐ and 5‐year‐old children in the Vision in Preschoolers ‐ Hyperopia in Preschoolers Study. Ophthalmic Physiol Opt 2021; 41:553-564. [DOI: 10.1111/opo.12810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Elise B Ciner
- Pennsylvania College of Optometry at Salus University Elkins Park Pennsylvania USA
| | | | - Maxwell Pistilli
- Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Gui‐Shuang Ying
- Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Maureen Maguire
- Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - T Rowan Candy
- School of Optometry Indiana University Bloomington Indiana USA
| | - Bruce Moore
- New England College of Optometry Boston Massachusetts USA
| | - Graham Quinn
- Children’s Hospital of Philadelphia Philadelphia Pennsylvania USA
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Collins ME, Guo X, Mudie LI, Slavin RE, Madden N, Chang D, Owoeye J, Repka MX, Friedman DS. Baseline vision results from the Baltimore Reading and Eye Disease Study. Can J Ophthalmol 2021; 57:29-35. [PMID: 33745870 DOI: 10.1016/j.jcjo.2021.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/22/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We describe the Baltimore Reading and Eye Disease Study, report baseline ocular findings, and explore the feasibility of eye examinations in the school setting. DESIGN Prospective, school-based cohort study. PARTICIPANTS Students in second and third grades. METHODS Baseline eye examinations, including near and distance presenting visual acuity (VA), stereopsis, ocular alignment, dilated retinal examination, and cycloplegic refraction, were performed in 12 Baltimore public schools during the 2014-15 school year. MAIN OUTCOME MEASURES Presenting VA, prevalence of refractive error, and other ocular findings. RESULTS Among the 1054 eligible students, 321 participated. There were 271 (84.4%) African American and 186 (57.9%) female students; mean age was 7.9 ± 0.8 years. Cycloplegia was achieved in 308. The mean presenting distance and near VA was 0.1 ± 0.2 logMAR (range -0.1 to 1.5) and 0.1 ± 0.2 logMAR (range 0.0-1.6) in the better-seeing eye, respectively. The most common ocular findings were +1.00 diopter (D) or greater hyperopia (34.7%), -0.50 D or greater myopia (29.5%), 1.00 D or greater astigmatism (23.4%), and convergence insufficiency (7.2%). Thirty-seven (11.5%) children needed referral to an eye care provider; 10% of students required glasses full-time. CONCLUSIONS Whereas the majority of second and third grade students in this study have good VA and minimal refractive error, 1 in 9 have an ocular finding necessitating further evaluation. It was feasible to conduct cycloplegic eye examinations in the school setting.
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Affiliation(s)
- Megan E Collins
- Wilmer Eye Institute, Johns Hopkins University School of Medicine; Dana Center for Preventive Ophthalmology, Johns Hopkins University; Berman Institute of Bioethics, Johns Hopkins University.
| | - Xinxing Guo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine; Dana Center for Preventive Ophthalmology, Johns Hopkins University
| | - Lucy I Mudie
- Department of Ophthalmology, University of Colorado School of Medicine
| | - Robert E Slavin
- Johns Hopkins School of Education, Center for Research and Reform in Education
| | - Nancy Madden
- Johns Hopkins School of Education, Center for Research and Reform in Education
| | | | - Josephine Owoeye
- University of Pikeville Kentucky College of Optometry, Pikeville, KY
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins University School of Medicine
| | - David S Friedman
- Massachusetts Eye and Ear Infirmary, Glaucoma Center of Excellence
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Reimelt C, Wolff N, Hölling H, Mogwitz S, Ehrlich S, Roessner V. The Underestimated Role of Refractive Error (Hyperopia, Myopia, and Astigmatism) and Strabismus in Children With ADHD. J Atten Disord 2021; 25:235-244. [PMID: 30371126 DOI: 10.1177/1087054718808599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To examine the association of refractive error (myopia, hyperopia, astigmatism) and strabismus with ADHD. Method: Based on data from the large, representative, epidemiological sample of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study (N = 13,488), the associations of myopia, hyperopia, astigmatism, and strabismus with ADHD were examined, with and without consideration of other common ADHD risk factors. Results: In single logistic regression models, all examined forms of refractive error and strabismus showed an association with ADHD. After controlling for confounding variables, results remained stable and showed an increased risk for ADHD in children with hyperopia, astigmatism, and strabismus compared with the control group. Only the association between myopia and ADHD in children was not significant. Conclusion: Hyperopia, astigmatism, and strabismus seem to be independently associated with ADHD. Health care professionals in different medical fields should consider this association to adequately diagnose and treat affected children.
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Abstract
Republished with written permission granted from the American Optometric Association, October 2, 2020.
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41
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Reduced visual acuity in children from 5 to 6 years old, with LEA chart. Graefes Arch Clin Exp Ophthalmol 2020; 259:759-768. [PMID: 32945936 DOI: 10.1007/s00417-020-04927-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/31/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To assess visual acuity in 5-year-old children with LEA chart and to estimate the frequency of reduced visual acuity in this age. METHOD Study aimed at children attending the last year of preschool education in Public Kindergartens and Private Social Solidarity Institutions (IPSS) under the influence Regional Health Administration of the Médio Tejo, in Portugal. The 15-line LEA charts at 3 m were used and the presentation visual acuity was measured monocularly starting with the right eye. The ETDRS-fast methodology was used. RESULTS A total of 3072 children participated, being 51% male and 54% from rural area. A rate of 13.7% children with a reduced level of visual acuity was found, that is, visual acuity worse or equal to 0.2 logMAR in at least one eye, or an interocular difference greater than two lines. CONCLUSION This research shows that reduced VA frequency rate in children between 5 and 6 years old is high. The literature presents amblyopia (refractive and/or strabismic) and uncorrected refractive errors without amblyopia as the main cause of reduced VA in childhood, and these anomalies negatively affect child development, especially at the educational level. Reduced VA interferes with performance on a number of key tasks in the learning process. Thus, it is important to preserve the running program to identify these deficits and lead to their correction before the beginning of the school stage.
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Nishimura M, Wong A, Dimaras H, Maurer D. Feasibility of a school-based vision screening program to detect undiagnosed visual problems in kindergarten children in Ontario. CMAJ 2020; 192:E822-E831. [PMID: 32690557 PMCID: PMC7828989 DOI: 10.1503/cmaj.191085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Visual problems can negatively affect visual development and learning but often go undetected. We assessed the feasibility of scaling up a school-based screening program to identify and treat kindergarten children with visual problems. METHODS We conducted a prospective cohort study offering vision screening to junior (JK) and senior kindergarten (SK) children attending 43 schools in 15 Ontario communities. Screening comprised photoscreeners and tests of visual acuity, stereoacuity and eye alignment. Children who failed any test were referred for a comprehensive eye examination, with treatment as needed (e.g., glasses). RESULTS Using a passive consent model, 89% of children were screened compared with 62% using an active consent model (p < 0.001). Referral rates to an optometrist varied across schools (mean referral rate for children in JK 53%, range 25%-83%; mean referral rate for children in SK 34%, range 12%-61%). Among 4811 children who were screened, a visual problem was detected in 516 (10.7%), including 164 (3.4%) with amblyopia and 324 (6.7%) with clinically significant refractive errors. For 347 (67.2%) of the children with a visual problem, this was their first eye examination. Rescreening in Year 2 did not lead to detection of additional problems among children who passed screening in Year 1. Regardless of location (child's school or optometrist's office), 1563 (68.9%) of children attended the follow-up optometry examination. Most of the children who were surveyed (291 of 322, 90.4%) indicated that they enjoyed vision screening. INTERPRETATION Many children in Ontario with a visual problem were not being identified by the status quo in 2015-2017. We found that in-school vision screening with follow-up eye examinations is an effective strategy for identifying at-risk children and placing them in eye care before grade 1.
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Affiliation(s)
- Mayu Nishimura
- Department of Ophthalmology and Vision Sciences (Nishimura, Wong, Dimaras), The Hospital for Sick Children; Department of Ophthalmology and Vision Sciences, Faculty of Medicine (Wong, Dimaras), University of Toronto; Institute of Health Policy Management and Evaluation (Wong, Maurer), and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program and Centre for Global Child Health (Dimaras), Sick-Kids Research Institute, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Nishimura, Maurer), Faculty of Science, McMaster University, Hamilton, Ont.
| | - Agnes Wong
- Department of Ophthalmology and Vision Sciences (Nishimura, Wong, Dimaras), The Hospital for Sick Children; Department of Ophthalmology and Vision Sciences, Faculty of Medicine (Wong, Dimaras), University of Toronto; Institute of Health Policy Management and Evaluation (Wong, Maurer), and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program and Centre for Global Child Health (Dimaras), Sick-Kids Research Institute, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Nishimura, Maurer), Faculty of Science, McMaster University, Hamilton, Ont
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences (Nishimura, Wong, Dimaras), The Hospital for Sick Children; Department of Ophthalmology and Vision Sciences, Faculty of Medicine (Wong, Dimaras), University of Toronto; Institute of Health Policy Management and Evaluation (Wong, Maurer), and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program and Centre for Global Child Health (Dimaras), Sick-Kids Research Institute, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Nishimura, Maurer), Faculty of Science, McMaster University, Hamilton, Ont
| | - Daphne Maurer
- Department of Ophthalmology and Vision Sciences (Nishimura, Wong, Dimaras), The Hospital for Sick Children; Department of Ophthalmology and Vision Sciences, Faculty of Medicine (Wong, Dimaras), University of Toronto; Institute of Health Policy Management and Evaluation (Wong, Maurer), and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program and Centre for Global Child Health (Dimaras), Sick-Kids Research Institute, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Nishimura, Maurer), Faculty of Science, McMaster University, Hamilton, Ont
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Vaughan J, Dale T, Herrera D. Comparison of Photoscreening to Chart Methodology for Vision Screening. J Sch Nurs 2020; 38:306-310. [PMID: 32662321 DOI: 10.1177/1059840520940370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The goal of this study is to assess the referral rate accuracy of photoscreening versus the chart methodology in identifying preschool children at risk of amblyopia and amblyogenic refractive error. Vision screenings using the plusoptiX S12 and the LEA chart were performed on 127 children, aged 3-5 years old. Comprehensive eye exams were performed after screenings. The sensitivity and specificity of the plusoptiX S12 were 80.3% and 92.1% and the LEA chart were 43.6% and 94.8%, respectively. The sensitivity of the plusoptiX S12 is significantly higher than the LEA (p value: <.001). After eye exams, 82.9% were correctly passed by the plusoptiX S12 and 64% were correctly passed by the LEA chart (p value: .009). Objective photoscreening is significantly more accurate in identifying preschool children at risk of developing amblyopia and should be considered best practice. The chart methodology provides an inaccurate report on a preschool child's amblyopic risk.
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Affiliation(s)
- Joannah Vaughan
- Elks Children's Eye Clinic, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Talitha Dale
- Elks Children's Eye Clinic, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Daniel Herrera
- Elks Children's Eye Clinic, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
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Tong L, Cui D, Zeng J. Effects of topical pilocarpine on ocular growth and refractive development in rabbits. Eur J Ophthalmol 2020; 31:2107-2115. [PMID: 32524847 DOI: 10.1177/1120672120934962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to investigate whether topical pilocarpine affects ocular growth and refractive development as well as the underlying biochemical processes in early eye development in rabbits. METHODS Twenty three-week-old New Zealand white rabbits were treated with 0.5% pilocarpine in the right eye for 6 weeks. The left eyes served as contralateral controls. The effects of pilocarpine on refractive error, corneal curvature and ocular biometrics were assessed using streak retinoscopy, keratometry, and A-scan ultrasonography, respectively. Eyeballs were enucleated for histological analysis. The ciliary body and sclera were homogenized to determine the mRNA and protein expression levels of five subtypes of muscarinic receptors. RESULTS Compared to control eyes, pilocarpine-treated eyes exhibited approximately -1.63 ± 0.54 D myopia accompanied by a 0.11 ± 0.04 mm increase in axial length (AL) (p < 0.001, respectively). The anterior chamber depth (ACD) was reduced, whereas the lens thickness (LT) and vitreous chamber depth (VCD) increased (p < 0.001, respectively). Corneal curvature decreased over time but was not significantly different between treated and control eyes. The mRNA and protein expression levels of five subtypes of muscarinic receptors were upregulated in the ciliary body and downregulated in the sclera. CONCLUSIONS Based on these results, pilocarpine can induce myopic shift, increase LT, elongate VCD and AL, and reduce muscarinic receptor expression in the sclera early in development. These changes raise the possibility that pilocarpine may promote axial elongation in ocular development and facilitate the emmetropization of hyperopic eyes.
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Affiliation(s)
- Liyang Tong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Dongmei Cui
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Junwen Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
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Leshno A, Stolovitch C, Zloto O, Blum Meirovitch S, Mezad-Koursh D. Reduced stereoacuity as a predictor for clinically significant convergence insufficiency. Br J Ophthalmol 2020; 105:37-41. [PMID: 32188680 DOI: 10.1136/bjophthalmol-2019-315208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Stereoacuity relies on accurate binocular alignment. Convergence insufficiency (CI) a binocular motor disorder, interferes with near work. OBJECTIVE To investigate the association between convergence amplitude (CA) and stereoacuity in a large paediatric cohort. METHODS Retrospective chart review included patients aged 6-17 years; excluded patients with amblyopia, manifest strabismus or visual acuity <20/30 in either eye. Stereoacuity, measured by Randot test was defined as normal (≤40arcsec), subnormal (50-400arcsec) and poor (>400 arcsec). CA, measured using base out prism bar was defined by fusion break point (BP) and recovery point (RP), as none (BP=0), poor (BP <20 prism diopter (PD)), borderline (BP <30 PD or RP <20 PD), good (BP ≥30 PD and RP ≥20 PD) and excellent (does not break at 40PD). RESULTS In 2200 subjects included, we found an increased prevalence of normal stereoacuity as convergence ability improves (χ2 test, p<0.001) with a negative correlation between stereoacuity and BP (Pearson correlation -0.13, p<0.001).CI was significantly associated with below normal stereopsis OR 1.86 (95% CI 1.3 to 2.7, p<0.001). Conversely, prevalence of CI was similar, whether or not CI-symptoms were reported. Follow-up data of at least 2.5 years from presentation was available for a small subgroup of 21 patients treated for CI. Convergence improved in 14 (66%), rate of normal stereoacuity increased from 29% at baseline to 76% at last follow-up (p=0.006). CONCLUSIONS CA affects stereoacuity function in children. Evaluation of CA is required in all cases with poor stereoacuity, especially when other etiologies are amiss. The role of convergence improvement exercise on stereoacuity warrants further investigation.
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Affiliation(s)
- Ari Leshno
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chaim Stolovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophtalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ofira Zloto
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Blum Meirovitch
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Mezad-Koursh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophtalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Bostamzad P, Horwood AM, Schalij‐Delfos NE, Boelaert K, de Koning HJ, Simonsz HJ. Plusoptix photoscreener use for paediatric vision screening in Flanders and Iran. Acta Ophthalmol 2020; 98:80-88. [PMID: 31197950 PMCID: PMC7003743 DOI: 10.1111/aos.14144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 04/28/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE Photoscreening assesses risk factors for amblyopia, as an alternative to measurement of visual acuity (VA) to detect amblyopia, on the premise that its early correction could prevent development of amblyopia. We studied implementations of Plusoptix photoscreening in existing population-based screening in Flanders and Iran. METHODS In Flanders, VA is measured at age 3, 4 and 6, photoscreening was added to existing screening at age 1 and 2.5 years in 2013. In Iran, VA is measured at ages 3-6 years, photoscreening was added at ages 3-6 years between 2011 and 2016. Plusoptix use was analysed in the literature for detection of risk factors for amblyopia and amblyopia itself, for ages 0-3 and for 4-6. A questionnaire, containing seven domains: existing vision screening, addition of photoscreening, implementation in screening program, training, attendance, diagnosis and treatment, and costs was distributed. In Iran, screening procedures were observed on site. RESULTS Implementation of Plusoptix photoscreening was mainly analysed from questionnaires and interviews, its effectiveness from literature data. In Flanders, of 56 759 children photoscreened at age one (81% of children born in 2013), 9.2% had been referred, 13% of these were treated, mostly with glasses, resulting in an increase of 4-year-old children wearing glasses from 4.7% to 6.4%. In Iran, 90% of children aged 3-6 years participated in vision screening in 2016, but only those who failed the vision test were subjected to photoscreening. CONCLUSIONS In Flanders, the use of Plusoptix photoscreening at ages 1 and 2.5 resulted in an increase of children wearing glasses, but it remains unknown how many cases of amblyopia have been prevented. Studies are needed to determine the relation between size and sort of refractive error and strabismus, and the increased chance to develop amblyopia.
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Affiliation(s)
| | - Anna M. Horwood
- Infant Vision laboratorySchool of Psychology & Clinical Language SciencesUniversity of ReadingReadingUK
| | | | | | - Harry J. de Koning
- Department of Public HealthErasmus Medical CenterRotterdamthe Netherlands
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Dudovitz RN, Sim MS, Elashoff D, Klarin J, Slusser W, Chung PJ. Receipt of Corrective Lenses and Academic Performance of Low-Income Students. Acad Pediatr 2020; 20:910-916. [PMID: 31926990 PMCID: PMC7343614 DOI: 10.1016/j.acap.2020.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Untreated vision problems are associated with poor school performance. Whether providing glasses alone improves performance, however, remains unknown. We sought to test whether receiving glasses was associated with improved school performance for low-income minority students in Los Angeles. METHODS From 2017 to 2018, we analyzed achievement marks in mathematics and language arts from 406 first to fifth grade students attending 24 public elementary schools who received glasses through a free school-based vision program between February and May 2014, and 23,393 of their nonparticipating same-school, same-grade peers. We calculated students' percentile rank during each grading period in 1 year before and 2 years since they received glasses. Multilevel linear regressions tested whether percentile rank differed from baseline at each subsequent grading period. Models accounted for clustering at the school level and controlled for gender, grade level, and baseline class rank. Interaction terms tested whether associations differed by gender and class rank. RESULTS Students increased 4.5 percentile points (P = .02) in language arts in the second year after receiving glasses. There was no change in math achievement overall; however, those with baseline performance in the bottom tercile had an immediate and sustained improvement of 10 to 24 percentile points from baseline (interaction term P < .001). Class rank for behavior marks decreased during the fourth grading period after receiving glasses but subsequently returned to baseline. There were no significant changes in work habits and no variation in results by gender. CONCLUSIONS Ensuring access to vision care may be a simple, scalable strategy to improve language arts performance for low-income minority children.
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Affiliation(s)
- Rebecca N. Dudovitz
- Department of Pediatrics and Children’s Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital
| | - Myung Shin Sim
- General Internal Medicine and Health Services Research, UCLA
| | - David Elashoff
- General Internal Medicine and Health Services Research, UCLA
| | | | - Wendelin Slusser
- Department of Pediatrics and Children’s Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital,UCLA Fielding School of Public Health,UCLA Chancellor’s Office – Semel Healthy Campus Initiative Center at UCLA
| | - Paul J. Chung
- Department of Pediatrics and Children’s Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital,UCLA Fielding School of Public Health,RAND Health, RAND Corporation
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Holmes JM, Kulp MT, Dean TW, Suh DW, Kraker RT, Wallace DK, Petersen DB, Cotter SA, Crouch ER, Lorenzana IJ, Ticho BH, Verderber LC, Weise KK. A Randomized Clinical Trial of Immediate Versus Delayed Glasses for Moderate Hyperopia in Children 3 to 5 Years of Age. Am J Ophthalmol 2019; 208:145-159. [PMID: 31255587 DOI: 10.1016/j.ajo.2019.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/14/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare visual acuity (VA) and binocularity outcomes in moderately hyperopic children with normal VA and binocularity assigned to glasses versus observation. DESIGN Prospective randomized clinical trial (RCT). METHODS One hundred nineteen 3- to 5-year-old children with hyperopia between +3.00D and +6.00D spherical equivalent were randomly assigned to glasses versus observation (with glasses prescribed if deteriorated for subnormal distance VA or near stereoacuity, or manifest strabismus). Follow-up occurred every 6 months. At 3 years, the treatment strategy was classified as "failed" if any of the following were met, both with and without correction: subnormal distance VA or stereoacuity; manifest strabismus; or strabismus surgery during follow-up. RESULTS Of 84 (71%) children who completed the primary outcome examination, failure occurred in five (12%; 95% confidence interval [CI]: 4%-26%) of 41 assigned to glasses and four (9%; 95% CI: 3%-22%) of 43 assigned to observation (difference = 3%; 95% CI: -12%-18%; P = .72). Deterioration prior to 3 years (requiring glasses per protocol) occurred in 29% (95% CI: 19%-43%) assigned to glasses and 27% (95% CI: 17%-42%) assigned to observation. CONCLUSIONS In an RCT comparing glasses to observation for moderately hyperopic 3- to 5-year-old children with normal VA and binocularity, failure for VA or binocularity was not common. With insufficient enrollment and retention, our study was unable to determine whether immediate glasses prescription reduces failure rate, but low failure rates suggest that immediate glasses prescription for these children may not be needed to prevent failure for VA and/or binocularity.
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Hopkins S, Black AA, White SLJ, Wood JM. Visual information processing skills are associated with academic performance in Grade 2 school children. Acta Ophthalmol 2019; 97:e1141-e1148. [PMID: 31228337 DOI: 10.1111/aos.14172] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/28/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE This study evaluated the association between performance on visual information processing tests and academic performance in school children. METHODS Visual-motor integration (VMI), the Developmental Eye Movement (DEM) test, visual acuity and stereoacuity were assessed in 222 Grade 2 children (mean age: 7.90 ± 0.33 years). Academic performance was assessed using standardized tests of reading and mathematics (PAT-R and PAT-M). Linear regression analyses examined associations between visual information processing (VMI and DEM) and academic measures, adjusting for school socio-economic background and age. Receiver operating characteristic (ROC) analysis was used to assess the ability of the tests to identify children with below average academic performance. RESULTS Visual-motor integration (VMI) and DEM (horizontal time) were most strongly associated with PAT-R and PAT-M. Linear regression models explained 28.6% of variance in PAT-R (VMI: standardized regression coefficient = 0.31, p < 0.01; DEM horizontal time: -0.28, p < 0.01) and 24.1% of variance in PAT-M (VMI: standardized regression coefficient = 0.29, p < 0.01; DEM horizontal time: -0.16, p = 0.02). Receiver operating characteristic (ROC) curve analysis indicated that VMI was most strongly associated with below average PAT-R (area under curve [AUC] of 0.74 [95% CI: 0.67-0.81]) and PAT-M (AUC of 0.73 [95% CI: 0.66-0.81]). CONCLUSION Visual-motor integration (VMI) was most strongly associated with reading and mathematics scores in school children. A child's academic performance can be an important factor in their optometric management. The ability of clinical tests to identify children at risk of underachieving academically provides additional support to clinicians in managing their patients.
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Affiliation(s)
- Shelley Hopkins
- School of Optometry and Vision Science and Institute of Health and Biomedical Innovation Queensland University of Technology Brisbane Queensland Australia
| | - Alex A. Black
- School of Optometry and Vision Science and Institute of Health and Biomedical Innovation Queensland University of Technology Brisbane Queensland Australia
| | - Sonia L. J. White
- School of Early Childhood and Inclusive Education Queensland University of Technology Brisbane Queensland Australia
| | - Joanne M. Wood
- School of Optometry and Vision Science and Institute of Health and Biomedical Innovation Queensland University of Technology Brisbane Queensland Australia
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Nishimura M, Wong A, Cohen A, Thorpe K, Maurer D. Choosing appropriate tools and referral criteria for vision screening of children aged 4-5 years in Canada: a quantitative analysis. BMJ Open 2019; 9:e032138. [PMID: 31558460 PMCID: PMC6773298 DOI: 10.1136/bmjopen-2019-032138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To assess the diagnostic accuracy of five vision screening tools used in a school setting using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). DESIGN We compared the results of the five best evidence-based screening tools available in 2014 to the results of a comprehensive eye exam with cycloplegic refraction by a licenced optometrist. Screening included Cambridge Crowded Acuity Cards, Plusoptix S12 and Spot photoscreeners, Preschool Randot Stereoacuity Test and the Pediatric Vision Scanner (PVS). Referral criteria followed AAPOS (2013) guidelines and published norms. SETTING A large school in Toronto, Canada, with 25 split classrooms of junior kindergarten (JK: 4 year olds) and senior kindergarten (SK: 5 year olds) children. PARTICIPANTS Over 2 years, 1132 eligible children were enrolled at the school. After obtaining parental consent, 832 children were screened. Subsequently, 709 children had complete screening and optometry exam data. MAIN OUTCOME MEASURES The presence/absence of a visual problem based on optometrist's assessment: amblyopia, amblyopia risk factors (reduced stereoacuity, strabismus and clinically significant refractive errors) and any other ocular problem (eg, nystagmus). RESULTS Overall, 26.5% of the screened children had a visual problem, including 5.9% with amblyopia. Using all five tools, screening sensitivity=84% (95% CI 78 to 89), specificity=49% (95% CI 44 to 53), PPV=37% (95% CI 33 to 42), and NPV=90% (95% CI 86 to 93). The odds of having a correct screening result in SK (mean age=68.2 months) was 1.5 times those in JK (mean age=55.6 months; 95% CI 1.1 to 2.1), with sensitivity improved to 89% (95% CI 80 to 96) and specificity improved to 57% (95% CI 50 to 64) among SK children. CONCLUSIONS A school-based screening programme correctly identified 84% of those kindergarten children who were found to have a visual problem by a cyclopleged optometry exam. Additional analyses revealed how accuracy varies with different combinations of screening tools and referral criteria.
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Affiliation(s)
- Mayu Nishimura
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Agnes Wong
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Cohen
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Daphne Maurer
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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