Vision Health Care Providers?? Attitudes and Experiences with Preschool Vision Screening in Ontario

Identifying barriers to referrals in preschool-age ocular screening in Southern India

Purpose:

The aim of this study was to identify barriers to follow-up among children aged 0–5 years who failed ocular screening.

Methods:

A cross-sectional, descriptive study was conducted for screening children aged 0–5 years, covering three districts of South India from January 2012 to December 2012. Screening was performed under Lavelle Paediatric Eye Care Project, included under Integrated Child Development Services (ICDS) program. A survey was conducted within 60 days of the screening, with the parents of children who failed to follow up at base hospital. Family demographics, parental awareness of childhood eye diseases and eye care for children, and barriers to follow up eye care were assessed.

Results:

A total of 19,408 children were screened. Among them, 913 (4.7%) failed screening and were referred. 319 (35%) of those referred attended the base hospital, of which 133 (41.6%) had no abnormality on detailed examination. 111 (34.7%) had refractive errors, 10 (3%)) had strabismus, and three (1%) had amblyopia. 62 (19.4%) had other ocular conditions. Parents of 324/594 (65%) children who did not attend the base hospital were traced and completed the questionnaire. Low level of education, low income, types of occupation, and distance factors were the main barriers to follow-up of referral in preschool children. Factors such as cost of time taking off from work and monthly family income were statistically significant (P < 0.001).

Conclusion:

Education, financial status, and distance factors were the main barriers to follow up of referral in preschool children. Identification of these barriers to follow up and improving the referral services could help in detecting visual problem effectively.

Vision Screening of Younger School Children by School Teachers: A Pilot Study in Udaipur City, Western India

PURPOSE

To assess the reliability of school teachers for vision screening of younger school children and to study the pattern of vision problems.

METHODS

In this cross-sectional study, trained school teachers screened 5,938 school children aged 3 to 8 years for vision and ocular disorders. Children were cross screened by professionals to assess the reliability of the teachers in vision screening and detecting ocular disorders in these children. The pattern of visual acuity, ametropia and ocular disorders was studied.

RESULTS

Sensitivity and specificity of the vision screening by school teachers was 69.2% (95% CI: 66.8-71.5%) and 95.3% (95% CI: 94.5-95.8%), respectively. The positive predictive value was 83.5% (95% CI: 81.4-85.6%) and negative predictive value was 89.8% (95% CI: 88.8-90.6%). The kappa statistic was 0.68 (95% CI: 0.66-0.7).

CONCLUSION

School teachers could effectively screen younger school children for vision assessment and ocular disorders.

Childhood vision screening in Canada: public health evidence and practice

OBJECTIVES

Best practice guidelines recommend vision testing in children 3 to 5 years of age for the prevention of amblyopia; however, universal vision screening is controversial. In Canada, amblyopia screening can be the responsibility of physicians, optometrists, and/or Public Health. We review the evidence underlying preschool vision screening for amblyopia using an Evidence-based Public Health (EBPH) approach, and consider implications for the Public Health provision of universal screening programs for amblyopia in Canadian jurisdictions in light of present practices.

METHODS

We searched the literature to address each major screening criterion (disease, test, treatment, program requirements) necessary to support preschool vision screening for amblyopia. We also reappraised papers cited in two systematic reviews related to the impact of vision screening. The Chief Medical Officer of Health of each province/territory was sent a short survey asking whether there currently was a Public Health preschool vision screening program in place and if so, for specifics about the program.

RESULTS

An EBPH approach to the literature with respect to the criteria for screening and available intervention studies support amblyopia screening by Public Health. There is a public health divide in amblyopia screening practice in Canada; while some provinces maintain organized programs, others have chosen to delegate the task to other professionals, without a concurrent surveillance function to monitor disparities in uptake.

CONCLUSIONS

Amblyopia deserves attention from Public Health. Efforts should be made to maintain existing programs, and provinces without organized screening programs should reconsider their role in the prevention of inequities with regard to preventable blindness in Canadian children.

Comparing a traditional single optotype visual acuity test with a computer-based visual acuity test for childhood amblyopia vision screening: a pilot study

OBJECTIVE

To investigate the effectiveness of a traditional flip-chart optotype test, the Sheridan Gardiner test (SGT), in measuring visual acuity and detecting amblyopia, compared with a free, computer-based test (CBT), LazyeyeTest.org.

DESIGN

Prospective, masked, cross-over study.

PARTICIPANTS

Seventy kindergarten-aged children from a downtown Toronto elementary school enrolled in the Kids2See vision screening program.

METHODS

Visual acuity in the children was measured monocularly using both tests. The visual acuity results, number of referrals, and outcomes of referrals were compared, as was the usability from the perspective of the child and the vision screener.

RESULTS

The children were more likely to score low visual acuity values with the CBT, a result predicted by the existence of crowding bars on the CBT's optotypes. The CBT referred an extra 5 children than the SGT, and of the 4 who saw an ophthalmologist 2 had amblyopia. The SGT referred one child not referred by the CBT. The Cohen's kappa coefficient was 0.67 and the difference in referral rates was not significant (p = 0.13). Relative to the SGT, the sensitivity of the CBT was 88%, specificity was 92%, positive predictive value was 58%, and negative predictive value was 98%. The CBT appeared to be easier and more efficient to administer, more stimulating, and was preferred by the children.

CONCLUSIONS

Replacing the SGT with LazyeyeTest.org would increase the efficiency and likely the sensitivity of amblyopia screening. Further research is warranted to confirm the outcomes and to determine if the CBT can be administered accurately by lay screeners.