Vision Screening, Vision Disorders, and Impacts of Hyperopia in Young Children: Outcomes of the Vision in Preschoolers (VIP) and Vision in Preschoolers - Hyperopia in Preschoolers (VIP-HIP) Studies

The Prevalence and Risk Factors of Abnormal Vision Among Preschool Children

Background

The presence of abnormal vision during early childhood has been shown to have a substantial impact on the development of visual, motor, and cognitive functions, potentially resulting in long-term adverse psychosocial outcomes. The objective of this study was to examine the prevalence and associated risk factors of abnormal vision among preschool children aged 4-6 years in Shaoxing, China.

Methods

A cross-sectional study was conducted from March to May 2023 in Shaoxing, involving a sample of 9913 children within the specified age range. Parents were interviewed using a structured questionnaire that gathered information on sociodemographic characteristics and other relevant factors.

Results

The study revealed that 14.4% of participants had abnormal vision. Logistic regression analysis indicated that individuals who watched TV for more than 3 hours daily had a 2.206 times higher likelihood of developing abnormal vision (P<0.05). Additional risk factors for abnormal vision included watching TV at a distance of less than 3 meters, misalignment of eyes and screen while watching TV, early exposure to electronic devices before the age of 2, parents are unaware of the impact of chewing on eye development, and lack of promotion of good eye habits in children (P < 0.05). An association was found between parent's and children's refractive error (P < 0.05), with good family lighting and a balanced dietary structure being identified as protective factors against abnormal vision.

Conclusion

The study concluded that exposure to electronic products was a significant factor in the development of abnormal vision among children aged 4-6. Furthermore, family environment and genetic predisposition were also found to influence vision. Regular ocular screenings and early interventions may be effective in preventing abnormal vision.

Vision Screening and Detection of Ocular Abnormalities in School Children by Teachers in Jordan

Purpose

To evaluate the accuracy of vision screening and detection of ocular abnormalities conducted by teachers in school children in Jordan compared with vision testing by optometrists and ocular disease identification by ophthalmologists.

Methods

A non-random, purposive sampling strategy where 6-year-old and 15-year-old school children from three schools in Amman, Jordan were included. Twenty-two teachers were trained to conduct visual acuity screening using the 0.2 logMAR line of the distance visual acuity (DVA) chart at 10 feet and near visual acuity (NVA) chart at 16 inches, in addition to detecting ocular abnormalities. An optometrist assessed the visual acuity and conducted objective and subjective refraction, while an ophthalmologist examined the ocular health of all children.

Results

A total of 542 children (51% female) were included in the study, of which 47% were 6 years old and 53% were 15 years old. Teacher screening had sensitivities of 76.92% for DVA, 68% for NVA, and 37.50% for abnormality detection. The specificities of DVA, NVA, and ocular abnormalities were 98.22%, 98.48%, and 99.24%, respectively. The positive predictive value for DVA, NVA, and ocular abnormalities were 83.33%, 99.00%, and 60%, respectively. The negative predictive value for each procedure was 98.22% for DVA, 98.48% for NVA, and 98.12% for ocular abnormalities.

Conclusion

Teachers were able to conduct vision screening with a high level of accuracy compared to the gold standard of testing by optometrists, which would be useful for the early detection and referral of refractive errors in school children. However, they were unable to detect ocular abnormalities compared with the gold standard for disease identification by ophthalmologists. Further training and monitoring, or different training approaches should be implemented to enable teachers to identify ocular abnormalities at acceptable levels.

Survey on pattern of myopia in school children in Hangzhou after the COVID-19 pandemic: a school-based vision screening study

BACKGROUND

Myopia is a major health issue around the world. Myopia in children has increased significantly during the COVID-19 pandemic in China, but reports are scarce on the prevalence of myopia following the pandemic. This study collected vision screening data of school children in China for five consecutive years to observe the changes in myopia after the pandemic and compare the observed prevalence of myopia before and after the pandemic.

METHODS

A school-based vision screening study used stratified samplings to collect the vision screening data in school children aged 6-13 from 45 primary schools in Hangzhou. Vision screening data including uncorrected visual acuity(UCVA) and spherical equivalent refraction(SER). Calculating the mean of SER and the prevalence of myopia and hyperopia from 2019 to 2023.

RESULTS

A total of 79,068 screening results (158,136 eyes) were included in the analysis. A substantial myopic shift (approximately -0.30 diopters [D] on average) was found in 2020 and 2021 compared with 2019 in all age groups and a substantial myopic shift (approximately 0.4 D on average) was found in 2022 compared with 2021. A slight myopic shift (approximately -0.14 D on average) was found in 2023 compared with 2022. The prevalence of myopia in all age groups was the highest for five years in 2020 or 2021, which was 31.3% for 6-year-olds, 43.0% for 7-year-olds, and 53.7% for 8-year-olds. A positive change in the prevalence rate of myopia was found at 6 years old (0.59%, 0.12%, 0.36%, 0.25%, p < 0.001). The change in prevalence rate in myopia was shifted slightly in children aged 10-13 years. Children aged 8 to 13 years had a slight increase in myopia prevalence from 2022 to 2023. The prevalence of hyperopia was low and stable in all grade groups, ranging from 0.7% to 2.2% over five years.

CONCLUSION

Myopia in children has increased rapidly during the COVID-19 pandemic. After the pandemic, the prevalence of myopia in children gradually decreased temporarily and then rebounded. Myopic shift was more apparent in younger children. Myopic shift in children may be related to the reduction of outdoor time, less light, and near work habits, and further research is needed.

Amblyogenic risk factors and validity of vision screening using spot-screener among kindergarten children in Qassim region, Saudi Arabia

PURPOSE

The purpose of the study was to present the outcomes of vision and amblyogenic risk factor (ARF) screening in kindergarten children in the Qassim region, Saudi Arabia.

METHODS

In this cross-sectional study, an optometrist conducted first-level screening in a kindergarten using a spot screener (Welch Allyn) in 2023. Refractive status and ocular alignment were evaluated. The visual acuity of each eye was measured. Those who failed the first screening or had impaired vision were re-evaluated at the second level of screening by an optometrist and pediatric ophthalmologist. Those who failed the screening in Kindergarten were referred to a pediatric ophthalmology clinic for confirmation and management (third level of screening).

RESULTS

We screened 222 children (mean age: 5.9 ± 0.4 years, 111 boys). A total of 59 (26.6%) children failed the spot vision screening test. A vision screening test by an optometrist identified 58 (26.1%) children with impaired vision. Refractive errors (REs) for children who failed the spot screener included hyperopia in 4 (6.7%) children, high myopia (>6.00 D) in 2 (3.4%) children, and astigmatism in 53 (89.83%) children. Compared to the evaluation by optometrists and pediatric ophthalmologists at KGs, spot screening had 0.845 sensitivity and 0.939 specificity. Validity parameters differed for RE, vision impairment, amblyopia, and strabismus. Seventy-one (31.98%) children were referred for third-level screening, but only 32 (44.4%) children attended, and among them, the prevalence of amblyopia was 25%.

CONCLUSION

The high prevalence of amblyopia and undetected ARFs necessitate establishing annual vision screening among 3- to 5-year-old children in the study area.

[Ophthalmic disqualification from the military services: Multicentric cross-sectional study]

PURPOSE

This article aims to describe the causes of ophthalmological disqualification from the military services detected during specialist consultations conducted at Army Training Hospitals.

METHODS

This observational, cross-sectional, multicenter study retrospectively included individuals deemed as "unfit for military service" due to eye diseases identified during the specialist consultation conducted at 3 ATHs between January 2020 and December 2021. The data collected included age, medical and surgical history, reasons for ophthalmological disqualification, uncorrected distance visual acuity, best corrected distance visual acuity and cycloplegic refraction.

RESULTS

Over this period, 133 subjects (98 men and 35 women) were included. Thirty-eight candidates (28.6%) were declared unfit due to a refractive error beyond the required limits, including 30 myopic subjects in excess of -10 diopters (D) and 8 hypermetropic subjects over +8 D. Twenty-five candidates (18.8%) were unfit under the age of 21 years due to corneal refractive surgery performed before the required age. Four subjects (3.0%) were unfit due to phakic intraocular lenses. Degenerative conditions were observed in 23 subjects (17.3%), including 21 patients with severe keratoconus. Other causes of incapacity were linked to oculo-orbital trauma in 11 subjects (8.3%), moderate or severe amblyopia in 7 patients (5.3%), congenital causes in 7 subjects (5.3%), inflammatory or infectious diseases in 7 candidates (5.3%), hereditary causes in 6 subjects (4.5%) and undetermined visual dysfunctions in 4 subjects (3.0%).

CONCLUSION

The three main causes of ophthalmological disqualification were high ametropia, refractive surgery performed before the required age and keratoconus.

Detection of significant vision conditions in children using QuickSee wavefront autorefractor

PURPOSE

This study evaluated the ability of QuickSee to detect children at risk for significant vision conditions (significant refractive error [RE], amblyopia and strabismus).

METHODS

Non-cycloplegic refraction (using QuickSee without and with +2 dioptre (D) fogging lenses) and unaided binocular near visual acuity (VA) were measured in 4- to 12-year-old children. Eye examination findings (VA, cover testing and cycloplegic retinoscopy) were used to determine the presence of vision conditions. QuickSee performance was summarised by area under the receiver operating characteristic curve (AUC), sensitivity and specificity for various levels of RE. QuickSee referral criteria for each vision condition were chosen to maximise sensitivity at a specificity of approximately 85%-90%. Sensitivity and specificity to detect vision conditions were calculated using multiple criteria. Logistic regression was used to evaluate the benefit of adding near VA (6/12 or worse) for detecting hyperopia. A paired t-test compared QuickSee without and with fogging lenses.

RESULTS

The mean age was 8.2 (±2.5) years (n = 174). RE ranged up to 9.25 D myopia, 8 D hyperopia, 5.25 D astigmatism and 3.5 D anisometropia. The testability of the QuickSee was 94.3%. AUC was ≥0.92 (excellent) for each level of RE. For the detection of any RE, sensitivity and specificity were 84.2% and 87.3%, respectively, using modified Orinda criteria and 94.5% and 78.2%, respectively, using the American Academy for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines. For the detection of any significant vision condition, the sensitivity and specificity of QuickSee were 81.1% and 87.9%, respectively, using modified Orinda criteria and 93% and 78.6%, respectively, using AAPOS criteria. There was no significant benefit of adding near VA to QuickSee for the detection of hyperopia ≥+2.00 (p = 0.34). There was no significant difference between QuickSee measurements of hyperopic refractive error with and without fogging lenses (difference = -0.09 D; p = 0.51).

CONCLUSIONS

QuickSee had high discriminatory power for detecting children with hyperopia, myopia, astigmatism, anisometropia, any significant refractive error or any significant vision condition.

Efficacy and safety of small-incision corneal intrastromal lenticule implantation for hyperopia correction: a systematic review and meta-analysis

Purpose

To assess the efficacy and safety of intrastromal lenticule implantation for the treatment of hyperopia.

Methods

A systematic search of PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Internet, and Wan Fang Database identified studies on small-incision intrastromal lenticule implantation for hyperopia correction until January 2023. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the quality of the retrospective research, and the Methodological Index for Non-randomized Studies (MINORS) was used to assess the quality of the prospective research. This study included postoperative visual outcomes, corneal morphology, and biomechanical outcomes.

Results

A total of 456 articles were identified, of which 10 were included in the meta-analysis. Ten single-arm studies involving 190 eyes were included. A meta-analysis demonstrated that corneal intrastromal lenticule implantation treatment significantly improved hyperopia. Uncorrected distance visual acuity (UDVA) significantly improved compared to the preoperative value (p = 0.027), corrected distance visual acuity showed no difference compared to the preoperative value (p = 0.27), and 87% eyes have no loss of one or more lines in the Snellen lines of CDVA (p < 0.00001). There was a significant difference between the spherical equivalent refractive (SE) and preoperative examination (p < 0.00001), 52% of eyes had ±0.5 diopters (D) postoperative SE (p < 0.00001), and 74% eyes had ±1.0 D postoperative SE (p < 0.00001). The central corneal thickness (CCT) increased by 72.68 μm compared to that preoperatively (p < 0.00001), and corneal curvature increased by 4.18D (p < 0.00001). The Q-value decreased by 0.82 (p < 0.00001), and higher-order aberration (HOA) decreased by 0.66 (p < 0.00001).

Conclusion

Small-incision intrastromal lenticule implantation may be an effective solution for correcting hyperopia. The effect of improved vision is significant, but further exploration is needed for changes in corneal biomechanics and long-term safety.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42023432343.

Orthokeratology vs. orthokeratology combined with atropine for the control of myopia in children: systematic review

The purpose of this investigation is to determine the efficacy of orthokeratology (OK) compared to orthokeratology combined with atropine (AOK) for the control of myopia in children. A systematic review that included systematic reviews with meta-analyses, as well as randomized and controlled clinical trials, was carried out in the PubMed, Web of Science, Scopus, Cochrane Library, ProQuest, Taylor & Francis, Science Direct databases, as well as a manual search. Of the Q1-Q4 journals of the Scimago Journal & Country Rank, published in the last 5 years in English and Spanish. Eighteen studies that met the eligibility criteria were considered. The articles selected included 6,866 patients for analysis, where orthokeratology combined with 0.01% atropine was found to be more effective due to its ability to reduce the progression of myopia and axial elongation. In our investigation, it was determined that there could be an additive effect in the combination of 0.01% atropine with orthokeratology in a period of 1-2 years of treatment in patients with mild myopia; however, more multiethnic studies should be carried out, in where a correct evaluation of the progression of myopia, genetic and environmental factors that may influence the results is considered.

Development and validation of a questionnaire for assessing parents' health literacy regarding vision screening for children: a Delphi study

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.

Refractive prescribing for preschool children by optometrists in England

PURPOSE

Correction of refractive error in children is important for visual and educational development. The aim of this questionnaire-based study was to explore paediatric refractive correction by optometrists in England.

METHODS

An online questionnaire was piloted and distributed to optometrists in England. The questionnaire asked about respondents' characteristics (such as type of practice), management of refractive error in 1- and 3-year-old children and sources of information used as a basis for decisions on prescribing refractive error in children.

RESULTS

Two hundred and ninety-three questionnaires were returned, although only 139 (47%) were fully completed. In an average month, about half of respondents examined no children between 0 and 2 years of age, and about half examined no more than five children aged 3-4 years. A significant proportion indicated they would refer children aged 1 or 3 years with refractive error and no other signs or symptoms into the hospital eye service. Almost a quarter would prescribe in full or in part an isometropic refractive correction of +2.00 D for a 3-year-old (within the normal range) with no other signs or symptoms, suggesting a degree of unnecessary prescribing. Almost all would act in cases of clinically significant refractive error. Respondents made similar use of their colleagues, optometric or postgraduate/continuing education, professional guidance and peer-reviewed research as sources of evidence on which to base decisions about prescribing for paediatric refractive errors. Most reported 'never' or 'rarely' using Cochrane reviews.

CONCLUSIONS

These results suggest optometrists often defer management of paediatric refractive error to the hospital eye service, with implications in terms of underutilisation of community optometric expertise and burden on the National Health Service. In some cases, the results indicate a mismatch between respondents' reported management and existing guidance/guidelines on paediatric prescribing.