Uncorrected refractive error among first-grade students of different racial/ethnic groups in southern California: results a year after school-mandated vision screening

Race, poverty, and the lack of follow-up for Arkansas students that fail vision screenings: a cross-sectional study over 7 years

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.

Use of Telemedicine in Pediatric Ophthalmology in the Underserved Population

Access to pediatric eye care is critical in diagnosing and treating eye disease promptly to prevent visual impairment. The demand for pediatric ophthalmology is high, even in developed countries, and significant socioeconomic disparities exist in access to care. The purpose of this article is to summarize the current literature on the use of telemedicine in pediatric ophthalmology in the underserved population and to identify areas of opportunity. A detailed literature review was performed in PubMed and Google Scholar on October 1, 2021. All articles in English that described the use of telemedicine in pediatric ophthalmology, with particular attention to the underserved pediatric population, were included. There is a paucity of literature on the visual outcomes from pediatric teleophthalmology alone, and even less in underserved populations specifically. Literature supports its use in subacute to chronic eye disease, return and postoperative visits, and screening for retinopathy in prematurity in particular. Collaboration between pediatric optometrists and pediatric ophthalmologists for both asynchronous and synchronous care delivery models has shown promise in several studies. It is essential to operate within the limits of pediatric teleophthalmology and utilize this valuable service for its strengths. Telemedicine may expand access to pediatric ophthalmologists in underserved populations and may reduce the burden of eye disease.

Development and evaluation of an intervention to promote the use of eyeglasses among Romani families in Bulgaria

Objective

Uncorrected refractive error (i.e., lack of eyeglasses for the treatment of refractive error) is one of the leading causes of visual impairment in Eastern Europe. Limited information is available on how to promote the use of eyeglasses among Romani families in Bulgaria. In step 1, the objective was to obtain suggestions by Romani mothers on how to promote the use of eyeglasses among children. In step 2, the objective was to evaluate an intervention to promote the use of eyeglasses based on suggestions received during step 1.

Methods

During step 1, 5 focus groups with Romani mothers took place in one neighborhood in Bulgaria. During step 2, the intervention used a one-group pre-test, post-test design. Families received eye examinations. Those who needed eyeglasses chose attractive eyeglasses. Parents received education on how to encourage their children to wear eyeglasses.

Results

During step 1, 54 mothers participated. Mothers suggested that the whole family should receive eye examinations and eyeglasses. During step 2, of 33 family members, 14 did not have refractive errors and 19 did. Of the 19 family members with refractive error, none had eyeglasses at pre-test. Approximately 6 months following the end of the intervention, 11 of the 19 family members (57.9%) wore eyeglasses and the remaining 8 (42.1%) did not.

Conclusion

Romani family members needed eyeglasses but did not have any at pre-test of the intervention. Future interventions that offer education on the importance of eye examinations may increase receipt of eye examinations and adherence to wearing eyeglasses.

Disparities in Vision Health and Eye Care

Significant disparities in vision health and eye care exist. To achieve health equity, we must understand the root causes and drivers of health disparities and inequities, including social determinants of health and systemic racism.

Improving Access to Eye Care: A Systematic Review of the Literature

PURPOSE

The goals were to develop a working and inclusive definition of access to eye care, identify gaps in the current system that preclude access, and highlight recommendations that have been identified in prior studies. This manuscript serves as a narrative summary of the literature.

CLINICAL RELEVANCE

Health care disparities continue to plague the nation's well-being, and eye care is no exception. Inequities in eye care negatively affect disease processes (i.e., glaucoma, cataracts, diabetic retinopathy), interventions (surgical treatment, prescription of glasses, referrals), and populations (gender, race and ethnicity, geography, age).

METHODS

A systematic review of the existing literature included all study designs, editorials, and opinion pieces and initially yielded nearly 2500 reports. To be included in full-text review, an article had to be US-based, be written in English, and address 1 or more of the key terms "barriers and facilitators to health care," "access," and "disparities in general and sub-specialty eye care." Both patient and health care professional perspectives were included. One hundred ninety-six reports met the inclusion criteria.

RESULTS

Four key themes regarding access to eye care from both patient and eye care professional perspectives emerged in the literature: (1) barriers and facilitators to access, (2) utilization, (3) compliance and adherence, and (4) recommendations to improve access. Common barriers and facilitators included many factors identified as social determinants of health (i.e., transportation, insurance, language, education). Utilization of eye care was largely attributable to having coverage for eye care, recommendations from primary care professionals, and improved health status. Geographic proximity, age, and lack of transportation surfaced as factors for compliance and adherence. There were a variety of recommendations to improve access to eye care, including improving presence in community health clinics, reimbursement for physicians, and funding of community-based programs such as DRIVE and REACH.

CONCLUSIONS

The eye care profession has abundant evidence of the disparities that continue to affect marginalized communities. Improving community-based programs and clinics, addressing social determinants of health, and acknowledging the effects of discrimination and bias on eye care serve as ways to improve equity in this field.

The prevalence and causes of pediatric uncorrected refractive error: Pooled data from population studies for Global Burden of Disease (GBD) sub-regions

Background

There are limited systematic reviews on the prevalence of uncorrected refractive errors in children. We aimed to summarize the prevalence and causes of pediatric uncorrected refractive error (URE) from studies in the Global Burden of Disease (GBD) sub-regions.

Methods

The pooled analysis used the individual participant data (ages less than 20 years old) from population-based studies around the world by regions. URE was defined as presenting VA < 6/18 and improving to ≥ 6/18 or ≥1 line on using a pinhole in either eye, with main causes of myopia, hyperopia or astigmatism. Each study provided data on any URE, myopia, hyperopia or astigmatism by age, gender, and ethnicity. Prevalence rates were directly age and gender standardized to the 2020 world population with all age groups. Estimates were calculated by study and sub-regions after pooling. Summary estimates included studies in which URE was assessed from a pinhole-corrected refraction in the better eye.

Results

The combined pooled data contained 302,513,219 patients including 8 963 URE cases individuals from 57 studies. Prevalence varied by age and GBD sub-regions and differed by gender. The age- and region-standardized prevalence of URE was 3.41 per 1000 (CI, 1.53~7.62) in Western Pacific region (12 studies), 2.26 per 1000 (CI, 0.85~6.01) in South-East Asia region (14 studies), 5.85 per 1000 (CI, 3.75~9.13) in Americans (11 studies) and 4.40 per 1000 (CI, 3.0~6.45) in Eastern Mediterranean region (13 studies). On the basis of these data, myopia was the first-leading cause in female children with 12~17 age group, with the prevalence rate 18.2 per 1000 (CI, 11.52~23.61). Astigmatism was detected in 27.2 per 1000 male children with 6~11 age group (CI: 19.12–30.68).

Conclusions

Prevalence of URE available data within these sub-regions are widely disparate. Myopia and astigmatism in young age children continue as the leading cause of URE worldwide. Providing appropriate refractive correction to those individuals whose vision can be improved is an important public health endeavor with implications for safety and quality of life.

Estimating need and coverage for five priority assistive products: a systematic review of global population-based research

INTRODUCTION

To improve access to assistive products (APs) globally, data must be available to inform evidence-based decision-making, policy development and evaluation, and market-shaping interventions.

METHODS

This systematic review was undertaken to identify studies presenting population-based estimates of need and coverage for five APs (hearing aids, limb prostheses, wheelchairs, glasses and personal digital assistants) grouped by four functional domains (hearing, mobility, vision and cognition).

RESULTS

Data including 656 AP access indicators were extracted from 207 studies, most of which (n=199, 96%) were cross-sectional, either collecting primary (n=167) or using secondary (n=32) data. There was considerable heterogeneity in assessment approaches used and how AP indicators were reported; over half (n=110) used a combination of clinical and self-reported assessment data. Of 35 studies reporting AP use out of all people with functional difficulty in the corresponding functional domains, the proportions ranged from 4.5% to 47.0% for hearing aids, from 0.9% to 17.6% for mobility devices, and from 0.1% to 86.6% for near and distance glasses. Studies reporting AP need indicators demonstrated >60% unmet need for each of the five APs in most settings.

CONCLUSION

Variation in definitions of indicators of AP access have likely led to overestimates/underestimates of need and coverage, particularly, where the relationship between functioning difficulty and the need for an AP is complex. This review demonstrates high unmet need for APs globally, due in part to disparate data across this sector, and emphasises the need to standardise AP data collection and reporting strategies to provide a comparable evidence base to improve access to APs.

The New York City Department of Health and Mental Hygiene School Vision Program: A description of program expansion

OBJECTIVE

This study describes how the School Vision Program (SVP) operates in NYC Public Schools, and how it has expanded to provide screening, follow-up, eye exams, and even glasses to more students in recent years.

METHODS

Using administrative data from the SVP, we analyze a population sample of all public-school students with non-missing demographic variables in grades Pre-K through 12, focusing on the most recent year of data, 2018-19. We tabulate rates of screening and other results across students by grade and student characteristics, highlighting the expansion of SVP in community schools beginning in 2015-16.

RESULTS

The SVP screens about 87% of students in Pre-K through 1st Grade each school year. Of the 22% of screened students who failed the screening in 2018-19, 69% received follow-up efforts, and 39% completed eye exams. Among students with completed eye exams, 13% of students in Pre-K through 1st grade were diagnosed with amblyopia, and 70% needed glasses. Less advantaged students in terms of race, ethnicity, and socioeconomic status were less likely to pass vision screenings and less likely to receive eye exams after failing the screening. The SVP's expansion to all grades in community schools and its provision of eye exams and glasses increased the rate of eye exams to 90% of students with a failed vision screening and distributed glasses to over 22,000 students in grades Pre-K to 12 in 2018-19.

CONCLUSION

The expansion of SVP services in community schools suggests large potential benefits from school districts connecting students who fail vision screenings directly to eye doctors. Otherwise, low rates of follow-up eye exams in younger grades can lead to unidentified and unmet need for vision services in older grades, especially among disadvantaged students.

Predictors of Spectacle Wear and Reasons for Nonwear in Students Randomized to Ready-made or Custom-made Spectacles: Results of Secondary Objectives From a Randomized Noninferiority Trial

Importance

Visual impairment from uncorrected refractive errors affects 12.8 million children globally. Spectacle correction is simple and cost-effective; however, low adherence to spectacle wear, which can occur in all income settings, limits visual potential.

Objective

To investigate predictors of spectacle wear and reasons for nonwear in students randomized to ready-made or custom-made spectacles.

Design, Setting, and Participants

In planned secondary objectives of a noninferiority randomized clinical trial, students aged 11 to 15 years who fulfilled eligibility criteria, which included improvement in vision with correction by at least 2 lines in the better eye, were recruited from government schools in Bangalore, India. Recruitment took place between January 12 and July 15, 2015, and analysis for the primary outcome occurred in August 2016. Data analysis for the secondary outcome was conducted in August 2018. Spectacle wear was assessed by masked observers at unannounced visits to schools 3 to 4 months after spectacles were distributed. Students not wearing their spectacles were asked an open-ended question to elicit reasons for nonwear.

Main Outcomes and Measures

Predictors of spectacle wear and reasons for nonwear.

Results

Of 460 students recruited and randomized (52.2% male; 46 students aged 11 to 12 years and 13 to 15 years in each trial arm), 78.7% (362 of 460) were traced at follow-up, and 25.4% (92 of 362) were not wearing their spectacles (no difference between trial arms). Poorer presenting visual acuity (VA) and improvement in VA with correction predicted spectacle wear. Students initially seen with an uncorrected VA less than 6/18 in the better eye were almost 3 times more likely to be wearing their spectacles than those with less than 6/9 to 6/12 (adjusted odds ratio, 2.84; 95% CI, 1.52-5.27). Improvement of VA with correction of 3 to 6 lines or more than 6 lines had adjusted odds ratios of 2.31 (95% CI, 1.19-4.50) and 2.57 (95% CI, 1.32-5.01), respectively, compared with an improvement of less than 3 lines. The main reason students gave for nonwear was teasing or bullying by peers (48.9% [45 of 92]). Girls reported parental disapproval as a reason more frequently than boys (difference, 7.2%).

Conclusions and Relevance

Three-quarters of students receiving spectacles were wearing them at follow-up, which supports the use of the prescribing guidelines applied in this trial. Predictors of spectacle wear, poorer presenting VA, and greater improvement in VA with correction are similar to other studies. Interventions to reduce teasing and bullying are required, and health education of parents is particularly needed for girls in this setting.

Trial Registration

isrctn.org Identifier: ISRCTN14715120.

Receipt of Corrective Lenses and Academic Performance of Low-Income Students

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.

Compliance and Predictors of Spectacle Wear in Schoolchildren and Reasons for Non-Wear: A Review of the Literature

Purpose: Uncorrected refractive errors are the leading cause of visual impairment in children, affecting children in all settings. The majority of refractive errors can be corrected with spectacles. High compliance with spectacle wear is required for children to realize the benefit, such as higher academic achievement. This review collates evidence on compliance with spectacle wear, factors which predict spectacle wear and reasons for non-compliance among schoolchildren.Methods: Literature searches were conducted on Medline, Embase, Global Health and the Cochrane Library. The date range was January 2000 to November 2017 and there were no language restrictions. The search retrieved a total of 1299 references, 522 duplicate records were removed leaving 777 references to assess. Twenty-five studies were included in the review.Results: Evidence suggests that greater severity of uncorrected refractive error and lower levels of uncorrected visual acuity are associated with higher levels of spectacle wear. Addressing socio-demographic reasons for non-compliance is complex as they are context specific. Evidence that children become less compliant with spectacle wear with increasing age is not consistent. Quantitative data indicate girls are more likely to be compliant with spectacles wear than boys, but qualitative studies highlight specific challenges faced by girls.Conclusion: There was considerable variation between studies in how spectacle compliance was defined, the time interval between dispensing the spectacles and assessment, and how compliance was assessed. There is need to standardize all aspects of the assessment of compliance. Further qualitative and quantitative studies are required in a range of settings to assess the biomedical and socio-demographic factors which affect spectacle wear compliance using standard definitions.

Implementing enhanced education to improve the UCLA Preschool Vision Program

PURPOSE

To examine whether educational pamphlets and videos for adults can increase follow-up rates for eye examinations among preschool children.

METHODS

The target population was 3- to 5-year-olds attending preschools within Los Angeles County and receiving services from the UCLA Preschool Vision Program (UPVP). Preschools were randomly assigned to standard and enhanced-education groups. The same procedures were followed in each group, except that preschool personnel and parents of children referred for eye examinations in the enhanced-education group received education materials and watched a 3-minute informational video on the screening day. The outcome measure was the follow-up rate for comprehensive examinations performed by the UPVP on a second date.

RESULTS

The follow-up rate for receiving a complete eye examination was 75.3% (438/582) in the enhanced-education group and 65.1% (430/661) in the standard group (P < 0.0001 [Fisher exact test]; OR = 1.63; 95% CI, 1.28-2.09).

CONCLUSIONS

Educating adults during the screening session can increase follow-up rates. Further studies are recommended to understand barriers to seeking eye care for children and to devise initiatives to help increase targeted awareness.

Spectacle Wear Among Children in a School-Based Program for Ready-Made vs Custom-Made Spectacles in India: A Randomized Clinical Trial

Importance

Uncorrected refractive errors are the most common cause of visual impairment in children despite correction being highly cost-effective.

Objective

To determine whether less expensive ready-made spectacles produce rates of spectacle wear at 3 to 4 months comparable to those of more expensive custom-made spectacles among eligible school-aged children.

Design, Setting, and Participants

This noninferiority, double-masked, randomized clinical trial recruited children aged 11 to 15 years from January 12 through July 31, 2015, from government schools in urban and periurban areas surrounding Bangalore, India. Follow-up occurred from August 1 through September 31, 2015. Participants met the following eligibility criteria for ready-made spectacles: failed vision screening at the 6/9 level in each eye; refraction was indicated; acuity improved with correction by 2 or more lines in the better-seeing eye; the corrected acuity with the spherical equivalent was not more than 1 line less than with full correction; anisometropia measured less than 1.0 diopter; and an appropriate frame was available.

Interventions

Eligible children were randomized to ready-made or custom-made spectacles.

Main Outcomes and Measures

Proportion of children wearing their spectacles at unannounced visits 3 to 4 months after the intervention.

Results

Of 23 345 children aged 11 to 15 years who underwent screening, 694 had visual acuity of less than 6/9 in both eyes, and 535 underwent assessment for eligibility. A total of 460 children (227 female [49.3%] and 233 male [50.7%]; mean [SD] age, 13.4 [1.3] years) were eligible for ready-made spectacles (2.0% undergoing screening and 86.0% undergoing assessment) and were randomized to ready-made (n = 232) or custom-made (n = 228) spectacles. Follow-up rates at 3 to 4 months were similar (184 [79.3%] in the ready-made group and 178 [78.1%] in the custom-made group). Rates of spectacle wear in the 2 arms were similar among 139 of 184 children (75.5%) in the ready-made arm and 131 of 178 children (73.6%) in the custom-made arm (risk difference, 1.8%; 95% CI, -7.1% to 10.8%).

Conclusions and Relevance

Most children were eligible for ready-made spectacles, and the proportion wearing ready-made spectacles was not inferior to the proportion wearing custom-made spectacles at 3 to 4 months. These findings suggest that ready-made spectacles could substantially reduce costs for school-based eye health programs in India without compromising spectacle wear, at least in the short term.

Trial Registration

isrctn.com Identifier: ISRCTN14715120.

Effectiveness of a novel mobile health education intervention (Peek) on spectacle wear among children in India: study protocol for a randomized controlled trial

Background

Uncorrected refractive errors are the commonest cause of visual loss in children despite spectacle correction being highly cost-effective. Many affected children do not benefit from correction as a high proportion do not wear their spectacles. Reasons for non-wear include parental attitudes, overprescribing and children being teased/bullied. Most school programmes do not provide health education for affected children, their peers, teachers or parents.

The Portable Eye Examination Kit (Peek) will be used in this study. Peek has applications for measuring visual acuity with software for data entry and sending automated messages to inform providers and parents. Peek also has an application which simulates the visual blur of uncorrected refractive error (SightSim).

The hypothesis is that higher proportion of children with uncorrected refractive errors in schools allocated to the Peek educational package will wear their spectacles 3–4 months after they are dispensed, and a higher proportion of children identified with other eye conditions will access services, compared with schools receiving standard school screening.

Methods/Design

Cluster randomized, double-masked trial of children with and without uncorrected refractive errors or other eye conditions. Government schools in Hyderabad, India will be allocated to intervention (Peek) or comparator (standard programme) arms before vision screening. In the intervention arm Peek will be used for vision screening, SightSim images will be used in classroom teaching and will be taken home by children, and voice messages will be sent to parents of children requiring spectacles or referral.

In both arms the same criteria for recruitment, prescribing and dispensing spectacles will be used. After 3–4 months children dispensed spectacles will be followed up to assess spectacle wear, and uptake of referrals will be ascertained.

The cost of developing and delivering the Peek package will be assessed. The cost per child wearing their spectacles or accessing services will be compared.

Discussion

Educating parents, teachers and children about refractive errors and the importance of wearing spectacles has the potential to increase spectacle wear amongst children. Innovative, potentially scalable mobile technology (Peek) will be used to screen, provide health education, track spectacle wear and adherence to follow-up amongst children referred.

Trial registration

Controlled-Trials.com, ISRCTN78134921. Registered on 29 June 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-1888-5) contains supplementary material, which is available to authorized users.

The met and unmet need for refractive correction and its determinants in 7-year-old children

Refractive errors are the leading cause of visual impairment and at the same time the most treatable cause of visual impairment in children and students. The aim of this study is to determine the prevalence of the unmet need for refractive correction and the spectacle coverage rate among 7-year-old Iranian children with refractive errors. The present cross-sectional study was performed in 2013 through multistage cluster sampling across eight cities in Iran. For all students, noncycloplegic autorefraction was done by a technician. The unmet need for glasses was defined as the ratio of people who did not have glasses or their vision with their current glasses was worse than 6/12 despite achieving 6/12 or better visual acuity with proper correction. A total of 67 schools were selected by multistage cluster sampling; 4106 subjects participated in the study (response rate, 89%), and 48.2% ( n = 1979) were girls. The prevalence of spectacle need was 4.11% (95% confidence interval [CI: 3.19–5.04]), the unmet need was 2.74% (95% CI [1.89–3.59]), and the spectacle coverage rate (met need/[met need + unmet need]) was 33.3%. Also, the unmet need in children whose families were in the lower income quartile was 7.14 times the rate seen in children in the upper income quartile. The concentration index for the unmet need was −.27 (±.05). The findings of this study confirm that in light of the detrimental effects of refractive errors in schoolchildren’s academic progress and their future, identification of the students who live in poorer families and have multiple risk factors for developing vision disorders should be a health priority.

Parent, Teacher, and Student Perspectives on How Corrective Lenses Improve Child Wellbeing and School Function

OBJECTIVES

Up to 20 % of school-age children have a vision problem identifiable by screening, over 80 % of which can be corrected with glasses. While vision problems are associated with poor school performance, few studies describe whether and how corrective lenses affect academic achievement and health. Further, there are virtually no studies exploring how children with correctable visual deficits, their parents, and teachers perceive the connection between vision care and school function.

METHODS

We conducted a qualitative evaluation of Vision to Learn (VTL), a school-based program providing free corrective lenses to low-income students in Los Angeles. Nine focus groups with students, parents, and teachers from three schools served by VTL explored the relationships between poor vision, receipt of corrective lenses, and school performance and health.

RESULTS

Twenty parents, 25 teachers, and 21 students from three elementary schools participated. Participants described how uncorrected visual deficits reduced students' focus, perseverance, and class participation, affecting academic functioning and psychosocial stress; how receiving corrective lenses improved classroom attention, task persistence, and willingness to practice academic skills; and how serving students in school rather than in clinics increased both access to and use of corrective lenses.

CONCLUSIONS

for Practice Corrective lenses may positively impact families, teachers, and students coping with visual deficits by improving school function and psychosocial wellbeing. Practices that increase ownership and use of glasses, such as serving students in school, may significantly improve both child health and academic performance.

Refractive Errors and Amblyopia in the UCLA Preschool Vision Program; First Year Results

PURPOSE

To report the outcomes of full ophthalmic examination for preschool children in LA County who failed screening with the Retinomax Autorefractor.

DESIGN

Retrospective, cross-sectional study.

METHODS

Between August 2012 and May 2013, the University of California Los Angeles (UCLA) preschool vision program screened 11 260 preschool children aged 3-5 years in Los Angeles County using the Retinomax Autorefractor only. Of those, 1007 children who failed the screening were examined by an ophthalmologist on the UCLA Mobile Eye Clinic. Data from the eye examination were recorded for all children. Amblyopia was defined as unilateral if there was ≥2 line interocular difference in the best-corrected visual acuity (BCVA) and as bilateral if BCVA was <20/50 for children <4 years old and <20/40 for children ≥4 years old.

RESULTS

Glasses were prescribed for 740 (74%) of those examined. Uncorrected visual acuity for all examined children was 0.4 ± 0.2 (logMAR mean ± SD), and BCVA was 0.2 ± 0.1. Of the 88% who underwent cycloplegia, 58% had hyperopia (spherical equivalent [SE] ≥+0.50 diopter [D]), mean of +2.50 D, and 21% had myopia (SE ≤-0.50 D), mean of -1.40 D. A total of 69% had astigmatism ≥1.50 D, mean of 1.97 D (range 0-5.75). Spherical and cylindrical anisometropia ≥1.00 D were each found in 26% of those examined. Refractive amblyopia was found in 9% of those examined, or 0.8% of the original population. Of the amblyopic subjects, 77% were unilateral.

CONCLUSIONS

Screening of preschoolers with the Retinomax led to diagnosis and early treatment of uncorrected refractive errors and amblyopia. By treating children early, amblyopia may be prevented, quality of life improved, and academic achievements enhanced.

The UCLA preschool vision program, 2012-2013

PURPOSE

To introduce the University of California Los Angeles (UCLA) Preschool Vision Program (UPVP) and describe the utilization pattern and challenges of the first year of implementation.

METHODS

The UPVP aims to improve vision in 3- to 5-year-old preschoolers of Los Angeles County. On the first visit, trained personnel use a handheld autorefractometer (Retinomax 3; Righton, Japan) for initial screening and identify those who would benefit from a complete eye examination. On the second visit, the UCLA Mobile Eye Clinic staff and ophthalmologists provide follow-up examinations. Prescribed eyeglasses are fit and provided by program personnel on the school site on a separate visit. Follow-up calls are made to ensure compliance.

RESULTS

From a population of 12,088 children in 215 preschools, 11,260 preschoolers (mean age, 4.3 years; 49.2% females) were screened successfully. In this sample, 86% were Latino, and almost all (97%) spoke either Spanish or English. About 65% of referred preschoolers underwent a complete eye examination. Prescription eye glasses were provided for 850 preschoolers (7.5%); 95 children (0.8%) were newly diagnosed with amblyopia.

CONCLUSIONS

A large proportion of Los Angeles County preschoolers with refractive errors have unmet needs in terms of refractive correction. Further studies are recommended to understand barriers to eye care for children and to devise initiatives for Los Angeles's large, densely populated, and complex community to increase awareness and willingness.

Use of Eyeglasses among Children in Elementary School: Perceptions, Behaviors, and Interventions Discussed by Parents, School Nurses, and Teachers during Focus Groups

Purpose.

To investigate the perceptions, behaviors, and recommendations that parents, school nurses, and teachers have regarding children's use of eyeglasses.

Approach.

Focus groups with parents, school nurses, and teachers were conducted.

Setting.

The study took place in one Southern California school district.

Participants.

There were 39 participants, including 24 parents, seven school nurses, and eight teachers.

Method.

An experienced moderator guided the focus group discussions. Transcripts were analyzed using grounded theory techniques.

Results.

Participants perceive visual impairment as a serious problem in the development of children. The lack of eyeglasses may lead to problems such as tiredness, headaches, inability to focus on school work, and decreased reading speed. Participants experienced disappointment, unhappiness, worry, and concern when they realized they needed eyeglasses at a young age. Negative societal perceptions toward eyeglasses, lack of eye doctors in minority communities, parental perceptions that children do not need eyeglasses, and peer bullying of children wearing eyeglasses are key obstacles to children's use of eyeglasses. Participants suggest school and national campaigns featuring respected public figures who wear eyeglasses to promote positive attitudes toward eyeglasses.

Conclusion.

Parents and teachers who closely follow the academic development of children have observed that visual impairment has negative consequences for the scholastic achievement of children. They recommend interventions to promote the attractiveness of eyeglasses in society. The participants discuss the need for a national preventative message for eye care similar to the message for dental care. The public health message should emphasize the importance of embracing and respecting differences among individuals.

Screening of vision and hearing in primary school children

BACKGROUND

Hearing and sight are two basic senses in terms of education and profession. The World Health Organization (WHO) estimates that 15 million children worldwide suffer from uncorrected refractive disorders and another 275 million people are handicapped due to compromised hearing. In Indonesia, screening primary school children for hearing and vision is not part of the free public health-care system. Knowledge of the status of a child's hearing and vision may help secure the child's education and future profession.

MATERIALS AND METHODS

In five primary schools in a poor urban neighborhood in Yogyakarta, Indonesia, we screened pupils from class 1 to 6, for vision and hearing handicaps, following the WHO's definitions of handicap. On location in the primary schools, we screened vision using a Snellen chart and hearing using distortion product otoacoustic emission (DPOAE). Those with vision below 6/18 were referred to an ophthalmologist and pupils with hearing below 30 decibels at 0.5, 1, 2, and 4 kilohertz were referred to an ear nose and throat (ENT) specialist for final testing.

RESULTS

Totally, 775 pupils were vision screened and 777 pupils were hearing screened. We found that 2% were disabled by sight and 6% by hearing.

CONCLUSION

Lost without proper education, these pupils can, with simple recommendations, have access to education. We recommend that Indonesia start screening its primary school pupils for hearing and vision to secure the country's future productivity and socioeconomic development.

Decreasing Uncorrected Refractive Error in the Classroom Through a Multifactorial Pilot Intervention

The study assessed the effectiveness of a pilot intervention to promote the use of eyeglasses in one school in California. The intervention used a one-group pretest, posttest design. Between January and June 2011, during the intervention, all first- and second-grade children received eye evaluations and the children with refractive error received two pairs of attractive eyeglasses. Parents received eye care education. Teachers monitored the use of eyeglasses in the classroom. Prior to the intervention in January 2011, 1 of the 15 children with refractive error (6.7%) wore eyeglasses in the classroom and the remaining 14 (93.3%) lacked eyeglasses altogether; 6 months following the end of the intervention in December 2011, 11 of the 15 children (73.3%) wore eyeglasses in the classroom and the remaining 4 (26.7%) did not ( p = .002). The multifactorial intervention increased the use of eyeglasses in the classroom even months after the end of the summer vacation.

Prevention of communication disorders--screening pre-school and school-age children for problems with hearing, vision and speech: European Consensus Statement

Background

Communication is an integral part of human behaviour. Communication disorders are associated mainly with impairment in hearing, vision, and/or speech, which influences the ability to receive, comprehend, produce, and express verbal, nonverbal, and graphic information. When unrecognized and unmanaged, these very often “invisible” conditions can have a significant detrimental effect on a child’s development, affecting educational, social, and psychological progress.

Material/Methods

A panel of experts discussed the screening of pre-school and school-age children for problems with hearing, vision, and speech during the 10^th Congress of the European Federation of Audiology Societies (EFAS), held in Warsaw, Poland, on 22 June, 2011.

Results

The European Consensus Statement on Hearing, Vision, and Speech Screening in Pre-School and School-Age Children was the result of the scientific discussions. It was endorsed by experts in audiology, otolaryngology, phoniatry, ophthalmology, and speech language pathology from throughout Europe^*. Key elements of the consensus, as described herein, are: 1) defining the role of screening programmes in the identification and treatment of communication disorders; 2) identifying the target population; 3) promoting general awareness about the consequences of communication disorders; 4) recognizing the need for a quality control system in screening programmes; 5) encouraging cooperation among European countries to provide a high level of public health services for the prevention, identification, and treatment of communication disorders.

Conclusions

The European Consensus Statement on Hearing, Vision, and Speech Screening in Pre-School and School-Age Children will encourage the appropriate authorities of the various countries involved to initiate screening for communication disorders in pre-school and school-age children.