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Nishimura M, Wong A, Maurer D. Continued care and provision of glasses are necessary to improve visual and academic outcomes in children: Experience from a cluster-randomized controlled trial of school-based vision screening. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:688-698. [PMID: 38691337 PMCID: PMC11303613 DOI: 10.17269/s41997-024-00884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/21/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To assess the effectiveness of a kindergarten vision screening program by randomly assigning schools to receive or not receive vision screening, then following up 1.5 years later. METHODS Fifty high-needs elementary schools were randomly assigned to participate or not in a vision screening program for children in senior kindergarten (SK; age 5‒6 years). When the children were in Grade 2 (age 6‒7 years), vision screening was conducted at all 50 schools. RESULTS Contrary to expectations, screened and non-screened schools did not differ in the prevalence of suspected amblyopia in Grade 2 (8.6% vs. 7.5%, p = 0.10), nor prevalence of other visual problems such as astigmatism (45.1% vs. 47.1%, p = 0.51). There was also no difference between screened and non-screened schools in academic outcomes such as the proportion of children below grade level in reading (33% vs. 29%) or math (44% vs. 38%) (p = 0.86). However, more children were wearing glasses in screened than in non-screened schools (10.2% vs. 7.8%, p = 0.05), and more children reported their glasses as missing or broken (8.3% vs. 4.7%, p = 0.01), suggesting that SK screening had identified successfully those in need of glasses. Examination of individual results revealed that 72% of children diagnosed and treated for amblyopia in SK no longer had amblyopia in Grade 2. CONCLUSION The prevalence of amblyopia and other visual problems was not reduced in Grade 2 by our SK vision screening program, perhaps because of poor treatment compliance and high attrition. The results suggest that a single screening intervention is insufficient to reduce visual problems among young children. However, the data from individuals with amblyopia suggest that continuing vision care and access to glasses benefits children, especially children from lower socioeconomic class.
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Affiliation(s)
- Mayu Nishimura
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada.
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Agnes Wong
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Daphne Maurer
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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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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Alsaqr A, Alhumaid S, Alanazi M, Abusharha A. Prescribing patterns for hyperopia: an insight of the optometrist perspective and practice. BMC Ophthalmol 2024; 24:226. [PMID: 38807053 PMCID: PMC11134738 DOI: 10.1186/s12886-024-03496-5] [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: 09/02/2023] [Accepted: 05/24/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND To investigate the current prescribing patterns for correcting hyperopia among optometrists in clinical practice in Saudi Arabia and compare those to current international guidelines. And explore the factors that influence practitioners' prescribing decision. METHOD This cross-sectional study employed 30 items online survey that encompass demographic data, current practice and cycloplegia use, numerical response to indicate the minimum level of hyperopia at which optometrists would consider prescribing spectacles to non-strabismic children and determine the diopter value required for prescribing correction for hyperopia if present with other factors. RESULT A total of 104 optometrists responded to the survey (52 females and 52 males). They recruited from 35 cities across Saudi Arabia. Out of total, 44% of them considered cycloplegic refraction essential under 12 years and 56% of them extended the range to 18 years. Large variation were found between the optometrists' responses and current guideline recommendations. Several factors influenced the decision-making of the practicing optometrist including signs and symptoms, bilateral hyperopia, average dioptric value, reading difficulty, and accommodative function. CONCLUSION There are some matches between the international guidelines and the practice patterns that followed by optometrists in Saudi Arabia, however, the optometrists did not report that they are following them purposefully. These findings highlight the need to improve optometrists' practice about spectacle prescription in pediatric population.
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Affiliation(s)
- Ali Alsaqr
- Department of Optometry, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, 11433, Riyadh, Saudi Arabia.
| | - Saleh Alhumaid
- Department of Optometry, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, 11433, Riyadh, Saudi Arabia
| | - Muteb Alanazi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, 11433, Riyadh, Saudi Arabia
| | - Ali Abusharha
- Department of Optometry, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, 11433, Riyadh, Saudi Arabia
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Vijendran S, Kamath YS, Alok Y, Kuzhuppilly NIR. Determination of Refractive Error Using Direct Ophthalmoscopy in Children. Clin Ophthalmol 2024; 18:989-996. [PMID: 38584720 PMCID: PMC10998502 DOI: 10.2147/opth.s453207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Refractive error is a major cause of visual impairment in children and its early detection can prevent ocular morbidity such as amblyopia and strabismus. Brückner test is a comprehensive test which can be easily administered in children using a direct ophthalmoscope. We aimed to determine refractive error in children by analysis of the red reflex using modified Brückner test. Patients and Methods This prospective observational study was conducted on 683 undilated eyes of 683 children aged four to 10 years. They were evaluated with a direct ophthalmoscope from one meter in a dimly lit room. The characteristics of the red reflex and crescent obtained were compared with photoscreener refraction value and analyzed. Results The presence of superior crescent was associated with hypermetropia (Chi square 37.11, p < 0.001, kappa = 0.15) and inferior crescent with myopia (Chi square 157.29, p < 0.001, kappa = 0.477). Superior crescent was 98.4% sensitive in detecting hypermetropia. Hypermetropia greater than +1.5D, was associated with larger superior crescent crossing horizontal midline of pupil (Chi square = 5.29, p = 0.021). Conclusion The modified Brückner test is useful in detection and quantification of refractive error in children. It is easy, simple, quick and can be employed in the community as a screening test to detect potentially amblyogenic refractive errors.
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Affiliation(s)
- Sruthi Vijendran
- Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Yogish S Kamath
- Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Yash Alok
- Department of Community Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Neetha I R Kuzhuppilly
- Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Chan VF, Wright DM, Mavi S, Dabideen R, Smith M, Sherif A, Congdon N. Modelling ready-made spectacle coverage for children and adults using a large global database. Br J Ophthalmol 2023; 107:1793-1797. [PMID: 36316099 PMCID: PMC10715461 DOI: 10.1136/bjo-2022-321737] [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: 09/27/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To model the suitability of conventional ready-made spectacles (RMS) and interchangeable-lens ready-made spectacles (IRMS) with reference to prescribing guidelines among children and adults using a large, global database and to introduce a web-based application for exploring the database with user-defined eligibility criteria. METHODS Using refractive power and interpupillary distance data for near and distance spectacles prescribed to children and adults during OneSight clinics in 27 countries, from 2 January 2016 to 19 November 2019, we modelled the expected suitability of RMS and IRMS spectacle designs, compared with custom-made spectacles, according to published prescribing guidelines. RESULTS Records of 18 782 presbyopic adult prescriptions, 70 619 distance adult prescriptions and 40 862 paediatric prescriptions were included. Globally, 58.7%-63.9% of adults could be corrected at distance with RMS, depending on the prescribing cut-off. For presbyopic adult prescriptions, coverage was 44.1%-60.9%. Among children, 51.8% were eligible for conventional RMS. Coverage for all groups was similar to the above for IRMS. The most common reason for ineligibility for RMS in all service groups was astigmatism, responsible for 27.2% of all ineligible adult distance prescriptions using the strictest cut-off, 31.4% of children's prescriptions and 28.0% of all adults near prescriptions globally. CONCLUSION Despite their advantages in cost and convenience, coverage delivered by RMS is limited under current prescribing guidelines, particularly for children and presbyopic adults. Interchangeable designs do little to remediate this, despite extending coverage for anisometropia. Our free application allows users to estimate RMS coverage in specific target populations.
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Affiliation(s)
- Ving Fai Chan
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - David M Wright
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Sonia Mavi
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Mike Smith
- Onesight Research Foundation, Mason, Ohio, USA
| | - Alan Sherif
- University of Lausanne Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- ORBIS International, New York, New York, USA
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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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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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Sah RP, Meyer D, Jaskulski M, Rickert M, Cheng X, Brennan N, Kollbaum PS. Impact of zone geometry on the introduction of myopic defocus in young adult eyes wearing multi-zone lenses. Ophthalmic Physiol Opt 2023; 43:1110-1124. [PMID: 37326329 DOI: 10.1111/opo.13182] [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: 01/11/2023] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Multizone contact lenses control myopia progression by proposed introduction of myopic defocus. This project investigated how much of the pupil area and how many dioptres of myopic defocus are introduced by different lens zone geometries with near- and off-axis viewing. METHODS Ten young myopic adults (18-25 years) binocularly wore four soft contact lenses including a single vision (SV), concentric-ring dual-focus (DF), centre-distance multifocal (MF) and a RingBoost™ (RB) multi-zone design containing a combination of coaxial and non-coaxial zones. A modified aberrometer captured aberrations and pupil sizes at four target vergences between -0.25 and -4.00 D (on-axis) and across the central ±30° of the horizontal retina (off-axis). Defocus was quantified as the difference between the measured refractive state and the target vergence within each zone of a multi-zone design within the pupil and compared with that of equivalent zone areas of the SV lens. The percentage of the pupil containing myopic defocused light for each lens was calculated. RESULTS Defocus within the distance correction zones of multi-zone lenses was similar to that of the SV lens. When viewing on-axis at -0.25 D target vergence, on average 11% of the pupil was myopic with SV, whereas 62%, 84% and 50% of the pupil was myopic for the DF, MF and RB designs, respectively. At -4.00 D target vergence, all lenses exhibited a systematic decrease in the percentage of pupil area having myopic defocus (SV: 3%; DF: 18%; MF: 5% and RB: 26%). The off-axis proportions were similar across multi-zone lenses; however, multi-zone lenses retained approximately 1.25-3.0× more myopic defocus than the SV lens. CONCLUSIONS Subjects accommodated using the distance-correction zones of multi-zone lenses. Multi-zone contact lenses introduced significant myopic defocus on-axis and across the central ±30° retina. However, the magnitude and proportion of defocus were influenced by zone geometry, add power and pupil size.
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Affiliation(s)
- Raman Prasad Sah
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Dawn Meyer
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Matt Jaskulski
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Martin Rickert
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Xu Cheng
- Johnson & Johnson Vision Care Inc., Jacksonville, Florida, USA
| | - Noel Brennan
- Johnson & Johnson Vision Care Inc., Jacksonville, Florida, USA
| | - Pete S Kollbaum
- School of Optometry, Indiana University, Bloomington, Indiana, USA
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Horwood A, Heijnsdijk E, Kik J, Sloot F, Carlton J, Griffiths HJ, Simonsz HJ. A population-level post-screening treatment cost framework to help inform vision screening choices for children under the age of seven. Strabismus 2023; 31:220-235. [PMID: 37870065 DOI: 10.1080/09273972.2023.2268128] [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] [Indexed: 10/24/2023]
Abstract
PURPOSE/BACKGROUND Visual acuity (VA) screening in children primarily detects low VA and amblyopia between 3 and 6 years of age. Photoscreening is a low-cost, lower-expertise alternative which can be carried out on younger children and looks instead for refractive amblyopia risk factors so that early glasses may prevent or mitigate the conditions. The long-term benefits and costs of providing many children with glasses in an attempt to avoid development of amblyopia for some of them needs clarification. This paper presents a framework for modeling potential post-referral costs of different screening models once referred children reach specialist services. METHODS The EUSCREEN Screening Cost-Effectiveness Model was used together with published literature to estimate referral rates and case mix of referrals from different screening modalities (photoscreening and VA screening at 2, 3-4 years and 4-5 years). UK 2019-20 published National Health Service (NHS) costings were used across all scenarios to model the comparative post-referral costs to the point of discharge from specialist services. Potential costs were compared between a) orthoptist, b) state funded ophthalmologist and c) private ophthalmologist care. RESULTS Earlier VA screening and photoscreening yield higher numbers of referrals because of lower sensitivity and specificity for disease, and a different case mix, compared to later VA screening. Photoscreening referrals are a mixture of reduced VA caused by amblyopia and refractive error, and children with amblyopia risk factors, most of which are treated with glasses. Costs relate mainly to the secondary care providers and the number of visits per child. Treatment by an ophthalmologist of a referral at 2 years of age can be more than x10 more expensive than an orthoptist service receiving referrals at 5 years, but outcomes can still be good from referrals aged 5. CONCLUSIONS All children should be screened for amblyopia and low vision before the age of 6. Very early detection of amblyopia refractive risk factors may prevent or mitigate amblyopia for some affected children, but population-level outcomes from a single high-quality VA screening at 4-5 years can also be very good. Total patient-journey costs incurred by earlier detection and treatment are much higher than if screening is carried out later because younger children need more professional input before discharge, so early screening is less cost-effective in the long term. Population coverage, local healthcare models, local case-mix, public health awareness, training, data monitoring and audit are critical factors to consider when planning, evaluating, or changing any screening programme.
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Affiliation(s)
- Anna Horwood
- Department of Psychology, University of Reading, Reading, UK
| | - Eveline Heijnsdijk
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jan Kik
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Frea Sloot
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Huibert J Simonsz
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Ramasubramanian V, Logan NS, Jones S, Meyer D, Jaskulski M, Rickert M, Chamberlain P, Arumugam B, Bradley A, Kollbaum PS. Myopia Control Dose Delivered to Treated Eyes by a Dual-focus Myopia-control Contact Lens. Optom Vis Sci 2023; 100:376-387. [PMID: 37097975 PMCID: PMC10317304 DOI: 10.1097/opx.0000000000002021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
PURPOSE This study examined the optical impact of a DF contact lens during near viewing in a sample of habitual DF lens wearing children. METHODS Seventeen myopic children aged 14 to 18 years who had completed 3 or 6 years of treatment with a DF contact lens (MiSight 1 Day; CooperVision, Inc., San Ramon, CA) were recruited and fit bilaterally with the DF and a single-vision (Proclear 1 Day; CooperVision, Inc.) contact lens. Right eye wavefronts were measured using a pyramidal aberrometer (Osiris; CSO, Florence, Italy) while children accommodated binocularly to high-contrast letter stimuli at five target vergences. Wavefront error data were used to compute pupil maps of refractive state. RESULTS During near viewing, children wearing single-vision lenses accommodated on average to achieve approximate focus in the pupil center but, because of combined accommodative lag and negative spherical aberration, experienced up to 2.00 D of hyperopic defocus in the pupil margins. With DF lenses, children accommodated similarly achieving approximate focus in the pupil center. When viewing three near distances (0.48, 0.31, and 0.23 m), the added +2.00 D within the DF lens treatment optics shifted the mean defocus from +0.75 to -1.00 D. The DF lens reduced the percentage of hyperopic defocus (≥+0.75 D) in the retinal image from 52 to 25% over these target distances, leading to an increase in myopic defocus (≤-0.50 D) from 17 to 42%. CONCLUSIONS The DF contact lens did not alter the accommodative behavior of children. The treatment optics introduced myopic defocus and decreased the amount of hyperopically defocused light in the retinal image.
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Affiliation(s)
| | - Nicola S. Logan
- School of Optometry, Aston University, Birmingham, United Kingdom
| | - Susie Jones
- School of Optometry, Aston University, Birmingham, United Kingdom
| | - Dawn Meyer
- School of Optometry, Indiana University Bloomington, Bloomington, Indiana
| | - Matt Jaskulski
- School of Optometry, Indiana University Bloomington, Bloomington, Indiana
| | - Martin Rickert
- School of Optometry, Indiana University Bloomington, Bloomington, Indiana
| | | | | | | | - Pete S. Kollbaum
- School of Optometry, Indiana University Bloomington, Bloomington, Indiana
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Flitcroft I, Ainsworth J, Chia A, Cotter S, Harb E, Jin ZB, Klaver CCW, Moore AT, Nischal KK, Ohno-Matsui K, Paysse EA, Repka MX, Smirnova IY, Snead M, Verhoeven VJM, Verkicharla PK. IMI-Management and Investigation of High Myopia in Infants and Young Children. Invest Ophthalmol Vis Sci 2023; 64:3. [PMID: 37126360 PMCID: PMC10153576 DOI: 10.1167/iovs.64.6.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the epidemiology, etiology, clinical assessment, investigation, management, and visual consequences of high myopia (≤-6 diopters [D]) in infants and young children. Findings High myopia is rare in pre-school children with a prevalence less than 1%. The etiology of myopia in such children is different than in older children, with a high rate of secondary myopia associated with prematurity or genetic causes. The priority following the diagnosis of high myopia in childhood is to determine whether there is an associated medical diagnosis that may be of greater overall importance to the health of the child through a clinical evaluation that targets the commonest features associated with syndromic forms of myopia. Biometric evaluation (including axial length and corneal curvature) is important to distinguishing axial myopia from refractive myopia associated with abnormal development of the anterior segment. Additional investigation includes ocular imaging, electrophysiological tests, genetic testing, and involvement of pediatricians and clinical geneticists is often warranted. Following investigation, optical correction is essential, but this may be more challenging and complex than in older children. Application of myopia control interventions in this group of children requires a case-by-case approach due to the lack of evidence of efficacy and clinical heterogeneity of high myopia in young children. Conclusions High myopia in infants and young children is a rare condition with a different pattern of etiology to that seen in older children. The clinical management of such children, in terms of investigation, optical correction, and use of myopia control treatments, is a complex and often multidisciplinary process.
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Affiliation(s)
- Ian Flitcroft
- Children's Health Ireland (CHI) at Temple Street, Dublin, Ireland
- Centre for Eye Research Ireland, Technological University of Dublin, Dublin, Ireland
| | - John Ainsworth
- Birmingham Children's Hospital, Steelhouse Lane Birmingham, United Kingdom
| | | | - Susan Cotter
- Southern California College of Optometry, Marshall B Ketchum University, Fullerton, California, United States
| | - Elise Harb
- Wertheim School Optometry and Vision Science, Berkeley, California, United States
- University of California - San Francisco, School of Medicine, San Francisco, California, United States
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Anthony T Moore
- University of California - San Francisco, School of Medicine, San Francisco, California, United States
| | - Ken K Nischal
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | - Evelyn A Paysse
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States
| | - Michael X Repka
- Wilmer Eye Institute, The John Hopkins University School of Medicine, Baltimore, Maryland, United States
| | | | - Martin Snead
- Department of Vitreoretinal Research, John van Geest Centre for Brain Repair, University of Cambridge, United Kingdom
| | - Virginie J M Verhoeven
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
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12
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Shah R, Edgar DF, Evans BJW. Worsening vision at age 4-5 in England post-COVID: Evidence from a large database of vision screening data. Ophthalmic Physiol Opt 2023; 43:454-465. [PMID: 36866712 DOI: 10.1111/opo.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Myopia prevalence has increased in the UK at age 10-16y, but little is known about younger children. We hypothesise that if the 'myopia epidemic' is affecting young children, then there will be increasing rates of bilateral reduced unaided vision (V) at vision screenings of children 4-5 years of age. METHODS Retrospective anonymised data from computerised vision screening at age 4-5 years were analysed from serial cross-sectional data. Refractive error is not assessed in UK vision screening, so vision was investigated. Data were only included from schools that screened every year from 2015/16 to 2021/22. The criterion used was unaided monocular logMAR (automated letter-by-letter scoring) vision >0.20 in both the right and left eyes, so as to maximise the chances of detecting bilateral, moderate myopia rather than amblyopia. RESULTS Anonymised raw data were obtained for 359,634 screening episodes from 2075 schools. Once schools were excluded where data were not available for every year and data were cleaned, the final database comprised 110,076 episodes. The proportion (percentage and 95% CI) failing the criterion from 2015/16 to 2021/22 were 7.6 (7.2-8.0), 8.5 (8.1-8.9), 7.5 (7.1-7.9), 7.8 (7.4-8.2), 8.7 (8.1-9.2), 8.5 (7.9-9.0) and 9.3 (8.8-9.7), respectively. The slope of the regression line showed a trend for increasing rates of reduced bilateral unaided vision, consistent with increasing frequency of myopia (p = 0.06). A decreasing linear trendline was noted for children 'Under Professional Care'. CONCLUSIONS For children 4-5 years of age, there were signs of reduced vision over the last 7 years in England. Consideration of the most likely causes support the hypothesis of increasing myopia. The increase in screening failures highlights the importance of eye care in this young population.
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Affiliation(s)
- Rakhee Shah
- Institute of Optometry, London, UK.,Centre for Applied Vision Research, City, University of London, London, UK
| | - David F Edgar
- Institute of Optometry, London, UK.,Centre for Applied Vision Research, City, University of London, London, UK
| | - Bruce J W Evans
- Institute of Optometry, London, UK.,Centre for Applied Vision Research, City, University of London, London, UK
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13
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Rosenfield M. And still the hyperope remains neglected. Ophthalmic Physiol Opt 2023; 43:173-175. [PMID: 36705057 DOI: 10.1111/opo.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/28/2023]
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14
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Thompson AL, Conway ML, Ctori I, Shah R, Suttle CM. Refractive prescribing for preschool children by optometrists in England. Ophthalmic Physiol Opt 2023; 43:6-16. [PMID: 36101930 PMCID: PMC10087314 DOI: 10.1111/opo.13050] [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: 01/27/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Amy L Thompson
- Division of Optometry and Visual Science, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Miriam L Conway
- Division of Optometry and Visual Science, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Irene Ctori
- Division of Optometry and Visual Science, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Rakhee Shah
- Division of Optometry and Visual Science, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Catherine M Suttle
- Division of Optometry and Visual Science, School of Health and Psychological Sciences, City, University of London, London, UK
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15
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Chan KH, Shik HT, Kwok KW, Kee CS, Leung TW. Bi-directional Refractive Compensation for With-the-Rule and Against-the-Rule Astigmatism in Young Adults. Invest Ophthalmol Vis Sci 2022; 63:15. [PMID: 36155745 PMCID: PMC9526370 DOI: 10.1167/iovs.63.10.15] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to investigate the short-term effect of imposing astigmatism on the refractive states of young adults. Methods Nineteen visually healthy low-astigmatic young adults (age = 20.94 ± 0.37 years; spherical-equivalent errors [M] = -1.47 ± 0.23 diopters [D]; cylindrical errors = -0.32 ± 0.05 D) were recruited. They were asked to wear a trial frame with treated and control lenses while watching a video for an hour. In three separate visits, the treated eye was exposed to one of three defocused conditions in random sequence: (1) with-the-rule (WTR) astigmatism = +3.00 DC × 180 degrees; (2) against-the-rule (ATR) astigmatism = +3.00 DC × 90 degrees; and (3) spherical defocus (SPH) = +3.00 DS. The control eye was fully corrected optically. Before and after watching the video, non-cycloplegic autorefraction was performed over the trial lenses. Refractive errors were decomposed into M, J0, and J45 astigmatism. Interocular differences in refractions (treated eye - control eye) were analyzed. Results After participants watched the video with monocular astigmatic defocus for an hour, the magnitude of the J0 astigmatism was significantly reduced by 0.25 ± 0.10 D in both WTR (from +1.53 ± 0.07 D to +1.28 ± 0.09 D) and 0.39 ± 0.15 D in ATR conditions (from -1.33 ± 0.06 D to -0.94 ± 0.18 D), suggesting an active compensation. In contrast, changes in J0 astigmatism were not significant in the SPH condition. No compensatory changes in J45 astigmatism or M were found under any conditions. Conclusions Watching a video for an hour with astigmatic defocus induced bidirectional, compensatory changes in astigmatic components, suggesting that refractive components of young adults are moldable to compensate for orientation-specific astigmatic blur over a short period.
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Affiliation(s)
- Kin-Ho Chan
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Special Administration Region of the People's, Republic of China.,Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Special Administration Region of the People's, Republic of China
| | - Ho-Tin Shik
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Special Administration Region of the People's, Republic of China
| | - Kwan William Kwok
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Special Administration Region of the People's, Republic of China
| | - Chea-Su Kee
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Special Administration Region of the People's, Republic of China.,Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Special Administration Region of the People's, Republic of China
| | - Tsz-Wing Leung
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Special Administration Region of the People's, Republic of China.,Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Special Administration Region of the People's, Republic of China.,Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hong Kong, Special Administration Region of the People's, Republic of China
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16
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Fixation instability, astigmatism, and lack of stereopsis as factors impeding recovery of binocular balance in amblyopia following binocular therapy. Sci Rep 2022; 12:10311. [PMID: 35725590 PMCID: PMC9209502 DOI: 10.1038/s41598-022-13947-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/31/2022] [Indexed: 11/22/2022] Open
Abstract
Dichoptic therapy is a promising method for improving vision in pediatric and adult patients with amblyopia. However, a systematic understanding about changes in specific visual functions and substantial variation of effect among patients is lacking. Utilizing a novel stereoscopic augmented-reality based training program, 24 pediatric and 18 adult patients were trained for 20 h along a three-month time course with a one-month post-training follow-up for pediatric patients. Changes in stereopsis, distance and near visual acuity, and contrast sensitivity for amblyopic and fellow eyes were measured, and interocular differences were analyzed. To reveal what contributes to successful dichoptic therapy, ANCOVA models were used to analyze progress, considering clinical baseline parameters as covariates that are potential requirements for amblyopic recovery. Significant and lasting improvements have been achieved in stereoacuity, interocular near visual acuity, and interocular contrast sensitivity. Importantly, astigmatism, fixation instability, and lack of stereopsis were major limiting factors for visual acuity, stereoacuity, and contrast sensitivity recovery, respectively. The results demonstrate the feasibility of treatment-efficacy prediction in certain aspects of dichoptic amblyopia therapy. Furthermore, our findings may aid in developing personalized therapeutic protocols, capable of considering individual clinical status, to help clinicians in tailoring therapy to patient profiles for better outcome.
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17
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Labadi L, Shahin R, Eperjesi F, Al-Shanti Y, Shehadeh M, Taha I. Prevalence of Visual Disorders among Urban Palestinian Preschool Children. Open Ophthalmol J 2022. [DOI: 10.2174/18743641-v16-e2112241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Childhood blindness is a major public health concern since 40% of visual disorders that can cause blindness among children are preventable. Vision screening programs among preschool children have been implemented in several countries as a tool for early detection and intervention of visual disorders. In Palestine, there is a lack of scientific data on the prevalence of visual disorders among children. In addition, vision-screening programs that are currently implemented are neither validated nor effective.
Objective:
Using validated vision screening protocols, a cross-sectional study is conducted to determine the prevalence of visual disorders among urban Palestinian preschool children between the ages of 3 to 5 years in Nablus city.
Methods:
All children attending eight preschools selected using single-stage cluster sampling technique, underwent a validated vision screening administered by trained eye care professionals. The screening protocol was based on a combination of clinical assessment adopted from the Modified Clinical Technique and the Vision in Preschoolers studies, including assessment of visual acuity, ocular alignment, depth perception, color vision, non-cycloplegic retinoscopy, and ocular health. A pass-fail criterion was used to refer all children who did not attend the vision screening for comprehensive eye examination, including cycloplegic retinoscopy and a dilated fundus exam. A chi-squared test was used to determine any association between visual disorders and their independent risk factors.
Results:
A total number of 764 children underwent vision screening. Out of the 290 children who did not attend the vision screening, 127 children responded to the referral call for comprehensive eye examinations. Refractive error was the most prevalent visual disorder with a prevalence of (29.37%), followed by amblyopia (4.10%), color vision deficiency (1.24%), strabismus (1.24%), and ocular health abnormalities (0.70%). There was no age (p=0.35) and gender (p=0.32) variation in children having refractive errors. Anisometropia was the leading cause for amblyopia (1.32%, n=7), followed by significant refractive error (1.13%, n=6) and strabismus (0.37%, n=2).
Conclusion:
Refractive error was the most prevalent visual disorder affecting Palestinian preschoolers in Nablus. Anisometropia and significant refractive errors were found to be the major causes of amblyopia. Effective nationwide preschool vision screening programs should be implemented in Palestine to screen amblyogenic risk factors.
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18
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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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Abstract
CLINICAL RELEVANCE For a correct spectacle prescription, accommodation spasm should not be overlooked in the measurements made using an autorefractometer. Although this can be easily understood with cycloplegia, it is not practical. Therefore, investigating practical methods that can predict excess accommodation will be useful in clinical practice. BACKGROUND To evaluate the performance of a photoscreener in detecting pseudo-myopia due to accommodation spasm and whether it eliminates the need for cycloplegia. METHODS Study was conducted in Van Training and Research Hospital. The manifest refraction of the patients was measured using an by an autorefractometer followed by a photoscreener before cycloplegia. Cycloplegic refraction errors were detected using an autorefractometer. Patients with pseudo-myopia due to accommodation spasm were diagnosed by observing a significant hyperopic shift in cycloplegic autorefractometer values compared to the non-cycloplegic values and were included in study. Cycloplegic autorefractometer and non-cycloplegic photoscreener measurements were compared. RESULTS The mean non-cycloplegic autorefractometer values were as follows: --6.34 ± 1.29D, -0.42 ± 0.58D, and -6.55 ± 1.36D for spherical, cylindrical, and spherical equivalents, respectively. These values were 0.23 ± 0.63D, -0.21 ± 0.41D, and 0.11 ± 0.73D for cycloplegic autorefractometer measurements, respectively. Cycloplegic autorefractometer values showed a significant hyperopic shift of 6.57 ± 1.26D and 6.67 ± 1.34D for spherical and spherical equivalents, respectively, compared to non-cycloplegic values (p < 0.001 for both). There was no significant difference between non-cycloplegic photoscreener and cycloplegic autorefractometer measurements for spherical, cylindrical, and spherical equivalents (p = 0.126, p = 0.078, and p = 0.053, respectively). . There was agreement between the measurements in the Bland-Altman graph. CONCLUSION There was consistency between non-cycloplegic photoscreener and cycloplegic autorefractometer measurements in patients with pseudomyopia due to accommodation spasm. Therefore, photoscreener measurements can be a fast, practical, cost-effective examination method for screening these patients without the need for cycloplegia.
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Affiliation(s)
- Mehmet Siraç Demir
- Van Training and Research Hospital, Ophthalmology Department, Saglik Bilimleri University, Van, Turkey
| | - Ersin Muhafiz
- Faculty of Medicine, Ophthalmology Department, Kafkas University, Kars, Turkey
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20
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Singh NK, Meyer D, Jaskulski M, Kollbaum P. Retinal defocus in myopes wearing dual-focus zonal contact lenses. Ophthalmic Physiol Opt 2021; 42:8-18. [PMID: 34687238 PMCID: PMC9298321 DOI: 10.1111/opo.12903] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/17/2022]
Abstract
Purpose To evaluate the refractive impact of dual‐focus (DF) myopia control contact lenses (CLs) on accommodating young myopic adults. Methods Phase 1: accommodative accuracy was assessed in 40 myopic participants. Phase 2: a subset of four subjects who demonstrated accurate accommodation and six who chronically underaccommodated were fitted with single vision (SV, Proclear 1 day) and centre‐distance DF myopia control CLs (MiSight 1 day) with approximately +2.00 D of additional power in two surrounding annular zones. While binocularly viewing high contrast characters at 4.00, 1.00, 0.50, 0.33, 0.25 and 0.20 m, aberrometry data were captured across the central ±30° of the horizontal retina. Local refractive errors were pooled for each area of the pupil covered by the central distance or first annular defocus zone of the DF CLs. Results In the “good” accommodator group fitted with SV CLs, accommodative lags were generally absent except at the closest viewing distance (mean errors: −0.09 ± 0.22 D, −0.12 ± 0.26 D, −0.05 ± 0.37 D and +0.38 ± 0.54 D for −2.00, −3.00, −4.00 and −5.00 D target vergences, respectively) but significantly larger in the “poor” accommodating participants (+0.81 ± 0.21 D, +0.97 ± 0.27 D, +1.18 ± 0.39 D, +1.47 ± 0.55 D). For most viewing distances, hyperopic defocus observed in the region of the pupil covered by the first annular zone was replaced with myopic defocus when fitted with the DF CLs. Myopic defocus created by the first annular region was present across the central 30° of the retina. Conclusions Some young adult myopes chronically experience high levels of hyperopic defocus when viewing near targets, which was replaced by myopic defocus in the annular part of the pupil covered by the treatment zones when fitted with a centre‐distance myopia control DF CL.
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Affiliation(s)
- Neeraj K Singh
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Dawn Meyer
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Matt Jaskulski
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Pete Kollbaum
- School of Optometry, Indiana University, Bloomington, Indiana, USA
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21
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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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22
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Malaika R, Raffa L, Algethami M, Alessa S. Pediatric spectacle prescription: Understanding practice patterns among ophthalmologists and optometrists in Saudi Arabia. Saudi J Ophthalmol 2021; 34:278-283. [PMID: 34527872 PMCID: PMC8409352 DOI: 10.4103/1319-4534.322608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 08/22/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022] Open
Abstract
PURPOSE This study aims to understand the approach to prescribing spectacles for children and the interpretation of refractive errors among ophthalmologists/optometrists in Saudi Arabia. METHODS A cross-sectional survey was conducted between September and November 2018 using a database of online registrants for ophthalmologists and optometrists practicing in Saudi Arabia. The survey included 10 multiple-choice questions designed to elicit information about how ophthalmologists and optometrists deal with commonly encountered case scenarios covering different practical aspects of pediatric refraction. The responses were compared using the proportion of pediatric clientele received in the respondents' practices (Group A: <25%, Group B: 25%) and drawing upon concepts from the published literature. RESULTS One hundred and three participants, including ophthalmologists, specialists/registrars, and optometrists from across Saudi Arabia, participated in this survey. Approximately 25% were classified as Group A. Large discrepancies were observed between the participants' responses and actual practices based on guideline recommendations. Responses varied significantly between Groups A and B on certain issues pertaining to pseudomyopia (P < 0.001), anisometropia (P = 0.033), and high astigmatism (P = 0.023). CONCLUSION Practice patterns regarding pediatric spectacle prescription varied among ophthalmologists and optometrists in Saudi Arabia. The approach to managing refractive errors in children was better among ophthalmologists/optometrists servicing a larger pediatric clientele, suggesting the need to increase awareness among all groups of ophthalmologists/optometrists.
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Affiliation(s)
- Rawan Malaika
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Lina Raffa
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | | | - Sara Alessa
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Datta S, Chilakala K, Vempati S, Oleti T, Kulkarni J, Murki S, Gaddam P, Satgunam P. Quantification of gaze reaction time in infants with Pediatric Perimeter. PLoS One 2021; 16:e0257459. [PMID: 34529713 PMCID: PMC8445470 DOI: 10.1371/journal.pone.0257459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose We quantified the eye/head (gaze) reaction time in infants to establish a normative database for the Pediatric Perimeter device. Additionally, we tested the hypothesis that gaze reaction time will reduce with age. Methods A cross-sectional study was conducted. Healthy infants between 3 to 10 months of age were recruited. Peripheral visual field stimuli (hemifield and quadrant stimuli) were presented in the Pediatric Perimeter device. Infant’s gaze to these stimuli was observed, documented in real time, and video recorded for offline analysis. Results A total of 121 infants were tested in three age group bins [3–5 months, n = 44; >5–7 months, n = 30 and >7–10 months, n = 47]. Overall, 3–5 months old had longer reaction time when compared to the older infants particularly for stimuli presented in the quadrants (Kruskal-Wallis, p<0.038). A significantly asymmetric difference (p = 0.025) in reaction time was observed between the upper (median = 820ms, IQR = 659-1093ms) and lower quadrants (median = 601ms, IQR = 540-1052ms) only for the 3–5 months old infants. Conclusion This study provides the normative gaze reaction time of healthy infants. With increase in age, there is reduction in reaction time and disappearance of reaction time asymmetry in quadrant stimuli. The longer reaction time for upward gaze could be due to delayed maturation of neural mechanisms and/or decreased visual attention.
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Affiliation(s)
- Sourav Datta
- Brien Holden Institute of Optometry and Vision Science, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Hyderabad, India
| | - Koteswararao Chilakala
- Center for Innovation, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Hyderabad, India
| | - Sandeep Vempati
- Center for Innovation, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Hyderabad, India
| | | | | | | | | | - PremNandhini Satgunam
- Brien Holden Institute of Optometry and Vision Science, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Hyderabad, India
- * E-mail:
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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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Scope and costs of autorefraction and photoscreening for childhood amblyopia-a systematic narrative review in relation to the EUSCREEN project data. Eye (Lond) 2020; 35:739-752. [PMID: 33257800 PMCID: PMC8026636 DOI: 10.1038/s41433-020-01261-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 09/26/2020] [Accepted: 10/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background Amblyopia screening can target reduced visual acuity (VA), its refractive risk factors, or both. VA testing is imprecise under 4 years of age, so automated risk-factor photoscreening appears an attractive option. This review considers photoscreening used in community services, focusing on costs, cost-effectiveness and scope of use, compared with EUSCREEN project Country Reports describing how photo- and automated screening is used internationally. Methods A systematic narrative review was carried out of all English language photoscreening literature to September 10th 2018, using publicly available search terms. Where costs were considered, a CASP economic evaluation checklist was used to assess data quality. Results Of 370 abstracts reviewed, 55 reported large-scale community photoscreening projects. Five addressed cost-effectiveness specifically, without original data. Photoscreening was a stand-alone, single, test event in 71% of projects. In contrast, 25 of 45 EUSCREEN Country Reports showed that if adopted, photoscreening often supplements other tests in established programmes and is rarely used as a stand-alone test. Reported costs varied widely and evidence of cost-effectiveness was sparse in the literature, or in international practice. Only eight (13%) papers compared the diagnostic accuracy or cost-effectiveness of photoscreening and VA testing, and when they did, cost-effectiveness of photoscreening compared unfavourably. Discussion Evidence that photoscreening reduces amblyopia or strabismus prevalence or improves overall outcomes is weak, as is evidence of cost-effectiveness, compared to later VA screening. Currently, the most cost-effective option seems to be a later, expert VA screening with the opportunity for a re-test before referral.
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Berdahl J, Bala C, Dhariwal M, Lemp-Hull J, Thakker D, Jawla S. Patient and Economic Burden of Presbyopia: A Systematic Literature Review. Clin Ophthalmol 2020; 14:3439-3450. [PMID: 33116396 PMCID: PMC7588278 DOI: 10.2147/opth.s269597] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/22/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose The objective of this systematic literature review (SLR) was to collate, report, and critique published evidence related to epidemiology and patient and economic burden of presbyopia. Patients and Methods A systematic literature search was conducted in MEDLINE®, Embase®, and Cochrane Library databases from the time of inception through October 2018 using Cochrane methodology. Studies published in English language reporting on epidemiology and patient and economic burden of presbyopia were included. Results Initial systematic literature search yielded 2,228 citations, of which 55 met the inclusion criteria (epidemiology, 44; patient burden, 14; economic burden, 1) and were included in this review. Globally, 1.09 billion people are estimated to be affected by presbyopia. The reported presbyopia prevalence varied across regions and by age groups, with the highest prevalence of 90% reported in the Latin America region in adults ≥35 years. Presbyopic patients report up to 22% decrease in quality-of-life (QoL) score, and up to 80% patients with uncorrected presbyopia report difficulty in performing near-vision related tasks. About 12% of presbyopes required help in performing routine activities, and these visual limitations reportedly induce distress and low self-esteem in presbyopia patients. Uncorrected presbyopia led to a 2-fold increased difficulty in near-vision-related tasks and a >8-fold increased difficulty in very demanding near-vision-related tasks. Further, uncorrected presbyopia leads to a decrement in patients’ QoL, evident by the low utility values reported in the literature. Annual global productivity losses due to uncorrected and under-corrected presbyopia in working-age population (<50 years) were estimated at US$ 11 billion (0.016% of the global domestic product (GDP) in 2011, which increased to US$ 25.4 billion if all people aged <65 years were assumed to be productive. Conclusion Uncorrected presbyopia affects patients’ vision-related quality of life due to difficulty in performing near-vision-related tasks. In addition, un-/under-corrected presbyopia could lead to productivity losses in working-age adults.
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Affiliation(s)
| | - Chandra Bala
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mukesh Dhariwal
- Global Health Economics & Outcomes Research, Alcon Vision LLC, Fort Worth, TX, USA
| | - Jessie Lemp-Hull
- Clinical Development and Medical Affairs, Alcon Vision LLC, Fort Worth, TX, USA
| | - Divyesh Thakker
- Patient Access Services, Novartis Healthcare Pvt Ltd., Hyderabad, Telangana, India
| | - Shantanu Jawla
- Patient Access Services, Novartis Healthcare Pvt Ltd., Hyderabad, Telangana, India
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Yap TP, Luu CD, Suttle C, Chia A, Boon MY. Effect of Stimulus Orientation on Visual Function in Children with Refractive Amblyopia. Invest Ophthalmol Vis Sci 2020; 61:5. [PMID: 32392311 PMCID: PMC7405838 DOI: 10.1167/iovs.61.5.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose We investigated and characterized the patterns of meridional anisotropies in newly diagnosed refractive amblyopes using pattern onset–offset visual evoked potentials (POVEPs) and psychophysical grating acuity (GA). Methods Twenty-five refractive amblyopes were recruited and compared with non-amblyopic controls from our previous study. Monocular POVEPs were recorded in response to sinewave 4 cycles per degree (cpd) grating stimuli oriented along each individual participants' principal astigmatic meridians, which were approximately horizontal (meridian 1) and vertical (meridian 2). Binocular POVEPs in response to the same stimuli, but oriented at 45°, 90°, 135°, and 180°, were recorded. Psychophysical GAs were assessed along the same meridians using a two-alternative non-forced-choice technique. The C3 amplitudes and peak latencies of the POVEPs and GAs were compared across meridians for both groups (refractive amblyopes and controls) using linear mixed models (monocular) and ANOVA (binocular), and post hoc analysis was conducted to determine if meridional anisotropies in this cohort of amblyopes were related to low (≤1.50 diopters [D]), moderate (1.75–2.75 D) and high (≥3.00 D) astigmatism. Results In the newly diagnosed refractive amblyopes, there were no significant meridional anisotropies across all outcome measures, but the post hoc analysis demonstrated that C3 amplitude was significantly higher in those with low (P = 0.02) and moderate (P = 0.004) astigmatism compared to those with high astigmatism. Refractive amblyopes had poorer GA and C3 amplitudes compared to controls by approximately two lines on the logMAR chart (monocular: P = 0.013; binocular: P = 0.014) and approximately 6 µV (monocular: P = 0.009; binocular: P = 0.027), respectively. Conclusions Deleterious effects of high astigmatism was evident in newly diagnosed refractive amblyopes, but the neural deficits do not seem to be orientation-specific for the stimulus parameters investigated.
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Pentland L, Patel S. Scottish Pre-School Vision Screening - First 3 Years of National Data. Br Ir Orthopt J 2020; 16:13-18. [PMID: 32999988 PMCID: PMC7510547 DOI: 10.22599/bioj.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 03/18/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Pre-school orthoptic vision screening (POVS) was implemented by the Scottish government and is a standardised assessment to promote early detection of visual problems in children. The target conditions are amblyopia, refractive errors and strabismus. We present the preliminary findings for the first three years of the screening program. METHODS The data from POVS was collected retrospectively. The data includes screening years 2013 to 2016 inclusive. Data was collected from each health board in Scotland. We report the coverage, referral rate, true positives and positive predictive values. RESULTS A total of 167,962 children were due to have vision screening over the 3 screening years included in this paper. This figure does not include the children that opted out of the eye test (mean opt-out rate 1.8%) and children that already attend the hospital eye service (mean already attend rate 3.1%). The POVS program had a mean coverage of 85.5%, ranging from 63.7% to 94.8% between health boards. Over the 3 year screening period, the mean referral rate was found to be 17.9%. The mean true positive rate was 88.9%, and the mean positive predictive value was 86.9%. CONCLUSION The Scottish data set on pre-school orthoptic vision screening has shown excellent mean coverage. A consistently high true positive rate over the three screening years demonstrates it is a sensitive screening program, which is essential for the detection of visual problems in children.
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Jones‐Jordan L, Wang X, Scherer RW, Mutti DO. Spectacle correction versus no spectacles for prevention of strabismus in hyperopic children. Cochrane Database Syst Rev 2020; 4:CD007738. [PMID: 32240551 PMCID: PMC7117860 DOI: 10.1002/14651858.cd007738.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Hyperopia in infancy requires accommodative effort to bring images into focus. Prolonged accommodative effort has been associated with an increased risk of strabismus. Strabismus may result in asthenopia and intermittent diplopia, and makes near work tasks difficult to complete. Spectacles to correct hyperopic refractive error is believed to prevent the development of strabismus. OBJECTIVES To assess the effectiveness of prescription spectacles compared with no intervention for the prevention of strabismus in infants and children with hyperopia. SEARCH METHODS We searched CENTRAL (2018, Issue 12; which contains the Cochrane Eyes and Vision Trials Register); Ovid MEDLINE; Embase.com; three other databases; and two trial registries. We used no date or language restrictions in the electronic search for trials. We last searched the electronic databases on 4 December 2018. SELECTION CRITERIA We included randomized controlled trials and quasi-randomized trials investigating spectacle intervention or no treatment for children with hyperopia. We required hyperopia to be at least greater than +2.00 diopters (D). DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. The primary outcome was the proportion of children with manifest strabismus, as defined by study investigators. Other outcomes included the amblyopia, stereoacuity, and the effect of spectacle use of strabismus and visual acuity. We also collected information on change in refractive error as a measurement of the interference of emmetropization. MAIN RESULTS We identified four randomized controlled trials (985 children enrolled who were aged six months to less than 36 months) in this review. Three trials were in the UK with follow-up periods ranging from one to 3.5 years and one in the US with three years' follow-up. Investigators reported both incidence and final status regarding strabismus. Evidence of the incidence of strabismus, measured in 804 children over three to four years in four trials was uncertain although suggestive of a benefit with spectacle use (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.41 to 1.02). We have very low confidence in these results due to high risk of bias, inconsistency, and imprecision. When assessed as the proportion of children with strabismus at the end of three years' follow-up, we found a similar level of evidence for an effect of spectacles on strabismus as reported in one study (RR 1.00, 95% CI 0.31 to 3.25; 106 children). We have very low confidence in these results because of low sample size and risk of bias. One trial reported on the risk for developing amblyopia and inadequate stereoacuity after three years in 106 children. There was unclear evidence for a decreased risk of developing amblyopia (RR 0.78, 95% CI 0.31 to 1.93), and limited evidence for a benefit of spectacles for prevention of inadequate stereoacuity (RR 0.38, 95% CI 0.16 to 0.88). We have very low confidence in these findings due to imprecision and risk of bias. The risk of not developing emmetropization is unclear. One trial reported on the proportion of children not achieving emmetropization at three years' follow-up (RR 0.75, 95% CI 0.18 to 3.19). One trial suggested spectacles impede emmetropization, and one trial reported no difference. These two trials could not be combined because the methods for assessing emmetropization were different. With the high risk of bias and inconsistency, the certainty of evidence for a risk for impeding or benefiting emmetropization is very low. Based on a meta-analysis of four trials (770 children), the risk of having visual acuity worse than 20/30 measured up to three years of age or at the end of three years of follow-up was uncertain for children with spectacle correction compared with those without correction (RR 0.87, 95% CI 0.64 to 1.18; very low confidence due to risk of bias and imprecision). AUTHORS' CONCLUSIONS The effect of spectacle correction for prevention of strabismus is still unclear. In addition, the use of spectacle on the risk of visual acuity worse than 20/30, amblyopia, and inadequate emmetropization is also unclear. There may be a benefit on prevention of inadequate stereoacuity. However, these effects may have been chance findings or due to bias.
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Affiliation(s)
- Lisa Jones‐Jordan
- The Ohio State UniversityCollege of Optometry338 West 10th Avenue649 Fry HallColumbusOhioUSA43210
| | - Xue Wang
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 N. Wolfe StreetBaltimoreMarylandUSA21205
| | - Roberta W Scherer
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 N. Wolfe StreetBaltimoreMarylandUSA21205
| | - Donald O Mutti
- The Ohio State UniversityCollege of Optometry338 West 10th Avenue649 Fry HallColumbusOhioUSA43210
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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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Yahya AN, Sharanjeet-Kaur S, Akhir SM. Distribution of Refractive Errors among Healthy Infants and Young Children between the Age of 6 to 36 Months in Kuala Lumpur, Malaysia-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234730. [PMID: 31783494 PMCID: PMC6926593 DOI: 10.3390/ijerph16234730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 11/16/2022]
Abstract
Uncorrected refractive error, especially myopia, in young children can cause permanent visual impairment in later life. However, data on the normative development of refractive error in this age group is limited, especially in Malaysia. The aim of this study was to determine the distribution of refractive error in a sample of infants and young children between the ages of 6 to 36 months in a prospective, cross-sectional study. Cycloplegic retinoscopy was conducted on both eyes of 151 children of mean age 18.09 ± 7.95 months. Mean spherical equivalent refractive error for the right and left eyes was +0.85 ± 0.97D and +0.86 ± 0.98D, respectively. The highest prevalence of refractive error was astigmatism (26%), followed by hyperopia (12.7%), myopia (1.3%) and anisometropia (0.7%). There was a reduction of hyperopic refractive error with increasing age. Myopia was seen to emerge at age 24 months. In conclusion, the prevalence of astigmatism and hyperopia in infants and young children was high, but that of myopia and anisometropia was low. There was a significant reduction in hyperopic refractive error towards emmetropia with increasing age. It is recommended that vision screening be conducted early to correct significant refractive error that may cause disruption to clear vision.
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Affiliation(s)
- Arifah Nur Yahya
- Optometry & Vision Science Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50200, Malaysia; (A.N.Y.); (S.M.A.)
- Ophthalmology Department, Hospital Queen Elizabeth, Karung Berkunci No. 2029, Kota Kinabalu 88586, Sabah, Malaysia
| | - Sharanjeet Sharanjeet-Kaur
- Optometry & Vision Science Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50200, Malaysia; (A.N.Y.); (S.M.A.)
- Correspondence:
| | - Saadah Mohamed Akhir
- Optometry & Vision Science Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50200, Malaysia; (A.N.Y.); (S.M.A.)
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Authors' Response. Optom Vis Sci 2019; 96:536-537. [DOI: 10.1097/opx.0000000000001403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Doherty SE, Doyle LA, McCullough SJ, Saunders KJ. Comparison of retinoscopy results with and without 1% cyclopentolate in school‐aged children. Ophthalmic Physiol Opt 2019; 39:272-281. [DOI: 10.1111/opo.12629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Sue E Doherty
- Optometry and Vision Science Research Group School of Biomedical Sciences Biomedical Sciences Research Institute University of Ulster Coleraine UK
| | - Lesley A Doyle
- Optometry and Vision Science Research Group School of Biomedical Sciences Biomedical Sciences Research Institute University of Ulster Coleraine UK
| | - Sara J McCullough
- Optometry and Vision Science Research Group School of Biomedical Sciences Biomedical Sciences Research Institute University of Ulster Coleraine UK
| | - Kathryn J Saunders
- Optometry and Vision Science Research Group School of Biomedical Sciences Biomedical Sciences Research Institute University of Ulster Coleraine UK
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Doyle LA, McCullough SJ, Saunders KJ. Cycloplegia and spectacle prescribing in children: attitudes of UK optometrists. Ophthalmic Physiol Opt 2019; 39:148-161. [PMID: 30957261 DOI: 10.1111/opo.12612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/12/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To survey a large number of UK-based optometrists, in a variety of settings, to determine current attitudes relating to the use of cycloplegia and spectacle prescribing in children aged ≤11 years. METHODS One thousand randomly selected members of the College of Optometrists (UK) were invited to complete an electronic questionnaire. The questionnaire was comprised of 42 questions relating to respondent demographics, practitioner use of cycloplegia and attitudes to using cycloplegia to assess childhood refractive error and prescribing spectacles for children aged ≤11 years. RESULTS Three hundred and eleven practitioners (31%) completed the questionnaire. Practitioners agreed that they are confident carrying out cycloplegic refraction (60%) and instilling cyclopentolate (77%); are not concerned about the time the procedure takes (69%); feel parents are receptive to its use (65%) and are not discouraged by side effects (72%). Most practitioners agreed that they would carry out a cycloplegic refraction in pre-school children (aged 2-4 years) at their first eye exam (34% vs 27%), but would not carry out a cycloplegic refraction in a child of school age (5-7 years: 25% vs 47%, 8-11 years: 12% vs 45%). More recently qualified practitioners are more likely to be proactive in using cycloplegia (Mann-Whitney, p = 0.003). Community practitioners prescribed at slightly lower levels of ametropia in non-strabismic children than those working in a hospital setting both in the present study and in comparison to previously published hospital optometry values, particularly for hyperopia at 1 year of age. CONCLUSIONS This is the first study to report practitioner use of cycloplegia and attitudes to using cycloplegia to assess childhood refractive error and prescribing spectacles for children in a large number of UK-based optometrists practising in a variety of settings. The majority of practitioners responded in a positive manner to the use of cycloplegia and reported patterns of use which adhere closely to available professional guidance. However, outcomes indicate practitioners may appreciate more comprehensive evidence-based resources to inform their decision-making relating to use of cycloplegia in paediatric examination.
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Affiliation(s)
- Lesley A Doyle
- Biomedical Sciences Research Institute, School of Biomedical Sciences, University of Ulster, Coleraine, UK
| | - Sara J McCullough
- Biomedical Sciences Research Institute, School of Biomedical Sciences, University of Ulster, Coleraine, UK
| | - Kathryn J Saunders
- Biomedical Sciences Research Institute, School of Biomedical Sciences, University of Ulster, Coleraine, UK
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Barnett-Itzhaki G, Friehmann A, Barnett-Itzhaki Z, Ela-Dalman N. Diagnosis and Management Practice Patterns among Pediatric Ophthalmology Personnel in Israel. J Binocul Vis Ocul Motil 2019; 69:34-41. [PMID: 30896300 DOI: 10.1080/2576117x.2019.1581552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the diagnosis and management practice patterns of different aspects of pediatric ophthalmology among pediatric ophthalmologists and orthoptists in Israel. METHODS A 21-question survey was delivered to all registered pediatric ophthalmologists and orthoptists in Israel. RESULTS The response rate was 58.3%. Most pediatric ophthalmology personnel in Israel do not document intermittent exotropia (IXT) with a control scale, do not use modalities other than patching for amblyopia, and do not use distance stereoacuity tests. There was no consensus regarding patching and over minus treatments in IXT. In contrast to frequent use of prism adaptation test (PAT) for evaluating strabismus, most Israeli pediatric ophthalmology personnel do not use postoperation diplopia test (PODT). While most orthoptists use a questionnaire when diagnosing convergence insufficiency (CI), most pediatric ophthalmologists do not. CONCLUSION This study highlights the current areas of consensus and disagreement regarding pediatric ophthalmology diagnosis and management practices in Israel. Adopting a uniform approach regarding diagnosing CI, including using a questionnaire by pediatric ophthalmologists and orthoptic exercises in the management of IXT, is warranted to enable unified treatment by pediatric ophthalmologist and orthoptists in Israel.
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Affiliation(s)
- Guy Barnett-Itzhaki
- a Department of Ophthalmology , Meir Medical Center , Kfar Saba , Israel.,b Sackler faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Asaf Friehmann
- a Department of Ophthalmology , Meir Medical Center , Kfar Saba , Israel.,b Sackler faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Zohar Barnett-Itzhaki
- c Public Health Services , Israeli Ministry of Health , Jerusalem , Israel.,d Bioinformatics Department , School of Life and Health Sciences, Jerusalem College of Technology , Jerusalem , Israel
| | - Noa Ela-Dalman
- a Department of Ophthalmology , Meir Medical Center , Kfar Saba , Israel.,b Sackler faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Harvey EM, McGrath ER, Miller JM, Davis AL, Twelker JD, Dennis LK. A preliminary study of astigmatism and early childhood development. J AAPOS 2018; 22:294-298. [PMID: 29929004 DOI: 10.1016/j.jaapos.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine whether uncorrected astigmatism in toddlers is associated with poorer performance on the Bayley Scales of Infant and Toddler Development, 3rd edition (BSITD-III). METHODS Subjects were 12- to 35-month-olds who failed an instrument-based vision screening at a well-child check. A cycloplegic eye examination was conducted. Full-term children with no known medical or developmental conditions were invited to participate in a BSITD-III assessment conducted by an examiner masked to the child's eye examination results. Independent samples t tests were used to compare Cognitive, Language (Receptive and Expressive), and Motor (Fine and Gross) scores for children with moderate/high astigmatism (>2.00 D) versus children with no/low refractive error (ie, children who had a false-positive vision screening). RESULTS The sample included 13 children in each group. The groups did not differ on sex or mean age. Children with moderate/high astigmatism had significantly poorer mean scores on the Cognitive and Language scales and the Receptive Communication Language subscale compared to children with no/low refractive error. Children with moderate/high astigmatism had poorer mean scores on the Motor scale, Fine and Gross Motor subscales, and the Expressive Communication subscale, but these differences were not statistically significant. CONCLUSIONS The results suggest that uncorrected astigmatism in toddlers may be associated with poorer performance on cognitive and language tasks. Further studies assessing the effects of uncorrected refractive error on developmental task performance and of spectacle correction of refractive error in toddlers on developmental outcomes are needed to support the development of evidence-based spectacle prescribing guidelines.
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Affiliation(s)
- Erin M Harvey
- Department of Ophthalmology and Vision Science, The University of Arizona, Tucson.
| | | | - Joseph M Miller
- Department of Ophthalmology and Vision Science, The University of Arizona, Tucson; College of Public Health, The University of Arizona, Tucson; College of Optical Sciences, The University of Arizona, Tucson
| | - Amy L Davis
- Department of Ophthalmology and Vision Science, The University of Arizona, Tucson
| | - J Daniel Twelker
- Department of Ophthalmology and Vision Science, The University of Arizona, Tucson
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Absent Foveal Pit, Also Known as Fovea Plana, in a Child without Associated Ocular or Systemic Findings. Case Rep Ophthalmol Med 2018; 2018:2146826. [PMID: 30147974 PMCID: PMC6083636 DOI: 10.1155/2018/2146826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/27/2018] [Accepted: 07/04/2018] [Indexed: 11/17/2022] Open
Abstract
The purpose of this report is to describe a case of bilateral foveal hypoplasia in the absence of other ophthalmological or systemic manifestations. We characterize the case of a 9-year-old Caucasian male who underwent full ophthalmologic examination, including functional measures of vision and structural measurements of the eye. Best corrected visual acuity was 0.50 logMAR in the right eye and 0.40 logMAR in the left eye. Ophthalmoscopy revealed a lack of foveal reflex that was further investigated. Optical coherence tomography (OCT) confirmed the absence of foveal depression (pit). OCT images demonstrated the abnormal structure of retina in a region in which we expected a fovea; these findings were decisive to determine the cause of reduced acuity in the child.
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Affiliation(s)
- Pradeep Sharma
- Dr. RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Nripen Gaur
- Dr. RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Sheeladevi S, Seelam B, Nukella PB, Modi A, Ali R, Keay L. Prevalence of refractive errors in children in India: a systematic review. Clin Exp Optom 2018; 101:495-503. [PMID: 29682791 DOI: 10.1111/cxo.12689] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 03/14/2018] [Accepted: 03/21/2018] [Indexed: 11/27/2022] Open
Abstract
Uncorrected refractive error is an avoidable cause of visual impairment which affects children in India. The objective of this review is to estimate the prevalence of refractive errors in children ≤ 15 years of age. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in this review. A detailed literature search was performed to include all population and school-based studies published from India between January 1990 and January 2017, using the Cochrane Library, Medline and Embase. The quality of the included studies was assessed based on a critical appraisal tool developed for systematic reviews of prevalence studies. Four population-based studies and eight school-based studies were included. The overall prevalence of refractive error per 100 children was 8.0 (CI: 7.4-8.1) and in schools it was 10.8 (CI: 10.5-11.2). The population-based prevalence of myopia, hyperopia (≥ +2.00 D) and astigmatism was 5.3 per cent, 4.0 per cent and 5.4 per cent, respectively. Combined refractive error and myopia alone were higher in urban areas compared to rural areas (odds ratio [OR]: 2.27 [CI: 2.09-2.45]) and (OR: 2.12 [CI: 1.79-2.50]), respectively. The prevalence of combined refractive errors and myopia alone in schools was higher among girls than boys (OR: 1.2 [CI: 1.1-1.3] and OR: 1.1 [CI: 1.1-1.2]), respectively. However, hyperopia was more prevalent among boys than girls in schools (OR: 2.1 [CI: 1.8-2.4]). Refractive error in children in India is a major public health problem and requires concerted efforts from various stakeholders including the health care workforce, education professionals and parents, to manage this issue.
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Affiliation(s)
- Sethu Sheeladevi
- School of Health Sciences, City, University of London, London, UK
| | - Bharani Seelam
- The George Institute for Global Health, New Delhi, India
| | | | | | | | - Lisa Keay
- The George Institute for Global Health, New Delhi, India
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Cole BL. Serving optometry for 100 years: the story of Clinical and Experimental Optometry. Clin Exp Optom 2017; 100:303-312. [PMID: 28556196 DOI: 10.1111/cxo.12554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/13/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Barry L Cole
- Kett Optometry Museum, Australian College of Optometry, Melbourne, Victoria, Australia.,Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Feldman S, Peterseim MMW, Trivedi RH, Edward Wilson M, Cheeseman EW, Papa CE. Detecting High Hyperopia: The Plus Lens Test and the Spot Vision Screener. J Pediatr Ophthalmol Strabismus 2017; 54:163-167. [PMID: 27977035 DOI: 10.3928/01913913-20161013-05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 09/28/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the usefulness of the Plus Lens (Goodlite Company, Elgin, IL) test and the Spot Vision Screener (Welch Allyn, Skaneateles Falls, NY) in detecting high hyperopia in a pediatric population. METHODS Between June and August 2015, patients were screened with the Spot Vision Screener and the Plus Lens test prior to a scheduled pediatric ophthalmology visit. The following data were analyzed: demographic data, Plus Lens result, Spot Vision Screener result, cycloplegic refraction, and examination findings. Sensitivity/specificity and positive/negative predictive values were calculated for the Plus Lens test and Spot Vision Screener in detecting hyperopia as determined by the "gold-standard" cycloplegic refraction. RESULTS A total of 109 children (average age: 82 months) were included. Compared to the ophthalmologist's cycloplegic refraction, the Spot Vision Screener sensitivity for +3.50 diopters (D) hyperopia was 31.25% and the specificity was 100%. The Plus Lens sensitivity for +3.50 D hyperopia was 43.75% and the specificity was 89.25%. Spot Vision Screener sensitivity increased with higher degrees of hyperopia. CONCLUSIONS In this preliminary study, the Plus Lens test and the Spot Vision Screener demonstrated moderate sensitivity with good specificity in detecting high hyperopia. [J Pediatr Ophthalmol Strabismus. 2017;54(3):163-167.].
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Negiloni K, Ramani KK, Sudhir RR. Do school classrooms meet the visual requirements of children and recommended vision standards? PLoS One 2017; 12:e0174983. [PMID: 28369118 PMCID: PMC5378392 DOI: 10.1371/journal.pone.0174983] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 03/18/2017] [Indexed: 11/18/2022] Open
Abstract
Background Visual demands of school children tend to vary with diverse classroom environments. The study aimed to evaluate the distance and near Visual Acuity (VA) demand in Indian school classrooms and their comparison with the recommended vision standards. Materials and methods The distance and near VA demands were assessed in 33 classrooms (grades 4 to 12) of eight schools. The VA threshold demand relied on the smallest size of distance and near visual task material and viewing distance. The logMAR equivalents of minimum VA demand at specific seating positions (desk) and among different grades were evaluated. The near threshold was converted into actual near VA demand by including the acuity reserve. The existing dimensions of chalkboard and classroom, gross area in a classroom per student and class size in all the measured classrooms were compared to the government recommended standards. Results In 33 classrooms assessed (35±10 students per room), the average distance and near logMAR VA threshold demand was 0.31±0.17 and 0.44±0.14 respectively. The mean distance VA demand (minimum) in front desk position was 0.56±0.18 logMAR. Increased distance threshold demand (logMAR range -0.06, 0.19) was noted in 7 classrooms (21%). The mean VA demand in grades 4 to 8 and grades 9 to 12 was 0.35±0.16 and 0.24±0.16 logMAR respectively and the difference was not statistically significant (p = 0.055). The distance from board to front desk was greater than the recommended standard of 2.2m in 27 classrooms (82%). The other measured parameters were noted to be different from the proposed standards in majority of the classrooms. Conclusion The study suggests the inclusion of task demand assessment in school vision screening protocol to provide relevant guidance to school authorities. These findings can serve as evidence to accommodate children with mild to moderate visual impairment in the regular classrooms.
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Affiliation(s)
- Kalpa Negiloni
- Medical Research Foundation, Sankara Nethralaya, Chennai, India
- Shanmugha Arts, Science, Technology & Research Academy (SASTRA) University, Thanjavur, India
- Elite School of Optometry, Chennai, India
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Latorre-Arteaga S, Gil-González D, Bascarán C, Núñez RH, Morales MDCP, Orihuela GC. Visual health screening by schoolteachers in remote communities of Peru: implementation research. Bull World Health Organ 2016; 94:652-659. [PMID: 27708470 PMCID: PMC5034634 DOI: 10.2471/blt.15.163634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 03/05/2016] [Accepted: 03/06/2016] [Indexed: 11/27/2022] Open
Abstract
Objective To describe the adaptation and scaling-up of an intervention to improve the visual health of children in the Apurimac region, Peru. Methods In a pilot screening programme in 2009–2010, 26 schoolteachers were trained to detect and refer visual acuity problems in schoolchildren in one district in Apurimac. To scale-up the intervention, lessons learnt from the pilot were used to design strategies for: (i) strengthening multisector partnerships; (ii) promoting the engagement and participation of teachers and (iii) increasing children’s attendance at referral eye clinics. Implementation began in February 2015 in two out of eight provinces of Apurimac, including hard-to-reach communities. We made an observational study of the processes and outcomes of adapting and scaling-up the intervention. Qualitative and quantitative analyses were made of data collected from March 2015 to January 2016 from programme documents, routine reports and structured evaluation questionnaires completed by teachers. Findings Partnerships were expanded after sharing the results of the pilot phase. Training was completed by 355 teachers and directors in both provinces, belonging to 315 schools distributed in 24 districts. Teachers’ appraisal of the training achieved high positive scores. Outreach eye clinics and subsidies for glasses were provided for poorer families. Data from six districts showed that attendance at the eye clinic increased from 66% (45/68 children referred) in the pilot phase to 92% (237/259) in the implementation phase. Conclusion Adaptation to the local context allowed the scaling-up of an intervention to improve visual health in children and enhanced the equity of the programme.
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Affiliation(s)
- Sergio Latorre-Arteaga
- Public Health Research Group, University of Alicante, Campus San Vicente del Raspeig, Ap. 99 CP 03080, San Vicente del Raspeig, Alicante, Spain
| | - Diana Gil-González
- Public Health Research Group, University of Alicante, Campus San Vicente del Raspeig, Ap. 99 CP 03080, San Vicente del Raspeig, Alicante, Spain
| | - Covadonga Bascarán
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, England
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Maconachie GDE, Gottlob I. The challenges of amblyopia treatment. Biomed J 2016; 38:510-6. [PMID: 27013450 PMCID: PMC6138377 DOI: 10.1016/j.bj.2015.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/08/2015] [Indexed: 11/22/2022] Open
Abstract
The treatment of amblyopia, particularly anisometropic (difference in refractive correction) and/or strabismic (turn of one eye) amblyopia has long been a challenge for many clinicians. Achieving optimum outcomes, where the amblyopic eye reaches a visual acuity similar to the fellow eye, is often impossible in many patients. Part of this challenge has resulted from a previous lack of scientific evidence for amblyopia treatment that was highlight by a systematic review by Snowdon et al. in 1998. Since this review, a number of publications have revealed new findings in the treatment of amblyopia. This includes the finding that less intensive occlusion treatments can be successful in treating amblyopia. A relationship between adherence to treatment and visual acuity has also been established and has been shown to be influenced by the use of intervention material. In addition, there is growing evidence of that a period of glasses wearing only can significantly improve visual acuity alone without any other modes of treatment. This review article reports findings since the Snowdon's report.
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Affiliation(s)
- Gail D E Maconachie
- Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, RKSCB, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - Irene Gottlob
- Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, RKSCB, Leicester Royal Infirmary, Leicester LE2 7LX, UK.
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Shneor E, Evans BJW, Fine Y, Shapira Y, Gantz L, Gordon-Shaag A. A survey of the criteria for prescribing in cases of borderline refractive errors. JOURNAL OF OPTOMETRY 2016; 9:22-31. [PMID: 26520884 PMCID: PMC4705315 DOI: 10.1016/j.optom.2015.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/09/2015] [Accepted: 09/12/2015] [Indexed: 05/26/2023]
Abstract
PURPOSE This research investigated the reported optometric prescribing criteria of Israeli optometrists. METHODS An online questionnaire based on previous studies was distributed via email and social networking sites to optometrists in Israel. The questionnaire surveyed the level of refractive error at which respondents would prescribe for different types of refractive error at various ages with and without symptoms. RESULTS 124 responses were obtained, yielding a response rate of approximately 12-22%, 92% of whom had trained in Israel. For all refractive errors, the presence of symptoms strongly influenced prescribing criteria. For example, for 10-20 year old patients the degree of hyperopia for which 50% of practitioners would prescribe is +0.75 D in the presence of symptoms but twice this value (+1.50 D) in the absence of symptoms. As might be expected, optometrists prescribed at lower degrees of hyperopia for older compared with younger patients. There was a trend for more experienced practitioners to be less likely to prescribe for lower degrees of myopia and presbyopia. Practitioner gender, country of training, the type of practice environment, and financial incentives were not strongly related to prescribing criteria. CONCLUSIONS The prescribing criteria found in this study are broadly comparable with those in previous studies and with published prescribing guidelines. Subtle indications suggest that optometrists may become more conservative in their prescribing criteria with experience.
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Affiliation(s)
- Einat Shneor
- Department of Optometry, Hadassah Academic College, Jerusalem, Israel.
| | | | - Yael Fine
- Department of Optometry, Hadassah Academic College, Jerusalem, Israel
| | - Yehudit Shapira
- Department of Optometry, Hadassah Academic College, Jerusalem, Israel
| | - Liat Gantz
- Department of Optometry, Hadassah Academic College, Jerusalem, Israel
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Narayanasamy S, Vincent SJ, Sampson GP, Wood JM. Simulated astigmatism impairs academic-related performance in children. Ophthalmic Physiol Opt 2014; 35:8-18. [DOI: 10.1111/opo.12165] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Sumithira Narayanasamy
- School of Optometry and Vision Science; Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane Australia
| | - 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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Jones-Jordan L, Wang X, Scherer RW, Mutti DO. Spectacle correction versus no spectacles for prevention of strabismus in hyperopic children. Cochrane Database Syst Rev 2014; 8:CD007738. [PMID: 25133974 PMCID: PMC4259577 DOI: 10.1002/14651858.cd007738.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hyperopia (far-sightedness) in infancy requires accommodative effort to bring images into focus. Prolonged accommodative effort has been associated with an increased risk of strabismus (eye misalignment). Strabismus makes it difficult for the eyes to work together and may result in symptoms of asthenopia (eye strain) and intermittent diplopia (double vision), and makes near work tasks difficult to complete. Untreated strabismus may result in the development of amblyopia (lazy eye). The prescription of spectacles to correct hyperopic refractive error is believed to prevent the development of strabismus. OBJECTIVES To assess the effectiveness of prescription spectacles compared with no intervention for the prevention of strabismus in infants and children with hyperopia. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to April 2014), EMBASE (January 1980 to April 2014), PubMed (1966 to April 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 3 April 2014. We also searched the Science Citation Index database in September 2013. SELECTION CRITERIA We included randomized controlled trials and quasi-randomized trials investigating the assignment to spectacle intervention or no treatment for children with hyperopia. The definition of hyperopia remains subjective, but we required it to be at least greater than +2.00 diopters (D) of hyperopia. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data using the standard methodologic procedures expected by The Cochrane Collaboration. One review author entered data into Review Manager and a second review author verified the data entered. The two review authors resolved discrepancies at all stages of the review process. MAIN RESULTS We identified three randomized controlled trials (855 children enrolled) in this review. These trials were all conducted in the UK with follow-up periods ranging from one to 3.5 years. We judged the included studies to be at high risk of bias, due to use of quasi-random methods for assigning children to treatment, no masking of outcomes assessors, and high proportions of drop-outs. None of the three trials accounted for missing data and analyses were limited to the available-case data (674 (79%) of 855 children enrolled for the primary outcome). These factors impair our ability to assess the effectiveness of treatment.Analyses incorporating the three trials we identified in this review (674 children) suggested the effect of spectacle correction initiated prior to the age of one year in hyperopic children between three and four years of age is uncertain with respect to preventing strabismus (risk ratio (RR) 0.71; 95% confidence interval (CI) 0.44 to 1.15; very low quality evidence). Based on a meta-analysis of three trials (664 children), the risk of having visual acuity worse than 20/30 at three years of age was also uncertain for children with spectacles compared with those without spectacle correction irrespective of compliance (RR 0.87; 95% CI 0.60 to 1.26; very low quality evidence).Emmetropization was reported in two trials: one trial suggested that spectacles impede emmetropization, and the second trial reported no difference in the rate of refractive error change. AUTHORS' CONCLUSIONS Although children who were allocated to the spectacle group were less likely to develop strabismus and less likely to have visual acuity worse than 20/30 children allocated to no spectacles, these effects may have been chance findings, or due to bias. Due to the high risk of bias and poor reporting of included trials, the true effect of spectacle correction for hyperopia on strabismus is still uncertain.
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Affiliation(s)
- Lisa Jones-Jordan
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Xue Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Roberta W Scherer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Donald O Mutti
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
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