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Malik AN, Evans JR, Gupta S, Mariotti S, Gordon I, Bowman R, Gilbert C. Universal newborn eye screening: a systematic review of the literature and review of international guidelines. J Glob Health 2022; 12:12003. [PMID: 36269293 PMCID: PMC9586142 DOI: 10.7189/jogh.12.12003] [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: 11/17/2022] Open
Abstract
Background This systematic review assessed the effectiveness of universal screening for newborn eye abnormalities compared with no screening in improving infant vision and health outcomes. Methods We searched CENTRAL (Cochrane Library), MEDLINE, Embase, Global Health, Global Index Medicus, clinical trials databases, and bibliographies of relevant articles. We included randomized and observational studies of all newborns, regardless of illness or risk factors, that compared universal screening for any eye abnormality by eight weeks of age with no universal screening. Two authors independently selected studies, extracted data, and evaluated the risk of bias. We used GRADE to assess the certainty of evidence. We also reviewed available recommendations on newborn eye screening. Results Fourteen studies were identified but only three compared universal red reflex screening with no screening. Findings suggest that universal red reflex testing in maternity wards (MWs) may increase the number of newborns with congenital cataracts referred for eye care from MWs or well-baby clinics (WBCs) in the first year of life (risk ratio (RR) = 9.83, 95% confidence interval (CI) = 1.36-71.20; low certainty evidence). However, the effect of screening in WBC is uncertain (RR = 6.62, 95% CI = 0.87-50.09). The effect of MW or WBC screening on referral from any health care facility (MWs, WBCs, paediatrician clinic, other) in the first year is uncertain (MW screening: RR = 1.22, 95% CI = 0.63-2.39; WBC screening: RR = 0.97, 95% CI = 0.46-2.05). However, referral or surgery by 6 weeks of age may be higher with universal MW screening (early referral: RR = 4.61, 95% CI = 1.12-19.01; early surgery: RR = 8.23, 95% CI = 1.13-59.80; low certainty evidence). The effect of WBC screening on early referral and surgery is uncertain (early referral: RR = 1.98, 95% CI = 0.43-9.19; early surgery: RR = 3.97, 95% CI = 0.50-31.33; very low certainty evidence). Universal red reflex testing may increase clinical conjunctivitis (OR = 1.22, 95% CI = 1.01-1.47; low certainty evidence) but the effect on confirmed bacterial conjunctivitis is uncertain (OR = 1.20, 95% CI = 0.76-1.90; very low-certainty evidence). Nine guidelines recommended universal newborn eye screening using red reflex testing. Conclusions Evidence supports the role of red reflex testing shortly after birth to increase early identification, referral, and surgery for congenital cataracts.
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Affiliation(s)
- Aeesha Nj Malik
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer R Evans
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.,Cochrane Eyes and Vision, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Shuchita Gupta
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), World Health Organization, Geneva, Switzerland
| | - Silvio Mariotti
- Department of Noncommunicable Diseases, Eye and Vision Care, World Health Organization, Geneva, Switzerland
| | - Iris Gordon
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.,Cochrane Eyes and Vision, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Richard Bowman
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Sabherwal S, Sood I, Siddiqui Z, Majumdar A, Singh BP, DasGupta S, Ganesh S. Door-to-door Screening as a New Model Augmenting School Eye Screening: Reaching Out to School Age Children in the Midst of a Pandemic. Ophthalmic Epidemiol 2022:1-9. [PMID: 36121011 DOI: 10.1080/09286586.2022.2123003] [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: 10/14/2022]
Abstract
PURPOSE Explore door-to-door eye screening in India as a model to reach school age children in need of eye care, especially during school closures due to the Covid-19 pandemic. METHODS Children between 5 and 18 years were screened in an urban-slum of Delhi from September 2020 to March 2021. Screening included capturing ocular complaints, visual acuity and conducting a torchlight examination. Children with any eye-related complaints, gross abnormality or a LogMAR acuity of more than 0.2 in either eye were referred to the nearby vision centre. Data were disaggregated by gender and age group. Reporting after referral and proportion of true positives referrals were used to assess the model. RESULTS 32,857 children were screened. 55% were boys. Only 917 children (2.8%) had previous eye examinations. 1814 (5.5%) children were referred. Overall compliance rate amongst those referred was 59% (1070 of 1814) and compliance was significantly higher (72%) amongst those referred with poor vision as compared to those with only ocular morbidities (38%). Overall compliance was significantly higher amongst older age group (64% vs 50%) and amongst girls than boys (61% vs 56%). 3.9% children were detected with refractive error (RE) and 2.5% with uncorrected RE which was significantly higher in girls and in older age group. Of 1070 children reporting after referral, 85% had confirmed diagnosis for RE or other ocular pathology. CONCLUSION Door-to-door screening had good referral compliance and positive predictive value. We recommend this model as a supplement to school screening especially in regions with low enrolment and high absenteeism in schools.
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Affiliation(s)
- Shalinder Sabherwal
- Department of Community Ophthalmology and Public Health Research, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Ishaana Sood
- Department of Community Ophthalmology and Public Health Research, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Zeeshan Siddiqui
- Department of Community Outreach, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Atanu Majumdar
- Biostatistician, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Birendra Pratap Singh
- Department of Community Ophthalmology and Public Health Research, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Shantanu DasGupta
- Department of Community Operations and Strategic Planning, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Suma Ganesh
- Department of Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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Vempuluru VS, Kaliki S. Screening for Retinoblastoma: A Systematic Review of Current Strategies. Asia Pac J Ophthalmol (Phila) 2021; 10:192-199. [PMID: 33793441 DOI: 10.1097/apo.0000000000000378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to review the literature on various screening programs, devices, and applications described for the early detection of retinoblastoma. DESIGN Systematic review article. METHODS A PubMed® search was performed to identify articles published with specific reference to screening of neonates, infants and children for retinoblastoma. RESULTS Various devices and mobile phone-based applications based on altered red reflex are finding their way into community screening. Diagnosis of retinoblastoma by newborn eye screening is emphasized in several countries, and red reflex is the most widely employed technique. CONCLUSIONS Several screening programs for early detection of retinoblastoma are evolving in the developing countries, but the practices are not uniform. Universal newborn screening should be the norm. Newer tools and software can be utilized to screen infants on a community scale. Focussed research on revolutionizing digital imaging for a versatile screening tool holds promise for early diagnosis of retinoblastoma.
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Affiliation(s)
- Vijitha S Vempuluru
- Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
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Tuteja SY, Blaikie A, Kekunnaya R. Identification of amblyogenic risk factors with the Brückner reflex test using the low-cost Arclight direct ophthalmoscope. Eye (Lond) 2021; 35:3007-3011. [PMID: 33414528 DOI: 10.1038/s41433-020-01341-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/12/2020] [Accepted: 11/25/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES The Arclight is a novel, low-cost, solar-powered direct ophthalmoscope developed for low resource settings as an alternative to more expensive, conventional devices. The Brückner reflex test (BRT) is a quick and effective means to screen for eye disease and amblyogenic risk factors. This test is however rarely performed in low resource settings due to the lack of access to ophthalmoscopes and trained health care workers. Our aim was to establish the sensitivity and specificity of the BRT when performed by a non-expert using an Arclight and compare to an expert as well as the results of a full clinic workup. SUBJECTS/METHODS In this prospective, blinded study, 64 patients referred to a paediatric ophthalmology clinic had the BRT performed by a 'non-expert' observer (medical student) then an 'expert' observer (consultant ophthalmologist). These results were then compared against the 'gold standard' outcomes of a full clinical workup. RESULTS BRT screening by the expert observer led to a sensitivity of 75.0% [95% CI: 57.9-86.8%] and a specificity of 90.6% [95% CI: 75.8-96.8%] in picking up media opacity, strabismus, refractive error or a combination of the above. For the non-expert, the sensitivity and specificity were 71.9% [95% CI: 54.6-84.4%] and 84.4% [95% CI: 68.3-93.1%], respectively. CONCLUSIONS The Arclight can be effectively used to perform the BRT and identify eye disease and common amblyogenic risk factors. Even when performed by a non-expert the results are highly specific and moderately sensitive. This study consequently offers support for the use of this low-cost ophthalmoscope in the expansion of eye screening by health care workers in low resource settings.
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Affiliation(s)
| | - Andrew Blaikie
- University of St Andrews, School of Medicine, St Andrews, Scotland. .,Department of Ophthalmology, Queen Margaret Hospital, NHS Fife, Dunfermline, Scotland.
| | - Ramesh Kekunnaya
- Head, Child Sight Institute & Jasti V Ramanamma Children's Eye Care Center, LV Prasad Eye Institute (LVPEI), Hyderabad, India
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Comment on: Reshaping ophthalmology training after COVID-19 pandemic. Eye (Lond) 2020; 35:2316-2318. [PMID: 32811996 PMCID: PMC7433268 DOI: 10.1038/s41433-020-01139-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 11/09/2022] Open
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O'Carroll V, Sagahutu JB, Ndayambaje D, Kayiranga D, Fiston Kitema G, Rujeni N, Blaikie A. Evaluation of a pilot interprofessional Arclight™ workshop for healthcare students in Rwanda: promoting collaborative practice in eye health. J Interprof Care 2020; 35:637-640. [PMID: 32648788 DOI: 10.1080/13561820.2020.1782356] [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: 10/23/2022]
Abstract
Preventable and treatable visual impairment affects more than 1 billion people worldwide. Rwanda has an estimated visual impairment prevalence of 3.7% amongst the 12 million inhabitants. Around one third of this demand could be addressed through a more integrated and collaborative approach, particularly in primary eye care services. Healthcare students, therefore, need to be prepared for collaborative practice in eye health through interprofessional learning. Interprofessional workshops were piloted with ophthalmic clinical officer, medical clinical officer, nursing and medical students from the University of Rwanda. The aim was to promote collaborative practice by teaching students how to assess and recognize common eye conditions using the Arclight; a low cost, solar powered, portable ophthalmoscope designed for use in low resource settings. Students reported that the workshop content was relevant to all professional groups. They valued the opportunity to learn interprofessionally, share their knowledge and perspectives, and acquire new knowledge and skills together. This pilot helped to identify the most relevant skills and knowledge for future interprofessional eye health training. It enabled the facilitators to reflect on how best to maintain a balance between a quality interprofessional experience and the more specific eye health related learning objectives.
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Affiliation(s)
| | | | - Denys Ndayambaje
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Dieudonné Kayiranga
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Nadine Rujeni
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Andrew Blaikie
- School of Medicine, University of St Andrews, St Andrews, Scotland
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Red reflex examination in reproductive and child health clinics for early detection of paediatric cataract and ocular media disorders: cross-sectional diagnostic accuracy and feasibility studies from Kilimanjaro, Tanzania. Eye (Lond) 2020; 35:1347-1353. [PMID: 32546747 DOI: 10.1038/s41433-020-1019-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/21/2020] [Accepted: 06/03/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/OBJECTIVES Late presentation of congenital cataract in the developing world has led to poor outcomes such that cataract is the leading cause of childhood blindness. Our hypothesis was that, sensitivity of red-reflex testing is greater than sensitivity of torchlight examination. We aimed to compare sensitivity of new red reflex screening tools and assess the feasibility of Arclight red reflex screening in the community. SUBJECT/METHODS We compared the diagnostic accuracy of four different screening tools for cataract and retinoblastoma performed by ophthalmic nurses, using a clinic based enriched sample of 41 positives and 60 negatives. We then conducted a separate feasibility study, training non-specialist community nurses. Following the training, community nurses examined 2827 children <5 years with Arclight who were attending their clinics for growth monitoring and immunisation. FINDINGS Diagnostic accuracy study: estimated sensitivities were 97.6% for Catcam, 92.7% for Arclight, 90.2% for PEEK retina and 7.3% for torchlight. Estimated specificities were above 90% for Catcam, Arclight and torchlight and 87% for PEEK retina. Feasibility study: twenty-four out of 2728 children screened failed community screening, seven were true positive (six cataract, one retinoblastoma). Prevalence of bilateral cataract was 1.5/1000 (95% CI: 0.40-3.75 per 1000). CONCLUSIONS Arclight and CatCam have higher sensitivity than torchlight, are easy to learn and use by primary health care nurses. Red reflex testing should be recommended in the WHO guidelines instead of torchlight examination to help early detection of potential blinding causes including congenital cataract and retinoblastoma.
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Kousha O, Blaikie A. The Arclight and how to use it. COMMUNITY EYE HEALTH 2019; 32:50-51. [PMID: 32123473 PMCID: PMC7041821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Obaid Kousha
- Ophthalmology Specialist Trainee, NHS Fife, Scotland, UK
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Hey SY, Buckley JC, Shahsavari S, Kousha O, Haddow KA, Blaikie A, Walker FDL. A mixed methods comparative evaluation of a low cost otoscope (Arclight) with a traditional device in twenty-one clinicians. Clin Otolaryngol 2019; 44:1101-1104. [PMID: 31319018 DOI: 10.1111/coa.13403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/08/2019] [Accepted: 05/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Shi Ying Hey
- Department of Otolaryngology, NHS Tayside, Ninewells Hospital, Dundee, UK.,Department of Otolaryngology, NHS Fife, Victoria Hospital, Kirkcaldy, UK
| | - Joanna C Buckley
- Department of Otolaryngology, NHS Tayside, Ninewells Hospital, Dundee, UK
| | - Somayyeh Shahsavari
- Department of Otolaryngology, NHS Tayside, Ninewells Hospital, Dundee, UK.,Department of Otolaryngology, NHS Fife, Victoria Hospital, Kirkcaldy, UK
| | - Obaid Kousha
- Department of Ophthalmology, NHS Fife, Queen Margaret Hospital, Dunfermline, UK
| | - Kerry A Haddow
- Department of Otolaryngology, NHS Tayside, Ninewells Hospital, Dundee, UK.,Department of Otolaryngology, NHS Fife, Victoria Hospital, Kirkcaldy, UK
| | - Andrew Blaikie
- Department of Ophthalmology, NHS Fife, Queen Margaret Hospital, Dunfermline, UK.,Global Health Team, School of Medicine, University of St Andrews, St Andrews, UK
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Gilmour-White JA, Picton A, Blaikie A, Denniston AK, Blanch R, Coleman J, Murray PI. Does access to a portable ophthalmoscope improve skill acquisition in direct ophthalmoscopy? A method comparison study in undergraduate medical education. BMC MEDICAL EDUCATION 2019; 19:201. [PMID: 31196068 PMCID: PMC6567496 DOI: 10.1186/s12909-019-1644-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/31/2019] [Indexed: 06/02/2023]
Abstract
BACKGROUND Direct ophthalmoscopy (DO) is an essential skill for medical graduates but there are multiple barriers to learning this. Medical students and junior doctors typically lack confidence in DO. Most students do not own an ophthalmoscope and learn via ward devices that vary in design and usability. The Arclight ophthalmoscope (AO) is an easy to use, low-cost and portable device that could help address device access. This study aimed to assess the impact of personal ownership of an AO on DO skill acquisition and competency amongst medical students in the clinical environment. METHODS Method comparison study with 42 medical students randomised to either traditional device ophthalmoscope (TDO) control or AO intervention group during an 18-week medical placement. Three objective assessments of DO competency were performed at the beginning and end of the placement: vertical cup to disc ratio (VCDR) measurement, fundus photo multiple-choice questions (F-MCQ) and model slide examination (MSE). DO examinations performed during the placement were recorded via an electronic logbook. RESULTS Students in both groups recorded a median number of six examinations each during an eighteen-week placement. There was no statistically significant difference between the groups in any of the objective assessment measures (VCDR p = 0.561, MCQ p = 0.872, Model p = 0.772). Both groups demonstrated a minor improvement in VCDR measurement but a negative performance change in F-MCQ and MSE assessments. CONCLUSIONS Students do not practice ophthalmoscopy often, even with constant access to their own portable device. The lack of significant difference between the groups suggests that device access alone is not the major factor affecting frequency of DO performance and consequent skill acquisition. Improving student engagement with ophthalmoscopy will require a more wide-ranging approach.
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Affiliation(s)
| | - A. Picton
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - A. Blaikie
- Global Health Implementation Team, School of Medicine, University of St Andrews, Scotland, UK
| | - A. K. Denniston
- University Hospitals Birmingham NHSFT, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - R. Blanch
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - J. Coleman
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - P. I. Murray
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Blundell R, Roberts D, Fioratou E, Abraham C, Msosa J, Chirambo T, Blaikie A. Comparative evaluation of a novel solar powered low-cost ophthalmoscope (Arclight) by eye healthcare workers in Malawi. ACTA ACUST UNITED AC 2018; 4:98-102. [PMID: 29670760 PMCID: PMC5890623 DOI: 10.1136/bmjinnov-2017-000225] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/10/2017] [Accepted: 01/11/2018] [Indexed: 11/24/2022]
Abstract
This study compared a novel low-cost solar powered direct ophthalmoscope called the Arclight with a traditional direct ophthalmoscope (TDO). After appropriate training, 25 Malawian eye healthcare workers were asked to examine 12 retinal images placed in a teaching manikin head with both the Arclight ophthalmoscope and a traditional direct ophthalmoscope (Keeler Professional V.2.8). Participants were scored on their ability to identify clinical signs, to make a diagnosis and how long they took to make a diagnosis. They were also asked to score each ophthalmoscope for ‘ease of use’. Statistically significant differences were found in favour of the Arclight in the number of clinical signs identified, correct diagnoses made and ease of use. The ophthalmoscopes were equally effective as a screening tool for diabetic retinopathy, and there was no statistically difference in time to diagnosis. The authors conclude that the Arclight offers an easy to use, low cost alternative to the traditional direct ophthalmoscope to meet the demands for screening and diagnosis of visually impairing eye disorders in low-income and middle-income countries.
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Affiliation(s)
| | - David Roberts
- Department of Ophthalmology, Ninewells Hospital, Dundee, UK
| | | | - Carl Abraham
- Department of Optometry, Malawi College of Health Sciences, Lilongwe, Malawi
| | - Joseph Msosa
- Lions Sight First Eye Unit, Kamuzu Central Hospital, Lilongwe, Central Region, Malawi
| | | | - Andrew Blaikie
- Global Health Implementation, School of Medicine, University of St Andrews, St Andrews, UK
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