Prevalence and characteristics of hearing and vision loss in preschool children from low income South African communities: results of a screening program of 10,390 children

Using Smartphones to Enhance Vision Screening in Rural Areas: Pilot Study

BACKGROUND

While it is treatable, uncorrected refractive error is the number one cause of visual impairment worldwide. This eye condition alone, or together with ocular misalignment, can also cause amblyopia, which is also treatable if detected early but still occurs in about 4% of the population. Mass vision screening is the first and most critical step to address these issues, but due to limited resources, vision screening in many rural areas remains a major challenge.

OBJECTIVE

We aimed to pilot-test the feasibility of using smartphone apps to enhance vision screening in areas where access to eye care is limited.

METHODS

A vision screening program was piggybacked on a charity summer camp program in a rural county in Sichuan, China. A total of 73 fourth and fifth graders were tested for visual acuity using a standard eye chart and were then tested for refractive error and heterophoria using 2 smartphone apps (a refraction app and a strabismus app, respectively) by nonprofessional personnel.

RESULTS

A total of 5 of 73 (6.8%, 95% CI 2.3%-15.3%) students were found to have visual acuity worse than 20/20 (logarithm of minimal angle of resolution [logMAR] 0) in at least one eye. Among the 5 students, 3 primarily had refractive error according to the refraction app. The other 2 students had manifest strabismus (one with 72-prism diopter [PD] esotropia and one with 33-PD exotropia) according to the strabismus app. Students without manifest strabismus were also measured for phoria using the strabismus app in cover/uncover mode. The median phoria was 0.0-PD (IQR 2.9-PD esophoria to 2.2-PD exophoria).

CONCLUSIONS

The results from this vision screening study are consistent with findings from other population-based vision screening studies in which conventional tools were used by ophthalmic professionals. The smartphone apps are promising and have the potential to be used in mass vision screenings for identifying risk factors for amblyopia and for myopia control. The smartphone apps may have significant implications for the future of low-cost vision care, particularly in resource-constrained and geographically remote areas.

Hearing Loss among Children Visiting Department of Otolaryngology and HNS of a Tertiary Care Centre

Introduction

Hearing loss is defined as the partial or total reduction in auditory acuity. Hearing loss can cause detrimental effects on speech, language, developmental, educational, and cognitive outcomes in children. This study aimed to find out the prevalence of hearing loss among children visiting the Department of Otolaryngology and HNS of a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted among children visiting the Department of Otolaryngology and HNS between 1 January 2022 and 31 December 2022 after obtaining ethical approval. All the patients who underwent pure tone evaluation were included in the study. A convenience sampling technique was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 3051 children, 328 (10.75%) (9.65-11.85, 95% Confidence Interval) had hearing loss. Among children with hearing loss, 170 (51.83%) of children were female. The mean age of children with hearing loss was 13.31±3.39 years. The mean pure tone average among 452 ears with hearing loss was 44.60±17.71 dB. The commonest degree of hearing loss was mild hearing loss 266 (58.85%), and the commonest type was conductive hearing loss 310 (68.58%). Among children with hearing loss, 124 (37.80%) had bilateral hearing loss.

Conclusions

The prevalence of hearing loss among children visiting the Department of Otolaryngology and HNS was found to be lower than similar studies done in similar settings.

Keywords

audiology; audiometry; hearing loss; outpatients; prevalence.

Combined hearing and vision screening programs: A scoping review

Background and aim

The World Health Organization (WHO) estimates that 1.5 billion and 2.2 billion people have hearing and vision impairment, respectively. The burden of these non-communicable diseases is highest in low- and middle-income countries due to a lack of services and health professionals. The WHO has recommended universal health coverage and integrated service delivery to improve ear and eye care services. This scoping review describes the evidence for combined hearing and vision screening programs.

Method

A keyword search of three electronic databases, namely Scopus, MEDLINE (PubMed), and Web of Science, was conducted, resulting in 219 results. After removing duplicates and screening based on eligibility criteria, data were extracted from 19 included studies. The Joanna Briggs Institute Reviewer Manual and the Preferred Reporting Items for Systematic Reviews and Meta-analyzes (PRISMA) Extension for Scoping Reviews were followed. A narrative synthesis was conducted.

Results

Most studies (63.2%) were from high-income countries, with 31.6% from middle-income and 5.2% from low-income countries. The majority of studies (78.9%) involved children and the four studies reporting on adults all included adults above 50 years of age. Vision screening was most commonly performed with the "Tumbling E" and "Snellen Chart," while hearing was typically screened using pure tone audiometry. Studies reported referral rates as the most common outcome with sensitivity and specificity rates not reported in any included articles. Reported benefits of combined vision and hearing screenings included earlier detection of vision and hearing difficulties to support functioning and quality of life as well as resource sharing for reduced costs. Challenges to combined screening included ineffective follow-up systems, management of test equipment, and monitoring of screening personnel.

Conclusions

There is limited research evidence for combined hearing and vision screening programs. Although potential benefits are demonstrated, especially for mHealth-supported programs in communities, more feasibility and implementation research are required, particularly in low- and middle-income countries and across all age groups. Developing universal, standardized reporting guidelines for combined sensory screening programs is recommended to enhance the standardization and effectiveness of combined sensory screening programs.

Global, Regional, and National Burdens of Blindness and Vision Loss in Children and Adolescents from 1990 to 2019: A Trend Analysis

PURPOSE

To provide estimates for regional and national burdens of blindness and vision loss among children and adolescents between 1990 and 2019 by disease, age, and sociodemographic index (SDI).

DESIGN

This was a retrospective demographic analysis based on aggregated data.

METHODS

This was a population-based study using 1990-2019 data on the burden of vision loss and blindness from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The burden of vision loss and blindness was evaluated in terms of case numbers, rates per 100 000 population, and average annual percentage changes (AAPCs) in prevalence rates and years lived with disability (YLDs).

RESULTS

Globally, the rates of blindness and vision loss per 100 000 population decreased in all age groups between 1990 and 2019, with prevalence rates decreasing from 1091.4 (95% uncertainty interval [UI], 895.2-1326.1) to 1036.9 (95% UI, 847.8-1265.9, AAPC, -0.2) and YLDs decreasing from 44.5 (95% UI, 28.1-66.5) to 40.2 (95% UI, 25.1-60.7, AAPC, -0.4). Most of these reductions in prevalence rates (AAPC, -0.2, 95% confidence interval [CI], -0.2 to -0.1) and YLDs (AAPC, -0.2, 95% CI, -0.3 to -0.2) were due to decreases in refractive disorder. Notably, near-vision loss prevalence (AAPC, 0.3, 95% CI, 0.2-0.4) and YLDs (AAPC, 0.3, 95% CI, 0.2-0.4) substantially increased in all age groups. Children and adolescents in low- and low-middle SDI countries exhibited substantial decreases in the prevalence rates and YLDs of blindness and vision loss, but their counterparts in high- and middle-high SDI countries experienced a substantial increase in prevalence.

CONCLUSIONS

Globally, efforts in the past 3 decades have substantially decreased the burdens of blindness and vision loss among children and adolescents. However, there is extensive variation according to the kind of impairment, age group, and country SDI.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.