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Strelnikov J, Zdonczyk A, Pruett JR, Culican S, Tychsen L, Gordon M, Marrus N, Todorov A, Reynolds M. Social and Quality of Life Impact of Refractive Surgery in Children with Developmental Disorders and Spectacle Non-Adherence. Am J Ophthalmol 2024:S0002-9394(24)00362-3. [PMID: 39168367 DOI: 10.1016/j.ajo.2024.08.009] [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: 04/17/2024] [Revised: 08/06/2024] [Accepted: 08/06/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE Children with autism spectrum disorder (ASD) and intellectual disability (ID) often cannot tolerate wearing spectacles or contact lenses, which are the standard of care for treating ametropia.1,2. We aimed to assess the impact of refractive surgery on social functioning and vision-specific quality of life in this population. DESIGN Prospective, before-and-after case series. METHODS SETTING: Single, academic tertiary care center. STUDY POPULATION 18 children with ASD and/or ID, ametropia, and spectacle non-adherence were included in the analysis. PROCEDURE Participants underwent refractive surgery with either intraocular lens implantation or keratectomy. Parents completed the Social Responsiveness Scale (SRS-2) and Pediatric Eye Questionnaire (PedEyeQ) at baseline and 1, 6, and 12 months post-surgery.3,4 MAIN OUTCOME MEASURES: Median change in SRS-2 T-scores and PedEyeQ scores 12 months after surgery, compared to baseline. The minimum clinically important difference (MCID) was set at 5 points for the SRS-2 and 10 points for the PedEyeQ. RESULTS At 12 months after surgery, statistically significant improvements were observed in the SRS-2 domains of Social Awareness (8 points, 95% CI 2 to 13, p = .03) and Social Motivation (7 points, 95% CI 2 to 15, p = .03). Total SRS-2 T-score improved in a clinically important manner for 56% (10/18) of patients, but the median change was not statistically significant (5 points, 95% CI -1 to 9, p = .10). Vision-specific quality of life showed statistically significant improvements in the domains of Functional Vision (40 points, 95% CI 7 to 73, p = .02) and Bothered by Eyes/Vision (23 points, 95% CI 3 to 45, p = .02). CONCLUSIONS Refractive surgery led to clinically and statistically significant improvements in domains of social functioning and vision-specific quality of life at 12 months after surgery. A narrow majority of patients demonstrated a clinically important improvement in overall social functioning, but these changes were not statistically significant. The results suggest that refractive surgery in children with neurodevelopmental disorders, ametropia, and spectacle non-adherence may provide developmental and quality of life benefits. Larger, controlled studies are required to validate these findings.
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Affiliation(s)
- Jacob Strelnikov
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine
| | - Alexandra Zdonczyk
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine
| | - John R Pruett
- Department of Psychiatry, Washington University School of Medicine
| | - Susan Culican
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School
| | - Lawrence Tychsen
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine
| | - Mae Gordon
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine
| | - Natasha Marrus
- Department of Psychiatry, Washington University School of Medicine
| | | | - Margaret Reynolds
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine.
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Bhartiya S, Wadhwani M, Ichhpujani P, Parmar UPS. Ocular morbidity profiles of out-of-school children in a North Indian urban slum. Indian J Ophthalmol 2024; 72:S617-S622. [PMID: 38622857 PMCID: PMC11338416 DOI: 10.4103/ijo.ijo_622_23] [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: 03/03/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 04/17/2024] Open
Abstract
PURPOSE This study evaluates the recent trends in ocular morbidities and vision-related practices in "out-of-school" children in urban slums of Gurugram in North India. METHODS In this observational study, a validated questionnaire was administered to 161 students from two nonformal slum schools. Sociocultural, demographic data, vision-related practices, and visual acuity with subjective refraction of the children were recorded. RESULTS A total of 80 boys and 81 girls (9.17 ± 2.58 years) participated in this study. About 40% of the children were from lower socioeconomic status. The visual acuity recorded for all the children, except three children, was 6/6 in both eyes. One child had a pre-phthisical eye with no light perception, following a childhood trauma, with the other eye having 6/6 vision. Two children had refractive errors (myopia and compound myopic astigmatism), with a best corrected visual acuity (BCVA) of 6/6. Thirteen children (8%) had Bitot's spots and 67 (35.4%) had allergic conjunctivitis. Eight (5%) children complained of dry eye-related symptoms like redness and watering of eyes, while 19 (11.8%) had diffuse headache. Average number of years spent in school for these children was less than 1.7 years (range: 1 month-6 years). Only 10.5% of the children gave the history of watching television more than 30 h/week. Significant association was found between the income of father and use of digital devices in children below 10 years ( P = 0.003) and children playing outdoors ( P = 0.001). There was a significant association noted for age and use of digital devices ( P = 0.037). CONCLUSION The prevalence of refractive errors in "out-of-school" children of urban slum was much less than the national average. Almost one in three children suffered from eye allergies, while 8% children had Bitot's spots. The data about the prevalence of ocular comorbidities in underserved areas like urban slums can be used to update and strategize eye health-care delivery models for out-of-school children.
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Birch EE, Duffy KR. Leveraging neural plasticity for the treatment of amblyopia. Surv Ophthalmol 2024:S0039-6257(24)00046-8. [PMID: 38763223 DOI: 10.1016/j.survophthal.2024.04.006] [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: 11/25/2023] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
Amblyopia is a form of visual cortical impairment that arises from abnormal visual experience early in life. Most often, amblyopia is a unilateral visual impairment that can develop as a result of strabismus, anisometropia, or a combination of these conditions that result in discordant binocular experience. Characterized by reduced visual acuity and impaired binocular function, amblyopia places a substantial burden on the developing child. Although frontline treatment with glasses and patching can improve visual acuity, residual amblyopia remains for most children. Newer binocular-based therapies can elicit rapid recovery of visual acuity and may also improve stereoacuity in some children. Nevertheless, for both treatment modalities full recovery is elusive, recurrence of amblyopia is common, and improvements are negligible when treatment is administered at older ages. Insights derived from animal models about the factors that govern neural plasticity have been leveraged to develop innovative treatments for amblyopia. These novel therapies exhibit efficacy to promote recovery, and some are effective even at ages when conventional treatments fail to yield benefit. Approaches for enhancing visual system plasticity and promoting recovery from amblyopia include altering the balance between excitatory and inhibitory mechanisms, reversing the accumulation of proteins that inhibit plasticity, and harnessing the principles of metaplasticity. Although these therapies have exhibited promising results in animal models, their safety and ability to remediate amblyopia need to be evaluated in humans.
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Affiliation(s)
- Eileen E Birch
- Crystal Charity Ball Pediatric Vision Laboratory, Retina Foundation, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Kevin R Duffy
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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Pirindhavellie GP, Yong AC, Mashige KP, Naidoo KS, Chan VF. The impact of spectacle correction on the well-being of children with vision impairment due to uncorrected refractive error: a systematic review. BMC Public Health 2023; 23:1575. [PMID: 37596579 PMCID: PMC10436410 DOI: 10.1186/s12889-023-16484-z] [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: 08/30/2022] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Despite being easily corrected with eyeglasses, over two-thirds of the world's child population presents with vision impairment (VI) due to uncorrected refractive errors. While systematic reviews have shown that VI can significantly impact children's depression and anxiety, none have reviewed the existing literature on the association between spectacle correction and well-being. This review aims to address this knowledge gap. MAIN OUTCOME MEASURES The main outcome measures were i) cognitive and education well-being which included mathematics and english literacy, reading fluency, school function, academic performance and grades; ii) psychological and mental health well-being which included physical anxiety, learning anxiety and mental health test scores and iii) quality of life. METHODS We searched eight databases for articles published between 1999 to 2021 that assessed the associations between spectacle correction and children's (0 to 18 years) well-being. There were no restrictions on language or geographic location. Two reviewers independently screened all publications using validated quality checklists. The findings of the review were analysed using narrative synthesis. [PROSPERO CRD42020196847]. RESULTS Of 692 records found in the databases, six randomised control trials, one cohort, one cross-sectional and one qualitative study (N = 9, 1.3%) were eligible for analysis. Data were collected from 25 522 children, 20 parents and 25 teachers across the nine studies. Seven were rated as good quality (67 to 100% of quality criteria fulfilled), and two were satisfactory (33 to 66% of quality criteria fulfilled). Spectacle correction was found to improve children's educational well-being (n = 4 very strong evidence; n = 2 strong evidence), quality of life (n = 1, very strong evidence) and decrease anxiety and increase mental health scores (n = 1, strong evidence). CONCLUSION Evidence suggests that spectacle correction improves children's cognitive and educational well-being, psychological well-being, mental health, and quality of life. More research is needed, given the paucity of published literature and the focus on only three aspects of well-being.
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Affiliation(s)
| | - Ai Chee Yong
- Queens University Belfast, University Rd, Belfast, BT7 1NN, UK
| | | | - Kovin S Naidoo
- University of KwaZulu Natal, College of Health Sciences, Private Bag X54001, Durban, 4000, South Africa
| | - Ving Fai Chan
- University of KwaZulu Natal, College of Health Sciences, Private Bag X54001, Durban, 4000, South Africa.
- Queens University Belfast, University Rd, Belfast, BT7 1NN, UK.
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Pilling RF, Allen L, Bowman R, Ravenscroft J, Saunders KJ, Williams C. Clinical assessment, investigation, diagnosis and initial management of cerebral visual impairment: a consensus practice guide. Eye (Lond) 2023; 37:1958-1965. [PMID: 36258009 PMCID: PMC10333179 DOI: 10.1038/s41433-022-02261-6] [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: 05/04/2022] [Revised: 08/01/2022] [Accepted: 09/12/2022] [Indexed: 11/08/2022] Open
Abstract
Cerebral Visual Impairment (CVI) is a common condition in the UK. Patients with conditions associated with CVI are frequently seen in paediatric ophthalmology clinics offering eye care professionals an opportunity to identify children proactively. In most cases CVI occurs as part of a neurodevelopmental condition or as a feature of multiple and complex disabilities. However, CVI can also be seen in children with apparently typical development. In some cases, high contrast visual acuity is normal and in other cases severely impaired. As such, identification of CVI requires evaluation of aspects of visual performance beyond high contrast acuity and consideration that visual function of those with CVI may fluctuate. Few paediatric ophthalmologists have received formal training in CVI. The detection and diagnosis of CVI varies across the UK and patients report hugely different experiences. A diagnosis of CVI is made based on professional clinical judgement and it is recognised that individual perspectives and local practice in the specific methodologies of assessment will vary. A systematic review and survey of professionals is underway to attempt to reach agreement on diagnostic criteria. Nonetheless, established pathways and published protocols can offer guidance on how a paediatric ophthalmology service can approach assessment of the child with suspected CVI. The purpose of this paper is to present a summary of research and clinical practice methods for detecting and diagnosing CVI in a paediatric ophthalmology outpatient setting. It represents current understanding of the topic and acknowledges the evolving nature of both practice and the evidence-base. A rapid literature review was undertaken to identify articles relating to clinical investigation of children with CVI. A focus group of QTVI and subject matter experts from sight loss charities was undertaken to address areas which were not covered by the literature review.
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Affiliation(s)
- Rachel Fiona Pilling
- University of Bradford, Bradford, England.
- Department of Ophthalmology, Bradford Teaching Hospitals, Bradford, UK.
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Williams C, Warnes P, Jary S, Young G, Blair PS, Benton CP, Miller H, Whitelaw A, Pople I, Luyt K. Vision function in children 10 years after grade 3 or 4 intraventricular haemorrhage with ventricular dilation: A masked prospective study. Dev Med Child Neurol 2023; 65:223-231. [PMID: 35735110 PMCID: PMC10084054 DOI: 10.1111/dmcn.15294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 01/06/2023]
Abstract
AIM We examined children 10 to 11 years after grade 3 or 4 intraventricular haemorrhage and ventricular dilation (IVHVD) and investigated whether the grade of IVHVD affected their visual outcome. We explored associations between visual outcomes with cognitive outcomes and extra support at school. METHOD The visual examinations were part of a 10-year follow-up study for children in a randomized trial. Testers followed a protocol and were masked to whether the child had experienced grade 3 or grade 4 IVHVD and all other data. RESULTS Thirty-two children were tested: 24 were male and mean (standard deviation) age was 10 years 5 months (1 year 2 months); range 8 years 9 months to 12 years 9 months. All had at least one visual impairment. The median (interquartile range) number of impairments per child was six (six to nine) for children who experienced a grade 4 IVHVD compared with three (two to four) for children who experienced a grade 3 IVHVD (p = 0.003). Each extra vision impairment per child was associated with increased educational support at school, after adjustment for developmental age equivalence (odds ratio = 1.7 [95% confidence interval 1.1-2.6], p = 0.015). INTERPRETATION Children who experience grade 3 or 4 IVHVD have a high level of visual morbidity at age 10 to 11 years. These children may have unmet visual needs and their outcomes might improve if these needs could be addressed. WHAT THIS PAPER ADDS Parent-reported questionnaire responses underestimated directly assessed visual morbidity. Grade 4 intraventricular haemorrhage and ventricular dilatation (IVHVD) was followed by more vision impairments than grade 3 IVHVD. Simple tests of visual perceptual skills correlated with the neuropsychology tests. Children with supranuclear eye movement disorders were more likely to be receiving extra help at school. Each additional visual impairment increased the likelihood of extra educational support.
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Affiliation(s)
- Cathy Williams
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Penny Warnes
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sally Jary
- Neonatal Neurology, Bristol Medical School, Bristol, UK
| | - Grace Young
- Bristol Randomised Trials Collaboration, Bristol Medical School, Bristol, UK
| | - Peter S Blair
- Bristol Randomised Trials Collaboration, Bristol Medical School, Bristol, UK
| | | | - Helen Miller
- Neonatal Neurology, Bristol Medical School, Bristol, UK
| | | | - Ian Pople
- Department of Neurosurgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Karen Luyt
- Neonatal Neurology, Bristol Medical School, Bristol, UK
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Bullaj R, Dyet L, Mitra S, Bunce C, Clarke CS, Saunders K, Dale N, Horwood A, Williams C, St Clair Tracy H, Marlow N, Bowman R. Effectiveness of early spectacle intervention on visual outcomes in babies at risk of cerebral visual impairment: a parallel group, open-label, randomised clinical feasibility trial protocol. BMJ Open 2022; 12:e059946. [PMID: 36130761 PMCID: PMC9494562 DOI: 10.1136/bmjopen-2021-059946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Hypoaccommodation is common in children born prematurely and those with hypoxic ischaemic encephalopathy (HIE), with the potential to affect wider learning. These children are also at risk of longer-term cerebral visual impairment. It is also well recognised that early intervention for childhood visual pathology is essential, because neuroplasticity progressively diminishes during early life. This study aims to establish the feasibility and acceptability of conducting a randomised controlled trial to test the effectiveness of early near vision correction with spectacles in infancy, for babies, at risk of visual dysfunction. METHODS AND ANALYSIS This is a parallel group, open-label, randomised controlled (feasibility) study to assess visual outcomes in children with perinatal brain injury when prescribed near vision spectacles compared with the current standard care-waiting until a problem is detected. The study hypothesis is that accommodation, and possibly other aspects of vision, may be improved by intervening earlier with near vision glasses. Eligible infants (n=75, with either HIE or <29 weeks preterm) will be recruited and randomised to one of three arms, group A (no spectacles) and two intervention groups: B1 or B2. Infants in both intervention groups will be offered glasses with +3.00 DS added to the full cycloplegic refraction and prescribed for full time wear. Group B1 will get their first visit assessment and intervention at 8 weeks corrected gestational age (B1) and B2 at 16 weeks corrected gestational age. All infants will receive a complete visual and neurodevelopmental assessment at baseline and a follow-up visit at 3 and 6 months after the first visit. ETHICS AND DISSEMINATION The South-Central Oxford C Research Ethics Committee has approved the study. Members of the PPI committee will give advice on dissemination of results through peer-reviewed publications, conferences and societies. TRIAL REGISTRATION NUMBER ISRCTN14646770, NCT05048550, NIHR ref: PB-PG-0418-20006.
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Affiliation(s)
- Raimonda Bullaj
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Leigh Dyet
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Subhabrata Mitra
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Catey Bunce
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Caroline S Clarke
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kathryn Saunders
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Naomi Dale
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Anna Horwood
- School of Psychology, University of Reading, Reading, UK
| | - Cathy Williams
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Richard Bowman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Ophthalmology, University College London Institute of Child Health, London, UK
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Haller K, Stolfi A, Duby J. Comparison of unmet health care needs in children with intellectual disability, autism spectrum disorder and both disorders combined. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:617-627. [PMID: 35357055 PMCID: PMC9314009 DOI: 10.1111/jir.12932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The purpose of this study was to assess the unmet health care needs of children with intellectual disability (ID) compared with children with autism spectrum disorder (ASD) and whether access to health insurance coverage is a contributing factor. Children with ID may be masked in the health care system due to increased diagnosis and awareness of ASD. The needs, unmet needs and insurance coverage of children with ID alone, ASD alone, and co-occurring ID and ASD were assessed in this study. METHODS The 2016 to 2019 United States' Census Bureau National Survey of Children's Health was used to determine differences in unmet needs, care not received and health insurance coverage during the past year for children with ID and/or ASD. Adjusted odds ratios and 95% confidence intervals for care not received were determined controlling for sex, insurance, race, age and parents' highest education level. RESULTS Children with ID were nearly four times more likely not to receive needed medical care as children with ASD. Results were similar for unmet hearing and mental health care. Children with both ID and ASD were more likely to have unmet health care but less likely to have unmet medical care compared with children with ASD alone. There were no significant differences for unmet dental or vision care. Children with ID were 3.58 (95% confidence interval: 1.6-8.0) times more likely to have inconsistent health insurance compared with children with ASD. CONCLUSIONS Children with ID alone are more likely to have unmet medical, hearing and mental health care needs than children with ASD alone. Children with co-occurring ID and ASD have a large amount of general unmet health care needs but less unmet medical needs. Children with ID are less likely to have consistent health insurance than children with ASD. This hinders the ability of children with ID to receive quality care. Further research is needed to determine if the diagnosis of ASD in children in the United States is negatively affecting children with ID alone.
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Affiliation(s)
- K. Haller
- Department of PediatricsWright State University Boonshoft School of MedicineDaytonOHUSA
| | - A. Stolfi
- Department of PediatricsWright State University Boonshoft School of MedicineDaytonOHUSA
| | - J. Duby
- Department of PediatricsWright State University Boonshoft School of MedicineDaytonOHUSA
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Choi KY, Wong HY, Cheung HN, Tseng JK, Chen CC, Wu CL, Eng H, Woo GC, Cheong AMY. Impact of visual impairment on balance and visual processing functions in students with special educational needs. PLoS One 2022; 17:e0249052. [PMID: 35486663 PMCID: PMC9053808 DOI: 10.1371/journal.pone.0249052] [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: 04/08/2021] [Accepted: 03/05/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Vision is critical for children's development. However, prevalence of visual impairment (VI) is high in students with special educational needs (SEN). Other than VI, SEN students are prone to having functional deficits. Whether visual problems relate to these functional deficits is unclear. This study aimed to assess the impact of vision on visual processing functions and balance in SEN students through a community service. METHODS Visual acuity (VA) and contrast sensitivity were measured in a total of 104 (aged 14.3±4.3) SEN students as the visual outcomes, followed by retinoscopy. Visual processing function assessment included facial expression recognition by card matching examiner's facial expression matching, and visual orientation recognition. Dynamic balance, by Timed Up and Go test, and static standing balance (postural sway in double-legged standing with feet-together and tandem-stance for open-eye and closed-eye conditions) were assessed. Static balance was presented in terms of the maximal medial-lateral and antero-posterior sways. RESULTS Of the 104 students, 62 (59.6%) were classified as visually impaired according to WHO classification of visual impairment based on presenting distance acuity. Ocular problems (e.g. optic nerve anomaly, uncorrected/ under-corrected refractive errors) and neurological anomalies were the major causes of vision loss. VA was positively associated with visual processing functions (all p ≤ 0.01), as SEN students with better vision tended to perform better in visual orientation and facial expression recognition tasks, as well as dynamic balance function (p = 0.04). For the static balance, postural sway and VA showed a positive relationship under open-eye and tandem stance conditions. However, the relationship between postural sway and VA became negative under closed-eye and tandem stance conditions. CONCLUSION This study found a high prevalence of SEN students with visual impairment, in which many of them were undetected. Optometric examination is important to improve their visual function to minimize the effect of vision on functional performance. Vision is critical in visual processing as well as playing an important role in maintaining balance in SEN students.
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Affiliation(s)
- Kai Yip Choi
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Ho Yin Wong
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Hoi Nga Cheung
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jung Kai Tseng
- Department of Optometry, Asia University, Taichung, Taiwan
| | | | - Chieh Lin Wu
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Helen Eng
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - George C. Woo
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Center for Eye and Vision Research (CEVR), Sha Tin, Hong Kong
| | - Allen Ming Yan Cheong
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Center for Eye and Vision Research (CEVR), Sha Tin, Hong Kong
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Chokron S, Kovarski K, Dutton GN. Cortical Visual Impairments and Learning Disabilities. Front Hum Neurosci 2021; 15:713316. [PMID: 34720906 PMCID: PMC8548846 DOI: 10.3389/fnhum.2021.713316] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Abstract
Medical advances in neonatology have improved the survival rate of premature infants, as well as children who are born under difficult neurological conditions. As a result, the prevalence of cerebral dysfunctions, whether minimal or more severe, is increasing in all industrialized countries and in some developing nations. Whereas in the past, ophthalmological diseases were considered principally responsible for severe visual impairment, today, all recent epidemiological studies show that the primary cause of blindness and severe visual impairment in children in industrialized countries is now neurological, with lesions acquired around the time of birth currently comprising the commonest contributor. The resulting cortical or cerebral visual impairments (CVIs) have long been ignored, or have been confused either with other ophthalmological disorders causing low vision, or with a range of learning disabilities. We present here the deleterious consequences that CVI can have upon learning and social interaction, and how these can be given behavioral labels without the underlying visual causes being considered. We discuss the need to train and inform clinicians in the identification and diagnosis of CVI, and how to distinguish the diagnosis of CVI from amongst other visual disorders, including the specific learning disorders. This is important because the range of approaches needed to enhance the development of children with CVI is specific to each child's unique visual needs, making incorrect labeling or diagnosis potentially detrimental to affected children because these needs are not met.
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Affiliation(s)
- Sylvie Chokron
- Hôpital Fondation Adolphe de Rothschild, Paris, France
- INCC UMR 8002, CNRS, Université de Paris, Paris, France
| | - Klara Kovarski
- Hôpital Fondation Adolphe de Rothschild, Paris, France
- INCC UMR 8002, CNRS, Université de Paris, Paris, France
| | - Gordon N. Dutton
- Department of Vision Science, Glasgow Caledonian University, Glasgow, United Kingdom
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Neitzel AJ, Wolf B, Guo X, Shakarchi AF, Madden NA, Repka MX, Friedman DS, Collins ME. Effect of a Randomized Interventional School-Based Vision Program on Academic Performance of Students in Grades 3 to 7: A Cluster Randomized Clinical Trial. JAMA Ophthalmol 2021; 139:1104-1114. [PMID: 34499111 DOI: 10.1001/jamaophthalmol.2021.3544] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Uncorrected refractive error in school-aged children may affect learning. Objective To assess the effect of a school-based vision program on academic achievement among students in grades 3 to 7. Design, Setting, and Participants This cluster randomized clinical trial was conducted in Baltimore City Public Schools during school years from 2016 to 2019 among 2304 students in grades 3 to 7 who received eye examinations and eyeglasses. Intervention Participating schools were randomized 1:1:1 to receive eye examinations and eyeglasses during 1 of 3 school years (2016-2017, 2017-2018, and 2018-2019). Main Outcomes and Measures The primary outcome was 1-year intervention impact, measured by effect size (ES), defined as the difference in score on an academic test (i-Ready or Partnership for Assessment of Readiness for College and Careers tests on reading and mathematics) between intervention and control groups measured in SD units, comparing cohort 1 (intervention) with cohorts 2 and 3 (control) at the end of program year 1 and comparing cohort 2 (intervention) with cohort 3 (control) at the end of program year 2. The secondary outcome was 2-year intervention impact, comparing ES in cohort 1 (intervention) with cohort 3 (control) at the end of program year 2. Hierarchical linear modeling was used to assess the impact of the intervention. Analysis was performed on an intention-to-treat basis. Results Among the 2304 students included in the study, 1260 (54.7%) were girls, with a mean (SD) age of 9.4 (1.4) years. The analysis included 964 students (41 schools) in cohort 1, 775 students (41 schools) in cohort 2, and 565 students (38 schools) in cohort 3. There were 1789 Black students (77.6%), 388 Latinx students (16.8%), and 406 students in special education (17.6%). There was an overall 1-year positive impact (ES, 0.09; P = .02) as assessed by the i-Ready reading test during school year 2016-2017. Positive impact was also observed among female students (ES, 0.15; P < .001), those in special education (ES, 0.25; P < .001), and students who performed in the lowest quartile at baseline (ES, 0.28; P < .001) on i-Ready reading and among students in elementary grades on i-Ready mathematics (ES, 0.03; P < .001) during school year 2016-2017. The intervention did not show a sustained impact at 2 years or on Partnership for Assessment of Readiness for College and Careers testing. Conclusions and Relevance Students in grades 3 to 7 who received eyeglasses through a school-based vision program achieved better reading scores. Students had improved academic achievement over 1 year; however, a sustained impact was not observed after 2 years. Trial Registration The Registry of Efficacy and Effectiveness Studies Identifier: 1573.1v1.
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Affiliation(s)
- Amanda J Neitzel
- Center for Research and Reform in Education, Johns Hopkins University School of Education, Baltimore, Maryland
| | - Betsy Wolf
- Institute of Education Sciences, Department of Education, Washington, DC
| | - Xinxing Guo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ahmed F Shakarchi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nancy A Madden
- Center for Research and Reform in Education, Johns Hopkins University School of Education, Baltimore, Maryland
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David S Friedman
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Megan E Collins
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
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12
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Wilson S, Ctori I, Suttle C, Conway M, Shah R. How accessible is primary eye care for children in England? Ophthalmic Physiol Opt 2021; 41:1021-1033. [PMID: 34402083 DOI: 10.1111/opo.12868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Good vision during childhood is vital for visual, educational, and social development. Previous research highlights challenges in the accessibility of eye care for children. This study investigates the accessibility of primary eye care for young children with typical development and those with autism in England. METHODS A telephone survey was conducted using four hypothetical scenarios (a child aged 1, 3, 5 years and a 13-year-old with autism). Four hundred community optometric practices (100 different practices for each scenario) were contacted to explore the availability of an eye examination. The caller acted as a parent, asking about the availability of an eye examination for their child and raising concerns regarding the child. Key barriers and enablers to the accessibility of primary eye care were identified through an analysis of qualitative information. RESULTS Of the 400 practices, only three (<1%) stated that they do not perform eye examinations on children. Fifty-six practices (14%) stated that they would examine a child at any age, the remainder (n = 341, 85%) specifying a minimum age at which they would perform eye examinations on children. Lack of 'communication' from the child and 'equipment' were identified as barriers to accessing eye care for young children. Eye care for children with autism was enabled by factors related to adaptability and appointment time. CONCLUSION Our results suggest that communication and a lack of appropriate equipment for examining children are potential barriers to accessing primary eye care. No clear barriers were identified for an older child with autism. Eye examinations are more accessible for older children in these scenarios (aged 5 with typical development and 13 years with autism) than younger children (aged 1 and 3 years old). While the UK General Ophthalmic Services (GOS) terms do not permit contract holders to exclude categories of patients from a GOS eye exam, our findings suggest this is taking place.
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Affiliation(s)
- Salma Wilson
- Division of Optometry and Vision Science, School of Health Sciences, City, University of London, London, UK
| | - Irene Ctori
- Division of Optometry and Vision Science, School of Health Sciences, City, University of London, London, UK
| | - Catherine Suttle
- Division of Optometry and Vision Science, School of Health Sciences, City, University of London, London, UK
| | - Miriam Conway
- Division of Optometry and Vision Science, School of Health Sciences, City, University of London, London, UK
| | - Rakhee Shah
- Division of Optometry and Vision Science, School of Health Sciences, City, University of London, London, UK
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13
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Williams C, Pease A, Warnes P, Harrison S, Pilon F, Hyvarinen L, West S, Self J, Ferris J. Cerebral visual impairment-related vision problems in primary school children: a cross-sectional survey. Dev Med Child Neurol 2021; 63:683-689. [PMID: 33533021 DOI: 10.1111/dmcn.14819] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 01/16/2023]
Abstract
AIM To estimate how many children in mainstream primary schools have cerebral visual impairment (CVI)-related vision problems and to investigate whether some indicators might be useful as red flags, if they were associated with increased risk for these problems. METHOD We conducted a survey of primary school children aged 5 to 11 years, using whether they were getting extra educational help and/or teacher- and parent-reported behaviour questionnaires to identify children at risk for CVI. These and a random 5% sample were assessed for CVI-related vision problems. We compared the usefulness of potential red flags using likelihood ratios. RESULTS We received questionnaires on 2298 mainstream-educated children and examined 248 children (152 [61%] males, 96 females [39%]; mean age 8y 1mo, SD 20mo, range 5y 6mo-11y 8mo). We identified 78 out of 248 children (31.5% of those examined, 3.4% of the total sample), who had at least one CVI-related vision problem. The majority (88%) were identified by one or more red flag but none were strongly predictive. Fewer than one in five children with any CVI-related vision problem had reduced visual acuity. INTERPRETATION Children with CVI-related vision problems were more prevalent than has been appreciated. Assessment of at-risk children may be useful so that opportunities to improve outcomes for children with CVI-related vision problems are not missed.
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Affiliation(s)
- Cathy Williams
- Bristol Medical School, University of Bristol, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Anna Pease
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Penny Warnes
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sean Harrison
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Florine Pilon
- Bartimeus Centre for Complex Visual Disorders, Zeist, the Netherlands
| | - Lea Hyvarinen
- Rehabilitation Sciences, TU Dortmund University, Dortmund, Germany
| | - Stephanie West
- University Hospital Southampton NHS Trust, Southampton, UK
| | - Jay Self
- University Hospital Southampton NHS Trust, Southampton, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - John Ferris
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
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14
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Allen LC, Dillon A, Bowen P. Eye Care for Children in Special Schools: An Audit of Provision. Br Ir Orthopt J 2021; 17:27-32. [PMID: 34278215 PMCID: PMC8269777 DOI: 10.22599/bioj.166] [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: 10/30/2020] [Accepted: 01/04/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: Children and young people with Special Educational Needs (SEN) are 28 times more likely to have eye problems than their typically developing peers. An ideal approach to the eye care for children attending special schools in England has been developed. Work in this area continues to evolve; therefore, an audit about existing services across the United Kingdom (UK) was undertaken. Method: A survey to ascertain key aspects of services for children with SEN that exist in the UK was developed and disseminated via Survey Monkey and at British and Irish Orthoptic Society (BIOS) events to all leads of the orthoptic profession. Results: Ninety-four service areas replied to the survey. Of these, 65 areas provide a special school service, 30 also provide a specialist service for SEN’s in hospital/community clinics; five provide only a specialist service in hospital/community clinics, and 24 reported no specialist service provision, outside that provided to everyone. In the school environment, 29 (44%) areas include vision and orthoptic assessment, whereas 31 (48%) include vision, orthoptic, and refraction assessment. All but two services were reported as orthoptic-led, 26 (40%) special school services involved optometric input within school, and no services had optical dispensing within school. Discussion: The results of this survey suggest that access to all aspects of eye care is not always available in school where a service exists. Families have to travel to the hospital or community optometrist for further assessment, which is not suitable in a number of cases, though it may be desirable, in some.
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Affiliation(s)
| | | | - Pamela Bowen
- Wrightington, Wigan and Leigh NHS Foundation Trust, GB
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15
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McConnell EL, Black SA, McClelland JF, McKerr L, Dillenburger K, Anketell P, Jackson AJ, Little JA, Saunders KJ. Parents and teachers of children in special education settings value in-school eyecare and written reports of visual status. PLoS One 2020; 15:e0238779. [PMID: 32915866 PMCID: PMC7485870 DOI: 10.1371/journal.pone.0238779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 08/24/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives To evaluate parent and teacher opinion of the provision of in-school eyecare and jargon-free written reporting of visual status for children in special educational settings. Participants and methods A nationally-agreed, in-school eyecare framework for children attending special schools which recommends a full eye examination, dispensing of spectacles and provision of a jargon-free written report of visual outcomes to parents and teachers, was provided to 200 children (mean age 10 years, 9 months; 70% male) attending a special school in the UK. The written ‘Vision Report’ detailed, in lay-language, results from the eye examination and provided practical advice to alleviate the impact of vision difficulties both at home and in the classroom. Following implementation of the framework, parents and teachers completed a feedback questionnaire to determine their opinion of the in-school eye examination and utility of the Vision Report. Results Parents of 123 participants returned a feedback questionnaire. Eighty-eight participants were represented by the 23 teachers who returned a questionnaire. The in-school eyecare was rated positively for children in special education by 82.4% of parents and 80.9% of teachers. Key benefits included the familiarity of the in-school setting (81.3% of parents and 100% of teachers agree), the convenience of the setting for parents (74.0% of parents and 100% of teachers agree), and the opportunity for teachers to speak directly to eyecare providers regarding a child’s visual needs (82.6% of teachers agree). The information provided by the Vision Report was deemed useful day-to-day by 78.3% of parents and 100% of teachers. The majority (80%) of teachers implemented classroom modifications suggested in the report, whereas only 47.9% of parents reported implementation of modifications at home. Conclusions Provision of in-school eyecare is valued by parents and teachers of children in special education settings. Jargon-free, written reports of visual status are valued and utilised by parents and teachers. Further support is required to aid parents in implementing vision modifications at home.
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Affiliation(s)
- Emma L. McConnell
- Centre for Optometry and Vision Science, School of Biomedical Sciences, Faculty of Life and Health Sciences, Ulster University, Coleraine, Northern Ireland
- Belfast Health and Social Care Trust, Belfast, Northern Ireland
- Northern Ireland Clinical Research Facility, Belfast City Hospital, Belfast, Northern Ireland
- * E-mail:
| | - Shelley A. Black
- Centre for Optometry and Vision Science, School of Biomedical Sciences, Faculty of Life and Health Sciences, Ulster University, Coleraine, Northern Ireland
| | - Julie F. McClelland
- Centre for Optometry and Vision Science, School of Biomedical Sciences, Faculty of Life and Health Sciences, Ulster University, Coleraine, Northern Ireland
| | - Lynne McKerr
- School of Social Sciences, Education and Social Work, Queen’s University, Belfast, Northern Ireland
| | - Karola Dillenburger
- School of Social Sciences, Education and Social Work, Queen’s University, Belfast, Northern Ireland
| | - Pamela Anketell
- Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | | | - Julie-Anne Little
- Centre for Optometry and Vision Science, School of Biomedical Sciences, Faculty of Life and Health Sciences, Ulster University, Coleraine, Northern Ireland
| | - Kathryn J. Saunders
- Centre for Optometry and Vision Science, School of Biomedical Sciences, Faculty of Life and Health Sciences, Ulster University, Coleraine, Northern Ireland
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Little JA, McConnell E, McClelland J, Black S, Saunders K. The Underreporting of Visual Issues in Statutory Education Documents: Comment on Harvey et al. (2020). J Autism Dev Disord 2020; 50:4566-4568. [PMID: 32656736 DOI: 10.1007/s10803-020-04609-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Julie-Anne Little
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK.
| | - Emma McConnell
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Julie McClelland
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Shelley Black
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Kathryn Saunders
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
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17
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Black SA, McConnell EL, McKerr L, McClelland JF, Little JA, Dillenburger K, Jackson AJ, Anketell PM, Saunders KJ. Correction: In-school eyecare in special education settings has measurable benefits for children's vision and behaviour. PLoS One 2019; 14:e0222300. [PMID: 31487320 PMCID: PMC6728012 DOI: 10.1371/journal.pone.0222300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0220480.].
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