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Haines C, Chakraborty R, Kho K, Henman J, Mansouri N, Anstice NS. Critical appraisal of Australian and New Zealand paediatric vision screening clinical practice guidelines using the AGREE II tool. Clin Exp Optom 2024:1-8. [PMID: 38714343 DOI: 10.1080/08164622.2024.2339276] [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: 10/09/2023] [Accepted: 03/30/2024] [Indexed: 05/09/2024] Open
Abstract
CLINICAL RELEVANCE Vision disorders in children impact health-related quality of life, with early detection and intervention improving outcomes and educational performance. Eye health professionals should be aware of paediatric vision screening guidelines and their development to understand the components of local programmes and the differences in sensitivity and specificity between protocols. BACKGROUND High-quality clinical practice guidelines (CPGs) for vision screening enable the early detection of common vision disorders; however, they require rigorous development to ensure optimal accuracy in detecting vision disorders, enabling timely interventions. This study evaluated the quality of available vision screening CPGs on vision screening of children in Australia and New Zealand. METHODS A systematic search of academic databases, guideline databases, professional associations and Google search engines was conducted to identify relevant paediatric vision screening CPGs. Four independent reviewers used the Appraisal of Guidelines, Research and Evaluation (AGREE II) instrument to assess the quality of individual guidelines and scores were aggregated and reported as the percentage of the total possible score across the six AGREE II domains: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence. RESULTS Initial 2,999 items were evaluated, with seven guidelines included. AGREE-II quality score agreement ranged from 43.3% to 95.8%. All guidelines scored >60.0% in the scope and purpose, however, most had poor scores of <26.5% in the rigour of development and <3.3% in editorial independence domains. All guidelines recommended screening using measures of habitual distance vision. CONCLUSION Of the guidelines developed for use in Australia and New Zealand, most guidelines scored poorly when assessed against the AGREE II tool, because of lack of editorial independence and rigour of development. Paediatric vision screening guidelines should prioritise systematic review of literature to inform practice and include statements regarding competing interests.
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Affiliation(s)
- Cassandra Haines
- Caring Futures Institute, Optometry and Vision Science, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia
| | - Ranjay Chakraborty
- Caring Futures Institute, Optometry and Vision Science, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia
| | - Kyden Kho
- Caring Futures Institute, Optometry and Vision Science, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia
| | - Jessica Henman
- Caring Futures Institute, Optometry and Vision Science, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia
| | | | - Nicola S Anstice
- Caring Futures Institute, Optometry and Vision Science, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia
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Stults CD, Liang SY, Wilcox J, Nyong’o OL. Amblyopia Care Trends Following Widespread Photoscreener Adoption. JAMA Ophthalmol 2024; 142:188-197. [PMID: 38300546 PMCID: PMC10835608 DOI: 10.1001/jamaophthalmol.2023.6434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/28/2023] [Indexed: 02/02/2024]
Abstract
Importance Amblyopia can result in permanent vision loss if not properly treated before age 7 years. In 2017, the US Preventive Services Task Force recommended that vision screening should occur at least once in all children aged 3 to 5 years to detect amblyopia. Objective To understand trends and factors associated with screening, referral, or diagnosis of amblyopia before and after photoscreening expansion across a relatively large health care system in late 2017. Design, Setting, and Participants This is a retrospective cohort study of electronic health record data from patients with a well child care visit at approximately age 3 years (ages 2.75-3.25 years) in a relatively large, multispecialty group practice in Northern California and linked census data between 2015 and 2022. Data were extracted and analyzed from October 2022 through August 2023. Exposures Patient sex, race and ethnicity, immunization records, previous well child care visits, and census-level median household income. Main Outcomes and Measures Vision screening, pediatric ophthalmology referral, or amblyopia diagnosis, compared using adjusted odds ratios (AORs). Results The study included 2015-2017 data from 23 246 patients aged 3 years with at least 1 well child care visit (11 206 [48.2%] female) compared with 2018-2022 postexpansion data from 34 281 patients (16 517 [48.2%] female). The screening rate increased from 5.7% (424 of 7505) in 2015 to 72.1% (4578 of 6354) in 2022. The referral rate increased from 17.0% (1279 of 7505) in 2015 to 23.6% (1836 of 7792) in 2018. The diagnosis rate was 2.7% (200 of 7505) in 2015, peaked at 3.4% (263 of 7792) in 2018, and decreased to 1.4% (88 of 6354) in 2022. Compared with White patients, patients who were Asian, Black, or Hispanic were less likely to be screened (Asian: AOR, 0.80; 95% CI, 0.72-0.88; Black: AOR, 0.71; 95% CI, 0.53-0.96; Hispanic: AOR, 0.88; 95% CI, 0.80-0.97). Compared with White patients, patients who were Asian or Hispanic were more likely to be referred (Asian: AOR, 1.49; 95% CI, 1.36-1.62; Hispanic: AOR, 1.32; 95% CI, 1.18-1.48) and were more likely to be diagnosed (Asian: AOR, 1.29; 95% CI, 1.07-1.56; Hispanic: AOR, 1.67; 95% CI, 1.33-2.11). Conclusions and Relevance In this study, increased availability of photoscreeners was associated with an increase in overall rates of vision screening for children aged 3 years in a relatively large health care system. Given that US rates of visual impairment are predicted to increase, additional targeted interventions would be needed to address remaining disparities in amblyopia care along patient- and clinician-level factors.
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Affiliation(s)
- Cheryl D. Stults
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, Palo Alto, California
| | - Su-Ying Liang
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, Palo Alto, California
| | - Joseph Wilcox
- Center for Health Systems Research, Sutter Health, Walnut Creek, California
| | - Omondi L. Nyong’o
- Crescendo MD, Portola Valley, California
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
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Hopkins S, Read SA, Cox RA, Oduro BA, Strang N, Wood JM. Hyperopia in schoolchildren: Investigating the impact on vision and determining appropriate methods for screening. Ophthalmic Physiol Opt 2024; 44:42-51. [PMID: 37787443 DOI: 10.1111/opo.13236] [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: 06/13/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Hyperopia is associated with reduced vision and educational outcomes in schoolchildren. This study explored the impact of clinically significant hyperopia (≥+2.00 D) on visual function in schoolchildren and compared the ability of different screening tests (alone and in combination) to detect this level of hyperopia. METHODS Vision testing including monocular logMAR visual acuity (VA) measured to threshold (distance [DVA], near [NVA] and DVA through a plus lens [+2.50 D]), stereoacuity and cycloplegic autorefraction (tropicamide 1%) were undertaken on 263 schoolchildren (mean age: 11.76 years ± 3.38) in Queensland, Australia. Vision measures were compared between children with clinically significant hyperopia in at least one meridian (≥+2.00 D) and emmetropia/low hyperopia (>0.00 and <+2.00 D). Receiver operating curve (ROC) analysis was performed to identify optimal pass/fail criteria for each test and the diagnostic accuracy of individual and combinations of tests. RESULTS Thirty-two children had clinically significant hyperopia and 225 had emmetropia/low hyperopia. DVA and NVA were worse (p < 0.01), while the difference in DVA through a plus lens was less in children with clinically significant hyperopia (p < 0.01). ROC analysis for individual tests resulted in areas under the curve (AUCs) ranging from 0.65 to 0.85. Combining screening tests revealed that failing one or more of the following tests was most effective for detecting hyperopia: DVA, NVA and difference in DVA through a plus lens, resulting in a sensitivity and specificity of 72% and 81%, respectively. CONCLUSION Significant differences in visual function existed between schoolchildren with clinically significant hyperopia and emmetropia/low hyperopia. Combining measures of DVA and NVA and the difference in DVA through a plus lens demonstrated good discriminative ability for detecting clinically significant hyperopia in this population.
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Affiliation(s)
- Shelley Hopkins
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Scott A Read
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Rebecca A Cox
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bright A Oduro
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Niall Strang
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Joanne M Wood
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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Alkalash SH, Alsayed HY, Alamshani TK, Almarhabi BA, Alsayed KN, Alsayed GM, Alqarni RS, Alkinani AI, Alsharif AR, Aljohani AA, Alkudaysi FM. Knowledge, Attitude, and Practice of Parents Regarding Children's Eye Care in Al-Qunfudah Governorate, Saudi Arabia. Cureus 2023; 15:e48044. [PMID: 38034266 PMCID: PMC10688390 DOI: 10.7759/cureus.48044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Visual impairment and blindness have a long-term impact on children. Common causes include refractive error, amblyopia, and cataracts, all of which are preventable. OBJECTIVES This study aims to evaluate the knowledge, attitude, and practice of parents regarding children's eye care in Al-Qunfudah governorate, Saudi Arabia. METHODS A cross-sectional study was carried out on a convenience sample of 403 parents residing in the governorate of Al-Qunfudah. Data were gathered using a validated, self-administered online questionnaire that required participants' consent and ensured data confidentiality. IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States) was used to do the statistical analysis of the data. RESULTS This study included 403 participants; 41.2% of them were 36-45 years old, 75.9% were female, and 88.8% were married. Most of the participants had had their children undergo eye examinations (65%). A positive attitude about child eye care among the participants was observed in 48.9% of them, while the level of knowledge about eye care and its regular examinations was poor in 60% of the study sample. A significant positive correlation was detected between participants' attitudes and knowledge scores about the eye care of their children (r = 0.238, p-value = <0.001). Older adults (P = 0.004), those with employment (P = 0.004), and those with a history of children suffering from eye problems (P = 0.018) are associated with a positive attitude, while better knowledge is associated with the parent's age (P = 0.007) and higher education level (P = 0.047). CONCLUSION The knowledge and attitude of the parents regarding their children's eye care were suboptimal, and the main reason for conducting eye examinations on their children was the presence of active eye disease and a symptomatic child. Positive attitudes were more prevalent among those aged 36-45 years, employed, and with a higher number of children with eye problems. Those in the age group of 36-45 who had a bachelor's degree were associated with greater knowledge. There is an urgent need to educate parents about routine and recommended eye screening. Family physicians should conduct opportunistic eye screenings for children who attend primary healthcare facilities and provide parents with educational materials about common eye disorders and children's eye care.
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Affiliation(s)
- Safa H Alkalash
- Community Medicine and Healthcare, Umm Al-Qura University, Al-Qunfudah, SAU
- Family Medicine, Menoufia University, Shibin Al Kawm, EGY
| | | | | | | | | | - Ghady M Alsayed
- Medicine and Surgery, Umm Al-Qura University, Al-Qunfudah, SAU
| | | | | | | | - Amal A Aljohani
- Medicine and Surgery, Umm Al-Qura University, Al-Qunfudah, SAU
| | - Fuad M Alkudaysi
- Emergency Medicine, South Al-Qunfudah General Hospital, Al-Qunfudah, SAU
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Lyubasyuk V, Jones KL, Caesar MA, Chambers C. Vision outcomes in children with fetal alcohol spectrum disorders. Birth Defects Res 2023; 115:1208-1215. [PMID: 37461259 PMCID: PMC10862690 DOI: 10.1002/bdr2.2223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Previous studies demonstrated that children with Fetal Alcohol Spectrum Disorders (FASD) are more likely to have vision impairments. However, existing human clinical and epidemiological investigations are few and include limited sample sizes. This study aimed to explore the association between ophthalmologic abnormalities and FASD in a sample of 5-7 year old children in the general population. METHODS This was a cross-sectional study nested in a larger study intended to estimate the prevalence of FASD in San Diego, California, conducted between 2012 and 2014. Prenatal exposure to alcohol, dysmorphology examinations, and a neurobehavioral testing battery were collected for each child and an FASD diagnosis was assigned. Parents of participating children were asked to release their child's vision screening or diagnostic records. RESULTS Vision records were obtained for 424 participants in the larger prevalence study. Of these, 53 children were classified as having FASD. A statistically significant association was found between FASD and a diagnosis of strabismus; 5/42 (11.9%) of children who were classified as having FASD had strabismus compared to 6/290 (2.1%) of children who were not classified as having FASD (p = .01). All five cases of strabismus in the FASD group occurred in 19 children classified as having partial fetal alcohol syndrome (pFAS). No association was found between FASD and vision impairment (p = .23), refractive errors (p = .66), glasses/contact lens prescription (p = .30), or having one or more ophthalmological abnormalities (p = .97). CONCLUSIONS An association between strabismus and FASD, specifically partial FAS, suggests that the effect of alcohol exposure on risk of strabismus must be severe enough to result in facial features consistent with FASD. This emphasizes the importance of vision screening in children with FASD.
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Affiliation(s)
| | - Kenneth Lyons Jones
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Michelle Ann Caesar
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Christina Chambers
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
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Liu J, Ye Q, Xiao C, Zhuang Y, Feng L, He Y, Xu Z, Zhou Y, Chen X, Yao Y, Jiang R, Pang Y, Yu W, Wen Y, Yuan J, Thompson B, Li J. Impact of COVID-19 pandemic control measures on amblyopia treatment: a retrospective study of records from a tertiary eye hospital in China. BMJ Open 2023; 13:e071839. [PMID: 37407054 PMCID: PMC10335509 DOI: 10.1136/bmjopen-2023-071839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES Amblyopia is the most common cause of unilateral visual impairment in children and requires long-term treatment. This study aimed to quantify the impact of pandemic control measures on amblyopia management. DESIGN AND SETTING This was a retrospective cohort study of data from a large amblyopia management database at a major tertiary eye care centre in China. PARTICIPANTS Outpatients with amblyopia who visited the hospital from 1 June 2019, through 28 February 2022. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the number of first and follow-up in-person visits to the hospital for amblyopia treatment. Secondary outcomes included the time interval between consecutive visits and improvement of vision (visual acuity, contrast sensitivity and stereopsis). Patient records were grouped into prepandemic and during pandemic periods. RESULTS A total of 10 060 face-to-face visits for 5361 patients (median age 6.7 years, IQR 5.4, 8.9) that spanned two lockdown periods were included in the analysis, of which 28% were follow-up visits. Pandemic control measures caused a sharp decline in the number of outpatient visits (3% and 30% of prepandemic levels in the months directly after the start of the first (2020) and second (2021) periods of pandemic control measures, respectively). However, these drops were followed by pronounced rebounds in visits that exceeded prepandemic levels by 51.1% and 108.5%, respectively. The interval between consecutive visits increased significantly during the pandemic from a median (IQR) of 120 (112, 127) days in 2019 to 197 (179, 224) in 2020 (p<0.001) and 189 (182, 221) in 2021 (p<0.001). There were no significant differences in the improvement of visual function or treatment compliance between the prepandemic and postpandemic groups. CONCLUSIONS The number of amblyopia patient hospital visits spiked well above prepandemic levels following lockdown periods. This pattern of patient behaviour can inform planning for amblyopia treatment services during and after public health-related disruptions.
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Affiliation(s)
- Jing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Qingqing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Chutong Xiao
- Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, California, USA
| | - Yijing Zhuang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Lei Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Yunsi He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Zixuan Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Yusong Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Xiaolan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Ying Yao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Rengang Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Yangfei Pang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Wentong Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Yun Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Junpeng Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Jinrong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-Sen University, Guangzhou, China
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Masarwa D, Niazov Y, Ben Natan M, Mostovoy D. The role of parental health beliefs in seeking an eye examination for their child. BMC Ophthalmol 2023; 23:269. [PMID: 37312052 DOI: 10.1186/s12886-023-02994-2] [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: 10/18/2022] [Accepted: 05/24/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND We aimed to explore the role of parental health beliefs in parent seeking of eye examinations for their children, using the Health Belief Model. METHODS In this quantitative correlational survey study, 100 parents who presented to Barzilai University Medical Center in July 2021 to perform an eye examination to their child completed a questionnaire. RESULTS Only 29.6% of the parents knew that a vision screening is performed in first grade, and 10% of the parents were unsure about where to find local eye care for their kids. Moreover, 19% of the parents indicated that they were concerned that their child would be prescribed glasses unnecessarily, and 10% believed that wearing glasses would weaken their child's eyes. Various parental health beliefs regarding children's eye examinations were found associated with parent seeking of eye examinations for their child. Thus, perceived susceptibility (r = 0.52, p < 0.01), perceived benefits (r = 0.39, p < 0.01), and perceived barriers (r=-0.31, p < 0.01) are associated with parent seeking of eye examinations for their child. Also, parents' level of knowledge was associated with seeking eye examinations for their child (r = 0.20, p < 0.01). CONCLUSION Parent perceptions of the child's susceptibility to vision problems and perceived barriers to seeking eye examinations predicted parents seeking of eye examinations for their child. Interventions aimed at increasing timely eye examinations among children should focus on raising parent awareness of vision problems in childhood, dispelling misconceptions, and providing parents with practical information regarding available services.
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Affiliation(s)
- Dua Masarwa
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel
| | - Yulia Niazov
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel
| | - Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel.
| | - Dina Mostovoy
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel
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Morrison AM, Mutti DO. Evaluation of a Pilot Protocol for Detecting Infant Hyperopia. Optom Vis Sci 2023; 100:304-311. [PMID: 36951871 DOI: 10.1097/opx.0000000000002011] [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: 03/24/2023] Open
Abstract
SIGNIFICANCE Highly hyperopic children are at greater risk for developing conditions such as strabismus, amblyopia, and early literacy and reading problems. High hyperopia is a common finding in infants in a pediatric medical practice, and early detection can be done effectively in that setting with tropicamide autorefraction. PURPOSE This study aimed to evaluate the effectiveness of a pilot screening program to detect high hyperopia in 2-month-old infants in a pediatric medical practice in Columbus, Ohio. METHODS Cycloplegic refractive error (1% tropicamide) was measured by retinoscopy and autorefraction with the Welch Allyn SureSight (Welch Allyn/Hillrom, Skaneateles Falls, NY) in 473 infants (55.4% female) who were undergoing their 2-month well-baby visit at their pediatrician's medical practice. Cycloplegic retinoscopy (1% cyclopentolate) was repeated at a subsequent visit in 35 infants with ≥+5.00 D hyperopia in the most hyperopic meridian during the screening. RESULTS Twenty-eight infants (5.9%) had high hyperopia (spherical equivalent, ≥+5.00 D), and 61 (12.9%) had high hyperopia (≥+5.00 D in at least one meridian of at least one eye) by retinoscopy with 1% tropicamide. The mean ± standard deviation spherical equivalent tropicamide cycloplegic refractive error measured with retinoscopy was +2.54 ± 1.54 D (range, -3.25 to +7.00 D) and with SureSight was +2.29 ± 1.64 D (range, -2.90 to +7.53 D). Retinoscopy done using 1% cyclopentolate was 0.44 ± 0.54 D more hyperopic in spherical equivalent than with 1% tropicamide ( P < .001). CONCLUSIONS High hyperopia was a common finding in 2-month-old infants in a pediatric medical setting that could be detected effectively by cycloplegic autorefraction using tropicamide. Greater cooperation between pediatric primary vision and medical care could lead to effective vision screenings designed to detect high hyperopia in infants.
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Affiliation(s)
| | - Donald O Mutti
- The Ohio State University College of Optometry, Columbus, Ohio
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Cao Y, Wang Y, Li B, Zhu D, Sang T, Du X, Shi W, Yang L. Analysis of risk factors associated with the high incidence of amblyopia in preterm infants at the corrected gestational age of 12 months. BMC Pediatr 2023; 23:136. [PMID: 36966278 PMCID: PMC10039439 DOI: 10.1186/s12887-023-03937-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 03/27/2023] Open
Abstract
OBJECTIVE To investigate the perinatal and in-hospital risk factors associated with the high incidence of amblyopia in preterm infants and to analyze the correlation between the amblyopia and neurodevelopment. METHODS Children discharged from the neonatal intensive care unit (NICU) at 12 months of corrected gestational age were retrospectively included in this study. Ocular screening was performed in children. At the risk of amblyopia was determined according to the American Academy of Ophthalmology Guidelines for automated preschool vision screening factors. Differences in perinatal characteristics, complications during hospitalization, and treatment modalities between the two groups of children were analyzed, and multifactorial logistic regression analysis was used to identify the independent risk factors for amblyopia. The results of developmental assessment were collected retrospectively to analyze the correlation between amblyopia and various aspects of neurological development. RESULTS A total of 128 preterm infants, 30 in the amblyopia risk group and 98 in the non-amblyopia risk group, were included in this study. Univariate analysis showed that the amblyopia risk group had lower birth weights, higher rates of asphyxia, preterm brain white matter injury, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), sepsis during hospitalization, and higher rates of treatment with pulmonary surfactant (PS), blood transfusion, invasive ventilator, and levothyroxine. Logistic regression analysis showed that BPD in the neonatal period (odds ratio [OR] 8.355, 95% confidence interval [CI] 1.492, 46.786), brain white matter injury (OR 16.742, 95% CI 0.684, 409.804), treatment with levothyroxine (OR 2.859, 95% CI 0.946, 8.639), and use of an invasive ventilator (OR 2.983, 95% CI 0.942, 9.445) were independent risk factors for amblyopia at 12 months of corrected gestational age, while the administration of glucocorticoids (OR 0.055, 95% CI 0.004, 0.737) was a protective factor. Regarding neurodevelopmental assessment, the number of infants with lagging fine motor development was greater in the amblyopia risk group. CONCLUSION The presence of BPD in the neonatal period, brain white matter damage in preterm infants, and use of levothyroxine and invasive ventilator were high risk factors for amblyopia. The use of glucocorticoids therapy was a protective factor. Children with risk of amblyopia had a higher rate of poor fine motor development.
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Affiliation(s)
- Yiwen Cao
- Department of Pediatric Ophthalmology, Peking University First Hospital, Beijing, 100034, China
| | - Ying Wang
- Department of Pediatric, Peking University First Hospital, Beijing, 100034, China
| | - Bian Li
- Department of Pediatric, Peking University First Hospital, Beijing, 100034, China
| | - Dehai Zhu
- Department of Pediatric Ophthalmology, Peking University First Hospital, Beijing, 100034, China
| | - Tian Sang
- Department of Pediatric, Peking University First Hospital, Beijing, 100034, China
| | - Xueyan Du
- Department of Pediatric, Peking University First Hospital, Beijing, 100034, China
| | - Wanjun Shi
- Department of Pediatric, Peking University First Hospital, Beijing, 100034, China
| | - Liu Yang
- Department of Ophthalmology, Peking University First Hospital, Beijing, 100034, China.
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Yum HR, Park YY, Shin SY, Park SH. Diagnostic performance of the Spot vision photoscreener for the detection of exodeviation in preschool-aged children. Ophthalmic Physiol Opt 2023; 43:212-219. [PMID: 36504165 DOI: 10.1111/opo.13080] [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: 07/16/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of the Welch Allyn Spot Vision photoscreener in preschool children for detecting exotropia, the most prevalent type of strabismus among Asian children. METHODS Children aged 3-6 years were screened using the Spot Vision photoscreener and then underwent a complete ophthalmologic examination on the same day. A child with exodeviation ≥8 Δ in the primary position using the cover-uncover test and the alternate prism cover test was confirmed to have exotropia. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the photoscreener in detecting exotropia were calculated. Subgroup analyses were performed according to the angle of deviation (≥25 Δ vs. <25 Δ) and fusional control (good/fair vs. poor). RESULTS Two hundred and ten children were included in this study. Among 80 exotropia-confirmed children, 23 needed referrals for exodeviation (screening-positive) and 57 were proven to be screening-negatives with the photoscreener. The overall sensitivity, specificity, PPV and NPV of the photoscreener for detecting exotropia were 28.8%, 95.4%, 79.3% and 68.5%, respectively. The positive and negative likelihood ratios were 6.26 and 0.75, respectively. Compared with the 57 children with false-negatives (71.3%), those with true-positive results with the photoscreener had significantly larger angles of exodeviation (p = 0.02) and a higher proportion of poor fusional control (p = 0.004). The photoscreener had low sensitivity even in detecting exotropia ≥25 Δ or those with poor fusional control (35.2% and 43.6%, respectively). Approximately 65% (42 out of 64) of the children with a significant exodeviation which needed strabismus surgery were not identified by the Spot Vision Photoscreener. CONCLUSIONS The Spot Vision photoscreener has low sensitivity for detecting exodeviation. It should not be used alone for assessing exotropia in preschool-aged children.
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Affiliation(s)
- Hae Ri Yum
- Department of Ophthalmology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo Yeon Park
- Department of Ophthalmology, College of Medicine, Dankook University, Cheonan, Korea
| | - Sun Young Shin
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Shin Hae Park
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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11
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Mezad-Koursh D, Skaat A, Davidov B, Manaim T, Leshno A. Qualification of non-pediatric ophthalmologists in examining children. Eur J Ophthalmol 2023; 33:123-128. [PMID: 35795924 DOI: 10.1177/11206721221111885] [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: 01/11/2023]
Abstract
BACKGROUND This study is aimed to evaluate the clinical approach of non-pediatric ophthalmologists, working in community-based clinics towards Pediatric Patients and their management including referral rates to Pediatric Ophthalmologists and Orthoptists. METHODS an online survey was sent to all community ophthalmologists through national society and social media platforms. The questionnaire included questions regarding the responders' professional experience as well as regarding the responders' approach to children younger than 8 years, and the level of confidence in 4 main aspects of children's management and referral rates. RESULTS 93 physicians working as general ophthalmologists completed the questionnaire. Most respondents have been in practice for over 10 years (64/93, 68.8%) and over two-thirds were also hospital affiliated (65/93, 69.1%). The responders estimated on average that 35.1 ± 29.6% of patients under 8 years of age are referred for a consult to a pediatric ophthalmologist The level of confidence of three aspects unique to Pediatric Ophthalmology; cycloplegic refraction, strabismus evaluation, and prescribing glasses were significantly lower (p < 0.01) than confidence in performing a basic eye exam. CONCLUSIONS many Ophthalmologists do not feel fully capable or experienced to perform the appropriate tests for the pediatric population, especially during the critical timeframe, before 8 years of age. The very high rate of referrals stands in contradiction to the reported low rate of eye pathologies in the pediatric population. These findings suggest that more pediatric-specific training is needed to improve the physician's skills to perform a comprehensive evaluation of pediatric patients in order to reduce the referral burden.
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Affiliation(s)
- Dapha Mezad-Koursh
- Department of Ophthalmology, 26738Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, 26745Tel-Aviv University, Tel Aviv, Israel
| | - Alon Skaat
- Sackler Faculty of Medicine, 26745Tel-Aviv University, Tel Aviv, Israel.,Goldschleger Eye Institute, 26744Sheba Medical Center, Israel
| | - Bar Davidov
- Department of Ophthalmology, 26738Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, 26745Tel-Aviv University, Tel Aviv, Israel.,Private Clinic, Tel Aviv, Israel
| | | | - Ari Leshno
- Sackler Faculty of Medicine, 26745Tel-Aviv University, Tel Aviv, Israel.,Goldschleger Eye Institute, 26744Sheba Medical Center, Israel.,The Sheba Talpiot Medical Leadership Program, Israel
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12
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Rosenblatt A, Stolovitch C, Gomel N, Bachar Zipori A, Mezad-Koursh D. A novel device for assessment of amblyopic risk factors in preverbal and verbal children-a pilot study. Eye (Lond) 2022; 36:2312-2317. [PMID: 34853432 PMCID: PMC9674697 DOI: 10.1038/s41433-021-01860-z] [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: 03/14/2021] [Revised: 10/15/2021] [Accepted: 11/12/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES This paper evaluates the accuracy of the Eye-N-JOY (ENJ), a novel device (Patent no. US 9844317 B2), for identifying the presence of amblyopic risk factors. This device was developed to assess both visual acuity, ocular alignment, and eye movement; all while watching images on a tablet screen. METHODS A prospective, single-center, comparison study. Participants were examined by the ENJ first and then underwent a comprehensive full eye examination by pediatric ophthalmologists including cycloplegic refraction. Both the technician operating the ENJ and the physicians were masked to each other's findings. Children aged 18-72 months (1.5 to 6 years) attending a tertiary medical center for a full standard pediatric ophthalmology examination were included. The visual acuity and alignment were compared between the ENJ and the gold standard full ophthalmologic examination. The differences were noted, and the sensitivity and specificity were calculated. RESULTS A total of 51 children were enrolled, 33 (64.7%) girls, aged 18-72 months. All children successfully completed the examination by the ENJ. No significant difference between the ENJ and the reference examination was detected in visual acuity measurements in both eyes (Pv = 0.553 for the right eye and 0.803 for the left). Overall agreement between all referral indications between the ENJ and reference examination was 84.3%, with 90.9% agreement in VA referral criteria and 90.1% in alignment referral criteria. CONCLUSIONS Eye-N-Joy can reliably examine both visual acuity and ocular misalignment in verbal and pre-verbal children.
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Affiliation(s)
- Amir Rosenblatt
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chaim Stolovitch
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Gomel
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Bachar Zipori
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Mezad-Koursh
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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13
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Xu Q, Zhang F, Li J, Liu J, Zhu R, Yu J, Xu X. Association of maternal diabetes during pregnancy with visual acuity development in offspring: a prospective cohort study. Acta Diabetol 2022; 59:1461-1468. [PMID: 35941247 DOI: 10.1007/s00592-022-01933-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/29/2022] [Indexed: 11/01/2022]
Abstract
AIMS We aimed to investigate the association between maternal diabetes before or during pregnancy and visual acuity development in offspring at 1 and 4 years old. METHODS This prospective cohort study comprised 301 individuals born in 2015-2017. Those who had maternal diabetes during or before pregnancy (type 1 diabetes, type 2 diabetes and gestational diabetes) were investigated. Two visual examinations were routinely performed on children relatively at the age of 1 at physical examination and at the age of 4 at admission to school to assess the possible effects of gestational exposure to diabetes on the visual system of the offspring. RESULTS Data were collected on children aged 1 and 4, which consisted of 173 children of mothers exposed to diabetes and 128 children of mothers without diabetes). We found no significant association between maternal diabetes during pregnancy and visual acuity development in 1-year-old offspring. At 4 years old, the incidence of amblyopia and strabismus was similar in both groups. Prenatal exposure to maternal diabetes was associated with a 171% increased risk of high RE: OR 2.71 (95% CI 1.08, 6.81), p < 0.05. Astigmatism (13.3% vs 5.5%) was found to be significantly more prevalent in children born to mothers with GD than in the controls (p = 0.025 in both groups). Moreover, offspring exposed to PGDM had a higher overall risk of high RE than those exposed to GDM during pregnancy (25.0% vs 17.4%). We further found that in the offspring of diabetic mothers, the risk of high RE was significantly increased among children who were female or who spent more time using electronic devices daily. CONCLUSIONS Our findings suggest that maternal diabetes during pregnancy is associated with an increased risk of high RE in offspring. Regular ophthalmological screening should be advised to offspring of mothers with diabetes diagnosed before or during pregnancy.
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Affiliation(s)
- Qinwen Xu
- Medicine School of Nantong University, Nantong, China
| | - Feng Zhang
- Medicine School of Nantong University, Nantong, China
| | - Jingyu Li
- Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, China
| | - Jin Liu
- Medicine School of Nantong University, Nantong, China
| | - Ruilin Zhu
- Medicine School of Nantong University, Nantong, China
| | - Jie Yu
- Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, China
| | - Xujuan Xu
- Affiliated Hospital of Nantong University, Nantong, China.
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14
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Margines JB, Yu F, Mehravaran S, Coleman AL. Non-Cycloplegic and Cycloplegic Autorefraction with Retinomax: An Agreement Study in Preschoolers in Los Angeles, California. Ophthalmic Epidemiol 2022:1-7. [PMID: 36168672 DOI: 10.1080/09286586.2022.2127786] [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 To evaluate the agreement between non-cycloplegic autorefraction (NCAR) and cycloplegic autorefraction (CAR) in an ethnically diverse population of preschool-aged children and the validity of the screening criteria used to refer for further evaluation. METHODS This study included data from 7,073 preschoolers who underwent NCAR and CAR, which enabled refractive error classification based on the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2013 criteria. Right eye data of sphere and cylinder were used to compare NCAR to CAR via paired t-testing and vector analyses, and left eye data for an analysis on anisometropia. The sensitivity and specificity of screening referral criteria for refractive error were calculated. RESULTS Mean values of sphere differed between NCAR and CAR by 1.95 ± 1.45 D (p < .05) with 95% limits of agreement (LoA) of -0.94 to 4.85 D, with less discrepancy found in myopic eyes. The mean values of cylinder differed by -0.08 ± 0.43 D (p < .05) with 95% LoA of -0.93 to 0.77 D. Power vector results reflected a similar lack of agreement. The sensitivity and specificity of our screening referral criteria were, respectively, 66% and 84% for myopia, 66% and 98% for hyperopia, and 98% and 58% for astigmatism. CONCLUSION NCAR is insufficient in preschoolers for spherical refractive error referrals. Level of agreements was lower for spherical (15.5% within 0.5D) and higher for cylindrical refractive errors (89.6%) compared to CAR. In the absence of cycloplegic examination, screening programs using NCAR should utilize low referral thresholds for spherical refractive error.
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Affiliation(s)
- Jack Benjamin Margines
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA
| | - Fei Yu
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA.,Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Shiva Mehravaran
- School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, Maryland, USA
| | - Anne Louise Coleman
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA.,Fielding School of Public Health, University of California, Los Angeles, California, USA
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15
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Harada S, Nakashima Y, Uematsu M, Morimoto S, Mohamed YH, Kitaoka T, Moriuchi H. Effectiveness of a photoscreener in identifying undiagnosed unilateral amblyopia at vision screening of 3-year-old children in Japan. Jpn J Ophthalmol 2022; 66:193-198. [PMID: 35044563 DOI: 10.1007/s10384-021-00896-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE In Japan a basic preparatory ophthalmic examination is routinely performed for 3-year-old children. This study aimed to determine the value of incorporating a photoscreener into the examination and evaluate parents' satisfaction with the photoscreener examination. STUDY DESIGN Prospective study. METHODS Children aged 42-47 months in Nagasaki City, Japan, underwent a visual acuity test by a parent at home and by automated vision screening using a photoscreener at their local municipal health center between October 2018 and March 2019. Subjects were children referred to Nagasaki University Hospital for examination after failing either test. Children previously diagnosed with strabismus and/or amblyopia were excluded. A questionnaire survey evaluated the level of satisfaction with the photoscreener-based screening by parents who attended these examinations at the local municipal health center. RESULTS Of children who completed the two tests, 52 (failed visual acuity test, 3; failed photoscreener examination, 49) were referred for examination. Of the 49 photoscreener failures, 12 were diagnosed with amblyopia: unilateral amblyopia with anisometropic hyperopia in 10 (83.3%), and bilateral amblyopia with astigmatism and hyperopia in 2 (16.7%). The photoscreener detected all 12 cases of amblyopia, whereas the home-based visual acuity test detected only two cases. More than 80% of 1035 parents were satisfied with the photoscreener examination. CONCLUSION Unilateral amblyopia with anisometropic hyperopia was easily overlooked with the home-based test but was detectable by photoscreener examination. The photoscreener proved to be an effective screening tool for amblyopia in children and was considered a satisfactory examination by a high proportion of parents.
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Affiliation(s)
- Shiori Harada
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Yumiko Nakashima
- Department of Pediatrics, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Masafumi Uematsu
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan.
| | - Shinpei Morimoto
- Clinical Research Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Yasser Helmy Mohamed
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Takashi Kitaoka
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Hiroyuki Moriuchi
- Department of Pediatrics, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
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16
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Paudel N, Thompson B, Chakraborty A, Harding J, Jacobs RJ, Wouldes TA, Yu ST, Anstice NS. Relationship between visual and neurodevelopmental measures at 2 years with visual acuity and stereopsis at 4.5 years in children born at risk of neonatal hypoglycaemia. Ophthalmic Physiol Opt 2021; 42:195-204. [PMID: 34747032 DOI: 10.1111/opo.12910] [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: 12/14/2020] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Mild to moderate vision loss affects many children and can negatively impact a child's early literacy and academic achievement. Nevertheless, there is no consensus on which factors present in early childhood indicate the need for long-term ophthalmic follow up, particularly in children with a history of perinatal adversity. This study identified the relationship between visual, cognitive, motor and demographic factors at 2 years of age and visual acuity (VA) and stereoacuity at 4.5 years of age. METHODS Five hundred sixteen children identified as being at risk of neonatal hypoglycaemia were recruited soon after birth. At 2 years of age, binocular VA, stereoacuity and non-cycloplegic refraction were measured and a clinical neuro-developmental assessment with the Bayley Scales of Infant Development III (BSID-III) was conducted by a trained examiner. Monocular VA and stereoacuity were measured at 4.5 years of age. RESULTS Three hundred twenty-eight children completed both the 2 and 4.5 year vision and neurodevelopmental assessments. Multiple linear regression showed oblique astigmatism and motor function at 2 years were significantly associated with VA at 4.5 years of age, while spherical equivalent refraction, motor scores and stereoacuity at 2 years were significantly associated with stereoacuity at 4.5 years of age. BSID-III motor scores had the best sensitivity (81.8%) and specificity (51.5%) for identifying impaired stereoacuity at 4.5 years. However, all measures at 2 years were poorly associated with VA at 4.5 years old. CONCLUSION Vision and neurodevelopmental measures at 2 years were poorly associated with visual function at 4.5 years of age. However, lower scores on tests of motor function at 2 years may be associated with vision abnormalities, particularly reduced stereopsis, at 4.5 years of age and referral for comprehensive vision assessment for these children may be warranted.
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Affiliation(s)
- Nabin Paudel
- Centre for Eye Research, Ireland, Technological University Dublin, Dublin, Ireland.,School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada.,Centre for Eye and Vision Research, Shatin, Hong Kong
| | - Arijit Chakraborty
- Chicago College of Optometry, Midwestern University, Downers Grove, Illinois, USA
| | - Jane Harding
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Robert J Jacobs
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Trecia A Wouldes
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Sandy Ty Yu
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Nicola S Anstice
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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17
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Pollack CE, Bozzi DG, Blackford AL, DeLuca S, Thornton R, Herring B. Using the Moving To Opportunity Experiment to Investigate the Long-Term Impact of Neighborhoods on Healthcare Use by Specific Clinical Conditions and Type of Service. HOUSING POLICY DEBATE 2021; 33:269-289. [PMID: 36968643 PMCID: PMC10038180 DOI: 10.1080/10511482.2021.1951804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We performed a secondary analysis of the Moving To Opportunity (MTO) social experiment to investigate the impact of different types of housing assistance and neighborhood environments on long-term patterns of health care use for specific conditions and across different types of health care services. MTO participants, who were randomized at baseline, were linked to up to 21 years of all-payer hospital discharge and Medicaid data. Among the 9,170 children at the time of randomization, those who received a voucher had subsequent hospital admissions rates that were 36% lower for asthma and 30% lower for mental health disorders compared to the control group; rates of psychiatric services, outpatient hospital services, clinic services and durable medical equipment were also lower among the voucher groups. Findings for adults were not statistically significant. The results suggest that housing policies that reduce neighborhood poverty exposure as a child are associated with lower subsequent healthcare use for specific clinical conditions and types of services.
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Affiliation(s)
- Craig Evan Pollack
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
- Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Debra G Bozzi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amanda L Blackford
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Stefanie DeLuca
- Department of Sociology, Johns Hopkins University, Baltimore, Maryland
| | - Rachel Thornton
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Bradley Herring
- Department of Economics, University of New Hampshire, Durham, New Hampshire
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18
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Chan VF, Yong AC, Azuara-Blanco A, Gordon I, Safi S, Lingham G, Evans J, Keel S. A Systematic Review of Clinical Practice Guidelines for Infectious and Non-infectious Conjunctivitis. Ophthalmic Epidemiol 2021; 29:473-482. [PMID: 34459321 DOI: 10.1080/09286586.2021.1971262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To systematically review and critically appraise clinical practice guidelines (CPGs) and summarise the recommendations for non-infectious and infectious conjunctivitis. METHODS CPGs published on non-infectious and infectious conjunctivitis between 2010 and March 2020 were reviewed, evaluated, and selected using nine items from the Appraisal of Guidelines for Research and Evaluation II tool (4, 7, 8, 10, 12, 13, 15, 22 and 23). CPGs with an average score for items 4, 7, 8, 12, or 22 below 3 and/or a sum of the two researchers' average score for all nine items less than 45 were excluded. Two authors independently extracted and validated the data using standardised forms. RESULTS Fifteen CPGs from five sources remained for data extraction. CPGs consistently recommended non-pharmacological interventions (artificial tears, cold compress, avoidance or removal of allergens) for non-infectious conjunctivitis and pharmacological interventions (topical anti-histamine, mast-cell stabiliser and dual-acting agent) for allergy types. Observation without treatment was strongly recommended for non-herpetic viral and bacterial infections. Systemic and topical anti-viral was consistently recommended for herpetic viral conjunctivitis, while systemic and topical antibiotics were recommended for chlamydial and gonorrhoeal conjunctivitis. The methods used to assess the level of evidence and the strength of recommendation varied among CPGs. CONCLUSIONS There are a number of high-quality CPGs for non-infectious and infectious conjunctivitis. While there were a number of consistencies in the recommendations provided within these CPGs, several inconsistencies were also identified. Many of which related to the scope of practise of the targeted end-user of the particular guideline.
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Affiliation(s)
- Ving Fai Chan
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK.,College of Health Sciences, University KwaZulu Natal, Durban, South Africa
| | - Ai Chee Yong
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK
| | | | - Iris Gordon
- Cochrane Eyes and Vision, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sare Safi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Who Collaborating Centre for the Eye Care and Prevention of Blindness, Iran
| | - Gareth Lingham
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Jennifer Evans
- Cochrane Eyes and Vision, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Stuart Keel
- Department of Noncommunicable Diseases, Vision and Blindness Prevention Programme, World Health Organization, Geneva, Switzerland
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19
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Leiva-Cepas F, Montaño Martínez A, López-López I. [Update on Duchenne muscular dystrophy]. Semergen 2021; 47:472-481. [PMID: 34417099 DOI: 10.1016/j.semerg.2021.06.008] [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: 11/23/2020] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 11/18/2022]
Abstract
Duchenne muscular dystrophy, DMD*(ICD-9-C: 359.1; ICD-10-ES: G71.01, ORPHA: 98896) is a dystrophic type, autosomal recessive myopathy linked to the X chromosome, low incidence 1/3300, with full penetrance and multi-organ involvement (neuro-muscular, respiratory, digestive and metabolic). It has great clinical variability. Symptoms begin in pediatric age (mobility limitation and early respiratory complications). Respiratory complications reduce the life expectancy of those affected. There is no treatment that modifies its evolution, although corticosteroids and new gene therapies are increasing the half-life of this disease. The role of the Primary Care Physician (PCP) is decisive in the monitoring and control of the complications of DMD, either coordinating the different specialties involved in it.
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Affiliation(s)
- F Leiva-Cepas
- Departamento de Ciencias Morfológicas, Sección de Histología, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, España; Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario Reina Sofía, Córdoba, España; Grupo de Investigación en Regeneración Muscular (REGMUS), Código PAIDI: CTS-285, Córdoba, España; Grupo GC-12 de Investigación Epidemiológica en Atención Primaria, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, España.
| | - A Montaño Martínez
- Hospital de Montilla, Empresa Pública Hospital Alto Guadalquivir, Montilla, Córdoba, España
| | - I López-López
- Servicio de Nefrología. Hospital Universitario Reina Sofía, Córdoba, España
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20
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Validation of the Pediatric Vision Scanner in a normal preschool population. J AAPOS 2021; 25:216.e1-216.e4. [PMID: 34256135 PMCID: PMC8449817 DOI: 10.1016/j.jaapos.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 12/06/2020] [Accepted: 03/01/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To assess the Pediatric Vision Scanner (PVS), a handheld vision screening device designed to test for amblyopia and strabismus, in a general pediatric population. METHODS In this prospective study, trained research staff screened 300 eligible children 24-72 months of age with no known eye conditions for amblyopia and strabismus using the PVS. A pediatric ophthalmologist masked to PVS screening results then performed a comprehensive eye examination. Sensitivity and specificity of the PVS was calculated with a 95% confidence interval. RESULTS Based on the gold standard eye examination, 6 children (2%) had amblyopia and/or strabismus. The PVS detected all 6 cases, yielding a sensitivity rate of 100% (95% CI, 54%-100%). The PVS referred 45 additional children (15%) who had normal ophthalmic findings, yielding a specificity rate of 85% (95% CI, 80%-89%). The median acquisition time for the PVS was 28 seconds. CONCLUSIONS The PVS detected amblyopia with high sensitivity in a nonenriched pediatric population. The device would allow children with amblyopia and/or strabismus to be referred to an eye care specialist as early as 2 years old. Given its short acquisition time, the PVS can be implemented in a pediatric clinic with minimal impact on workflow.
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Amblyopia risk factors among pediatric patients in a hospital-based setting using photoscreening. PLoS One 2021; 16:e0254831. [PMID: 34324539 PMCID: PMC8320995 DOI: 10.1371/journal.pone.0254831] [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] [Received: 01/11/2021] [Accepted: 07/04/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of our study was to determine the prevalence of amblyopia risk factors in children visiting the American University of Beirut Medical Center (AUBMC) using automated vision screening. METHODS This was a hospital-based screening of 1102 children aged between 2 and 6 years. Vision screening was performed using PlusoptiX S12 over 2 years (2018-2020). The need for referral to a pediatric ophthalmologist was based on the amblyopia risk factors set forth by the American Association for Pediatric Ophthalmology and Strabismus. Referred patients underwent a comprehensive eye examination. RESULTS A total of 1102 children were screened, 63 were referred for amblyopia risk factors (5.7%); 37/63 (59%) underwent comprehensive eye examination and 73% were prescribed glasses. Of the non-referred group of children, 6.35% had astigmatism, 6.25% were hyperopic and 3.27% were myopic. The refractive errors observed among the examined patients were distributed as follows: 41% astigmatism, 51% hyperopia, and 8% myopia; amblyopia was not detected. Refractive amblyopia risk factors were associated with the presence of systemic disorders. Bland-Altman plots showed most of the differences to be within limits of agreement. CONCLUSION Using an automated vision screener in a hospital-based cohort of children aged 2 to 6 years, the rate of refractive amblyopia risk factors was 5.7%. Hyperopia was the most commonly encountered refractive error and children with systemic disorders were at higher risk.
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Van der Ploeg CPB, Grevinga M, Eekhout I, Vlasblom E, Lanting CI, van Minderhout HME, van Dijk-van der Poel J, van den Akker-van Marle ME, Verkerk PH. Costs and effects of conventional vision screening and photoscreening in the Dutch preventive child health care system. Eur J Public Health 2021; 31:7-12. [PMID: 32893298 PMCID: PMC7851894 DOI: 10.1093/eurpub/ckaa098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Little is known about costs and effects of vision screening strategies to detect amblyopia. Aim of this study was to compare costs and effects of conventional (optotype) vision screening, photoscreening or a combination in children aged 3–6 years. Methods Population-based, cross-sectional study in preventive child health care in The Hague. Children aged 3 years (3y), 3 years and 9 months (3y9m) or 5–6 years (5/6y) received the conventional chart vision screening and a test with a photoscreener (Plusoptix S12C). Costs were based on test duration and additional costs for devices and diagnostic work-up. Results Two thousand, one hundred and forty-four children were included. The estimated costs per child screened were €17.44, €20.37 and €6.90 for conventional vision screening at 3y, 3y9m and 5/6y, respectively. For photoscreening, these estimates were €6.61, €7.52 and €9.40 and for photoscreening followed by vision screening if the result was unclear (combination) €9.32 (3y) and €9.33 (3y9m). The number of children detected with amblyopia by age were 9, 14 and 5 (conventional screening), 6, 13 and 3 (photoscreening) and 10 (3y) and 15 (3y9m) (combination), respectively. The estimated costs per child diagnosed with amblyopia were €1500, €1050 and €860 for conventional vision screening, €860, €420 and €1940 for photoscreening and €730 (3y) and €450 (3y9m) for the combination. Conclusions Combining photoscreening with vision screening seems promising to detect amblyopia in children aged 3y/3y9m, whereas conventional screening seems preferable at 5/6y. As the number of study children with amblyopia is small, further research on the effects of these screening alternatives in detecting children with amblyopia is recommended.
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Affiliation(s)
| | - Manon Grevinga
- Department of Child Health, TNO, Leiden, The Netherlands
| | - Iris Eekhout
- Department of Child Health, TNO, Leiden, The Netherlands
| | - Eline Vlasblom
- Department of Child Health, TNO, Leiden, The Netherlands
| | | | | | | | | | - Paul H Verkerk
- Department of Child Health, TNO, Leiden, The Netherlands
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Kavitha V, Heralgi MM, Rani JS. Commentary: Photo screeners: The present and future of preschool screening. Indian J Ophthalmol 2021; 69:776. [PMID: 33595527 PMCID: PMC7942093 DOI: 10.4103/ijo.ijo_1858_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- V Kavitha
- Department of Pediatric Ophthalmology, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, India
| | - Mallikarjun M Heralgi
- Department of Cornea and Refractive Services, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, India
| | - J Shilpa Rani
- Department of Optometry, Sankara Eye Hospital, Harakere, Shimoga, Karnataka, India
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Misra N, Khanna RC, Mettla AL, Marmamula S, Keeffe JE. Agreement and diagnostic accuracy of vision screening in preschool children between vision technicians and spot vision screener. Indian J Ophthalmol 2021; 69:117-121. [PMID: 33323593 PMCID: PMC7926156 DOI: 10.4103/ijo.ijo_1740_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose Screening preschool children for vision-related disorders poses a challenge. This study is designed to determine the agreement and diagnostic accuracy of the spot vision screener (SVS) in screening preschool children compared to screening procedure by vision technicians (VT). Methods This study was conducted as a part of the ongoing study titled "Initiative for Screening Children for Refractive Errors and other Eye Health Needs (I-SCREEN)." Children from 33 Anganwadis (preschools) in two districts, Adilabad district of Telangana and Krishna district of Andhra Pradesh, in South India, underwent eye health screening by a VT and by a trained community eye health workers (CEHW) using the SVS. Findings were compared for agreement and diagnostic accuracy of assessment. Results A total of 976 preschool children were screened by the VT and separately by the CEHW using the SVS in Adilabad (15 schools) and Krishna (18 schools) districts. The overall mean age of these children was 2.5 years (SD ± 1.3 years). There were 48 (4.9%) referrals by VT compared to 105 (10.8%) referrals by CEHW using SVS. The overall sensitivity of SVS was 91.7% (95% CI: 80%-97.7%) and the specificity was 93.4% (95% CI: 91.6%-94.9%). Positive predictive value was 41.9% (95% CI: 32.3%-51.9%) and negative predictive value was 99.5% (95% CI: 98.8%-99.9%) with a moderate agreement (0.54; 95% CI 0.49-0.64) between VT screening and screening with SVS. Conclusion The SVS showed good diagnostic accuracy and agreement in screening for possible vision-related disorders in preschool children.
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Affiliation(s)
- Neha Misra
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| | - Asha Latha Mettla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana; Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute; Department of Biotechnology / Wellcome Trust India Alliance Research Fellow, L V Prasad Eye Institute, Hyderabad, India
| | - Jill E Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Technical Report: A New Device Attached to a Smartphone for Objective Vision Screening. Optom Vis Sci 2021; 98:18-23. [PMID: 33394927 DOI: 10.1097/opx.0000000000001621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE A new device attached to a smartphone was created for objective vision screening of young children including infants and newborns. The device is compact, lightweight, portable, cost-effective, and easy to operate. Therefore, it is suitable for screening large numbers of children in clinical settings, schools, and communities. PURPOSE This article introduces a new device attached to a smartphone for objective vision screening. It can detect and categorize significant refractive errors, anisometropia, strabismus, cloudy ocular media, and ptosis that may cause amblyopia. METHODS The new device applies the same principles as conventional streak retinoscopy but examines both eyes simultaneously and records the results electronically. The device comprises optical elements that produce a precise streak light beam and move it across a child's both eyes. The smartphone's video camera catches and records the motion of retinal reflex inside the child's pupils. By observing the direction of motion of the retinal reflex relative to the light beam motion, as well as its speed, width, and brightness, the examiner is able to assess the individual and comparative refractive status, ocular alignment, and other conditions. RESULTS Vision screening with this device does not require any subjective response from children. The examination can be performed and analyzed by nonprofessionals after a short learning period of time. Because the examination results are electronically recorded by the smartphone, they can be stored in the child's files and sent out for professional consultations. CONCLUSIONS The new device will provide the same functions as conventional streak retinoscopy but examines a child's both eyes simultaneously, so that, in addition to categorizing refractive errors and assessing clarity of refractive media of the eyes, it can also detect anisometropia, strabismus, and anisocoria. In addition to showing the examination results on the smartphone's screen, the device can also store the results electronically.
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Lequeux L, Thouvenin D, Couret C, Audren F, Costet C, Dureau P, Leruez S, Defoordt-Dhellemmes S, Daien V, Espinasse Berrod MA, Arsene S, Lebranchu P, Denis D, Bui-Quoc E, Speeg-Schatz C. [Vision screening for children: Recommended practices from AFSOP]. J Fr Ophtalmol 2020; 44:244-251. [PMID: 33388188 DOI: 10.1016/j.jfo.2020.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022]
Abstract
In light of the international literature, a workgroup of experts from the AFSOP met in February 2019 to formulate updated recommendations for visual screening in children. An ophthalmologic examination during the first month of life is recommended for children at risk of developing infantile organic amblyopia. An ophthalmologic examination including cycloplegic refraction between 12 and 15 months of age is recommended for children at risk of developing functional amblyopia. At any age, a prompt ophthalmologic examination is recommended for a child suspected of functional or organic ocular pathology. In children without risk factors or warning signs, a systematic orthoptic screening examination is recommended during the third year of life, including a monocular visual acuity test, a cover-test and a refraction by photoscreener. The child is referred to the ophthalmologist only in the case of an abnormal screening result, according to the following criteria: visual acuity <5/10, or >1 difference between eyes, abnormal cover test, photodetection refraction values <-3D or>+2.5D for the sphere,>1.5D for astigmatism and>1D for anisometropia. Finally, we review normal childhood refractive errors as a function of age as well as the correct use of photo screening devices.
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Affiliation(s)
- L Lequeux
- Ophtalmologie Rive-Gauche, clinique Rive-Gauche, 47, allées Charles-de-Fitte, 31300 Toulouse, France.
| | - D Thouvenin
- Ophtalmologie Rive-Gauche, clinique Rive-Gauche, 47, allées Charles-de-Fitte, 31300 Toulouse, France
| | - C Couret
- Service d'ophtalmologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - F Audren
- Fondation ophtalmologique Adolphe-de-Rothschild, 25, rue Manin, 75019 Paris, France
| | - C Costet
- 14, avenue Felix-Faure, 06000 Nice, France
| | - P Dureau
- Fondation ophtalmologique Adolphe-de-Rothschild, 25, rue Manin, 75019 Paris, France
| | - S Leruez
- Centre Ophtalmologique Saint-Joseph, 17, rue de Bellinière, 49800 Trélazé, France
| | - S Defoordt-Dhellemmes
- Service d'exploration de la vision et neuro-ophtalmologie fonctionnelles, CHU de Lille, hôpital Roger-Salengro, rue du Pr.-Emile-Laine, 59037 Lille, France
| | - V Daien
- Service d'ophtalmologie, hôpital Gui-de-Chauliac, CHU de Montpellier, 80 avenue Augustin-Fliche, 34090 Montpellier, France
| | - M-A Espinasse Berrod
- Service d'ophtalmologie, hôpital Necker, AP-HP, 149 rue de Sevres, 75015, Paris, France
| | - S Arsene
- Service d'ophtalmologie, CHU Bretonneau Tours, 2, boulevard Tonnelle, 37000 Tours, France
| | - P Lebranchu
- Service d'ophtalmologie, CHU Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - D Denis
- Service d'ophtalmologie, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France
| | - E Bui-Quoc
- Service d'ophtalmologie, hopital Robert-Debré, 48, boulevard Serurier, 75019 Paris, France
| | - C Speeg-Schatz
- Service d'ophtalmologie, nouvel hopital civil CHU de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
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Abstract
Republished with written permission granted from the American Optometric Association, October 2, 2020.
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Jac-Okereke CC, Jac-Okereke CA, Ezegwui IR, Okoye O. Vision Screening in Infants Attending Immunization Clinics in a Developing Country. J Prim Care Community Health 2020; 11:2150132720907430. [PMID: 32100627 PMCID: PMC7045294 DOI: 10.1177/2150132720907430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Vision screening in infants is an important part of the medical care of children as some eye abnormalities, if not treated in the first few months or years of life, can lead to irreversible vision loss. Objective: The objective of this cross-sectional, descriptive study was to identify ocular anomalies among infants attending immunization clinics in Nigeria and refer promptly and appropriately. Methodology: Infants were screened across 6 immunization clinics. Screening activities included relevant ocular history, vision assessment, external ocular examination, ocular motility, Hirschberg's test, pupil examination, and the red reflex test. Infants with abnormal findings were referred for comprehensive eye examination. Result: Of the 142 infants who underwent vision screening, 29 were referred. These referrals were either as a result of ocular abnormalities (n = 22) or presence of risk factors from history (n = 7). The prevalence of ocular abnormalities was 15.5% and neonatal conjunctivitis (38%), was the commonest ocular abnormality found. Others were bacterial conjunctivitis (14%), nasolacrimal duct obstruction (14%), strabismus (14%), capillary hemangiomas (10%), iris nevi (5%), and vernal keratoconjunctivitis (5%). Of the 7 infants referred based on history alone, 6 (85.7%) had a history of prematurity. Conclusion: Conjunctivitis, strabismus, congenital nasolacrimal duct obstruction, and capillary hemangioma are some of the prevalent disorders seen in infants at immunization clinics in Nigeria. Babies at risk of retinopathy of prematurity (preterm birth and oxygen therapy) can be identified. Immunization clinics can serve as good points of vision screening for infants in developing countries to facilitate prompt referral and treatment.
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Affiliation(s)
| | | | | | - Obiekwe Okoye
- University of Nigeria Teaching Hospital, Enugu, Nigeria
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Sharma M, Ganesh S, Tibrewal S, Sabharwal S, Sachdeva N, Adil M, Chaudhary J, Siddiqui Z. Accuracy of noncycloplegic photorefraction using Spot photoscreener in detecting amblyopia risk factors in preschool children in an Indian eye clinic. Indian J Ophthalmol 2020; 68:504-509. [PMID: 32057013 PMCID: PMC7043179 DOI: 10.4103/ijo.ijo_701_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: To evaluate the accuracy of Spot photoscreener (PS) as a noncycloplegic photorefractor in detecting amblyopia risk factors (ARFs) in preschool children in an Indian eye clinic setting. Also, to derive appropriate cutoff values for screening to obtain maximum sensitivity and specificity of the device in detecting ARF. Methods: This was a cross-sectional study conducted in the outpatient pediatric eye clinic at a tertiary eye care institute. A Spot PS was used to screen all the children between the ages of 6 months and 5 years that presented to the eye clinic from August 2018 to October 2018. This screening was followed by a complete eye examination, including cycloplegic refraction by a masked examiner. The 2013 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines were considered the standard cutoff values for clinically significant refractive error in children younger than 5 years of age. Results: The study comprised of 219 children. The Spot PS diagnosed 135 (61.64%) children with ARF as compared with 124 (56.62%) children detected by clinic examination. For ARF detection, the Spot photoscreeneer had 85.48% sensitivity, 69.47% specificity, 78.52% positive predictive value and 78.57% negative predictive value. The sensitivity for detection of strabismus and hypermetropia was very low (42% and 36%, respectively). The 95% limits of agreement ranged from −5.48 to +5.59 diopters (D) with a bias of 0.06 D for spherical equivalent between noncycloplegic photorefraction and cycloplegic refraction. Conclusion: The Spot PS may be used as a screening tool to detect ARF in children younger than 5 years of age keeping its limitations in consideration. However, the performance can be improved by modifying the cutoff values for the referral.
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Affiliation(s)
- Manasvini Sharma
- Department of Pediatric Ophthalmology and Strabismus, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Suma Ganesh
- Department of Pediatric Ophthalmology and Strabismus, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Shailja Tibrewal
- Department of Pediatric Ophthalmology and Strabismus, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Shalinder Sabharwal
- Department of Community Outreach Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | | | - Mohd Adil
- Department of Pediatric Ophthalmology and Strabismus, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Jyotsana Chaudhary
- Department of Pediatric Ophthalmology and Strabismus, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Zeeshan Siddiqui
- Department of Community Outreach Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
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Preschool Vision Screening Collaborative: Successful Uptake of Guidelines in Primary Care. Pediatr Qual Saf 2020; 4:e241. [PMID: 32010867 PMCID: PMC6946235 DOI: 10.1097/pq9.0000000000000241] [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] [Received: 03/01/2019] [Accepted: 10/31/2019] [Indexed: 11/26/2022] Open
Abstract
Preschool vision screening rates in primary care are suboptimal and poorly standardized. The purpose of this project was to evaluate pediatric primary care adherence to and improvement in preschool vision screening guidelines through a learning collaborative environment.
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Gopal SKS, Kelkar J, Kelkar A, Pandit A. Simplified updates on the pathophysiology and recent developments in the treatment of amblyopia: A review. Indian J Ophthalmol 2020; 67:1392-1399. [PMID: 31436180 PMCID: PMC6727694 DOI: 10.4103/ijo.ijo_11_19] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Amblyopia is the most common cause of monocular visual impairment affecting 2-5% of the general population. Amblyopia is a developmental cortical disorder of the visual pathway essentially due to abnormal visual stimulus, reaching the binocular cortical cells, which may be multivariate. Ganglion cells are of two types: parvocellular (P cells) and magnocellular (M cells); they are the first step where the light energy is converted in to neural impulse. P cells are involved in fine visual acuity, fine stereopsis, and color vision and M cells are involved in gross stereopsis and movement recognition. Strabismus, refractive error, cataract, and ptosis, occurring during critical period are highly amblyogenic. The critical period extends from birth to 7--8 years. The earlier the clinically significant refractive error and strabismus are detected and treated, the greater the likelihood of preventing amblyopia. Treatment for amblyopia in children includes: optical correction of significant refractive errors, patching, pharmacological treatment, and alternative therapies which include: vision therapy, binocular therapy, and liquid crystal display eyeglasses are newer treatment modalities for amblyopia. Age of starting the treatment is not predictive of outcome, instituting treatment on detection and early detection plays a role in achieving better outcomes. This review aims to give a simplified update on amblyopia, which will be of use to a clinician, in understanding the pathophysiology of the complex condition. We also share the cortical aspects of amblyopia and give recent developments in the treatment of amblyopia.
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Affiliation(s)
- Santhan K S Gopal
- Kamala Nethralaya Eye Clinic and Surgical Centre, Bengaluru, Karnataka, India
| | - Jai Kelkar
- National Institute of Ophthalmology, Maharashtra, India
| | - Aditya Kelkar
- National Institute of Ophthalmology, Maharashtra, India
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Margines JB, Huang C, Young A, Mehravaran S, Yu F, Mondino BJ, Coleman AL. Refractive Errors and Amblyopia Among Children Screened by the UCLA Preschool Vision Program in Los Angeles County. Am J Ophthalmol 2020; 210:78-85. [PMID: 31647932 DOI: 10.1016/j.ajo.2019.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To summarize the results of 5 years of vision screening with the University of California, Los Angeles (UCLA) Preschool Vision Program (UPVP). DESIGN Retrospective evaluation of a screening program. METHODS The UPVP performed visual acuity and undilated noncycloplegic refractive screening using an autorefractor on 93,097 children between 2012 and 2017. Of these, 79,451 children, who were between 3 and 5 years old, were screened for the first time, and 14,259 were referred for full cycloplegic examination if they met specific refractive criteria for myopia, hyperopia, astigmatism, or anisometropia. UPVP performed 6779 cycloplegic examinations on this population. Data from the right eye only were included in this analysis. RESULTS Of the examined population, hyperopia was found in 61% (4018), myopia in 20% (1336), and astigmatism in 93% (6122) of children. Latino children had higher rates of astigmatism and worse visual acuity compared to all other races/ethnicities. An astigmatism cutoff of ≥1.50 diopters (D) in either eye correctly predicted the need for glasses 93% of the time; increasing this cutoff to ≥1.50 D in both eyes increased the positive predictive value to 96%. Refractive amblyopia was found in 780 children (1.0% of the screened population and 11.5% of the examined population), and of these, 211 (27%) were bilaterally amblyopic. CONCLUSIONS These data represent the largest published sample of vision screening results on preschool-aged children, provide additional insight on the proportion of common refractive errors and their association with race/ethnicity, and can inform screening criteria to more accurately identify children who need intervention to prevent permanent vision loss.
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Stoll N, Speeg-Schatz C, Sauer A. Dépistage visuel de l’enfant : revue de la littérature. J Fr Ophtalmol 2019; 42:1116-1123. [DOI: 10.1016/j.jfo.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/06/2019] [Accepted: 08/21/2019] [Indexed: 11/27/2022]
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Thomas J, Rajashekar B, Kamath A, Gogate P. Diagnostic accuracy and agreement between visual acuity charts for detecting significant refractive errors in preschoolers. Clin Exp Optom 2019; 103:347-352. [PMID: 31566805 DOI: 10.1111/cxo.12962] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/15/2019] [Accepted: 08/05/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Preschool vision screenings are considered to be cost-effective methods to identify children with vision disorders. The children of this age group are poor at communicating their symptoms and hence screening is mandated. This study is aimed at estimating the diagnostic accuracy and agreement of Lea, HOTV and E visual acuity charts for detecting significant refractive errors. METHODS A cross-sectional study was conducted, in which monocular unaided vision assessment of each study participant was performed with Lea, HOTV and E charts. Stereo acuity was measured with the Randot Preschool Test and a comprehensive eye examination including dilatation was performed. Significant refractive error was defined as hyperopia > 3.25 D, myopia > 2.00 D, astigmatism > 1.50 D, anisometropia if interocular difference > 1.00 D for hyperopia, > 3.00 D for myopia or > 1.50 D for astigmatism. Sensitivity, specificity, positive and negative predictive values were estimated. Bland-Altmann plots were generated to help identify the level of agreement between the vision charts. RESULTS A total of 256 eyes were analysed. Lea, HOTV and E had sensitivities of 87.8 per cent, 90.2 per cent and 90.2 per cent, respectively. Specificity and positive predictive values were better for HOTV (77.3 per cent, 65.5 per cent) and Lea (75 per cent, 62.6 per cent), compared to E chart (69.8 per cent, 58.7 per cent). Negative predictive values for Lea, HOTV and E charts were 92.8 per cent, 93.8 per cent and 93.8 per cent, respectively. Bland-Altmann analysis showed good agreement between Lea and HOTV, Lea and E, and HOTV and E visual acuity charts. The acuity difference was least between Lea and HOTV charts (0.1 logMAR). Eighty-five (33.2 per cent) eyes had significant refractive errors. Eighty (94.1 per cent) eyes were astigmatic. CONCLUSION The diagnostic accuracy of the visual acuity charts was high for the identification of significant refractive errors in preschool children. There was very good agreement between the visual acuity charts.
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Affiliation(s)
- Jyothi Thomas
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Bellur Rajashekar
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Asha Kamath
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Parikshit Gogate
- Department of Ophthalmology, DY Patil Medical College Hospital, Pune, India
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Nik Azis NN, Chew FLM, Rosland SF, Ramlee A, Che-Hamzah J. Parents' performance using the AAPOS Vision Screening App to test visual acuity in Malaysian preschoolers. J AAPOS 2019; 23:268.e1-268.e6. [PMID: 31520719 DOI: 10.1016/j.jaapos.2019.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/07/2019] [Accepted: 01/13/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate parents' performance in using the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Vision Screening App (application) as a vision screening tool among preschool children and to evaluate the reliability of this app. METHODS A total of 195 5- and 6-year-old preschoolers were recruited from children attending Hospital Selayang, Selangor, Malaysia, to test the app. Uncooperative children and those with visual acuity of >logMAR 0.6 were excluded. Results from parents and the screening doctor using the app (Lea symbols) to test visual acuity were compared to each other and to gold standard vision testing by an optometrist using the Lea symbols chart. RESULTS Children 5 years of age represented 46.7% of the study population. The mean age of parents was 37.27 ± 7.68 years. Bland-Altman scatterplot agreement between assessors mainly was within the 95% confidence interval for bilateral eyes screening. Parents obtained a sensitivity of 86.6% (right vision) and 79.5% (left vision) and specificity of 78.9% (right vision) and 71.8% (left vision). Parents took a mean of 191.2 ± 70.82 seconds for bilateral screening. The intraclass correlation coefficient between optometrist and parents in bilateral eyes screening was good (P < 0.001). Cronbach's α for all three assessors was >0.7, indicating high internal reliability of the app. Most parents (178/195 [91.3%]) strongly agreed on the app's acceptability and ease of use. CONCLUSIONS The AAPOS Vision Screening App used by parents is a promising tool for visual acuity screening among Malaysian preschool children and a reliable app for vision screening.
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Affiliation(s)
- Nik Nazihah Nik Azis
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Department of Ophthalmology, Hospital Selayang, Ministry of Health Malaysia, Selangor, Malaysia.
| | - Fiona Lee Min Chew
- Department of Ophthalmology, Hospital Selayang, Ministry of Health Malaysia, Selangor, Malaysia
| | - Siti Famira Rosland
- Department of Ophthalmology, Hospital Selayang, Ministry of Health Malaysia, Selangor, Malaysia
| | - Azura Ramlee
- Department of Ophthalmology, Hospital Selayang, Ministry of Health Malaysia, Selangor, Malaysia
| | - Jemaima Che-Hamzah
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Zimmerman DR, Ben-Eli H, Moore B, Toledano M, Stein-Zamir C, Gordon-Shaag A. Evidence-based preschool-age vision screening: health policy considerations. Isr J Health Policy Res 2019; 8:70. [PMID: 31514739 PMCID: PMC6739935 DOI: 10.1186/s13584-019-0339-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background There are many causes of visual impairment, and even blindness, which are treatable or at least preventable. Two such conditions are strabismus (crossed-eye, squint) and refractive error (visual image not focused on the most sensitive part of the retina). If these are not detected and corrected at an early age, they can lead to an irreversible impairment known as amblyopia (lazy eye). Pediatric vision screening and subsequent treatment for amblyopia and amblyogenic risk factors are thus key to preventing vision loss. Furthermore, vision screening can detect moderate to high hyperopia, which has been found to be associated with poor school readiness. Evidence-based recommendations call for screening children at 3–5 years of age; they are old enough to cooperate, but still within the window of effective intervention. However, these recommendations have yet to be universally implemented as the standard of care. Methods This paper integrates a review of the literature and the international experience of preschool vision screening with the findings from a preliminary feasibility study of expanded screening in Israel to formulate a discussion of the current health policy challenge in Israel and the options for addressing it. The advantages and disadvantages of various venues for vision screening are discussed. Findings Screening by optometrists in Mother and Child Health Centers, as implemented in a recent pilot project in the Jerusalem District, would allow the most comprehensive testing. Photo-screening in preschools would reach the most children, but at the cost of missing hyperopia (farsightedness). Either approach would probably constitute improvements over the current situation. The relative strengths of the two approaches depends in part on the ability to purchase automatic screening equipment (and the efficacy of that equipment) vs. the ongoing cost of paying trained personnel. Conclusions Further research should be conducted in Israel to determine the prevalence of refractive errors, so that best practices can be established for Israel’s population and social needs. In the interim, the Ministry of Health should promptly implement the inclusion of preschool visions screening for children in the approved “basket of services” covered by the National Health Insurance Laws, using photo-screening, including collection of the clinical data. Electronic supplementary material The online version of this article (10.1186/s13584-019-0339-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Hadas Ben-Eli
- Department of Optometry, Hadassah Academic College, Jerusalem, Israel.,Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Bruce Moore
- New England College of Optometry, Boston, MA, USA
| | - Monique Toledano
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Chen Stein-Zamir
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel.,The Hebrew University of Jerusalem, Faculty of Medicine, The Hebrew University and Hadassah Braun School of Public and Community Medicine, Jerusalem, Israel
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Abstract
Early vision care is critical for all children. If undetected, eye disorders such as amblyopia and strabismus may result in permanent vision loss. Vision exams should include a careful history and physical including fix and follow, red reflex, and cover/uncover testing. Photo screening and visual acuity exams should be administered whenever possible.
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Affiliation(s)
- Elaine F Martin
- Elaine F. Martin is an assistant professor at Southern Connecticut State University, New Haven, Conn
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Zhao KK, Yang Y, Wang H, Li L, Wang ZY, Jiang F, Qu JF. Axial length/corneal radius of curvature ratio and refractive development evaluation in 3- to 4-year-old children: the Shanghai Pudong Eye Study. Int J Ophthalmol 2019; 12:1021-1026. [PMID: 31236363 DOI: 10.18240/ijo.2019.06.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/17/2018] [Indexed: 12/25/2022] Open
Abstract
AIM To measure and analysis axial length (AL)/corneal radius of curvature (CRC) ratio and other refractive parameters, provide a medical reference range for refractive development evaluation and earlier visual impairment screening of 3 to 4y kindergarten students. METHODS Between April and June 2017, a total of 4350 participants aged 3- to 4-year-old (8700 eyes) from 10 cluster random sampling kindergartens in Shanghai, Pudong District were involved. According to the measurement and analysis of the unaided visual acuity (VA), AL, CRC, AL/CRC ratio, astigmatism and other refractive parameters, the data distribution and reference range were obtained. RESULTS Uncorrected VA of examined children was 0.23±0.08 (logMAR, mean±SD) [95% confidence interval (CI) range ≤0.36]; AL was 22.10±0.79 mm (95%CI 20.55-23.65); CRC was 7.86±0.26 mm (95%CI, 7.35-8.37); AL/CRC ratio was 2.81±0.12 (95%CI, 2.57-3.05). The median of astigmatism was -0.5 D, a total of 56.3% had astigmatism <-0.50 D, 85.3%<-1.00 D, 6.7%>-1.50 D; 71% were astigmatism with the rule. Eye-specific analyses were conducted. Statistical difference of VA was in right and left eyes. There were no significant differences between two eyes of AL, CRC, AL/CRC ratio and astigmatism (P>0.05). CONCLUSION VA and AL/CRC ratio reference could be used to assess refractive development in children and screening uncorrected refractive errors or amblyopia. Astigmatism needs to be considered in the diagnosis.
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Affiliation(s)
- Ke-Ke Zhao
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yuan Yang
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Hong Wang
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Lu Li
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Zhao-Yang Wang
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
| | - Fan Jiang
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Ji-Fang Qu
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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Wang J, Ding G, Li Y, Hua N, Wei N, Qi X, Ning Y, Zhang Y, Li X, Li J, Song L, Qian X. Refractive Status and Amblyopia Risk Factors in Chinese Children with Autism Spectrum Disorder. J Autism Dev Disord 2019; 48:1530-1536. [PMID: 29170942 DOI: 10.1007/s10803-017-3387-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Amblyopia risk factors in children with autism spectrum disorders (ASD) are usually hard to detect in early childhood due to poor cooperation and has not been reported in the Chinese population. We screened 168 Chinese children with ASD, aged between 3 and 8 years, and 264 age-matched neurotypical children with Spot photoscreener and basic ophthalmologic examinations. Children with ASD were found to have normal refractive status but significantly higher incidence of strabismus (16.1%), compared with control children (1.5%) (p < 0.01). Most of the cases of strabismus found in children with ASD were classified as esodeviation. Strabismus in children with ASD should be considered more seriously as an amblyopia risk factor by ophthalmologists and other healthcare professionals.
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Affiliation(s)
- Jiaxing Wang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China.,Department of Ophthalmology, Emory University, Atlanta, GA, USA
| | - Gang Ding
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Ying Li
- Department of Ophthalmology, Emory University, Atlanta, GA, USA
| | - Ning Hua
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Nan Wei
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Xiaoli Qi
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Yuxian Ning
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Ying Zhang
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Xue Li
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Jing Li
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Linlin Song
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Xuehan Qian
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China.
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Yasir ZH, Almadhi N, Tarabzouni S, Alhommadi A, Khandekar R. Refractive error of Saudi children enrolled in primary school and kindergarten measured with a spot screener. Oman J Ophthalmol 2019; 12:114-118. [PMID: 31198298 PMCID: PMC6561051 DOI: 10.4103/ojo.ojo_62_2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS To evaluate the refractive status of young Saudi schoolchildren with a "Spot Screener." SUBJECTS AND METHODS This cross-sectional study was conducted from January to July 2016 in Riyadh, Saudi Arabia. Children of kindergarten (3-5 years) and grades 1 and 2 (6-7 years) were screened for refractive error (RE) using the handheld Spot Screener (Welch Allyn, Skaneateles Falls, NY, USA). Data were collected on age, gender, and spectacle use. The pass/fail notation from the Spot Screener and the RE were documented. Children with a "fail" were re-tested with an autorefractor (AR). The rate of agreement was evaluated for the spherical equivalent (SE) from the Spot Screener and AR. RESULTS We examined 300 schoolchildren and 114 preschool children. The prevalence of RE was 22% in schoolchildren and 25% in preschoolers. There were 183 (61%) hyperopes, 110 (36.7%) myopes, 6 (2%) emmetropes, and 29 (9.7%) astigmats (>2 D cylinder) in grade 1 and 2. There were 85 (74.6%) hyperopes, 22 (19.3%) myopes, 7 (6.1%) emmetropes, and 10 (8.8%) astigmats among preschoolers. The SE differed between the AR and the Spot Screener in 17 (28%) children of 61 failed Spot Screener tests. Accommodation (9, 53%) and high astigmatism (8, 47%) were the main underlying causes of the difference. The Spot Screener could identify RE for the first time in 51 (17%) schoolchildren and 26 (22%) preschoolers. End-users suggested that Spot Screener was child-friendly and quick to test RE. CONCLUSIONS The Spot Screener could be a good initial screening tool for RE in young schoolchildren.
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Affiliation(s)
- Ziaul Haq Yasir
- Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Nada Almadhi
- Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Salma Tarabzouni
- Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Rajiv Khandekar
- Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Noritz G, Naprawa J, Apkon SD, Kinnett K, Racca F, Vroom E, Birnkrant DJ. Primary Care and Emergency Department Management of the Patient With Duchenne Muscular Dystrophy. Pediatrics 2018; 142:S90-S98. [PMID: 30275253 DOI: 10.1542/peds.2018-0333k] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 12/26/2022] Open
Abstract
Primary care providers (PCPs) are usually the first point of contact with the health care system for patients with Duchenne muscular dystrophy (DMD), and patients often present to emergency departments in which providers have little experience in dealing with this condition. With this article, we give primary care and emergency medicine providers a background in the common issues that affect people with DMD. By acquiring some specialized knowledge about the multisystem medical complications of DMD and by applying general principles of primary care, such as timely immunization, anticipatory safety counseling, behavioral screening, and routine nutritional and developmental assessments, the PCP can be a valued and effective medical provider to patients with DMD. The PCP can provide access to and effective coordination among the patient's specialty caregivers. Moreover, the PCP can become a trusted advisor to the patient and his family about important medical decisions, as well as issues in the psychosocial, behavioral, and educational domains. This article also contains a "pocket guide" used to assess and manage common urgent medical problems that cause patients with DMD to seek care in the emergency department. With the background information discussed in this article, both PCPs and emergency medicine physicians can skillfully care for patients with DMD in their respective settings, optimizing patient outcomes.
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Affiliation(s)
| | - James Naprawa
- Department of Emergency Medicine, UCSF Benioff Children's Hospital, University of California, San Francisco, Oakland, California
| | | | - Kathi Kinnett
- Parent Project Muscular Dystrophy, Hackensack, New Jersey
| | | | - Elizabeth Vroom
- Duchenne Parent Project Netherlands, Amsterdam, Netherlands; and
| | - David J Birnkrant
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
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Chegeni M, Khanjani N, Rahmatpour P, Ahmadi Pishkuhi M, Abdolalian N. The prevalence of amblyopia in Iran: A systematic review. J Curr Ophthalmol 2018; 30:194-201. [PMID: 30197947 PMCID: PMC6127360 DOI: 10.1016/j.joco.2018.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/07/2018] [Accepted: 02/06/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to determine the prevalence of amblyopia in the population of Iran. METHODS This article is a systematic review. A comprehensive search was conducted in PubMed, Scopus, Science Direct, Ovid, Web of Science, SID, Magiran, with appropriate terms. Information related to the sample size and the prevalence of amblyopia was extracted and summarized in tables. Analysis was performed using STATA software. RESULTS From 551 articles that were originally extracted from the databases, 31 articles met the criteria for entering the review. These studies were conducted in different regions of Iran. The prevalence of amblyopia in different regions varied between 0.19 and 3.69%. Study results were heterogeneous (I2 = 99.7%), and therefore, a meta-analysis was not done. CONCLUSIONS The prevalence of amblyopia in Iran is very different. In addition to conducting national screenings, it is necessary to report the incidence of amblyopia and its related factors in different parts of the country.
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Affiliation(s)
- Maryam Chegeni
- Department of Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Narges Khanjani
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Pardis Rahmatpour
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Vernacchio L, Trudell EK, Nigrosh J, Focht G. Primary Care Implementation of Instrument-Based Vision Screening for Young Children. Clin Pediatr (Phila) 2018; 57:1020-1026. [PMID: 29090597 DOI: 10.1177/0009922817738342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vision screening for young children can detect conditions that may lead to amblyopia and vision loss if left untreated. Portable vision screening devices with high levels of precision are now available, but their effectiveness in busy primary care settings is unknown. We analyzed the effect of deploying instrument screening devices (SPOT Vision Screener, Welch-Allyn) in 19 pediatric practices. At baseline, using chart-based screening, 65.3% of 3- to 5-year-old children completed screening. A significant increase was observed starting 3 weeks after delivery of devices, and a stable level was reached 12 weeks after implementation, with 86.5% of children completing vision screening ( P = .007 by interrupted time series analysis). Improvement was greatest among 3-year-olds (44.0%-79.8%) but was also seen among 4-year-olds (70.9%-88.4%) and 5-year-olds (80.3%-90.8%). The deployment of vision screening devices in primary care practices substantially improved completed screening among preschool-aged children.
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Affiliation(s)
- Louis Vernacchio
- 1 Pediatric Physicians' Organization at Children's, Brookline, MA, USA.,2 Boston Children's Hospital, MA, USA.,3 Harvard Medical School, Boston, MA, USA
| | - Emily K Trudell
- 1 Pediatric Physicians' Organization at Children's, Brookline, MA, USA
| | - Jason Nigrosh
- 1 Pediatric Physicians' Organization at Children's, Brookline, MA, USA
| | - Glenn Focht
- 1 Pediatric Physicians' Organization at Children's, Brookline, MA, USA
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Qian X, Li Y, Ding G, Li J, Lv H, Hua N, Wei N, He L, Wei L, Li X, Wang J. Compared performance of Spot and SW800 photoscreeners on Chinese children. Br J Ophthalmol 2018; 103:517-522. [DOI: 10.1136/bjophthalmol-2018-311885] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/24/2018] [Indexed: 11/03/2022]
Abstract
PurposeTo evaluate the effectiveness of Spot photoscreener and SW800 vision screener in detecting amblyopia risk factors in Chinese children between 4 and 6 years of age.MethodsOne hundred and thirteen children (226 eyes) underwent complete ophthalmologic examination, cycloplegic retinoscopy refraction, prism cover tests and photoscreen using both Spot (v2.1.4) and SW800 (v1.0.1.0) photoscreeners. The agreement of results obtained from photoscreener and retinoscopy was evaluated by paired t-test as well as Pearson correlation test. The sensitivity and specificity of detecting amblyopia risk factors were calculated based on the American Association of Pediatric Ophthalmology and Strabismus 2013 guidelines. The overall effectiveness of detecting amblyopia risk factors by using either photoscreener was analysed by receiver operating characteristic (ROC) curves.ResultsA strong linear agreement was observed between Spot and retinoscopy (p<0.01) in aspects of spherical equivalent (SE, Pearson’s r=0.95), dioptre sphere (DS, r=0.97), dioptre cylinder (DC, r=0.84) and horizontal deviation (Hdev, r=0.91), with overall −0.17 D myopic shift of SE. Significant correlation was also shown between SW800 and retinoscopy (p<0.01) in aspects of SE (r=0.90), DS (r=0.93), DC (r=0.82) and Hdev (r=0.80), with overall −0.12 D myopic shift of SE. The overall sensitivity and specificity in detecting amblyopia risk factors were 94.0% and 80.0% for Spot and 88.8% and 81.1% for SW800.ConclusionThe measurements of Spot and SW800 photoscreener showed a strong agreement with cycloplegic retinoscopy refraction and prism cover tests. The performance of both screeners in detecting individual amblyopia risk factors is satisfactory. ROC analysis indicates that the Spot and SW800 performed very similarly in detecting amblyopia risk factors.
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Kemper AR, Krist AH, Tseng CW, Gillman MW, Mabry-Hernandez IR, Silverstein M, Chou R, Lozano P, Calonge BN, Wolff TA, Grossman DC. Challenges in Developing U.S. Preventive Services Task Force Child Health Recommendations. Am J Prev Med 2018; 54:S63-S69. [PMID: 29254527 DOI: 10.1016/j.amepre.2017.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/29/2017] [Accepted: 08/22/2017] [Indexed: 12/01/2022]
Abstract
The U.S. Preventive Services Task Force (USPSTF) uses an objective evidence-based approach to develop recommendations. As part of this process, the USPSTF also identifies important research gaps in scientific evidence. In March 2016, the USPSTF convened an expert panel to discuss its portfolio of child and adolescent recommendations and identify unique methodologic issues when evaluating evidence regarding children and adolescents. The panel identified key domains of challenges, including measuring patient-centered health outcomes; identifying intermediate outcomes predictive of important health outcomes; evaluating the long time horizon needed to assess the balance of benefits and harms; understanding trajectories of growth and development that result in unique windows of time when expected benefits or harms of a preventive service can vary; and considering the perspectives of other individuals who might be affected by the delivery of a preventive service to a child or adolescent. Although the expert panel expressed an interest in being able to make more recommendations for or against preventive services for children and adolescents, it also reinforced the importance of ensuring recommendations were based on sound and sufficient evidence to ensure greatest benefit and minimize unnecessary harms. Accordingly, the need to highlight areas with insufficient evidence is as important as making recommendations. Having identified these key challenges, the USPSTF and other organizations issuing guidelines have an opportunity to advance their methods of evidence synthesis and identified evidence gaps represent important opportunities for researchers and policy makers.
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Affiliation(s)
- Alex R Kemper
- U.S. Preventive Services Task Force, current or former member; Nationwide Children's Hospital, Columbus, Ohio.
| | - Alex H Krist
- U.S. Preventive Services Task Force, current or former member; Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Chien-Wen Tseng
- U.S. Preventive Services Task Force, current or former member; Department of Family Medicine and Community Health, University of Hawaii John A. Burns School of Medicine and Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - Matthew W Gillman
- U.S. Preventive Services Task Force, current or former member; Division of Chronic Disease Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts; Environmental Influences on Child Health Outcomes Program, Office of the Director, NIH, Rockville, Maryland
| | - Iris R Mabry-Hernandez
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Michael Silverstein
- U.S. Preventive Services Task Force, current or former member; Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | - Paula Lozano
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - B Nedrow Calonge
- U.S. Preventive Services Task Force, current or former member; The Colorado Trust, Denver, Colorado
| | - Tracy A Wolff
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland
| | - David C Grossman
- U.S. Preventive Services Task Force, current or former member; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Department of Health Services and Pediatrics, University of Washington, Seattle, Washington
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Wallace DK, Repka MX, Lee KA, Melia M, Christiansen SP, Morse CL, Sprunger DT. Amblyopia Preferred Practice Pattern®. Ophthalmology 2018; 125:P105-P142. [DOI: 10.1016/j.ophtha.2017.10.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022] Open
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Pediatric Eye Evaluations Preferred Practice Pattern®: I. Vision Screening in the Primary Care and Community Setting; II. Comprehensive Ophthalmic Examination. Ophthalmology 2017; 125:P184-P227. [PMID: 29108745 DOI: 10.1016/j.ophtha.2017.09.032] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/22/2022] Open
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Huang D, Chen X, Zhu H, Ding H, Bai J, Chen J, Fu Z, Pan CW, Liu H. Prevalence of amblyopia and its association with refraction in Chinese preschool children aged 36-48 months. Br J Ophthalmol 2017; 102:767-771. [PMID: 28848024 DOI: 10.1136/bjophthalmol-2016-310083] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 08/05/2017] [Accepted: 08/16/2017] [Indexed: 11/04/2022]
Abstract
PURPOSE To determine the prevalence of amblyopia and its association with refraction in Chinese preschool children. METHODS The Yuhuatai Pediatric Eye Disease Study, a cross-sectional, population-based study, was conducted in children aged 36-48 months in Yuhuatai District, Nanjing, China, in 2015. Visual acuity was measured in 1695 eligible children. RESULTS Of the 1695 subjects, manifested amblyopia was detected in 25 children (1.47%, 95% CI 0.90% to 2.05%), including 11 and 14 with bilateral and unilateral amblyopia, respectively. Amblyopia prevalence did not differ by gender (p=0.77). Significant refractive errors were found in 22 (88.0%) of children with amblyopia, and strabismus was found in 6 (24.0%) children with amblyopia. In multivariate analysis, amblyopia was significantly associated with hyperopia (≥+2.00 dioptres (D); OR 8.81, 95% CI 3.27 to 23.69, p<0.0001), astigmatism (≥2.00 D; OR 17.90, 95% CI 6.78 to 47.21, p<0.0001) and anisometropia (≥2.00 D; OR 5.87, 95% CI 1.52 to 22.77, p<0.05). CONCLUSIONS The prevalence of amblyopia in children 36-48 months old in Eastern China was 1.47%. The refractive error is a major risk factor for amblyopia.
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Affiliation(s)
- Dan Huang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xuejuan Chen
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hui Zhu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hui Ding
- Department of Ophthalmology, Maternal and Child Healthcare Hospital of Yuhuatai District, Nanjing, Jiangsu, China
| | - Jing Bai
- Department of Ophthalmology, Maternal and Child Healthcare Hospital of Yuhuatai District, Nanjing, Jiangsu, China
| | - Ji Chen
- Department of Ophthalmology, Maternal and Child Healthcare Hospital of Yuhuatai District, Nanjing, Jiangsu, China
| | - Zhujun Fu
- Department of Ophthalmology, Nanjing Children's Hospital, Nanjing, China
| | - Chen-Wei Pan
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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Shapira Y, Machluf Y, Mimouni M, Chaiter Y, Mezer E. Amblyopia and strabismus: trends in prevalence and risk factors among young adults in Israel. Br J Ophthalmol 2017; 102:659-666. [DOI: 10.1136/bjophthalmol-2017-310364] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/03/2017] [Accepted: 07/28/2017] [Indexed: 11/04/2022]
Abstract
AimsTo estimate the prevalence of amblyopia, present strabismus and amblyopia risk factors (ARFs) among young adults in Israel and to analyse trends over time of prevalence rates.MethodsWe conducted a cross-sectional study including 107 608 pre-enlistees aged 17.4±0.6 years born between 1971 and 1994. Across the birth years, the following trends of prevalence rates among young adults were analysed: prevalence of amblyopia, prevalence of strabismus, severity of amblyopia and prevalence of ARFs (strabismsus, anisometropia and isoametropia). Unilateral amblyopia was defined as best corrected visual acuity (BCVA) of <0.67 (6/9) in either eye or as an interocular difference of two lines or more. Bilateral amblyopia was defined as BCVA of <0.67 (6/9) in both eyes. The severity of amblyopia was classified as mild (BCVA ≥0.5 [6/12]), moderate (BCVA <0.5 [6/12] and ≥0.25 [6/24]) or severe (BCVA <0.25 [6/24]).ResultsThe prevalence of young adulthood amblyopia declined by 33%, from 1.2% to 0.8% (R2=0.87, p<0.001) across 24 birth years. This decline may be due to a drop in unilateral amblyopia from 1% to 0.6% (R2=0.93, p<0.001), while the prevalence of bilateral amblyopia remained stable (0.2%, p=0.12). The decline in amblyopia was apparent in mild and moderate amblyopia, but not in severe amblyopia. Strabismus and anisometropia were detected in 6–12% and 11–20% of subjects with unilateral amblyopia, respectively, without significant trends. Strabismic amblyopia remained constant in the entire population across years. Isoametropia was detected in 46–59% of subjects with bilateral amblyopia without a significant trend across birth years. Prevalence of strabismus in the study population decreased by 50%, from 1.2% to 0.6% (R2=0.75, p<0.001). In subjects with present strabismus, the prevalence of mild unilateral amblyopia increased, while moderate or severe unilateral amblyopia remained relatively stable.ConclusionAmong young adults, the prevalence of unilateral amblyopia, as well as the prevalence of present strabismus, decreased significantly over a period of a generation. The prevalence of strabismic, bilateral or severe (both unilateral and bilateral) amblyopia remained stable. The establishment of the national screening programme for children and the improved utility of treatment for amblyopia and strabismus coincide with these trends. Thus, it is possible that these early interventions resulted in modification of the ‘natural history’ of these conditions and their prevalence in adolescence.
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Pediatric vision screening using the plusoptiX A12C photoscreener in Chinese preschool children aged 3 to 4 years. Sci Rep 2017; 7:2041. [PMID: 28515427 PMCID: PMC5435680 DOI: 10.1038/s41598-017-02246-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/10/2017] [Indexed: 11/13/2022] Open
Abstract
This study evaluated the performance of plusoptiX A12C in detecting amblyopia risk factors (ARFs) in Chinese children aged 3-to-4-year. PlusoptiX examination was successfully conducted among 1,766 subjects without cycloplegia to detect refractive error, asymmetry and media opacity. Cycloplegic retinoscopy (CR) was conducted on 357 children suspected of having vision abnormalities. Statistical differences between CR and the device were confirmed using the mean spherical value (+1.41 ± 0.87 D versus +1.14 ± 0.81 D), cylindrical value (−0.47 ± 0.64 versus −0.84 ± 0.78) and spherical equivalent (SE) value (+1.17 ± 0.84 D versus +0.72 ± 0.64 D) (all P < 0.0001). In the emmetropia group, the differences were statistically significant for the cylinder and SE (all P < 0.0001) but not the sphere (P = 0.33). In the hyperopia group, the differences were statistically significant for the sphere, cylinder and SE (all P < 0.0001). For refractive and strabismic ARFs detection, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated, respectively.
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