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Nishimura M, Wong A, Maurer D. Continued care and provision of glasses are necessary to improve visual and academic outcomes in children: Experience from a cluster-randomized controlled trial of school-based vision screening. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:688-698. [PMID: 38691337 PMCID: PMC11303613 DOI: 10.17269/s41997-024-00884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/21/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To assess the effectiveness of a kindergarten vision screening program by randomly assigning schools to receive or not receive vision screening, then following up 1.5 years later. METHODS Fifty high-needs elementary schools were randomly assigned to participate or not in a vision screening program for children in senior kindergarten (SK; age 5‒6 years). When the children were in Grade 2 (age 6‒7 years), vision screening was conducted at all 50 schools. RESULTS Contrary to expectations, screened and non-screened schools did not differ in the prevalence of suspected amblyopia in Grade 2 (8.6% vs. 7.5%, p = 0.10), nor prevalence of other visual problems such as astigmatism (45.1% vs. 47.1%, p = 0.51). There was also no difference between screened and non-screened schools in academic outcomes such as the proportion of children below grade level in reading (33% vs. 29%) or math (44% vs. 38%) (p = 0.86). However, more children were wearing glasses in screened than in non-screened schools (10.2% vs. 7.8%, p = 0.05), and more children reported their glasses as missing or broken (8.3% vs. 4.7%, p = 0.01), suggesting that SK screening had identified successfully those in need of glasses. Examination of individual results revealed that 72% of children diagnosed and treated for amblyopia in SK no longer had amblyopia in Grade 2. CONCLUSION The prevalence of amblyopia and other visual problems was not reduced in Grade 2 by our SK vision screening program, perhaps because of poor treatment compliance and high attrition. The results suggest that a single screening intervention is insufficient to reduce visual problems among young children. However, the data from individuals with amblyopia suggest that continuing vision care and access to glasses benefits children, especially children from lower socioeconomic class.
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Affiliation(s)
- Mayu Nishimura
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada.
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Agnes Wong
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Daphne Maurer
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Wang P, Bianchet S, Carter M, Hopman W, Law C. Utilization and barriers to eye care following school-wide pediatric vision screening. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:465-471. [PMID: 35525265 DOI: 10.1016/j.jcjo.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/27/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE In August 2018, Ontario introduced the Child Visual Health and Vision Screening Protocol outlining school-based senior kindergarten (aged 4-6 years) vision screening. We determine the prevalence of children at risk based on screening in an Ontario community and follow up to determine resource utilization after screening. METHODS Vision screening data (HOTV, Randot, Autorefractor) from 41 schools (1127 children) were collected for the 2018-2019 and 2019-2020 school years. Phone follow-up was conducted 1-1.5 years after screening to determine whether an optometry visit occurred, if glasses were prescribed, and potential barriers to accessing eye care. Independent t tests were used to compare time to follow-up between groups, and χ2 testing was used for associations between material and social deprivation. RESULTS Overall screening resulted in a 32.2% referral rate within our region. Of the referred children who responded, the rate of seeking out eye care was 69.9% (n = 64), and 65.2% of these visits were prompted specifically by vision screening, and 34.4% of referred children respondents were prescribed glasses. There was a significant relationship between receiving a referral and living in a more materially deprived (p = 0.001) and a more socially deprived area (p = 0.006). The most frequently reported barriers were related to insufficient insurance coverage for eye care or glasses, COVID-19-related difficulties, and scheduling conflicts. CONCLUSION Our vision screening program identified and referred more than one third of children screened for follow-up eye examinations, with children in more deprived neighbourhoods being more frequently referred. Around two thirds of referred children sought care, and one third were prescribed glasses in the follow-up sample.
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Affiliation(s)
- Patrick Wang
- Department of Ophthalmology, School of Medicine, Queen's University, Kingston, Ont
| | - Sonya Bianchet
- Department of Public Health Sciences, Kingston, Frontenac, Lennox, and Addington Public Health, Kingston, Ont
| | - Megan Carter
- Department of Public Health Sciences, Kingston, Frontenac, Lennox, and Addington Public Health, Kingston, Ont.; Department of Public Health Sciences, Queen's University, Kingston, Ont
| | - Wilma Hopman
- KGH Research Institute and Department of Public Health Sciences, Queen's University, Kingston, Ont
| | - Christine Law
- Department of Ophthalmology, Queen's University, Kingston, Ont..
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Esteves S, Martinez-Perez C, Alvarez-Peregrina C, Sánchez-Tena MÁ. Citation Network Analysis on the Influence of Vision on Academic Performance. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10030591. [PMID: 36980150 PMCID: PMC10047661 DOI: 10.3390/children10030591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/14/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Proper vision is absolutely critical to children's academic performance, as vision problems can drastically affect learning ability. Currently, the existing literature in this field is somewhat inconsistent and carries several controversies about the influence of vision on academic performance. In this study, citation networks were utilized in order to analyze the relationship between publications and authors, the most-cited publication, and the different research areas. Additionally, the most commonly utilized publication sources along with the most common research areas were also pinpointed. METHODS The aforementioned search was executed in the Web of Science database, with a time range beginning in 1941 and ending in 2022. In order to scrutinize the publications, VOSviewer, CiteSpace software, and the Citation Network Explorer were utilized for analysis about the most-cited publication and the different research areas. RESULTS Overall, 1342 papers were found in all fields along with 2187 citation networks. Moreover, 2020 was the year with the most publications, including 127 publications and 4 citation networks. Bull et al., published in 2008, was the most-cited work, reaching a citation index of 975. The clustering function managed to identity four groups with the most engaging research topics from researchers: motor visual skills, visual memory, the influence of vision on the different learning styles, and abnormal development of the visual system. CONCLUSIONS In the end, the topic with the greatest interest was the influence of visual motor skills on academic performance. Ideally, this paper will assist fellow researchers in quickly noting which topics are of greatest interest and how research in this area has evolved.
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Affiliation(s)
- Sandrina Esteves
- ISEC LISBOA (Instituto Superior de Educação e Ciências), 1750-142 Lisbon, Portugal
| | - Clara Martinez-Perez
- ISEC LISBOA (Instituto Superior de Educação e Ciências), 1750-142 Lisbon, Portugal
| | - Cristina Alvarez-Peregrina
- Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
| | - Miguel Ángel Sánchez-Tena
- ISEC LISBOA (Instituto Superior de Educação e Ciências), 1750-142 Lisbon, Portugal
- Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
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Jindani Y, Nash D, Fleming N, Sabri K. National survey of paediatric vision screening programs across Canada: Identifying major gaps and call to action. Paediatr Child Health 2021; 26:486-492. [DOI: 10.1093/pch/pxab036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/12/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Paediatric vision screening programs identify children with ocular abnormalities who would benefit from treatment by an eye care professional. A questionnaire was conducted to assess existence and uptake of school-based vision screening programs across Canada. A supplementary questionnaire was distributed among Ontario’s public health units to determine implementation of government mandated vision screening for senior kindergarten children.
Methods
Chief Medical Officers of Health for each province and territory, and Ontario’s thirty-four public health units were sent a questionnaire to determine: 1) whether school-based vision screening is being implemented; 2) what age groups are screened; 3) personnel used for vision screening; 4) the type of training provided for vision screening personnel; and 5) vision screening tests performed.
Results
Of the thirteen provinces/territories in Canada, six perform some form of school-based vision screening. Two provinces rely solely on non-school-based programs offering eligible children an eye examination by an optometrist and three rely on ocular assessment conducted by a nurse at well-child visits. In Ontario, where since 2018 vision screening for all senior kindergarten students is government mandated, only seventeen public health jurisdictions are implementing universal vision screening programs using a variety of personnel ranging from food safety workers to optometrists.
Conclusion
Good vision is key to physical and emotional development. There is an urgent need for a universal, evidence-based and cost-effective multidisciplinary approach to standardize paediatric vision screening across Canada and break down barriers preventing children from accessing eye care.
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Affiliation(s)
- Yasmin Jindani
- McMaster Paediatric Eye Research Group (McPERG), McMaster University, Hamilton, Ontario, Canada
| | - Dallas Nash
- McMaster Paediatric Eye Research Group (McPERG), McMaster University, Hamilton, Ontario, Canada
| | - Natalie Fleming
- McMaster Paediatric Eye Research Group (McPERG), McMaster University, Hamilton, Ontario, Canada
| | - Kourosh Sabri
- McMaster Paediatric Eye Research Group (McPERG), McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
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Wang S, Hao X, Ma X, Yu Y, Wu L, Wang Y, Li Y. Associations between Poor Vision, Vision-Related Behaviors and Mathematics Achievement in Chinese Students from the CNAEQ-PEH 2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228561. [PMID: 33218140 PMCID: PMC7698834 DOI: 10.3390/ijerph17228561] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/16/2020] [Indexed: 11/20/2022]
Abstract
Purpose: Poor vision is prevalent in school-aged students, especially in East Asia. This can not only cause irreversibly physical health impairments like glaucoma and cataracts, but also the loss of individual education and employment opportunities and deterioration of the quality of life. The present study aims to investigate the associations between poor vision, vision-related risk behaviors, and mathematics achievement in youth from China. Methods: The present study included a total of 106,192 Grade 4 students and 70,236 Grade 8 students from the China National Assessment of Educational Quality-Physical Education & Health 2015 (CNAEQ-PEH 2015). We conducted a standard logarithmic visual acuity scale for vision screening, a self-reported questionnaire for vision-related risk behavior and a standardized mathematics assessment for mathematics performance. Poor vision is defined as the visual acuity below 5.0 by using the standard logarithmic visual acuity chart. Linear regression was conducted. Results: The prevalence rate of poor vision in China was 37.1% in Grade 4 and 66.2% in Grade 8 in 2015. Students who had poor vision were more likely to have better mathematics achievement than those with normal vision. Reading in bed, insufficient sleep, and screen time during weekdays and weekends were associated with higher odds of poor vision. Conclusions: Poor vision was positively associated with mathematics academic achievements, while vision-related risk behaviors such as screen time, homework time and reading in bed were associated with a high prevalence of poor vision in compulsory education cycle students.
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Bonuck K, Collins-Anderson A, Ashkinaze J, Karasz A, Schwartz A. Environmental Scan of Sleep Health in Early Childhood Programs. Behav Sleep Med 2020; 18:598-610. [PMID: 31318273 PMCID: PMC6980449 DOI: 10.1080/15402002.2019.1640222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To ascertain how sleep health knowledge is translated to early care and education (ECE) programs, using a multi-component environmental scan. METHODS A website scan identified organizations' sleep content re: recommended practices, developmental effects, and "actionable" ratings (0-2). ECE staff surveys assessed preparedness, practices, and beliefs about addressing sleep health and sleep problems in ECE programs. Semi-structured interviews with stakeholders from the ECE, pediatric and sleep communities assessed awareness, priorities, and practices at their organizations. RESULTS Of 15 websites scanned, half lacked sleep content on links to development, optimal duration, or scientific background. ECE staff (n = 31) were comfortable speaking to parents about healthy sleep, and with incorporating sleep education and guidance into ECE. Stakeholders (n = 15) rated healthy sleep as a high relevance, but lower priority issue. Within ECE settings stakeholders reported that knowledge about specific links to health and development was poor and that sleep health was often obscured by "safe sleep" issues. Their recommendations included: linking sleep health to "hot topics" such as obesity or preschool suspensions and expulsions, integrating it with the teaching of routines, and raising public awareness. CONCLUSION Despite understanding that healthy sleep promotes school readiness, there is insufficiently specific, actionable information in ECE training, programs, or policies. Findings suggest a need for an awareness campaign with clear, actionable messaging, dissemination of turnkey materials, and integration with policy and professional training systems. TRIAL REGISTRATION - ClinicalTrials.Gov: NCT03556462.
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Affiliation(s)
- Karen Bonuck
- Family and Social Medicine, Albert Einstein College of Medicine , Bronx, NY, USA
| | | | | | - Alison Karasz
- Department of Family and Social Medicine, Albert Einstein College of Medicine , Bronx, NY
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Nishimura M, Wong A, Dimaras H, Maurer D. Feasibility of a school-based vision screening program to detect undiagnosed visual problems in kindergarten children in Ontario. CMAJ 2020; 192:E822-E831. [PMID: 32690557 PMCID: PMC7828989 DOI: 10.1503/cmaj.191085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Visual problems can negatively affect visual development and learning but often go undetected. We assessed the feasibility of scaling up a school-based screening program to identify and treat kindergarten children with visual problems. METHODS We conducted a prospective cohort study offering vision screening to junior (JK) and senior kindergarten (SK) children attending 43 schools in 15 Ontario communities. Screening comprised photoscreeners and tests of visual acuity, stereoacuity and eye alignment. Children who failed any test were referred for a comprehensive eye examination, with treatment as needed (e.g., glasses). RESULTS Using a passive consent model, 89% of children were screened compared with 62% using an active consent model (p < 0.001). Referral rates to an optometrist varied across schools (mean referral rate for children in JK 53%, range 25%-83%; mean referral rate for children in SK 34%, range 12%-61%). Among 4811 children who were screened, a visual problem was detected in 516 (10.7%), including 164 (3.4%) with amblyopia and 324 (6.7%) with clinically significant refractive errors. For 347 (67.2%) of the children with a visual problem, this was their first eye examination. Rescreening in Year 2 did not lead to detection of additional problems among children who passed screening in Year 1. Regardless of location (child's school or optometrist's office), 1563 (68.9%) of children attended the follow-up optometry examination. Most of the children who were surveyed (291 of 322, 90.4%) indicated that they enjoyed vision screening. INTERPRETATION Many children in Ontario with a visual problem were not being identified by the status quo in 2015-2017. We found that in-school vision screening with follow-up eye examinations is an effective strategy for identifying at-risk children and placing them in eye care before grade 1.
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Affiliation(s)
- Mayu Nishimura
- Department of Ophthalmology and Vision Sciences (Nishimura, Wong, Dimaras), The Hospital for Sick Children; Department of Ophthalmology and Vision Sciences, Faculty of Medicine (Wong, Dimaras), University of Toronto; Institute of Health Policy Management and Evaluation (Wong, Maurer), and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program and Centre for Global Child Health (Dimaras), Sick-Kids Research Institute, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Nishimura, Maurer), Faculty of Science, McMaster University, Hamilton, Ont.
| | - Agnes Wong
- Department of Ophthalmology and Vision Sciences (Nishimura, Wong, Dimaras), The Hospital for Sick Children; Department of Ophthalmology and Vision Sciences, Faculty of Medicine (Wong, Dimaras), University of Toronto; Institute of Health Policy Management and Evaluation (Wong, Maurer), and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program and Centre for Global Child Health (Dimaras), Sick-Kids Research Institute, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Nishimura, Maurer), Faculty of Science, McMaster University, Hamilton, Ont
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences (Nishimura, Wong, Dimaras), The Hospital for Sick Children; Department of Ophthalmology and Vision Sciences, Faculty of Medicine (Wong, Dimaras), University of Toronto; Institute of Health Policy Management and Evaluation (Wong, Maurer), and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program and Centre for Global Child Health (Dimaras), Sick-Kids Research Institute, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Nishimura, Maurer), Faculty of Science, McMaster University, Hamilton, Ont
| | - Daphne Maurer
- Department of Ophthalmology and Vision Sciences (Nishimura, Wong, Dimaras), The Hospital for Sick Children; Department of Ophthalmology and Vision Sciences, Faculty of Medicine (Wong, Dimaras), University of Toronto; Institute of Health Policy Management and Evaluation (Wong, Maurer), and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program and Centre for Global Child Health (Dimaras), Sick-Kids Research Institute, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Nishimura, Maurer), Faculty of Science, McMaster University, Hamilton, Ont
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Peterseim MMW, Trivedi RH, Feldman S, Husain M, Walker M, Wilson ME, Wolf BJ. Evaluation of the Spot Vision Screener in School-Aged Children. J Pediatr Ophthalmol Strabismus 2020; 57:146-153. [PMID: 32453847 DOI: 10.3928/01913913-20200331-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/18/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the accuracy of the Spot Vision Screener (Welch Allyn, Skaneateles Falls, NY) in children 6 years and older and recommend device thresholds to improve its accuracy for the detection of refractive error. METHODS The Spot Vision Screener results were compared with three gold standard conditions of increasingly narrow refractive error criterion. The sensitivity, specificity, positive predictive value, and negative predictive value of the Spot Vision Screener in detecting each gold standard criterion were calculated. The most accurate threshold setting for each parameter was identified by calculating the area under the curve receiver operating characteristic. RESULTS The Spot Vision Screener was able to successfully evaluate 313 of 330 children (95%). The sensitivity of the Spot Vision Screener to detect American Association for Pediatric Ophthalmology and Strabismus guidelines for amblyopia risk factors was 89.5% and the specificity was 76.7%. The sensitivity decreased to 80% and the specificity increased to 75.3% with narrower refractive criteria. The sensitivity in detecting refractive criteria improved with the proposed optimized device thresholds. Estimates for the general population indicate that the positive predictive value is reasonable at 52.3% to 61.8%, depending on the stringency of the criteria, with excellent negative predictive values. CONCLUSIONS In school-aged children, the primary screening focus shifts from preventing amblyopia to detecting visual disturbances, including refractive error, that may interfere with academic performance. In this age group, the Spot Vision Screener was an acceptable method of detecting significant refractive error with improved sensitivity with threshold optimization. [J Pediatr Ophthalmol Strabismus. 2020;57(3):146-153.].
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