Vision screening of 4-year-old children in Singapore

AIM OF THE STUDY

To evaluate the feasibility of an improved visual acuity screening program for Singapore 4-year-old preschool children and to draw up an appropriate referral criteria as well as evaluating the rates and outcomes of these referrals.

METHOD

A total of 450 children aged 4 to 4 1/2 years, who attended 3 polyclinics of the Family Health Service (FHS) for their 4-year-old Developmental Health Screening during the study period from 1/4/1997 to 30/6/1997 were recruited for the study. Children who were tested with Snellen (or Sloan) visual acuity chart resulting in visual acuity of 6/9 or worse, or failed to pass the 3 mm medium plate at 30 cm distance (300 seconds of arc) in the Frisby Stereotest, or were found to have strabismus, or were untestable in either visual acuity test or stereotest were offered referral to ophthalmologists in the hospitals for specialist assessment.

RESULT

82.7% of the 450 children were successfully screened with Snellen (or Sloan) chart while 91.6% were successfully screened with Frisby Stereotest. In all, 180 children were evaluated by ophthalmologists. Majority of the children were referred because of their abnormal visual acuity test while only 2 children were referred for failing stereotest alone. Among the 180 children referred, 63 (35.0%) were found to have refractive errors for which spectacles were prescribed. Eight children had amblyopia and 2 children had strabismus which were not detected at the polyclinic screening. The untestable children evaluated had significantly higher abnormality rate (37.5%) than that of children who had 6/9 vision (8.8%) therefore they should be offered referral for further evaluation. There was high "refused referral" rate of 39.0%. Parents of children who were untestable or had 6/9 vision were found to be more likely to refuse offer of referral. If these two groups of children were excluded, the "refused referral" rate dropped to 13.3%. When the referral criteria for visual acuity was reset at 6/12 instead of 6/9, the referral rate dropped from 39.6% to a more manageable 26.7% and the positive predictive value improved from 35.4% to 48.3% and none of the children with amblyopia were missed being screened-out.

CONCLUSION

The study confirmed the feasibility of doing visual acuity screening at 4 to 41/2 year-old. The referral criteria for abnormal visual acuity should be set at 6/12. The efficacy of adding Frisby stereotest needs further evaluation.

Infant walker use, injuries, and motor development

OBJECTIVES

To study the impact of infant walker use on motor development and injuries.

POPULATION

One hundred and eighty five parents or primary care givers who attended a Singapore government polyclinic from September 1993 to February 1994, with their infants between 7 to 10 months, for a developmental assessment session.

SETTING

A government polyclinic in Singapore.

METHODS

The parent or primary care giver answered questions pertaining to infant walker use and injuries attributed to its use. Each infant was then given the Singapore modified version of the Denver Developmental Screening Test (DDST-S), along with a full clinical examination; both testers were blinded to walker use.

RESULTS

One hundred and sixty seven (90%) of 185 infants used walkers regularly, and 21 (12.5%) of the users had one or more injuries. Most injuries were minor, such as bruises and swellings on the head, forehead, face, and cheeks. None of the children who did not use walkers showed any abnormal DDST-S results whereas 18 (10.8%) of the 167 walker users had either abnormal or questionable DDST-S results.

CONCLUSIONS

12.5% of walker users had one or more injuries and walker use may also delay the child's motor development. These findings will help the physician or nurse in primary care settings to advise parents about the potential hazards of walker use.

Pain characteristics and treatment in an outpatient cancer population

Thirty of 100 consecutive outpatients at a comprehensive cancer center were assessed by their physicians as having pain due to cancer severe enough to require regular or narcotic medication. These 30 patients and their physicians then were approached with a semistructured questionnaire about pain characteristics and management. Pain severity correlated only with age older than 55 years. Patients tended to rate their pain as more severe than did their physicians, but believed that pain medications generally were effective. Side effects of pain medication and patient fears of dependence on medication appeared to be more important limiting factors in achieving complete pain relief from medication than undermedication by physicians. Both patients and physicians acknowledged a relationship between emotional state and pain, but there was a greater appreciation among patients than physicians of the usefulness of techniques such as relaxation and distraction in pain control.