1
|
Bui A, Mitchell GL, McDaniel C, Morrison A, Toole A, Buckland M, Kulp MT. Detection of significant vision conditions in children using QuickSee wavefront autorefractor. Ophthalmic Physiol Opt 2024; 44:501-513. [PMID: 38504505 DOI: 10.1111/opo.13301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE This study evaluated the ability of QuickSee to detect children at risk for significant vision conditions (significant refractive error [RE], amblyopia and strabismus). METHODS Non-cycloplegic refraction (using QuickSee without and with +2 dioptre (D) fogging lenses) and unaided binocular near visual acuity (VA) were measured in 4- to 12-year-old children. Eye examination findings (VA, cover testing and cycloplegic retinoscopy) were used to determine the presence of vision conditions. QuickSee performance was summarised by area under the receiver operating characteristic curve (AUC), sensitivity and specificity for various levels of RE. QuickSee referral criteria for each vision condition were chosen to maximise sensitivity at a specificity of approximately 85%-90%. Sensitivity and specificity to detect vision conditions were calculated using multiple criteria. Logistic regression was used to evaluate the benefit of adding near VA (6/12 or worse) for detecting hyperopia. A paired t-test compared QuickSee without and with fogging lenses. RESULTS The mean age was 8.2 (±2.5) years (n = 174). RE ranged up to 9.25 D myopia, 8 D hyperopia, 5.25 D astigmatism and 3.5 D anisometropia. The testability of the QuickSee was 94.3%. AUC was ≥0.92 (excellent) for each level of RE. For the detection of any RE, sensitivity and specificity were 84.2% and 87.3%, respectively, using modified Orinda criteria and 94.5% and 78.2%, respectively, using the American Academy for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines. For the detection of any significant vision condition, the sensitivity and specificity of QuickSee were 81.1% and 87.9%, respectively, using modified Orinda criteria and 93% and 78.6%, respectively, using AAPOS criteria. There was no significant benefit of adding near VA to QuickSee for the detection of hyperopia ≥+2.00 (p = 0.34). There was no significant difference between QuickSee measurements of hyperopic refractive error with and without fogging lenses (difference = -0.09 D; p = 0.51). CONCLUSIONS QuickSee had high discriminatory power for detecting children with hyperopia, myopia, astigmatism, anisometropia, any significant refractive error or any significant vision condition.
Collapse
Affiliation(s)
- Anh Bui
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | - G Lynn Mitchell
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | | | - Ann Morrison
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | - Andrew Toole
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| | | | - Marjean T Kulp
- The Ohio State University College of Optometry, Columbus, Ohio, USA
| |
Collapse
|
2
|
Diamond DF, Hirji S, Xing SX, Gorroochurn P, Horowitz JD, Wang Q, Park L, Harizman N, Maruri SC, Henriquez DR, Liebmann JM, Cioffi GA, Hark LA. Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT): optometric exam improves access and utilization of eye care services. Graefes Arch Clin Exp Ophthalmol 2024; 262:1619-1631. [PMID: 38189973 DOI: 10.1007/s00417-023-06344-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/22/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE To describe the benefits of optometric evaluation for detection of vision-affecting conditions in the context of community-based eye health screenings and identify factors associated with having a recent dilated eye exam. METHODS Enrolled participants were age 40 and older, living independently in affordable housing developments in New York City. Eye health screening failure and criteria for seeing the on-site study optometrist were defined as visual acuity 20/40 or worse in either eye, intraocular pressure 23-29 mmHg, or an unreadable fundus image. The optometrist conducted a manifest refraction using loose lenses and used a portable slit lamp and ophthalmoscope to perform a non-dilated anterior and posterior segment ocular health evaluation. Demographics, social determinants of health, eye health screening results, and rates of suspected ophthalmic conditions were recorded. To determine factors associated with having a recent dilated eye exam, which was the main outcome for this statistical analysis, a stepwise multivariate logistic regression was performed. RESULTS A total of 708 participants were screened, 308 attended the optometric exam; mean age 70.7 ± 11.7 [standard deviation (SD)] years. Among this subgroup, 70.1% identified as female, 54.9% self-identified as African American, 39% as Hispanic/Latino, and 26.6% Dominican ethnicity; 78.2% (241/308) had not undergone a dilated eye exam within the last year, 71.4% reported they did not have an eye care provider. Stepwise multivariate logistic regression analysis indicated that participants who self-reported having cataracts (odds ratio (OR) 2.15; 95% confidence interval (CI) 1.03-4.47; p = 0.041), self-reported having glaucoma/glaucoma suspect (OR 5.60; 95% CI 2.02-15.43; p = 0.001), or spoke Spanish as their primary language (OR 3.25; 95% CI 1.48-7.11; p = 0.003) had higher odds of having a recent dilated eye exam. CONCLUSIONS This community-based screening initiative demonstrated the effectiveness of optometric exams in detecting vision-affecting conditions and identified factors associated with having a recent dilated eye exam. Optometrists play a vital role in increasing access to eye care for high-risk, underserved populations. TRIAL REGISTRATION ClinicalTrials.gov (NCT04271709).
Collapse
Affiliation(s)
- Daniel F Diamond
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Sitara Hirji
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Samantha X Xing
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jason D Horowitz
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Qing Wang
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa Park
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Noga Harizman
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Desiree R Henriquez
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - George A Cioffi
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa A Hark
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA.
| |
Collapse
|
3
|
Antonio-Aguirre B, Block SS, Asare AO, Baldanado K, Ciner EB, Coulter RA, DeCarlo DK, Drews-Botsch C, Fishman D, Hartmann EE, Killeen OJ, Yuen J, Collins ME. Association of Sociodemographic Characteristics with Pediatric Vision Screening and Eye Care: An Analysis of the 2021 National Survey of Children's Health. Ophthalmology 2024; 131:611-621. [PMID: 38086435 DOI: 10.1016/j.ophtha.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Vision screening and regular eye care can help detect and treat potentially irreversible vision impairment. This study aims to investigate the associations between sociodemographic and health characteristics and the receipt of eye care among children aged 17 years and younger in the United States. DESIGN This cross-sectional study used data from the National Survey of Children's Health (NSCH), a nationally representative and population-based survey of randomly sampled households. PARTICIPANTS Participants were children aged 0 to 17 years, residing in all 50 states and the District of Columbia, whose caregivers or parents answered an address-based survey by mail or online. METHODS Weighted prevalence calculations were applied to analyze the data, and logistic regression was performed to explore associations between reported eye care and demographic, health, and parent-related variables. MAIN OUTCOME MEASURES Caregiver-reported vision screenings, referral to an eye doctor after vision screening, eye doctor visits, and prescription of corrective lenses. RESULTS Caregivers reported that 53.2% of children had a vision screening at least once (if child ≤ 5 years) or within the past 2 years (if child > 5 years). Of those screened, 26.9% were referred to an eye doctor. Overall, 38.6% of all children had a previous eye doctor visit, and among them, 55.4% were prescribed corrective lenses during the visit. Factors associated with decreased odds of vision screening included younger age, lack of health care visits, no insurance coverage, parent education high school or less, and lower household income. Non-White ethnicities, households with a non-English primary language, and lower incomes were more likely to be referred to an eye doctor after vision screening. Lower rates of eye doctor visits were associated with younger age, lack of insurance coverage, and primary household languages other than English. CONCLUSIONS Children from disadvantaged backgrounds are less likely to receive vision screening and eye care. Targeted strategies are needed to increase vision screening and access to eye care services in these vulnerable groups. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
Collapse
Affiliation(s)
| | | | - Afua O Asare
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, Spencer Fox Eccles School of Medicine at the University of Utah Health, Salt Lake City, Utah
| | | | - Elise B Ciner
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania
| | | | - Dawn K DeCarlo
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | - Jenay Yuen
- University of Southern California, Los Angeles, California
| | - Megan E Collins
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
| |
Collapse
|
4
|
Dias LR, Tomasi YT, Boing AF. The newborn screening tests in Brazil: regional and socioeconomic prevalence and inequalities in 2013 and 2019. J Pediatr (Rio J) 2024; 100:296-304. [PMID: 38169234 PMCID: PMC11065651 DOI: 10.1016/j.jped.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To analyze the prevalence evolution of Guthrie, hearing, and eye screening testing among newborns in Brazil, between 2013 and 2019, according to demographic and socioeconomic characteristics. METHODS This is a cross-sectional study with data from 5231 infants from the Pesquisa Nacional de Saúde (PNS), in 2013, and 6637 infants, in 2019, for the Guthrie test, hearing, and red reflex tests. The authors analyzed the outcomes according to the region of residence, self-reported color/race, having health insurance, and per capita household income. By using bivariate and multivariate Poisson regression models, the prevalence ratios and their respective 95 % Confidence Intervals (CI95%) were calculated for each year. RESULTS In 2013, Guthrie test, hearing, and red reflex tests were performed in 96.5 % (95%CI 95,8;97,0), 65.8 % (95%CI 63,9;67,7), and 60.4 % (95%CI 58,5;62,3) of infants, respectively. In 2019, the prevalence was 97.8 % (95%CI 97,3;98,2) in the Guthrie test, 81.6 % (95%CI 80,3;82,9) in the hearing test, and 78.6 % (95%CI 77,1;79,9) in the red reflex test. The testing frequency was higher among residents of the Southeast and South regions of Brazil, among infants whose mother or guardian was white, had health insurance, and was in the higher income strata; and the most evident differences were in the eye and hearing testing. CONCLUSIONS The coverage inequalities according to the region of residence, income, and having health insurance highlight the need to use strategies that enable exams to be carried out, with more information about their importance, encompassing actions from primary care, prenatal care to the puerperium, aiming at universal access and equity.
Collapse
Affiliation(s)
- Letícia R Dias
- Universidade Federal de Santa Catarina (UFSC), Programa de Pós-Graduação em Saúde Coletiva (PPGSC), Florianópolis, SC, Brazil.
| | - Yaná T Tomasi
- Universidade do Estado de Santa Catarina (UDESC), Departamento de Enfermagem, Florianópolis, SC, Brazil
| | - Antonio F Boing
- Universidade Federal de Santa Catarina (UFSC), Departamento de Saúde Pública, Florianópolis, SC, Brazil.
| |
Collapse
|
5
|
Lyu P, Shi J, Hu J, Wang J, He X, Shi H. Barriers and facilitators to using ophthalmic clinical health services following school vision screening: a mixed-methods study. BMJ Paediatr Open 2024; 8:e002459. [PMID: 38631844 PMCID: PMC11029195 DOI: 10.1136/bmjpo-2023-002459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To identify determinants of the utilisation of ophthalmic clinical health services among students who failed school vision screening. METHODS This study employed a sequential explanatory mixed methods design, underpinned by Andersen's Behavioural Model of Health Service Utilisation. Data were initially gathered through interviews with 27 stakeholders-comprising 5 ophthalmologists, 7 community doctors, 7 public health professionals and 8 teachers. The qualitative insights informed the construction of a questionnaire, which subsequently garnered responses from 6215 participants. Qualitative data underwent thematic analysis with NVivo V.12, while quantitative data were analysed using multivariable multinomial logistic regression in SAS V.9.4. Data integration was performed using the Pillar Integration Process for a deductive, evidence-based synthesis of findings. RESULTS The research revealed that students attending vision demonstration schools and receiving encouragement from schools or communities to access clinical ophthalmic services demonstrated higher adherence to referral (OR=1.66, 95% CI 1.30 to 2.12; OR=1.54, 95% CI 1.33 to 1.80). Conversely, older students and those from higher-income families exhibited lower adherence rates (OR=0.31, 95% CI 0.23 to 0.44; OR=0.34, 95% CI 0.25 to 0.46). Moreover, students with less urgent medical needs were more likely to adhere to referrals compared with those needing immediate referrals (OR=1.24, 95% CI 1.06 to 1.45).Four pillars emerged: (a) adherence decreased with age, (b) financial constraints did not pose an obstacle, (c) public health services played a critical role, (d) referral urgency did not linearly correlate with adherence. CONCLUSION The utilisation of ophthalmic clinical health services following vision screening failure in students is significantly influenced by public health services provided by schools or communities, such as prompting those with abnormal screening results to access ophthalmic clinical health services.
Collapse
Affiliation(s)
- Pingping Lyu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, Shanghai, China
| | - Jiaojiao Shi
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, Shanghai, China
| | - Jingwen Hu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, Shanghai, China
| | - Jingjing Wang
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai, Shanghai, China
| | - Xiangui He
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai, Shanghai, China
| | - Huijing Shi
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, Shanghai, China
| |
Collapse
|
6
|
Kim AB, Cheng BT. Association of household language and vision screening among children in the United States. J AAPOS 2024; 28:103858. [PMID: 38438074 DOI: 10.1016/j.jaapos.2024.103858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 03/06/2024]
Abstract
The American Academy of Pediatrics recommends annual testing in children beginning at 3 years of age to detect vision problems and prevent amblyopia. However, rates of vision testing in children from non-English primary language (NEPL) households are not well delineated. This study analyzed the 2018-2020 National Survey of Children's Health to examine patterns and predictors of vision testing among children from NEPL households. In this nationally representative cohort of 89,697 children 3-17 years of age, 70.9% of children received vision testing during the previous 12 months. Children from non-English-speaking households were less likely to undergo vision testing (64.3% vs 72.0%; aOR [95% CI] = 0.83 [0.72-0.95], P = 0.008). Decreased vision testing among children from NEPL households was driven by lower rates of testing at school (16.1% vs 21.0%; 0.72 [0.57-0.89], P = 0.009) or from an ophthalmologist or optometrist (49.0% vs 54.0%; 0.72 [0.61-0.85], P = 0.0004), whereas children from NEPL households were more likely to receive vision testing at health clinics (14.4% vs 3.1%; 3.25 [2.40-4.39], P < 0.0001). No differences were observed in rates of testing by a pediatrician (41.1% vs 44.0%; 1.05 [0.89-1.23], P = 0.69). Interventions to improve language services and health literacy are warranted to increase rates of vision testing among children from NEPL households.
Collapse
Affiliation(s)
- Anne B Kim
- Department of Ophthalmology, Rush University Medical College, Chicago, Illinois
| | | |
Collapse
|
7
|
Weinert MC. Photoscreeners for Amblyopia-Access Does Not Equate to Equity. JAMA Ophthalmol 2024; 142:197-198. [PMID: 38300592 DOI: 10.1001/jamaophthalmol.2023.6651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Marguerite C Weinert
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| |
Collapse
|
8
|
Oke I, Slopen N, Galbraith AA, Hunter DG, Wu AC. Gaps in the Vision Screening Pathway for School-Aged US Children. JAMA Ophthalmol 2024; 142:268-270. [PMID: 38270959 PMCID: PMC10811585 DOI: 10.1001/jamaophthalmol.2023.6316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/24/2023] [Indexed: 01/26/2024]
Abstract
This cross-sectional study uses a nationally representative survey of the US pediatric population to identify gaps in the vision screening pathway.
Collapse
Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
| | - Alison A. Galbraith
- Department of Pediatrics, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - David G. Hunter
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ann Chen Wu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| |
Collapse
|
9
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
10
|
Horowitz JD, Adeghate JO, Karani R, Henriquez DR, Gorroochurn P, Sharma T, Park L, Wang Q, Diamond DF, Harizman N, Auran JD, Maruri SC, Liebmann JM, Cioffi GA, Hark LA. Manhattan Vision Screening and Follow-Up Study: (NYC-SIGHT)Tele-Retinal Image Findings and Importance of Photography. Telemed J E Health 2024; 30:664-676. [PMID: 37651209 DOI: 10.1089/tmj.2023.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Purpose: To describe tele-retinal abnormality image findings from the Manhattan Vision Screening and Follow-up Study (NYC-SIGHT), which aims to investigate whether community-based eye health outreach strategies using telemedicine can improve visual outcomes among at-risk populations in Upper Manhattan. Methods: A 5-year prospective, cluster-randomized clinical trial was conducted. Eligible individuals aged 40 years and older were recruited from affordable housing developments and senior centers in New York City. Participants underwent on-site eye health screening (best-corrected visual acuity, intraocular pressure [IOP] measurements, and fundus photography). Fundus images were graded via telemedicine by a retina specialist. Multivariate logistic regression modeling was used to assess the factors associated with abnormal retinal findings requiring referral to ophthalmology. Results: Participants with a retinal abnormality on fundus photography (n = 157) were predominantly older adults, with a mean age of 68.4 ± 11.1 years, female (63.7%), African American (50.3%), and Hispanic (43.3%). A total of 32 participants in our study passed the vision and IOP screening but had an abnormal retinal image and ocular pathology that would have been missed without fundus photography. Individuals who self-identified as having preexisting glaucoma (odds ratio [OR] = 3.749, 95% confidence interval [CI] = 1.741-8.074, p = 0.0001) and had severe vision impairment (OR = 4.1034, 95% CI = 2.0740-8.1186, p = 0.000) at the screening had significantly higher odds of having an abnormal retinal image. Conclusion: This community-based study targeted populations at-risk for eye disease, improved access to eye care, detected a significant number of retinal image abnormalities requiring follow-up by using telemedicine, and provided evidence of the importance of fundus photography during eye health screenings. CTR number: NCT04271709.
Collapse
Affiliation(s)
- Jason D Horowitz
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Jennifer O Adeghate
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Rabia Karani
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Desiree R Henriquez
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Tarun Sharma
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Lisa Park
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Qing Wang
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Daniel F Diamond
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Noga Harizman
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - James D Auran
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - George A Cioffi
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| | - Lisa A Hark
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Edward S. Harkness Eye Institute, Columbia University, Irving Medical Center, New York, New York, USA
| |
Collapse
|
11
|
Guimaraes S, Vieira MJ, Boas JMV. Predicting myopic changes in children wearing glasses using the Plusoptix photoscreener. Int Ophthalmol 2024; 44:84. [PMID: 38363427 PMCID: PMC10873442 DOI: 10.1007/s10792-024-02954-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 12/04/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION With high increase in myopia prevalence, we aimed to assess whether Plusoptix_A09 can be used in myopic children over spectacles to predict visual acuity (VA) and myopic refraction changes. METHODS Myopic children underwent a complete ophthalmological examination. Plusoptix_A09 was performed over spectacles. VA changes, refraction changes and time since previous glasses prescription, were determined. Age, current or past history of amblyopia, presence of strabismus and self-perception of VA changes were registered. RESULTS In total, 199 patients were included. Spherical power (SP) and spherical equivalent (SE) measured by Plusoptix_A09 over spectacles predicted both VA changes (p < 0.001) and refraction changes (p < 0.001). Values of SP < - 0.06D or SE < - 0.22D indicated a VA decrease (AUC > 0.9, p < 0.01) for sensitivity and specificity of 85.1%, 82.1% and 82.6%, 83.3%, respectively. Age and ophthalmological comorbidities did not influence Plusoptix_A09 measurements (p > 0.05). Plusoptix_A09 over spectacles was a stronger predictor of VA changes when compared to children's self-perception, either in 4-9-year-old patients (p < 0.001 versus p = 0.628) and in 10-18-year-old children (OR < = 0.066 versus OR = 0.190). A decrease in SP and SE of - 0.10D in Plusoptix_A09 predicted a myopia progression of - 0.04D and - 0.05D, respectively. CONCLUSION/RELEVANCE This study unveiled new features for the Plusoptix, a worldwide available photoscreener used in amblyopia screening. When Plusoptix is performed in children with their glasses on, it can rapidly predict myopia progression. For each decrease of - 0.10D in Plusoptix, a myopia progression of -0.05D is expected. Moreover, Plusoptix is more reliable than children's self-perception of visual acuity changes, making it a useful tool either in primary care or ophthalmology practice.
Collapse
Affiliation(s)
- Sandra Guimaraes
- FP-I3ID (Instituto de Investigação, Inovação e Desenvolvimento da Universidade Fernando Pessoa), Porto, Portugal.
- HE-UFP (Hospital-Escola da Universidade Fernando Pessoa), Av. Fernando Pessoa 150, São Cosme, 4420-096, Portugal.
- FCS-UFP (Faculdade de Ciências da Saúde da da Universidade Fernando Pessoa), Porto, Portugal.
| | - Maria João Vieira
- HE-UFP (Hospital-Escola da Universidade Fernando Pessoa), Av. Fernando Pessoa 150, São Cosme, 4420-096, Portugal
| | | |
Collapse
|
12
|
Stalin A, Narayan A, Labreche T, Khan S, Stanberry A, Christian LWT, Leat SJ. Status of Vision and Eye Care Among Patients in Rehabilitation Hospital Units: A Cross-Sectional Study. J Am Med Dir Assoc 2024; 25:361-367.e1. [PMID: 38052415 DOI: 10.1016/j.jamda.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES The prevalence of vision disorders is high among geriatric and hospital inpatient populations, yet they often go undetected, resulting in consequences such as falls or prolonged recovery time. A needs assessment study was conducted to investigate levels of vision and the potential prevalence of unmanaged/undiagnosed ocular disorders among adult inpatients in a hospital-based rehabilitation unit. DESIGN Cross-sectional study. SETTING & PARTICIPANTS Inpatient rehabilitation units of an acute care hospital system in Ontario, Canada. Adults (n = 112) in a hospital inpatient rehabilitation unit participated from October 2018 to February 2019. METHODS Participants were surveyed regarding their demographic, ocular, and medical data and spectacle wear. Visual acuity, contrast sensitivity, visual fields, and stereoacuity plus the spectacle condition were directly assessed. RESULTS The majority (75%) were found to have reduced habitual vision while in hospital. Nearly 60% of participants reported at least some difficulty reading a newspaper or distinguishing a face or were "not happy with their vision." This was despite 80% of participants reporting that they had an eye care practitioner and 70% that they had an eye examination within the last 2 years. More than half (51.8%) of the participants received the recommendation to follow up with their eye care practitioner on discharge from the hospital. CONCLUSIONS AND IMPLICATIONS Reduced vision and vision disorders has a high prevalence among hospital patients in rehabilitation units and should be evaluated at or soon after hospital intake. By incorporating vision screening tools, necessary precautions may be taken to avoid possible falls and promote recovery.
Collapse
Affiliation(s)
- Amritha Stalin
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada.
| | | | - Tammy Labreche
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Shamrozé Khan
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Andre Stanberry
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Lisa W T Christian
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan J Leat
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
13
|
Hark LA, Lin WV, Hirji S, Gorroochurn P, Horowitz JD, Diamond DF, Park L, Wang Q, Auran JD, Maruri SC, Henriquez DR, Sharma T, Valenzuela I, Liebmann JM, Cioffi GA, Friedman DS, Harizman N. Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT): Subanalysis of Referral to Ophthalmology. Curr Eye Res 2024; 49:197-206. [PMID: 37812506 DOI: 10.1080/02713683.2023.2269614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/08/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE The Manhattan Vision Screening and Follow-up Study aims to provide access to eye care for underserved populations, detect native rates of ocular pathology, and refer participants with eye disease to ophthalmology. This subanalysis describes the reasons for referral to ophthalmology and identifies risk factors associated with being referred. METHODS Enrolled participants were aged ≥40 years, living independently in public housing developments and able to provide consent for eye health screenings. Those with habitual visual acuity 20/40 or worse, intraocular pressure (IOP) 23-29 mmHg, or an unreadable fundus image failed and were scheduled with the on-site optometrist. The optometric exam determined whether further referral to ophthalmology for a clinic exam was warranted. Those with an abnormal image or IOP ≥30 mmHg were referred directly to ophthalmology. Main outcome was factors associated with referral to ophthalmology. RESULTS A total of 708 individuals completed the eye health screening over 15 months. A total of 468 participants were referred to ophthalmology (250 had an abnormal image and 218 were referred by the optometrist). Those referred were predominantly older adults (mean age 70.0 ± 11.4 years), female (66.7%), African American (55.1%) and Hispanic (39.5%). Seventy percent of participants had not had a recent eye exam. Stepwise multivariate logistic regression analysis showed that participants with pre-existing glaucoma (OR 3.14, 95% CI 1.62 to 6.08, p = 0.001), an IOP ≥23 mmHg (OR 5.04, 95% 1.91 to 13.28, p = 0.001), or vision impairment (mild) (OR 2.51, 95% CI 1.68 to 3.77, p = 0.001) had significantly higher odds of being referred to ophthalmology. CONCLUSION This targeted community-based study in Upper Manhattan provided access to eye care and detected a significant amount of ocular pathology requiring referral to ophthalmology in this high-risk population.
Collapse
Affiliation(s)
- Lisa A Hark
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Weijie Violet Lin
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Sitara Hirji
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jason D Horowitz
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel F Diamond
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa Park
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Qing Wang
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - James D Auran
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Desiree R Henriquez
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Tarun Sharma
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Ives Valenzuela
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - George A Cioffi
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - David S Friedman
- Harvard Medical School, Massachusetts Eye and Ear Infirmary, Glaucoma Service, Boston, MA, USA
| | - Noga Harizman
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
14
|
Devanathan N, Scheive M, Nawash BS, Selvam A, Murphy A, Morrow M, Anant S, Chen N, Martin EA, Kruger JS, Yung CWR, Johnson TV. Capabilities and Limitations of Student-Led Free Vision Screening Programs in the United States. Transl Vis Sci Technol 2024; 13:9. [PMID: 38224327 PMCID: PMC10793386 DOI: 10.1167/tvst.13.1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/19/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose The Consortium of Student-Led Eye Clinics (CSLEC), founded in 2021, administered a comprehensive survey to document the types of services, most common diagnoses, and follow-up care protocols offered by student-led free vision screening programs (SLFVSP) in the United States. Methods An 81-question institutional review board (IRB)-approved survey was administered to student-led vision screening eye clinics from October 1, 2022 to February 24, 2023. Results Sixteen SLFVSPs were included in the final analysis, of which 81% (n = 13) conducted variations of fundoscopic examinations and 75% (n = 12) measured intraocular pressure. Cataracts and diabetic retinopathy were reported as the most frequent diagnoses by the majority of SLFVSPs (n = 9, 56%); non-mobile SLFVSPs more commonly reported cataract as a frequent diagnosis (P < 0.05). Most patients screened at participating programs were uninsured or met federal poverty guidelines. Prescription glasses were offered by 56% of the programs (n = 9). SLFVSPs that directly scheduled follow-up appointments reported higher attendance rates (66.5%) than those that only sent referrals (20%). Transportation was the most cited barrier for follow-up appointment attendance. Conclusions SLFVSPs, one community vision screening initiative subtype, vary significantly in scope and capabilities of identifying vision threatening disease. The follow-up infrastructure is not uniformly robust and represents a key target for improving care delivery to at-risk populations. Translational Relevance The CSLEC aims to develop a consensus-based standardization for the scope of screening services, offer guidelines for diagnostic criteria, promote real-time data stewardship, and identify means to improve follow-up care mechanisms in member communities.
Collapse
Affiliation(s)
- Nirupama Devanathan
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Melanie Scheive
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Baraa S. Nawash
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Amrish Selvam
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alec Murphy
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - McKenna Morrow
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shruti Anant
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nickolas Chen
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elizabeth A. Martin
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jessica S. Kruger
- Department of Community Health and Health Behavior, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Chi-Wah Rudy Yung
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thomas V. Johnson
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
15
|
Li Y, Duffy S, Wilks S, Keel R, Beswick R, Dai S. Uptake of paediatric vision screening in Queensland, Australia: An analysis of socioeconomic factors. Clin Exp Ophthalmol 2024; 52:118-121. [PMID: 37963827 DOI: 10.1111/ceo.14323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023]
Affiliation(s)
- Ye Li
- Department of Ophthalmology, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Shelley Duffy
- Child and Youth Community Health Services, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Sagen Wilks
- Child and Youth Community Health Services, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Rachel Keel
- Child and Youth Community Health Services, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Rachael Beswick
- Child and Youth Community Health Services, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Shuan Dai
- Department of Ophthalmology, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| |
Collapse
|
16
|
Waisberg E, Ong J, Zaman N, Kamran SA, Sarker P, Tavakkoli A, Lee AG. Extended reality for strabismus screening in developing countries. Eye (Lond) 2024; 38:224. [PMID: 37369763 PMCID: PMC10764831 DOI: 10.1038/s41433-023-02649-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Affiliation(s)
- Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV, USA
| | - Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV, USA
| | - Prithul Sarker
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV, USA
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV, USA
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA.
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA.
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA.
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA.
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA.
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Texas A&M College of Medicine, Bryan, TX, USA.
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| |
Collapse
|
17
|
Joseph E, Ck M, Kumar R, Sebastian M, Suttle CM, Congdon N, Sethu S, Murthy GV. Prevalence of refractive errors among school-going children in a multistate study in India. Br J Ophthalmol 2023; 108:143-151. [PMID: 36562766 PMCID: PMC10804007 DOI: 10.1136/bjo-2022-322123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
AIM Much existing data on childhood refractive error prevalence in India were gathered in local studies, many now dated. The aim of this study was to estimate the prevalence, severity and determinants of refractive errors among school-going children participating in a multistate vision screening programme across India. METHODS In this cross-sectional study, vision screening was conducted in children aged 5-18 years at schools in five states using a pocket vision screener. Refractive error was measured using retinoscopy, and subjective refraction and was defined both by spherical equivalent (SE) and spherical ametropia, as myopia ≤-0.5 diopters (D), hyperopia ≥+1.0 D and/or astigmatism as >0.5 D. Data from the eye with less refractive error were used to determine prevalence. RESULTS Among 2 240 804 children (50.9% boys, mean age 11.5 years, SD ±3.3), the prevalence of SE myopia was 1.57% (95% CI 1.54% to 1.60%) at 5-9 years, 3.13% (95% CI 3.09% to 3.16%) at 10-14 years and 4.8% (95% CI 4.73% to 4.86%) at 15-18 years. Hyperopia prevalence was 0.59% (95% CI 0.57% to 0.61%), 0.54% (95% CI 0.53% to 0.56%) and 0.39% (95% CI 0.37% to 0.41%), respectively. When defined by spherical ametropia, these values for myopia were 0.84%, 2.50% and 4.24%, and those for hyperopia were 2.11%, 2.41% and 2.07%, respectively.Myopia was associated with older age, female gender, private school attendance, urban location and state. The latter appeared to be driven by higher literacy rates. CONCLUSIONS Refractive error, especially myopia, is common in India. Differences in prevalence between states appear to be driven by literacy rates, suggesting that the burden of myopia may rise as literacy increases.
Collapse
Affiliation(s)
- Elizabeth Joseph
- Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India
| | - Meena Ck
- Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India
| | - Rahul Kumar
- Orbis India Country office, ORBIS International, Gurugram, Haryana, India
| | - Mary Sebastian
- Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India
| | | | | | - Sheeladevi Sethu
- Orbis India Country office, ORBIS International, Gurugram, Haryana, India
| | | |
Collapse
|
18
|
Sil A, Aggarwal P, Sil S, Mitra A, Jain E, Sheeladevi S, Murthy G. Design and delivery of the Refractive Errors Among Children (REACH) school-based eye health programme in India. Clin Exp Optom 2023; 106:859-868. [PMID: 37914536 DOI: 10.1080/08164622.2022.2125793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
CLINICAL RELEVANCE Optimisation of vision screening programmes can result the detection of refractive anomalies in a high proportion of school children. BACKGROUND The Refractive Errors Among Children (REACH) programme aims to optimise outcomes of school-based vision screening in India by collaborating with hospitals and monitoring eye care throughout school attendance. METHODS REACH delivers school vision screening using pocket vision screeners (cards presenting rows of seven 0.2 logMAR Sloan letters at a 3 m viewing distance) in five states across India. Children who fail screening are referred for detailed evaluation including refraction, those requiring cycloplegic refraction are referred to partner hospitals. Spectacles are dispensed as needed and compliance is assessed. All data are recorded electronically. RESULTS Out of 2,240,805 children aged 5 to 18 (mean 11.5; SD ±3.3) years, 2,024,053 have undergone REACH screening in 10,309 schools predominantly in rural locations (78.7%) and government-funded (76%). Of those screened, 174,706 (8.6%) underwent detailed evaluation. A higher proportion of children in private or urban schools (11.8% and 10.4% respectively) were referred for detailed evaluation than those in government-funded or rural schools (5.9% and 7.2%, respectively; p < 0.001). The proportion referred for detailed evaluation differed by state (p < 0.001), from 4.0% in West Bengal to 14.4% in Kerala. CONCLUSION The REACH programme screened a high proportion of school children, providing further care and follow-up to optimise visual outcomes.
Collapse
Affiliation(s)
- Asim Sil
- Community Eye Care, Vivekananda Mission Ashram Netra Nirmay Niketan, West Bengal, India
| | | | - Subhra Sil
- Community Eye Care, Vivekananda Mission Ashram Netra Nirmay Niketan, West Bengal, India
| | - Ankita Mitra
- Community Eye Care, Vivekananda Mission Ashram Netra Nirmay Niketan, West Bengal, India
| | - Elesh Jain
- Department of Community Ophthalmology, Sadguru Netra Chikitsalaya, Madhya Pradesh, India
| | | | - Gvs Murthy
- Department of Public Health, Indian Institute of Public Health, Telangana, India
| |
Collapse
|
19
|
Wasser LM, Cassidy J, Cecconi K, McGinnis-Thomas D, Ayalon A, Zaheer HA, Waxman EL, Sahel JA, Williams AM. Predictors of Clinic Attendance After Community-Based Vision Screening. Transl Vis Sci Technol 2023; 12:2. [PMID: 37910081 PMCID: PMC10627300 DOI: 10.1167/tvst.12.11.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/21/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose The purpose of this study was to analyze appointment attendance rates and patient characteristics associated with follow-up adherence after referral from a community vision screening event. Methods A retrospective chart review of patients who attended a 2021 or 2022 community vision screening event and were referred to the university clinic for further care. Appointments were offered without charge and scheduled at the event. Associations between patients' clinical and demographic characteristics and appointment attendance were assessed by binary logistical regression. Results A total of 935 patients attended the annual community vision screening events held in 2021 and 2022. Of these patients, 117 (13%) were referred to the clinic for follow-up, of whom 56 (48%) attended their scheduled follow-up appointment. The most common reasons for clinic referral included cataract (12, 10%), diabetic retinopathy (11, 9%), glaucoma (9, 8%), and challenging refractive error (9, 8%). Health insurance and male gender were predictors of follow-up (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 1.19-7.99, P = 0.021 and OR = 2.72, 95% CI = 1.10-6.61, P = 0.035, respectively). Conclusions Half of the referred patients followed up after vision screening. Providing appointment scheduling at the point of care and offering follow-up care at no cost may help to promote clinic follow-up, but further assessment of barriers to regular eye care is warranted. Health insurance most strongly predicted successful clinic attendance. Translational Relevance This study emphasizes the enduring impact of health insurance status as a barrier to accessing comprehensive vision care.
Collapse
Affiliation(s)
- Lauren M. Wasser
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel
| | - Julie Cassidy
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Katherine Cecconi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dana McGinnis-Thomas
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anfisa Ayalon
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Haniah A. Zaheer
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Evan L. Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew M. Williams
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
20
|
Collins ME, Antonio-Aguirre B. Bridging the Gap in Adolescent Vision Care Through Schools. JAMA Ophthalmol 2023; 141:1073-1074. [PMID: 37824109 DOI: 10.1001/jamaophthalmol.2023.4702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Megan E Collins
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | |
Collapse
|
21
|
Prakash WD, Marmamula S, Mettla AL, Keeffe J, Khanna RC. Variations in the prevalence of vision impairment across regions among school children in Telangana State, South India. Indian J Ophthalmol 2023; 71:3322-3327. [PMID: 37787229 PMCID: PMC10683682 DOI: 10.4103/ijo.ijo_215_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 10/04/2023] Open
Abstract
Purpose Undetected vision impairment (VI) could negatively affect the overall development in children. School vision screening program is a viable and cost-effective approach for the early identification and management of VI. Aim This study aims to estimate the prevalence of VI, its risk factors, and ocular morbidity among school children in Telangana, South India. Methods Children aged 4-15 years attending schools in the study area were screened in this study. The vision screenings were performed in schools by trained community eye health workers using 6/12 tumbling E optotypes. Children who failed the test and/or presented with other eye conditions were referred to vision centers or secondary and tertiary eye care centers. A comprehensive eye examination was conducted in these centers, including cycloplegic refraction and fundus examination. Results A total of 774,184 children, with a mean age of 9.4 ± 3.27 years, were screened. Overall, 51.49% (N = 398,596) were male. In total, 4.33% [N = 33,528; 95% confidence interval (CI): 4.29-4.38] required referral services, while 1.16% (N = 9,002) had a presenting visual acuity of < 6/12. Multivariate analysis showed a high risk of VI among older children [Adj. odds ratio (OR): 5.75; 95% CI: 5.18-6.38], those with disabilities (Adj. OR: 5.12; 95% CI: 4.14-6.33), female gender (Adj. OR: 1.29; 95% CI: 1.24 - 1.35), and those residing in the urban areas (Adj. OR: 2.87; 95% CI: 2.42-3.39). The main cause of VI was uncorrected refractive errors (74.14%). Conclusion The prevalence of VI among school children was 1.16% in Telangana, South India, and refractive error was the leading cause of VI among this population. Increasing age, urban location, female gender and other disabilities increase the risk of VI among children.
Collapse
Affiliation(s)
- Winston D Prakash
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Institute of Optometry and Vision Science, 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 Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Asha Latha Mettla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jill Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, 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 Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, 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
| |
Collapse
|
22
|
Koch C, Neros T. Concussion and vision screening. J Optom 2023; 16:315-316. [PMID: 37302954 PMCID: PMC10518758 DOI: 10.1016/j.optom.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 06/13/2023]
|
23
|
Rac VE, Whiteside C, Bowen JM, Maberley D, Brent MH. To save the vision of persons with diabetes Canada needs data-informed timely screening. Can J Ophthalmol 2023; 58:e228-e229. [PMID: 37141921 DOI: 10.1016/j.jcjo.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/09/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Valeria E Rac
- Toronto General Hospital Research Institute and the University of Toronto, Toronto, ON.
| | | | - James M Bowen
- Toronto General Hospital Research Institute and the University of Toronto, Toronto, ON
| | - David Maberley
- The Ottawa Hospital and the University of Ottawa, Ottawa, ON
| | - Michael H Brent
- Toronto Western Hospital, University Health Network, and the University of Toronto, Toronto, ON
| |
Collapse
|
24
|
Oke I, Lutz SM, Hunter DG, Galbraith AA. Vision Screening Among Children With Private Insurance: 2010-2019. Pediatrics 2023; 152:e2023062114. [PMID: 37605872 DOI: 10.1542/peds.2023-062114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVES To describe trends in vision screening based on insurance claims for young children in the United States. METHODS This cross-sectional study used administrative claims data from the 2010-2019 IBM MarketScan Commercial Claims and Encounters Database. We included children aged 1 to <5 years at the beginning of each calendar year. The primary outcome was a vision screening claim within 12 months for chart-based or instrument-based screening. Linear regression was used to evaluate trends over time in vision screening claims and practitioner payment. RESULTS This study included a median of 810 048 (interquartile range, 631 523 - 1 029 481) children between 2010 and 2019 (mean [standard deviation] age, 2.5 [1.1] years; 48.7% female). The percentage of children with vision screening claims increased from 16.7% in 2010 to 44.3% in 2019 (difference, 27.5%; 95% confidence interval, 27.4% to 27.7%). Instrument-based screening claims, which were identified in <0.2% of children in 2010, increased to 23.4% of children 1 to <3 years old and 14.4% of children 3 to <5 years old by 2019. From 2013 to 2018, the average of the median practitioner payment for instrument-based screening was $23.70, decreasing $2.10 per year during this time (95% confidence interval, $0.85 to $3.34; P = .009). CONCLUSIONS Vision screening claims among young children nearly tripled over the last decade, and this change was driven by increased instrument-based screening for children aged <3 years. Further investigation is needed to determine whether the decreasing trends in practitioner payment for screening devices will reduce the adoption of vision screening technology in clinical practice.
Collapse
Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sharon M Lutz
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alison A Galbraith
- Department of Pediatrics, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| |
Collapse
|
25
|
Suh DW, Shahraki K. Vision Screening Claims for Young Children in the United States. Pediatrics 2023; 152:e2023062804. [PMID: 37605873 DOI: 10.1542/peds.2023-062804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 08/23/2023] Open
Affiliation(s)
- Donny W Suh
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, California
| | - Kourosh Shahraki
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, California
| |
Collapse
|
26
|
Horwood A, Heijnsdijk E, Kik J, Sloot F, Carlton J, Griffiths HJ, Simonsz HJ. A population-level post-screening treatment cost framework to help inform vision screening choices for children under the age of seven. Strabismus 2023; 31:220-235. [PMID: 37870065 DOI: 10.1080/09273972.2023.2268128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
PURPOSE/BACKGROUND Visual acuity (VA) screening in children primarily detects low VA and amblyopia between 3 and 6 years of age. Photoscreening is a low-cost, lower-expertise alternative which can be carried out on younger children and looks instead for refractive amblyopia risk factors so that early glasses may prevent or mitigate the conditions. The long-term benefits and costs of providing many children with glasses in an attempt to avoid development of amblyopia for some of them needs clarification. This paper presents a framework for modeling potential post-referral costs of different screening models once referred children reach specialist services. METHODS The EUSCREEN Screening Cost-Effectiveness Model was used together with published literature to estimate referral rates and case mix of referrals from different screening modalities (photoscreening and VA screening at 2, 3-4 years and 4-5 years). UK 2019-20 published National Health Service (NHS) costings were used across all scenarios to model the comparative post-referral costs to the point of discharge from specialist services. Potential costs were compared between a) orthoptist, b) state funded ophthalmologist and c) private ophthalmologist care. RESULTS Earlier VA screening and photoscreening yield higher numbers of referrals because of lower sensitivity and specificity for disease, and a different case mix, compared to later VA screening. Photoscreening referrals are a mixture of reduced VA caused by amblyopia and refractive error, and children with amblyopia risk factors, most of which are treated with glasses. Costs relate mainly to the secondary care providers and the number of visits per child. Treatment by an ophthalmologist of a referral at 2 years of age can be more than x10 more expensive than an orthoptist service receiving referrals at 5 years, but outcomes can still be good from referrals aged 5. CONCLUSIONS All children should be screened for amblyopia and low vision before the age of 6. Very early detection of amblyopia refractive risk factors may prevent or mitigate amblyopia for some affected children, but population-level outcomes from a single high-quality VA screening at 4-5 years can also be very good. Total patient-journey costs incurred by earlier detection and treatment are much higher than if screening is carried out later because younger children need more professional input before discharge, so early screening is less cost-effective in the long term. Population coverage, local healthcare models, local case-mix, public health awareness, training, data monitoring and audit are critical factors to consider when planning, evaluating, or changing any screening programme.
Collapse
Affiliation(s)
- Anna Horwood
- Department of Psychology, University of Reading, Reading, UK
| | - Eveline Heijnsdijk
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jan Kik
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Frea Sloot
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Huibert J Simonsz
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
27
|
Ravid-Saffir A, Sella S, Ben-Eli H. Development and validation of a questionnaire for assessing parents' health literacy regarding vision screening for children: a Delphi study. Sci Rep 2023; 13:13887. [PMID: 37620666 PMCID: PMC10449776 DOI: 10.1038/s41598-023-41006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023] Open
Abstract
Preschool vision screening is recommended to reduce the incidence of amblyopia that persists into adulthood. However, parent's perceptions regarding the importance of screening and early intervention may constitute a significant barrier to seeking vision exams and pursuing treatment. The aim of this study is to develop and validate a questionnaire for assessing parent's awareness, perception and health literacy of children's vision tests. The questionnaire was developed using the Delphi method with experts from the fields of pediatric ophthalmology, optometry, orthoptics, pediatric medicine, social sciences and Mother and Child Health Care centers. Experts were provided with drafts of the questions iteratively in three rounds until a consensus was reached independently on the relevant items, coherently language and redundancies. For the first, second and third stages of the Delphi process, 17, 15 and 13 experts participated in the panel respectively. Validity was achieved by wide consensus among the panel on the relevance of each question, of 75%, 85% and 90%, for the three rounds respectively. Here we describe the final questionnaire, EYES: Evaluating Young-Children Eye health Survey, which includes 31 questions regarding demographics, ocular history, parental health literacy, and perceptions of vision and vison exams.
Collapse
Affiliation(s)
- Ahuva Ravid-Saffir
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Shulamit Sella
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
| | - Hadas Ben-Eli
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel.
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| |
Collapse
|
28
|
Harris N, Roche E, Lee P, Asper L, Wiseman N, Keel R, Duffy S, Sofija E. Vision screening outcomes of 4-5 year-olds reflect the social gradient. Clin Exp Optom 2023; 106:640-644. [PMID: 36038506 DOI: 10.1080/08164622.2022.2109947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/02/2022] [Accepted: 03/13/2022] [Indexed: 10/14/2022] Open
Abstract
CLINICAL RELEVANCE Children in socioeconomically disadvantaged communities often do not access follow-up eye care services when referred from vision screenings; whether this is due to lack of availability is not known. This paper highlights the need for vision and eye care for vulnerable children with practicing clinical optometrists well placed to provide vision care. BACKGROUND Vision impairments develop from a young age and may inhibit learning experiences and impact life outcomes. Vision screening to detect and refer vision abnormalities supports children in their education and prevents minor vision impairments from worsening. This research describes outcomes from a vision screening programme for 4- to 5-year-olds delivered in Queensland, Australia. METHODS The programme involved all prep children from participating schools in Queensland. Vision screening was conducted with the Parr 4 m Visual Acuity Test and Welch Allyn Spot Vision Screener. A cross-sectional study design was adopted. Descriptive data analyses explored the frequency of vision screening and referral outcomes. Inferential analyses examined associations between vision screening and referral outcomes with socio-economic indexes for areas (SEIFA) scores . RESULTS Of 71,003 prep students screened, 4,855 (6.8%) received a referral recommendation. A higher proportion of children who received a referral recommendation was from more disadvantaged locations (?2 = 109.16, p < 0.001). Of the students referred, 3,017 were seen by an eye health professional. Further vision assessment of students by an eye health professional revealed that 43.3% of the referred children were diagnosed with a vision abnormality, 18.9% had no vision abnormality and 37.7% had an 'undetermined' diagnosis. A higher proportion of children confirmed with a vision abnormality were from more disadvantaged locations (?2 = 52.27, p < 0.001). CONCLUSION It is important that vision screening programmes target disadvantaged populations and support families of children who require further health assessment to access health services.
Collapse
Affiliation(s)
- Neil Harris
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Elisha Roche
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Patricia Lee
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Lisa Asper
- School of Optometry and Vision Science, UNSW, Sydney, Australia
| | - Nicola Wiseman
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Rachel Keel
- Children's Health Queensland Hospital and Health Services, Brisbane, Australia
| | - Shelley Duffy
- Children's Health Queensland Hospital and Health Services, Brisbane, Australia
| | - Ernesta Sofija
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| |
Collapse
|
29
|
Oke I, Lutz SM, Hunter DG, Galbraith AA. Use and Costs of Instrument-Based Vision Screening for US Children Aged 12 to 36 Months. JAMA Pediatr 2023; 177:728-730. [PMID: 37213124 PMCID: PMC10203963 DOI: 10.1001/jamapediatrics.2023.0808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/26/2023] [Indexed: 05/23/2023]
Abstract
This cohort study examines patterns and out-of-pocket costs of instrument-based screening among children 12 to 36 months.
Collapse
Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sharon M. Lutz
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - David G. Hunter
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alison A. Galbraith
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Now with Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Massachusetts
| |
Collapse
|
30
|
Ly VV, Elhusseiny AM, Cannon TC, Brown CC. Race, poverty, and the lack of follow-up for Arkansas students that fail vision screenings: a cross-sectional study over 7 years. J AAPOS 2023; 27:129.e1-129.e6. [PMID: 37150435 DOI: 10.1016/j.jaapos.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To analyze rates of follow-up eye care for students that failed school vision screenings over a 7-year period in 238 Arkansas school districts. METHODS In this cross-sectional study, vision screening, demographic, socioeconomic, academic, and eye care provider data were collected. The main outcomes were referral rates, rates of follow-up eye care for students with failed vision screenings, and estimated associations between the rate of follow-up and school district and county-level characteristics, such as race, poverty, insurance coverage, academic achievement, and the number of eye care providers. RESULTS A total of 1,744,805 vision screenings over 7 academic years (2013-2020) were included. The average screening rate was 35.4% across the study years. The screening failure rate ranged from 8.0% to 9.4%. Two-thirds of districts had a follow-up rate between 20% and 50%. 91% had follow-up rates of <60%. School districts with higher concentrations of White students (P < 0.001), higher graduation rates (P = 0.024), higher percentages of students on government-assisted insurance (P = 0.035), and higher standardized scores (P < 0.001) had higher rates of follow-up. There were no statistically significant relationships between the rate of follow-up eye care and the number of school nurses per school district or the number of ophthalmologists or optometrists per county. CONCLUSIONS Arkansas children in our study cohort that failed vision screenings had inadequate follow-up eye care. Follow-up rates were associated with several key indicators of socioeconomic status.
Collapse
Affiliation(s)
- Victoria V Ly
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas; Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Thomas C Cannon
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Clare C Brown
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| |
Collapse
|
31
|
Monahan SR, Smith SM, Gammeltoft ET, Trivedi RH, Wilson ME, Bowsher JD, Peterseim MMW. The blinq™ Vision Screener in Detection of Amblyopia and Strabismus. Am J Ophthalmol 2023; 250:20-24. [PMID: 36682517 DOI: 10.1016/j.ajo.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE The blinq (Rebion Inc) is a new screening device designed to directly detect amblyopia and strabismus rather than amblyopia risk factors. We performed an independent assessment of the effectiveness of the blinq in detecting amblyopia and strabismus. DESIGN Prospective clinical validity analysis of a screening device based on sensitivity and specificity. METHODS Children presenting for examination in the pediatric ophthalmology clinic underwent screening with the blinq before examination by a pediatric ophthalmologist blinded to the screening results. Results of the blinq and examination findings of strabismus or amblyopia were compared. RESULTS In our cohort of 267 children with an average age of 6.3 years, the sensitivity of the blinq to detect amblyopia or any constant strabismus was 87.5% (78.2%-93.8%) and specificity was 51.3% (43.9%-58.7%). Using the previously described "appropriate referral gold standard" criteria, including children with intermittent strabismus and high refractive error, the sensitivity increased to 91.3% and the specificity to 63.2%. We found a high number of children (44 [16%]) upon whom the blinq timed out and were included as automatic referrals. CONCLUSIONS Our results support use of the blinq as a screening device to detect amblyopia and strabismus in children.
Collapse
Affiliation(s)
- Savannah Reaves Monahan
- From the Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - Samantha M Smith
- From the Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | | | - Rupal H Trivedi
- From the Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - M Edward Wilson
- From the Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - James D Bowsher
- From the Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | | |
Collapse
|
32
|
Chen W, Fu J, Sun A, Li L, Sun Y, Meng Z. Paediatric vision screening in Urban Lhasa from the Tibetan Plateau of Southwest China. Eye (Lond) 2023; 37:1336-1341. [PMID: 35668139 PMCID: PMC10170070 DOI: 10.1038/s41433-022-02126-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/05/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Few studies of vision screening in school-aged children were reported in Tibetan Plateau. We herein summarize the results of a mandatory vision screening conducted in young children in the Tibetan Plateau of Southwest China. METHODS The Lhasa Childhood vision Screening (LCVS) performed uncorrected distant visual acuity (UCVA) test on primary school students in urban Lhasa from July to September 2019. Pin-hole corrected VA (PCVA) was obtained for individuals with the UCVA less than 20/25. Decreased VA was defined for UCVA based on the American Academy of Pediatrics guidelines 2016 (UCVA < 20/32 for over 60 months). Visual impairment (VI), Mild VI, and moderate VI to blindness, defined as a PCVA less than 20/40, less than 20/40 to 20/63 and less than 20/63 in the better eye, respectively. RESULTS Overall, 34,848 children aged 9.03 ± 1.87 years fulfilled the screening with a response rate of 98.5%. 18,412 (52.8%) of the participants were males, and 30,531(87.6%) were Tibetan. The prevalence of decreased VA, VI, Mild VI, and moderate VI to blindness was 35.6%, 4.4%, 3.5%, and 1.0%, respectively. The prevalence of decreased VA in grade 1-6 students was 28.8%, 20.8%, 26.9%, 40.7%, 50.8%, 59.5%, respectively. The prevalence of VI in grade 1 to 6 students was 1.5%, 1.4%, 2.4%, 5.6%, 7.7% and 9.9%, respectively. CONCLUSION This study documented a relatively low prevalence of decreased VA and VI in Tibetan primary school students than other urban populations in China. An increasing trend of poor vision with grades was found.
Collapse
Affiliation(s)
- Weiwei Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Jing Fu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China.
| | - Ali Sun
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Lei Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Yunyun Sun
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Zhaojun Meng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| |
Collapse
|
33
|
Storey N, Stafford-Hudson K, Harrow I, Tow B, Seo JY, Vidis JD, Collins M. School-Based Delivery of Vision Care in Chicago Public Schools. J Sch Health 2023; 93:324-330. [PMID: 36401570 DOI: 10.1111/josh.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/06/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In 2012, Chicago Public Schools and the Chicago Department of Public Health partnered together to create the Chicago School-Based Vision Program (CSBVP). This ongoing, city-wide program provides school-based vision services (eye examinations, eyeglasses provision, and eye care referrals) to students with limited access. METHODS Descriptive analysis of the program operations from 2012 to 2020, including number of students served and exam findings during 2017-2020, as well as lessons learned and recommendations for reproducing the successes of the CSBVP in other contexts. RESULTS During its first 8 years, the CSBVP provided eye examinations to over 350,000 students. During the years 2017-2020, this included 126,238 eye exams and provision of eyeglasses to 73,751 students. CONCLUSIONS The CSBVP is built upon strong community and school relationships. The program offers vision services, equitably, to all students across the district. The lessons learned through the implementation of the CSBVP may provide guidance for future district-wide vision programs.
Collapse
Affiliation(s)
- Nathan Storey
- Johns Hopkins University School of Education, Baltimore, MD, USA
| | | | - Ilana Harrow
- XXX, (YYY), Chicago Public Schools, Chicago, IL, USA
| | - Berenice Tow
- Chicago Department of Public Health, Chicago, IL, USA
| | | | | | - Megan Collins
- Johns Hopkins University School of Education; Johns Hopkins Wilmer Eye Institute; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| |
Collapse
|
34
|
Oosthuizen I, Frisby C, Chadha S, Manchaiah V, Swanepoel DW. Combined hearing and vision screening programs: A scoping review. Front Public Health 2023; 11:1119851. [PMID: 36998276 PMCID: PMC10043331 DOI: 10.3389/fpubh.2023.1119851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
Background and aim The World Health Organization (WHO) estimates that 1.5 billion and 2.2 billion people have hearing and vision impairment, respectively. The burden of these non-communicable diseases is highest in low- and middle-income countries due to a lack of services and health professionals. The WHO has recommended universal health coverage and integrated service delivery to improve ear and eye care services. This scoping review describes the evidence for combined hearing and vision screening programs. Method A keyword search of three electronic databases, namely Scopus, MEDLINE (PubMed), and Web of Science, was conducted, resulting in 219 results. After removing duplicates and screening based on eligibility criteria, data were extracted from 19 included studies. The Joanna Briggs Institute Reviewer Manual and the Preferred Reporting Items for Systematic Reviews and Meta-analyzes (PRISMA) Extension for Scoping Reviews were followed. A narrative synthesis was conducted. Results Most studies (63.2%) were from high-income countries, with 31.6% from middle-income and 5.2% from low-income countries. The majority of studies (78.9%) involved children and the four studies reporting on adults all included adults above 50 years of age. Vision screening was most commonly performed with the "Tumbling E" and "Snellen Chart," while hearing was typically screened using pure tone audiometry. Studies reported referral rates as the most common outcome with sensitivity and specificity rates not reported in any included articles. Reported benefits of combined vision and hearing screenings included earlier detection of vision and hearing difficulties to support functioning and quality of life as well as resource sharing for reduced costs. Challenges to combined screening included ineffective follow-up systems, management of test equipment, and monitoring of screening personnel. Conclusions There is limited research evidence for combined hearing and vision screening programs. Although potential benefits are demonstrated, especially for mHealth-supported programs in communities, more feasibility and implementation research are required, particularly in low- and middle-income countries and across all age groups. Developing universal, standardized reporting guidelines for combined sensory screening programs is recommended to enhance the standardization and effectiveness of combined sensory screening programs.
Collapse
Affiliation(s)
- Ilze Oosthuizen
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States
- University of Pretoria, Pretoria, South Africa
| | - Caitlin Frisby
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States
- University of Pretoria, Pretoria, South Africa
| | - Shelly Chadha
- WHO Programme for Prevention of Deafness and Hearing Loss, World Health Organization, Geneva, Switzerland
| | - Vinaya Manchaiah
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States
- University of Pretoria, Pretoria, South Africa
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States
- UCHealth Hearing and Balance, University of Colorado Hospital, Aurora, CO, United States
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States
- University of Pretoria, Pretoria, South Africa
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States
- Ear Science Institute Australia, Subiaco, WA, Australia
| |
Collapse
|
35
|
Wang Y, Fu Q, Yu H. [Design of Adjustable Liquid Simulated Eye for Spherical Power Detection of Eccentric Photographic Vision Screening Instrument]. Zhongguo Yi Liao Qi Xie Za Zhi 2023; 47:140-144. [PMID: 37096465 DOI: 10.3969/j.issn.1671-7104.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A liquid simulated eye was designed to detect different spherical diopter indexes in the type inspection of medical equipment vision screening instrument. This liquid test simulation eye design is composed of three parts: lens, cavity and retina-imitation piston. By using the principle of geometric optics and the optical scattering effect of human retina, the relationship between the accommodation displacement of the designed adjustable liquid simulated eye and the spherical mirror power was calculated and analyzed. The designed liquid test simulated eye can be applied to vision screening instruments, computer refractometers and other optometry equipments based on photography principle in spherical lens measurement and so on.
Collapse
Affiliation(s)
- Yiqiao Wang
- Shanghai Institute of Medical Device Testing, Shanghai, 201318
- NMPA Key Laboratory for Medical Electrical Equipment, Shanghai, 201318
| | - Qiang Fu
- Shanghai Institute of Medical Device Testing, Shanghai, 201318
- NMPA Key Laboratory for Respiratory and Anaesthetic Equipment, Shanghai, 201318
| | - Hongyi Yu
- Shanghai Institute of Medical Device Testing, Shanghai, 201318
- NMPA Key Laboratory for Medical Electrical Equipment, Shanghai, 201318
| |
Collapse
|
36
|
Peterseim MMW, Trivedi RH, Monahan SR, Smith SM, Bowsher JD, Alex A, Wilson ME, Wolf BJ. Effectiveness of the Spot Vision Screener using updated 2021 AAPOS guidelines. J AAPOS 2023; 27:24.e1-24.e7. [PMID: 36642243 PMCID: PMC10251219 DOI: 10.1016/j.jaapos.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate the Spot Vision Screener according to updated 2021 AAPOS Vision Screening Committee guidelines for instrument-based pediatric vision screen validation. METHODS As part of an IRB-approved ongoing prospective study, children were screened with the Spot prior to a complete examination. RESULTS Spot screening was successful in 1,036 of 1,090 children (95%). Forty-eight percent of participants were referred for further screening using the Spot manufacturer guidelines, and 40% of all children were found to have a 2021 amblyopia risk factor or visually significant refractive error by gold standard examination. The Spot recommendation compared reasonably well to the 2021 criteria, with an overall sensitivity of 0.88 and a specificity of 0.78. Applying updated guidelines to the Spot for hyperopia, anisometropia, and astigmatism yielded moderate-to-poor sensitivity (0.27-0.77) but excellent specificity (>0.9). The area under the curve of the receiver operating characteristic analysis demonstrates overall good prediction performance for the Spot for each diagnosis-myopia, hyperopia, astigmatism, anisometropia (range, 0.87-0.97). Results of our study suggest increasing the instrument referral criterion for astigmatism from 1.5 D (manufacturer thresholds of the screener used in this study) to 2 D in older children. Decreasing the anisometropia cut-off from 1 D to 0.75 D would improve sensitivity from 0.59 to >0.8. CONCLUSIONS In our study population, the overall predictive ability of the Spot is good, with a sensitivity of 0.88 and a specificity of 0.78. We recommend specific device refractive referral criteria to maximize screening effectiveness using the updated AAPOS guidelines.
Collapse
Affiliation(s)
| | - Rupal H Trivedi
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Samantha M Smith
- Medical University of South Carolina, Charleston, South Carolina
| | - James D Bowsher
- Medical University of South Carolina, Charleston, South Carolina
| | - Anastasia Alex
- Medical University of South Carolina, Charleston, South Carolina
| | - M Edward Wilson
- Medical University of South Carolina, Charleston, South Carolina
| | - Bethany J Wolf
- Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
37
|
Kane SA, Gaspich M, Kane J, Weitzman SA, Hofeldt A. Automated vision screening of children using a mobile graphic device. Eye (Lond) 2023; 37:30-33. [PMID: 34873296 PMCID: PMC9829910 DOI: 10.1038/s41433-021-01862-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/01/2021] [Accepted: 11/12/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND/OBJECTIVE Can measuring interocular brightness disparity, acuity, and colour vision classify children with amblyopia? SUBJECTS/METHODS Two hundred eight subjects (3-14 years) were recruited for a prospective, observational protocol to measure interocular brightness disparity, uniocular acuities with and without a pinhole, and colour vision using an iPad. Subjects looked through polarizing filters and chose the brighter of two spaceships to measure interocular brightness disparity. The differential brightness of image pairs was varied through a staircase algorithm until equal brightness was perceived. Acuities and colour vision were tested with tumbling Es and AO-HRR colour plates, respectively. Unilateral amblyopia was later confirmed in two subjects. RESULTS Binocular brightness balance on the iPad detected amblyopes with 100% sensitivity and specificity. Using 20/30 as cutoff for normal acuity, 1 of the amblyopes was detected, and non-amblyopes were excluded by visual acuity pinhole testing. The mean difference between iPad and E-Chart visual acuities with pinhole was 0.02 logMAR with limits of agreement from -0.08 to +0.11 logMAR. iPad and printed plates Colour vision testing produced identical results. Testing times were brief and exit pleasure responses were positive. Mean and range testing times for Brightness Sense, Colour vision, and Visual Acuity were 32.7 s (range = 12-63 s), 52.8 min (range = 17-95 s), and 88.75 s (range = 41-188 s), respectively. CONCLUSIONS Interocular brightness disparity, acuity, and colour vision can be measured in children as young as 3 years old solely through playing a game on a mobile device. Interocular brightness disparity is a sensitive and specific method to detect unilateral amblyopia.
Collapse
Affiliation(s)
- Steven A Kane
- Vagelos College of Physicians and Surgeons, Columbia University, The Edward S. Harkness Eye Institute, 635 West 165th Street, Room 372, New York, USA.
| | | | | | - Sarah A Weitzman
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Albert Hofeldt
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| |
Collapse
|
38
|
Ulangca RA, Oh CJ, Atiga CR, Dunbar JA, Khazaeni LM. Reaching Target Communities in a Community Preschool Vision Screening Program. J Pediatr Ophthalmol Strabismus 2022; 59:375-379. [PMID: 35275775 DOI: 10.3928/01913913-20220210-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To develop a method to identify preschools with the greatest need for vision screening, correlations between socioeconomic status, preschool capacity, and rates of pediatric vision screenings performed by a community vision screening program were investigated. Geoinformatics mapping software was used to visually display the areas of greatest need. METHODS Vision screening data from a community vision screening program, child care facility data from California Department of Social Services, and income data from the U.S. Census Bureau through ArcGIS software (Esri) were collected. When possible, data were consolidated at the ZIP code level. Kolmogorov-Smirnov analysis was used to determine correlations between data elements. Licensed child care facilities were scored on a scale (from 1 to 5) based on the socioeconomic status of the ZIP code and the facility capacity. The scoring system prioritized larger facilities in lower income communities to most efficiently use vision screening program resources. RESULTS There was a positive correlation between the capacity of the child care facility and the median household income (P = .005). Second, we found a positive correlation between child care capacity and the median household income (P = .005). Licensed child care facilities were mapped and colored using GIS software according to their cumulative score. CONCLUSIONS Challenges to vision screening in under-served communities include the lack of child care facilities and smaller facility size. The use of a scoring system and mapping software can direct vision screening programs to reach a greater number of children with the most efficient use of resources. [J Pediatr Ophthalmol Strabismus. 2022;59(6):375-379.].
Collapse
|
39
|
Chung M, Robinson B, Fukuda M, Dunbar JA, Ulangca RA, Khazaeni LM. Access to Pediatric Eye Care Following Vision Screening. J Pediatr Ophthalmol Strabismus 2022; 59:369-374. [PMID: 35275779 DOI: 10.3928/01913913-20220210-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To quantify the accessibility of eye care providers from photoscreening centers within the vision screening region in relation to population density and median household income. METHODS Driving times between vision screening locations and eye care centers were mapped and analyzed using OpenStreetMap software (Open Street Map Foundation). U.S. Census Bureau data of population density and median household income were linked with screening centers using ArcGIS Online (Esri) to determine correlations with driving times. RESULTS A total of 290 driving times for 145 photo-screening centers, 147 optometrists, and 7 pediatric ophthalmologists were calculated and mapped. Median driving times from a photoscreening center to the nearest optometrist and ophthalmologist were 4.74 and 25.10 minutes, respectively, with 90% of the screening centers residing within 12.46 and 67.19 minutes of the nearest optometrist and ophthalmologist, respectively. Driving times to optometrists are far less than times to pediatric ophthalmologists due to the greater number of optometrists. Decreasing driving times with increasing population and median household income indicate the concentration of optometrists and pediatric ophthalmologists within urbanized areas. CONCLUSIONS Most photoscreening centers reside within 5 and 70 minutes of the nearest optometrist and pediatric ophthalmologist, respectively. Driving times indicate the region's greater accessibility to optometrists than to pediatric ophthalmologists. Eye care centers tend to be localized within urbanized areas with higher population densities and higher median household incomes. [J Pediatr Ophthalmol Strabismus. 2022;59(6):369-374.].
Collapse
|
40
|
Atta S, Zaheer HA, Clinger O, Liu PJ, Waxman EL, McGinnis-Thomas D, Sahel JA, Williams AM. Characteristics Associated with Barriers to Eye Care: A Cross-Sectional Survey at a Free Vision Screening Event. Ophthalmic Res 2022; 66:170-178. [PMID: 36063808 PMCID: PMC9985665 DOI: 10.1159/000526875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/18/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Social determinants of health can limit access to regular eye care, but their role in ophthalmology is underexamined. The purpose of this study is to assess the relationship between patient characteristics and self-reported barriers to eye care. METHODS This anonymous, cross-sectional survey was conducted at a 2-day free eye clinic event in Pittsburgh, Pennsylvania. Adult patients presenting for vision screening were eligible to participate. Patient characteristics (demographics, health status) and self-reported barriers to eye care were collected. Predictors of barriers to eye care were analyzed using binary logistic regression. RESULTS Of 269 eligible, consecutive patients approached for survey completion, 183 comprised the volunteer sample. The 183 participants (105 female patients [59%]) had a mean (standard deviation) age of 53 (15) years and generally self-identified as Black (74, 46%) or White (67, 41%). While a third reported having no health insurance (60, 34%), the remaining two-thirds of participants had public (84, 48%) or private coverage (34, 19%). Three-quarters of respondents reported at least one barrier to receiving regular eye care (136, 76%), most commonly medical costs (89, 50%) and insurance issues (73, 41%). Not having health insurance or vision insurance was strongly associated with reporting at least one barrier to care (OR: 5.00, p = 0.002, and OR: 7.46, p < 0.001, respectively). Those with self-reported eye disease were more likely to report transportation difficulties (OR: 4.45, p = 0.013), and employed participants reported difficulty getting time off work to attend eye exams (OR: 7.73, p = 0.002). Finally, compared to Black race, White race was associated with a higher likelihood of reporting any barrier to care (OR: 2.79, p = 0.013). CONCLUSION Three-quarters of vision screening attendees reported at least one barrier to regular eye care, most commonly medical costs and insurance.
Collapse
Affiliation(s)
- Sarah Atta
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Haniah A Zaheer
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA,
| | - Owen Clinger
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Peggy J Liu
- Department of Business Administration, Marketing and Business Economics Area, Joseph M. Katz Graduate School of Business, Pittsburgh, Pennsylvania, USA
| | - Evan L Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Dana McGinnis-Thomas
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Andrew M Williams
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
41
|
French AN, Murphy E, Martin F, de Mello N, Rose KA. Vision Screening in Children: The New South Wales Statewide Eyesight Preschooler Screening Program. Asia Pac J Ophthalmol (Phila) 2022; 11:425-433. [PMID: 36179336 DOI: 10.1097/apo.0000000000000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim was to investigate universality of access, screening rate, and outcomes from the New South Wales (NSW) Statewide Eyesight Preschooler Screening (StEPS) over the period of 2009 to 2016. DESIGN Cross-sectional, observational study. METHODS The StEPS program provides vision screening to 4-year-old children residing in NSW and is administered within Local Health Districts (LHDs). Visual acuity (VA) was examined by trained lay and nurse screeners using HOTV logMAR. Children who had VA <6/9-2 were referred to local practitioners while those with VA <6/18 were referred to public hospital pediatric ophthalmic outpatient clinics where available. Activity data were collected by NSW Health and screening rates determined from population projections of 4-year-olds per LHD based on adjusted 2014 Census data. To determine factors impacting screening and referral rates, a random effects panel analysis was undertaken. RESULTS A total of 719,686 (96.4%) NSW 4-year-old children were offered StEPS vision screening between 2009 and 2016, 84% accepted and 564,825 children (75.6%) were screened. The screening rate increased from 67.3% in 2009 to 74.5% in 2016, with an 80% target reached for 3 consecutive years from 2013 to 2015. Of those screened, 19.2% were referred to an eye health professional or advised to have a vision retest in 12 months. This referral rate remained steady over the period studied, with little variation between metropolitan, and rural and regional LHDs. CONCLUSIONS StEPS is an ideal service model for preschool vision screening providing coverage that is comparable to school-based screening programs and at an age likely to facilitate optimal treatment outcomes.
Collapse
Affiliation(s)
- Amanda N French
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Elisabeth Murphy
- Child and Family Health, Health and Social Policy Branch, NSW Ministry of Health, Sydney, NSW, Australia
| | - Frank Martin
- Sydney Children's Hospital Network, Sydney, NSW, Australia
- Department of Paediatrics and Child Health and Ophthalmology, University of Sydney, Sydney, NSW, Australia
| | - Nguyet de Mello
- Child and Family Health, Health and Social Policy Branch, NSW Ministry of Health, Sydney, NSW, Australia
| | - Kathryn A Rose
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| |
Collapse
|
42
|
McGwin G, Owsley C. Vision Screening for Motor Vehicle Collision Involvement among Older Drivers. Ophthalmology 2022; 129:1022-1027. [PMID: 35483493 PMCID: PMC10038163 DOI: 10.1016/j.ophtha.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate the epidemiologic association between visual acuity and other measures of visual function and motor vehicle collisions (MVCs) as well as their performance as screening tests for MVCs. DESIGN Prospective cohort study. PARTICIPANTS A total of 2000 licensed drivers aged 70 years and older who resided in the environs of Jefferson County, Alabama. METHODS Visual acuity, contrast sensitivity, useful field of view, Motor-free Visual Perception Test, and visual field sensitivity were measured at a baseline visit. Study participants were followed for up to 4 years for the occurrence of MVC involvement. Area under the curve (AUC), sensitivity, and specificity were calculated to determine the screening performance of each visual function measure with respect to MVC occurrence. Poisson regression was used to estimate rate ratios (RRs) for the association between each visual function measure and MVC occurrence. MAIN OUTCOME MEASURES Police-reported MVCs. RESULTS For all visual function measures, the AUC values were only slightly higher than 0.50; additionally, none of the measures exhibited adequate values for both sensitivity and specificity (i.e., > 80%). For all visual function measures except visual acuity, there were statistically significant positive RRs for the association between vision impairment and MVC occurrence, although the magnitude of the associations was weak (i.e., < 2.0). CONCLUSIONS The negative impact of involuntary driving cessation on mobility and the associated mental health implications likely outweigh the safety benefit of vision screening. Alternative approaches to improving older driver safety should be considered.
Collapse
Affiliation(s)
- Gerald McGwin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham; Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham.
| | - Cynthia Owsley
- Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham
| |
Collapse
|
43
|
Matsuo T, Matsuo C, Kayano M, Mitsufuji A, Satou C, Matsuoka H. Photorefraction with Spot Vision Screener versus Visual Acuity Testing as Community-Based Preschool Vision Screening at the Age of 3.5 Years in Japan. Int J Environ Res Public Health 2022; 19:ijerph19148655. [PMID: 35886507 PMCID: PMC9321534 DOI: 10.3390/ijerph19148655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/04/2022]
Abstract
Nationwide in Japan, a community-based vision-screening program in 3.5-year-old children is conducted in three steps: questionnaires and home visual acuity testing as the primary screening; visual acuity testing by nurses and pediatricians’ inspection in community health centers as the secondary screening; and examinations by ophthalmologists as the tertiary screening. In this study, we introduced photorefraction with a Spot vision screener in addition to visual acuity testing to answer the clinical question of whether photorefraction could better detect eye diseases and potentially replace visual acuity testing. Photorefraction was performed on 813 consecutive 3.5-year-old children in a center. The children were sent to tertiary examinations, which were based on the Spot vision screener standard, in addition to the visual acuity testing standard: failure in either eye to pass 0.5 visual acuity in a center. A notice to visit ophthalmologists was issued for 95 children (11%), and documents with the diagnosis were sent back to the Heath Office for 76 children (80%). The rate of children with anisometropic or ametropic amblyopia or accommodative esotropia as treatment-requiring diseases was highest in cases of no pass at both standards (10/15 = 66%), and higher in cases of no pass only at the Spot vision screener standard (13/45 = 28%), compared with cases of no pass only at the visual acuity testing standard (6/33 = 18%, p = 0.0031). Photorefraction, in addition to visual acuity testing and inspection led to additional eye diseases detection at 3.5 years. Visual acuity testing at home would not be omitted in the introduction of photorefraction.
Collapse
Affiliation(s)
- Toshihiko Matsuo
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama 700-8558, Japan;
- Department of Ophthalmology, Okayama University Hospital, Okayama 700-8558, Japan
- Correspondence:
| | - Chie Matsuo
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama 700-8558, Japan;
| | - Masami Kayano
- Okayama City Government Health Office, Okayama 700-8546, Japan; (M.K.); (A.M.); (C.S.); (H.M.)
| | - Aya Mitsufuji
- Okayama City Government Health Office, Okayama 700-8546, Japan; (M.K.); (A.M.); (C.S.); (H.M.)
| | - Chiyori Satou
- Okayama City Government Health Office, Okayama 700-8546, Japan; (M.K.); (A.M.); (C.S.); (H.M.)
| | - Hiroaki Matsuoka
- Okayama City Government Health Office, Okayama 700-8546, Japan; (M.K.); (A.M.); (C.S.); (H.M.)
| |
Collapse
|
44
|
Coleman AL, McLeod SD. Screening for Impaired Visual Acuity in Older Adults. JAMA 2022; 327:2090-2091. [PMID: 35608845 DOI: 10.1001/jama.2022.6688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Anne L Coleman
- Stein and Doheny Eye Institutes, David Geffen School of Medicine, University of California, Los Angeles
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Stephen D McLeod
- Department of Ophthalmology, School of Medicine, University of California, San Francisco
- Francis I. Proctor Foundation, University of California, San Francisco
- American Academy of Ophthalmology, San Francisco, California
| |
Collapse
|
45
|
|
46
|
Opioids, Vision Screening, Altered Mental Status, Hemochromatosis, Osteomyelitis, Renal Disease. Am Fam Physician 2022; 105:362. [PMID: 35426640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
|
47
|
Burton E, Assi L, Vongsachang H, Swenor BK, Srikumaran D, Woreta FA, Johnson TV. Demographics, clinical interests, and ophthalmology skills confidence of medical student volunteers and non-volunteers in an extracurricular community vision screening service-learning program. BMC Med Educ 2022; 22:143. [PMID: 35246114 PMCID: PMC8894556 DOI: 10.1186/s12909-022-03194-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 02/22/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND Medical school curricular hours dedicated to ophthalmology are low and declining. Extracurricular ophthalmology activities, such as participation in community vision screenings, may serve an important adjunctive role in medical school curricula. The Johns Hopkins University (JHU) Vision Screening In Our Neighborhoods (ViSION) Program is an example of a voluntary medical student-directed community service-learning program. METHODS We used a mixed-methods cross-sectional approach, including an online survey and semi-structured interviews. JHU School of Medicine students enrolled in MD or MD/PhD programs during the 2019-2020 academic year were surveyed regarding demographics, career and service interests, involvement in ophthalmology-related activities, and confidence in their ophthalmology-related skills. Survey responses were compared between ViSION volunteers and non-volunteers using Fisher's exact chi-square tests. Semi-structured interviews were conducted via webconference with 8 prior or current ViSION volunteers and responses analyzed using inductive thematic analysis. Data were collected when ViSION volunteers were in variable stages of their medical education and involvement with the ViSION program. RESULTS A total of 118 medical students were included, representing an overall response rate of 24.6% of JHU medical students. ViSION volunteers reported greater involvement in ophthalmology-related research (42% vs. 4%, p < 0.001), intent to apply to ophthalmology residency programs (35% vs. 1%, p = 0.001), and confidence with multiple ophthalmology knowledge and clinical skill domains. In particular, ViSION volunteers were more likely to feel confident estimating cup-to-disc ratio using direct ophthalmoscopy (20% vs. 0%, p < 0.001). In open-ended survey and interview questions, most volunteers attributed at least some degree of their ophthalmology skill development and desire to pursue ophthalmology and public health careers to their ViSION experience. CONCLUSIONS Medical students who volunteered with a student-led community vision screening program were more likely to have a prior interest in ophthalmology than those who did not volunteer, but only 1/3 of volunteers planned to pursue a career in ophthalmology. Overall, volunteers reported higher confidence performing ophthalmology-related clinical skills, suggesting that student-led community vision screening programs may provide an important avenue for medical students to explore public health aspects of ophthalmology, while practicing ophthalmology exam skills and learning about common ophthalmic pathologies, regardless of their career intentions.
Collapse
Affiliation(s)
- Eleanor Burton
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lama Assi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA
| | | | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA
| | - Thomas V Johnson
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA.
| |
Collapse
|
48
|
Metsing TI, Jacobs WE, Hansraj R. Vision screening as part of the school health policy in South Africa from the perspective of school health nurses. Afr J Prim Health Care Fam Med 2022; 14:e1-e8. [PMID: 35144447 PMCID: PMC8905394 DOI: 10.4102/phcfm.v14i1.3172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 11/05/2022] Open
Abstract
Background Vision screenings of school-going children are essential in the early detection of visual anomalies common in different age categories, which may negatively affect their academic ability and social development. Hence, their inclusion in school health policies is imperative. The aim of this study was to assess the implementation of vision screening protocols in the current Integrated School Health Screening policy of South Africa from the perspective of school health personnel. Aim The study sought to explore the perceptions, experiences and attitudes of the school health nurses on vision screenings included as part of the school health screenings in Gauteng province (South Africa). Setting This study was located across three public healthcare facilities across Gauteng at primary healthcare levels. Methods Three teams of 13 school health personnel from three primary healthcare facilities in the district of Ekurhuleni were invited to participate in the study. Focus group interviews were conducted for generating information on collective opinions and the rationale behind their views. Results Results of the collected qualitative data revealed challenges related to training, vision screening tests, referral criteria and follow-ups or referral pathways. In addition, further challenges reported were related to communication, time, space and consent forms not signed by the parents. Conclusion Improved cohesion and communication between all role players will enable reasonable and professional provision of validated vision screening services that have the best chance of early detection of children with vision anomalies to negate possible adverse effects on their scholarly performance.
Collapse
Affiliation(s)
- Thokozile I Metsing
- Discipline of Optometry, Faculty of Health Sciences, University of Johannesburg, Johannesburg.
| | | | | |
Collapse
|
49
|
Collins ME, Guo X, Repka MX, Neitzel AJ, Friedman DS. Lessons Learned From School-Based Delivery of Vision Care in Baltimore, Maryland. Asia Pac J Ophthalmol (Phila) 2022; 11:6-11. [PMID: 35066521 DOI: 10.1097/apo.0000000000000488] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT In an effort to address health care disparities in pediatric eye care, school-based vision programs have been established. These programs, while not universally available, have been established at individual schools or across school districts in at least 20 states in the United States (US). They play a critical role for students who are not accessing eye care, especially in disadvantaged communities. In the US, school-based vision programs often provide vision screenings, eye exams, and eyeglasses directly in the school setting. The rationale for involving schools in vision care delivery is the recognition of the inter-relatedness between health and education, including how poor vision can impact learning. Vision for Baltimore is a citywide school-based vision program that provides vision care for all Baltimore City Public Schools elementary and middle school students (age range 4 to 16 years). The goal of this paper is to summarize lessons learned from our work on clinical outcomes from screenings and eye exams, the academic impact of Vision for Baltimore, and qualitative work about consent challenges and stakeholder engagement. While school-based vision programs may vary in operations, we hope the lessons learned through our work may help demonstrate the transformative impact on vision and learning, as well as the importance of addressing stakeholder needs to maximize impact and ensure program sustainability.
Collapse
Affiliation(s)
- Megan E Collins
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, US
- School of Education, Johns Hopkins University, Baltimore, MD, US
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, US
| | - Xinxing Guo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Amanda J Neitzel
- School of Education, Johns Hopkins University, Baltimore, MD, US
| | - David S Friedman
- Massachusetts Eye and Ear, Glaucoma Center of Excellence, Harvard Medical School, Boston, MA, US
| |
Collapse
|
50
|
Kulp MT, Ciner E, Ying GS, Candy TR, Moore BD, Orel-Bixler D. Vision Screening, Vision Disorders, and Impacts of Hyperopia in Young Children: Outcomes of the Vision in Preschoolers (VIP) and Vision in Preschoolers - Hyperopia in Preschoolers (VIP-HIP) Studies. Asia Pac J Ophthalmol (Phila) 2022; 11:52-58. [PMID: 35044337 PMCID: PMC8813881 DOI: 10.1097/apo.0000000000000483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT This review summarizes clinically relevant outcomes from the Vision in Preschoolers (VIP) and VIP-Hyperopia in Preschoolers (VIP-HIP) studies. In VIP, refraction tests (retinoscopy, Retinomax, SureSight) and Lea Symbols Visual Acuity performed best in identifying children with vision disorders. For lay screeners, Lea Symbols single, crowded visual acuity (VA) testing (VIP, 5-foot) was significantly better than linear, crowded testing (10-foot). Children unable to perform the tests (<2%) were more likely to have vision disorders than children who passed and should be referred for vision evaluation. Among racial/ethnic groups, the prevalence of amblyopia and strabismus was similar while that of hyperopia, astigmatism, and anisometropia varied. The presence of strabismus and significant refractive errors were risk factors for unilateral amblyopia, while bilateral astigmatism and bilateral hyperopia were risk factors for bilateral amblyopia. A greater risk of astigmatism was associated with Hispanic, African American, and Asian race, and myopic and hyperopic refractive error. The presence and severity of hyperopia were associated with higher rates of amblyopia, strabismus, and other associated refractive error. In the VIP-HIP study, compared to emmetropes, meaningful deficits in early literacy were observed in uncorrected hyperopic 4- and 5-year-olds [≥+4.0 diopter (D) or ≥+3.0 D to ≤+6.0 D associated with reduced near visual function (near VA 20/40 or worse; stereoacuity worse than 240")]. Hyperopia with reduced near visual function also was associated with attention deficits. Compared to emmetropic children, VA (distance, near), accommodative accuracy, and stereoacuity were significantly reduced in moderate hyperopes, with the greatest risk in those with higher hyperopia. Increasing hyperopia was associated with decreasing visual function.
Collapse
Affiliation(s)
| | - Elise Ciner
- Pennsylvania College of Optometry at Salus University, Elkins Park, PA, US
| | | | - T Rowan Candy
- Indiana University School of Optometry, Bloomington, IN, US
| | | | | |
Collapse
|