The role of vision screening and classroom illumination in the vision health of Korean school children.
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Adolescent↗
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Results for “Vision Screening”
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Comparison of the HOTV and Lea Symbols charts for preschool vision screening.
PURPOSE: Two preliterate acuity charts, the Lea Symbol chart and the HOTV chart, were compared prospectively in an established preschool vision screening program. The charts were compared by measuring time required to test, reliability coefficients, and the percentage of children testable with each chart. METHODS AND MATERIALS: Seven hundred and seventy-seven 3- to 5-year-old children were randomized to four screening sequences that determined the order of chart use. Each child was screened on two occasions within 6 weeks. Testing was performed at 10 feet, and optotypes were not isolated for testing. RESULTS: Mean test time was significantly less for older children, but was not related to the chart used. Reliability coefficients were similar for the Lea Symbols and the HOTV charts. The percentage of children testable by each chart improved with increased age of the child. More 3 year olds were testable with the Lea Symbols chart compared to the HOTV chart (92% versus 85%, P = .05). CONCLUSIONS: Vision screening with either chart was more rapid and more frequently achieved with 4- and 5-year-old children compared with the 3 year olds. For the population as a whole, each chart gave similar results. Among the 3 year olds, however, testability rates were better for the Lea Symbols chart. The Lea Symbols chart is an acceptable option for preschool vision screening, and may be more efficacious than the HOTV chart for screening 3-year-old children.
Child, Preschool↗
The True Daylight Illuminator (TDI): a less expensive source of illumination for color vision screening.
This experiment was designed to examine the feasibility of using the True Daylight Illuminator (TDI) as an illumination option for conducting color vision screening with the Ishihara Test(s). The MacBeth Easel Lamp was designed to provide proper illumination for performing color vision screening with a variety of pseudoisochromatic (PIC) plate tests including the Ishihara. However, over the years, the MacBeth Lamp has become so expensive that many smaller programs cannot afford to purchase one. This problem has promoted the use of alternate light sources that have had a deleterious effect on test results and in some instances contributed to job discrimination. Recently the MacBeth Division of the Kollmorgan Corporation discontinued the manufacture of the MacBeth Lamp due to lack of demand. Thus, it is important to find an inexpensive illumination option for conducting color vision screening. Two groups of subjects were used to compare test results for the 24-plate edition of the Ishihara Test using both the MacBeth Lamp and the True Daylight Illuminator. The first group contained 45 subjects with inherited color defective vision. The second group was made up of 30 color normals. The Nagel anomaloscope was used to confirm the color vision status of the subjects in both groups. Statistics to test the significance of differences between group means clearly demonstrated that there were no significant differences between the mean error scores of the two groups for these two pieces of equipment. Thus, it was concluded that the TDI can be used in lieu of the MacBeth Easel Lamp for screening color vision with the Ishihara test.
Adolescent↗
Comparison of preschool vision screening tests as administered by licensed eye care professionals in the Vision In Preschoolers Study.
PURPOSE: To compare 11 preschool vision screening tests administered by licensed eye care professionals (LEPs; optometrists and pediatric ophthalmologists). DESIGN: Multicenter, cross-sectional study. PARTICIPANTS: A sample (N = 2588) of 3- to 5-year-old children enrolled in Head Start was selected to over-represent children with vision problems. METHODS: Certified LEPs administered 11 commonly used or commercially available screening tests. Results from a standardized comprehensive eye examination were used to classify children with respect to 4 targeted conditions: amblyopia, strabismus, significant refractive error, and unexplained reduced visual acuity (VA). MAIN OUTCOME MEASURES: Sensitivity for detecting children with > or =1 targeted conditions at selected levels of specificity was the primary outcome measure. Sensitivity also was calculated for detecting conditions grouped into 3 levels of importance. RESULTS: At 90% specificity, sensitivities of noncycloplegic retinoscopy (NCR) (64%), the Retinomax Autorefractor (63%), SureSight Vision Screener (63%), and Lea Symbols test (61%) were similar. Sensitivities of the Power Refractor II (54%) and HOTV VA test (54%) were similar to each other. Sensitivities of the Random Dot E stereoacuity (42%) and Stereo Smile II (44%) tests were similar to each other and lower (P<0.0001) than the sensitivities of NCR, the 2 autorefractors, and the Lea Symbols test. The cover-uncover test had very low sensitivity (16%) but very high specificity (98%). Sensitivity for conditions considered the most important to detect was 80% to 90% for the 2 autorefractors and NCR. Central interpretations for the MTI and iScreen photoscreeners each yielded 94% specificity and 37% sensitivity. At 94% specificity, the sensitivities were significantly better for NCR, the 2 autorefractors, and the Lea Symbols VA test than for the 2 photoscreeners for detecting > or =1 targeted conditions and for detecting the most important conditions. CONCLUSIONS: Screening tests administered by LEPs vary widely in performance. With 90% specificity, the best tests detected only two thirds of children having > or =1 targeted conditions, but nearly 90% of children with the most important conditions. The 2 tests that use static photorefractive technology were less accurate than 3 tests that assess refractive error in other ways. These results have important implications for screening preschool-aged children.
Amblyopia↗
Preschool vision screening for amblyopia and strabismus. Programs, methods, guidelines, 1983.
Amblyopia and strabismus, which afflict at least 5% of children, require treatment early in life for best visual results. At present, many such children are treated late or not at all. Mass screening at preschool age, and perhaps ultimately of infants, appears the only viable solution to this problem. To ascertain the present status of preschool screening in the United States, on-site visits, mail questionnaires and telephone interviews were used to study existing preschool vision screening programs at the federal, state and private organization levels. We estimate that, at most, 21% of preschool children receive any form of vision screening. Only two states, Michigan and Minnesota, have legislated requirements for such screening. Several organizations have attempted to establish screening guidelines, with suggestions of specific test and referral criteria. These guidelines are reviewed. The guidelines are of particular interest because screening programs following them typically indicate far lower prevalence rates than most studies indicate actually exist, suggesting that the guidelines result in underreferrals. In order to assess this matter, vision screening methods appropriate for preschoolers or infants, based on current evidence, are reviewed. Stereoscopic testing, utilizing a random dot stereogram format, appears the best instrument available for amblyopia and strabismus screening, but large scale comparative studies of the different test methods are needed to arrive at a final determination. Suggestions are made for the physician interested in initiating preschool vision screening programs.
Amblyopia↗
The NYSOA vision screening battery--a total approach.
A vision screening battery has been developed by a project team of the New York Optometric Association. This battery screens those visual skills that are important to the academic task demands. This battery is so organized that it can be utilized without the need of a vision care professional. A pre-pilot study was conducted by the New York State Optometric Association and the New York State Educational Department. This battery was a far more sensitive detector of visual problems related to learning than the Snellen alone. This battery was efficiently and effectively utilized by educators and parents without the need of a vision care professional. The battery and statistical study are discussed.
Child↗
Results of community-based vision screenings of older adults in the Birmingham, Alabama metropolitan area.
BACKGROUND: Two-hundred one adults age 65 and older underwent vision screening at community senior centers and nutrition sites in the Birmingham, Alabama metropolitan area. METHODS: Using a multiple-test format recommended by the American Optometric Association, 89 percent of those screened failed. Reduction in visual acuity associated with anterior segment abnormalities was the most common reason for failure. Almost half (48 percent) of the overall population had less than 20/50 distance acuity in both eyes. Median visual acuity for the population was 20/50. Median visual acuity decreased with age from 20/40 at age 65 to 20/80 for those over the age of 85, while only 8 percent were legally blind. RESULTS: Results show that a large percentage of older adults have reduced vision without being legally blind and will fail vision screening. CONCLUSIONS: Given the high failure rate, the value of this type of vision screening is questionable.
Aged↗
Vision screening of individuals with severe or profound mental retardation.
A vision screening program was established at a regional center for individuals with severe or profound mental retardation. The visual acuity measure used was the acuity card procedure, a type of forced-choice preferential looking. Acuity values were evaluated in terms of test-retest reliability as well as inter- and intraobserver reliability. Acuity results compared favorably to those obtained in less compromised populations, and we conclude that the acuity card procedure is a useful screening tool for this population. Suggestions for its application in evaluating functional vision were also discussed.
Adolescent↗
Vision screening of illiterate populations.
To assess the amount of reduced vision in a population is an important public health matter, especially in areas where blinding diseases are endemic. Testing visual acuity is, however, a complex problem when a major part of the population is illiterate. The best-known test of vision is the E-test, but this produces the problem of untestability in illiterate populations.The introduction of the Sjögren hand-test as an alternative to the E-test for vision screening of unselected illiterate populations in West Africa resulted in a highly significant reduction of untestability. For certain vision levels it is possible to correlate the results of the hand-test directly with those of the E-test. The hand-test is less well defined than the E-test, but has important advantages for the purpose of vision screening of illiterate populations.
Adolescent↗
Preschool vision screening in pediatric practice: a study from the Pediatric Research in Office Settings (PROS) Network. American Academy of Pediatrics.
In this cross-sectional study, the vision-screening process is described for 8417 children aged 3 to 5 seen for health supervision in a group of 102 pediatric practices in 23 states and Puerto Rico. Three hundred forty children who failed screening (63% of those who failed) were followed up 2 months after initial screening. The sample was 52% male, 86% white, 9% black, 3% Hispanic, and 1% Asian. Vision screening was attempted on 66% of children overall. Pediatricians' reasons for not screening were "not routine" (44%), "too young" (40%), and "screening done previously" (17%). Younger children were less likely to be screened than older children (39% of those aged 3), and Hispanics were less likely to be screened than other ethnic groups (P less than .001). Thirty-three percent of children received no screening for latent strabismus. Two months later, 50% of parents whose child had failed a vision test were unaware of this fact on questionnaire follow-up. Eighty-five percent of children referred to an eye specialist had made or kept an appointment. It is concluded that pediatricians need to increase vision screening among younger preschool children and communicate more effectively to parents the results of screening failure.
Amblyopia↗
Vision screening project--Eilat, Israel.
The author relates his experience in developing and conducting a vision screening program for 1,522 children between age one to six of Eilat, Israel. He describes a method similar to the Modified Clinical Technique which he adapted to the specific circumstances and devised a simplified two-minute procedure which proved very effective in use. The author clearly demonstrates the need and advantage of a professionally conducted program with cooperation of the Yosepthal Hospital, the public health nurses and the teachers of the Eilat school system. The results indicate a low overall referral rate of 7-1/2%, probably due to the early and careful attention most children receive. His conclusions support the importance of a vision screening program and substantiate the value of a Modified Clinical Screening procedure.
Child↗
Paediatric community vision screening with combined optometric and orthoptic care: a 64-month review.
We report a new model of community-based secondary vision screening and demonstrate that a high proportion of children can be effectively managed in such a clinic without referral to the hospital eye service (HES). We performed a 64-month retrospective study of a secondary vision screening clinic providing the combined skills of an optometrist and orthoptist in a community setting. Particular attention was given to the diagnosis and management of children not referred to the HES. During this period, 1755 children were sent appointments and 74% (1300) attended the clinic. The community orthoptist and school nurses referred 53% of the patients and health visitors, general practitioners and community medical officers made 32% of the clinic referrals. Spectacles were prescribed for 41% of the children and 8% were prescribed patching. Sixteen per cent of the children were referred on to the HES. This model of care using the combined expertise of the orthoptist and optometrist is able to diagnose and manage the majority of children who have failed primary vision screening and avoids unnecessary referrals to the HES.
Ambulatory Care↗
Vision screening practices in central Iowa: a follow-up evaluation.
In response to data from the initial survey published in October 2001, interventions were developed to increase vision screening knowledge and promote use of the Iowa Vision Screening Program Guidelines. The purpose of this evaluation was to measure differences in practice after interventions, including attendance at a half-day workshop and practice session. Results of the study indicate that participants of the workshop and practice session were more likely to conduct yearly distance and near vision, and depth perception screening. In addition, they were more likely to use the recommended screening instruments for distance and near vision, and depth perception. They were also much more likely to use recommended referral criteria for all types of screening and to have changed some aspect of their vision screening practice in the past year. Results are presented with implications for school nursing practice.
Child↗
Vision screening of primary school children.
This week's report in Nursing Standard (p44) looks at the issues of vision screening for primary school children. In this article, the author describes how she carried out a study to explore whether there was an increase in the number of primary school children failing vision screening tests. During this exploratory study, the visual screening records of 3,447 children from eight Glasgow primary schools were examined. From 1989/90 and 1994/95 onwards, the author observed an increase in the number of children failing the visual acuity screening test. This article describes the study and the possible reasons for the findings.
Child↗
Results from a pediatric vision screening and its ability to predict academic performance.
BACKGROUND: Children attending three New York City public schools were screened in 1998-1999. These three schools were previously screened in 1996-1997. This allowed comparison of referral rates between the two years. In addition, we were able to follow individual children who attended the schools between these two years. Finally, using results of the citywide achievement test scores, we were able to correlate the specific vision screening tests with academic performance. METHODS: Results from each of the years were analyzed to determine if any trend existed in referral frequency and screening procedures failed. Referral criteria were failure on one or more of the screening battery tests. In addition, the children's vision screening performance was compared with their reading achievement test scores. Vision screening results of children in both the top 25% and bottom 25% of the class were evaluated and academic improvement based on optometric intervention was also monitored. RESULTS: Twenty-nine percent (29%) of children screened in 1996-1997 were referred. This matched the 25% referral rate found in 1998-1999. The screenings in 1998-1999 yielded a higher referral rate (35%) in functional vision tests as opposed to visual acuity screening procedures than the screening in 1996-1997 (30%). The King Devick Eye Movement Test and the hyperopia assessment screening showed significant correlation with citywide achievement test scores. Both these tests were significant for predicting those students in the lower 25% of the class for all grades in both years of the screenings. CONCLUSIONS: Early detection and remediation increased the potential for more effective learning in a small sample size of 25 children. Further studies involving larger sample sizes are indicated.
Child↗
Preschool vision screening tests administered by nurse screeners compared with lay screeners in the vision in preschoolers study.
PURPOSE: To compare the performance of nurse screeners with that of lay screeners in administering preschool vision screening tests. METHODS: Trained nurse and lay screeners administered the Retinomax Autorefractor (Right Manufacturing, Virginia Beach, VA), SureSight Vision Screener (Welch Allyn, Inc., Skaneateles Falls, NY), crowded Linear Lea Symbols visual acuity (VA) test at 10 ft (Precision Vision, Inc., La Salle, IL), and Stereo Smile II test (Stereo Optical, Inc., Chicago, IL) to 3- to 5-year-old Head Start participants. Lay screeners also administered a crowded Single Lea Symbols VA test at 5 ft (Good-Lite, Inc.). Screening results were compared with the classification of the children according to the presence of one or more of four conditions (amblyopia, strabismus, significant refractive error, and unexplained reduced VA) based on the results of a gold standard eye examination by study-certified optometrists and ophthalmologists. The primary outcome measure was sensitivity for detecting children with one or more targeted conditions at 0.90 specificity. RESULTS: Nurse screeners achieved slightly higher sensitivities with the Retinomax, SureSight, and Stereo Smile II tests than did lay screeners; however, most differences were small and not statistically significant. Nurse screeners achieved significantly higher sensitivity with the Linear Lea Symbols VA test than did lay screeners. Lay screeners achieved strikingly higher sensitivity with the Single Lea Symbols VA test than did nurse or lay screeners using the Linear Lea Symbols VA test. Combining the Stereo Smile II test with each of the other tests did not result in improved sensitivities for detecting one or more targeted conditions. CONCLUSIONS: Nurse and lay screeners can achieve similar sensitivity, when specificity is set at 0.90, for detecting preschool children in need of a comprehensive eye examination.
Allied Health Personnel↗
Detecting ocular and visual anomalies in a vision screening setting using the Lang stereotest.
BACKGROUND: Effectiveness of random dot stereotests (RDS) as vision-screening procedures vary. In this investigation, 183 school-aged children (6-10 years) had their vision screened using the Modified Clinical Technique (20.7 percent referred) and the Lang stereotest (12.0 percent referred)--a type of RDS test not requiring dissociating glasses. For the populations as a whole, the Lang test demonstrated low sensitivity, 31.6 percent; yet specificity was high, 93.1 percent. The phi coefficient (phi) was +0.31 for use as a sole procedure that rose to +0.43 when combined with Snellen acuity and +0.60 when combined with refractive error. Test/retest reliability conducted on a subgroup of 27 children showed a correlation (r) of +0.69. In another subgroup of 17 multiply handicapped children, 41.2 percent were referred by the Lang stereotest; the sensitivity was 100 percent, specificity 90.9 percent and effectivity (phi) +0.88. While not as effective as reports of the Random Dot E stereotest in screening 6-10 year old children, results obtained with the Lang stereotest in the group of exceptional children are remarkable.
Child↗
Validity of vision screening by school nurses in seven regions of Oman.
We tested the validity of vision screening in schools in 7 regions of Oman in 2003. Two researchers tested 1719 randomly selected students in 4 school grades using the Snellen E acuity test. Trained school nurses had previously screened 182 233 students. The visual status recorded in the 2 screenings was compared. Sensitivity of screening by nurses was 68.34% (95% CI: 67.30-69.38) and specificity 99.23% (95% CI: 99.19-99.27). The positive predictive value was 85.42% (95% CI: 84.63-86.21) and negative predictive value was 97.93% (95% CI: 97.87-98.00). The sensitivity of the vision test was significantly higher in females, older students and in North Sharqiya region. In general, the vision screening of school students in Oman has satisfactory validity. Periodic training of nurses and supervision of the screening procedures could improve its sensitivity. Underlying causes of the high numbers of false negative cases should be further investigated.
Adolescent↗