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PubMed2004

Vision screening in schoolchildren: two years results.

OBJECTIVE: To assess the prevalence of visual impairment and ocular abnormalities among schoolchildren in Chiang Mai. DESIGN: A community-based survey. SUBJECTS AND METHOD: The vision screening project was conducted from June 2000 to March 2002. Students in grade I in the Chiang Mai municipal area were examined for visual acuity (VA), color vision, ocular alignment, anterior segment and fundus. Subjective refraction was done in students with subnormal vision (VA 20/30 or less). Referral to the hospital for further evaluation and treatment was made for students with strabismus, amblyopia and other ocular abnormalities. RESULTS: A total of 3,431 and 3,467 students were enrolled in 2000 and 2001, respectively. The prevalence of normal vision (VA 20/20), VA 20/30 or better in at least one eye and 20/40 or less in at least one eye were similar in both years (87%, 5.7%, 7.3% and 85%, 6.4%, 8.7%, respectively). There was no statistically significant difference in visual acuity among boys and girls in either year (p = 0.6 and p = 0.2). Prevalence of abnormal color vision was 4.2%. Other causes of visual impairment in both years included strabismus (1.5% and 6.2%), amblyopia (1.1% and 1.4%) and some congenital abnormalities. Most cases of amblyopia were due to uncorrected refractive errors. CONCLUSION: The authors found that over 10% of school-aged children had subnormal vision. The important causes of visual deterioration came from refractive errors, strabismus and amblyopia. The authors concluded that vision screening is a cost-effective way of reducing visual morbidity from preventable visual impairment, which is a tragedy that cannot be ignored.

Amblyopia↗
PubMed2003

Cost-efficient vision screening for astigmatism in native american preschool children.

PURPOSE: To design and test a cost-efficient, community-based vision screening program for a population of Native American preschool children in which there is a high prevalence of astigmatism. METHODS: Based on analysis of vision screening and eye examination data from a preschool population with a 33% prevalence of astigmatism, comparative costs to conduct a 1000-child screening program with a target sensitivity of 90% were estimated for photoscreening, noncycloplegic autorefraction, autokeratometry, and Lea symbols distance visual acuity testing. Results of the cost analysis and examination of sensitivity and specificity data from the preschool population led to development of a hybrid screening program of autokeratometry and visual acuity screening with referral thresholds of 2.25 D of corneal astigmatism or inability to read a 20/63 Lea symbols line on two separate attempts. The screening program was prospectively implemented in a community-based screening of a similar cohort of 167 children, and its efficiency was evaluated by comparison to results of cycloplegic refraction. RESULTS: The community-based screening showed 96.8% sensitivity and 79.2% specificity for detecting the presence of refractive astigmatism of 1.50 D or more. CONCLUSIONS: Referring children who have at least 2.25 D of corneal astigmatism or acuity worse than 20/63 on two attempts, provides the high sensitivity and specificity associated with automated keratometry while maintaining an acuity component that can detect other causes of reduced acuity in the absence of astigmatism.

Astigmatism↗
PubMed1987

Assessment of the Queensland School Health Service vision screening programme.

Despite the widespread acceptance of vision screening programmes as a means of detecting ocular disorders in children, there has been little formal assessment of their validity and reliability. One such screening programme is conducted in Queensland State Primary Schools by the Division of School Health Services of the State Department of Health. A group of 877 children was screened by the Service and subsequently subjected to a formal independent ophthalmological examination. A comparison of the results of these procedures revealed that the visual screen as performed by the Service was highly accurate in the determination of distant visual acuity. Detection of manifest strabismus was less satisfactory, with between 30 and 74% of sufferers being detected. There is no evidence to suggest that a more complex protocol will improve the detection of ocular disorders. Rather, a more effective implementation of the current screening procedure is required.

Child↗
PubMed2004

School vision screening, ages 5-16 years: the evidence-base for content, provision and efficacy.

The optometric profession in the UK has a major role in the detection, assessment and management of ocular anomalies in children between 5 and 16 years of age. The role complements a variety of associated screening services provided across several health care sectors. The review examines the evidence-base for the content, provision and efficacy of these screening services in terms of the prevalence of anomalies such as refractive error, amblyopia, binocular vision and colour vision and considers the consequences of their curtailment. Vision screening must focus on pre-school children if the aim of the screening is to detect and treat conditions that may lead to amblyopia, whereas if the aim is to detect and correct significant refractive errors (not likely to lead to amblyopia) then it would be expedient for the optometric profession to act as the major provider of refractive (and colour vision) screening at 5-6 years of age. Myopia is the refractive error most likely to develop during primary school presenting typically between 8 and 12 years of age, thus screening at entry to secondary school is warranted. Given the inevitable restriction on resources for health care, establishing screening at 5 and 11 years of age, with exclusion of any subsequent screening, is the preferred option.

Adolescent↗
PubMed1981

A vision screening of a Down's syndrome population.

A vision screening of 55 (24 male, 31 female) Down's syndrome children was done by SUNY vision training residents. In the past, similar screenings have been done with older children. The children in this study ranged in age from 2 years, 2 months, to 8 years, 5 months. The median age was about 3.5 years. This study will enable vision care practitioners to be more aware of visual conditions in this population which have a greater incidence than the normal population.

Child↗
PubMed1984

Vision screening and the private practitioner--a status report.

Private optometric practitioners have traditionally been involved with schools and other organizations in conducting vision screening programs, although the extent of the involvement varies considerably from one location to another. A national survey of 500 optometrists (49% response rate) was conducted to examine the extent of optometric involvement in screening programs. Seventy percent of the optometrists surveyed have participated in screening during their professional careers although only 30% are currently active. Most screenings were done in the schools with the Modified Clinical Technique (MCT) battery although only 7% knew of perceptual screening activities. The study indicates that in areas where vision screening is conducted, most practitioners are involved and where programs are infrequent, knowledge about screenings is limited.

Child↗
PubMed1998

Vision screening of preschool children: evaluating the past, looking toward the future.

Vision problems of preschool children are detectable with a comprehensive eye examination; however, it is estimated that only 14% of children below the age of 6 years receive an eye examination. Screening is advocated as a cost-effective alternative to identify children in need of further vision care. Thirty-four states recommend or require vision screening of preschool children. Although laws and guidelines exist, only 21% of preschool children are actually screened for vision problems. There is little agreement concerning the best screening methods, and no validated, highly effective model for screening vision of preschool children. Newer screening tests have been designed specifically for preschool populations, and can be administered by lay screeners. Many have not been validated. Several are recommended by states or organizations without convincing scientific evidence of their effectiveness. This paper summarizes current laws and guidelines for preschool vision screening in the United States, reviews advantages and disadvantages of several test procedures, and provides recommendations for developing future preschool vision screening programs.

Child, Preschool↗
PubMed1999

Paediatric community vision screening--a new model.

The purpose of this study was to establish if a community based model using a Hospital Optometrist and Community Orthoptist can provide a practical secondary vision screening service for children. These professionals working in an Inner London Health Centre, assessed children who had failed primary vision screening. In total 483 new patients were seen between April 1994 and March 1996 with the largest referral source being the school nurse screening programme. The majority were managed by the team with a total onward referral rate to the Hospital Eye Service of 14%. In 78% of these cases the consultant's diagnosis agreed with the reason for referral. Where the consultant's diagnosis differed the children were identified as normal or a variant of normal. This model of care provides a 'one stop service' where a child identified as having a potential visual problem at primary screening can be assessed, refracted and provided with spectacles in a local setting without hospital referral. Referrals to the Hospital Eye Service are considerably reduced and a convenient service is provided for parents and children.

Age Distribution↗
PubMed1994

The pros and cons of vision screening.

Following the implementation of the DSE Regulations last year vision screening has become routine for many OHNs. Hazel Davis examines the pros and cons of current equipment and techniques.

Humans↗
PubMed2004

A study of pre-school vision screening tests' testability, validity and duration: do group differences matter?

Vision screening was performed on 268 pre-school children: 170 from a private pre-school, 33 from a Caribbean-American parochial pre-school and 65 pre-school children from a clinic serving indigent Spanish farm-workers. Using a multi-station format, a stereoacuity test and two visual acuity tests were performed during a single screening session. The time it took to complete a test was recorded. To pass the screening, children were required to pass one visual acuity test and the stereoacuity test. Children who could not complete the protocol were retested at a later date. Children who failed the screening and every fourth child who passed the screening were referred for a full eye examination. The parents and teachers were masked to the results of the screening as well as the optometrists who performed the eye examination. Sensitivity, specificity and accuracy scores were 100%, 79% and 80%, respectively. Three-year-old children completed the Lea Symbol Chart more often than the HOTV. No differences in time required to complete a visual acuity test were found. The Lea Symbol chart is more likely to be completed by young children. Testability changes significantly with age rather than with the instrument when socio-ethnic factors are held constant. Differences among groups and the sensitivity of the screening are discussed.

Child↗
PubMed1999

Measurement of the validity of a preschool vision screening program.

OBJECTIVES: The validity (sensitivity and specificity) of a preschool vision screening program was measured over a 3-year period to determine how well strabismus and significant refractive errors could be detected. METHODS: Public health nurses were trained to administer tests of visual acuity, stereoacuity, and ocular alignment. Failure on any test, visual acuity of 6/9 or less, stereoacuity of less than 100 seconds of arc, or an apparent misalignment of the eyes resulted in referral to an eye care practitioner. An age-matched control was also referred. Analysis of practitioner reports used predefined study-based criteria for ocular abnormalities. RESULTS: More than 1100 children were screened each year. The annually calculated prevalence of vision problems ranged between 10.5% and 13.8%. The estimated sensitivity varied from 60.4% to 70.9% (specificity, 69.6% to 79.9%). The yield indicated that a very high percentage of children with vision problems were identified for the first time. CONCLUSIONS: The validity of this screening is comparable to that of other school screenings. The limitations are predictable. Consideration should be given to replacing visual acuity tests with a rapid, objective measure of refractive error and ocular alignment.

Age Factors↗
PubMed1999

Vision screening of abused and neglected children by the UCLA Mobile Eye Clinic.

BACKGROUND: The purpose of our study was to present descriptive findings of ocular abnormalities in vision screening examinations of abused and neglected children. We compared the prevalence and the nature of eye diseases and refractive error between abused and neglected boys staying at the Hathaway Home, a residential facility for abused children, and boys from neighboring Boys and Girls clubs. METHODS: The children in the study received vision screening examinations through the UCLA Mobile Eye Clinic following a standard format. Clinical data were analyzed by chi-square test. RESULTS: The children with a history of abuse demonstrated significantly higher prevalence of myopia, astigmatism, and external eye disorders. CONCLUSIONS: Our study suggests that children with a history of abuse may be at higher risk for visual impairment. These visual impairments may be the long-term sequelae of child abuse.

Adolescent↗
PubMedDate not supplied

Effectiveness of preschool vision screening.

The ninth systematic review (Snowdon and Stewart-Brown 1997) from the NHS Centre for Reviews and Dissemination concludes that the lack of good evidence about the effectiveness of preschool vision screening justifies the withdrawal of the programme. The authors are concerned about the ethical correctness of inviting very young children to an implicitly beneficial examination when there is little to justify the intervention. The following article discusses the issues associated with vision screening of children aged three and four years old.

Child, Preschool↗
PubMed1979

Vision screening of adolescents and their use of glasses.

Vision screening was performed in over 11 000 16-year-olds who were taking part in the National Child Development Study. For distance vision 75% had normal acuity, 9% a minor defect, and 16% a more severe unilateral or bilateral defect. For near vision 85% had normal vision, 8% a minor defect, and 7% a unilateral or bilateral defect. Few children (62) with normal distant vision had defects in near vision, though many more (607) had both poor distant vision and poor near vision. Vision defects were more common in girls than in boys and occurred more often in adolescents from non-manual than manual families. Athough 18% of children had been prescribed glasses for current use, a third did not have their glasses available at the examination: 27% of the children prescribed glasses had normal unaided distant visual acuity or only a minor defect, and they constituted 42% of those who were not wearing their glasses. Further investigation is needed into the criteria on which glasses are prescribed for children and into the reasons for which they are not worn.

Adolescent↗
PubMed1984

Vision screening of specialized populations.

This paper describes the vision screening tests for specialized populations as used by the Community Eye Care Services Program of the Pennsylvania College of Optometry. Referral criteria have been elaborated. This paper is designed to help those who are interested in organizing such a screening.

Adult↗
PubMed1996

Is school vision screening effective?

A population-based cohort of all children entering kindergarten in a three-year period (N = 2,938) was followed retrospectively from kindergarten through 12th grade to estimate incidence of abnormal school vision screening tests and rates of follow-up by community ophthalmologists or optometrists. Overall 28% of children had at least one abnormal school vision screening test. Abnormal screening with referral increased from 1.2% of five-year-olds to 9.1% of 13-year-olds. Overall, 91% of children referred had further evaluation by eye care professionals. However, visits to an eye care professional often were delayed; median time was 0.8 years for children seeing an ophthalmologist and 1.8 years for children seeing an optometrist. Results support the continued use of simple visual acuity screening in schools. Consideration should be given to screening children beyond age 12 and developing methods to increase the rapidity of parental response to referral recommendations.

Adolescent↗