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PubMed1995

Children's vision screening: impact on inequalities in central England.

STUDY OBJECTIVE: To investigate the relationship between age at presentation of amblyopia and social deprivation before and after the introduction of changes to a vision screening service. DESIGN: Two cohorts of children treated for amblyopia in 1983 and 1992. SETTING: THe orthoptic department of Leicester Royal Infirmary. PARTICIPANTS: The 209 patients treated for amblyopia who first attended the orthoptic department in 1983, and 203 who first attended in 1992. MEASUREMENTS: Age at presentation to the orthoptic department was the main outcome measure. Social deprivation was measured by Townsend deprivation score for the electoral ward in which the child lived, using 1981 and 1991 census data. MAIN RESULTS: After the introduction of changes in the screening programme, the mean at presentation of amblyopia associated with microtropia or no strabismus was reduced from 6.6 years to 5.0 years. In 1983 there was a significant relationship between deprivation and age at presentation (p = 0.0001), with those from more deprived areas presenting later. No similar association was found in children referred in 1992 (p = 0.17). There was no change in mean age of presentation of amblyopia associated with a large angle of strabismus (3.3 years in 1983 and 1992) and no relationship between deprivation and age at presentation 1983 or 1992 (p = 0.24 and p = 0.39 respectively). CONCLUSION: Since the introduction of changes to vision screening, the relationship between social deprivation and the age of presentation of asymptomatic amblyopia seems to have disappeared. Children are now referred earlier and those from deprived areas are not being overlooked.

Age Factors↗
PubMed1990

Vision screening in a primary care setting. A missed opportunity?

To determine the effectiveness of vision screening in a primary care setting, we administered a questionnaire and a vision test to 458 patients from a general medical clinic. Subjects were referred for complete ophthalmologic evaluation if they failed the vision test or met other "high-risk" criteria based on information contained in the questionnaire. Patient-initiated requests for eye examinations were also honored. A total of 169 patients were scheduled for eye examinations, and 148 actually underwent ophthalmologic evaluation. One hundred one of those examined were referred on the basis of the study criteria. "Serious eye disease" (cataract, glaucoma, diabetic retinopathy, or age-related macular degeneration) was diagnosed in 96 (95%) of these patients. Prompt surgical intervention was recommended in 27 (27%), and medical treatment was begun in 21 (21%). Of those with serious eye disease, 59% met the criteria by failing the vision test, while 69% met the high-risk criteria determined by the questionnaire. Of the 148 subjects who received ophthalmologic evaluations, 47 requested them. Serious eye disease was diagnosed in 23 (50%) of the 47 patients. None of these individuals required immediate surgery, and medical treatment for glaucoma was begun in eight (17%). These data suggest that screening for serious eye disease in a primary care setting is an efficient mechanism to use for the identification of patients with undetected ocular disorders that require follow-up or treatment.

Aged↗
PubMed1991

Comparison of the automated vision screening test to the Snellen test.

The comparison of an automatic vision screening machine using the Landolt rings and the usual Snellen Chart was carried out among 123 second grade and 149 fifth grade students in an elementary school in Jerusalem. The sensitivity of the test for a cut-off point of greater than or equal to 6/12 according to the Snellen test was 41.7% (CI = 16.5-71.4) and the specificity was 86.5% (CI 78.1-92.2) for second graders. For fifth graders the values were 50.0% (CI = 20.1-79.9) and 90.6% (CI 83.7-94.8) respectively. Diagnosis by a specialist decreased the number of 'false negatives' and confirmed the pathological cases. The automatic test was well accepted by the children. Though more time is needed for assessment using the automatic test, its advantage is that no professional staff are required.

Child↗
PubMed1985

Validation study of the New York State Optometric Association (NYSOA) Vision Screening Battery.

The New York State Optometric Association (NYSOA) Vision Screening Battery was administered to 1983 grade school children. Complete visual examinations were performed on 125 children. A consensus method for determining a diagnosis was developed and a double-blind paradigm was used to validate the screening battery. The sensitivity was found to be 71.7% and the specificity to be 65%. When compared to the Snellen test, the NYSOA battery is far more sensitive. The Snellen test is 100% specific but misses 75.5% of the children found to have vision problems when given a complete visual examination.

Child↗
PubMed1995

Results of a vision screening program: an initial study.

BACKGROUND: More than 100 children between the ages of 5 and 13 years (grades K through 6) were screened with the New York State Optometric Association vision screening battery. METHODS: A comparison between regular and special education referral rates was performed. Two groups of tests were established: acuity testing and functional testing. A comparison of the failure rates of these two groups was also analyzed. RESULTS: This study revealed that although the referral rate between the two populations showed no statistical difference, the particular "group" of tests failed differed significantly. CONCLUSIONS: Although no conclusions can be drawn from these numbers as the sample was not varied enough, further screenings in different geographical and socioeconomic areas need to be performed to determine the validity of this trend.

Adolescent↗
PubMed1976

Comparison of vision screening by lay and professional personnel.

A previously described vision screening procedure was administered to 652 elementary school children, using lay volunteers. These students were later screened by optometrists, using the Modified Clinical Technique (MCT). Using MCT as the standard, the lay screening correctly identified 90% of the children; the incorrect identifications included 28 children (4.3%) as false negatives and 36 children (5.5%) as false positives. Analysis indicates a lower cost for the combined lay and professional screening than for professional screening alone.

Allied Health Personnel↗
PubMed2001

The visual profile of Romanian children and adults assessed through vision screenings.

BACKGROUND: The purpose of this study was to databank epidemiological information from Romanian children and adults. METHODS: A vision screening was performed on 690 children (2 to 18 years of age) and 190 adults (19 to 77 years of age). Prevalence of refractive errors, binocularity, and ocular health problems were recorded and evaluated. RESULTS: Data from the childrens' population showed that 45% were emmetropic, 27% were myopic, and 28% were hyperopic. For the adults, 42% were emmetropic, 16% were myopic, and 42% were hyperopic. When compared with other nations, the average refractive error of the Romanian children was more myopic, and for the adults it was slightly more hyperopic. With-the-rule astigmatism had the highest occurrence when compared to other axis orientations, yet the overall occurrence of astigmatism was less than that found in other nations for both children and adults. The prevalence of strabismus and ocular disease was less in the Romanian children in relation to other nations. CONCLUSION: Due to many years of isolation from the Free World, little information has been available on nations such as Romania relative to the health status of its people. This study begins an epidemiological base forthe nation. It is especially important to public health officials in planning health policy measures, and provides a basis for additional U.S.-based outreach missions to such nations in Europe. It also illustrates the efficacy of using a basic screening-type examination to determine vision care needs and the use of recycled eyewear to satisfy these needs.

Adolescent↗
PubMed1984

Color vision screening: a comparison of the AO H-R-R and Farnsworth F-2 tests.

Vision screening tests should include a simple, reliable, and valid test of color vision defects. In this investigation the single plate Farnsworth F-2 test and the AO H-R-R pseudoisochromatic plates were compared as primary screening tests for red-green color defective vision. The tests were administered to 2827 children, kindergarten through high school grades. Both tests failed a higher percentage of children than expected in the lower grades (kindergarten through 3). In grades 4 through high school, however, 4.16% failed the F-2 test and 4.02% failed the AO H-R-R, compared to a predicted 4.2% of the general population with inherited red-green deficiencies. The failure rates of the F-2 test for 1171 high school boys and girls were 7.3 and 0.89%, respectively, very close to the expected incidence of red-green defects in males and females. Although the F-2 test passed a few pupils who failed the AO H-R-R test, their defects were categorized as mild or borderline on the AO H-R-R test and therefore not likely to be of practical significance. Less than 0.5% of the children in grades 4 through high school failed the F-2 test after passing the AO H-R-R. Some children with normal color vision, particularly very young children, may fail the F-2 test because of difficulty picking out the less obvious blue square. Nevertheless, for screening purposes the F-2 test is comparable to the AO H-R-R test and except for kindergarten and grade 1 pupils is an excellent single plate color vision screening test.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

An audit of preschool vision screening.

An audit was carried out to clarify the dispute surrounding the vision screening test at 3.5 years. The uptake was 53.5%, sensitivity 77%, specificity 96%, and positive predictive value 50%. In particular the uptake was poor and the test needed a clear policy for the future.

Child, Preschool↗
PubMed1997

A review of school vision screening in Glasgow.

OBJECTIVES: To assess to what extent the primary school vision screening programme was being carried out in the years 1993-94 and 1994-95, what the prevalence of eye defects was in the primary schools and how many children had a positive screening test. DESIGN: Summary sheets of the results of screening were returned by each school nurse. SETTING: All 315 mainstream primary schools served by Greater Glasgow Health Board. SUBJECTS: All school nurses working in these schools. RESULTS: Large numbers of tests were being performed but the screening programme was not fully carried out in 10% of schools in 1993-94 and in 68% in 1994-95, although the number of schools where some screening was performed did increase. The years were not directly comparable due to a change in the age groups screened. When a class was screened 94-96% of children were tested. The rate of positive screening varied from 4% to 15.6% and varied with age and locality. Fewer abnormalities were found at five years than in the older age groups (Primary 1-7.6%, Primary 4-11.4%, and Primary 7-9.7%) and fewer abnormalities were detected in the North-West area where a pre-school orthoptic screening programme was operating (4% in the North-West compared with 11% in the South where no pre-school screening was carried out). CONCLUSION: If the recommended programme is carried out, then 95% of children at age five years could be tested at a stage when amblyopia is still potentially treatable. The reasons for the programme not being completed require to be addressed. Variations between areas need to be confirmed and the reasons for them identified. Further evaluation of the programme is required, exploring the accuracy of it and the long-term outcomes.

Child↗
PubMed1997

Preschool vision screening.

OBJECTIVES: To undertake a systematic review of the effectiveness of preschool vision screening. To provide evidence on which decisions about the future provision of this service can be made. To indicate areas for further research. STUDY SELECTION: The Centre for Reviews and Dissemination guidelines for systematic reviews were used. The research questions were formulated using the Wilson and Jungner criteria for evaluating screening programmes. They concerned prevalence, natural history, disability, treatment and screening in relation to three target conditions: amblyopia, refractive errors and squints which are not cosmetically obvious. Studies were considered for inclusion according to pre-determined criteria for the age group studied, the outcomes measured and the study design. The following types of study design were considered: cross-sectional studies of prevalence, cohort studies of natural history, any type of study (e.g., cross-sectional surveys, case-series, qualitative studies) of disability attributable to a target condition, controlled trials, observational studies and audits of screening programmes, and prospective controlled trials of treatment. DATA SOURCES: The following electronic databases were searched: Biological Abstracts, CINAHL, Embase, ERIC, IAC Health Periodicals, IAPV, Medline, Psychlit, Science Citation Index, System for Information on Grey Literature in Europe, DHSS-Data, Faculty of Public Health Medicine Database of Dissertations, Index of Scientific and Technical Proceedings, Dissertation Abstracts, Index of Theses, NHS Research Register, Public Health Information Sharing Database. A limited amount of handsearching was undertaken. Reference lists were scanned to identify other relevant studies, and requests for unpublished data were made to people working in the field. DATA EXTRACTION: Data was extracted by the first author and then checked by the second. DATA SYNTHESIS: Quantitative analysis was undertaken where possible. Qualitative analysis was performed where studies were too heterogeneous for the data to be combined, or for research questions that were not suitable for quantitative synthesis. RESEARCH FINDINGS: The electronic search yielded over 5000 references, and over 500 abstracts were downloaded from the databases for further scrutiny. A total of 85 studies were included in the main analysis. PREVALENCE: No studies were found with the primary aim of establishing the prevalence of visual defects in preschool children. Data from studies of screening programmes report a range of yields for all the target conditions combined of 2.4-6.1%. NATURAL HISTORY: No studies designed with the intention of documenting the natural history of the target conditions in children aged 3 or 4 years were found. Other studies that provide some natural history data suggest that mild degrees of amblyopia may resolve spontaneously. In the absence of information about natural history it is impossible to estimate the effect of treatment from studies without a control group that was not treated. DISABILITY: A total of 21 studies exploring disability in relation to the target conditions were included. The literature provides a reasonable basis for generating plausible hypotheses about the ways in which the target conditions might disable people, but is insufficient to draw any firm conclusions about their impact on quality of life. The research to date is not sufficient to determine appropriate outcomes for controlled trials of treatment. TREATMENT: Five randomised controlled trials of treatment and six prospective controlleld trials without randomisation were found. No studies compared treatment with no treatment. Most of the studies were methodologically flawed.(ABSTRACT TRUNCATED)

Child, Preschool↗
PubMed1989

Review of children referred from the school vision screening programme in Kettering during 1976-8.

The progress of 108 children who were identified by the vision screening programme in school as having defective vision (excluding those with puberty onset myopia) was reviewed. Treatment of these children resulted in improvement in visual acuity of the worst eye (two lines or better) for 16 children. Eighteen children had severe amblyopia (6/24 or worse). Among these the vision of only five was improved by treatment. Two thirds of the children had refractive errors in the better eye which required correction. It seems sensible to identify and treat children with bilateral refractive errors, but the need to treat children with lesser degrees of amblyopia is questioned.

Amblyopia↗
PubMedDate not supplied

Stereopsis testing to reduce overreferral in preschool vision screening.

Three- and 4-year-old children who obtain the minimum failing visual acuity result of one-line difference between eyes in preschool vision screening with isolated optotypes have a high rate of overreferral. We evaluated the Random Dot E Stereotest (RDES) to determine if a passing result at a high threshold on this test, as administered by lay screeners, could safely nullify referral for a minimum failing visual acuity test result. Fifty-eight children with a "one-line difference" result also had the RDES administered to them during screening at distances of 40 cm and 1.5 m. Upon subsequent ophthalmologic examination, 45 of these children were found to be normal, and 13 had abnormal findings. Thirty-nine of the children with normal examinations had correctly passed the RDES at 1.5 m. Seven of the 13 children with abnormal findings had correctly failed the RDES. Thus, the specificity of stereotesting was 87% and the sensitivity was 54%. Among the six children who falsely passed the stereopsis test during screening, best-corrected visual acuity was no worse than 20/40 and no child had greater than a one-line difference in acuity. Therefore, no amblyopia was missed. If a passing result on the stereotest at 1.5 m had been allowed to nullify a one-line difference referral, overreferral would have decreased 87% but underreferral would have increased 46%. We cannot yet recommend modifying current visual acuity referral criteria based on stereopsis testing results until the sensitivity of stereopsis screening by lay screeners at a sufficient threshold is improved.

Child, Preschool↗
PubMed1981

Feedback on prekindergarteners failing vision screenings.

This study is a sequel to an earlier report on a random vision screening of 651 prekindergarteners and compares the findings of the 35 children who failed this screening with the results and dispositions after retesting. Of the number failed, 32 (91.4%) were accounted for, of whom 28 (80%) were retested and 14 (40%) received no treatment; the other 4 (11.4%) were not retested. A discourse on probable discrepancies between screening and retesting results follows, along with corrective recommendations.

Adolescent↗
PubMed2003

Preschool vision screening in primary care after a legislative mandate for diagnostic eye examinations.

BACKGROUND: Kentucky legislation now requires that children entering public school receive a diagnostic eye examination. METHODS: Mail survey of randomly selected office-based primary care pediatricians (PDs, n = 221) and family physicians (FPs, n = 207) in Kentucky to assess the impact of the mandated eye examination. RESULTS: The response rate was 71% PDs and 51% FPs. Most offer preschool vision screening (PD 86%; FP 79%; P = 0.16), but many report they will be less likely to offer it in the future because of the mandated diagnostic eye examination (PD 61%; FP 50%; P = 0.09). Perceived barriers to the diagnostic eye examination include lack of parental knowledge about the requirement, belief by parents that they will need to pay, difficulty in getting an appointment, and lack of endorsement by primary care physicians. CONCLUSION: Most primary care physicians in Kentucky offer preschool vision screening, but many now are likely to reduce their screening effort. Until more data are available regarding the impact of the required eye examination, primary care providers should not change their screening practices.

Attitude of Health Personnel↗
PubMed1985

Vision screening and eye examination of school children.

In Kuopio, Finland, vision screening for school children is done by school nurses once every 2 years. All children who have impaired vision, suspected strabismus or heterophoria, suspected eye disease or ocular discomfort, are sent for an eye examination to the ophthalmologist at the Community Health Centre, Kuopio. In 1977 the number of children referred for eye examination was 741 and 1134 in 1984. One hundred consecutive eye examinations were analysed both in 1977 and 1984. There were more girls than boys in both materials: 63 girls and 37 boys in 1977 and 60 girls and 40 boys in 1984. This difference between girls and boys was statistically highly significant in 1977 and significant in 1984. There was no significant difference in age distribution in 1977 and 1984. The largest age group was the 13-year-olds; in 1977 there were 13 and in 1984 22 children in this age group. In 1977, impaired vision (34 children) and in 1984 check-up on glasses (56 children) were the most common reasons for examination. The most usual finding in both years was myopic refraction; 52 cases in 1977 and 58 cases in 1984. It is noteworthy that in 1977 there were 16 children with normal eye examination but in 1984 there were only 6. This difference is almost significant. The cooperation between the ophthalmologist and the school nurses may account for this change.

Adolescent↗