Preschool vision screening in primary care pediatric practice.
ABSTRACT We determined the efficacy of pediatric-based preschool vision screening, as knowledge of vision screening effectiveness in primary care pediatrics is incomplete.
Pediatricians and staff at nine primary care pediatric practices were trained in vision screening, and practices screened children aged 3-5 years from May 2007 through July 2008. Children failing or considered untestable were referred for pediatric ophthalmology examinations. We determined rates of testability, failure, referral, and ophthalmologic examination completion, as well as positive predictive values (PPVs) of screening failure and untestability. We also surveyed practices to assess the ease and accuracy of preschool vision screening.
Of 2,933 children screened, 93 (3.2%) failed the vision screening and 349 (11.9%) were untestable. Untestability was highest (27.1%) among 3-year-olds. The PPV for failing any aspect of the vision screening was 66.7%; for children aged 3, 4, and 5 years, the PPVs for failing were 30.0%, 77.8%, and 87.5%, respectively. However, only 38.7% of children who failed the vision screening received ophthalmologic examinations, despite multiple follow-up attempts. Pediatricians rated the ease and accuracy of screening 3-year-old children lower than for screening older children.
Visual acuity-based screening had good PPV for vision loss for 4- and 5-year-old children but was less successful for 3-year-olds. Rates of referral and ophthalmologic examination completion were low, especially among children from low-income families.
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ABSTRACT: The random dot stereogram E (RDE) has been shown to be a simple and effective test for the detection of binocular abnormalities and defective visual acuity in children. We determined the validity of the RDE as a screening test for reduced visual acuity, amblyopia and strabismus in two separate populations of children. A nonselective group of 100 school children (aged 5 to 15 years) who presented consecutively to the ophthalmology department at Auckland Public Hospital were tested with the RDE. All cases of amblyopia and strabismus were detected by the RDE. Similar screening with the RDE test of 168 preschool children (aged three to four years) in the community resulted in an unacceptably high over-referral rate. The test was unreliable in the preschool age group because of difficulty in distinguishing between test failure and non-cooperation with the test. The low positive predictive value of the test in the younger age group suggests the test to be unsuitable for preschool vision screening.Australian and New Zealand Journal of Ophthalmology 09/1990; 18(3):319-24.
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ABSTRACT: 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.Survey of Ophthalmology 11/1983; 28(3):145-63. DOI:10.1016/0039-6257(83)90092-9 · 3.51 Impact Factor
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ABSTRACT: A prospective study of the efficacy of amblyopia treatment in preschool children has recently been called for, requiring an untreated control group. The present study assessed data from patients with amblyopia untreated owing to lack of compliance, or with amblyopia risk factors, to determine outcome. Longitudinal data were obtained from 18 4-6 year old patients who had initially been screened for amblyopia, strabismus, and/or bilateral refractive error, failed to comply with prescribed treatment, and in whom amblyopia was detected at a rescreening approximately a year later. The data from three previous studies comparing outcome of patients compliant and non-compliant with amblyopia treatment were also reanalysed. One child of the 18, who wore glasses sporadically, showed some improvement in visual acuity in the amblyopic eye. Otherwise, no child showed an improvement, and seven of the 17 (41%) for whom visual acuities were available at both screenings showed a deterioration of visual acuity in the amblyopic eye, including three who apparently developed amblyopia for the first time. A child with an ametropic risk factor for amblyopia whose visual acuity was not obtained at the first screening and who was largely non-compliant presented with amblyopia at the second screening. The reanalysed data from the three previous studies demonstrated a significantly poorer visual acuity outcome in the amblyopic eye in the non-compliant patient groups than in the compliant groups in each study. Preschool children with amblyopia or its risk factors are at risk of having the current amblyopia deteriorate, or of developing amblyopia, if not treated. These results raise questions about the ethical acceptability of a prospective study of amblyopia treatment at these ages.British Journal of Ophthalmology 06/1999; 83(5):582-7. DOI:10.1136/bjo.83.5.582 · 2.81 Impact Factor