[Show abstract][Hide abstract] ABSTRACT: To outline the prevalence and disparities of vision problems among school-aged urban minority youth, causal pathways through which vision problems adversely affects academic achievement, and proven or promising approaches for schools to address these problems.
More than 20% of school-aged youth have some kind of vision problem. In a nationally representative sample of more than 48,000 youth under age 18, those from lower income families were less likely to have diagnosed eye conditions than White children and children living in higher income families. When diagnosed with eye care problems, Black youth living in poverty received fewer and less intensive services. Causal pathways through which vision problems adversely affect academic achievement include sensory perceptions, cognition, and school connectedness. Vision screening is widespread in the nation's schools, but the educational (and public health) benefits from these efforts are jeopardized by lack of follow-up and coordination of efforts.
Vision problems are highly and disproportionately prevalent among school-aged urban minority youth, have a negative impact on academic achievement through their effects on sensory perceptions, cognition, and school connectedness, and effective practices are available for schools to address these problems. School-based vision screening programs are a logical approach for the early detection and treatment of vision problems affecting youth and are widely implemented in the nation's schools. To more fully realize the educational (and public health) benefits of current investments in screening, programs will require improved follow-up and coordination between and among agencies conducting screening, school nurses, teachers and parents, and in some cases community resources.
Journal of School Health 10/2011; 81(10):599-605. DOI:10.1111/j.1746-1561.2011.00633.x · 1.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Amblyopia presents early in childhood and affects approximately 3% of western populations. The monocular visual acuity loss is conventionally treated during the 'critical periods' of visual development by occluding or penalising the fellow eye to encourage use of the amblyopic eye. Despite the measurable success of this approach in many children, substantial numbers of people still suffer with amblyopia later in life because either they were never diagnosed in childhood, did not respond to the original treatment, the amblyopia was only partially remediated, or their acuity loss returned after cessation of treatment.
In this review, we consider whether the visual deficits of this largely overlooked amblyopic group are amenable to conventional and innovative therapeutic interventions later in life, well beyond the age at which treatment is thought to be effective.
There is a considerable body of evidence that residual plasticity is present in the adult visual brain and this can be harnessed to improve function in adults with amblyopia. Perceptual training protocols have been developed to optimise visual gains in this clinical population. Results thus far are extremely encouraging; marked visual improvements have been demonstrated, the perceptual benefits transfer to new visual tasks and appear to be relatively enduring. The essential ingredients of perceptual training protocols are being incorporated into video game formats, facilitating home-based interventions.
Many studies support perceptual training as a tool for improving vision in amblyopes beyond the critical period. Should this novel form of treatment stand up to the scrutiny of a randomised controlled trial, clinicians may need to re-evaluate their therapeutic approach to adults with amblyopia.
[Show abstract][Hide abstract] ABSTRACT: PURPOSE: To evaluate the relationship of anisometropia with unilateral amblyopia, interocular acuity difference (IAD), and stereoacuity among Head Start preschoolers using both clinical notation and vector notation analyses. DESIGN: Multicenter, cross-sectional study. PARTICIPANTS: Three- to 5-year-old participants in the Vision in Preschoolers (VIP) study (n = 4040). METHODS: Secondary analysis of VIP data from participants who underwent comprehensive eye examinations, including monocular visual acuity testing, stereoacuity testing, and cycloplegic refraction. Visual acuity was retested with full cycloplegic correction when retest criteria were met. Unilateral amblyopia was defined as IAD of 2 lines or more in logarithm of the minimum angle of resolution (logMAR) units. Anisometropia was defined as a 0.25-diopter (D) or more difference in spherical equivalent (SE) or in cylinder power and 2 approaches using power vector notation. The percentage with unilateral amblyopia, mean IAD, and mean stereoacuity were compared between anisometropic and isometropic children. MAIN OUTCOMES MEASURES: The percentage with unilateral amblyopia, mean IAD, and mean stereoacuity. RESULTS: Compared with isometropic children, anisometropic children had a higher percentage of unilateral amblyopia (8% vs. 2%), larger mean IAD (0.07 vs. 0.05 logMAR), and worse mean stereoacuity (145 vs. 117 arc sec; all P<0.0001). Larger amounts of anisometropia were associated with higher percentages of unilateral amblyopia, larger IAD, and worse stereoacuity (P<0.001 for trend). The percentage of unilateral amblyopia increased significantly with SE anisometropia of more than 0.5 D, cylindrical anisometropia of more than 0.25 D, vertical and horizontal meridian (J0) or oblique meridian (J45) of more than 0.125 D, or vector dioptric distance of more than 0.35 D (all P<0.001). Vector dioptric distance had greater ability to detect unilateral amblyopia than cylinder, SE, J0, or J45 (P<0.001). CONCLUSIONS: The presence and amount of anisometropia were associated with the presence of unilateral amblyopia, larger IAD, and worse stereoacuity. The threshold level of anisometropia at which unilateral amblyopia became significant was lower than current guidelines. Vector dioptric distance is more accurate than spherical equivalent anisometropia or cylindrical anisometropia in identifying preschoolers with unilateral amblyopia. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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