Article
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

This study compares different vision screening batteries and documents the failure rates of different vision tests in children who receive periodic vision screenings. Vision screenings were conducted on 1,992 preschool through fifth grade children attending schools in lower socioeconomic areas in New York City. The screening battery incorporated visual acuity, retinoscopy, cover test, stereopsis, near point of convergence, ocular motility, accommodation, color vision, and ocular health. Slightly less than one third (30%) of the children screened failed the State University of New York (SUNY) battery and were referred for a comprehensive examination, of which 249 (41%) children actually passed distance visual acuities. The referral rate for distance visual acuity alone was 19%. The referral rate for the Modified Clinical Technique (MCT) was 22%. A greater percentage (33%) of the children in grades kindergarten through fifth were referred compared with the preschoolers (20%). Only a small percentage (8%) of the children wore corrective lenses at the time of testing. There was a significant increase in the prevalence of binocular vision problems found in children from grades kindergarten through 5. Poor visual acuity and binocular vision problems exist in schoolchildren despite ongoing vision screenings. The results provide evidence for the necessity of periodic rescreening starting in kindergarten and the importance of screening for hyperopia and binocular vision problems in addition to distance visual acuities.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Accommodative and vergence binocular anomalies are vision disorders that affect clarity and binocularity, and impair comfort and efficiency of visual performance of an individual when near tasks such as reading, writing and computer-based works are performed. 1,2,3,4,5 For the school-age child, especially the high school learner, symptoms associated with accommodative-vergence anomalies tend to increase as the child advances through school; 1,2,3,4,5 this is because there is a greater demand at higher grade levels on the accommodative and vergence system for sustained clear vision owing to prolonged reading and increased information processing. 1,2,3,4,5 In Part 1, studies on vergence anomalies in school-age children were reviewed. ...
... Accommodative and vergence binocular anomalies are vision disorders that affect clarity and binocularity, and impair comfort and efficiency of visual performance of an individual when near tasks such as reading, writing and computer-based works are performed. 1,2,3,4,5 For the school-age child, especially the high school learner, symptoms associated with accommodative-vergence anomalies tend to increase as the child advances through school; 1,2,3,4,5 this is because there is a greater demand at higher grade levels on the accommodative and vergence system for sustained clear vision owing to prolonged reading and increased information processing. 1,2,3,4,5 In Part 1, studies on vergence anomalies in school-age children were reviewed. ...
... 1,2,3,4,5 For the school-age child, especially the high school learner, symptoms associated with accommodative-vergence anomalies tend to increase as the child advances through school; 1,2,3,4,5 this is because there is a greater demand at higher grade levels on the accommodative and vergence system for sustained clear vision owing to prolonged reading and increased information processing. 1,2,3,4,5 In Part 1, studies on vergence anomalies in school-age children were reviewed. In the current paper (Part 2), anomalies of accommodation are reviewed. ...
Article
Full-text available
Comfortable reading and the performance of related near point activities involve efficient accommodative and vergence systems. However, accommodative and convergence anomalies are associated with various symptoms of asthenopia that impair efficient near point tasks. In Part 1 of this two-part article, studies on vergence anomalies were reviewed. In the current paper (Part 2), anomalies of accommodation are reviewed. The aims of the latter paper were to derive the prevalence and distribution estimates of anomalies of accommodation in school-age children and address variations in the study methods and findings. Despite variations in the study methods and findings, anomalies of accommodation are prevalent among school-age populations. Variations and limitations of previous studies are discussed and recommendations for improving future studies are suggested.
... The NYSOA screening battery was developed in 1985 with the aim to identify a wider range of visual problems in the paediatric population related to learning. 48 The sensitivity and specificity of the NYSOA battery were 72% and 65%, respectively. 49 Compared to the MCT, the NYSOA targeted reduced distance and near VA. ...
... The NYSOA screening battery was reported to be more timeconsuming than the MCT because of its additional tests. 48 The Orinda MCT can be administered quickly, between 5 min and 6 min per child, compared with 15 min using the NYSOA battery. 34,49 Rapidity is the essence of any screening programme. ...
... In The sensitivity of the VERA screening results increased to 64% and specificity to 100% when done in conjunction with the classroom behaviour survey, particularly in children showing unexplained reduced academic performance. 47 However, the study conducted by Hatch 48 showed VERA to have 75% sensitivity and 93% specificity in detecting a range of visual anomalies including VA, refractive errors and visual skills problems, compared to eye examination results in 36 subjects. Nevertheless, the sensitivity and specificity of VERA improved when combined with a symptom survey (Convergence Insufficiency Symptom Survey), reading level and classroom behaviour survey (completed by a teacher). ...
Article
Full-text available
Background: What constitutes an appropriate vision screening protocol is controversial, because the tests or methods are expected to be cost-effective, expedient and easy but efficient in detecting visual anomalies among children. Aim: This review intends to compare the different vision screening tests for children and methods in the interest of identifying the most effective screening method from the standpoint of validity, public acceptance, expediency and cost. Method: The literature search was performed for this review using the Medline, Science Direct and EBSCOhost databases. The search terms used were vision screening methods or tests, children’s vision screenings, computer software programs and vision screening instruments. The inclusion criteria for the articles reviewed were all types of articles related to vision screening methods. The exclusion criteria were all articles for which full text was not available and those not available in English. Eighty articles were analysed, of which 33 were found to have complied with the inclusion criteria and were selected. From the first round of articles retrieved, additional references were identified by a manual search among the cited references. Results: Evidence from the literature reviewed demonstrated that the conventional vision screening method (isolated and combination tests) is the method commonly used to detect a range of relevant visual anomalies among the schoolgoing age group (≥ 6 years) and drew attention to the need for training of vision screening personnel. However, in addition to the conventional method, other vision screening methods include instruments as an adjunct for screening preschoolers and those difficult to screen (≤ 6 years). Conclusion: Inconsistencies in what constitutes an appropriate vision screening method still exist, especially with the booming market of using computer software programs, which still needs to be validated.
... In another study involving high school children with poor reading ability in California, only 17% had reduced VA of less than 20/40 or worse in at least one eye, whereas 80% had deficiency in at least one of the clinical measures of accommodative and vergence functions including, near fusional amplitude, accommodative facility and near point of convergence [41] . Likewise, a significant increase in the prevalence of binocular vision problems was found among public school children in New York City [42] . The implication of these findings is that with traditional VA measurement which is mostly used in school vision screening programs, many children with impaired reading ability would be missed. ...
... The implication of these findings is that with traditional VA measurement which is mostly used in school vision screening programs, many children with impaired reading ability would be missed. Consequently, Bodack et al [42] had reiterated the importance of periodic screening and rescreening for hyperopia and binocular vision anomalies in addition to distance visual acuities. Provision of Vision Screening Vision screening conducted by adequately trained health professionals is vital for the detection of vision problems in children [5,43] . ...
... The guidelines on school eye health recently developed by IAPB recommend that schools be visited at least once in every two years to screen new intake and to rescreen those given spectacle the previous year [5] . Similarly, Bodack et al [42] have stressed the relevance of periodic screening and rescreening for various ocular defects. CONCLUSION Vision screening of children is a valuable approach for the detection of potential visual disorders that may impact negatively on the overall development of a child. ...
Article
Full-text available
Vision screening plays an important role in the early detection of children who have or probably are predisposed to have specific visual problems. The validity and reliability of the screening batteries in relation to the age group to be screened, and the person administering the test as well as the referral and follow-up criteria contribute to the overall outcome of the vision screening. Despite the long history of vision screening and significant improvement in the development of screening protocols, no agreement exists concerning the age at which children should be screened, the exact test batteries that should be included and who should conduct the screening. This review highlights some important aspects of the history of paediatric vision screening and available evidence in support of their use to detect visual conditions in children. It also examines some of the barriers against the development of paediatric vision screening models especially in low and medium income countries. •
... Non-strabismic accommodative and vergence binocular anomalies affect clarity and binocularity, and impair comfort and efficiency of visual performance when near tasks such as reading, writing and computer-based work is performed. 1,2,3,4,5 Learning involves reading, which is the process of extracting meaning from written text and is a fundamental part of a child's education. 6 A significant proportion of a child's activities in the classroom 7,8 and at home 8 involve the accommodative and vergence mechanism. ...
... 9,10,11,12,13 For school-age children and especially high school learners, such symptoms tend to increase as pupils progress through school and demand increases of their accommodative-vergence system for sustained clear vision, as a result of prolonged reading and increased information processing. 1,2,3,4,5 AVAs have several negative consequences that further highlight their clinical importance. Several studies 9,10,14 have reported on the association of AVAs with some behavioural and learning problems. ...
Article
Full-text available
Comfortable reading and the performance of near point activities involve efficient accommodative and vergence systems. However, accommodative and vergence anomalies are associated with various symptoms that impair efficient near point tasks. Although several studies investigated accommodative-vergence anomalies in school-age populations, their findings were diverse owing to differences in diagnostic techniques and the criteria used to define the variables. The aim of this paper is to derive prevalence and distribution estimates of vergence anomalies in school-age children and address variations in the study methods and findings. Despite variations in the study methods and findings, accommodativevergence anomalies were common in school-age populations. Variations and limitations of previous studies are discussed and recommendations for improving future studies are suggested.
... Often, optometrists see patients with complaints of blurred vision at near, diplopia, headaches, eye strain, watery eyes and ocular fatigue during reading. These symptoms, which are often related to near vision anomalies (NVAs) create discomfort and impair efficient near tasks including reading, writing or computer-based work [1][2] . For the school-aged child, especially those in high school, such symptoms tend to increase as the child progresses through school when there is greater demand on the accommodative and vergence system for sustained clear vision due to prolonged reading and increased information processing 1,2 . ...
... These symptoms, which are often related to near vision anomalies (NVAs) create discomfort and impair efficient near tasks including reading, writing or computer-based work [1][2] . For the school-aged child, especially those in high school, such symptoms tend to increase as the child progresses through school when there is greater demand on the accommodative and vergence system for sustained clear vision due to prolonged reading and increased information processing 1,2 . Near vision anomalies affect clarity, binocularity, impair comfort and efficiency of visual performance of an individual particularly when near tasks are performed 1,3 . ...
Article
Full-text available
Background: The ability to read efficiently and comfortably is important in the intellectual development and academic performance of a child. Some children experience difficulties when reading due to symptoms related to near vision anomalies. Aim: To explore the feasibility of conducting a large study to determine the prevalence, distribution and characteristics of near vision anomalies in high school children in Empangeni, South Africa. Methods: The study was a cross sectional descriptive pilot study designed to provide preliminary data on prevalence, distribution and characteristics of near vision anomalies in a sample of high school-children in South Africa. Study participants comprised 65 Black children (30 males and 35 females), ages ranged between 13 and 19 years with a mean age and standard deviation of 17 ± 1.43 years. The visual functions evaluated and the techniques used included visual acuity (LogMAR acuity chart), refractive error (autorefractor and subjective refraction), heterophoria (von Graefe), near point of convergence (push-in-to-double), amplitude of accommodation (push-in-to-blur) accommodation facility (± 2 D flipper lenses), relative accommodation, accommodation response (monocular estimation method) and fusional vergences (step vergence with prism bars). Possible associations between symptoms and near vision anomalies were explored using a 20-point symptoms questionnaire. Results: Prevalence estimates were: Myopia 4.8%, hyperopia 1.6% and astigmatism 1.6%. For accommodative anomalies, 1.6% had accommodative insufficiency while 1.6% had accommodative infacility. For convergence anomalies, 3.2% had receded near point of convergence, 16% had low suspect convergence insufficiency, no participant had high suspect convergence insufficiency, 1.6% had definite convergence insufficiency and 3.2% had convergence excess. Female participants reported more symptoms than the males and the association between clinical measures and symptoms were not remarkable. Conclusion: Although the overall prevalence of near vision anomalies was low, convergence anomalies were found to be more prevalent than refractive and accommodative anomalies. Symptoms were not significantly associated with near vision anomalies. Overall, the pilot project reveals that it is feasible to conduct the study on a large scale with minor modifications. Identification and referrals for near vision anomalies are important steps towards diagnosis and treatment which will minimize discomfort with reading and subsequent poor performance which may be associated with such anomalies.
... Cycloplegic retinoscopy is commonly emplo yed in cli nics to detect refractive errors and prevent refractive amblyopia in children; however, the technique has its disadvantages, including operator dependency and the need for extensive training (3,4) . In 2012, the American Academy of Pediatrics, the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), and the American Association of Certified Orthoptists (AACO) recommended early instrument-based pediatric vision screening (5) . ...
... Based on the mean refractive error according to the AAPOS ARF criteria, the specificity and sensitivity values of the Spot Vision Screener were calculated. [3][4][5][6][7][8][9][10]). The results of the fixed autorefractometer measurements were as follows: median cycloplegic spherical value +1.5 diopter (D) (range, -3.75 to +7.5), median astigmatism of -0.5 D (range, -4.75 to -0.25), and median spherical equivalent of +1.12 D (range, -5.87 to +7.38) ( Table 2). ...
Article
Full-text available
Purpose: The aim of this study was to evaluate the effect of anterior chamber depth and axial length on clinical performance of the Spot Vision Screener in detecting amblyopia risk factors in children aged 3-10 years. Methods: A total of 300 eyes from 150 patients aged 3-10 years were prospectively tested with Spot Vision Screener (firmware version 3.0.02.32, software version 3.0.04.06) and a standard autorefractometer (Nidek ARK-1). The anterior chamber depth and axial length were measured with an optical biometer (Nidek AL-Scan). The sensitivity and specificity values for detecting significant refractive errors using the referral criteria of the American Association for Pediatric Ophthalmology and Strabismus were determined. Pearson's correlation analysis was employed to evaluate the relationship between the Spot Vision results and the anterior chamber depth and axial length. Results: Compared with the standard autorefractometer results, the Spot Vision Screener's sensitivity and specificity was 59% and 94%, respectively. The differences between the cycloplegic autorefractometer and the Spot Vision Screener spherical equivalents were negatively correlated with anterior chamber depth (r=-0.48; p<0.001) and axial length (r=-0.45; p<0.001). Conclusion: The Spot Vision Screener has moderate sensitivity and high specificity, using the criteria of the American Association for Pediatric Ophthalmology and Strabismus. The anterior chamber depth and axial length affect the Spot Vision results.
... Referral rates from school vision screenings in both Australia and the USA are typically around 20-30 per cent, [7][8][9] but vary depending on a number of factors. These factors include the prevalence of eye conditions in the population of interest, access to eye-care services, as well as the pass/fail criteria and the range of conditions targeted by the screening. ...
... 10 For example, screening for reduced visual acuity alone results in substantially fewer referrals compared to more comprehensive vision screenings designed to detect all refractive errors and a range of binocular vision conditions. 8 Nevertheless, these referral rates indicate that a number of children are potentially impacted by untreated visual conditions. The fact that many vision conditions go undetected in school-aged children 11 is highly relevant, given the functional impact that uncorrected eye conditions can theoretically have on a child's ability to achieve and maintain clear, comfortable vision. ...
Article
The role of visual acuity and refractive errors in the academic performance of children is controversial due to the variable quality of the research in this area and the mixed findings reported. This review aims to provide clarity by reviewing and critiquing relevant peer‐reviewed publications and also summarises what is known regarding the visual demands of modern classroom environments. The outcomes of this review suggest that while a number of studies have investigated the role of vision in relation to children's academic performances, the veracity of the evidence obtained from the majority of these studies is undermined by methodological limitations. Comparisons between studies are constrained by differences in experimental designs, instrumentation and sample characteristics. Despite these limitations, the weight of evidence suggests there is an association between academic performance and both visual acuity and refractive error in children. However, well‐designed experimental studies are necessary to further understand the relationship between these parameters.
... Indeed, the Lea Symbols chart offers a better visual impairment detection rate for preschool vision screening than the Sheridan Gardiner chart (30,39). The results reported in this study compared well with those of other countries, where the failure rate was 11.9% for children aged 4 years old-5 years old in Scotland (12) and up to 19% failure rate for children in economically disadvantaged areas of New York City (40). However, when measured with the Sheridan Gardiner chart, only 2.7%-3.8% of Hong Kong children aged 2 years old-6 years old presented with visual acuity worse than or equal to 6/12 (41). ...
Article
Full-text available
Background: Vision screening programmes' outcomes are routinely used to report the prevalence of vision anomalies in children. However, the association between vision screening outcomes and the children's socioeconomic status remains underexplored. This cross-sectional study determined the association between socioeconomic and birth status with vision screening outcomes in a sample of children in Klang Valley. Methods: Total 411 children (mean age: 5.49 ± 0.47 years old) attending preschools were selected via stratified cluster sampling. Habitual distance visual acuity, near visual acuity, and stereoacuity were measured. The fail criteria were distance visual acuity ≥ 0.3 logarithm of the Minimum Angle of Resolution (logMAR), near visual acuity ≥ 0.4 logMAR or stereoacuity ≥ 300 arcsec. Socioeconomic and birth history data were obtained using parent-report questionnaires. The association between socioeconomic factors and screening outcomes were determined with binary logistic regression. Results: Sixty-two children (15.1%) failed the screening, with a significantly higher failure rate for Bumiputera children (16.34%) compared to non-Bumiputera children (4.08%) (χ 2 (1, 410) = 5.21; P = 0.024). After adjusting for confounders, Bumiputera children were four times more likely to fail vision screening (OR: 4.54; 95% confidence intervals [CI]: 1.07, 17.76; P = 0.044). Other socioeconomic factors were not significant predictors for failing vision screening. Conclusion: Preschool children's ethnicity is associated with vision screening outcomes. Bumiputera children are more likely to fail vision screening than their non-Bumiputera peers.
... Retinoscopy (often in combination with cycloplegia) is commonplace for refracting very young children in most clinical practices today. Nonetheless, retinoscopy has some limitations because it (1) is mostly user-dependent; (2) requires advanced clinical ophthalmic training; and (3) is mostly subject to inter-observer variability [11][12][13]. Using autorefractors in children presents its own problems, such as difficulty in maintaining the appropriate position of the child, ensuring head alignment, and achieving visual fixation on a target for a sufficient length of time [14]. ...
Article
Full-text available
Photorefractive devices have been evaluated for their effectiveness in detecting anisometropia, hyperopia, myopia, and astigmatism. We investigated the reliability of Plusoptix S08, the newest photoscreener, and Topcon autorefractometer by comparing them with cycloplegic retinoscopy. Plusoptix S08, cycloplegic retinoscopy, and cycloplegic autorefractometer measurements for 235 eyes of 118 children (59 female, 59 male) with a mean age of 4.9 ± 2.6 and median age of 5 years (range 1-12) were conducted. The Plusoptix S08 produced the following mean (±SD) results-spherical 0.27 ± 1.64, cylindrical power -0.81 ± 0.71, axis 89.73 ± 61.18, and spherical equivalent -0.05 ± 1.61. The cycloplegic retinoscopy produced the following mean (±SD) results-spherical 0.12 ± 1.35, cylindrical power -0.89 ± 0.71, axis 92.18 ± 68.39, and spherical equivalent -0.15 ± 1.31. The cycloplegic autorefractometer produced the following mean (±SD) results-spherical 0.16 ± 1.44, cylindrical power -0.88 ± 0.72, axis 90.86 ± 68.21, and spherical equivalent -0.12 ± 1.41. This study has shown that cycloplegic autorefractometer and retinoscopy results are similar and Plusoptix S08 is a very safe, easy-to-use and reliable screening method of refraction, especially for ophthalmologists unskilled in retinoscopy. Plusoptix S08 is a useful tool for estimating refraction in patients for whom conventional autorefraction is not an option.
... 15 Children who resided in urban areas were more susceptible to poverty, malnutrition, and poor vision than their peers in higher socioeconomic areas. 16,17 In a study conducted in a Connecticut school district, researchers found that 29% of students who failed vision screenings did not receive follow-up eye care owing to parental unawareness of the results. 18 Miscommunication and lack of clarity in screening results were the most prominent barriers for receiving follow-up. ...
... 5,6,11,12 The prevalence of CI is estimated to be 4%-13% in fifth-and sixth-graders. 13,14 The Convergence Insufficiency Symptom Survey score 15,16 was created to provide a quantitative measure of the symptoms caused by abnormally poor convergence ability. This score has been used in randomized controlled trials to measure the improvement in symptoms after various treatments for CI. ...
Article
To measure the difference in Convergence Insufficiency Symptom Survey scores for reading versus favorite near visual activities. Comparative validity analysis of diagnostic tools. At a single clinical private practice, 100 children ages 9 to 18 with normal binocular vision were recruited to receive either the original survey emphasizing reading or a modified survey replacing "reading" with their favorite near activity. Average survey scores and subscores for questions emphasizing fatigue, discomfort, impaired vision, and cognitive performance were compared using t-tests, while responses to individual questions were compared using Mann Whitney U tests. The average reading survey score was significantly greater than the favorite near activity survey score (14.1±11.5 versus 6.7±5.8, p=0.0001). The largest difference resulted from questions emphasizing cognitive performance (subscore 5.8±4.3 versus 2.0±2.1, p=0.0000002), although significant differences were also found for fatigue (5.4±3.8 versus 3.0±2.7, p=0.0003), discomfort (3.9±4.6 versus 1.8±2.2, p = 0.004), and impaired vision (3.2±3.9 versus 1.8±2.2, p=0.02). Significant differences were found for seven survey questions, with higher symptom scores for the reading survey in every case. Using survey scores ≥ 16 to diagnose convergence insufficiency, significantly more children taking the reading survey would have been diagnosed with convergence insufficiency than children taking the favorite near activity survey (19 of 50 (38%) versus 5 of 50 (10%), p=0.001). By emphasizing reading, the Convergence Insufficiency Symptom Survey score significantly overestimates near visual symptoms in children with normal binocular vision compared with symptoms caused by preferred near activities that require similar amplitudes of accommodation and convergence. Copyright © 2015 Elsevier Inc. All rights reserved.
... Findings on the increased prevalence of headache with advancing age may be related to increased near tasks demand which is usually more prevalent in high school than in primary school age groups. 30,31 Ocular headache is a reflex pain caused by sustained contraction of the ciliary muscle which in turn causes vascular engorgement that leads to eye ache and headaches. 27,32,33 The abnormal use of the ciliary muscles acts as a stimulus to reflex headache. ...
Article
Full-text available
Background: Asthenopia is a common complaint amongst patients who attend eye care settings. Owing to associated discomfort or distress, asthenopia affects efficient reading and performance of near tasks.Purpose: To study the prevalence of asthenopia and any association with refractive errors in a clinical setting.Methods: In this cross-sectional practice-based study, the clinic records of 1109 school-aged children (mean age and standard deviation 14.39 ± 3.39 years) were analysed. The sample comprised 427 (38.5%) male and 682 (61.5%) female patients between the ages of 6 and 19 years. Refractive errors were classified into various types, and the association between these refractive types and symptoms in asthenopia were explored.Results: The most common symptom of asthenopia was headaches (40.8%), of which temporal headaches were the most frequent type (15.7%). Various symptoms were significantly associated with mainly astigmatism.Conclusion: Headaches were the most frequent complaint amongst patients who attended the author’s optometric practice. Astigmatism was the most frequent cause of asthenopia. Female patients were more likely than male patients to complain of asthenopia, whilst high school students were more likely than primary school children to complain of asthenopia. Further studies to relate asthenopia to binocular anomalies will be relevant in enhancing our understanding of the relationship between asthenopia and vision anomalies.
... Visual acuity is routinely measured by clinicians as part of ocular health and visual function assessment, and during pre-school vision screenings. Detection of amblyopia, a developmental vision disorder affecting approximately 3.5% of adults (Attebo et al., 1998), is a key reason for pre-school vision screening (Bodack, Chung, & Krumholtz, 2010;Friendly, 1978;Kemper, Keating, Jackson, & Levin, 2005;Schlenker, Christakis, & Braga-Mele, 2010;Schmucker et al., 2009;U.S. Preventive Services Task Force, 2004) as treatment is more likely to be successful if initiated early in life (Flynn, Schiffman, Feuer, & Corona, 1998;Flynn et al., 1999). Inter-ocular visual acuity differences are a key component of amblyopia diagnosis and monitoring of treatment outcomes (Attebo et al., 1998;Flom & Neumaier, 1966;Flynn et al., 1998Flynn et al., , 1999Holmes & Clarke, 2006;Simons, 2005). ...
Article
Full-text available
Crowding refers to the degradation of visual acuity for target optotypes with, versus without, surrounding features. For letter targets, crowding is strongest when surrounding features are also letters, in close physical proximity. Crowding is important clinically, however the effect of target-flanker spacing on acuity for symbols and pictures, compared to letters, has not been investigated. Five adults with corrected-to-normal vision had visual acuity measured for modified single target versions of Kay Pictures, Lea Symbols, HOTV and Cambridge Crowding Cards, tests. Single optotypes were presented in isolation and with surrounding features placed 0-5 stroke-widths away. Visual acuity measured with Kay Picture optotypes is 0.13-0.19logMAR better than for other test optotypes and varies significantly across picture. The magnitude of crowding is strongest when the surrounding features abut, or are placed 1 stroke-width away from the target optotype. The slope of the psychometric function is steeper in the region just beyond maximum crowding. Crowding is strongest and the psychometric function steepest, with the Cambridge Crowding Cards arrangement, than when any single optotype is surrounded by a box. Estimates of crowding extent are less variable across test when expressed in units of stroke-width, than optotype-width. Crowding for single target presentations of letters, symbols and pictures used in paediatric visual acuity tests can be maximised and made more sensitive to change in visual acuity, by careful selection of optotype, by surrounding the target with similar flankers, and by using a closer target-flanker separation than half an optotype-width.
... 4 Stereopsis is also deficient in cases of strabismus 5,6 and refractive errors. 7,8 Stereopsis is affected by multiple factors like poor vision, literacy, age, deprivation, and amblyopia. 9,10 Stereoacuity may be improved by treating the cause such as refraction, strabismus, or cataract. ...
Article
Full-text available
Aim To evaluate central macular thickness (CMT) following improved vision and stereoacuity in pediatric patients after medical intervention. Method We enrolled children having refractive errors, squint, or cataract. Anterior and posterior segment examinations were done with stereoacuity evaluated. We subjected all eyes for Spectral domain optical coherence tomography (SD-OCT) and measured CMT. After appropriate treatment, stereoacuity and OCT were evaluated again after 3 months. Result Here, we enrolled 229 children with mean age 10.6 ± 4.5 and found significant improvement in vision and stereoacuity after treatment (p < 0.05) in children with refractive errors, squint, and cataract. Conclusion Appropriate treatment makes functional changes in terms of stereoacuity as well as structural changes in form of CMT in children with refractive errors, squint, and cataract.
... Though estimates of prevalence vary depending on population and specific vision issues, studies show that 22%-30% of children fail vision screening [8][9][10][11]. About 80% of learning occurs through visual tasks such as reading, writing and using computers; studies conclude that uncorrected vision problems impede a child's ability to read and that correction of the problem improved performance [12][13][14]. ...
Article
Full-text available
Methods: Investigators reviewed websites of state departments of health and education, and legislation for all 50 states and DC. For states with mandated screenings and a required form, investigators applied structured analysis to assess HBL inclusion. Results: No state mandated that schools require screening for all 7 HBLs. Less than half (49%) required comprehensive school health examinations and only 12 states plus DC required a specific form. Of these, 12 of the forms required documentation of vision screening, 11 of hearing screening, and 12 of dental screening. Ten forms asked about asthma and 9 required documentation of lead testing. Seven asked about general well-being, emotional problems, or mental health. None addressed hunger. When including states without comprehensive school health examination requirements, the most commonly required HBL screenings were for vision (80% of states; includes DC), hearing (75% of states; includes DC) and dental (24% of state; includes DC). Conclusion: The lack of state mandated requirements for regular student health screening represents a missed opportunity to identify children with HBLs. Without state mandates, accompanying comprehensive forms, and protocols, children continue to be at risk of untreated health conditions that can undermine their success in school.
... The King-Devick (K-D) test is a rapid number-naming task that has recently been repurposed as a clinical measure of visual tracking and saccadic eye movements in athletes before and after a suspected SC. 10 The K-D test was originally developed in the 1970s to test attention, processing, and speech 11 and to measure reading comprehension and learning disabilities in elementary school children. 12 Administration of the K-D test involves the patient visually following and reading aloud sequences of numbers from 3 test cards that increase in difficulty, whereas the sum time to complete all 3 cards is recorded. 13 Postinjury increases in time to complete the K-D test, usually 5 or more seconds relative to a patient's baseline time, have been described as a sign of SC. 11 The K-D was first described as a measure of SC in a sample of mixed martial art fighters and boxers who had suffered head trauma. ...
Article
Objective: To determine the test-retest reliability and the influence of exercise on King-Devick (K-D) test performance. Design: Crossover study design. Setting: Controlled laboratory. Participants: Participants consisted of 63 (39 women and 24 men) healthy, recreationally active college students who were 21.0 + 1.5 years of age. Independent variables: Participants completed the K-D test using a 2-week, test-retest interval. The K-D test was administered before and after a counterbalanced exercise or rest intervention. Reliability was assessed using testing visits (visit 1 and visit 2) as the independent variables. Exercise or rest and time (baseline, postintervention) were used as independent variables to examine the influence of exercise. Main outcome measures: Intraclass correlation (ICC) coefficients with 95% confidence intervals were calculated between visits to assess reliability of K-D test completion time. A repeated-measure 2 x 2 analysis of variance (intervention × time) with post hoc paired t tests was used to assess the influence of exercise on K-D test performance. Results: The K-D test was observed to have strong test-retest reliability [ICC2,1 = 0.90 (0.71, 0.96)] over time. No significant intervention-by-time interaction (P = 0.55) or intervention main effects (P = 0.68) on K-D time were observed. Mean differences of -1.5 and -1.7 seconds (P < 0.001) were observed between baseline and rest and exercise interventions for K-D test performance, respectively. Up to 32% (20/63) of participants were observed to have a false-positive K-D test performance before and after each intervention. Conclusions: Although strong test-retest reliability coefficients were observed using clinically relevant time points, a high false-positive rate warrants caution when interpreting the K-D test.
... Traditionally, paediatric vision screening involved only the Snellen visual acuity test and was focused on detecting children with reduced distance visual acuity thereby having the possibility of missing several other important basic visual skills. 2,3,4 Consequently, test batteries including the modified clinical technique, 5 the New York State Optometric Association test battery 6 and the http://www.avehjournal.org Open Access have improved the provision and participation of vision screening in their domains. ...
Article
Full-text available
Background: Vision screening is an important component of any child eye health system. Availability of standardised and broad screening guidelines is important to its success because it will allow for uniform and full utilisation of services through the system. Aim: This study aimed to evaluate the coverage, components, and referral criteria of the paediatric vision screening services in Abia State, Nigeria, towards the development of a uniform vision screening guideline. Methods: Eighty-three registered optometrists practising in Abia State for at least one year prior to the commencement of the study were invited to participate. Self-administered questionnaires were distributed directly or via email to the optometrists. The questionnaire covered areas such as the participation of optometrists in paediatric vision screening, coverage of the screening programmes, screening tools and referral criteria. Results: A response rate of 77.1% (64 participants) was recorded for the survey. Twenty-eight (43.8%) respondents offered more than one paediatric vision screening outside their practice in the last year before the survey. Among those respondents, 20 were from the private sector and 20 were based in urban cities. Only 10 respondents undertook more than four paediatric screening services within this period. Visual acuity measurement and ocular health assessment were the main components of the screening batteries of optometrists. While a child with any disease abnormality was referred for evaluation, the referral criteria for a full examination were inconsistent. Conclusion: The existing paediatric screening programmes in Abia State are inadequate. Of the few conditions that are screened for, varied referral criteria for further examination are applied. It therefore appears that the current screening programmes are not meeting the visual needs of the paediatric population and suggests the need for a new strategy to improve vision screening provisions to children in Abia State.
... Prevalence estimates of vision impairments vary across different populations and with respect to specific vision issues: while some studies from the US report up to 22-30% of vision screen-positives [18,[20][21][22], the prevalence in our study sample was considerably low (i.e. 9%). ...
Article
Full-text available
Background Each child in Germany undergoes a preschool health examination including vision screening and recommendations for further ophthalmic care. This study investigated the frequency of and adherence to these recommendations. Methods A population-based prospective cohort study was performed in the area of Mainz-Bingen (Rhineland-Palatinate, Germany). All preschoolers were examined at the statutory preschool health examination, which includes vision testing (Rodenstock vision screener) with available correction in the last preschool year. Based on the results, recommendations for further ophthalmic care were given to the parents. Six weeks prior to school entry, parents were surveyed concerning ophthalmic health care visits, diagnoses, and treatments. Ophthalmic care recommendation frequency and its adherence were investigated using logistic regression analysis adjusted for potential confounders. Results 1226 children were included in this study, and 109 children received a recommendation for ophthalmic care based on the preschool health examination. At the follow-up, 84% of children who had received a recommendation had visited an ophthalmologist within the preceding year compared to 47% of children who had not received a recommendation. The recommendation for ophthalmic care was clearly associated with a higher number of ophthalmological visits (odds ratio = 7.63; 95% confidence interval: 3.96–14.7). In a subgroup analysis, adherence to a recommendation was lower in children with migrant background (OR = 2.26; 95%-CI: 0.64–7.90, compared to: OR = 11.6; 95%-CI: 4.95–27.4) and in those with low socio-economic status. Conclusions Adherence to preschool recommendations for ophthalmic care is high in German preschoolers. However, a migrant background and low socio-economic status may reduce this adherence.
... However, most children do not notice their visual impairment, especially if only one eye is involved (5). Currently, the most widely used method for myopia screening is the uncorrected visual acuity test, which requires an acuity chart and trained nurses or technicians, possessing a sensitivity and specificity of 63.6% and 94.0%, respectively (6,7). Timely and annual manual optometric examinations of the entire at-risk population of individuals would help prevent the development of myopia. ...
Article
Background: Myopia is the leading cause of visual impairment and affects millions of children worldwide. Timely and annual manual optometric screenings of the entire at-risk population improve outcomes, but screening is challenging due to the lack of availability and training of assessors and the economic burden imposed by the screenings. Recently, deep learning and computer vision have shown powerful potential for disease screening. However, these techniques have not been applied to large-scale myopia screening using ocular appearance images. Methods: We trained a deep learning system (DLS) for myopia detection using 2,350 ocular appearance images (processed by 7,050 pictures) from children aged 6 to 18. Myopia is defined as a spherical equivalent refraction (SER) [the algebraic sum in diopters (D), sphere + 1/2 cylinder] ≤-0.5 diopters. Saliency maps and gradient class activation maps (grad-CAM) were used to highlight the regions recognized by VGG-Face. In a prospective clinical trial, 100 ocular appearance images were used to assess the performance of the DLS. Results: The area under the curve (AUC), sensitivity, and specificity of the DLS were 0.9270 (95% CI, 0.8580-0.9610), 81.13% (95% CI, 76.86-5.39%), and 86.42% (95% CI, 82.30-90.54%), respectively. Based on the saliency maps and grad-CAMs, the DLS mainly focused on eyes, especially the temporal sclera, rather than the background or other parts of the face. In the prospective clinical trial, the DLS achieved better diagnostic performance than the ophthalmologists in terms of sensitivity [DLS: 84.00% (95% CI, 73.50-94.50%) versus ophthalmologists: 64.00% (95% CI, 48.00-72.00%)] and specificity [DLS: 74.00% (95% CI, 61.40-86.60%) versus ophthalmologists: 53.33% (95% CI, 30.00-66.00%)]. We also computed AUC subgroups stratified by sex and age. DLS achieved comparable AUCs for children of different sexes and ages. Conclusions: This study for the first time applied deep learning to myopia screening using ocular images and achieved high screening accuracy, enabling the remote monitoring of the refractive status in children with myopia. The application of our DLS will directly benefit public health and relieve the substantial burden imposed by myopia-associated visual impairment or blindness.
... [6] Other studies also suggest that objective refraction like retinoscopy can play a vital role here, but retinoscopy requires advanced clinical training. [7,8] Moreover, many international organizations recommended more than one single test would be perform well to detect a refractive abnormality. [9] In such circumstances, when the screening process itself needs standardization, using inexperienced nonclinical personnel for screening again raises a controversy. ...
Article
Full-text available
PURPOSE: School eye screening program is an integrated part of SarvaShikshyaAbhiyan. Distance visual acuity was the only tool used in such school eye screening for making referrals. We aim to evaluate the referral rate when only distance visual acuity was used as the screening tool versus using retinoscopy. METHODS: School children were earlier screened using distant visual acuity as the sole criteria. They were again examined as per the guidelines recommended by State of Alaska and American Academy of Pediatrics, and the results of the two examinations were compared. Microsoft Excel 2007 was used for the statistical analysis. RESULTS: Earlier 384 school children of class first to fourth (aged 6–10 years) had been screened using distant visual acuity. Of them, 87 (22.6%) were referred. The rest 297 (male 183 61.6%) students with a mean age of 7.8 years (standard deviation ± 1.23) were again examined and 42/384 (11%) were detected as having visual anomaly that were false negative/or missed during the initial screening. Refractive errors were detected in 33/42 (78.6%) students by retinoscopy. Retinoscopy showed the highest sensitivity (78.6%) and negative predictive value (96.6%) to detect all types of refractive error among all types of tests. Of 42 pair of eyes, 36 right eyes and 39 left eyes had refractive errors, mostly astigmatic, or hyperopic, which were missed earlier. CONCLUSION: Only distance visual acuity failed to detect hyperopia and astigmatism properly. Introduction of retinoscopy would increase the validity of school eye screening. Keywords: Refractive error, retinoscopy, school eye screening, sensitivity, under referral
... 111 Additionally, a study of 1,992 school-age children found that 41% of children who failed the State University of New York screening battery would not have been identified if the screening was based on visual acuity alone. 112 Many children who fail a screening do not receive the necessary treatment of their conditions. A study of public school children reported only 38.7% who failed the vision screening received follow-up care after screenings. ...
Article
Republished with written permission granted from the American Optometric Association, October 2, 2020.
... and 3.3.3), and binocular vision problems are relatively common in children 76,77 ; thus, it is important to perform a binocular vision assessment at baseline (potentially as part of exclusion criteria to ensure they are not a confounding factor) and at periodic times throughout a myopia control study, such as during annual assessments. Typically, participants with a manifest strabismus would be precluded from participating in a myopia control clinical study, although this is not always specifically stated in the reported exclusion criteria (see Section 2.5). ...
Article
Full-text available
The evidence-basis based on existing myopia control trials along with the supporting academic literature were reviewed; this informed recommendations on the outcomes suggested from clinical trials aimed at slowing myopia progression to show the effectiveness of treatments and the impact on patients. These outcomes were classified as primary (refractive error and/or axial length), secondary (patient reported outcomes and treatment compliance), and exploratory (peripheral refraction, accommodative changes, ocular alignment, pupil size, outdoor activity/lighting levels, anterior and posterior segment imaging, and tissue biomechanics). The currently available instrumentation, which the literature has shown to best achieve the primary and secondary outcomes, was reviewed and critiqued. Issues relating to study design and patient selection were also identified. These findings and consensus from the International Myopia Institute members led to final recommendations to inform future instrumentation development and to guide clinical trial protocols.
... Development of a diagnostic system. Our system was implemented with the Caffe software (Berkeley Vision and Learning Centre, deep-learning framework) 32,33 , and all of the models were trained in parallel on four NVIDIA TITAN X graphics processing units. We tested the model using fourfold cross-validation of our dataset, preserving the percentage of samples in each class per iteration of the validation process. ...
Article
Full-text available
The development of artificial intelligence algorithms typically demands abundant high-quality data. In medicine, the datasets that are required to train the algorithms are often collected for a single task, such as image-level classification. Here, we report a workflow for the segmentation of anatomical structures and the annotation of pathological features in slit-lamp images, and the use of the workflow to improve the performance of a deep-learning algorithm for diagnosing ophthalmic disorders. We used the workflow to generate 1,772 general classification labels, 13,404 segmented anatomical structures and 8,329 pathological features from 1,772 slit-lamp images. The algorithm that was trained with the image-level classification labels and the anatomical and pathological labels showed better diagnostic performance than the algorithm that was trained with only the image-level classification labels, performed similar to three ophthalmologists across four clinically relevant retrospective scenarios and correctly diagnosed most of the consensus outcomes of 615 clinical reports in prospective datasets for the same four scenarios. The dense anatomical annotation of medical images may improve their use for automated classification and detection tasks. A workflow that segments anatomical structures in slit-lamp images and that annotates pathological features in each image improves the performance of a deep-learning algorithm for the diagnosis of ophthalmic disorders.
... If vision screening programs are to identify uncorrected ametropia in childhood it may be important to employ a range of vision tests rather than rely on VA measures alone. The incorporation of a +4.00DS lens in screening programs has been proposed to help detect moderate hyperopia [12], and the public schools screening in New York City involves assessment of both distance and near acuities and the use of a +2.00DS hyperopia test [21]. However there is no firm evidence as to which tests would best support screening for ametropia. ...
Article
Full-text available
To investigate the utility of uncorrected visual acuity measures in screening for refractive error in white school children aged 6-7-years and 12-13-years. The Northern Ireland Childhood Errors of Refraction (NICER) study used a stratified random cluster design to recruit children from schools in Northern Ireland. Detailed eye examinations included assessment of logMAR visual acuity and cycloplegic autorefraction. Spherical equivalent refractive data from the right eye were used to classify significant refractive error as myopia of at least 1DS, hyperopia as greater than +3.50DS and astigmatism as greater than 1.50DC, whether it occurred in isolation or in association with myopia or hyperopia. Results are presented from 661 white 12-13-year-old and 392 white 6-7-year-old school-children. Using a cut-off of uncorrected visual acuity poorer than 0.20 logMAR to detect significant refractive error gave a sensitivity of 50% and specificity of 92% in 6-7-year-olds and 73% and 93% respectively in 12-13-year-olds. In 12-13-year-old children a cut-off of poorer than 0.20 logMAR had a sensitivity of 92% and a specificity of 91% in detecting myopia and a sensitivity of 41% and a specificity of 84% in detecting hyperopia. Vision screening using logMAR acuity can reliably detect myopia, but not hyperopia or astigmatism in school-age children. Providers of vision screening programs should be cognisant that where detection of uncorrected hyperopic and/or astigmatic refractive error is an aspiration, current UK protocols will not effectively deliver.
... [5] Retinoscopy has some drawbacks because it is time-consuming, necessitates advanced training, and is subject to interobserver variability. [6] Autorefractors are devices which perform automated retinoscopy on each eye separately. They are easy to operate, are quicker, and have more repeatability than other techniques of objective refraction such as retinoscopy. ...
Article
Full-text available
Purpose: To compare refractive measurements of noncycloplegic photoscreener Plusoptix S12R with cycloplegic retinoscopy, noncycloplegic autorefractor, and cycloplegic autorefractor in children. Methods: The study population (200 eyes of 100 children) was divided into two groups: Group 1 (age 3-7 years) and Group 2 (age 8-15 years). In Group 1, Plusoptix was compared with cycloplegic retinoscopy. In Group 2, Plusoptix was compared with cycloplegic retinoscopy and autorefraction. The second group was made because the younger group was found to be uncooperative for autorefraction. Paired t-test and Pearson's correlation were used for statistical analysis. Results: The mean difference in sphere (DS), spherical equivalent (DSE), and cylinder (DC) between cycloplegic retinoscopy and Plusoptix in Group 1 was 0.68 ± 0.55 (P < 0.001), 0.77 ± 0.61 (P < 0.001), and 0.18 ± 0.28 (P < 0.001), respectively. In Group 2, DS, DSE, and DC between cycloplegic retinoscopy and Plusoptix were 0.86 ± 0.49 (P < 0.001), 0.97 ± 0.51 (P < 0.001), and 0.23 ± 0.28 (P < 0.001); between cycloplegic autorefractor and Plusoptix were 0.69 ± 0.47 (P < 0.001), 0.74 ± 0.49 (P < 0.001), and 0.10 ± 0.31 (P = 0.002); and between noncycloplegic autorefractor and Plusoptix were - 0.25 ± 0.39 (P < 0.001), -0.19 ± 0.41 (P < 0.001), and 0.11 ± 0.31 (P < 0.001), respectively. Pearson's correlation coefficients of S, SE, and C between Plusoptix and cycloplegic retinoscopy were 0.948, 0.938, and 0.924 in Group 1 and 0.972, 0.972, and 0.946 in Group 2, and these values were statistically significant. Bland-Altman plots showed good agreement between cycloplegic retinoscopy and Plusoptix in both groups. Plusoptix gave axis values within 10° of cycloplegic retinoscopy in 81.56% of eyes in Group 1 and in 71.44% of eyes in Group 2. Conclusion: Plusoptix photoscreener can be used for prescription of axis of cylinder in children; however, other refractive measurements must be refined by cycloplegic retinoscopy.
... Given the high number of children reported as failing vision screening with uncorrected refractive error (Bruce et al. 2018), a secondary aim of the present study was to determine whether incorporating an additional assessment of visual acuity with the child looking through a plus (convex) lens may help improve the detection of hyperopia (Bodack et al. 2010;Bosse et al. 1992;Laatikainen & Erkkila 1980;Thomson & Evans 1999;Williams et al. 2005). Viewing through a plus lens should blur the distance vision of those children who are not hyperopic but have little or no impact on children who are hyperopic. ...
Article
Full-text available
Background: We applied the National Screening Committee vision screening protocol [pass criterion monocular acuity ≤ 0.2 LogMAR in both eyes(BE)] to children four to five years old to investigate the visual profile of children who passed/failed. Previous studies have only evaluated those failing. The aim was to derive false positive and negative values, specificity/sensitivity of the vision screening protocol for detecting significant visual defects (strabismus and/or significant refractive error) and the utility of a 'plus blur test' in identifying hyperopia. Methods: Participants included 294 children (5.2 ± 0.4 yrs). In addition to the vision screening protocol (monocular acuity-3 m crowded Keeler LogMAR letters), acuities were recorded through +2.50D and +4.00D lenses and ocular alignment and cycloplegic refractive error were assessed. Using acuity measures, participants were classed as passing/failing the screening protocol. Each participant was also classed as having a strabismus and/or significant refractive error (hyperopia ≥ +4.00DS; myopia ≤ -0.50DS; astigmatism ≤ -1.50DC; anisometropia ≥ +1.50DS) or no significant visual defects. Results: Of the 284 children who completed all tests, 27.8% failed to achieve 0.2 LogMAR in BE. The acuity pass/fail criterion had a sensitivity of 70.4% and specificity of 82.2% for detecting strabismus and/or significant refractive error. Of those who failed, 51.9% (n = 41/79) had no strabismus and/or significant refractive error (false positives). Of those who passed, 7.8% (n = 16/205) had visual defects (false negatives). The 'plus blur tests' improved sensitivity in detecting significant refractive error (+2.50D & +4.00D 90.7%) but significantly reduced specificity (+2.50D = 65.2%; +4.00D = 60.9%). Conclusions: School-entry vision screening is reasonably sensitive and specific for detecting strabismus and/or significant refractive error. Most children with visions poorer than 0.2 LogMAR need refractive intervention, and the majority of the remainder are likely false positives for significant visual defects. One in 13 children who pass have either strabismus and/or significant refractive error (7.8%). The inclusion of a 'plus blur test' was not a useful addition to the vision screening protocol.
Article
Aims: To evaluate the refractive status of young Saudi schoolchildren with a "Spot Screener." Subjects and methods: This cross-sectional study was conducted from January to July 2016 in Riyadh, Saudi Arabia. Children of kindergarten (3-5 years) and grades 1 and 2 (6-7 years) were screened for refractive error (RE) using the handheld Spot Screener (Welch Allyn, Skaneateles Falls, NY, USA). Data were collected on age, gender, and spectacle use. The pass/fail notation from the Spot Screener and the RE were documented. Children with a "fail" were re-tested with an autorefractor (AR). The rate of agreement was evaluated for the spherical equivalent (SE) from the Spot Screener and AR. Results: We examined 300 schoolchildren and 114 preschool children. The prevalence of RE was 22% in schoolchildren and 25% in preschoolers. There were 183 (61%) hyperopes, 110 (36.7%) myopes, 6 (2%) emmetropes, and 29 (9.7%) astigmats (>2 D cylinder) in grade 1 and 2. There were 85 (74.6%) hyperopes, 22 (19.3%) myopes, 7 (6.1%) emmetropes, and 10 (8.8%) astigmats among preschoolers. The SE differed between the AR and the Spot Screener in 17 (28%) children of 61 failed Spot Screener tests. Accommodation (9, 53%) and high astigmatism (8, 47%) were the main underlying causes of the difference. The Spot Screener could identify RE for the first time in 51 (17%) schoolchildren and 26 (22%) preschoolers. End-users suggested that Spot Screener was child-friendly and quick to test RE. Conclusions: The Spot Screener could be a good initial screening tool for RE in young schoolchildren.
Article
Purpose Screening for uncorrected hyperopia in school children is important given its association with poorer visual function and academic performance. However, standard distance visual acuity screening may not detect low to moderate hyperopia. The plus lens test is used to screen for hyperopia in many school screening protocols, but has not been well validated. The current study investigated the effectiveness of the plus lens test to identify hyperopia in school children. Methods Participants included Grade 2 school children. Monocular distance visual acuity (logMAR letter chart) was measured unaided, and then through a +1.50D lens, known as the plus lens test. Cycloplegic refraction was undertaken to classify moderate hyperopia (≥+2.00D). Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated for commonly used cut‐offs for the plus lens test: 6/6, 6/9 and less than two lines difference between unaided acuity and acuity through the plus lens test. Results The sample included 59 children (mean age 7.2 ± 0.4 years). Fourteen (24%) children were classified as having uncorrected hyperopia. The sensitivity and specificity of the +1.50 plus lens test for identifying hyperopia were 0% and 98% respectively for a 6/6 cut‐off, 29% and 91% for 6/9 cut‐off, and 50% and 76% for a <2 line reduction between unaided acuity and acuity through the plus lens test. Receiver Operating Curve (ROC) analysis revealed area under curves of 0.69 based on acuity through the plus lens test, and 0.65 for a reduction in acuity through the plus lens test. Conclusions The plus lens test has low sensitivity for detecting uncorrected hyperopia using traditional cut‐offs of 6/9 or better. This raises questions about the role of the plus lens test in school screening batteries.
Article
Full-text available
Background Vision screening programmes for preschool children (aged 3–5 years) have been implemented for early detection and intervention of blinding visual disorders. In the occupied Palestinian territory, scientific data on visual disorders among preschool children are lacking. The aim of this study was to determine the prevalence of visual disorders in Palestinian preschool children living in urban areas. Methods In this cross-sectional study, preschools in Nablus city were selected using a cluster sampling randomised technique. All attending children aged 3–5 years were included in a vision screening after parental consent was obtained and a self-administered parental questionnaire was completed. The screening assessment included visual acuity, ocular alignment, depth perception, colour vision, non-cycloplegic retinoscopy, and ocular health. Children who failed the screening were referred for cycloplegic comprehensive eye examination. We used percentage and 95% CI to describe the prevalence, and the Pearson χ² test was applied to determine any associations. A p value less than 0·05 was considered significant. An Institutional Review Board's ethical approval was obtained. Findings 764 children from eight preschools were included in the vision screening. 127 children failed the screening test and proceeded to the comprehensive eye examination referral. The most prevalent visual disorders were refractive error (176 [29%] children), amblyopia (15 [4%]), colour vision deficiency (seven [1%]), strabismus (seven [1%]), and ocular health abnormalities (four [1%]). We found no variation in the prevalence of refractive errors by age (p=0·35) or sex (p=0·32). The leading causes for amblyopia were anisometropia (seven [1%] children), significant refractive error (six [1%]), and strabismus (two [<1%]). Interpretation Refractive error was the most prevalent visual disorder in Palestinian preschool children in Nablus. Both anisometropia and significant refractive errors were found to be the major causes of amblyopia. Although this study presented valuable information with respect to visual disorders among children at preschool age, the small sample size is a major limitation and the results cannot be extrapolated to the entire country. Funding None.
Article
Background Vision screenings of a school-based program were conducted in state-mandated grades (pre-kindergarten [pre-K] or kindergarten [K], 1st and 8th grade), and nonmandated grades (2nd to 7th). Methods During school years 2016-19, 51,593 pre-K to 8th grade students from 123 Baltimore City Public Schools underwent vision screenings, with 85% of the schools qualifying for Free and Reduced Price Meals. Assessments included distance visual acuity, Spot photoscreening, stereopsis, and cover testing. Screening failures were analyzed by grade using aggregate data. Failure rates for mandated and nonmandated grades were compared using a logistic regression model, and visual acuity distributions were analyzed using individual data. Results Over the 3-year period, 17,414 (34%) of students failed vision screening. Failure rates by grade ranged from 28% to 38%. Children in kindergarten and 3rd grade and higher were statistically more likely to fail screening than those in 1st grade. Reduced visual acuity was the most common reason for failure (91%). Failure rates were significantly higher in nonmandated grades than in state-mandated testing grades (34.7% vs 32.5% [P < 0.001]). Mean visual acuity of all students who failed vision screening was 20/50 in the worse-seeing eye and was 20/40 in the better-seeing eye. Conclusions One-third of students failed vision screening. High screening failure rates across all grades suggest that screening in select grade levels, as currently mandated in Maryland schools, is inadequate for detecting vision problems in the low-income communities served by this program.
Article
Significance: Methods and frequency of vision screenings for school-aged children vary widely by state, and there has been no recent comparative analysis of state requirements. This analysis underscores the need for developing evidence-based criteria for vision screening in school-aged children across the United States. Purpose: The purpose of this study was to conduct an updated comprehensive analysis of vision screening requirements for school-aged children in the United States. Methods: State laws pertaining to school-aged vision screening were obtained for each state. Additional information was obtained from each state's Department of Health and Education, through their websites or departmental representatives. A descriptive analysis was performed for states with data available. Results: Forty-one states require vision screening for school-aged children to be conducted directly in schools or in the community. Screening is more commonly required in elementary school (n = 41) than in middle (n = 30) or high school (n = 19). Distance acuity is the most commonly required test (n = 41), followed by color vision (n = 11) and near vision (n = 10). Six states require a vision screening annually or every 2 years. Conclusions: Although most states require vision screening for some school-aged children, there is marked variation in screening methods and criteria, where the screening occurs, and grade levels that are screened. This lack of standardization and wide variation in state regulations point to a need for the development of evidence-based criteria for vision screening programs for school-aged children.
Article
Many disadvantaged students with refractive errors, such as myopia (nearsightedness) and hyperopia (farsightedness), do not have eyeglasses, and their reduced vision may impact reading proficiency. Providing eyeglasses may increase their reading success. This article reports the findings of a study in Baltimore City in which disadvantaged second and third graders were assessed for vision problems. Of 317 students, 182 were given glasses. Those who needed glasses were given two pairs, one for home and one for school, as well as replacements if glasses were lost or broken. School staff assisted in ensuring that students wore their glasses, storing them safely, and replacing glasses when necessary. Students who received glasses improved more on Woodcock reading measures than those who never needed glasses (ES = +0.16, p < .03). The study demonstrates the potential of providing eyeglasses to disadvantaged students who need them to improve their reading performance.
Article
Full-text available
Sociedad Española de Óptica Type: Introduction to Research Paper / Tipo: Artículo de Introducción a la Investigación Section: Optics Education / Sección: Enseñanza de la Óptica Reference normal values and design of a vision screening for 4 to 5 years old preschoolers Diseño de un screening visual y valores normales de referencia para preescolares con edad entre 4 y 5 años ABSTRACT: A vision screening program for preschool children of 4-5 years old was designed and analyzed. Information of the prevalence of ocular conditions among preschool children was obtained. The vision health of a group of 127 children was evaluated by a comprehensive examination in their own school. If a child failed one or more screening tests, he was referred to the ophthalmologist. Of the children screened in this study, 61% passed distance visual acuity and retinoscopy tests, 17% were referred to the ophthalmologist and 22% will be annually monitoring. Values of monocular/binocular acuity worse than 0.5/0.6 are too poor for 4 years old children, whereas these limits increase up to 0.6/0.8 for 5 years old children. In conclusion, the prevalence of undetected vision problems in preschool children has been clearly demonstrated. Vision screening programs in schools are highly recommended. Nevertheless, coordination among professionals conducting screening, school personnel and parents are needed to reach high levels of success. The results of this study validate an easy and fast battery of tests. The vision screening has been highly reliable because reference normal values have been defined by analyzing statistically the results of these tests.
Article
Full-text available
Background: Childhood blindness is a major public health concern since 40% of visual disorders that can cause blindness among children are preventable. Vision screening programs among preschool children have been implemented in several countries as a tool for early detection and intervention of visual disorders. In Palestine, there is a lack of scientific data on the prevalence of visual disorders among children. In addition, vision-screening programs that are currently implemented are neither validated nor effective. Objective: Using validated vision screening protocols, a cross-sectional study is conducted to determine the prevalence of visual disorders among urban Palestinian preschool children between the ages of 3 to 5 years in Nablus city. Methods: All children attending eight preschools selected using single-stage cluster sampling technique, underwent a validated vision screening administered by trained eye care professionals. The screening protocol was based on a combination of clinical assessment adopted from the Modified Clinical Technique and the Vision in Preschoolers studies, including assessment of visual acuity, ocular alignment, depth perception, color vision, non-cycloplegic retinoscopy, and ocular health. A pass-fail criterion was used to refer all children who did not attend the vision screening for comprehensive eye examination, including cycloplegic retinoscopy and a dilated fundus exam. A chi-squared test was used to determine any association between visual disorders and their independent risk factors. Results: A total number of 764 children underwent vision screening. Out of the 290 children who did not attend the vision screening, 127 children responded to the referral call for comprehensive eye examinations. Refractive error was the most prevalent visual disorder with a prevalence of (29.37%), followed by amblyopia (4.10%), color vision deficiency (1.24%), strabismus (1.24%), and ocular health abnormalities (0.70%). There was no age (p=0.35) and gender (p=0.32) variation in children having refractive errors. Anisometropia was the leading cause for amblyopia (1.32%, n=7), followed by significant refractive error (1.13%, n=6) and strabismus (0.37%, n=2). Conclusion: Refractive error was the most prevalent visual disorder affecting Palestinian preschoolers in Nablus. Anisometropia and significant refractive errors were found to be the major causes of amblyopia. Effective nationwide preschool vision screening programs should be implemented in Palestine to screen amblyogenic risk factors.
Article
The aim of children's vision screenings is to detect visual problems that are common in this age category through valid and reliable tests. Nevertheless, the cost effectiveness of paediatric vision screenings, the nature of the tests included in the screening batteries and the ideal screening age has been the cause of much debate in Australia and worldwide. Therefore, the purpose of this review is to report on the current practice of children's vision screenings in Australia and other countries, as well as to evaluate the evidence for and against the provision of such screenings. This was undertaken through a detailed investigation of peer-reviewed publications on this topic. The current review demonstrates that there is no agreed vision screening protocol for children in Australia. This appears to be a result of the lack of strong evidence supporting the benefit of such screenings. While amblyopia, strabismus and, to a lesser extent refractive error, are targeted by many screening programs during pre-school and at school entry, there is less agreement regarding the value of screening for other visual conditions, such as binocular vision disorders, ocular health problems and refractive errors that are less likely to reduce distance visual acuity. In addition, in Australia, little agreement exists in the frequency and coverage of screening programs between states and territories and the screening programs that are offered are ad hoc and poorly documented. Australian children stand to benefit from improved cohesion and communication between jurisdictions and health professionals to enable an equitable provision of validated vision screening services that have the best chance of early detection and intervention for a range of paediatric visual problems.
Article
Purpose: To investigate practices, barriers, and facilitators of universal pre-school vision screening (PVS) at pediatric primary care offices. Methods: Focus group sessions (FGS) were moderated on-site at nine pediatric practices. A semi-structured topic guide was used to standardize and facilitate FGS. Discussions were audiotaped, and transcriptions were used to develop themes. All authors reviewed and agreed on the resultant themes. Results: FGS included 13 physicians and 32 nurses/certified medical assistants (CMAs), of whom 82% personally conducted some facet of PVS. In all practices, nurses/CMAs tested visual acuity (most using a non-recommended test), and physicians completed vision screening with external observation, fix/follow, red reflex, and cover test. Facilitators included (1) accepting that PVS is a routine part of the well-child visit, and (2) using an electronic medical record with prompts to record acuity (eight of nine practices). Barriers were related to difficulty testing pre-schoolers, distractions in the office setting, time constraints, and limited reimbursement. Conclusions: Responsibility for PVS is shared by physicians and nurses/CMAs; thus, interventions to improve PVS should target both. Few practices are aware of new evidence-based PVS tests; thus, active translational efforts are needed to change current primary care practices.
Article
Full-text available
Aim: To study the prevalence of nearpoint vergence anomalies (convergence insufficiency, convergence excess and fusional vergence dysfunction) and association with gender, age groups, grade level and study site (suburban and rural). Methods: The study design was cross sectional and data was analyzed for 1201 high school students aged 13-19 years who were randomly selected from 13 high schools in uMhlathuze municipality. Of the total sample, 476 (39.5%) were males and 725 (60.5%) were females. The visual functions evaluated included refractive errors, heterophoria, near point of convergence, accommodative functions and fusional vergences. Possible associations between vergence anomalies and demographic variables (gender, age groups, school grade levels and study site) were explored. Results: Prevalence estimates were 11.8%, 6% and 4.3% for low suspect, high suspect and definite convergence insufficiency, and 1.9% for the pseudo convergence insufficiency. Convergence excess prevalence was 5.6%, and fusional vergence dysfunction was 3.3%. The prevalence of low suspect CI was significantly higher in suburban than in rural participants (p=0.01), the reverse was the case for pseudoconvergence insufficiency while the prevalence of convergence excess was significantly higher in the younger than in the older age group (p=0.02). No other category showed any statistically significant associations with vergence anomalies. Conclusion: The prevalence estimates for vergence anomalies in a sample of black high school students in South Africa were relatively low. Only study location and age influenced some vergence anomalies. Identification and referrals are important steps toward diagnosis and treatment for vergence anomalies. Further studies to compare vergence anomalies in various racial populations will be relevant.
Article
Full-text available
Fourth year optometry students screened 745 preschoolers using a slightly altered Modified Clinical Technique (MCT) under the supervision of a faculty doctor. Children who failed the MCT were randomly selected and then matched by age, sex, and ethnic origin to children who had passed the screening battery. The 61 screening failures and 45 matched controls were later given full eye examinations with cycloplegia by University of Alabama at Birmingham faculty doctors who were unaware of the screening results. The positive predictive value (PPV) (0.52) and negative predictive value (NPV) (0.78) of the MCT were calculated directly from the 2 x 2 contingency table crossing screening results and a standard diagnosis. Sensitivity [0.50, k(1,0) = 0.29], specificity [0.79, k(0,0) = 0.30], efficiency [0.70, k(0.5,0) = 0.29] of the MCT, and the prevalence (0.30) of children failing the standard diagnosis were estimated using statistics appropriate to the prospective sampling design. The reproducibility of the diagnosis, estimated by analyzing multiple, independent diagnosis of each study child by seven doctors was moderate (kappa D 0.58). Statistics summarizing the agreement between the MCT and the diagnosis by the individual study doctor are similar to those obtained with comparison to the standard diagnosis. The characteristics of the MCT may be generalized only to similar populations that are screened by clinicians with similar experience, using the same tests.
Article
Full-text available
The efficiency of preschool visual screening programmes to detect amblyopia is questionable. In this study such a programme in an inner city was assessed to determine its effectiveness. The results of screening and hospital treatment of 712 patients who were considered to require referral were entered into a database for analysis. Default rates were assessed and the efficacy of treatment determined. The only effective screening test for the detection of amblyopia was visual acuity. A large proportion of referred patients had refractive problems only. High default rates, particularly in geographical areas of lower socioeconomic grading, severely handicapped any attempt to reduce the incidence of amblyopia. A fresh approach to the detection and care of amblyopia in the inner city community is required, perhaps by performing screening of children in their first year of attendance at school to reduce default rates. Cycloplegic refraction of children who are found to have reduced visual acuity before their referral to hospital is also recommended.
Article
Full-text available
The purpose of this study was to fill a significant void in the ophthalmic literature by performing a large scale, comprehensive, prospective study of the prevalence of vision disorders and ocular pathology in a clinical pediatric population using well-defined diagnostic criteria. A prospective study was performed on 2,023 consecutive patients between the ages of 6 months and 18 years presenting for an initial comprehensive examination at the Eye Institute of The Pennsylvania College of Optometry. There were 373 subjects between 6 months and 5 years, 11 months of age, and 1,650 subjects between 6 years and 18 years of age. The most important finding from this study is that other than refractive anomalies, the most common conditions optometrists are likely to encounter in a pediatric population are binocular vision and accommodative disorders. The prevalence of accommodative and binocular (strabismic and non-strabismic) vision disorders is 9.7 times greater than the prevalence of ocular disease in children 6 months to 5 years of age, and 8.5 times greater than the prevalence of ocular disease in children 6 to 18 years of age. The data from this study has great significance for clinicians, optometric educational institutions, health care planners, and administrators. This data suggests that other than refractive anomalies, the most prevalent conditions in the clinical pediatric population are binocular and accommodative disorders. Clinicians should use a minimum data base that includes assessments of accommodation and binocular vision that will allow them to detect conditions with the highest prevalence.
Article
Full-text available
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. 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. 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. 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.
Article
Full-text available
A state-by-state survey regarding preschool vision screening guidelines, policies, and procedures was conducted. Currently 34 states provide vision screening guidelines and 15 states require vision screening of at least some of their preschool-aged children. The Department of Public Health administers the programs in 26 states, the Department of Education in 13. A wide range of professional and lay personnel conduct preschool vision screenings, and nurses participate in the screening process in 22 states. Visual acuity is assessed in 30 states, eye alignment in 24 states, refractive error in eight states, and color vision in 10 states. A combination of screening tests is recommended in 24 states. Currently, 45 states do not require screening of all preschool children. Thus, although laws, guidelines, and recommendations exist in most states, many preschool-age children do not have access to vision screening programs.
Article
Full-text available
The authors report their experience in preschool vision screening in the east of France, involving the Mother and Child Welfare Service and the School Health Service, under the administration of the National Ministry of Education. The review underlines the importance of early diagnosis of visual disorders in children before they reach three years of age. They recommend screening of every child at least once before the age of four years.
Article
Full-text available
To assess determinants of spectacle acceptance and use among rural Chinese children. Children with uncorrected acuity < or = 6/12 in either eye and whose presenting vision could be improved > or = 2 lines with refraction were identified from a school-based sample of 1892 students. Information on obtaining glasses and the benefits of spectacles was provided to children, families, and teachers. Purchase of new spectacles and reasons for nonpurchase were assessed by direct inspection and interview 3 months later. Among 674 (35.6%) children requiring spectacles (mean age, 14.7 +/- 0.8 years), 597 (88.6%) were followed up. Among 339 children with no glasses at baseline, 30.7% purchased spectacles, whereas 43.2% of 258 children with inaccurate glasses replaced them. Most (70%) subjects paid US$13 to $26. Among children with bilateral vision < or = 6/18, 45.6% bought glasses. In multivariate models, presenting vision < 6/12 (P < 0.009), refractive error < -2.0 D (P < 0.001), and amount willing to pay for glasses (P = 0.01) were predictors of purchase. Reasons for nonpurchase included satisfaction with current vision (78% of those with glasses at baseline, 49% of those without), concerns over price or parental refusal (18%), and fear glasses would weaken the eyes (13%). Only 26% of children stated that they usually wore their new glasses. Many families in rural China will pay for glasses, though spectacle acceptance was < 50%, even among children with poor vision. Acceptance could be improved by price reduction, education showing that glasses will not harm the eyes, and parent-focused interventions.
Conference Paper
Purpose: To compare the testability and threshold acuity levels for very young children on the crowded HOTV logMAR distance visual acuity test presented on the BVAT apparatus and the Lea Symbols logMAR distance visual acuity chart. Methods: Subjects were 87 Head Start children from age 3 to 3.5 years. Testing consisted of binocular pretraining at near using a lap card as needed, binocular pretraining at 3 m, and threshold testing for each eye. The testing procedure, adapted from the Amblyopia Treatment Study, presented optotypes until the child was unable to correctly name or match three of three or three of four optotypes of a given size. Threshold acuity was the smallest size for which at least three optotypes were correctly identified. Results. Both near and distance pretraining were completed by 71% of children for HOW and by 75% for Lea Symbols (P = .39). The distribution of threshold acuities differed between the two tests. For the 69 eyes of 53 children who were successfully tested with both optotypes, results from the crowded HOW acuity test were on average 0.25 logMar (2.5 lines) better than those from the Lea Symbols acuity test (P < .001). Conclusions. The proportion of children between 3 and 3.5 years of age whose monocular visual acuity could be assessed was high and was similar for the two charts tested. Crowded HOW acuity results were better on average than results using Lea symbols. The different formats of the two tests may explain the observed differences in threshold acuity level.
Article
Vision assessments were provided to 297 Head Start children in nine Westchester County, New York programs. An optometrist and an orthoptist administered a protocol which included retinoscopy, visual acuity, fly, cover, motility and convergence tests. Sixty-three children (21.2%) were referred for further evaluation. The visual deficits detected by this screening included decreased acuity, strabismus combined with decreased acuity, astigmatism, and nonspecific visual problems. The protocol used provided a thorough evaluation of the visual system and required only seven minutes per patient.
Article
Purpose: To compare the performance of 3- to 5-year-old children on visual acuity screening with HOTV letters vs. Lea symbols as optotypes. Methods: Subjects included 1253 Head Start children who were aged either 3 or 4 years on September 1 of the school year of testing. The sample over-represented children who had not passed a Head Start screening. Binocular pretesting at 1 m demonstrated the child's ability to identify the optotypes verbally or by matching optotypes on a lap card. Acuity was tested monocularly at 3 m using crowded single lines of optotypes. Lines tested were based on age at the beginning of the school year (September 1) with 3-year-old children tested with lines 10/100, 10/32, 10/25, and 10/20 and 4-year-old children tested with 10/100, 10/25, 10/20, and 10/16. Results: Overall, 99% of children were able to complete the binocular pretest for each test successfully, and there was no difference between the tests (p = 0.83). Children's ability to complete the pretest increased slightly with age. HOTV test scores were slightly worse than Lea symbols test scores (p = 0.047), primarily because more children were unable to pass the monocular 10/100 card for the HOTV test than for the Lea symbols test (2.6% vs. 1.3%). The percentage of identical results on HOTV vs. Lea overall was 67.3% and increased significantly with age. When the results were different, 3-year-old children, but not 4- and 5-year-old children, tended to have worse results on the HOTV letter test. Conclusions: The vision of nearly all 3- to 5-year-old children can be screened using either HOTV letters or Lea symbols. HOTV letters may be slightly more difficult than Lea symbols for 3- to 5-year-old children, with the largest difference between acuity results on the two tests occurring in 3-year-old children.
Article
Conducted school vision screening programs at the Storefront School and the City and Country School. At the Storefront School, Ss included 73 male and female Black and Hispanic children (aged 6–14 yrs), and at the City and Country School, Ss included 82 male and female White, Asian, Black, and Hispanic children (aged 4–12 yrs). A significantly different failure rate for the Storefront School Ss (38%) as compared to the City and Country School Ss (24%) was found, possibly due to less access to health care and less parental education on visual problems. 53% of Storefront School Ss (as opposed to 33% of City and Country Ss) required glasses for near-sightedness. Screening also yielded 2 cases of strabismus in the City and Country School, one case with amblyopia. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Background: Controversy exists about the role of visual parameters and vision in learning to read. This study aims to determine whether ocular parameters or performance on a dynamic test of visual function differs for children of differing reading ability. Methods: Two hundred and eighty-four children (mean age 9.9 ±1.8 years) received a vision screening emphasising binocular anomalies associated with discomfort at near (distance and near visual acuity, distance vision challenged with binocular +1 D lenses, near heterophoria, near point of convergence, stereopsis and accommodative facility). Non-verbal mentation age and reading accuracy were assessed. One hundred and six children performed a computerised task of motion coherence detection. Children were classified as normal readers (n = 195), children with dyslexia (n = 49) or learning disabled children (n = 40) based on their mentation age and their reading age. Results: There were no statistically significant differences or correlations between visual parameters and reading performance. Over thirty per cent of the children had accommodative facilities below or equal to six cycles per minute. Children with learning disabilities performed worst on the motion coherence task but this was statistically significant only when compared to the performance of dyslexics. Discussion: The lack of association between ophthalmic parameters and poor reading ability supports the view of the Committee on Children with Disabilities. However, 39 per cent of the children might be expected to experience difficulty ‘reading to learn’, as suggested by the American Academy of Optometry, as they showed anomalies associated with visual discomfort with prolonged reading. The motion coherence test did not differentiate dyslexics from normal readers and was worst in children with learning disability. Accommodative facility testing remained the most useful predictor of potential visual discomfort.
Article
The vision screening of preschool and school children is a widely accepted procedure to detect vision problems that can interfere with learning. The Indiana General Assembly requires the annual vision screening with the Modified Clinical Technique (MCT) of all children upon their enrollment in either kindergarten or the first grade, with the exception of schools that apply for and receive waivers to conduct only a distance Snellen chart screening. In association with the Indiana State Department of Health, the Indiana University School of Optometry conducted an analysis of statewide school screening data on 36,967 grade 1 children from 139 of the 294 Indiana school corporations that submitted data for the 2000-2001 school year to examine differences in referral rate by screening method, the socioeconomic status of children screened, and academic performance. The MCT was used by 125 of the school corporations, and some other technique was used by 14 school corporations. Significant differences were seen when comparing the mean referral rates of school corporations that conduct the MCT against school corporations that do not conduct the MCT (P = 0.001) and in the rate of referral by median family income of the children screened (P = 0.050). A median family income of $46,500 was identified as the level at which the income-specific difference in referral rates ceased to be significant (P = 0.074). In spite of an observed tendency toward a higher referral rate for children who performed below average on the standardized Indiana Statewide Testing for Educational Progress Plus (ISTEP+) exam, results were found to be not significant (P = 0.116) when comparing the percentage of grade 1 children referred to an eye care provider in 2000-2001 with their percentages of passing both the English/language arts and mathematics components of the 2002-2003 ISTEP+ exam (in grade 3). Schools using the highly sensitive and specific MCT identified more visually at-risk children than schools using alternative, less sensitive vision screening techniques, and the percentage of grade 1 children referred to an eye care provider was higher for school corporations with lower median family incomes. Although statistically insignificant, the results indicate that students who fail the vision screening in grade 1 tend to be more at risk for poorer academic performance on standardized testing in grade 3.
Article
The purpose of this study was to investigate the prevalence and types of non-strabismic accommodative and/or vergence dysfunctions in primary school children, and to determine the relationship of these dysfunctions to academic achievement. A total of 1031 parents and their children aged 9-13 years responded to the College of Optometrists in Vision Development Quality of Life (COVD-QOL) questionnaire. Of these, 258 children whose visual symptom scores were > or =20 were identified for further evaluation. Comprehensive eye and vision examinations were provided to the children who met the eligibility criteria (114 of 258): eligible symptomatic children were those without amblyopia, strabismus, ocular and systemic pathology, and contact lens wear. Children were also excluded if they had visual acuity poorer than 20/25 in either eye or vertical phoria >1 prism diopter. The results showed that 82 of 114 (71.9%) of criteria-eligible symptomatic primary school children had non-strabismic accommodative and/or vergence dysfunctions. In addition, a significant relationship was found between these dysfunctions and academic scores in every academic area (reading, mathematics, social science and science) in the total sample. Therefore, accommodative and vergence functions should be tested for all school children who have visual symptoms and/or academic difficulties. Additional study is needed to determine if improvements of accommodative and vergence functions also improve academic achievement.
Article
This paper reviews and evaluates the research literature on the relationship of binocular anomalies to reading problems. The weight of the evidence supports a positive relationship between certain binocular anomalies and reading problems. The evidence is positive for exophoria at near, fusional vergence reserves, aniseikonia, anisometropia, convergence insufficiency, and fixation disparity. There is some weak positive evidence for esophoria at near and mixed evidence for stereopsis. The evidence on lateral phorias at distance is negative.
Article
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.
Article
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. 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. This study revealed that although the referral rate between the two populations showed no statistical difference, the particular "group" of tests failed differed significantly. 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.
Article
A cross-sectional study was performed to describe the prevalence of ocular abnormalities among six and seven year old children of Hispanic and Caucasian ancestry in Los Angeles County. Data were obtained from vision screenings of lower to middle income Hispanic and Caucasian children completed by the UCLA Mobile Eye Clinic at public neighborhood elementary schools and community centers between January and August of 1989, and January and March of 1990. Out of a total sample of 854 children, 64% were Hispanic; 36% were Caucasian; 51% were female and 49% were male. Ocular abnormalities observed were similar for both ethnic groups. Caucasians, however, showed non-significant, but consistently higher prevalences of most ocular abnormalities. Stronger associations between ethnicity and visual abnormalities were observed within the female subgroup. For example, hyperopia was found more commonly among female Caucasian children than among female Hispanic children (p < 0.01). This information can be used in planning for the eye care needs of communities with Caucasian and Hispanic components.
Article
The diagnosis and management of many oculomotor anomalies is within the domain of optometry. Thus, a thorough understanding of these systems and their relation to reading performance is vital. Efficient reading requires accurate eye movements and continuous integration of the information obtained from each fixation by the brain. A relation between oculomotor efficiency and reading skill has been shown in the literature. Frequently, these visual difficulties can be treated successfully with vision therapy.
Article
A masked investigation of the relation between performance on various vision tests and reading was conducted with 90 kindergartners (mean age 5.73 years) and 91 first graders (mean age 6.76 years) from a middle class, suburban, elementary school near Cleveland, Ohio. Vision testing included the Modified Clinical Technique (MCT), +/- 2.00 D flipper lenses with red/green suppression check for accommodative facility, and Randot for stereoacuity. Reading performance was independently evaluated with the Metropolitan Achievement Test 6 Reading Test and teachers' assessments. The results revealed that accommodative facility was predictive of successful reading performance in 7-year-olds (p = 0.0431), first graders (p = 0.0125), and in the entire subject group when age (p = 0.0254) or grade (p = 0.0224) was controlled. Failure on the MCT was significantly associated with decreased reading skill in 5-year-olds (p = 0.0431). In addition, stereoacuity worse than 100 sec arc (p = 0.0316), MCT failure plus stereoacuity worse than 50 sec arc (p = 0.0316), and accommodative facility (p 0.0155) were predictive of whether children of average intelligence would show successful or unsuccessful reading ability. Thus, visual performance was significantly related to reading performance even in children of average intelligence when IQ was partially controlled. Also, the predictive value of the MCT for reading achievement could be improved by the addition of a referral criterion for stereoacuity. This would make the results of MCT screening more readily applicable to educators.
Article
Although population outcome studies support the utility of preschool screening for reducing the prevalence of amblyopia, fundamental questions remain about how best to do such screening. Infant photoscreening to detect refractive risk factors prior to onset of esotropia and amblyopia seems promising, but our current understanding of the natural history of these conditions is limited, thus limiting the prophylactic potential of early screening. Screening for strabismic, refractive and ocular disease conditions directly associated with amblyopia is more clearly proven, but the diversity of equipment, methods and subject populations studied make it difficult to draw precise summary conclusions at this point about the efficacy of photoscreening. Sensory-based testing of preschool-age children exhibits a similar combination of promise and limitations. The visual acuity tests most widely used for this purpose are prone to problems of testability and false negatives. Moreover, the utility of random-dot stereograms has been confused by misapplication, and new small-target binocularity tests, while attractive, are as yet inadequately field-proven. The evaluation standard for any screening modality is treatment outcome. However, variables in amblyopia classification and quantitative definition differences, timing of presentation, nonequivalent treatment comparisons, and compliance variability have been uncontrolled in virtually all extant studies of amblyopia treatment outcome, making it difficult or impossible to evaluate either the relative efficacy of different treatment regimens for amblyopia or the effects of age on treatment outcome within the preschool age range. The latter issue is a central one, since existence of such an age effect is the primary rationale for screening at younger rather than older preschool ages. The relatively low prevalence of amblyopia makes it difficult to achieve a high screening yield in terms of predictive value, but functionally increasing prevalence by selective screening of high risk populations causes further problems. Unless a "supertest" can be devised, with very high sensitivity and specificity, health policy decisions will be required to determine which of these two characteristics should be emphasized in screening programs. Performance of screening tests can be optimized, however, with adequate training, perhaps via instructional videotapes.
Article
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. 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. 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). 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.
Article
First-and second-generation immigrant children are the fastest-growing component of the U.S. population under 15 years of age. Prevalences of ocular conditions in first-generation immigrant children are described, stratified by ethnicity and sex, and compared to previous UCLA Mobile Eye Clinic (MEC) studies and the National Health and Nutrition Examination Surveys. Clinical data from 2,229 newly immigrated students, ages 8 to 16 years of age, examined by the UCLA Mobile Eye Clinic from 1990-1996, were analyzed by chi-squares test. Females have significantly higher prevalences of astigmatism (p = 0.003) and myopia (p = 0.001) than males. Asians have significantly higher prevalences of myopia (p < 0.001) and visual acuity worse than 20/40 without correction (p < 0.001) than Hispanics. Overall ocular health of this sample is very close to that of age-matched U.S. children, but with markedly lower prevalences of extraocular muscle imbalance and color vision deficiencies. Examiners should be aware of the higher rate of astigmatism and myopia in first-generation female immigrants, as well as the higher prevalence of myopia among Asians.
Article
The purpose of this study is to assess the predictive ability of the test-positive findings of an elementary school vision screening program, conducted by 2nd-year optometry students, in identifying children with eye or vision disorders. A modified version of the Modified Clinical Technique (MCT) vision screening was administered to elementary children from a below-average socioeconomic neighborhood in Houston, Texas. Comprehensive eye and vision examinations were provided to the available children who failed the vision screening. The screening was administered by groups of 2nd-year optometry students with the assistance of a 4th-year optometry student, and supervised by a faculty member licensed to practice optometry. The follow-up examinations were provided by supervised 4th-year optometry students in a clinical setting based at the elementary school. Positive predictive values calculated from the screening and examination findings estimate the probability that a failure on one or more of the screening tests would identify children with eye or vision disorders. Sixty-nine percent of the test-positive children examined were found to be true positives by the criteria developed in a study of vision screening methods in Orinda, California from 1954 through 1956. The predictive ability of this study's test-positive findings for identifying eye and vision disorders was found to be less than the predictive ability of the Orinda Study findings. This reduced predictive ability of the present study resulted in a larger number of children being overreferred for examinations than had occurred in the Orinda Study. The reduction in the ability of the test-positive findings of the current study's screening program to identify accurately children with eye and vision problems is most likely due to the limited experience of the optometry students conducting the screening program. The inability of this retrospective study to evaluate the accuracy of the test-negatives is a major limitation in assessing the total effectiveness of this vision screening program. Although the present study may indicate some value in optometry students conducting elementary vision screening programs, a prospective study which could assess the predictive ability of both test-positive and test-negative findings, as well as determine the sensitivity and specificity of the screening program, is needed to assess more fully the effectiveness of school vision screening programs using professional students.
Article
Both race and socio-economic status are correlated to performance in the classroom. These two factors are inter-related, since minorities, proportion-wise, are more highly represented in the lower socio-economic strata. Inefficient visual skills have been shown to be more prevalent among minority groups and in low socio-economic groups. These inefficient visual skills impact the students' learning. This study was undertaken to discover the visual skills that were significantly correlated with academic performance problems. A total of 2,659 examinations were performed on 540 children over the course of six examination periods, which were administered over three consecutive school years. Socio-economic, racial, and standardized academic performance data (Iowa Test of Basic Skills--ITBS) were furnished by the families and the school system. The visual and demographic data from the examinations were then compared to performance on the 21 subtests of the ITBS. Some visual factors were found to be a much better predictor of scores on the ITBS than either race or socio-economic status. Even though the significance of these two demographic variables was small, race and socio-economic variables were each significant in about a third of the 21 ITBS scores. Visual factors are significantly better predictors of academic success as measured by the ITBS than is race or socio-economics. Visual motor activities are better predictors of ITBS scores than are binocularity or accommodation. These latter skills were significant predictors also, but to a lesser degree.
Article
To compare visual acuity results obtained using the Lea Symbols chart with visual acuity results obtained with the Bailey-Lovie chart in school-aged children and adults using a within-subjects comparison of monocular acuity results. Subjects were 62 individuals between 4.5 and 60 years of age, recruited from patients seen in five optometry clinics. Each subject had acuity of the right eye and the left eye tested with the Lea Symbols chart and the Bailey-Lovie chart, with order of testing varied across subjects. Outcome measures were monocular logarithm of the minimum angle of resolution (logMAR) visual acuity and inter-eye acuity difference in logMAR units for each test. Correlation between acuity results obtained with the two charts was high. There was no difference in absolute inter-eye acuity difference measured with the two acuity charts. However, on average, Lea Symbols acuity scores were one logMAR line better than Bailey-Lovie acuity scores, and this difference increased with worse visual acuity. The Lea Symbols chart provides a measure of inter-eye difference that is similar to that obtained with the Bailey-Lovie chart. However, the monocular acuity results obtained with the Lea Symbols chart differ from those obtained with the Bailey-Lovie chart, and the difference is dependent on the individual's absolute level of visual acuity.
Article
The purpose was to determine whether preschool children aged 3 years 0 months through 3 years 6 months could be tested with the Random Dot E, Stereo Smile, and Randot Preschool stereoacuity tests, which are random dot stereotests marketed for use with preschoolers. A total of 118 children from five Vision In Preschoolers Study Clinical Centers participated. Strabismic children, as determined by the cover test at distance and near, were excluded from this study. Stereopsis was tested on each child using each of the three tests in a variable, balanced order. A child's testability for each test was determined by the ability to complete the nonstereo task (pretest) and the gross stereo task for each stereotest. Proportions of children able to perform each test were compared using statistical methods accommodating multiple measurements per child. Testability of children on the pretest was greater for the Stereo Smile test (91%) than for the Random Dot E test (81%; p = 0.007) or the Randot Preschool test (71%; p < 0.0001) and greater for the Random Dot E test than for the Randot Preschool test (p = 0.02). For all children, testability on the gross stereo task was greater for the Stereo Smile (77%; p < 0.0001) and Random Dot E (74%; p = 0.005) tests than for the Randot Preschool test (56%) but did not differ significantly between the Stereo Smile and Random Dot E tests (p = 0.19). There were no significant differences among the proportion of children able to complete the gross stereo task among those who were testable on the pretest (p > 0.12, all comparisons). Among preschoolers aged 3 years 0 months through 3 years 6 months, testability differs significantly across the three commercially available random dot stereotests evaluated. The results suggest that two-choice procedures increase testability of young preschoolers.
Article
To compare the testability and threshold acuity levels for very young children on the crowded HOTV logMAR distance visual acuity test presented on the BVAT apparatus and the Lea Symbols logMAR distance visual acuity chart. Subjects were 87 Head Start children from age 3 to 3.5 years. Testing consisted of binocular pretraining at near using a lap card as needed, binocular pretraining at 3 m, and threshold testing for each eye. The testing procedure, adapted from the Amblyopia Treatment Study, presented optotypes until the child was unable to correctly name or match three of three or three of four optotypes of a given size. Threshold acuity was the smallest size for which at least three optotypes were correctly identified. Both near and distance pretraining were completed by 71% of children for HOTV and by 75% for Lea Symbols (P =.39). The distribution of threshold acuities differed between the two tests. For the 69 eyes of 53 children who were successfully tested with both optotypes, results from the crowded HOTV acuity test were on average 0.25 logMar (2.5 lines) better than those from the Lea Symbols acuity test (P <.001). The proportion of children between 3 and 3.5 years of age whose monocular visual acuity could be assessed was high and was similar for the two charts tested. Crowded HOTV acuity results were better on average than results using Lea symbols. The different formats of the two tests may explain the observed differences in threshold acuity level.
Article
To compare 11 preschool vision screening tests administered by licensed eye care professionals (LEPs; optometrists and pediatric ophthalmologists). Multicenter, cross-sectional study. A sample (N = 2588) of 3- to 5-year-old children enrolled in Head Start was selected to over-represent children with vision problems. 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). 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. 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. 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.
Article
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. 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. 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. 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.
Article
The aim of this prospective study was to compare visual screening at the age of 3 years with screening at 4 years using two different charts. A total of 478 3-year-old children were tested at four child health care centres (CHCCs). Of these children, 440 were tested again at the age of 4 years. A third group, a control group, consisting of 229 children, was examined only at the age of 4 years. All children were tested with both the HVOT chart and the Lea Symbol chart. Testability rates for 3-year-olds were almost the same with the Lea Symbol chart and the HVOT chart (82.8% and 84.8%, respectively). The corresponding rates for the same children tested at 4 years of age were 96.5% and 97.0%, and for the 4-year-olds not previously tested 92.9% and 92.8%. The mean testing time was somewhat shorter for the Lea Symbol chart in all three groups, but the difference was not statistically significant. The difference in the assessment of visual acuity between the two charts was small and less than 1/10th of a line. The positive predictive value was lower at 3 years (58%) than has previously been found at 4 years (74.6%). Three-year-old children co-operate well in visual acuity testing. However, the examination time is a little longer and the testability rate is about 10% lower than at 4 years. Both 3-year-old and 4-year-old children can be tested equally well with the HVOT and the Lea Symbol charts.
Article
Little is known about the distribution of eye and vision conditions among children and about possible disparities in the distribution of these conditions. The purpose of this report is to describe the prevalence of diagnosed eye and vision conditions among children younger than 18 years in the United States. Repeated population-based cross-sectional study. Forty-eight thousand three hundred four members of randomly selected households in the U.S. who were younger than 18 years in the years 1996 through 2001 were analyzed. The prevalence of children with diagnosed eye and vision conditions was estimated using self-reported information from the nationally representative Medical Expenditure Panel Surveys (MEPS) for 1996 through 2001. Descriptive statistics are presented, and the associations between the likelihood of diagnosed eye and vision conditions and child and family characteristics were assessed using logistic regression analyses adjusted for the complex survey design of MEPS. Prevalence of diagnosed eye and vision conditions and measures of the association between diagnosed eye and vision conditions and child and family characteristics. On average, approximately 6.8% (95% confidence interval [CI], 6.4%-7.2%) of children < 18 years in the U.S. have a diagnosed eye and vision condition, ranging from 8.6% (95% CI, 7.8%-9.5%) in 1996 to 5.8% (95% CI, 5.2%-6.4%) in 2001. Excluding conjunctivitis, the 4 most common conditions were refractive disorders, potentially blinding disorders, trauma or injury, and other disorders not elsewhere classified. White children, children with more educated mothers, and children living in higher income families were more likely to have a diagnosed eye and vision condition. Hispanic children, children in very good or excellent health, and uninsured children were less likely to have any self-reported diagnosed eye and vision condition. This article presents a method for using MEPS to identify children younger than 18 years with eye and vision conditions. Although this method does not identify all children with eye and vision conditions, it does identify children with diagnosed eye and vision conditions. Results provide some evidence that underprivileged children may be underdiagnosed, undertreated, or both, placing them at risk for future problems.
Article
Prior findings suggest that poor readers tend to have poor visual skills, but few reports give full frequency distributions of skill variables, and little data are available for adolescents. Visual skills and visual acuity were measured in 461 students (average age 15.4 years) in 4 California high schools within the same school district. Participating students had been identified by their schools as poor readers. Standard optometric tests and published criteria for "adequate" or "weak" visual skills were used. In this sample, 80% of the students were found to be inadequate or weak in 1 or more of the following visual skills: binocular fusion ranges at near, accommodative facility, and convergence near point. More students were deficient in binocular fusion range than in either accommodative function or near point of convergence. In contrast, only 17% had deficient visual acuity--20/40 or worse in 1 eye--the standard model of deficiency for school vision screenings. The results support and extend previous studies showing that large numbers of poor readers in high school may be at high risk for visual skills dysfunction.
Article
Previous studies have examined how people feel about others who wear glasses, but no studies of children have been published on the subject. We conducted the Children's Attitudes about Kids in Eyeglasses (CAKE) study to determine how children feel about other children who wear glasses. Subjects compared a series of 24 picture pairs and answered six questions regarding which child ...he or she would rather play with, looks better at playing sports, appears smarter (more intelligent), appears nicer, looks more shy and looks more honest. The children in each pair of pictures differed by gender, ethnicity and spectacle wear. Logistic regression was performed to determine the probability and confidence interval that a subject would pick a particular child. Eighty subjects between the ages of 6 and 10 years participated. The average (+/-SD) age of the subjects was 8.3 +/- 1.3 years, 42 (53%) were females, 51 (64%) were whites, 21 (26%) were blacks, and 30 (38%) wore glasses. The spectacle wearer appeared smarter (0.66, CI = 0.60-0.71) and more honest (0.57, CI = 0.50-0.64), and children who wore glasses looked smarter regardless of whether the child picking wore glasses. Both boys (0.66, CI = 0.68-0.79) and girls (0.77, CI = 0.71-0.82) thought that boys looked better at playing sports. The old adage 'Boys never make passes at lasses who wear glasses' may be outmoded, but glasses may tend to make children look smarter and slightly more honest to their peers.
Children in poverty impact on health, visual development, and school failure
  • Solan
Solan HA, Mozlin R. Children in poverty impact on health, visual development, and school failure. J Optom Vis Dev 1997;28:7-25.
Available at: http://www.acf.hhs.gov/programs/ hsb/about/ index.htm. Last accessed
  • About Head
  • Start
About Head Start. Available at: http://www.acf.hhs.gov/programs/ hsb/about/ index.htm. Last accessed March 3, 2006.
General issues Optomet-ric management of learning-related vision problems
  • N Flax
Flax N. General issues. In: Scheiman MM, Rouse MW, eds. Optomet-ric management of learning-related vision problems. St. Louis: Mosby Elsevier; 2006:193-8.
Visual factors: A primary cause of failure in beginning reading
  • B Young
  • K Collier-Gary
  • S Schwing
Young B, Collier-Gary K, Schwing S. Visual factors: A primary cause of failure in beginning reading. J Optom Vis Dev 1994;32(1):58-71.
Prevalence of amblyopia and strabismus in African-American and Hispanic children ages 6 to 72 months the multi-ethnic pediatric eye disease study
Multi-ethnic Pediatric Eye Disease Study Group. Prevalence of amblyopia and strabismus in African-American and Hispanic children ages 6 to 72 months the multi-ethnic pediatric eye disease study. Ophthalmology 2008;115:12299-36.
The Orinda vision study
  • H B Peters
  • H B Blum
  • J W Bettman
Peters HB, Blum HB, Bettman JW, et al. The Orinda vision study. Am J Optom Arch Ophthalmol 1959;36:455-69.
Results of a pediatric vision screening program
  • Krumholtz
Krumholtz I. Results of a pediatric vision screening program. J Behav Optom 1996;7:127-9.