Article

Child Development and Refractive Errors in Preschool Children

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Abstract

Many parents are concerned about their child's development. The purpose of this study is to determine whether parental concerns about overall development are associated with significant refractive errors among urban preschool children. A cross-sectional population-based study was conducted to evaluate the prevalence of ocular disorders in white and African American children aged 6 through 71 months in Baltimore, Maryland. A comprehensive eye examination with cycloplegic refraction was performed. Parental concerns about development were measured with the Parents' Evaluation of Developmental Status screening tool. Of 2546 eligible children 2381 (93.5%), completed the refraction and the parental interview. Parental concerns about development were present in 510 of the 2381 children evaluated [21.4%; 95% confidence intervals (CI): 9.8 to 23.1]. The adjusted odds ratios [OR] of parental concerns with hyperopia [≥3.00 diopters (D)] was 1.26 (95% CI: 0.90 to 1.74), with myopia (≥1.00 D) was 1.29 (95% CI: 0.83 to 2.03), with astigmatism (≥1.50 D) was 1.44 (95% CI: 1.08 to 1.93) irrespective of the type of astigmatism, and with anisometropia (≥2.00 D) was 2.61 (95% CI: 1.07 to 6.34). The odds of parental concerns about development significantly increased in children older than 36 months with hyperopia ≥3.00 D, astigmatism ≥1.50 D, or anisometropia ≥2.00 D. Parental concerns about general developmental problems were associated with some types of refractive error, astigmatism ≥1.50 D and anisometropia ≥2.00 D, in children aged 6 to 71 months. Parental concerns were also more likely in children older than 36 months with hypermetropia, astigmatism, or anisometropia. Parental concerns were not associated with myopia. Because of the potential consequences of uncorrected refractive errors, children whose parents have expressed concerns regarding development should be referred for an eye examination with cycloplegic refraction to rule out significant refractive errors.

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... Quality scores varied between studies ( Table 2). Only 13 studies met 6 or more criteria and thus were deemed of high quality [7,14,16,18,29,34,[47][48][49][50]52,54,56]. Key areas of potential bias were lack of random selection of the sample (22/37), a biased sampling frame (20/37), less than 300 participants (11/37), less than 70% response rate and refusers not described (11/37); confidence intervals not given for prevalence results and lack of subgroup analysis (31/37). ...
... Narrative summary of single studies, cumulative risk and life course analysis A wide range of additional child, family, and service level factors were noted in single studies [36,37,39,40,56]. Child level factors were ear infections prior to age 2 (p < 0.001) [40], history of hospital admissions aOR 1.80 (95% CI 1.35-2.40) ...
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Parental concerns about their children’s development can be used as an indicator of developmental risk. We undertook a systematic review of the prevalence of parents’ concerns as an indicator of developmental risk, measured by the Parents’ Evaluation of Developmental Status (PEDS) and associated risk factors. Electronic databases, bibliographies and websites were searched and experts contacted. Studies were screened for eligibility and study characteristics were extracted independently by two authors. A summary estimate for prevalence was derived. Meta-regression examined the impact of study characteristics and quality. Meta-analysis was used to derive pooled estimates of the impact of biological and psychosocial risk factors on the odds of parental concerns indicating high developmental risk. Thirty seven studies were identified with a total of 210,242 subjects. Overall 13.8% (95% CI 10.9 -16.8%) of parents had concerns indicating their child was at high developmental risk and 19.8% (95% CI 16.7-22.9%) had concerns indicating their child was at moderate developmental risk. Male gender, low birth weight, poor/fair child health rating, poor maternal mental health, lower socioeconomic status (SES), minority ethnicity, not being read to, a lack of access to health care and not having health insurance were significantly associated with parental concerns indicating a high developmental risk. The prevalence of parental concerns measured with the PEDS indicating developmental risk is substantial. There is increased prevalence associated with biological and psychosocial adversity. Trial registration PROSPERO Registration: CRD42012003215.
... Urban children are at greater risk of myopia and there is increasing evidence that time spent outdoors is protective, although the biological mechanisms are not clear [9][10][11][12][13]. Correcting RE in children can lead to improvement in visual functioning [14] academic performance [15], social development [16,17] and quality of life [18]. ...
... 277 (20%) children were excluded as their visual acuity was 6/9.5 in both eyes on retesting (174/604 (29%) control, 103/748 (14%) intervention). A further 79 were excluded after refraction and basic eye examination and were referred (63 control, 16 specialist refraction or examination and were referred (Fig. 1). amongst the 1352 children who screened positive, 701 (51.8%) were recruited and prescribed spectacles: 325 control, 376 intervention. ...
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Background Uncorrected refractive errors can be corrected by spectacles which improve visual functioning, academic performance and quality of life. However, spectacle wear can be low due to teasing/bullying, parental disapproval and no perceived benefit. Hypothesis: higher proportion of children with uncorrected refractive errors in the schools allocated to the intervention will wear their spectacles 3–4 months after they are dispensed. Methods A superiority, cluster-randomised controlled trial was undertaken in 50 government schools in Hyderabad, India using a superiority margin of 20%. Schools were the unit of randomization. Schools were randomized to intervention or a standard school programme. The same clinical procedures were followed in both arms and free spectacles were delivered to schools. Children 11–15 years with a presenting Snellen visual acuity of <6/9.5 in one or both eyes whose binocular acuity improved by ≥2 lines were recruited. In the intervention arm, classroom health education was delivered before vision screening using printed images which mimic the visual blur of uncorrected refractive error (PeekSim). Children requiring spectacles selected one image to give their parents who were also sent automated voice messages in the local language through Peek. The primary outcome was spectacle wear at 3–4 months, assessed by masked field workers at unannounced school visits. www.controlled-trials.com ISRCTN78134921 Registered on 29 June 2016 Findings 701 children were prescribed spectacles (intervention arm: 376, control arm: 325). 535/701 (80%) were assessed at 3–4 months: intervention arm: 291/352 (82.7%); standard arm: 244/314 (77.7%). Spectacle wear was 156/291 (53.6%) in the intervention arm and 129/244 (52.9%) in the standard arm, a difference of 0.7% (95% confidence interval (CI), -0.08, 0.09). amongst the 291 (78%) parents contacted, only 13.9% had received the child delivered PeekSim image, 70.3% received the voice messages and 97.2% understood them. Interpretation Spectacle wear was similar in both arms of the trial, one explanation being that health education for parents was not fully received. Health education messages to create behaviour change need to be targeted at the recipient and influencers in an appropriate, acceptable and accessible medium. Funding USAID (Childhood Blindness Programme), Seeing is Believing Innovation Fund and the Vision Impact Institute.
... Vision is important in development because it allows children to interact with their environment. 9 Eye-care practitioners in Nigeria, routinely conduct eye-screening exercises in schools to identify children who may have visual and ocular problems and also to encourage parents or guardians to seek necessary care for their wards. In most cases, these examinations are the first for most children. ...
... All the parents in this study agreed on the importance of the eye as a vital tool in learning. Ibironke and colleagues 9 reported the fact that parents showed more concern about the symptoms before school examinations. This might suggest that parents pay more attention to a child's ocular condition and seek care when they think it could interfere with the child's academic performance. ...
Article
Background: The eye-care seeking behaviour of parents for their children has a role to play in increasing or reducing the prevalence of childhood blindness. In Nigeria, little or no work has been done in this area. Hence, this study was carried out with a view to assisting eye-care professionals plan better program regimens and also to help them identify various elements that either facilitate or hinder eye-care seeking behaviour of parents for their school age children. Methods: This was a qualitative narrative study. Data were collected using in-depth interviews (IDIs) and focus group discussions (FGDs). Thirty-five parents and 10 eye-care practitioners were selected by random sampling and homogenous sampling methods, respectively. Parents were selected, based on those who sought care and those who did not seek care for their children after a school screening exercise. Collected data were analysed qualitatively by transcribing the voice recordings of interview sessions into textual data and themes were raised. Results: Four FGDs and 13 IDIs were conducted. Parents were more likely to seek care for manifest conditions than for conditions they could not perceive. A family history of ocular disease and repetitiveness of complaints facilitated parents to seek eye care for their children. The cost of eye-care services was a major barrier. Logistics such as fixing a doctor's appointment, getting time off work and long waiting periods at the clinic were also reported as barriers. Fear of treatment options and family interferences were also mentioned. Conclusion: Parents have some concerns and challenges in seeking eye care for their children. This study recommends that more work be done through planned awareness programs to educate parents and help them overcome the concerns and barriers that hinder them from seeking eye care for their children.
... Children may have difficulty understanding their experience and relating their visual complaints and associated ocular discomfort to their parents and guardians. [9] This necessitates visual screening. A thorough evaluation can identify potential vision problems and eye disorders. ...
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Refractive errors are common in children. These refractive errors are expected to change with the increasing age of the subject. While myopic powers may increase in early childhood and late teens, hyperopic powers usually decrease. Refractive errors result from the inability of the ocular refractive apparatus to sufficiently and accurately bend rays of light to a point focused on the retina. The prevalence of blurred vision precipitated by refractive errors amongst school-age children may reduce attention to detail, create a lack of interest in classwork and result in poor academic performance. Uncorrected refractive errors in children may be correlated to higher child morbidity, poor academic accomplishment, and overall reduced educational opportunities. In some cases, significant refractive errors and spectacle use in parents may increase the likelihood of refractive errors in children being picked up earlier. Children possess an active and malleable accommodation, which is attributable to the elasticity of the crystalline lens, intact extrinsic properties of the crystalline lens fibers, and degree of aggregated lens fibers. Consequently, children are more prone to vergence and accommodative dysfunctions, giving rise to binocular vision anomalies. The amplitude of accommodation tends to gradually and progressively recede in flexibility and magnitude with age. The higher amounts of the amplitude of accommodation in children provided by the crystalline lens elasticity can mask a refractive error and bring parallel rays of light traveling from a distant object into focus on the retinal. This may grant the eye a pseudo-emmetropic status. This compensatory mechanism may break down with time resulting in fatigue and expressed symptoms. Children may have difficulty understanding their experience and relating their visual complaints and associated ocular discomfort to their parents and guardians. This necessitates visual screening. A thorough evaluation can identify potential vision problems and eye disorders. Visual screening of children and teenagers, which can be done formally and informally, can help identify refractive errors, thus, enabling prompt medical attention. In regions with limited resources, teachers can be trained to conduct vision screening. Spectacles are the most common means to manage and address refractive errors. Vision is commonly measured and recorded as visual acuity. Visual acuity is a measure of the resolving power of the human eye. It is customary for clinicians to denote an individual's visual acuity using a fraction. The upper value usually indicates the test distance, while the lower value indicates the size of the letter or optotype read. Visual acuity can also be measured by calculating the minimum angle of resolution (MAR). The MAR is usually the reciprocal of the visual acuity when written as a fraction, i.e., visual acuity of 20/80 corresponds to a MAR of 4. The logarithmic value of the MAR (logMAR) is also a good indicator of visual acuity.
... 14 The recent USPSTF report concluded that there is adequate evidence that early treatment of amblyopia results in improved visual outcomes. 3 In addition, optical correction of significant refractive error may be related to child development 15 and may improve school readiness. 16,17 The USPSTF recommends that children undergo vision screening at least once between the ages of 36 and 72 months instead of waiting until children are schoolaged. ...
Article
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This article provides recommendations for screening children aged 36 to younger than 72 months for eye and visual system disorders. The recommendations were developed by the National Expert Panel to the National Center for Children's Vision and Eye Health, sponsored by Prevent Blindness, and funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration, United States Department of Health and Human Services. The recommendations describe both best and acceptable practice standards. Targeted vision disorders for screening are primarily amblyopia, strabismus, significant refractive error, and associated risk factors. The recommended screening tests are intended for use by lay screeners, nurses, and other personnel who screen children in educational, community, public health, or primary health care settings. Characteristics of children who should be examined by an optometrist or ophthalmologist rather than undergo vision screening are also described. There are two current best practice vision screening methods for children aged 36 to younger than 72 months: (1) monocular visual acuity testing using single HOTV letters or LEA Symbols surrounded by crowding bars at a 5-ft (1.5 m) test distance, with the child responding by either matching or naming, or (2) instrument-based testing using the Retinomax autorefractor or the SureSight Vision Screener with the Vision in Preschoolers Study data software installed (version 2.24 or 2.25 set to minus cylinder form). Using the Plusoptix Photoscreener is acceptable practice, as is adding stereoacuity testing using the PASS (Preschool Assessment of Stereopsis with a Smile) stereotest as a supplemental procedure to visual acuity testing or autorefraction. The National Expert Panel recommends that children aged 36 to younger than 72 months be screened annually (best practice) or at least once (accepted minimum standard) using one of the best practice approaches. Technological updates will be maintained at http://nationalcenter.preventblindness.org.
... 14 The recent USPSTF report concluded that there is adequate evidence that early treatment of amblyopia results in improved visual outcomes. 3 In addition, optical correction of significant refractive error may be related to child development 15 and may improve school readiness. 16,17 The USPSTF recommends that children undergo vision screening at least once between the ages of 36 and 72 months instead of waiting until children are schoolaged. ...
Article
Purpose. To recommend a standardized approach for measuring progress toward national goals to improve preschool children's eye health. Methods. A multidisciplinary panel of experts reviewed existing measures and national vision-related goals during a series of face-to-face meetings and conference calls. The panel used a consensus process, informed by existing data related to delivery of eye and non-eye services to preschool children. Results. Currently, providers of vision screening and eye examinations lack a system to provide national- or state-level estimates of the proportion of children who receive either a vision screening or an eye examination. The panel developed numerator and denominator definitions to measure rates of children "who completed a vision screening in a medical or community setting using a recommended method, or received an eye examination by an optometrist or ophthalmologist at least once between the ages of 36 to <72 months." A separate measure for children with neurodevelopmental disorders and measures for eye examination and follow-up were also developed. The panel recommended that these measures be implemented at national, state, and local levels. Conclusions. Standardized performance measures that include all eye services received by a child are needed at state and national levels to measure progress toward improving preschool children's eye health.
... 14 The recent USPSTF report concluded that there is adequate evidence that early treatment of amblyopia results in improved visual outcomes. 3 In addition, optical correction of significant refractive error may be related to child development 15 and may improve school readiness. 16,17 The USPSTF recommends that children undergo vision screening at least once between the ages of 36 and 72 months instead of waiting until children are schoolaged. ...
Article
Purpose. This article provides recommendations for screening children aged 36 to younger than 72 months for eye and visual system disorders. The recommendations were developed by the National Expert Panel to the National Center for Children's Vision and Eye Health, sponsored by Prevent Blindness, and funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration, United States Department of Health and Human Services. The recommendations describe both best and acceptable practice standards. Targeted vision disorders for screening are primarily amblyopia, strabismus, significant refractive error, and associated risk factors. The recommended screening tests are intended for use by lay screeners, nurses, and other personnel who screen children in educational, community, public health, or primary health care settings. Characteristics of children who should be examined by an optometrist or ophthalmologist rather than undergo vision screening are also described. Results. There are two current best practice vision screening methods for children aged 36 to younger than 72 months: (1) monocular visual acuity testing using single HOTV letters or LEA Symbols surrounded by crowding bars at a 5-ft (1.5 m) test distance, with the child responding by either matching or naming, or (2) instrument-based testing using the Retinomax autorefractor or the SureSight Vision Screener with the Vision in Preschoolers Study data software installed (version 2.24 or 2.25 set to minus cylinder form). Using the Plusoptix Photoscreener is acceptable practice, as is adding stereoacuity testing using the PASS (Preschool Assessment of Stereopsis with a Smile) stereotest as a supplemental procedure to visual acuity testing or autorefraction. Conclusions. The National Expert Panel recommends that children aged 36 to younger than 72 months be screened annually (best practice) or at least once (accepted minimum standard) using one of the best practice approaches. Technological updates will be maintained at http://nationalcenter.preventblindness.org.
... Hence, the responsibility of providing eye care to children is that of the parents. In Baltimore (United States), Ibironke et al. 15 has shown parents' prediction of developmental problems in children to be 80% sensitive and 94% specific if parents carefully elicit concerns toward the child's development. Thus, understanding the parents' awareness and knowledge in eye conditions might help explain why the ''avoidable'' type of blindness exists among children. ...
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To report parents' awareness and perception of eye diseases in their children. Thirty-five parents and 16 eye care practitioners either participated in in-depth interviews or focus group discussions. Data on parents' awareness and perception were collected using interview guides with unstructured questions. Data were transcribed, familiarized, and coded, and themes were generated. Redundancy was considered as the end point of data collection. The study results conveyed that parents were aware of common eye problems like refractive error, squint, and cataract, except for amblyopia, in their children. The causative factors for ocular diseases were not well understood by parents. The parents' perception was that eye problems can be treated with food, such as eggs or carrots, and exercises. Most of the parents perceived squint as a sign of good luck and spectacle correction as a social stigma. One of the prerequisites of health-seeking behavior is knowledge of disease and their symptoms, which seems to be lacking in parents of children. The findings of this study suggest that programs to increase awareness of the causative factors, spectacle wearing, and on the harmful effects of squint should be conducted.
... 4 A recent report concluded that there is adequate evidence that early treatment of amblyopia results in improved visual outcomes. 3 In addition, optical correction of significant refractive error may be related to child development 5 and improve school readiness. 6,7 Healthy People 2020 specifically includes the goal of increasing vision screening rates in children aged 5 years and under, with a modest 44% target. ...
... 4 A recent report concluded that there is adequate evidence that early treatment of amblyopia results in improved visual outcomes. 3 In addition, optical correction of significant refractive error may be related to child development 5 and improve school readiness. 6,7 Healthy People 2020 specifically includes the goal of increasing vision screening rates in children aged 5 years and under, with a modest 44% target. ...
... 4 A recent report concluded that there is adequate evidence that early treatment of amblyopia results in improved visual outcomes. 3 In addition, optical correction of significant refractive error may be related to child development 5 and improve school readiness. 6,7 Healthy People 2020 specifically includes the goal of increasing vision screening rates in children aged 5 years and under, with a modest 44% target. ...
... In devising the Zagreb Amblyopia Preschool Screening (ZAPS) study protocol, we decided to use Lea Symbols in lines test and to screen preschool children aged 48-54 months to address the problems declared. Near VA testing was introduced in addition to commonly accepted distance VA testing (14,22,24,32,45,(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69) due to several reasons: first, hypermetropia is the most common refractive error in preschool children (70), hence near VA should more reliably detect the presence of hypermetropia; second, the larger the distance, the shorter the attention span is; and third, to increase the accuracy of the test. ...
Article
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Aim To present and evaluate a new screening protocol for amblyopia in preschool children. Methods Zagreb Amblyopia Preschool Screening (ZAPS) study protocol performed screening for amblyopia by near and distance visual acuity (VA) testing of 15 648 children aged 48-54 months attending kindergartens in the City of Zagreb County between September 2011 and June 2014 using Lea Symbols in lines test. If VA in either eye was >0.1 logMAR, the child was re-tested, if failed at re-test, the child was referred to comprehensive eye examination at the Eye Clinic. Results 78.04% of children passed the screening test. Estimated prevalence of amblyopia was 8.08%. Testability, sensitivity, and specificity of the ZAPS study protocol were 99.19%, 100.00%, and 96.68% respectively. Conclusion The ZAPS study used the most discriminative VA test with optotypes in lines as they do not underestimate amblyopia. The estimated prevalence of amblyopia was considerably higher than reported elsewhere. To the best of our knowledge, the ZAPS study protocol reached the highest sensitivity and specificity when evaluating diagnostic accuracy of VA tests for screening. The pass level defined at ≤0.1 logMAR for 4-year-old children, using Lea Symbols in lines missed no amblyopia cases, advocating that both near and distance VA testing should be performed when screening for amblyopia.
... Vision in preschool children is uniquely important because their visual system is still developing, and they are at risk of developing amblyopia from some forms of uncorrected high ametropia or anisometropia and deprivation may lead to long-term visual impairment. [6] In school-based study done in Sudan (2013), the overall prevalence of refractive error was 2.19%. Myopia was found in 10,064 (1.50%) children while 4661 (0.70%) were hypermetropic. ...
... In our society, there is a doctrine that the child must obey its parents without any form of contradiction. An American series on child development and refractive errors in preschool children, Josephine O [26] in 2018 observes that parents were forced to educate children to accept. ...
... First, both the general public and eye care professionals do not perceive myopia as a serious sight-threatening problem. 2 Myopia is regarded as a minor inconvenience; the condition is not considered a disease and can be managed simply with spectacles, contact lenses, or a refractive surgical procedure. Myopia is thus mostly under the clinical care of optometrists and not specialist ophthalmic surgeons. ...
Article
It is a commonly held view that ophthalmologists do not care much about myopia, despite the fact that myopia is the most common eye condition worldwide, affecting about 1.5 billion people.¹ Why is this so? First, both the general public and eye care professionals do not perceive myopia as a serious sight-threatening problem.² Myopia is regarded as a minor inconvenience; the condition is not considered a disease and can be managed simply with spectacles, contact lenses, or a refractive surgical procedure. Myopia is thus mostly under the clinical care of optometrists and not specialist ophthalmic surgeons. Second, serious blinding ocular complications are thought to affect only a small number of individuals with high myopia (traditionally defined as a spherical equivalent of −6.00 or −8.00 diopters [D] or worse) and are thought to be uncommon for the larger population with simple myopia (traditionally defined as spherical equivalent of −0.50 to −6.00 D).³ Pathological myopia characterized by early excessive and progressive elongation of the eye with retinal and optic nerve degeneration was reported to be rare.⁴ Third, at least in Western societies, myopia is not generally regarded as a major public health issue, and thus, the need for increased government funding for research is clear. As a result, our understanding of the epidemiology, public health effect, risk factors, pathogenesis, and treatment options may not have progressed as much for myopia as for other eye conditions, such as age-related macular degeneration or glaucoma, which are actually less common than myopia in terms of the number of people affected.
... Astigmatic blur in early childhood can result in reduced visual performance (e.g., poor visual acuity when spectacles are not worn) as well as poor visual development (e.g., poor visual acuity that persists when spectacles are worn (astigmatism-related amblyopia)) [1]. In addition, several studies have suggested that astigmatism may influence other aspects of childhood development and performance of more complex tasks [2][3][4]. ...
Article
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Purpose . To determine if spectacle corrected and uncorrected astigmats show reduced performance on visual motor and perceptual tasks. Methods . Third through 8th grade students were assigned to the low refractive error control group (astigmatism < 1.00 D, myopia < 0.75 D, hyperopia < 2.50 D, and anisometropia < 1.50 D) or bilateral astigmatism group (right and left eye ≥ 1.00 D) based on cycloplegic refraction. Students completed the Beery-Buktenica Developmental Test of Visual Motor Integration (VMI) and Visual Perception (VMIp). Astigmats were randomly assigned to testing with/without correction and control group was tested uncorrected. Analyses compared VMI and VMIp scores for corrected and uncorrected astigmats to the control group. Results . The sample included 333 students (control group 170, astigmats tested with correction 75, and astigmats tested uncorrected 88). Mean VMI score in corrected astigmats did not differ from the control group ( p=0.829 ). Uncorrected astigmats had lower VMI scores than the control group ( p=0.038 ) and corrected astigmats ( p=0.007 ). Mean VMIp scores for uncorrected ( p=0.209 ) and corrected astigmats ( p=0.124 ) did not differ from the control group. Uncorrected astigmats had lower mean scores than the corrected astigmats ( p=0.003 ). Conclusions . Uncorrected astigmatism influences visual motor and perceptual task performance. Previously spectacle treated astigmats do not show developmental deficits on visual motor or perceptual tasks when tested with correction.
... In astigmatism, the refractive power of the eye is uneven across different meridians (5). Vision is important in child development because it allows children to interact with their environment (6). Vision in preschool children is uniquely important because their visual system is still developing and they are at risk of developing amblyopia from some forms of uncorrected high ametropia or anisometropia (7). ...
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Background: The purpose of our study was to assess the distribution and patterns of refractive errors in children for the proper planning of paediatric eye care at the centre. Material and methods: The study was conducted in the hospital of the Lithuanian University of Health Sciences in Kaunas, from 1 January 2012 to 31 December 2012. During this period, a total of 11,406 children, aged 0-18 years, were evaluated at the outpatient department of paediatric ophthalmology, Kauno klinikos, the Lithuanian University of Health Sciences. All the children underwent a complete ophthalmic examination with cycloplegic refraction. Results: Myopia increased from 1.5% (95% CI:1.2, 1.8) in the age group of 0-1 to 44.7% (95% CI:43.46, 45.94) in the age group of 14-18 (p < 0.001). Myopia was associated with older age, female gender (20.3%; 95% CI:19.3, 21.3; p < 0.001). Hypermetropia decreased from 84.6% (95% CI:83.7, 85.5) in the cohort of 0-1 to 11.4% (95% CI: 10.61, 12.19) in the 14-18 age group (p < 0.001). Hypermetropia was associated with younger age, male gender (43.4%; 95% CI:42.16, 44.64; p < 0.001), preterm birth (56.1%; 95% CI:54.86, 57.34; 43.4%; p < 0.001), low birth weight (61.8%; 95% CI:60.59, 63.01; p < 0.001), and birth by Caesarean section (57.1%; 95% CI: 55.87; 58.33) (p < 0.001). The prevalence of astigmatism was 25.5% (95% CI: 24.41; 26.59) (p < 0.001). Astigmatism was associated with female gender (20.1%; 95%. CI: 19.1; 21.1) and too big pregnancy weight (22.1%.; 95%. CI: 21.06; 23.14) (p < 0.001). Conclusions: Of the 14-18 age group, 44.7% of the patients were myopic. Of the 0-1 age group, 84.6% were hypermetropic. Astigmatism was detected in about 25.5% of children. The prevalence of refractive errors was associated with age, gender, gestation age, gestation weight, and parental refractive error.
... V isual impairment (VI) in early childhood can significantly impair development of visual, motor, and cognitive function [1][2][3] and lead to adverse psychosocial consequences. 4 For example, the Vision in Preschoolers study 5 reported that VI from uncorrected hyperopia was associated with deficits in early literacy and in other essential skills for school readiness. ...
Article
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Importance: Visual impairment (VI) in early childhood can significantly impair development. Objective: To determine demographic and geographic variations in VI in children aged 3 to 5 years in the United States in 2015 and to estimate projected prevalence through 2060. Design, setting, and participants: Descriptive study reporting statistics estimated based on prevalence data from 2 major population-based studies conducted in the United States between 2003 and 2011. Using US census projections, prevalence of VI and cause-specific VI in the better eye were reported by race/ethnicity, state and region, and per capita prevalence of VI by state. The study included preschool children in the United States. Analyses for this study were conducted between February 2016 and March 2017. Main outcomes and measures: Prevalence of VI among children aged 3 to 5 years in the United States. Results: In 2015, more than 174 000 children aged 3 to 5 years in the United States were visually impaired. Almost 121 000 of these cases (69%) arose from simple uncorrected refractive error, and 43 000 (25%) from bilateral amblyopia. By 2060, the number of children aged 3 to 5 years with VI is projected to increase by 26%. In 2015, Hispanic white children accounted for the highest number of VI cases (66 000); this group will remain the most affected through 2060, with an increasingly large proportion of cases (37.7% in 2015 and 43.6% in 2060). The racial/ethnic group with the second most VI is projected to shift from non-Hispanic white children (26.3% in 2015 decreasing to 16.5% in 2060) to African American children (24.5% in 2015 and 22.0% in 2060). From 2015 to 2060, the states projected to have the most children with VI are California (26 600 in 2015 and 38 000 in 2060), Texas (21 500 in 2015 and 29 100 in 2060), and Florida (10 900 in 2015 and 13 900 in 2060). Conclusions and relevance: These data suggest that the number of preschool children with VI is projected to increase disproportionally, especially among minority populations. Vision screening for refractive error and related eye diseases may prevent a high proportion of preschool children from experiencing unnecessary VI and associated developmental delays.
... A relationship between reduce visual-motor and visual-cognitive development and ocular disorders had been established by [1,2]. According to [3] parents may not present any visual development concerns do to the fact that the presence of uncorrected refractive errors associated with a vision deficit may be difficult to identify in young children. A vision deficit may be very often perceived by parents as a general development problem. ...
Article
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This study aimed to identify the prerequisites for reading/writing in Preschool age of children with low vision. Therefore, we expected to help teachers to choose strategies in order to endow each child the required bases in the domains of reading/writing. Twenty-six children aged between 3 and 6 years included in regular settings participated in the study. Puzzle 3D, Key response, Play cards and Low Vision symbols from Lea Tests were chosen and children evaluated in their school context. At the study first stage we observed a lack of information at schools concerning children ophthalmologic data. According to tests results it seems that two children had a visual acuity above usual values followed concerning low vision. The easiest symbols identified were the circle and the square. It was possible to establish strategies concerning reading/writing pre-requisites based on the M size and the ability to draw and recognise shapes demonstrated by the child; it was observed the need for an effective communication and sharing of knowledge between professionals.
... months of age. 16 We conducted a preliminary study to determine whether there is evidence of an association between astigmatism and developmental task performance in toddlers 12-35 months of age. ...
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Purpose: To determine whether uncorrected astigmatism in toddlers is associated with poorer performance on the Bayley Scales of Infant and Toddler Development, 3rd edition (BSITD-III). Methods: Subjects were 12- to 35-month-olds who failed an instrument-based vision screening at a well-child check. A cycloplegic eye examination was conducted. Full-term children with no known medical or developmental conditions were invited to participate in a BSITD-III assessment conducted by an examiner masked to the child's eye examination results. Independent samples t tests were used to compare Cognitive, Language (Receptive and Expressive), and Motor (Fine and Gross) scores for children with moderate/high astigmatism (>2.00 D) versus children with no/low refractive error (ie, children who had a false-positive vision screening). Results: The sample included 13 children in each group. The groups did not differ on sex or mean age. Children with moderate/high astigmatism had significantly poorer mean scores on the Cognitive and Language scales and the Receptive Communication Language subscale compared to children with no/low refractive error. Children with moderate/high astigmatism had poorer mean scores on the Motor scale, Fine and Gross Motor subscales, and the Expressive Communication subscale, but these differences were not statistically significant. Conclusions: The results suggest that uncorrected astigmatism in toddlers may be associated with poorer performance on cognitive and language tasks. Further studies assessing the effects of uncorrected refractive error on developmental task performance and of spectacle correction of refractive error in toddlers on developmental outcomes are needed to support the development of evidence-based spectacle prescribing guidelines.
... Vision in preschool children is uniquely important because their visual system is still developing, and they are at risk of developing amblyopia from some forms of uncorrected high ametropia or anisometropia and deprivation may lead to long-term visual impairment. [6] In school-based study done in Sudan (2013), the overall prevalence of refractive error was 2.19%. Myopia was found in 10,064 (1.50%) children while 4661 (0.70%) were hypermetropic. ...
... Excessive stimulation of the parasympathetic nerves, which occurs due to a strong accommodation mechanism in individuals with high hyperopia, may interfere with the function of the vestibular system to regulate postural control. The findings of the present study apply only to healthy people in their 20s; and further study is needed to determine potential factor with greater impact in growing children with relatively incomplete physical functions and higher prevalence of latent hyperopia [30,31]. In addition, future studies to analyze postural stability in real patients with hyperopia, low vision, or amblyopia in the clinical setting are needed to validate the results of the current study using experimental model. ...
Article
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Reports have indicated the effect of myopic blur on postural stability. The objective of this study was to investigate the minimum refractive error to significantly affect postural stability through a various levels of hyperopia and myopia induced by ophthalmic lenses. Forty subjects with a mean age of 22.95 ± 2.21 years were enrolled. In all subjects, the subjective refraction with MPMVA (Maximum to Plus Maximum Visual Acuity) was performed to correct refractive error. To induce hyperopia and myopia, spherical lenses of ±1.0, ±2.0, ±3.0, ±4.0, ±5.0 and ±6.0 D were used on top of the trial frame with corrected condition as MPMVA (eyes-open with MPMVA). Under each induced-refractive error condition, general stability (ST) and sway power (SP) in frequencies by each subsystem were measured with Tetrax posturography with firm plates at patient’s upright position, after performed the measurements under the conditions of eyes-open with MPMVA and eyes-closed. ST at eyes-closed was significantly greater than that at eyes-open with MPMVA (p < 0.001). ST was increased significantly for induced hyperopia of -1.0 D (p < 0.001) with decimal visual acuity of 1.07 ± 0.17 and for induced myopia of +3.0 D (p = 0.011) with decimal visual acuity of 0.16 ± 0.09, as compared to that at eyes-open with MPMVA. No significant difference was observed between induced hyperopia of -6.0 D and those at eyes-closed only. SP was increased significantly at low medium-frequencies of the peripheral vestibular signals in induced hyperopia, moreover, hyperopia induced at -6.0 D lenses was significantly different compared to that at eyes-open with MPMVA. Uncorrected low hyperopia in young subjects may lead to postural instability, although they can obtain clear vision. The corrected state of ametropia, especially hyperopia, is a more important factor of appropriate visual input in stable postural adjustment than visual acuity.
... 5 Improved child development and school readiness is a potential outcome of early optical correction of refractive error. [6][7][8] Uptake and consistency of vision screening in the pediatric setting are inadequate. According to the 2008 and 2011 National Health Interview Surveys, only 40% of children 6 years old and younger had a vision screening completed by their primary care physician or other healthcare professional. ...
Article
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Preschool vision screening rates in primary care are suboptimal and poorly standardized. The purpose of this project was to evaluate pediatric primary care adherence to and improvement in preschool vision screening guidelines through a learning collaborative environment. Methods: Thirty-nine Ohio primary care providers interested in preschool vision screening self-selected to participate in an Institute for Healthcare Improvement Breakthrough Series learning collaborative that spanned 18 months. Charts of patients attending 3-, 4-, and 5-year well-child visits were randomly selected and reviewed for documentation of vision screening attempts, referrals, and need for rescreening. Results: Practitioners improved evidenced-based screening attempts for distance visual acuity and stereopsis of 3-5-year-old patients from 18% at baseline to 87% (P < 0.001) at 6 months; improved screening rates were sustained through completion of the collaborative. Baseline referral rates (26%) of abnormal vision screens improved by 59% (P < 0.001) during the first 6 months and were maintained through month 18. Rates for children with incomplete screens that were scheduled for a repeated screening increased during the first 6 months. However, changes in this metric did not reach statistical significance (P = 0.265), nor did it change during the remainder of the collaborative. Conclusions: Rapid integration and maintenance of preschool vision screening guidelines are feasible across primary care settings utilizing a structured learning collaborative. Challenges with the rescreening processes for children with incomplete vision screens remain, with the 3-year age group having the greatest room for improvement.
... For example, the Vision in Preschoolers study reported that VI from uncorrected hyperopia was associated with de cits in early literacy and in other essential skills for school readiness. More importantly, interventions such as spectacle correction in preschool children, have been shown to restore the visual-motor function of affected ametropic preschool children back to emmetropic levels [4][5][6][7][8] . ...
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Background: Development of the visual system begins prenatally and continues after birth. However, owing to how personal and subjective a person’s sight is, children may not realize they have a vision problem. Visual impairment in early childhood can significantly impair development of visual, motor, and cognitive function and lead to adverse psychosocial consequences. This research aimed to study the epidemiological patterns of ocular morbidity in children aged less than five years old. Methods: The study is a retrospective patient record study carried out in three tertiary eye care hospitals in Khartoum State- Sudan. All children records for the year 2019 were reviewed, and the total number included was 10886 patients’ files. The records were reviewed estimate the number of under five years of age children and the patterns of ocular morbidity. The data were summarized and analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0. The proportions were estimated, patterns of ocular morbidity were identified according to age groups and gender. Results: The proportion of under five years children was 5% of the total population and 45% of the total children below 16 years. The predominant age group affected with ocular morbidity is (3–5 years old with 53%). Eye infections affected (19%), allergic eye diseases (16.8%), orbital diseases (12.4%), refractive errors (10.8%), squint (9.3%), corneal diseases (6.6%), cataract (6%), glaucoma (2.3%), neurogenic eye (2%) and tumors (0.23%).There are some variations in morbidity according to age groups among the under five years of age children. Conclusions: The proportion of under five years children is high. The predominant ocular morbidity affecting children below five years of age is eye infections, followed by allergic eye diseases and refractive errors while other serious and blinding eye diseases mounted a considerable percentage. Although of small percentage but worth mentioning that malignant eye tumors were one of the patterns of ocular morbidities affecting children of under five years of age. Patterns of ocular morbidity showed some gender variations.
... For example, the Vision in Preschoolers study reported that VI from uncorrected hyperopia was associated with de cits in early literacy and in other essential skills for school readiness. More importantly, interventions such as spectacle correction in preschool children, have been shown to restore the visual-motor function of affected ametropic preschool children back to emmetropic levels [4][5][6][7][8] . ...
Preprint
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Background Development of the visual system begins prenatally and continues after birth. Visual impairment in early childhood can significantly impair development of visual, motor, and cognitive functions and lead to adverse psychosocial consequences. This research objective is to study the epidemiological patterns of ocular morbidity among children aged less than five years old aiming to reveal information for prevention and control.Methods The study is a retrospective patient’s records study carried out in three tertiary eye care hospitals in Khartoum State- Sudan. Records of all children attended in 2019 amounting 10886were reviewed. The data had been summarized and analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0. The prevalence of under-five children was estimated in contrast to the overall population and as a proportion from the total children number. The patterns of ocular morbidity were identified according to type, age groups and gender. ResultsThe prevalence of under- five children with ocular morbidity was 5% and they represented 45% of the total children below 16 years. The predominant age group affected with ocular morbidity was (3-5 years old with 53%). Eye infections affected (19%), allergic eye diseases (16.8%), orbital diseases (12.4%), refractive errors (10.8%), squint (9.3%), corneal diseases (6.6%), cataract (6%), glaucoma (2.3%), neurogenic eye (2%) and tumors (0.23%).There were some variations in morbidities according to age groups and gender among the study participants.ConclusionsThe proportion of under-five children is high. The predominant ocular morbidity affecting children of this age is eye infections, followed by allergic eye diseases and refractive errors while other serious blinding eye diseases mounted a considerable percentage. Although of small percentage but worth mentioning that malignant eye tumors were one of the patterns of ocular morbidities affecting under-five children. Patterns of ocular morbidity showed some gender variations.
... Despite that, all of them were convinced of the importance of providing timely and proper eyecare to their children. They also had a clear understanding of the impact of leaving the refractive error untreated and the possible implications of this on the academic and social development of their children 22 . One of the reasons for this enhanced awareness could be the accessibility of healthcare in the country. ...
Article
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Uncorrected refractive error is the leading cause of moderate and severe visual impairment across the globe. An important driver for early detection and management of refractive errors among children is appropriate parental awareness. This study aims to understand the awareness and perception among parents of children with refractive errors utilizing the conceptual framework of Health Belief Model. This qualitative study focused to conduct semi-structured interviews of parents who sought eye care for their children. Thirty-five parents who visited an eye care center for refractive error correction of their children between 5 to 15 years of age were purposively selected. The four constructs of the Health Belief Model (perceived susceptibility, perceived severity, perceived benefits and perceived barriers) were applied to prepare the interview guide. The voice records of participants were transcribed verbatim, coded and qualitatively analyzed to generate relevant themes. All participants were well aware of refractive errors and the implications of them on the visual and social development of children if they leave the errors untreated. However,there were varying perception about refractive error leading to serious consequences. The enanced quality of life with proper refractive correction prompted parents to seek timely eyecare for their children.
... [68][69][70] The rationale for vision and hearing screening during early childhood is not simply because these problems are common but that identification and treatment may prevent or attenuate a variety of related adverse outcomes, including speech and language problems, reduced school performance, behavior problems, decreased psychosocial well-being and poor adaptive skills. 33,34,[71][72][73][74] We partially confirmed our hypotheses that hearing and visions problems would be related to behavioral and developmental problems, independent of other acknowledged risk markers prevalent in this group of children. Hearing problems were strongly associated with about a 2.5 to 5.0-fold risk for practitioner diagnosed or treated developmental, learning, cognitive and speech problems. ...
Article
To determine the occurrence of vision and hearing deficits in international adoptees and their associations with emotional, behavioral and cognitive problems. The Minnesota International Adoption Project (MnIAP) was a 556-item survey that was mailed to 2,969 parents who finalized an international adoption in Minnesota (MN) between January 1990 and December 1998 and whose children were between 4 and 18 years-old at the time of the survey. Families returned surveys for 1,906 children (64 %); 1,005 had complete data for analyses. The survey included questions about the child's pre-adoption experiences and post-placement medical diagnoses, and the Child Behavior Checklist (CBCL). Multivariate logistic regression assessed associations between hearing and vision problems and problems identified by the CBCL. Information on hearing and vision screening and specific vision and hearing problems was also collected via a telephone survey (HVS) from 96/184 children (52 %) seen between June 1999 and December 2000 at the University of Minnesota International Adoption Clinic. In both cohorts, 61 % of children had been screened for vision problems and 59 % for hearing problems. Among those children screened, vision (MnIAP = 25 %, HVS = 31 %) and hearing (MnIAP = 12 %, HVS = 13 %) problems were common. For MnIAP children, such problems were significant independent predictors for T scores >67 for the CBCL social problems and attention subscales and parent-reported, practitioner-diagnosed developmental delay, learning and speech/language problems, and cognitive impairment. Hearing and vision problems are common in international adoptees and screening and correction are available in the immediate post-arrival period. The importance of identifying vision and hearing problems cannot be overstated as they are risk factors for development and behavior problems.
... Childhood visual impairment due to refractive errors is one of the most common problems among school-age children, and is the second leading cause for treatable blindness [10] . Vision is important in child development because it allows children to interact with their environment [11] . Vision in preschool children is uniquely important because their visual system is still developing and they are at risk of developing amblyopia from some forms of uncorrected high ametropia or anisometropia [12] . ...
... These include visual acuity assessment, cover-uncover and alternate cover tests, ocular movements, cycloplegic refraction, slit-lamp examination and dilated fundus examination. Significant refractive error were defined as hyperopia ≥3.00 diopters (D), myopia ≥1.00 D or astigmatism ≥1.50 D in either eye, or anisometropia ≥ 2.00 D [8]. Children with underlying refractive errors were prescribed glasses and children with other ocular problems were managed accordingly. ...
Article
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Background To screen for visual impairment in Malaysian preschool children. Methods Visual screening was conducted in 400 preschool children aged 4 to 6 years. The screening involved two basic procedures; the distant visual acuity test using the Sheridan Gardiner chart and the depth perception test using the Langs stereoacuity test. Criteria for referral were a visual acuity of 6/12 or less in the better eye or a fail in the depth perception test. Results The prevalence of visual impairment was 5% (95% confidence interval [CI] = 3.3, 7.6). Of the 400 preschool children screened, 20 of them failed the distant visual acuity test or the stereopsis test. Refractive errors were the most common cause of visual impairment (95%, 95% CI = 76.2, 98.8); myopic astigmatism was the commonest type of refractive error (63.2%, 95% CI = 40.8, 80.9). Conclusion The study is a small but important step in the effort to understand the problem of visual impairment among our preschool children. Our study showed that it is feasible to measure distant visual acuity and stereopsis in this age group.
... Nystagmus appears to be a predisposing factor to the presence of an astigmatism, having regard to the strong association existing between the two. In agreement with previous studies [5,14], we also found that astigmatism shows a tendency to increase with age [15,16]. In fact, the prevalence of the condition was largely skewed towards the adult subset of our study population, with 605 patients out of a total number of 976 being aged 13 years and over. ...
Article
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Purpose: To evaluate the association between astigmatism and idiopathic congenital nystagmus (ICN) in infantile nystagmus syndrome (INS). Materials and methods: We analysed refractive errors in a cohort of 488 consecutive patients with ICN (group A) and further compared the results obtained with those of 488 age-matched controls with no nystagmus (group B). Only the worst eye was considered for statistical analysis. All patients were stratified into the following age groups: 1 to 4 years (age group 1); 5 to 12 years (age group 2); and 13 years to 57 years (age group 3) (mean age: 29). Results: Three hundred and seventy patients (69.7 %) in group A and 269 patients (55,12 %) in group B had refractive errors. The types of refractive errors observed were: myopia, hyperopia (>0.50 dioptres) and astigmatism (>1.25 dioptres). Results in group A were as follows: 319 patients (65.37 %) were astigmatic, 34 (6.97 %) were hyperopic, and 17 (3.48 %) were myopic. Mean right-eye astigmatism was 2.72 dioptres, and mean left-eye astigmatism was 2.69 dioptres. Results in group B were as follows: 56 (11.47 %) were astigmatic, 165 (33.81) were hyperopic, and 48 (9.84) were myopic. Mean right-eye astigmatism was 2.05 dioptres, and mean left-eye astigmatism was 2.37 dioptres. The prevalence of astigmatism is greater, in the entire sample, for subjects from age groups 2 and 3 (p<0.005). It shows a tendency to increase with age for patients of group A and in age group 3 (p=0.009). Conclusions: Astigmatism is more common in patients with ICN than in the general population (65.37 % vs 11.47 %) (p<0.001). Astigmatism increases with age, with a very high statistical significance in patients 13 years old and above (age group 3) when nystagmus is also present. Thus, nystagmus appears to be a predisposing factor for both the presence of astigmatism and the development with the age of high values of this refractive error. This findings should be taken into due account when considering visual dysfunctions in nystagmic patients.
... Although this study is consistent with a negative impact of uncorrected astigmatism on the child, the relationship between this study's measures and the academic readiness of the children is unclear. 10 Finally, in a study of adults, Wills et al. found that induced astigmatic blur resulted in poor word recognition and slow reading rate. This study established the basic plausibility of astigmatic blur as a mechanism that might impact learning. ...
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This study investigated the relationship between uncorrected astigmatism and early academic readiness in at-risk preschool-aged children. A vision screening and academic records review were performed on 122 three- to five-year-old children enrolled in the Philadelphia Head Start program. Vision screening results were related to two measures of early academic readiness, the teacher-reported Work Sampling System (WSS) and the parent-reported Ages and Stages Questionnaire (ASQ). Both measures assess multiple developmental and skill domains thought to be related to academic readiness. Children with astigmatism (defined as >|-0.25| in either eye) were compared with children who had no astigmatism. Associations between astigmatism and specific subscales of the WSS and ASQ were examined using parametric and nonparametric bivariate statistics and regression analyses controlling for age and spherical refractive error. Presence of astigmatism was negatively associated with multiple domains of academic readiness. Children with astigmatism had significantly lower mean scores on Personal and Social Development, Language and Literacy, and Physical Development domains of the WSS, and on Personal/Social, Communication, and Fine Motor domains of the ASQ. These differences between children with astigmatism and children with no astigmatism persisted after statistically adjusting for age and magnitude of spherical refractive error. Nonparametric tests corroborated these findings for the Language and Literacy and Physical Health and Development domains of the WSS and the Communication domain of the ASQ. The presence of astigmatism detected in a screening setting was associated with a pattern of reduced academic readiness in multiple developmental and educational domains among at-risk preschool-aged children. This study may help to establish the role of early vision screenings, comprehensive vision examinations, and the need for refractive correction to improve academic success in preschool children.
Article
The purpose of this study was to investigate the prevalence of astigmatism among a paediatric population. A total of 322 consecutive patients of the department of Orthodontics and Gnathology, Dental Clinic, University of L'Aquila, were enlisted for the study and 176 were selected according to the exclusion criteria. Pre- treatment diagnostic data, which included radiographic cephalometric and dental cast evaluation, were recorded and presence of astigmatism was assessed through an ophthalmological examination. Differences in the prevalence of astigmatism by sex and malocclusion were analysed by using the chi-square (Pearson's chi-square test) and Fisher's exact tests. According to the sagittal malocclusion, patients were classified as Class I (N=122), Class II Division 1 (N=26), Class II Division 2 (N=9), or Class III (N=19); according to the transverse malocclusion patients were classified into cross-bite (N=39) and no cross-bite (N=137) groups; after ophthalmological examination astigmatism was detected in 32 patients (18.18%). Statistically significant correlations were found between astigmatism and cross-bite (p < 0.0001), while no associations were found with other malocclusions. No gender influence was found for astigmatism or malocclusion. Few study investigated a possible relationship between the ocular and stomatognathic system, and no data are available in the scientific literature. A higher prevalence of astigmatism was found in patients with cross-bite: as expected no other significant association was found. The relationship between astigmatism and cross-bite could be either related to a specific skeletal pattern, which could induce visual alterations, or to the effect of abnormal visual input on the postural system, which could induce stomatognathic alterations. The findings of the present study suggest a possible association between astigmatism and cross-bite, but future studies are needed to confirm and explain this observation.
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Purpose: Most causes of childhood blindness are treatable or preventable. Knowledge of parents' awareness and perception of eye problems is important in helping to understand parents' eye care seeking behavior. This understanding becomes necessary as early detection and intervention can be effective when done at an early age. Method: Study was carried out in Benin City, Nigeria. Thirty-five parents aged 38-54 years with a mean age of 43(±2) years were recruited. Twenty six were females and nine males. Ten eye care practitioners aged 30-45 years with a mean age of 40 (±2) were included. Seven were males and three were females. Data was analyzed qualitatively and in percentages. Results: Majority of parents were aware of common eye problems: Blurry vision (85.7%), measles in eye (48.5%), cataract (74.3%), conjunctivitis (48.5%), itching and redness (74.3%), crossed eyes (34.3%), strabismus (57.1%), short sightedness (48.5%) and stye or hordeolum (57.1%). Too much carbohydrate, night reading and too much TV were some of the reasons given for bad eyesight. Self medication and use of local remedies for treatment of conjunctivitis was common practice (94.3%). Chloramphenicol eyedrop was the most common drug used for any eye problem before visiting a doctor (80.0%). Conclusion: Parents are aware of common eye diseases in children but have wrong perception of their causes. Programs to increase public awareness of causes of eye problems and harmful effects of self medication are advocated for to expose inherent dangers.
Article
AIM: To analyze the refractive development in infants, to screen for the high risk group for infant refractive error and to explore the best timing for early intervention of the condition. METHODS: Noncycloplegic refraction data in 7 stages of age (6, 9, 12, 18, 24, 30, and 36 months) were collected with Suresight autorefractor from 2 447 healthy infants (4 894 eyes). The development and distribution of refraction were analyzed. RESULTS: Most of the 4 894 eyes were found to be hyperopic and astigmatic. The mean and standard deviation of sphere, cylinder, and spherical equivalent for seven age groups from 1.5 years as well as reference ranges (P25~P75 and P5~P95) were obtained. Hypermetropic and astigmatic refractive error reduced rapidly with age until the age of 1.5 years old, after which they did not change significantly. CONCLUSION: In infants, spherical lens deviating from P25~P75(D) and cylindrical lens exceeding P75(D) amblyopia are the suspected signs of amblyopia, and spherical lens deviating from P5~P95(D) and cylindrical lens exceeding P95(D) indicate high risk of amblyopia. Intervention of refractive error may start at the age of 1.5 years.
Conference Paper
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The aim of this research is to determine the frequency of refractive errors in individuals aged 7 to 18 years using the Nikon Auto Refractometer NR- 1000F. Methods. We examined 1000 of 7-18 year-old children. Children were divided into three age groups: I group from age 7 to 9 years, II group from age 10 to 13 years and III group from age 14 to 18 years. The Nikon Auto Refractometer NR- 1000F was used to determine the refractive errors. Results. Prevalence of emetropia was overall 3.5 % in the 7-18 years olds children. Prevalence of myopia was overall 37.9 % and increased from 16.7% in the I-st age group to 50.8% in the III-rd age group. I-st degree of myopia was prevail in all age groups. Hypermetropia was found in 58.6% and decreased from 81.2% in the I-st age group to 45.3% in the III-rd age group. I-st degree of hypermetropia was the most common refractive error in all age groups. Conlusion. The prevalence of emetropia was 3.5%, of myopia was 37.9 % and of hypermetropia was 58.6%. I-st degree myopia and I-st degree hypermetropia was the most common refractive errors in all age groups.
Article
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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.
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Background and aims: Visual impairment in early childhood can significantly affect the development of visual, motor, and cognitive function and potentially lead to long-term adverse psychosocial consequences. This study aimed to identify the risk factors of ocular morbidity among under 5-year old children in Khartoum State, Sudan. Methods: A cross-sectional study was conducted in three tertiary eye care hospitals in Khartoum State, Sudan. The study included 391 children under the age of 5 years. The parent(s) were interviewed using a precoded, pretested, closed-ended questionnaire that included questions regarding socio-demographic profile and possible risk factors. Data were analyzed using Statistical Package for the Social Sciences (version 21.0). A P-value of less than .05 was regarded as significant. Results: There was a significant association between participants with diabetes mellitus and poor vision (P-value <.001). Two-thirds of participants (57%) with visual impairment had mothers, who reportedly attended antenatal care services regularly (P-value .001), revealing a significant statistical association. Maternal diseases, specifically diabetes, was identified as a risk factor for poor visual acuity in their offspring (P-value <.001). A significant relation was revealed between family history of eye disease and the degree of relationship to the affected participant (P-value <.001). There was an association between watching TV and current visual acuity (P-value <.001); as well as using mobile phones and current visual acuity (P-value <.001). Multilinear analysis revealed the stronger influence of TV watching rather than the use of mobile phones (P-value <.001). Conclusions: Diabetes, diabetic mothers, a family history of ocular morbidity, watching television, and using mobile phones emerged as significant risk factors of ocular morbidity among children under the age of 5 years in this study. Many of these risk factors are either modifiable or controllable ocular morbidities among under-five children can be reduced with suitable interventions.
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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
Analyses of the National Survey of Children's Health (2016-2020) demonstrated a 9.4% decrease in the proportion of children receiving eye screening from a specialist with an 85.7% increase in unmet vision care after the SARS-CoV-2 pandemic.
Article
Thesis (Ph. D.)--University of Notre Dame, June 1940. Bibliography, p. 59-60.
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Objective: Pediatricians are encouraged by the American Academy of Pediatrics and the Bright Futures Guidelines to elicit and respond to parents' psychosocial concerns. This is especially important given research showing that parents' concerns can be significant predictors of developmental problems. Still there are many unanswered questions about the implications of parent-provider discussions of concerns: How likely are parents to engage in discussions of psychosocial concerns? Do providers use parents' concerns when making decisions about which families to counsel versus refer? Do family characteristics affect which parents discuss concerns? The purpose of this study is to provide preliminary answers to these questions and to view the implications of parent-provider discussions about concerns in developmental surveillance. Design: Survey. Setting: Public schools and day care centers in four diverse geographic sites representing the Northern, Central, Southern and Western US. Patients and other participants. 408 children beween 1 1/4 and 7 years of age and their parents, whose socioeconomic and demographic characteristics reflect proportions in the 1990 US Census. Main outcome measures: Licensed psychological examiners and educational diagnosticians elicited parents' concerns, measured children's development with measures of intelligence, language, motor, and school skills, and reported on whether children were previously enrolled in special education services. Results: 220 parents had developmental concerns. Of these, 59% could identify health care providers. Those families with providers were more likely to have: multiple concerns; concerns most predictive of developmental problems and to perceive their children as having health problems. Of those with providers, 66% shared concerns. Conclusions: Parents were more likely to share concerns if they were fathers, when they perceived their children to have health problems, and when they had expressive language concerns. Parents who seek health care for their children seem to have more developmental concerns than those without providers. Although some parents do not discuss their concerns, most do. However, parents tend to share concerns only about expressive language and only when they perceive their child to have health problems, perhaps not recognizing that more complete discussions of concerns are of interest to pediatric providers. This may contribute to providers low referral rates for children with disabilities. Nevertheless, disabled children are far more likely to be enrolled in special education services when concerns were discussed and when providers make referrals. Implications for practice: Routine use of standardized questions is recommended for ensuring that all parents discuss the range of their developmental concerns. A standardized approach such as that used in this study has known levels of accuracy in detecting children with developmental problems and gives providers' evidence-based guidance about when to refer versus counsel, provide reassurance, or watchfully wait.
Article
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In a population-based infant vision screening programme, 5295 infants were screened and those with significant refractive errors were followed up. To assess the relationship between the development of vision and other domains, we report a longitudinal study comparing infants with significant hyperopia, identified at age 9 months ('hyperopes') with infants with normal refractions ('controls'). Children are included who completed at each age a broad set of visual, cognitive, motor and language measures taken over a series of follow-up visits up to age 5.5 years. Hyperopes performed significantly worse than controls on the Atkinson Battery of Child Development for Examining Functional Vision at 14 months and 3.5 years and the Henderson Movement Assessment Battery for Children at 3.5 and 5.5 years. The Griffiths Child Development Scales, MacArthur Communicative Development Inventory and British Picture Vocabulary Scales showed no significant differences. Exclusion of those infants who became amblyopic and strabismic did not substantially alter these results, suggesting that the differences between groups were not a consequence of these disorders. These results indicate that early hyperopia is associated with a range of developmental deficits that persist at least to age 5.5 years. These effects are concentrated in visuocognitive and visuomotor domains rather than the linguistic domain.
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This article briefly reviews the recent literature identifying the possible reasons why children with subtle developmental problems are passing through health care systems undetected. It offers some explanations as to why consequently, in many Western societies, a large number of these children are not identified by health professionals until they reach school age. Early identification is one of the challenges facing health visitors or child health nurses, and it is suggested that if they can utilize the knowledge and experience of parents, the opportunities for early identification and intervention would be dramatically improved.
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To examine cognitive abilities of low-income preschoolers with uncorrected ametropia and effects of spectacle correction. Baseline and 6-week data from a longitudinal controlled study were analyzed. Subjects were 70 preschoolers (mean age, 4.6 years; 60.0% were female; and 85.7% were Latino), including 35 children with previously uncorrected ametropia and 35 emmetropic control subjects. Ametropia was defined as bilateral hyperopia of 4.00 diopters (D) or more in children aged 3 to 5 years, astigmatism of 2.00 D or more in children aged 3 years and 1.50 D or more in children aged 4 and 5 years, or a combination of both. Emmetropia was defined as 2.00 sphere diopters or less and 1.00 cylinder diopter or less in both eyes. Ametropes were assessed before and 6 weeks after correction and compared with control subjects. Primary and secondary outcome measures were Beery-Buktenica Developmental Test of Visual-Motor Integration and Wechsler Preschool and Primary Scale of Intelligence-Revised scores, respectively. At baseline, uncorrected ametropes scored significantly lower on the Beery-Buktenica Developmental Test of Visual-Motor Integration (P = .005) and the Wechsler Preschool and Primary Scale of Intelligence-Revised performance scale (P = .01). After 6 weeks of correction, the ametropic group significantly improved on the Beery-Buktenica Developmental Test of Visual-Motor Integration compared with emmetropic control subjects (P = .02). Preschoolers with uncorrected ametropia had significant reduction in visual-motor function. Wearing spectacles for 6 weeks improved Beery-Buktenica Developmental Test of Visual-Motor Integration scores to emmetropic levels.
Article
PURPOSE. To assess the impact of Retinomax reading confidence number on screening accuracy and to determine whether repeated testing to achieve a higher confidence number improves screening accuracy in preschool children. METHODS. Lay and nurse screeners trained in the use of the Retinomax Autorefractor screened 1452 children enrolled in the Vision in Preschoolers (VIP) Phase II Study. All children also received a comprehensive eye examination. Using statistical comparison of correlated proportions, we compared sensitivity and specificity for detecting any VIP-targeted condition and conditions grouped by severity and by type (amblyopia, strabismus, significant refractive error, and unexplained decreased visual acuity) among three groups of children who had confidence numbers below, at or above the manufacturer's suggested confidence number of 8. The reading with the highest confidence number for each eye was used in the analysis. Each child's confidence number group was defined based on the lower confidence number of the pair of readings for the two eyes. Among the 771 (53.1%) children who had repeated testing either by lay or nurse screeners because of a low confidence number (<8) for one or both eyes in the initial testing, the same analyses were also conducted to compare results between the initial reading with confidence number <8 and repeated test reading with the highest confidence number in the same child. These analyses were based on the failure criteria associated with 90% specificity for detecting any VIP condition in VIP Phase II. We also examined the association between ocular conditions and confidence number. Hochberg procedure was used to adjust the p value for multiple comparisons. RESULTS. A lower confidence number category was associated with higher sensitivity (0.78, 0.65, and 0.61 for <8, 8, >8, respectively, p = 0.04) but much lower specificity (0.64, 0.89, and 0.93, p < 0.0001) of detecting any VIP-targeted condition. Through repeated testing, 87% of readings that initially had a confidence number below 8 reached 8 or above, and the increased confidence number that resulted from repeated testing was associated with significantly higher specificity (0.81 vs. 0.86, p = 0.002) and a nonsignificant change (by -0.04 to 0.03) in sensitivities. Children with any VIP-targeted condition, significant refractive error, hyperopia, astigmatism, or myopia were more likely to have a low confidence number. CONCLUSIONS. A higher confidence number obtained during Retinomax Autorefractor screening is associated with better screening accuracy. Repeated testing to reach the manufacturer's recommended minimum value is worthwhile in preschool vision screening with the Retinomax. Failure to achieve manufacturer's recommended minimum value through repeated testing should be a factor considered in referring children for a comprehensive eye examination.
Article
We have previously reported that significant hyperopia at 9 months predicts mild deficits on vistiocognitive and visuomotor measures between 2 years and 5 years 6 months. Here we compare the motor skills of children who had been hyperopic in infancy (hyperopic group) with those who had been emmetropic (control group), using the Movement Assessment Battery for Children (Movement ABC). Children were tested at 3 years 6 months (hyperopic group: 47 males, 63 females, mean age 3y 7mo, SD 1.6mo; control group: 61 males, 70 females, mean age 3y 7mo, SD 1.2mo) and at 5 years 6 months (hyperopic group: 43 males, 56 females, mean age 5y 4mo, SD 1.7mo; control group: 51 males, 62 females, mean age 5y 3mo, SD 1.6mo). The hyperopic group performed significantly worse at both ages, overall and on at least one test from each category of motor skill (manual dexterity, balance, and ball skills). Distributions of scores showed that these differences were not due to poor performance by a minority but to a widespread mild deficit in the hyperopic group. This study also provides the first normative data on the Movement ABC for children below 4 years of age, and shows that it provides a useful measure of motor development at this young age.
Article
To determine the age-specific prevalence of strabismus in white and African American children aged 6 through 71 months and of amblyopia in white and African American children aged 30 through 71 months. Cross-sectional, population-based study. White and African American children aged 6 through 71 months in Baltimore, MD, United States. Among 4132 children identified, 3990 eligible children (97%) were enrolled and 2546 children (62%) were examined. Parents or guardians of eligible participants underwent an in-home interview and were scheduled for a detailed eye examination, including optotype visual acuity and measurement of ocular deviations. Strabismus was defined as a heterotropia at near or distance fixation. Amblyopia was assessed in those children aged 30 through 71 months who were able to perform optotype testing at 3 meters. The proportions of children aged 6 through 71 months with strabismus and of children aged 30 through 71 months with amblyopia. Manifest strabismus was found in 3.3% of white and 2.1% of African American children (relative prevalence [RP], 1.61; 95% confidence interval [CI], 0.97-2.66). Esotropia and exotropia each accounted for close to half of all strabismus in both groups. Only 1 case of strabismus was found among 84 white children 6 through 11 months of age. Rates were higher in children 60 through 71 months of age (5.8% for whites and 2.9% for African Americans [RP, 2.05; 95% CI, 0.79-5.27]). Amblyopia was present in 12 (1.8%) white and 7 (0.8%) African American children (RP, 2.23; 95% CI, 0.88-5.62). Only 1 child had bilateral amblyopia. Manifest strabismus affected 1 in 30 white and 1 in 47 African American preschool-aged children. The prevalence of amblyopia was <2% in both whites and African Americans. National population projections suggest that there are approximately 677,000 cases of manifest strabismus among children 6 through 71 months of age and 271 000 cases of amblyopia among children 30 through 71 months of age in the United States.
Article
To determine the age-specific prevalence of refractive errors in white and African-American preschool children. The Baltimore Pediatric Eye Disease Study is a population-based evaluation of the prevalence of ocular disorders in children aged 6 to 71 months in Baltimore, Maryland. Among 4132 children identified, 3990 eligible children (97%) were enrolled and 2546 children (62%) were examined. Cycloplegic autorefraction was attempted in all children with the use of a Nikon Retinomax K-Plus 2 (Nikon Corporation, Tokyo, Japan). If a reliable autorefraction could not be obtained after 3 attempts, cycloplegic streak retinoscopy was performed. Mean spherical equivalent (SE) refractive error, astigmatism, and prevalence of higher refractive errors among African-American and white children. The mean SE of right eyes was +1.49 diopters (D) (standard deviation [SD] = 1.23) in white children and +0.71 D (SD = 1.35) in African-American children (mean difference of 0.78 D; 95% confidence interval [CI], 0.67-0.89). Mean SE refractive error did not decline with age in either group. The prevalence of myopia of 1.00 D or more in the eye with the lesser refractive error was 0.7% in white children and 5.5% in African-American children (relative risk [RR], 8.01; 95% CI, 3.70-17.35). The prevalence of hyperopia of +3 D or more in the eye with the lesser refractive error was 8.9% in white children and 4.4% in African-American children (RR, 0.49; 95% CI, 0.35-0.68). The prevalence of emmetropia (<-1.00 D to <+1.00 D) was 35.6% in white children and 58.0% in African-American children (RR, 1.64; 95% CI, 1.49-1.80). On the basis of published prescribing guidelines, 5.1% of the children would have benefited from spectacle correction. However, only 1.3% had been prescribed correction. Significant refractive errors are uncommon in this population of urban preschool children. There was no evidence for a myopic shift over this age range in this cross-sectional study. A small proportion of preschool children would likely benefit from refractive correction, but few have had this prescribed.
Article
• Parents are often concerned about their child's development, but it is unknown whether concerns indicate actual developmental problems. Pilot studies within 96 families showed that parents' concerns about their children's development took the form of value judgments, could be classified into commonly accepted developmental domains, and related to performance on screening tests. In our study, 100 families seeking pediatric care were asked to list any concerns about their child's development while their children received developmental screening. Eighty percent of the children who failed screening had parents with concerns about articulation, language, fine-motor skills, or global development. Ninety-four percent of the children who passed screening had parents with no concerns or concerns in other developmental areas. The types of concerns parents raised did not vary significantly with level of education, experience in child rearing, or other demographic variables. These results suggest that parental concerns may be a helpful adjunct to standardized developmental screening. (AJDC. 1989;143:955-958)
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
At present, medical therapy is the first line of attack against primary open-angle glaucoma. beta-blockers, miotics, sympathomimetics, carbonic anhydrase inhibitors, and prostaglandins have been used with varying degrees of success. The alpha 2-agonists, clonidine, apraclonidine, and now brimonidine are powerful inhibitors of aqueous humor production, thereby lowering intraocular pressure (IOP) in these patients. Brimonidine is emerging as a potential first-line therapy for primary open-angle glaucoma, with a peak IOP-lowering efficacy comparable to that of timolol, but without timolol's adverse cardiopulmonary side effects. Brimonidine promises to be an important new drug to help meet the therapeutic challenges faced by ophthalmologists in treating glaucoma.
Article
Half of all children with disabilities are not identified before school entrance, precluding their participation in early intervention programs with known value in reducing high school dropout rates, increasing employment, delaying child-bearing, and reducing criminal behavior. Screening tests that can greatly improve detection rates have not been popular in primary care. This article describes an alternative approach in an evidence-based technique relying on professional elicitation and interpretation of parents' concerns. 971 children from pediatric practices, day-care centers, public schools, and their siblings. Research shows that parents' concerns are as accurate as quality screening tests and that parents are equally able to raise important concerns regardless of differences in education and child-rearing experience. Parents' concerns can be elicited quickly, and 92% of parents can answer questions in writing while in exam or waiting rooms. Parents' concerns can help make a range of other important decisions about children's developmental and behavioral needs.
Article
To determine if thresholds exist for the development of amblyopia and subnormal binocularity with various types of anisometropia and to compare these with existing guidelines for the treatment or observation of anisometropia. The records of all previously untreated patients evaluated for isolated refractive error during a 42-month period were reviewed to assess the association between anisometropia, amblyopia, and subnormal binocularity. Three hundred sixty-one (361) patients with anisometropia and 50 nonanisometropic control participants, examined over a 42-month period, with no history of treatment for refractive error, amblyopia, or other ocular pathologic characteristics were evaluated. Uncorrected visual acuity in each eye, monofixation response, and degree of stereopsis were recorded for each patient. Patients with unequal or subnormal uncorrected visual acuity were retested with cycloplegic refraction. If the visual acuity was still abnormal, patients were retested while wearing spectacles. Degree and type of anisometropia were compared with incidence and severity of amblyopia and subnormal binocularity. Spherical myopic anisometropia (SMA) of more than 2 diopters (D) or spherical hypermetropic anisometropia (SHA) of more than 1 D results in a significant increase in the incidence of amblyopia and decrease in binocular function when compared with nonanisometropic patients (P = 0.05). Increasing levels of SMA and SHA beyond these thresholds result in increased incidence and severity of amblyopia. Cylindrical myopic anisometropia (CMA) or cylindrical hyperopic anisometropia (CHA) of more than 1.5 D results in a significant increase in amblyopia and a decrease in binocular function (P = 0.05). Levels of CMA and CHA more than 1.5 D result in an increased incidence and severity of amblyopia. This study supports existing guidelines for the treatment or observation of anisometropia and characterizes the association between the type and degree of anisometropia and the incidence and severity of amblyopia and subnormal binocularity.
Article
This study was undertaken to determine which parental concerns are most associated with significant behavioral/emotional problems and the extent to which parents' concerns can be depended on in the detection of mental health problems. An additional goal is to view how well a recently published screening test relying on parents' concerns, Parents' Evaluation of Developmental Status (PEDS), detects behavioral and emotional problems. Subjects were a national sample of 472 parents and their children (21 months to 8 years old) who were participants in 1 of 2 test standardization and validation studies. Sites included various pediatric settings, public schools, and Head Start programs in 5 diverse geographic locations. Subjects were representative of U.S. demographics in terms of ethnicity, parental level of education, gender, and socioeconomic status. At each site, psychological examiners, educational diagnosticians, or school psychologists recruited families, and obtained informed consent. Examiners disseminated a demographics questionnaire (in English or Spanish) and a developmental screening test that relies on parents' concerns (PEDS). Examiners were blinded to PEDS' scoring and interpretation administered either by interview or in writing, the Eyberg Child Behavior Inventory (ECBI) or the Possible Problems Checklist (PPC), a subtest of the Child Development Inventory that includes items measuring emotional well-being and behavioral self-control. PEDS was used to sort children into risk for developmental disabilities according to various types of parental concern. Those identified as having high or moderate risk were nominated for diagnostic testing or screening followed by developmental and mental health services when indicated. Because their emotional and behavioral needs would have been identified and addressed, these groups were removed from the analysis (N = 177). Of the 295 children who would not have been nominated for further scrutiny on PEDS due to their low risk of developmental problems, 102 had parents with concerns not predictive of developmental disabilities (e.g., behavior, social skills, self-help skills) and 193 had no concerns at all. Of the 295 children, 12% had scores on either the ECBI or the PPC indicative of mental health problems. Two parental concerns were identified through logistic regression as predictive of mental health status: behavior (OR = 4.74, CI = 1.69-13.30); and social skills (OR = 5.76, CI = 2.46-13.50). If one or more of these concerns was present, children had 8.5 times the risk of mental health problems (CI = 3.69-19.71) In children 434 years of age and older, one or both concerns was 87% sensitive and 79% specific to mental health status, figures keeping with standards for screening test accuracy. In young children, the presence of one or both concerns was 68% sensitive and 66% specific to mental health status. The findings suggest that certain parental concerns, if carefully elicited, can be depended on to detect mental health problems when children are 41 years and older and at low risk of developmental problems. For younger children, clinicians should counsel parents in disciplinary techniques, follow up, and if suggestions were not effective, administer a behavioral-emotional screening test such as the Pediatric Symptoms Checklist or the ECBI before making a referral decision.
Article
Best-corrected acuity was measured for vertical and horizontal gratings and for Lea Symbols recognition acuity in 3- to 5-year-old children with high astigmatism and in non-astigmatic children. There was significant amblyopia among astigmatic children at baseline. There was no evidence that eyeglass correction of astigmatism resulted in a reduction in amblyopia over a 4-month average treatment duration (although vision in astigmatic children was significantly improved immediately upon eyeglass correction, indicating that eyeglass correction did provide a visual benefit). Treatment outcome results are discussed in terms of both methodological issues and theoretical implications.
Article
We have previously reported that significant hyperopia at 9 months predicts mild deficits on visuocognitive and visuomotor measures between 2 years and 5 years 6 months. Here we compare the motor skills of children who had been hyperopic in infancy (hyperopic group) with those who had been emmetropic (control group), using the Movement Assessment Battery for Children (Movement ABC). Children were tested at 3 years 6 months (hyperopic group: 47 males, 63 females, mean age 3 y 7 mo, SD 1.6 mo; control group: 61 males, 70 females, mean age 3 y 7 mo, SD 1.2 mo) and at 5 years 6 months (hyperopic group: 43 males, 56 females, mean age 5 y 4 mo, SD 1.7 mo; control group: 51 males, 62 females, mean age 5 y 3 mo, SD 1.6 mo). The hyperopic group performed significantly worse at both ages, overall and on at least one test from each category of motor skill (manual dexterity, balance, and ball skills). Distributions of scores showed that these differences were not due to poor performance by a minority but to a widespread mild deficit in the hyperopic group. This study also provides the first normative data on the Movement ABC for children below 4 years of age, and shows that it provides a useful measure of motor development at this young age.
Article
Best-corrected acuity was measured for vertical and horizontal gratings and for recognition acuity optotypes (Lea Symbols) in a group of three- to five-year-old children with a high prevalence of astigmatism. Results showed meridional amblyopia (MA) among children with simple/compound myopic or mixed astigmatism, due to reduced acuity for horizontal gratings. Children with simple/compound hyperopic astigmatism showed no MA, but did show reduced acuity for both grating orientations. Reduced best-corrected recognition acuity was shown by both myopic/mixed and hyperopic astigmats. These results suggest that optical correction of astigmatism should be provided prior to age three to five years, to prevent development of amblyopia.
Article
Previous studies evaluating the effect of anisometropia on amblyopia development have been biased because subject selection occurred as a result of decreased acuity. Photoscreening identifies anisometropic children in a manner that is not biased by acuity, and allows an opportunity to evaluate how patient age influences the prevalence and depth of amblyopia. Retrospective observational study of preschool children with anisometropia. A statewide preschool photoscreening program screened 119,311 children and identified 792 with anisometropia >1.0 diopters. We correlated age with visual acuity and amblyopia depth. Results were compared with 562 strabismic children similarly identified. Only 14% (six of 44) of anisometropic children aged 1 year or younger had amblyopia. Amblyopia was detected in 40% (32 of 80) of 2-year-olds, 65% (119 of 182) of 3-year-olds, and 76% of 5-year-olds. Amblyopia depth also increased with age. Moderate amblyopia prevalence was 2% (ages 0 to 1), 17% (age 2), and rose steadily to 45% (ages 6 to 7). Severe amblyopia was rare for children aged 0 to 3, 9% at age 4, and 14% at age 5. Children with strabismus had a relatively stable prevalence (30% ages 0 to 2; 42% ages 3 to 4; and 44% ages 5 to 7) and depth of amblyopia. Younger children with anisometropia have a lower prevalence and depth of amblyopia than older children. By age 3, when most children undergo traditional screening, amblyopia has usually already developed. New vision screening technologies that allow early detection of anisometropia provide ophthalmologists an opportunity to intervene early, perhaps retarding or even preventing the development of amblyopia.
Article
The prescribing of spectacles for preschool children is very different from that for adults. Reasons for these differences include the inability to determine accurately a child's uncorrected and corrected visual acuity; as well as their lesser visual demands; their more proximal working distance; and their more plastic visual cortex, which places them at risk for amblyopia and strabismus. Most guidelines for spectacle treatment in such children are based upon clinical experience rather than randomized, masked clinical trials. Fortunately, the prescribing thresholds suggested by optometrists are quite similar to those suggested by pediatric ophthalmologists.
Article
To report on two population screening programs designed to detect significant refractive errors in 8308 8- to 9-month-old infants, examine the sequelae of infant hyperopia, and test whether early partial spectacle correction improved visual outcome (strabismus and acuity). The second program also examined whether infant hyperopia was associated with developmental differences across various domains such as language, cognition, attention, and visuomotor competences up to age 7 years. Linked programs in six European countries assessed costs of infant refractive screening. In the first program, screening included an orthoptic examination and isotropic photorefraction, with cycloplegia. In the second program we carried out the same screening procedure without cycloplegia. Hyperopic infants (> or = +4 D) were followed up alongside an emmetropic control group, with visual and developmental measures up to age 7 years, and entered a controlled trial of partial spectacle correction. The second program showed that accommodative lag during photorefraction with a target at 75 cm (focus > or = +1.5 D) was a marker for significant hyperopia. In each program, prevalence of significant hyperopia at 9 to 11 months was around 5%; manifest strabismus was 0.3% at 9 months and 1.5 to 2.0% by school age. Infant hyperopia was associated with increased strabismus and poor acuity at 4 years. Spectacle wear by infant hyperopes produced better visual outcome than in uncorrected infants, although an improvement in strabismus was found in the first program only. The corrections did not affect emmetropization to 3.5 years; however, both corrected and uncorrected groups remained more hyperopic than controls in the preschool years. The hyperopic group showed poorer overall performance than controls between 1 and 7 years on visuoperceptual, cognitive, motor, and attention tests, but showed no consistent differences in early language or phonological awareness. Relative cost estimates suggest that refractive screening programs can detect visual problems in infancy at lower overall cost than surveillance in primary care. Photo/videorefraction can successfully screen infants for refractive errors, with visual outcomes improved through early refractive correction. Infant hyperopia is associated with mild delays across many aspects of visuocognitive and visuomotor development. These studies raise the possibility that infant refractive screening can identify not only visual problems, but also potential developmental and learning difficulties.
Article
Anisometropia is an important cause of amblyopia. The relationship between anisometropia depth and amblyopia magnitude is not well characterized, as previous studies have been limited to patients identified because of their amblyopia. We analyzed results from anisometropic patients identified with photoscreening to eliminate this selection bias. We performed a retrospective observational study of preschool children with anisometropia >1.0 D identified during a statewide photoscreening program. Nine hundred seventy-four children with anisometropia were detected over a 9-year period. Visual acuity, cycloplegic refraction data, and patient age from a formal follow-up examination were analyzed. Effect of anisometropia magnitude on amblyopia was measured by ordinal logistic regression, taking age into account. Six hundred forty (65.7%) children had amblyopia > or =2 lines. Three hundred sixty-four (37.4%) had > or =4 lines amblyopia. There was a statistically significant increase in risk of amblyopia with increasing magnitude of anisometropia. Calculated odds ratios for amblyopia with maximal meridional anisometropia of > or =2 to <4 D compared with >1 to <2 D was 2.13 (95% CI [1.63, 2.78], p < 1 x 10(-7)), and 2.34 (95% CI [1.67, 3.28], p < 1 x 10(-6)) when comparing > or =4 D to > or =2 to <4 D. Odds ratios for spherical equivalent anisometropia were also highly statistically significant. Children with higher magnitudes of anisometropia had higher prevalence and greater depth of amblyopia. Older children had an increased risk of amblyopia compared with younger children for moderate levels of anisometropia. Low magnitude anisometropia in young children may not predispose to amblyopia; these findings have implications for vision screening criteria at various ages.
Article
To determine the age- and ethnicity-specific prevalence of decreased visual acuity (VA) in white and black preschool-aged children. Cross-sectional study. The Baltimore Pediatric Eye Disease Study is a population-based evaluation of the prevalence of ocular disorders in children 6 through 71 months of age in Baltimore, Maryland, United States. Among 4132 children identified, 3990 eligible children (97%) were enrolled and 2546 children (62%) were examined. This report focuses on 1714 of 2546 examined children (67%) who were 30 through 71 months of age. Field staff identified 63 737 occupied dwelling units in 54 census tracts. Parents or guardians of eligible participants underwent an in-home interview, and eligible children underwent a comprehensive eye examination including optotype visual acuity (VA) testing in children 30 months of age and older, with protocol-specified retesting of children with VA worse than an age-appropriate standard. The proportion of children 30 through 71 months of age testable for VA and the proportion with decreased VA as defined by preset criteria. Visual acuity was testable in 1504 of 1714 children (87.7%) 30 through 71 months of age. It was decreased at the initial test (wearing glasses if brought to the clinic) in both eyes of 7 of 577 white children (1.21%; 95% confidence interval [CI], 0.49-2.50) and 13 of 725 black children (1.79%; 95% CI, 0.95-3.08), a difference that is not statistically significant. Decreased VA in both eyes after retesting was found in 3 of 598 white children (0.50%; 95% CI, 0.10-1.48) and in 8 of 757 black children (1.06%, 95% CI = 0.45, 2.10), also not statistically significantly different. Uncorrected ametropia explained the decreased VA on initial testing in 10 of the 20 children. Decreased VA in both eyes of children 30 through 71 months of age at presentation in urban Baltimore was 1.2% among white children and 1.8% among black children. After retesting within 60 days of the initial examination and with children wearing best refractive correction, the rate of decreased VA in both eyes was 0.5% among white children and 1.1% among black children.
Collaborating with Parents: Using Parents' Evaluation of Developmental Status (PEDS) to Detect and Address Developmental and Behavioral Problems.
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Author manuscript; available in PMC 2012 February 1. Child characteristics N (%) Parent Evaluation of Developmental Status ** p value High risk of developmental problems Low risk of developmental problems Household income range † 0
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Optom Vis Sci. Author manuscript; available in PMC 2012 February 1. Child characteristics N (%) Parent Evaluation of Developmental Status ** p value High risk of developmental problems Low risk of developmental problems Household income range † 0.002
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Amblyopia in astigmatic preschool children.
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