Preverbal visual photo screening Project implementation in Portugal / Implementação de projeto de foto rastreio visual pré-verbal em Portugal

Abstract Purpose: To present the design and implementation of an amblyopia risk factors screening project, in a large based Portuguese population. Methods: Two referral centers have been enrolled to assess all children aged 2 under their direct referral area. The photoscreener used was PlusOptix ® A09. At this age, the cut-off defined for referral was: ≥1 Diopter (D) of anisometropia, ≥1.5D of astigmatism, ≥2D of myopia and ≥1.5D of hyperopia. The results were reported to a reading platform that allowed the ophthalmologist to see all exams, and provide timely appointment with a complete ophthalmologic assessment for those who needed. Results: A total of 2867 photo screens were made to the population eligible to both referral centers, which comprises a coverage rate of 55%. Out of 2611 children under one of the referral area, 53% (n=1395) adhered to the screening. Within these children, 17.5% (n=245) were referred and 15.3 % (n=214) appointments were performed. The comparison of refraction between PlusOptix ® and cycloplegic refraction showed a strong correlation regarding the sphere and cylinder values. From the 214 children observed in consultation, glasses were prescribed in 25.7% (n=55), corresponding to 3.9% of all screened children under one of the referral area. This screening method showed a positive predictive value of 58.4%. Conclusion: This screening program may be highly relevant to eradicate untreated amblyopia from our population. The results may lead to the implementation of this project to the whole country.

Resumo Objetivo: Apresentação da implementação de um projeto de rastreio de fatores de risco de ambliopia, numa população alargada portuguesa. Métodos: dois centros de referência foram selecionados para avaliar todas as crianças de 2 anos, na sua área de referenciação direta. Para o foto rastreio foi utilizado o PlusOptix ® A09. Nesta idade, os valores definidos para referenciação foram: ≥1 Dioptria (D) de anosimetropia, ≥1.5 D de astigmatismo, ≥2 D de miopia e ≥1.5 D de hipermetropia. Os resultados foram reportados a uma plataforma de leitura que permitiu ao oftalmologista ver todos os exames e providenciar uma consulta oportuna com uma avaliação oftalmológica completa para aqueles que precisavam. Resultados: Foram realizados 2867 foto rastreios na população elegível para ambos os centros de referência, perfazendo uma taxa de cobertura de 55%. Das 2611 crianças sob uma área de referência, 53% (n = 1395) aderiram ao rastreio. Dentro desse grupo, 17,5% (n = 245) foram referenciadas e 15,3% (n = 214) consultas foram realizadas. Verificou-se uma forte correlação entre a refração do PlusOptix® e a refração cicloplégica. Das 214 crianças observadas em consulta, foram prescritos óculos em 25,7% (n = 55), correspondendo a 3,9% de todas as crianças sob uma área de referência. Este método de triagem mostrou um valor preditivo positivo de 58,4%. Conclusão: Este programa de rastreio pode ser altamente relevante para erradicar a ambliopia não tratada na nossa população. Os resultados podem levar à implementação deste projeto em todo o país.

Associação entre hiperopia e outros erros refrativos e visuais em crianças / Associations between hyperopia and others refractive and visual errors in children

RESUMO Objetivo: Investigar a associação da hipermetropia com ambliopia, estrabismo, anisometropia e astigmatismo. Métodos: A hiperopia foi classificada em Grupo 1: maior ou igual a +5.00D; Grupo 2: maior que +3.25D e menor que +5.00D, com diferença de equivalente esférico maior ou igual a 0.50D; Grupo 3: maior que +3.25D e menor que +5.00D, com diferença de equivalente esférico menor que 0.50D e Grupo 4: com equivalente esférico maior e igual a +2.00D. O Grupo controle pertencente ao equivalente esférico menor que +2.00D. Resultados: A presença de hipermetropia maior e igual a SE+2.00D foi significativamente associada à maior proporção de crianças com ambliopia (27,2 vs. 14,8%, OR = 2,150, p<0,001) e estrabismo (70,8 vs. 39,3%, OR = 3,758, p<0,0001. A presença de hipermetropia também foi significativamente associada à maior proporção de anisometropia nos grupos com hipermetropia maior e igual a SE+2.00 (29,1 vs. 9,9%, OR = 3,708, p<0,0001) e astigmatismo (24 vs. 9,9%, OR = 2,859 p<0,0001). Conclusão: A presença e magnitude da hipermetropia entre crianças foram associadas à maior proporção de erros refrativos e visuais, como estrabismo, ambliopia, astigmatismo e anisometropia.

RESUMO Objective: Evaluate ocular trauma cases related to falling in elderly patients e compare the prevalence and severity of the cases. Methods: A series of cases was made with 52 patients aging 60 or more within the period of 36 months presenting ocular trauma related to falling, whereas the prevalence between the gender, the need for hospitalization or surgery and subsequent visual deficit were evaluated, as well as the severity of the cases. Results: Thirty-three (63.5%) of 52 patients were from the female gender, over which 30.3% had need for surgery and 18.2% developed visual deficit and 19 (36.5%) were from the male gender where 42.1% needed surgery and 26.3% developed visual deficit. Conclusions: The study has shown a higher prevalence of cases in the female gender, although the severity was higher in the male gender.

Análisis colorimétrico computarizado del color de la piel palpebral: un potencial método No Invasivo para monitorizar el cumplimiento de la terapia con parche en ambliopía / Computerized colorimetric analysis of skin palpebral color. A potential non invasive method for monitoring patch Compliance in the Treatment of amblyopia

Objetivo: evaluar el análisis colorimétrico computarizado del color de la piel del párpado antes y después de realizar oclusión, con el fin de determinar qué cambios en el color de la piel permiten conocer el cumplimiento de la terapia oclusiva en el tratamiento de la ambliopía. Métodos: se analizó el cambio de coloración de la piel tomando fotografías estandarizadas, antes y después de 48 horas de aplicación del parche. Los análisis se hicieron con el programa PS CS2 de Adobe Systems que proporciona discriminación de los colores primarios en una imagen determinada y permite analizar y comparar numéricamente las intensidades. Resultados: el promedio basal de intensidades fue de 52.50 con un rango entre 42.11 y 72.87. La desviación estándar fue de 37.34. El promedio después de 48 horas oclusión fue de 102.33 con un rango de entre 96.32 y 109.28 y una desviación estándar de 62.49. (P≤0.05). Al comparar el cambio de la piel ocluida en los párpados con la piel de la mejilla, expuesta a la luz pero no ocluida, se demostraron cambios igualmente significativos. Conclusiones: el análisis colorimétrico computarizado no invasivo de los cambios en la coloración de la piel de los pacientes en tratamiento con ambliopía puede convertirse en un método estándar para monitorizar el cumplimiento de la terapia con oclusión. Los resultados del presente trabajo son claros en evidenciar que tan rápidamente se inducen cambios colorimétricos en la piel, incluso antes de que éstos sean detectables a simple vista. Saber qué tan disciplinado ha sido el tratamiento da la posibilidad de conocer exactamente en qué situación está el paciente y estimulará a padres y pacientes para cumplir la terapia.

Objective: to evaluate the colorimetric computerized analysis of palpebral skin color before and after occluding the eye, in order to determine what changes in skin color allow to understand the compliance with patching treatment while treating amblyopia. Methods: skin color change was analyzed taking standardized pictures before and after 48 hours occlusion. Analysis was done with the program PS CS2 from Adobe Systems that gives color discrimination from an image and allows numerical comparison between intensities. Results: palpebral skin mean basal intensity was 52.50 (between 42-11 and 72-87). SD was 37.34. Average after 48 hours occlusion was 102.33 (96.32 to 109.28) and SD of 62.49 (P≤0.05). When comparing occluded skin color with cheek color, exposed to light but not occluded, there were also significant changes. Conclusions: Noninvasive colorimetric computerized analysis from changes in skin color in amblyopic patients treated with patching, could become a standard method for monitoring compliance with occlusion therapy. Results of this experiment are clear and evidence that changes in skin color occur quickly after starting the patch, even before they are visible to the bare eye. Knowing how disciplined has been the patient with his treatment gives the opportunity of knowing the exact situation of the patient and will stimulate parents and patients to improve patch compliance.

Características clínicas y epidemiológicas de ambliopía en pacientes atendidos en el Servicio de Oftalmología del Hospital Nacional Arzobispo Loayza en el periodo Enero - Setiembre 2010 / Clinical and epidemiological characteristics of amblyopia in patients treated in the Service of Ophthalmology at the National Hospital Arzobispo Loayza in the period January-September 2010

La investigación tiene como objetivo determinar las características clínicas y epidemiológicas de Ambliopía en pacientes atendidos en el Servicio de Oftalmología del Hospital Nacional Arzobispo Loayza. El Estudio es retrospectivo, observacional, de corte transversal, la muestra estará conformada por 56 pacientes que ingresaron al Servicio de Oftalmología del Hospital Nacional Arzobispo Loayza que fueron diagnosticados clínicamente de Ambliopía en el periodo de enero a setiembre 2010. De los resultados tenemos que la Ambliopía en varones se presentaron 16 casos (28.6 por ciento) y en mujeres 40 casos (71.4 por ciento). Del total de pacientes varones con Ambliopía el 28,6 por ciento presentaron Hallazgos normales de Párpados, vías lagrimales y conjuntivas; el 28.6 por ciento presentaron motilidad ocular conservada y del total de pacientes mujeres con Ambliopía el 66 por ciento presentaron Hallazgos normales de Párpados, vías lagrimales, conjuntivas y el 5.4 por ciento patológico, los pacientes de 5 a 10 años con Ambliopía el 12.5 por ciento presentaron hallazgos normales de Párpados, vías lagrimales y conjuntivas; de 10 a 15 años el 23.2 por ciento presentaron hallazgos normales de Párpados, vías lagrimales y conjuntivas; los pacientes de 15 a mas años el 58.9 por ciento presentaron hallazgos normales de Párpados, vías lagrimales y conjuntivas. El 17.9 por ciento presentan Ambliopía Estrábica; el 35.7 por ciento Ambliopía Ametrópica; el 46.4 por ciento presentan Ambliopía Anisometrópica. El principal síntoma es la disminución de agudeza visual (100 por ciento). EI 62.5 por ciento presentan Ambliopía unilateral y el 37.5 por ciento Ambliopía bilateral. El 17.9 por ciento presentan déficit visual leve; el 37.5 por ciento presentan déficit visual moderado y el 44.6 por ciento presentan déficit visual severo.

The research aims to determine the clinical and epidemiological characteristics of Amblyopia in patients treated at the Department of Ophthalmology at the National Hospital Archbishop Loayza. The study is retrospective, observational, cross-sectional, the sample will consist of 56 patients admitted to the Department of Ophthalmology Arzobispo Loayza National Hospital who were clinically diagnosed with Amblyopia in the period January to September 2010. The results we have that Amblyopia in males are presented 16 cases (28.6 per cent) and female 40 cases (71.4 per cent). Of the male patients with Amblyopias in 28,6 per cent findings Normal eyelids, tear ducts and conjuntival, 28.6 per cent had ocular motility preserved and women of all patients with Amblyopia showed 66 per cent findings Normal eyelids, tear ducts, and conjuntival and 5.4 per cent pathological, the patients 5 to 10 years with Amblyopia showed 12.5 per cent findings Normal eyelids, tear duct and conjuntival, and patients 10 to 15 years with 23.2 per cent had Amblyopia findings Normal eyelids, tear duct and conjuntival, those patients with more than 15 years with Amblyopia showed 58.9 per cent findings Normal eyelids, tear ducts, conjuntival. Conclusions 17.9 per cent have strabismic Amblyopia, 35.7 per cent ametropic Amblyopia, 46.4 per cent have anisometric Amblyopia. The main symptom is decreased visual acuity (100 per cent). 62.5 per cent presented unilateral Amblyopia and 37.5 per cent bilateral Amblyopia, 17.9 per cent have level visual deficit, 37.5 per cent have moderate visual deficit and 44.6 per cent develop severe visual deficit.

Prevalencia de ambliopía en la escuela primaria Augusto Cesar Sandino de Ciego de Ávila / Prevalence of amblyopia at Augusto Cesar Sandino primary school in Ciego de Avila

La ambliopía se define como una disminución de la agudeza visual sin existir ninguna lesión orgánica que la justifique. Se identificó la prevalencia de la ambliopía en los estudiantes de la escuela primaria Augusto César Sandino del municipio de Ciego de Ávila, en el período comprendido desde marzo de 2008 a marzo de 2009. Se estudió el total de niños matriculados (557); se realizó un estudio observacional descriptivo de corte transversal en busca de ambliopía, se les realizó un examen físico ocular completo que fue la fuente de información. El 2.33 porciento de los escolares presentó ambliopía. El 46.15 porciento de los pacientes pertenecieron al grupo de edad de 6 a 4 años, predominó el sexo femenino 69.23 porciento. La ambliopía refractiva y la forma ligera fueron las más frecuentes (53.85 y 61.54 porciento). En el 76.92 porciento de los niños el desconocimiento de los padres fue la principal causa del diagnóstico tardío. El valor de ambliopes obtenido se encuentra dentro de la cifra promedio de prevalencia a nivel mundial, predominó el grupo de edad de 4 a 6 años, el sexo femenino, la ambliopía refractiva y la forma ligera; el desconocimiento de los padres o tutores fue la causa fundamental de diagnóstico tardío.

Amblyopia is defined as a decrease in visual acuity without existing any organic lesion to justify it. It was identified the prevalence of amblyopia in Primary School "Augusto Cesar Sandino” in Ciego de Avila municipality from March 2008 to March 2009. It was studied the total of children enrolled (557) where an observational descriptive cross-sectional study was carried out in search of amblyopia, they underwent a complete ocular physical examination that was the source of information. 2.33 percent of the students had amblyopia, 46.15 percent of patients were from 6 to 4 years old, females were the predominant sex (69.23 percent). Refractive and small amblyopia were the most frequent (53.85 and 61.54 percent). In 76.92 percent of children, their parents’ ignorance was the main cause of late diagnosis. The obtained value of amblyopes is in the average number of prevalence worldwide, dominated ages from 4 to 6 years, female sex, refractive and small amblyopia; the ignorance of parents or guardians was fundamental causes of late diagnosis.

Detecção de ambliopia, ametropias e fatores ambliogênicos em comunidade assistida por Programa da Saúde da Família no Rio de Janeiro, Brasil / Amblyopia, ametropia and amblyogenic factors detection in a community assisted by Health Family Program in Rio de Janeiro, Brazil

OBJETIVO: Estimar a prevalência dos fatores ambliogênicos e ambliopia na área adscrita do Programa Saúde da Família (PSF) da Lapa (RJ) e estimar na mesma área a sensibilidade/especificidade entre os métodos de medida da acuidade visual (tabelas ETDRS e LEA) para triagem em crianças pré-escolares (três a seis anos). MÉTODOS: Estudo transversal de 93 crianças entre três e seis anos da área adscrita do PSF Lapa, RJ. Todas as crianças foram submetidas a avaliação oftalmológica completa que incluiu: anamnese dirigida, ectoscopia, medida da acuidade visual com tabela de ETDRS e LEA de forma duplo cega, reflexo vermelho, teste de Titmus, refração objetiva sob cicloplegia, refração subjetiva, avaliação da motilidade ocular, biomicroscopia do segmento anterior, fundoscopia sob midríase.Os dados foram coletados na Policlínica Ronaldo Gazolla, da Universidade Estácio de Sá. RESULTADOS: A prevalência dos fatores ambliogênicos foi encontrada e distribuída em: 8,4 por cento de estrabismo, 11,86 por cento de anisometropia e 15,2 por cento de ametropia. O teste de acuidade visual ETDRS apresentou sensibilidade de 100 por cento e especificidade de 18 por cento para detecção de ambliopia. O teste de acuidade visual LEA apresentou sensibilidade de 100 por cento e especificidade de 30,9 por cento para detecção de ambliopia. CONCLUSÃO: Ambas tabelas ETDRS e LEA podem ser usadas para a triagem de ambliopia porque tiveram 100 por cento de sensibilidade. A especificidade foi maior para a tabela LEA. Porém, ainda em nível baixo. Portanto, há necessidade da complementação com o exame oftalmológico completo para confirmar e ratificar a presença de fatores ambliogênicos em pacientes triados positivamente. A triagem visual feita pelos agentes comunitários de saúde pode identificar crianças com distúrbios visuais, referenciando para exame oftalmológico completo; em um grupo etário onde a resolução dos problemas visuais se apresenta como prioridade...

OBJECTIVES: To determine amblyogenic factors and amblyopia prevalence in a Health Family assisted community área of Lapa (RJ); and to estimate in the same area the sensiblity and specificity among visual acuity methods ( ETDRS versus LEA optotypes) in pre-school children. METHODS: Cross section study of 93 children from three to six years old. All the children were submitted to complete ophthalmological evaluation which included: anamnesis, ectoscopy, double blind visual acuity measurements with LEA and ETDRS optotypes, red reflex, Titmus Test, objective cycloplegic refraction, subjective refraction, ocular motility evaluation, anterior segment biomicroscopy, fundoscopy. The data were collected in Ronaldo Gazolla Policlinic of Estacio de Sá University. RESULTS: The amblyogenic factors prevalence were : 8,4 percent of strabismus, 11,86 percent of anisometropia and 15,2 percent of ametropia. The ETDRS visual acuity test had 100 percent of sensibility and 18 percent of specificity for amblyopia detection. Lea visual acuity test had 100 percent sensibility and 30,9 percent specificity for amblyopia detection. CONCLUSION: Both optotype tests ETDRS and LEA can be used for amblyopia screening because they had 100 percent sensibility. The specificity was higher for LEA optotypes. However, the specificity still remained in a low level. Therefore, it is necessary to complement the visual acuity screening with a complete ophthalmological exam in the individuals screened to have amblyopia. Visual screening performed by Health Community Agents could identify children with visual acuity problems, and they could be referred to an ophthalmological complete exam, in an age group that visual acuity problems resolution is a priority. Helth Family Program can be used to evaluate visual acuity children status and it would be useful that this evaluation could be a statiscal SUS mark.

Evaluation of ‘vision screening’ program for three to six-year-old children in the Republic of Iran.

Background: Since 1996, vision screening of three to six-year-old children is conducted every year in Iran. We present outcomes of project review held in August 2006. Materials and Methods: Kindergarten teachers examined vision by using Snellen's illiterate ‘E’ chart. They used torchlight to detect strabismus. On a repeat test, if either eye had vision <20/30, the child was referred to the optometrist. A pediatric ophthalmologist examined and managed children with strabismus or amblyopia. Provincial managers supervised the screening program. The evaluator team assessed the coverage, yield, quality and feasibility, and cost-effectiveness of vision screening, as well as magnitude of amblyopia, and its risk factors. Result: In 2005, 1.4 million (67%) children were examined in all provinces of Iran. Opticians examined 90,319 (61%) children with defective vision that were referred to them. The prevalence of uncorrected refractive error, strabismus and amblyopia was 3.82% (95% CI 3.79 – 3.85), 0.39% (95% CI 0.38 – 0.40) and 1.25% (95% CI 1.24 – 1.26) respectively. Validity test of 7,768 children had a sensitivity of 74.5% (95% CI 72.7 – 76.3) and specificity of 97.2% (95% CI 96.7 – 97.7). The cost of amblyopia screening was US $ 1.5 per child. While the cost of screening and treating one child with amblyopia was US $ 245. Conclusion: A review of the vision screening of children in Iran showed it with screening and useful exercise and had a yield of 1:21. The coverage of vision screening was low and the management of children with amblyopia, low vision and refractive error needed strengthening.

Tamización de salud visual en población infantil: prevención de la ambliopía / Vision screening in childhood: prevention of amblyopia

Estudio descriptivo en la institución Aldeas Infantiles del barrio Las Cruces de Bogotá DC. (Colombia). Tuvo por objeto describir y confirmar la frecuencia de alteraciones visuales en niños entre seis meses y once años de edad. Se aplicaron pruebas de tamizaje para defectos visuales a 101 niños de estrato socioeconómico uno y dos, según su edad (seis meses a dos años, tres a cuatro años, cinco a seis años y mayores de seis años). Los resultados indican que esta población tiene una prevalencia de defectos visuales similar a la encontrada en otros estudios y que los niños enfermos no tienen la corrección ni el tratamiento apropiados para prevenir defectos mayores en el futuro. Se pretende incentivar la realización de tamizaje en niños por personal médico entrenado para la detección temprana de alteraciones visuales prevenibles.

This was a descriptive study carried out at the Small Towns for Children of the Las Cruces neighborhood at Bogotá DC. (Colombia). Its purpose was to describe and confirm the frequency of visual impairments in children aged 0.6 months to 11 years. Age-appropriate screening vision tests were applied to 101 boys/girls (0.6 months to 2 years, 3 to 4 years, 5 to 6 years and 6 years and older), belonging to socio-economic status one and two. Results revealed that the prevalence of visual impairments in this population is similar to that found in other studies and that these children remain untreated thus failing to prevent greater future consequences. We pretend to boost vision screening in childhood delivered by qualified medical professionals to provide early detection of preventable visual alterations.

Vision screening among children in primary schools in a district of western Turkey: an epidemiological study

To determine the prevalence of visual impairments among children in primary schools. This cross-sectional study was conducted between from November 1st to December 31st 2006. Visual acuity was determined with the Snellen's E chart. Visual impairment was defined as visual acuity of d"20/40 in the better eye, as amblyopia if the difference in visual acuity between both eyes was 0.2d"dioptry, and as strabismus if the cover test was positive. Of the study group [n=1606], 53.7% [n=864] were boys and 46.3% [n=742] girls. The mean age of the participants was 10.52 +/- 2.28 [range 6-17]. The girls had a higher frequency of a presenting visual impairment than boys [2.4% vs. 1.0%], [p<0.05]. Twenty seven [1.7%] children presented with vision of d"20/40 in the better eye. The prevalence of presenting visual acuity for d"20/40 was significantly higher in children with glasses compared to the group of children without glasses [p<0.05]. The prevalence of amblyopia was 5.0%, whereas that of strabismus was 1.7%. The number of students with visual impairments was high, and many students were unaware of visual impairments and their risk factors

Treatment options for non-compliant children with amblyopia in Kuwait

The mainstay treatment for more than 250 years has been occlusion of the better eye by an opaque patch. Pharmacological penalization is an alternative therapy for noncompliant child. The aim of this study is to investigate the effects of atropine penalization in amblyopic patients who are noncompliant with conventional occlusion. This is a retrospective study of 114 children aged 24 to 78 months with unilateral Ambyliopia diagnosed at the Pediatric Ophthalmology unit of AL-Bahar Eye Center in Kuwait during the time period December 1999 to august 2005 and fulfilling the inclusion criteria. The mean follow up time after starting amblyopia treatment was 38.4 +/- 27.12 months. All children with amblyopia were prescribed 6 hours occlusion per day. Children who are non compliant with occlusion were instructed to instil 1 drop of atropine 1% into the nonambyliopic once per day. A total of 114 patients participated in the study.72 [63.16%] patients were compliant with occlusion, 64 of them [88.9%] reached cure within mean time of 23.23 +/- 16.89 months. The remaining 42[36.84%] patients who are not compliant with occlusion were instructed to use atropine 1% eye drops once per day. 38 of them [90.5%] were compliant with penalization and 36 [94.7%] of them reached cure with a mean time 12.9 +/- 9.7 months. Conclusion: The result of this study suggests that atropine penalization should be considered as an alternative therapy in those who are noncompliant with occlusion in treatment of amblyopia

Experiência em projeto: "Enxergando através das mãos" / \"Vision through the hands\": experience of a project

OBJETIVO: A Fundação Altino Ventura realizou o projeto "Enxergando através das mãos", com o objetivo de investigar a situação atual da múltipla deficiência no estado de Pernambuco, verificar a demanda reprimida nesta área e analisar relevância para implantação de um centro especializado de referência para o diagnóstico e tratamento desses pacientes. MÉTODOS: Foi avaliado o perfil de um grupo de pacientes atendidos em cinco serviços de referência do grande Recife. Os casos foram avaliados quanto a ocorrências perinatais, inclusão social e dificuldades de acesso aos serviços especializados. Promoveu-se o atendimento oftalmológico especializado e o tratamento indicado para cada caso. O projeto foi desenvolvido de forma prospectiva, seguindo protocolo e organograma previamente elaborados. Os atendimentos foram realizados em seis dias não consecutivos, durante os quais todos os casos passavam pelas etapas de entrevista dos genitores e exame oftalmológico completo. Durante o período de espera entre entrevista e exame oftalmológico os pacientes realizavam atividades lúdicas com artistas plásticas. Contou-se com equipe multidisciplinar de 31 profissionais. RESULTADOS: Foram atendidos 309 pacientes. Estavam incluídos na sociedade 83,1 por cento dos pacientes, apenas 45,4 por cento freqüentavam escola (normal ou especial). A dificuldade de acesso aos serviços na área de oftalmologia foi relatada por 51,1 por cento dos casos. Foram identificadas 274 crianças com múltiplas deficiências, destas, 154 (56,2 por cento) nunca haviam sido examinadas pelo oftalmologista e 33 por cento tinham baixa de visão (inferior à 20/60 na tabela de Snellen). Os diagnósticos oftalmológicos mais freqüentes foram: erro refracional, estrabismo, ambliopia, alterações do nervo óptico (glaucoma e atrofia), e catarata. Foram prescritos e doados 84 óculos. CONCLUSÃO: O projeto foi pioneiro na região, permitindo a obtenção de importantes dados quanto à problemática da deficiência...

PURPOSE: The Project "Vision through the hands" was performed by the Altino Ventura Foundation, with the purpose of investigating the present child situation with multiple disabilities in the state of Pernambuco, Brazil. METHODS: Birth and social conditions, social problems, and difficulty in accessing the specialized services were evaluated, aiming to collect relevant data with the goal of posterior implantation of a specialized diagnosis and treatment center. Ophthalmologic care and proper treatment were offered. RESULTS: Three hundred and nine children from five reference institutions in disabilities were attended, on six non consecutive days. All cases underwent ophthalmologic examinations and parent interviews. During the waiting time between the ophthalmologic visits and parent interviews the patients performed activities with artists. A multidisciplinary team of 31 professionals was available. According to parent information 83.1 percent of the patients were considered included in the society and only 45.4 percent attended school (normal or special). The difficulty to get access to ophthalmologic service was reported by 51.1 percent. Two hundred and seventy children with multiple disabilities were indentified, 154 (56.2 percent) of whom underwent an ophthalmologic examination for the first time, and 33.0 percent had low visual acuity (inferior to 20/60 Snellen). The most frequent diagnoses were: refraction error, strabismus, ambliopia, alterations of optic nerve (glaucoma and atrophy), and cataract. Eighty-four glasses were prescribed. CONCLUSION: This project was pioneer in the region, allowing to obtain the information about important problems regarding multiple disabilities, and making possible ophthalmologic care and specialized treatment to the children.

Vision screening in schoolchildren: two years results.

OBJECTIVE: To assess the prevalence of visual impairment and ocular abnormalities among schoolchildren in Chiang Mai. DESIGN: A community-based survey. SUBJECTS AND METHOD: The vision screening project was conducted from June 2000 to March 2002. Students in grade I in the Chiang Mai municipal area were examined for visual acuity (VA), color vision, ocular alignment, anterior segment and fundus. Subjective refraction was done in students with subnormal vision (VA 20/30 or less). Referral to the hospital for further evaluation and treatment was made for students with strabismus, amblyopia and other ocular abnormalities. RESULTS: A total of 3,431 and 3,467 students were enrolled in 2000 and 2001, respectively. The prevalence of normal vision (VA 20/20), VA 20/30 or better in at least one eye and 20/40 or less in at least one eye were similar in both years (87%, 5.7%, 7.3% and 85%, 6.4%, 8.7%, respectively). There was no statistically significant difference in visual acuity among boys and girls in either year (p = 0.6 and p = 0.2). Prevalence of abnormal color vision was 4.2%. Other causes of visual impairment in both years included strabismus (1.5% and 6.2%), amblyopia (1.1% and 1.4%) and some congenital abnormalities. Most cases of amblyopia were due to uncorrected refractive errors. CONCLUSION: The authors found that over 10% of school-aged children had subnormal vision. The important causes of visual deterioration came from refractive errors, strabismus and amblyopia. The authors concluded that vision screening is a cost-effective way of reducing visual morbidity from preventable visual impairment, which is a tragedy that cannot be ignored.

Pesquisa de ambliopía en preescolares del Centro de Salud familiar Bernardo Leighton / Screening for amblyopia in pre-school children in the Family Health Centre, Bernardo Leighton

Introducción: La ambliopía corresponde a una disminución de la agudeza visual sin causa orgánica conocida y tiene una prevalencia estimada entre 1 a 5 por ciento de la población general. Objetivos: Cuantificar la prevalencia y determinar las causas de ambliopía en preescolares de 4 a 5 años. Material y Métodos: Se realizó examen oftalmológico completo a 94 niños derivados en forma aleatoria desde el programa control de niño sano del Centro de Salud Familiar Bernardo Leighton y se registraron la agudeza visual y refracción con mejor visión corregida, determinándose la existencia de ambliopía. Resultados: Se encontró ambliopía en 9,6 por ciento, siendo bilateral en 5,3 por ciento y asociándose principalmente a astigmatismo. El 93,3 por ciento de los ojos con agudeza visual sin corrección menor o igual a 0,5 tenían ambliopía. Conclusiones:La alta prevalencia de ambliopía encontrada hace necesario instaurar programas de screening visual para su detección precoz. Presentar agudeza visual sin corrección de 0,5 o inferior sería un factor de riesgo de esta patología.

Medida da acuidade visual e detecçäo de ambliopia em pacientes internados no Hospital da Criança Santo Antônio, Porto Alegre,RS / Visual acuity and prevalence of amblyopia in hospitalized at Santo Antonio Children's Hospital, Porto Alegre,RS

Os autores apresentam uma análise de 105 pacientes internados no Hospital da Criança Santo Antônio no período de março a maio de 1997, com o objetivo de estimar a prevalência de ambliopia na faixa etária entre 3 e 10 anos, através da medida da acuidade visual. Entre os 93 pacientes examinados, 15 apresentaram alguma alteraçäo oftalmológica ao exame. Constatou-se a presença de ambliopia em 6,8 por cento dos casos. Entre as anormalidades observadas, houve maior prevalência de estrabismo e paralisia da musculatura extrínseca ocular. Enfatiza-se a importância do exame oftalmológico sumário como rotina na prática pediátrica

Resultados del tratamiento quirúrgico en la endotropia monocular vs alterna: estudio comparativo / Results of the surgical treatment in the monocular esotropia vs alrnate cases. A compartive study

Estudio restrospectivo que tiene como objetivo determinar si existen diferencias entre los pacientes con endotropia posicional inervacional primaria monocular y alterna en el resultado del tratamiento quirúrgico y estabilidad del resultado. Se estudiaron los expediente de 66 pacientes, 41 con desviación alterna y 25 con desviación monocular, recopilando la desviación preoperatoria, postoperatoria inmediata, y a su más largo seguimiento. Los pacientes fueron operados con el mismo procedimiento quirúrgico. Los pricipales resultados mostraron que no existe diferencia estadísticamente significativa en la respuesta al tratamiento inmediato ni diferencia en la estabilidad del resultado entre pacientes con endotropia posicional inervacional primaria, monocular vs alterna, el tiempo promedio de seguimiento fue de 1 años y 5 meses, con un rango de 3 meses a 10 años.

Causas oftalmológicas de pensiones de invalidez en el área metropolitana norte, años 1990-1994 / Ophthalmologic cause of invalidity files at metropolitan north area, 1990-1994

Se revisaron 1.186 expedientes de pensiones de Invalidez aprobados por la Comisión de Medicina Preventiva e Invalidez del área Metropolitana Norte de Salud desde el año 1990 a 1994, de las cuales se encontraron 100 de causa oftalmológica. Estos expedientes se analizaron registrando el nombre completo, sexo, edad, causal de la pensión y tipo de ella (parcial permanente o absoluta y permanente), agudeza visual y fecha del dictamen. Del total de Pensiones concedidas, las originadas en una causa oftalmológica correspondieron al 8,43 por ciento del total. El rango de edad del grupo estudiado fue entre los 40 y los 76 años, con una edad promedio de 56,79 años. La principal causa correspondió a Retinopatía Diabética, con el 33 por ciento de los casos, seguida por Glaucoma (15 por ciento), Miopía (11 por ciento). Desprendimiento de Retina (5 por ciento) y Ambliopía (5 por ciento). Del total de pensiones oftalmológicas, el 72 por ciento se originó en pacientes de sexo masculino, y el 28 por ciento en pacientes de sexo femenino. Se establece una relación con otros trabajos realizados en las áreas Oriente y Sur de Santiago, concluyendo que las causas principales de ceguera son similares, con algunas diferencias en cuanto a frecuencias. Se hace hincapié en la necesidad de uniformar los criterios a seguir para el otorgamiento de pensiones de invalidez oftalmológicas, a fin de obtener información comparable en el futuro

Incidencia de ambliopía en población escolar del área metropolitana de Caracas, Venezuela / Incidence of ambliopia in school population at metropolitan area of Caracas, Venezuela

Se llevó a cabo un estudio en Colegios de la Parroquia La Vega ubicada en el área metropolitana de Caracas, con el fin de determinar la incidencia de ambliopía funcional en la población general de Venezuela. En una muestra representativa de 1330 escolares en edades comprendidas entre los 6 y 15 años tomados aleatoriamente de un total de 3060 cursantes en la I y II etapa de educación básica resultaron 4,44 porciento de ambliopes uni o bilaterales con agudeza visual de 20/40 o peor en uno o los dos ojos, encontrándose como factor determinante las ametropías especialmente de tipo astigmático. La medición de AV se hizo utilizando la tabla optométrica de Snellen con la particularidad de haberse realizado cicloplejía y refracción de los casos sospechosos el mismo día y en los propios institutos docentes, reduciéndose al máximo la deserción (0.92 porciento del total de la mustra estudiada). El estrabismo ocupó el 8.5 porciento de los casos destacándose las endotropias como causal importante de ambliopía profunda