Cohort study on the change trend of astigmatism among preschool children in Baiyun district, Guangzhou from 2018 to 2021.

AIM: To explore the characteristics of astigmatism in preschool children before, during and after the COVID-19 epidemic, so as to provide a reference for further prevention and control of children's vision. *METHODS: In the consecutive four years from January 2018 to December 2021, a retrospective analysis of vision data was conducted on 2 273 preschool children (4546 eyes) younger than 4 years old who participated in children' s vision screening test in Baiyun district, Guangzhou. They were divided into 1 - year old group (ages<1-year old, 420 cases), 2-year old group (1-year <= ages < 2- year, 543 cases), 3- year old group (2- year <=ages <3-year, 614 cases), and 4 - year old group (3 - year <= ages< 4- year, 696 cases) according to ages. The analysis included astigmatic degrees of children's eyes as well as their conditions of astigmatism. *RESULTS: In 2018, the astigmatic degrees of the both eyes of 1-year-old group were higher than those of other groups (P<0.05). The binocular astigmatic degrees of the preschool children in four groups were obviously higher in 2020 than 2019 (P < 0. 05), while they were significantly decreased in 2021 when compared with 2020 (P < 0. 05). From 2019 to 2020, the increase of astigmatic degrees of the right eye is more considerable than the left eye of preschool children in those four groups (P < 0. 001). Furthermore, the morbidity of astigmatism basically echoes with the changing tendency of astigmatic degrees from 2018 to 2021. *CONCLUSIONS: Preschool children in Baiyun district, Guangzhou, have the highest degree of astigmatism and the fastest progression rate within 1 year old. Before COVID - 19 epidemic, the changes in astigmatism and prevalence were relatively stable;during COVID - 19 epidemic, the astigmatism and prevalence increased significantly and the astigmatic degrees of right eye increased more than that of the left eye;after the normalization of epidemic prevention and control, the astigmatism and prevalence decreased significantly.Copyright © 2023 International Journal of Ophthalmology (c/o Editorial Office). All rights reserved.

Vision impairment is common in non-hospitalised patients with post-COVID-19 syndrome.

CLINICAL RELEVANCE: Vision-related problems can be part of longstanding sequelae after COVID-19 and hamper the return to work and daily activities. Knowledge about symptoms, visual, and oculomotor dysfunctions is however scarce, particularly for non-hospitalised patients. Clinically applicable tools are needed as support in the assessment and determination of intervention needs. BACKGROUND: The purpose of this study was to evaluate vision-related symptoms, assess visual and oculomotor function, and to test the clinical assessment of saccadic eye movements and sensitivity to visual motion in non-hospitalised post-COVID-19 outpatients. The patients (n = 38) in this observational cohort study were recruited from a post-COVID-19 clinic and had been referred for neurocognitive assessment. METHODS: Patients who reported vision-related symptoms reading problems and intolerance to movement in the environment were examined. A structured symptom assessment and a comprehensive vision examination were undertaken, and saccadic eye movements and visual motion sensitivity were assessed. RESULTS: High symptom scores (26-60%) and prevalence of visual function impairments were observed. An increased symptom score when reading was associated with less efficient saccadic eye movement behaviour (p < 0.001) and binocular dysfunction (p = 0.029). Patients with severe symptoms in visually busy places scored significantly higher on the Visual Motion Sensitivity Clinical Test Protocol (p = 0.029). CONCLUSION: Vision-related symptoms and impairments were prevalent in the study group. The Developmental Eye Movement Test and the Visual Motion Sensitivity Clinical Test Protocol showed promise for clinical assessment of saccadic performance and sensitivity to movement in the environment. Further study will be required to explore the utility of these tools.

Pediatric and School-Age Vision Screening in the United States: Rationale, Components, and Future Directions.

Pediatric vision screening detects children at risk for visual conditions with the goal of connecting those in need with an eye care provider for evaluation and treatment. The primary aim for vision screening in younger children is the detection of those at risk for amblyopia, which can result in irreversible vision loss if left untreated. In older children, screening goals broaden to include the detection of risk for uncorrected refractive error. In the United States, professional organization guidelines and state-mandated requirements for vision screening vary widely across both the timing and components of screening. In this article, we describe the goals and components of pediatric vision screenings, current challenges, novel approaches to providing follow-up services through school-based vision programs, and future directions.

Worsening vision at age 4-5 in England post-COVID: Evidence from a large database of vision screening data.

PURPOSE: Myopia prevalence has increased in the UK at age 10-16y, but little is known about younger children. We hypothesise that if the 'myopia epidemic' is affecting young children, then there will be increasing rates of bilateral reduced unaided vision (V) at vision screenings of children 4-5 years of age. METHODS: Retrospective anonymised data from computerised vision screening at age 4-5 years were analysed from serial cross-sectional data. Refractive error is not assessed in UK vision screening, so vision was investigated. Data were only included from schools that screened every year from 2015/16 to 2021/22. The criterion used was unaided monocular logMAR (automated letter-by-letter scoring) vision >0.20 in both the right and left eyes, so as to maximise the chances of detecting bilateral, moderate myopia rather than amblyopia. RESULTS: Anonymised raw data were obtained for 359,634 screening episodes from 2075 schools. Once schools were excluded where data were not available for every year and data were cleaned, the final database comprised 110,076 episodes. The proportion (percentage and 95% CI) failing the criterion from 2015/16 to 2021/22 were 7.6 (7.2-8.0), 8.5 (8.1-8.9), 7.5 (7.1-7.9), 7.8 (7.4-8.2), 8.7 (8.1-9.2), 8.5 (7.9-9.0) and 9.3 (8.8-9.7), respectively. The slope of the regression line showed a trend for increasing rates of reduced bilateral unaided vision, consistent with increasing frequency of myopia (p = 0.06). A decreasing linear trendline was noted for children 'Under Professional Care'. CONCLUSIONS: For children 4-5 years of age, there were signs of reduced vision over the last 7 years in England. Consideration of the most likely causes support the hypothesis of increasing myopia. The increase in screening failures highlights the importance of eye care in this young population.

Missed Vision Screenings for School-Age Children During The COVID-19 Pandemic: A Survey Based Study of NASN Representatives.

During the 2020-21 academic year, COVID-19-related educational disruptions impacted school-based vision screenings. However, limited information regarding changes in vision screening and the number of students impacted has been reported. Delayed screenings can negatively impact students' referral to eye care providers, which may affect a child's ability to see clearly and academic success. This study aims to describe changes in school-based vision screening practices through a survey of National Association of School Nurses state representatives (n = 49). Among states with vision screenings mandates, participants reported that 23.7% (9/38) states waived screenings, 31.6% (12/38) continued screenings, and 36.8% (14/38) modified requirements, such as grades screened or assessments included (e.g., color vision and stereoacuity screenings). These results suggest that millions of students across the United States missed vision screenings during the 2020-21 academic year. Efforts by education and school health stakeholders should be directed towards addressing the pandemic-related disruption in vision screening.

Five-year trends in pediatric vision screening and access in the United States.

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.

Door-to-door Screening as a New Model Augmenting School Eye Screening: Reaching Out to School Age Children in the Midst of a Pandemic.

PURPOSE: Explore door-to-door eye screening in India as a model to reach school age children in need of eye care, especially during school closures due to the Covid-19 pandemic. METHODS: Children between 5 and 18 years were screened in an urban-slum of Delhi from September 2020 to March 2021. Screening included capturing ocular complaints, visual acuity and conducting a torchlight examination. Children with any eye-related complaints, gross abnormality or a LogMAR acuity of more than 0.2 in either eye were referred to the nearby vision centre. Data were disaggregated by gender and age group. Reporting after referral and proportion of true positives referrals were used to assess the model. RESULTS: 32,857 children were screened. 55% were boys. Only 917 children (2.8%) had previous eye examinations. 1814 (5.5%) children were referred. Overall compliance rate amongst those referred was 59% (1070 of 1814) and compliance was significantly higher (72%) amongst those referred with poor vision as compared to those with only ocular morbidities (38%). Overall compliance was significantly higher amongst older age group (64% vs 50%) and amongst girls than boys (61% vs 56%). 3.9% children were detected with refractive error (RE) and 2.5% with uncorrected RE which was significantly higher in girls and in older age group. Of 1070 children reporting after referral, 85% had confirmed diagnosis for RE or other ocular pathology. CONCLUSION: Door-to-door screening had good referral compliance and positive predictive value. We recommend this model as a supplement to school screening especially in regions with low enrolment and high absenteeism in schools.

Smartphone ocular check application accuracy in comparison to traditional test for Saudi school children

Purpose: Visual acuity screening in children during and after the Covid-19 pandemic by recommending parents a free and easy Ocular Check Application. Methods: Visual acuity (VA) test were conducted for 86 eyes of 43 subjects between the age of 5 to 13 years, using both gold standard chart and Ocular Check application. The participants had gone through ocular screening to avoid amblyopia, strabismus or any ocular pathology. Many tests for screening were done like external eye exam, cover and uncover, light reflex, and ocular alignment examinations. Results: The median VA logMAR of all eyes tested using Standard and Ocular Check application were 0.0 LogMar. Intraclass Correlation Coefficient (ICC) showed a strong positive correlation between the two charts (ICC=0.857;P<0.001) in total number of eyes. In addition, a strong positive correlation was also found between the two charts for each eye (OD: ICC=0.845;P<0.001, OS: ICC=0.87;P<0.001). Conclusion: VA measurements with Ocular Check application corresponded well to the standard chart, suggesting potential utility of alternative portable VA tests for in-office or remote vision monitoring, particularly during the curfew time in pandemic situation of Covid 19.

COVID-19 safety guidelines for school eye health screening programs.

COVID-19 pandemic has significantly impacted every sphere of life. Health care workers, including eye care professionals, are at a higher risk of contracting infection directly or indirectly. To mitigate the risk of cross-infection among these front-line workers, it is vital to follow appropriate safety protocols. On the other hand, childhood eye conditions lead to permanent vision loss unless these are identified and treated early. School eye health programs are the best option to reach a large childhood population for early detection and treatment of vision-threatening eye conditions. While several clinical safety guidelines have been developed for ophthalmic practice, no such guidelines are available for carrying out school eye health programs. This article aims to set out COVID-19 safety guidelines for conducting school eye health programs in India.

Comparing a Home Vision Self-Assessment Test to Office-Based Snellen Visual Acuity.

PURPOSE: To evaluate the agreement of a home vision screening test compared to standard in-office technician-measured Snellen visual acuity to allow for remote screening and triaging of patients. PATIENTS AND METHODS: In this prospective study, English-speaking patients with in-office ophthalmology appointments from May to August 2020 and visual acuity better than 20/125 were asked to complete a home vision test one week before their scheduled in-office appointment. The home vision test was a modified ETDRS chart displayed in a PDF document that could be printed or viewed on a monitor. The primary outcome was the mean difference between office-based and home visual acuity. RESULTS: Eighty-two eyes of 45 patients were included in the study with 45 study eyes analyzed. The mean difference between office-based and home visual acuity was -0.02 logMAR (SD 0.15, P=0.28) among study eyes. Of these eyes, 91% demonstrated agreement between the two methods within 0.2 logMAR of the mean difference, and 60% had agreement within 0.1 logMAR of the mean difference. There were no significant demographic or ocular risk factors leading to a greater difference between the tests. CONCLUSION: There was good agreement between the home and in-office Snellen tests for patients with vision better than 20/125. The home vision test can be used to remotely determine if there is a significant vision change of >0.2 logMAR or approximately 2 lines of visual acuity.