Sampling and measurement methods for a study of childhood refractive error in a UK population.

BACKGROUND: There is a paucity of data describing the prevalence of childhood refractive error in the United Kingdom. The Northern Ireland Childhood Errors of Refraction study, along with its sister study the Aston Eye Study, are the first population-based surveys of children using both random cluster sampling and cycloplegic autorefraction to quantify levels of refractive error in the United Kingdom. METHODS: Children aged 6-7 years and 12-13 years were recruited from a stratified random sample of primary and post-primary schools, representative of the population of Northern Ireland as a whole. Measurements included assessment of visual acuity, oculomotor balance, ocular biometry and cycloplegic binocular open-field autorefraction. Questionnaires were used to identify putative risk factors for refractive error. RESULTS: 399 (57%) of 6-7 years and 669 (60%) of 12-13 years participated. School participation rates did not vary statistically significantly with the size of the school, whether the school is urban or rural, or whether it is in a deprived/non-deprived area. The gender balance, ethnicity and type of schooling of participants are reflective of the Northern Ireland population. CONCLUSIONS: The study design, sample size and methodology will ensure accurate measures of the prevalence of refractive errors in the target population and will facilitate comparisons with other population-based refractive data.

Refractive error and visual impairment in school children in Northern Ireland.

AIMS: To describe the prevalence of refractive error (myopia and hyperopia) and visual impairment in a representative sample of white school children. METHODS: The Northern Ireland Childhood Errors of Refraction study, a population-based cross-sectional study, examined 661 white 12-13-year-old and 392 white 6-7-year-old children between 2006 and 2008. Procedures included assessment of monocular logarithm of the minimum angle of resolution (logMAR), visual acuity (unaided and presenting) and binocular open-field cycloplegic (1% cyclopentolate) autorefraction. Myopia was defined as -0.50DS or more myopic spherical equivalent refraction (SER) in either eye, hyperopia as > or =+2.00DS SER in either eye if not previously classified as myopic. Visual impairment was defined as >0.30 logMAR units (equivalent to 6/12). RESULTS: Levels of myopia were 2.8% (95% CI 1.3% to 4.3%) in younger and 17.7% (95% CI 13.2% to 22.2%) in older children: corresponding levels of hyperopia were 26% (95% CI 20% to 33%) and 14.7% (95% CI 9.9% to 19.4%). The prevalence of presenting visual impairment in the better eye was 3.6% in 12-13-year-old children compared with 1.5% in 6-7-year-old children. Almost one in four children fails to bring their spectacles to school. CONCLUSIONS: This study is the first to provide robust population-based data on the prevalence of refractive error and visual impairment in Northern Irish school children. Strategies to improve compliance with spectacle wear are required.

Community-based study of the association of high myopia in children with ocular and systemic disease.

PURPOSE: High myopia in childhood is associated with important ocular and systemic conditions. However in the UK, high myopia in early childhood is not specifically identified in current ophthalmology, optometry, or orthoptic protocols for screening, referral, or investigation. An ongoing study in the West Midlands, UK, is investigating high myopia presenting to community health care clinics with the aim of compiling guidelines for assessment and subsequent referral. METHODS: Children with high myopia were identified from community optometric and orthoptic sources and invited for an ophthalmology and optometry examination to ascertain possible ocular or systemic disease. RESULTS: High myopia with no associated ocular or systemic condition was present in 15 (56%) of the children. In seven children (25%), associated ocular problems were found including unrecognized retinal dystrophies and amblyopia. Systemic disorders associated with high myopia were found in five children (19%) and included Sticklers syndrome, Weill-Marchesani syndrome, and homocystinuria. In one child, the diagnosis made before this study was found to be incorrect, and in another child, the results were inconclusive. In two cases, the diagnosis of a systemic condition in the child led to the identification of the disease in at least one relative. CONCLUSIONS: There is a high prevalence of ocular and systemic abnormality in young children seen in the community. Optometric and ophthalmologic assessment of children less than 10 years with myopia > or =5 D is likely to identify significant ocular or systemic disease, a proportion of which will respond to medical intervention. Detection and prompt referral of these cases by community health care services may be expected to prolong vision and possibly life expectancy.

Promoting the recruitment and retention of minority faculty.

The need for proactive recruitment programs, I believe, will be even more essential as faculty-ALL faculty-become more difficult to identify, as private practice and other professional options continue to be more available and attractive and as student debt levels continue to rise. Active retention programs for new faculty will also be critical activities for departments and colleges of dentistry. Several factors threaten the longevity of junior faculty: As dentistry schools are required to become more financially self-reliant with less support from the parent university (and/or the state), faculty will be asked to "produce" more (and the trend toward clinic track appointments is not likely to mitigate this problem). The standards and rigor of the promotion process at many universities are continually increasing. The increased teaching loads required by our seemingly inexorably increasing curricula are not supported by a commensurate increase in the number of faculty. Lastly, the need for a more diverse faculty intensifies these pressures on many new appointees. Therefore, in my view, we can no longer afford to rely on our largely informal recruitment and retention networks of the past. We must develop programs to support and monitor the transition of new faculty into our university culture.

Computation of retinal contour in anisomyopia.

It is well documented that myopia is associated with an increase in axial length of the posterior vitreous chamber. Whether equatorial or transverse dimensions are likewise affected in myopia is relevant to further understanding of the development of ametropia. We have utilised a computing method to determine retinal contour from real eye measurements of keratometry, A-scan ultrasonography and peripheral refraction as a means of assessing the transverse dimensions of the vitreous chamber. This technique has been applied to a 21-year-old female Caucasian anisomyope with a refractive error of R -1.50/-0.50 x 130 and L -4.00/-0.50 x 160. Anisomyopia offers a special opportunity for inter-eye comparison of different degrees of myopia. The repeatability of the technique was assessed by taking 10 separate sets of the aforementioned measurements and thus generating 10 retinal contours for each eye. We conclude that this method is repeatable and is capable of demonstrating differences between anisomyopic eyes although validation against in vivo measurements is required.

Prosthodontic survey. Part II: Removable prosthodontic curriculum survey.

A removable prosthodontic curriculum questionnaire was mailed to 60 United States dental schools. Fifty-one were returned. The results were compared with those of Part I of the study, the removable prosthodontic laboratory survey. The comparisons and their implications were discussed.

Prosthodontic survey. Part I: Removable prosthodontic laboratory survey.

A questionnaire was mailed to 488 dental laboratories in five midwestern states, of which 303 or 62% were returned after two mailings. The survey was conducted to discern what techniques are most frequently used by practicing dentists. The results indicate that dentists frequently use techniques that require a minimum of appointment time.