Prevalence of Comprehensive Eye Examination in Preschool Children With Eye Conditions.

Introduction: The purpose of this study is to assess the prevalence of comprehensive eye examinations in multiethnic preschool children, including children with visually significant eye conditions, and identify factors associated with comprehensive eye examinations. Methods: A sample of 9,197 African American, Hispanic, Asian American, and non-Hispanic White children aged 6-72 months was recruited for the Multi-Ethnic Pediatric Eye Disease Study from 2003 to 2011. Logistic regression performed in 2022 identified independent factors associated with parent-reported history of comprehensive eye examinations. The proportion of children with previous comprehensive eye examinations and the proportion with undetected amblyopia or strabismus were measured. Results: The prevalence of comprehensive eye examinations was 6.3% overall and 38.3%, 24.8%, 19.1%, 15.1%, and 9.8% among children with strabismus, amblyopia, significant anisometropia, hyperopia, and astigmatism, respectively. Children without prior comprehensive eye examinations were more likely to have undetected amblyopia or strabismus than those with comprehensive eye examination history (ps<0.001). The prevalence of comprehensive eye examinations was higher among older children. Prevalence varied by race/ethnicity, with 8.1%, 7.9%, 6.3%, and 4.9% of non-Hispanic White, Asian American, African American, and Hispanic children having had prior comprehensive eye examinations, respectively; however, the differences did not remain after adjusting for other associated factors. Older age, a primary caregiver with a college/university degree or higher, having vision insurance, gestational age <33 weeks, neurodevelopmental disorder diagnosis, strabismus, and ocular disease history were all statistically significantly associated with a relatively higher prevalence of comprehensive eye examinations in multivariable analyses. Conclusions: Comprehensive eye examinations were uncommon among preschool children, including those with treatable vision disorders. Interventions, such as parent education and vision insurance, are needed to imaprove comprehensive eye examination access and utilization for at-risk preschool children.

Photorefraction with Spot Vision Screener versus Visual Acuity Testing as Community-Based Preschool Vision Screening at the Age of 3.5 Years in Japan.

Nationwide in Japan, a community-based vision-screening program in 3.5-year-old children is conducted in three steps: questionnaires and home visual acuity testing as the primary screening; visual acuity testing by nurses and pediatricians' inspection in community health centers as the secondary screening; and examinations by ophthalmologists as the tertiary screening. In this study, we introduced photorefraction with a Spot vision screener in addition to visual acuity testing to answer the clinical question of whether photorefraction could better detect eye diseases and potentially replace visual acuity testing. Photorefraction was performed on 813 consecutive 3.5-year-old children in a center. The children were sent to tertiary examinations, which were based on the Spot vision screener standard, in addition to the visual acuity testing standard: failure in either eye to pass 0.5 visual acuity in a center. A notice to visit ophthalmologists was issued for 95 children (11%), and documents with the diagnosis were sent back to the Heath Office for 76 children (80%). The rate of children with anisometropic or ametropic amblyopia or accommodative esotropia as treatment-requiring diseases was highest in cases of no pass at both standards (10/15 = 66%), and higher in cases of no pass only at the Spot vision screener standard (13/45 = 28%), compared with cases of no pass only at the visual acuity testing standard (6/33 = 18%, p = 0.0031). Photorefraction, in addition to visual acuity testing and inspection led to additional eye diseases detection at 3.5 years. Visual acuity testing at home would not be omitted in the introduction of photorefraction.

Validity of vision screening program conducted by preschool teachers: An interventional study.

Background: Clear vision is crucial for effective learning among preschool children. Hence, early detection of vision impairment and prompt treatment are required to improve prognosis. Currently, limited information is available, and no program exists to screen for vision impairment among preschoolers in Bangladesh. This study aimed to validate the KieVision™ Preschool Vision Screening Kit, translated into the Bengali language, to improve vision impairment detection among preschool children. Methods: In this prospective case-control study, 60 preschool teachers from Chittagong were randomly selected. The study group was trained to conduct vision screening among preschool children using the translated kit, whereas the control group was trained using the Chittagong Eye Infirmary and Training Complex (CEITC) School Teachers' Training Module. Fifteen preschool children aged 4-6 years were screened by each preschool teacher and again by the optometrist. Results: Sixty preschool teachers screened 900 children. The results showed a higher validity of vision screening findings by the preschool teachers in the study group (sensitivity, 68.00%; specificity, 92.75%) than in the control group (sensitivity 47.37%, specificity 70.39%). The level of agreement between the preschool teachers and optometrists was high for all tests (first-order agreement coefficient [AC1] ≥ 0.80 in the study group). The sensitivity and specificity of the visual acuity test for the study group were 59.65% and 94.15%, respectively, while in the control group it was 13.33% and 62.54%, respectively. A similar trend was noted in the general observation component and Hirschberg's test. Conclusions: The Bengali Language KieVision™ Preschool Vision Screening Kit can be used effectively by preschool teachers in vision screening programs to improve the identification of vision impairment among preschool children in Bangladesh.

Outcome of vision screening by community health workers at immunization outlets in Nigeria to support access to early visual evaluation in children aged 0-2 years.

PURPOSE: Routine eye examination in early life is not the practice in most resource-limited countries. Delay in the presentation for eye problems is typical. Community health officers are often consulted by caregivers for all health problems during routine immunization and well-baby clinics in primary healthcare for children aged 0-2 years. This study evaluated the value and limitation of interview, Bruckner red reflex test, and instrument vision screener by noneye care middle-level staff of rural and urban well-baby immunization clinics, in early detection and referral for childhood eye disorders. MATERIALS AND METHODS: This was a cross-sectional study. Middle-level community health workers (CHWs) working at well-baby/immunization clinics were trained to perform vision screening using interview of caregivers, red reflex eye examination with ophthalmoscope, and instrument vision screener (Welch Allyn SPOT™ Vision Screener) without mydriatic drugs during routine immunization of children aged 0-2 years. IRB approval was obtained. RESULTS: Over a 6-month period in 2017, the CHWs screened 5609 children. Overall, 628 (11.2%) patients were referred to the tertiary child eye care unit. Referred cases included cataract, glaucoma, congenital nasolacrimal duct obstruction, ophthalmia neonatorum, retinoblastoma, and significant refractive errors. Referral from the interview of mothers was enhanced if specific questions to elicit visual function were asked. Bruckner red reflex test was more effective than instrument vision screener in the detection of cataract and life-threatening diseases such as retinoblastoma. Instrument vision screener was preferred by parents and better at detecting amblyopic risk factors. CONCLUSION: Preschool vision screening during routine immunization by primary healthcare workers in resource-limited settings was effective. Whenever instrument vision screener does not give any recommendation during screening, consider vision- or life-threatening pathology and refer.

Relationship between Geography and Refractive Error from the UCLA Preschool Vision Program.

PURPOSE: Using the screening data collected through the University of California, Los Angeles Preschool Vision Program (UPVP) that provides free vision screening to children 2.5 to 6 years of age attending public preschools in five Supervisory Districts in Los Angeles County, this paper explores whether geographic location of where children attended preschool affects the vision screening results. METHODS: 62,936 children were screened using a handheld device (Nikon Retinomax) between academic years 2012 and 2015. The criteria for failing the screening was set to sphere of ≤ -3.25 diopters (D), sphere ≥ +1.75 D, or cylinder of ≥1.50 D in either eye, or inter-ocular difference of >2.00 D in spherical error (>1.50D in case of antimetropia) or ≥1.00 D in cylinder error. RESULTS: Higher fail rates were found among girls, Latino race, and those who primarily spoke Spanish at home. In addition, there was a geographical variance in screening outcomes among Supervisory Districts with District 1 having the highest fail rate and District 4 having the lowest fail rate. CONCLUSION: This paper provides preliminary evidence of geographic factors contributing to the development of refractive errors among preschoolers which may be used in future studies to address the unmet needs of children with vision impairments in Los Angeles County.

Comparison of the efficacy of Lea Symbol chart and Sheridan Gardiner chart for preschool vision screening.

Purpose: To compare the efficacy of Lea symbols (LS) chart and Sheridan Gardiner (SG) chart for vision screening among preschool children, in a semi-urban district of South India. Methods: Vision screening was conducted among 260 preschool children aged 3-5 years in cluster sampled kindergartens using LS chart and SG chart. Pass/fail scores and time taken for visual acuity (VA) estimation were compared. VA scores and time taken were compared using unpaired t-test. Sensitivity, specificity, and positive and negative predictive values were compared between the charts. Results: There was a significant difference between LS and SG charts in the VA score in both the eyes (P = 0.04). LS showed 76.09% pass score and 23.90% fail score, whereas SG showed 87.65% pass score and 12.35% fail score with a cutoff value of > 0.3 log MAR. Time for screening using LS was higher, when compared to SG, both for the right eyes (P < 0.001) and the left eyes (P < 0.001). The sensitivity of the LS was 94.74% (95% confidence interval [CI]: 70.13%-81.06%) and that of SG was 52.63% (95% CI: 45.29%-59.8%). The specificity of LS was 66.67% (95% CI: 90.26%-97.30%) and SG was 83.33% (95% CI: 70.12%-91.30%). Conclusion: LS chart showed better sensitivity and negative predictive value when compared to SG chart. However, SG chart showed better specificity and positive predictive value, and screening was less time-consuming. Considering the high sensitivity and negative predictive value, LS is the preferred tool, when compared to SG chart in preschool vision screening in our population.

Vision and eye health: moving into the digital age with instrument-based vision screening.

Significant advancements in vision screening research are leading to improved design, functionality, and reliability of screening tools. Presently, two vision screening approaches are available to school nurses for children ages 3 years and older: optotype-based screening and instrument-based screening. Optotype-based screening pertains to tests of visual acuity using optotypes (e.g., pictures, letters, and numbers), which children identify to determine visual acuity. Instrument-based screening pertains to automated devices that measure amblyogenic risk factors, such as refractive error, media opacities, and eye misalignment. Differences between the two approaches; best and acceptable practice recommendations for both approaches; unacceptable tests of visual acuity; and best, acceptable, and unacceptable occluders are described.

Preschool Vision Screening in Korea: Results in 2003

PURPOSE: To report the results of preschool vision screening in South Korea in 2003. METHODS: Nation wide, population-based vision screening tests were conducted in preschool children over the age of 3 years from March to September 2003. The first step involved home-screening using picture cards. The children who did not pass the first test were sent to public health care centers, where their visual acuity was re-tested. After the re-tests, some children were referred to ophthalmologists. The referral criteria for visual acuity were: age 3, less than 0.5 visual acuity; age 4 or older, less than 0.63 visual acuity in at least one eye. RESULTS: Among 56,836 subjects who had been enrolled, 2,637 (4.6%) children were referred to ophthalmologists. Refractive error was found in 1,746 (66.2%) children. Amblyopia was discovered in 480 (18.2%) children. Anterior segment abnormalities were detected in 269 (10.2%) children, manifest strabismus was detected in 169 (6.4%) children, and fundus abnormalities were found in 17 (0.6%) children. Myopic astigmatism (31.0%) was the most common type of refractive error. Refractive error (87.9%) was the most common cause of amblyopia and exodeviation (63.9%) was the most common type of strabismus. CONCLUSIONS: From the results of the 2003 Preschool Vision Screening, we collected data about the ophthalmic abnormalities that can affect visual development in children. This information will foster improvement in the overall quality and design of preschool vision screening systems.

Preschool Vision Screening in Korea: Results in the Year of 2001

PURPOSE: To report the results of preschool vision screening of South Korean children in the year of 2001. METHODS: Nation-wide population-based vision screening tests were conducted in a stepwise manner on the preschool children over 3 years of age. The first step of test was home-screening using 5 familiar picture cards. The children who didn't pass the first step (VA < 0.5 in at least one eye) were sent to the Public Health Care Centers and re-tested there with regular vision charts. After this second step of test, some children were referred to the ophthalmologists. The referral criteria for visual acuity were: at 3 years less than 0.5, at 4 or above 4 years less than 0.63 in at least one eye. Data were collected for the 67, 315 children to evaluate the ophthalmologic conditions. RESULTS: Among 67, 315 subjects who had been enrolled, 97% of children had visual acuity of 0.5 or better. Of those screened, 5, 221 (7.8%) children were referred to the ophthalmologists. The feedback results for 3, 058 (4.6%) children could be collected. Of those referred, 2, 488(80.6%) had one or more ophthalmologic disorders. Refractive errors were found in 2183 children. Amblyopia was discovered in 560 children. Manifest strabismus was detected in 144 children. CONCLUSIONS: In this population setting, ocular disorders which can affect visual development were found in 2, 488 children. This attests to the importance of performing early and effective screening tests for preschool children.

Visual Acuity Charts Comparison for Preschool Vision Screening

We assessed the best method for preschool vision screening using four visual acuity charts. The subjects were 162 childrens(324 eyes), who were divided into all aged group(162 childrens), 3-year-old group(58 childrens), 4-year-old group(58 childrens) and 5-year-old group(46 childrens), We compared Hahn's test, HOTV test, Allen figures and E test by measuring the time required for test, the percentage of children testable with each chart, visual acuity score and consistency of score. There was no significant differences among the time of each group(p>0.05). Visual acuity score with Hahn's test was lower than that of the rest 3 tests in all aged group and 3-year-old group(p<0.05). The percentage of children testable with Hahn's test was lower than that with the other tests(p<0.05). For assessing the consistency, analysis of variance was used. E test was more variable than the other test and Allen figures showed most consistency than the other tests(p<0.05). In young chidren, there were some difficulties in measuring visual acuity with Hahn's test, and the E test caused variable results because of difficulty in distinguishing the left-right orientation, but relatively Allen figures showed consistency, high visual acuity and testability in all groups.