Tent photoscreening and patched HOTV visual acuity by school nurses: validation of the ASD-ABCD protocol. (Anchorage School District- Alaska Blind Child Discovery program).

BACKGROUND: Novel objective tests of risk factors for amblyopia offer an alternative for preschool vision screening. We compared the merits of photoscreening versus portable patched acuity testing in elementary schools. Photoscreening may outperform routine acuity testing in pediatric offices; however, both have fairly good validity when performed by specialists in preschool vision screening. METHODS: School nurses performed patched HOTV surround acuity testing and two types of photoscreening (MTI and Gateway DV-S20) in a portable tent near each classroom. RESULTS: 1700 children (696 1st grade, 710 Kindergarteners and 271 special-needs pre-Kindergarten). 14% had comprehensive exams and another 65% had normal photoscreens combined with patched acuities of 20/20 or better OU. We estimate the overall sensitivity/specificity using AAPOS guidelines for the modalities to be 39%:99% for patched HOTV acuity, 77%:99% for MTI photoscreening, and 85%:98% for Gateway photoscreening. The specificity of acuity testing was particularly low in pre-K due to 33% unable to complete the test, but about 80% of initial acuity failures were able to pass with pinhole. CONCLUSION: Tent photoscreening in younger elementary school children was more sensitive and faster than patched acuity particularly in developmentally delayed pre-K children.

Diabetes mellitus and the elderly: special considerations for foot ulcer prevention and care.

The risk of lower extremity amputation in persons with diabetes mellitus increases with advanced age, necessitating clinical vigilance. Individualized and comprehensive prevention efforts are required to address the complicated and diverse nature of the diabetic foot in the elderly patient, including promotion of lifestyle changes to offset diabetes, attention to cognitive deficits and economic limitations, and provision of foot care education and management (eg, emphasizing the need for appropriate foot wear). If an ulcer develops, physiologic and socioeconomic factors may influence its clinical presentation, assessment, diagnosis, and treatment. To help ulcer-related complications and prevent lower leg amputations, clinicians must address diabetes management; the cost of supplies; the importance of offloading, nutrition, and exercise; and challenges inherent to impaired eyesight, dexterity, and ability to self-care. A multidisciplinary approach is recommended. Additional research to enhance understanding of practice parameters in this population is needed to help clinicians manage the increasing numbers of older adults with diabetes mellitus.

A comparison of patched HOTV visual acuity and photoscreening.

Early detection of significant vision problems in children is a high priority for pediatricians and school nurses. Routine vision screening is a necessary part of that detection and has traditionally involved acuity charts. However, photoscreening in which "red eye" is elicited to show whether each eye is focusing may outperform routine acuity testing in pediatric offices and schools. This study compares portable acuity testing with photoscreening of preschoolers, kindergarteners, and 1st-graders in 21 elementary schools. School nurses performed enhanced patched acuity testing and two types of photoscreening in a portable tent. Nearly 1,700 children were screened during spring semester 2004, and 14% had confirmatory exams by community eye care professionals. The results indicate that one form of photoscreening using a Gateway DV-S20 digital camera is significantly more sensitive to children with significant vision problems, as well as being the most cost effective (85% specificity and only $0.11 per child). This suggests that the adaptation of photoscreening into a routine vision screening protocol would be beneficial for efficiently detecting vision problems that could lead to amblyopia.

Amblyopia detection by camera: Gateway to portable, inexpensive vision screening (calibration and validation of inexpensive, pocket-sized photoscreeners).

BACKGROUND: Photoscreening can allow early detection of amblyopia. The Gateway DV-S20, and similar models of miniature, digital flash cameras, have similar optical dimensions to existing photoscreeners for less than $200. METHODS: These cameras were calibrated on known, threshold amblyogenic refractive errors induced by placing minus and toric contact lenses on a normal subject's left eye. The DV-S20 was then applied to known amblyopic patients. Students under age 7 were vision screened with patched acuity and sequential photoscreeners (MTI and Gateway). RESULTS: The digital cameras and the MTI photoscreeners produced similar magnitude interpretable crescents for amblyopiagenic refractive errors. They had very similar validation with sensitivities of 80-90% and specificities of 98% for serious eye disorders in known patients and school-aged children. CONCLUSION: Combined with careful interpretation, pocket-sized, digital flash cameras provide a portable and inexpensive digital alternative for pediatric photoscreening. A category 3 CPT code (0065T) can be used for this valid, public health technique: Amblyopia Detection By Camera (ADBC).