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Clinical & Experimental Optometry Aug 2023Children in socioeconomically disadvantaged communities often do not access follow-up eye care services when referred from vision screenings; whether this is due to lack...
CLINICAL RELEVANCE
Children in socioeconomically disadvantaged communities often do not access follow-up eye care services when referred from vision screenings; whether this is due to lack of availability is not known. This paper highlights the need for vision and eye care for vulnerable children with practicing clinical optometrists well placed to provide vision care.
BACKGROUND
Vision impairments develop from a young age and may inhibit learning experiences and impact life outcomes. Vision screening to detect and refer vision abnormalities supports children in their education and prevents minor vision impairments from worsening. This research describes outcomes from a vision screening programme for 4- to 5-year-olds delivered in Queensland, Australia.
METHODS
The programme involved all prep children from participating schools in Queensland. Vision screening was conducted with the Parr 4 m Visual Acuity Test and Welch Allyn Spot Vision Screener. A cross-sectional study design was adopted. Descriptive data analyses explored the frequency of vision screening and referral outcomes. Inferential analyses examined associations between vision screening and referral outcomes with socio-economic indexes for areas (SEIFA) scores .
RESULTS
Of 71,003 prep students screened, 4,855 (6.8%) received a referral recommendation. A higher proportion of children who received a referral recommendation was from more disadvantaged locations (?2 = 109.16, p < 0.001). Of the students referred, 3,017 were seen by an eye health professional. Further vision assessment of students by an eye health professional revealed that 43.3% of the referred children were diagnosed with a vision abnormality, 18.9% had no vision abnormality and 37.7% had an 'undetermined' diagnosis. A higher proportion of children confirmed with a vision abnormality were from more disadvantaged locations (?2 = 52.27, p < 0.001).
CONCLUSION
It is important that vision screening programmes target disadvantaged populations and support families of children who require further health assessment to access health services.
Topics: Child; Humans; Child, Preschool; Vision Screening; Cross-Sectional Studies; Students; Vision, Low; Social Class
PubMed: 36038506
DOI: 10.1080/08164622.2022.2109947 -
Canadian Journal of Ophthalmology.... Oct 2023In August 2018, Ontario introduced the Child Visual Health and Vision Screening Protocol outlining school-based senior kindergarten (aged 4-6 years) vision screening. We...
OBJECTIVE
In August 2018, Ontario introduced the Child Visual Health and Vision Screening Protocol outlining school-based senior kindergarten (aged 4-6 years) vision screening. We determine the prevalence of children at risk based on screening in an Ontario community and follow up to determine resource utilization after screening.
METHODS
Vision screening data (HOTV, Randot, Autorefractor) from 41 schools (1127 children) were collected for the 2018-2019 and 2019-2020 school years. Phone follow-up was conducted 1-1.5 years after screening to determine whether an optometry visit occurred, if glasses were prescribed, and potential barriers to accessing eye care. Independent t tests were used to compare time to follow-up between groups, and χ testing was used for associations between material and social deprivation.
RESULTS
Overall screening resulted in a 32.2% referral rate within our region. Of the referred children who responded, the rate of seeking out eye care was 69.9% (n = 64), and 65.2% of these visits were prompted specifically by vision screening, and 34.4% of referred children respondents were prescribed glasses. There was a significant relationship between receiving a referral and living in a more materially deprived (p = 0.001) and a more socially deprived area (p = 0.006). The most frequently reported barriers were related to insufficient insurance coverage for eye care or glasses, COVID-19-related difficulties, and scheduling conflicts.
CONCLUSION
Our vision screening program identified and referred more than one third of children screened for follow-up eye examinations, with children in more deprived neighbourhoods being more frequently referred. Around two thirds of referred children sought care, and one third were prescribed glasses in the follow-up sample.
Topics: Child; Humans; Vision Screening; COVID-19; Vision, Ocular; Schools; Optometry; Refractive Errors
PubMed: 35525265
DOI: 10.1016/j.jcjo.2022.04.009 -
Clinical & Experimental Optometry Mar 2024Detecting deterioration of visual field sensitivity measurements is important for the diagnosis and management of glaucoma. This review surveys the current methods for... (Review)
Review
Detecting deterioration of visual field sensitivity measurements is important for the diagnosis and management of glaucoma. This review surveys the current methods for assessing progression that are implemented in clinical devices, which have been used in clinical trials, alongside more recent advances proposed in the literature. Advice is also offered to clinicians on what they can do to improve the collection of perimetric data to help analytical progression methods more accurately predict change. This advice includes a discussion of how frequently visual field testing should be undertaken, with a view towards future developments, such as digital healthcare outside the standard clinical setting and more personalised approaches to perimetry.
Topics: Humans; Visual Fields; Visual Field Tests; Glaucoma; Disease Progression; Vision Disorders
PubMed: 38467126
DOI: 10.1080/08164622.2024.2316002 -
Journal For Specialists in Pediatric... Jan 2024Newborn and infant vision screening is an essential component of the health promotion visit, where the provider screens for ocular risk factors and abnormalities that... (Review)
Review
PURPOSE
Newborn and infant vision screening is an essential component of the health promotion visit, where the provider screens for ocular risk factors and abnormalities that may cause future impairment or vision loss. Providers may underestimate the importance of screening or find neonatal vision assessments difficult due to poor patient cooperation or time-consuming exams, but the reversibility of vision impairment in infants makes early detection paramount to proper treatment. This article provides a clinical review of evidence-based, practical guidance to providers who care for infants from birth through 6 months of age in the primary care setting.
CONCLUSIONS
The comprehensive eye exam in infants should include a thorough history and physical examination of eye structures, visual acuity, evaluation of extraocular movements and alignment, and assessment of the red reflex. Recommended exam maneuvers differ with age as visual acuity improves and development advances through infancy.
PRACTICE IMPLICATIONS
Early detection of ocular pathology is critical to avoid permanent vision loss, serious morbidity, and even mortality. The seemingly complex vision screening exam can be completed with little to no cooperation from the patient when a competent pediatric healthcare provider prioritizes opportunistic exam maneuvers. The opportunistic exam allows providers to maximize efficiency while maintaining thorough technique during vision exams and screenings.
Topics: Infant; Infant, Newborn; Child; Humans; Vision Screening; Visual Acuity; Primary Health Care
PubMed: 38284218
DOI: 10.1111/jspn.12421 -
Ophthalmic & Physiological Optics : the... Sep 2023To present the objective metrics from a study that evaluated the clinical performance of a senofilcon A contact lens, both with and without a new manufacturing technique. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To present the objective metrics from a study that evaluated the clinical performance of a senofilcon A contact lens, both with and without a new manufacturing technique.
METHODS
This was a single-site, five-visit, controlled, randomised, subject-masked, 2 × 2 crossover study (May-August 2021) with a 2-week lens dispensing period (bilateral wear) and weekly follow-up visits. Healthy adult (18-39 years), habitual spherical silicone hydrogel contact lens wearers were included. The High-definition (HD) Analyzer™ was used to objectively measure the lens-on-eye optical system resulting from the study lenses at 1-week follow-up. Measurements assessed were vision break-up time (VBUT), modulation transfer function (MTF) cutoff, Strehl ratio (SR), potential visual acuity (PVA) for 100% contrast and objective scatter index (OSI).
RESULTS
Of the 50 enrolled participants, 47 (94.0%) were randomly assigned to one of the two possible lens wear sequences (test/control or control/test) and dispensed at least one study lens. The estimated odds ratio of VBUT > 10 s was 1.582 (95% confidence interval [CI]: 1.009 to 2.482) in test versus control lens. The least squares mean difference estimates of MTF cutoff, SR and PVA for 100% contrast between test versus control lens were 2.243 (95% CI: 0.012 to 4.475), 0.011 (95% CI: -0.002 to 0.023) and 0.073 (95% CI: -0.001 to 0.147), respectively. The estimated ratio of median OSI between test versus control lens was 0.887 (95% CI: 0.727 to 1.081). The test lens demonstrated superiority over the control lens with respect to VBUT and MTF cutoff. No serious adverse events were reported; eight adverse events (three ocular, five non-ocular) were indicated by six participants during the study.
CONCLUSION
The test lens demonstrated an increased probability of having a longer VBUT (>10 s). Future studies may be designed to assess the efficacy and long-term use of the test lens in a larger population.
Topics: Adult; Humans; Cross-Over Studies; Contact Lenses, Hydrophilic; Visual Acuity; Vision, Ocular; Silicones; Tears
PubMed: 37310193
DOI: 10.1111/opo.13169 -
Experimental Eye Research Dec 2023This study aimed to identify the corneal metabolic biomarkers for moderate and high myopia in human. We enrolled 221 eyes from 221 subjects with myopia to perform the...
This study aimed to identify the corneal metabolic biomarkers for moderate and high myopia in human. We enrolled 221 eyes from 221 subjects with myopia to perform the femtosecond laser small incision lenticule extraction (SMILE) surgery. Among these, 71 eyes of 71 subjects were enrolled in the low myopic group, 75 eyes of 75 subjects in the moderate myopic group and 75 eyes of 75 subjects in the high myopic group. The untargeted metabolomics analysis was performed to analyze the corneal tissues extracted during the SMILE surgery using an ultra-high-performance liquid chromatography (UHPLC) coupled to a quadrupole time-of-flight (Q-TOF) mass spectrometry (MS). The one-way analysis of variance (ANOVA) was used to identify the different metabolites among the three myopic groups, the orthogonal partial least-squares discriminant analysis (OPLS-DA) model was used to reveal the different metabolites between moderate myopia and low myopia, and between high myopia and low myopia. The Venn gram was used to find the overlapped metabolites of the three datasets of the different metabolites. The stepwise multiple linear regression analysis was used to determine the metabolic molecules associated with manifest refractive spherical equivalents (MRSE). The Receiver Operating Characteristics (ROC) analysis was performed to reveal the corneal biomarkers for moderate and high myopia. The hub biomarker was further selected by the networks among different metabolites created by the Cytoscape software. A total of 1594 metabolites were identified in myopic corneas. 321 metabolites were different among the three myopic groups, 106 metabolites were different between high myopic corneas and low myopic corneas, 104 metabolites were different between moderate myopic corneas and low myopic corneas, and 30 metabolic molecules overlapped among the three datasets. The multivariate linear regression analysis revealed the myopic degree was significantly influenced by the corneal levels of azelaic acid, arginine-proline (Arg-Pro), 1-stearoyl-2-myristoyl-sn-glycero-3-phosphocholine, and hypoxanthine. The ROC curve analysis showed that azelaic acid, Arg-Pro and hypoxanthine were effective in discriminating low myopia from moderate to high myopia with the area under the curve (AUC) values as 0.982, 0.991 and 0.982 for azelaic acid, Arg-Pro and hypoxanthine respectively. The network analysis suggested that Arg-Pro had the maximum connections among these three biomarkers. Thus, this study identified azelaic acid, Arg-Pro and hypoxanthine as corneal biomarkers to discriminate low myopia from moderate to high myopia, with Arg-Pro serving as the hub biomarker for moderate and high myopia.
Topics: Humans; Visual Acuity; Cornea; Refraction, Ocular; Myopia; Biomarkers; Hypoxanthines; Corneal Stroma; Lasers, Excimer
PubMed: 37871883
DOI: 10.1016/j.exer.2023.109689 -
Eye (London, England) Dec 2023Home visual acuity tests could ease pressure on ophthalmic services by facilitating remote review of patients. Home tests may have further utility in giving service...
BACKGROUND
Home visual acuity tests could ease pressure on ophthalmic services by facilitating remote review of patients. Home tests may have further utility in giving service users frequent updates of vision outcomes during therapy, identifying vision problems in an asymptomatic population, and engaging stakeholders in therapy.
METHODS
Children attending outpatient clinics had visual acuity measured 3 times at the same appointment: Once by a registered orthoptist per clinical protocols, once by an orthoptist using a tablet-based visual acuity test (iSight Test Pro, Kay Pictures), and once by an unsupervised parent/carer using the tablet-based test.
RESULTS
In total, 42 children were recruited to the study. The mean age was 5.6 years (range 3.3 to 9.3 years). Median and interquartile ranges (IQR) for clinical standard, orthoptic-led and parent/carer-led iSight Test Pro visual acuity measurements were 0.155 (0.18 IQR), 0.180 (0.26 IQR), and 0.300 (0.33 IQR) logMAR respectively. The iSight Test Pro in the hands of parents/carers was significantly different from the standard of care measurements (P = 0.008). In the hands of orthoptists. There was no significant difference between orthoptists using the iSight Test Pro and standard of care (P = 0.289), nor between orthoptist iSight Test Pro and parents/carer iSight Test Pro measurements (P = 0.108).
CONCLUSION
This technique of unsupervised visual acuity measures for children is not comparable to clinical measures and is unlikely to be valuable to clinical decision making. Future work should focus on improving the accuracy of the test through better training, equipment/software or supervision/support.
Topics: Humans; Child; Child, Preschool; Prospective Studies; Vision Tests; Visual Acuity; Research Design
PubMed: 37328509
DOI: 10.1038/s41433-023-02597-7 -
Journal of Refractive Surgery... Sep 2023To compare the efficacy and safety of the glasses-free three-dimensional (3D) display and conventional optical microscope in Implantable Collamer Lens (ICL; STAAR... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To compare the efficacy and safety of the glasses-free three-dimensional (3D) display and conventional optical microscope in Implantable Collamer Lens (ICL; STAAR Surgical) surgery.
METHODS
This randomized controlled trial enrolled 51 eyes of 26 patients who received ICL surgery. After random allocation, patients received surgery under either a glasses-free 3D display (16 eyes) or a conventional optical microscope (35 eyes). The surgical duration, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), intraocular pressure, vault, postoperative manifest refraction spherical equivalent (MRSE), and complications were evaluated.
RESULTS
Mean surgical time was 5.04 ± 2.74 minutes for the glasses-free 3D group and 4.65 ± 2.63 minutes for the conventional microscope group ( = .639). Postoperative UDVA was -0.02 ± 0.04 and -0.04 ± 0.05 logMAR ( = .169), CDVA was -0.03 ± 0.04 and -0.02 ± 0.05 logMAR ( = .434), and IOP was 17.01 ± 3.15 and 14.82 ± 2.20 mm Hg ( = .055) at 1 month of follow-up, respectively. Vault was 562.86 ± 192.89 and 520.18 ± 215.19 µm, and MRSE was +0.25 ± 0.21 and +0.10 ± 0.51 diopters, respectively, at 1 month postoperatively; all were comparable between the glasses-free 3D group and conventional microscope group (all > .05). No complication occurred in both groups.
CONCLUSIONS
The glasses-free 3D group achieved similar efficacy and safety compared to the conventional microscope group, and glasses-free 3D surgery is expected to show a significant advantage in clinical and medical education. .
Topics: Humans; Pilot Projects; Refraction, Ocular; Visual Acuity; Vision Tests; Intraocular Pressure
PubMed: 37675913
DOI: 10.3928/1081597X-20230728-02 -
Scientific Reports Apr 2024Primary congenital glaucoma is a rare disease that occurs in early birth and can lead to low vision. Evaluating affected children is challenging and there is a lack of...
Primary congenital glaucoma is a rare disease that occurs in early birth and can lead to low vision. Evaluating affected children is challenging and there is a lack of studies regarding color vision in pediatric glaucoma patients. This cross-sectional study included 21 eyes of 13 children with primary congenital glaucoma who were assessed using the Farnsworth D-15 test to evaluate color vision discrimination and by spectral domain optical coherence tomography to measure retinal fiber layer thickness. Age, visual acuity, cup-to-disc ratio and spherical equivalent data were also collected. Global and sectional circumpapillary and macular retinal fiber layer thicknesses were measured and compared based on color vision test performance. Four eyes (19%) failed the color vision test with diffuse dyschromatopsia patterns. Only age showed statistical significance in color vision test performance. Global and sectional circumpapillary and macular retinal fiber layer thicknesses were similar between the color test outcomes dyschromatopsia and normal. While the color vision test could play a role in assessing children with primary congenital glaucoma, further studies are needed to correlate it with damage to retinal fiber layer thickness.
Topics: Humans; Female; Male; Child; Cross-Sectional Studies; Tomography, Optical Coherence; Glaucoma; Child, Preschool; Color Vision; Visual Acuity; Adolescent; Color Vision Defects; Color Perception; Retina; Color Perception Tests
PubMed: 38664551
DOI: 10.1038/s41598-024-60320-2 -
American Journal of Ophthalmology Sep 2023To systematically assess the ability to detect change and retest reliability for a panel of visual function assessments in ABCA4 retinopathy.
PURPOSE
To systematically assess the ability to detect change and retest reliability for a panel of visual function assessments in ABCA4 retinopathy.
DESIGN
Prospective natural history study (NCT01736293).
METHODS
Patients with at least 1 documented pathogenic ABCA4 variant and a clinical phenotype consistent with ABCA4 retinopathy were recruited from a tertiary referral center. Participants underwent longitudinal, multifaceted functional testing, including measures of function at fixation (best-corrected visual acuity, low-vision Cambridge Color Test), macular function (microperimetry), and retina-wide function (full-field electroretinography [ERG]). Two- and 5-year ability to detect change was determined based on the η statistic.
RESULTS
A total of 134 eyes from 67 participants with a mean follow-up of 3.65 years were included. In the 2-year interval, the microperimetry-derived perilesional sensitivity (η of 0.73 [0.53, 0.83]; -1.79 dB/y [-2.2, -1.37]) and mean sensitivity (η of 0.62 [0.38, 0.76]; -1.28 dB/y [-1.67, -0.89]) showed most change over time, but could only be recorded in 71.6% of the participants. In the 5-year interval, the dark-adapted ERG a- and b-wave amplitude showed marked change over time as well (eg, DA 30 a-wave amplitude with an η of 0.54 [0.34, 0.68]; -0.02 log(µV)/y [-0.02, -0.01]). The genotype explained a large fraction of variability in the ERG-based age of disease initiation (adjusted R of 0.73) CONCLUSIONS: Microperimetry-based clinical outcome assessments were most sensitive to change but could only be acquired in a subset of participants. Across a 5-year interval, the ERG DA 30 a-wave amplitude was sensitive to disease progression, potentially allowing for more inclusive clinical trial designs encompassing the whole ABCA4 retinopathy spectrum.
Topics: Humans; Visual Fields; Visual Field Tests; Prospective Studies; Reproducibility of Results; Retina; Retinal Diseases; Electroretinography; Vision Disorders; ATP-Binding Cassette Transporters
PubMed: 37211138
DOI: 10.1016/j.ajo.2023.05.014