Eye Health Screening Research Articles

Combination of 2 test methods, single-picture optotype visual acuity chart and spot™ vision screener, in the eye health screening program for 3-year-old children in Tokyo: A retrospective, observational study.

To evaluate the usefulness of the Tokyo Metropolitan Government's Eye Health Screening Program for 3-year-old children, which combines the Single-Picture Optotype Visual Acuity Chart (SPVAC) and Spot™ Vision Screener (SVS) tests. This was a retrospective, observational, matched study. Patients who underwent the eye health screening program and had abnormalities were classified into 3 groups according to the outcomes of the SPVAC (SPVAC-passed, SPVAC-P; SPVAC-failed, SPVAC-F) and SVS (SVS-passed, SVS-P; SVS-failed, SVS-F) tests as follows: SPVAC-P/SVS-F, SPVAC-F/SVS-P, and SPVAC-F/SVS-F. We evaluated the age at examination, SPVAC and SVS test success rates, and SVS refractive power. Additionally, the rates of refractive error, amblyopia, and strabismus were compared among the 3 groups. The SPVAC-P/SVS-F, SPVAC-F/SVS-P, and SPVAC-F/SVS-F groups comprised 158, 28, and 74 eyes, respectively. The mean age was 37.4 months. The success rates of the SPVAC and SVS tests were 69.8% and 96.2%, respectively. The mean SVS hyperopia value in the SPVAC-F/SVS-F group (2.71 ± 1.50 D) was significantly higher than that of the SPVAC-P/SVS-F group. The mean SVS astigmatism and myopia values were -2.21 diopter (D) ± 1.09 D and -3.40 ± 1.82 D, respectively; they did not differ significantly from that of the SPVAC-P/SVS-F group. Significant differences were observed in the refractive error, amblyopia, and strabismus rates among the 3 groups. Regarding disease determination, no significant difference was observed among participants who passed and failed the SPVAC test, regardless of the outcome of the other test. However, a significant difference was observed between those passing and failing the SVS tests. The SPVAC method used to screen 3-year-old children should be modified to commence at 42 months of age or be replaced with a single Landolt C test. The SVS test is useful for screening younger patients. Furthermore, the SVS test showed that the degree of hyperopia was higher in patients who did not pass the SPVAC test.

Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): a nested cross-sectional assessment of falls risk within a cluster randomised trial

BackgroundTo investigate the feasibility of using the Stopping Elderly Accidents, Deaths and Injuries (STEADI) Falls Risk Tool Kit during community-based eye health screenings to assess falls risk of participants enrolled...

Expert Consensus on Geographic Atrophy in the EU: A Call for Urgent Policy Action.

Geographic atrophy is an eye disease that greatly interferes with the daily lives of patients and their families, posing a serious threat to the aging European demographic. Over the past 30months, this initiative has assembled leading experts in the field of ophthalmology to share insights on the necessary policy steps that need to be taken to overcome this challenge on an EU-wide scale. Through analyzing best practices in Germany, Italy, France, and Spain, this consensus paper sets out a series of policy recommendations, which, if implemented, could greatly benefit all individuals affected by geographic atrophy. Amongst other features, these countries have provided valuable examples of awareness campaigns and an overall commitment to inclusive and comprehensive policies. The policy recommendations emerging from this paper include the adoption of comprehensive screening programs, retinal disease screening in the EU Driving License Directive, the development of a white paper at the European Commission, and the creation of Council recommendations on eye health screening. Given the significant improvements made at the national level throughout the EU, countries will require unitary support at the European level to further develop their policies and successfully address the burden of geographic atrophy.

SCREENING ON CATARACT APPLICATION (SERIOC)

Introduction & Objectives : West Nusa Tenggara is a province that has the second highest prevalence of blindness at the national level according to the results of the 2014 Rapid Assessment of Avoidable Blindness (RAAB) survey. During the covid-19 period the offline cataract screening is not permitted, as a result it’s difficult to reach underprivileged and isolated areas, also people with disabilities. In 2021 West Nusa Tenggara Eye Hospital launched a smartphone-based eye health examination application Screening On Cataract namely SERIOC, while still paying attention to service standards clinically and in management. SERIOC can be used by public health as the nearest public health facility.
 Methods : The waterfall method is used in the development of this application, The waterfall methodology is a project management approach that emphasizes a linear progression from beginning to end of a project. This methodology, is front-loaded to rely on careful planning, detailed documentation, and consecutive execution.
 Results : SERIOC has successfully screened 2,713 patients from 2021 with 2117 patients diagnosed cataract and 593 patients diagnosed non-cataract whose data is centralized and directly connected to an ophthalmologist at the West Nusa Tenggara Eye Hospital. Patients diagnosed with cataracts will be referred to the hospital for further action.
 Conclusion : Based on the information above, it can be concluded that SERIOC application in eye health screening is very effective and efficient method to avoid blindness on West Nusa Tenggara.

COMMUNITY-BASED EYE HEALTH SCREENING REPORT IN MALAYSIA: URBAN-RURAL REFERRAL COMPARISON

This study compared urban and rural referrals from a community-based eye health screening program named 'Jom Check Mata Malaysia (JCMM)'. The program was carried out in nine different states in Peninsular Malaysia—a total of 18 screening locations with a mix of urban and rural. Two mobile eye clinics were mobilised for community-based eye health screenings. This study involved 3,139 participants (1,158 and 1,981 participants from rural and urban, respectively). Visual complaints were collected via interviews using an ocular symptom checklist. The visual acuity was screened using a Snellen Chart. Ocular health screening, including anterior and posterior eye segments, was screened using slit-lamp bio-microscopy and fundus camera. Overall referrals were 2,139 (68%), 846 (27%) and 362 (12%) based on visual complaints, visual acuity and ocular health screening, respectively. Rural locations had significantly higher referral rates for visual complaint screening (χ2 = 422.53, p<0.05), visual acuity screening (χ2 = 20.20, p<0.05) as well as ocular health screening (χ2 = 64.70, p<0.05) compared to the urban locations. There was a consistent pattern of higher rural referrals for all types of vision screening. Information from our three-category screening analysis could help to design a vision screening for our rural and urban populations.

Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT): Subanalysis of Referral to Ophthalmology

Purpose The Manhattan Vision Screening and Follow-up Study aims to provide access to eye care for underserved populations, detect native rates of ocular pathology, and refer participants with eye disease to ophthalmology. This subanalysis describes the reasons for referral to ophthalmology and identifies risk factors associated with being referred. Methods Enrolled participants were aged ≥40 years, living independently in public housing developments and able to provide consent for eye health screenings. Those with habitual visual acuity 20/40 or worse, intraocular pressure (IOP) 23-29 mmHg, or an unreadable fundus image failed and were scheduled with the on-site optometrist. The optometric exam determined whether further referral to ophthalmology for a clinic exam was warranted. Those with an abnormal image or IOP ≥30 mmHg were referred directly to ophthalmology. Main outcome was factors associated with referral to ophthalmology. Results A total of 708 individuals completed the eye health screening over 15 months. A total of 468 participants were referred to ophthalmology (250 had an abnormal image and 218 were referred by the optometrist). Those referred were predominantly older adults (mean age 70.0 ± 11.4 years), female (66.7%), African American (55.1%) and Hispanic (39.5%). Seventy percent of participants had not had a recent eye exam. Stepwise multivariate logistic regression analysis showed that participants with pre-existing glaucoma (OR 3.14, 95% CI 1.62 to 6.08, p = 0.001), an IOP ≥23 mmHg (OR 5.04, 95% 1.91 to 13.28, p = 0.001), or vision impairment (mild) (OR 2.51, 95% CI 1.68 to 3.77, p = 0.001) had significantly higher odds of being referred to ophthalmology. Conclusion This targeted community-based study in Upper Manhattan provided access to eye care and detected a significant amount of ocular pathology requiring referral to ophthalmology in this high-risk population.

Distribution and reference intervals of daytime intraocular pressure in the eye health screening population of Handan

Objective: To describe the distribution and establish reference intervals (RI) of daytime intraocular pressure (IOP) in the eye health screening population of Handan. Methods: This cross-sectional study included subjects who participated in eye health screening at the Physical Examination Center of Handan First Hospital from May 2021 to June 2022. A complete general and ocular examination was performed, including measurements of visual acuity and IOP (using Goldmann tonometry), slit lamp microscopy, fundus photography, and anterior and posterior segment optical coherence tomography. Subjects with factors that could cause significant changes in IOP or affect the accuracy of IOP measurement, or with an inability to measure IOP were excluded. Simple random sampling was used to select participants, who were grouped by gender and age (18 to <30, 30 to <40, 40 to <50, 50 to <60, 60 to <70, and ≥70 years). Central corneal thickness and IOP at 8 to 11 o'clock in one eye of each participant were recorded. The independent sample t test and ANOVA were used for statistical analysis, and the RI of IOP values was calculated by x¯±1.96s. Results: A total of 9 310 subjects had their IOP measured, and 3 491 participants (3 491 eyes) were randomly selected from 7 886 healthy subjects. The age of the participants was (47.74±14.47) years old, ranging from 18 to 90 years old. There were 1 694 males and 1 797 females. The central corneal thickness of all participants was (525.56±49.39) μm. The daytime IOP of all participants was (15.40±2.54) mmHg (1 mmHg=0.133 kPa), and the RI was 10.42 to 20.39 mmHg. The IOP was (15.49±2.58) mmHg for males and (15.29±2.49) mmHg for females, and the gender difference was statistically significant (P<0.05). The RI of daytime IOP values was 10.43 to 20.54 mmHg for males and 10.41 to 20.18 mmHg for females. There were significant differences in daytime IOP [(15.13±2.58), (15.33±2.53), (15.49±2.50), (15.53±2.55), (15.39±2.62), and (15.28±2.52) mmHg] among 6 age groups (P<0.05). Conclusions: The distribution of daytime IOP in different gender and age groups in the eye health screening population of Handan and the RIs derived from the distribution were roughly the same as the international normal IOP RI (10 to 21 mmHg). It is recommended to refer to the RI of daytime IOP values of different genders and ages for clinical decision.

Eye Health Screening in Migrant Population: Primary Care Experience in Lazio (Italy) from the PROTECT Project

Italy is a natural corridor for entry into Europe, receiving thousands of refugees and migrants needing socio-economic and health assistance yearly. Impaired vision due to eye disease is estimated to affect at least 2.2 billion people worldwide, especially in this underprivileged population. To overcome this deep disparity, new intervention strategies, such as the PROTECT project, were planned with the aim of assessing, in the context of the head–neck area, the eye health in vulnerable applicants and holders of international protection. A total of 3023 migrants were involved in the project. Demographic factors and eye history were collected using a questionnaire. Using portable diagnostic instruments, an eye screening including monocular visual acuity, intraocular pressure, anterior segment, and ocular fundus was performed. The mean age was 31.6 ± 13.1 years and more than 50% underwent the first eye evaluation. Vision impairment was claimed by 16.6% of subjects and the most frequent diseases diagnosed were: refractive errors (11%), strabismus (6%), red eye (6%), cataract (5.3%), and ocular hypertension (1%). Retinal alterations were observed in 5% of migrants. The PROTECT project allows us to increase the accessibility of head–neck disease prevention care. Moreover, our results confirm the utility of an eye screening assessment for early identification of the most relevant and preventable ocular diseases, especially in disadvantaged populations.

Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): Baseline Results and Costs of a Cluster-Randomized Trial

To describe the 15-month baseline results and costs of the Manhattan Vision Screening and Follow-up Study, which aims to investigate whether innovative community-based eye health screening can improve early detection and management of glaucoma and other eye diseases among high-risk populations. Five-year prospective, cluster-randomized controlled trial. Individuals aged 40+ years were recruited from public housing buildings in New York City for an eye health screening (visual acuity (VA) with correction, intraocular pressure measurements (IOP), and fundus photography). Participants with VA 20/40 or worse, IOP 23-29 mm Hg, or an unreadable fundus image failed the screening and were scheduled for an optometric examination at the same location; those with an abnormal image were referred to ophthalmology. A cost analysis was conducted alongside the study. A total of 708 participants were screened; mean age 68.6±11.9 years, female (65.1%), African American (51.8%) and Hispanic (42%). 78.4% (n = 555) failed the eye health screening; 35% (n= 250) had an abnormal image and were also referred to ophthalmology. 308 participants attended the optometric exam; 218 were referred to ophthalmology. Overall, 66.1% were referred to ophthalmology. The cost per participant to deliver the eye health screening and optometric examination was $180.88. The cost per case of eye disease detected was $273.64. This innovative study in public housing developments targeted high-risk populations, provided access to eye-care, and improved early detection of ocular diseases in New York City. The study has identified strategies to overcoming barriers to eye care to reduce eye health disparities.

Proposal for a Common Nomenclature and Risk-Based Approach to Pediatric Eye Health Screening and Examinations: Why, Who, and How?

Proposal for a Common Nomenclature and Risk-Based Approach to Pediatric Eye Health Screening and Examinations: Why, Who, and How?

It Is Time to Rethink Adult Glaucoma Screening Recommendations.

It Is Time to Rethink Adult Glaucoma Screening Recommendations.

Prevalence and Causes of Low Vision and Blind in Ophthalmology Department, Miri Hospital, Sarawak

Prevalence and causes of low vision and blind have been studied nationally and globally. However, similar studies have not been conducted locally in Sarawak. This study aims to identify the prevalence and causesof low vision and blind patients of different gender, age, and race in the Ophthalmology Department, Miri Hospital, Sarawak, for five years from 2016 to 2020. This study is a retrospective observational study. A total of 17,868 patients’ clinical records were screened. The clinical records with fulfilled inclusion criteria will be extracted and reviewed. In this study, 269 (1.50%) patients were diagnosed with irreversible visual impairments. The prevalence of low vision and blindness was 0.78% and 0.72%, respectively. Most subjects (187, 69.5%) were more than 50 years old. Furthermore, 151 (56.13%) subjects were male, while 118 (43.87%) were female. Race Iban has a higher prevalence of low vision and blind (88, 32,7%), followedby Chinese (81, 30.1%), Malay (53, 19.7%), and other local natives (17, 5%). The four leading causes of low vision and blind were diabetic retinopathy (68, 25.3%), glaucoma (62, 23.0%), retinitis pigmentosa (26, 9.7%),and age-related macular degeneration (17, 6.3%). Low vision and blind due to diabetic retinopathy, glaucoma, and age-related macular degeneration could be avoided if eye health screening is conducted as early as age 40. For patients diagnosed with low vision and blind, integrated low vision and blind rehabilitation training should be accessible in all public healthcare systems. For the stakeholder, enforcing low vision and blind registry, fortifying low vision rehabilitation services, and precise mechanism of welfare intervention are the measures for more holistic low vision and blind management.

Eye Health Screening for Students in an Elementary School within the Scope of School Health Nursing Roles

Eye Health Screening for Students in an Elementary School within the Scope of School Health Nursing Roles

Is an integrated model of school eye health delivery more cost-effective than a vertical model? An implementation research in Zanzibar

ObjectiveTo review and compare the cost-effectiveness of the integrated model (IM) and vertical model (VM) of school eye health programme in Zanzibar.Methods and analysisThis 6-month implementation research was conducted in...

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.

Agreement and diagnostic accuracy of vision screening in preschool children between vision technicians and spot vision screener.

Purpose:Screening preschool children for vision-related disorders poses a challenge. This study is designed to determine the agreement and diagnostic accuracy of the spot vision screener (SVS) in screening preschool children compared to screening procedure by vision technicians (VT).Methods:This study was conducted as a part of the ongoing study titled “Initiative for Screening Children for Refractive Errors and other Eye Health Needs (I-SCREEN).” Children from 33 Anganwadis (preschools) in two districts, Adilabad district of Telangana and Krishna district of Andhra Pradesh, in South India, underwent eye health screening by a VT and by a trained community eye health workers (CEHW) using the SVS. Findings were compared for agreement and diagnostic accuracy of assessment.Results:A total of 976 preschool children were screened by the VT and separately by the CEHW using the SVS in Adilabad (15 schools) and Krishna (18 schools) districts. The overall mean age of these children was 2.5 years (SD ± 1.3 years). There were 48 (4.9%) referrals by VT compared to 105 (10.8%) referrals by CEHW using SVS. The overall sensitivity of SVS was 91.7% (95% CI: 80%–97.7%) and the specificity was 93.4% (95% CI: 91.6%–94.9%). Positive predictive value was 41.9% (95% CI: 32.3%–51.9%) and negative predictive value was 99.5% (95% CI: 98.8%–99.9%) with a moderate agreement (0.54; 95% CI 0.49–0.64) between VT screening and screening with SVS.Conclusion:The SVS showed good diagnostic accuracy and agreement in screening for possible vision-related disorders in preschool children.

Refractive Error Among School Going Children in Solukhumbu, Nepal

Introduction: Reduced vision among school-going children is a global public health problem and uncorrected refractive error, the main causative factor is most prevalent in under-developed countries. Correction of refractive error can be easily done when diagnosed. Therefore regular eye health screening among school-going children and early correction is necessary to alleviate the problem and reduce its consequences.&#x0D; Materials and Methods: It was a retrospective cross-sectional stud and the data were retrieved from eye health screening camps conducted in different schools of Dudhkunda municipality in 2015 in collaboration with Solukhumbu Polytechnic Academy and District Community Eye Center Solukhumbu. Permission from respective authorities and ethical approval for the research was received from the institutional review committee of the Tilganga Institute of Ophthalmology. Out of 3097 records, 2517 records were analyzed to identify the prevalence of refractive error.&#x0D; Results: Age of the children ranged from 6 to 18 years and most of the children were studying in grade 1 to 7, from government school and janajatis. Most common eye disorder noted was refractive error and prevalence was 3.5% (87). Refractive error was higher among older children compared to younger children. Higher proportion of students from private schools had refractive error compared to students from government schools. Both the findings were statistically significant.&#x0D; Conclusions: Refractive error among school children in our study is lower than that of other studies conducted in Nepal and it may be due to the representation of younger age groups in our study.

Smartphone-based screening for visual impairment in Kenyan school children: a cluster randomised controlled trial.

SummaryBackgroundChildhood visual impairment is a major public health concern that requires effective screening and early intervention. We investigated the effectiveness of Peek school eye health, a smartphone-based sight test and referral system (comprising Peek Acuity test, sight simulation referral cards, and short message service [SMS] reminders), versus standard care (Snellen's Tumbling-E card and written referral).MethodsWe initially compared the performance of both the Snellen Tumbling-E card and the Peek Acuity test to a standard backlit EDTRS LogMAR visual acuity test chart. We did a cluster randomised controlled trial to compare the Peek school eye health system with standard school screening care, delivered by school teachers. Schools in Trans Nzoia County, Kenya, were eligible if they did not have an active screening programme already in place. Schools were randomly allocated (1:1) to either the Peek school eye health screening and referral programmes (Peek group) or the standard care screening and referral programme (standard group). In both groups, teachers tested vision of children in years 1–8. Pupils with visual impairment (defined as vision less than 6/12 in either eye) were referred to hospital for treatment. Referred children from the standard group received a written hospital referral letter. Participants and their teachers in the Peek group were shown their simulated sight on a smartphone and given a printout of this simulation with the same hospital details as the standard referral letter to present to their parent or guardian. They also received regular SMS reminders to attend the hospital. The primary outcome was the proportion of referred children who reported to hospital within 8 weeks of referral. Primary analysis was by intention to treat, with the intervention effect estimated using odds ratios. This trial is registered with Pan African Clinical Trial Registry, number PACTR201503001049236.FindingsSensitivity was similar for the Peek test and the standard test (77% [95% CI 64·8–86·5] vs 75% [63·1–85·2]). Specificity was lower for the Peek test than the standard test (91% [95% CI 89·3–92·1] vs 97·4% [96·6-98·1]). Trial recruitment occurred between March 2, 2015, and March 13, 2015. Of the 295 eligible public primary schools in Trans Nzoia County, 50 schools were randomly selected and assigned to either the Peek group (n=25) or the standard group (n=25). 10 579 children were assessed for visual impairment in the Peek group and 10 284 children in the standard group. Visual impairment was identified in 531 (5%) of 10 579 children in the Peek group and 366 (4%) of 10 284 children in the standard care group. The proportion of pupils identified as having visual impairment who attended their hospital referral was significantly higher in the Peek group (285 [54%] of 531) than in the standard group (82 [22%] of 366; odds ratio 7·35 [95% CI 3·49–15·47]; p<0·0001).InterpretationThe Peek school eye health system increased adherence to hospital referral for visual impairment assessment compared with the standard approach among school children. This indicates the potential of this technology package to improve uptake of services and provide real-time visibility of health service delivery to help target resources.FundingSeeing is Believing, Operation Eyesight Universal, Queen Elizabeth Diamond Jubilee Trust, and Wellcome Trust.

Diagnosis of retinal health in digital fundus images using continuous wavelet transform (CWT) and entropies

Vision is paramount to humans to lead an active personal and professional life. The prevalence of ocular diseases is rising, and diseases such as glaucoma, Diabetic Retinopathy (DR) and Age-related Macular Degeneration (AMD) are the leading causes of blindness in developed countries. Identifying these diseases in mass screening programmes is time-consuming, labor-intensive and the diagnosis can be subjective. The use of an automated computer aided diagnosis system will reduce the time taken for analysis and will also reduce the inter-observer subjective variabilities in image interpretation. In this work, we propose one such system for the automatic classification of normal from abnormal (DR, AMD, glaucoma) images. We had a total of 404 normal and 1082 abnormal fundus images in our database. As the first step, 2D-Continuous Wavelet Transform (CWT) decomposition on the fundus images of two classes was performed. Subsequently, energy features and various entropies namely Yager, Renyi, Kapoor, Shannon, and Fuzzy were extracted from the decomposed images. Then, adaptive synthetic sampling approach was applied to balance the normal and abnormal datasets. Next, the extracted features were ranked according to the significances using Particle Swarm Optimization (PSO). Thereupon, the ranked and selected features were used to train the random forest classifier using stratified 10-fold cross validation. Overall, the proposed system presented a performance rate of 92.48%, and a sensitivity and specificity of 89.37% and 95.58% respectively using 15 features. This novel system shows promise in detecting abnormal fundus images, and hence, could be a valuable adjunct eye health screening tool that could be employed in polyclinics, and thereby reduce the workload of specialists at hospitals.

Surgical eye camp in rural area of Nepal and its role in Vision 2020

Blindness continues to remain a major public health problem in Nepal and cataract is the leading cause. Cataract surgical coverage is relatively low in the rural areas where prevalence of blindness is high. To evaluate the role of surgical out­reached eye camps in rural Nepal and its impact in Vision 2020. This is a descriptive cross sectional camp based study in a remote village of Nepal, where 4 days screening of the eye disease mainly the cataract was done. 250 patients (54.80% males and 45.20% females) underwent eye health screening tests. Cataract was the commonest ocular disease (29.6%) among the screened population and 24% (60 patients) of them required cataract surgery (57% male and 43% female). The mean age of the operated patient was 71.84 ± 10.6years. Among the operated cases, bilateral blindness was present in 21.66% and unilateral blindness in 70% but after vision restoring cataract surgery, normal visual acuity (6/6-6/18) was achieved in 31(51.66%), and vision of 6/24-6/60 in 23 (38.33%) cases. Cataract remains to be the major cause of blindness in Nepal and arrangement of repeated surgical eye camps in the remote areas of Nepal could aid in reducing the prevent­able cause of blindness thereby help in achieving the goal of Vision 2020.