Infant Vision Screening Research Articles

Newborn and infant vision screening in primary care: A clinical review.

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. 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. 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.

Vision Screening in Infants Attending Immunization Clinics in a Developing Country.

Background: Vision screening in infants is an important part of the medical care of children as some eye abnormalities, if not treated in the first few months or years of life, can lead to irreversible vision loss. Objective: The objective of this cross-sectional, descriptive study was to identify ocular anomalies among infants attending immunization clinics in Nigeria and refer promptly and appropriately. Methodology: Infants were screened across 6 immunization clinics. Screening activities included relevant ocular history, vision assessment, external ocular examination, ocular motility, Hirschberg’s test, pupil examination, and the red reflex test. Infants with abnormal findings were referred for comprehensive eye examination. Result: Of the 142 infants who underwent vision screening, 29 were referred. These referrals were either as a result of ocular abnormalities (n = 22) or presence of risk factors from history (n = 7). The prevalence of ocular abnormalities was 15.5% and neonatal conjunctivitis (38%), was the commonest ocular abnormality found. Others were bacterial conjunctivitis (14%), nasolacrimal duct obstruction (14%), strabismus (14%), capillary hemangiomas (10%), iris nevi (5%), and vernal keratoconjunctivitis (5%). Of the 7 infants referred based on history alone, 6 (85.7%) had a history of prematurity. Conclusion: Conjunctivitis, strabismus, congenital nasolacrimal duct obstruction, and capillary hemangioma are some of the prevalent disorders seen in infants at immunization clinics in Nigeria. Babies at risk of retinopathy of prematurity (preterm birth and oxygen therapy) can be identified. Immunization clinics can serve as good points of vision screening for infants in developing countries to facilitate prompt referral and treatment.

Approach of Family Physicians to Pediatric Eye Screening in Diyarbakır

Objectives:In Turkey, preventive medicine services are the responsibility of family physicians and vision screening is a key component of this responsibility. In this study, we aimed to investigate the approach of family physicians to vision screening in infants and children.Materials and Methods:Data were collected using a 16-item questionnaire administered to 100 family physicians working in the center and provinces of Diyarbakır.Results:The results indicated that 88 (88%) physicians declared knowing what the red reflex test was, while 12 physicians declared that they had never heard of it. Only 16 (16%) physicians performed the test routinely and 36 (36%) physicians performed it only in suspicious cases. Ten (10%) physicians indicated that they did not refer the patients to an ophthalmologist even though they did not perform the red reflex test. Moreover, 5 (5%) physicians did not have an ophthalmoscope and 12 (12%) physicians reported not knowing how to use an ophthalmoscope. Forty (40%) of the physicians measured preschool visual acuity at least once. Sixty-six (66%) physicians referred younger children who could not express their vision problems to an ophthalmologist. Four (4%) physicians declared that they would delay surgery in children with strabismus until they were old enough for surgery. Ninety-three (93%) physicians suggested that educational seminars about vision screening would be beneficial.Conclusion:Educational seminars about vision screening may have favorable outcomes. The medical devices in family medicine centers should be improved. Vision screening can be added to the negative performance-based compensation system in order to increase physicians’ attention to vision screening. To implement detailed eye screening programs like those in developed countries, an infrastructure should be established for this screening program.

Optics and psychophysics in a clinical setting: Success of a screening battery for assessing visual functioning in human infants

Compared to preschool screening, infant vision screening has typically been regarded as much less feasible as infants require more expensive equipment, highly trained personnel, and/or much longer screening times for individual patients. However, early infancy to 3 years marks a critical period of plasticity during which time synaptic connections within the brain are capable of rearranging based on experience. This critical period extends for a variable period of time, but the extent of the plasticity diminishes with age, thus, responsiveness to treatment lessens with age and the depth of impairment is influenced by the duration of the visual abnormality. The evidence for early sensitive, or critical periods, suggests that the best opportunity for prevention and treatment can be expected if screening takes place as early in life as possible. -- The primary objective of the present study was to develop and assess a suitable vision screening battery for infants, namely those within the initial stages of the period of visual plasticity. Infants and toddlers (N=189) were assessed with a battery of the latest optical and psychological tests. Within a single session, we attempted to measure, for each eye, optical refractive error, visual acuity, contrast sensitivity, and conducted a full ocular alignment/motility examination. -- The battery was relatively successful with all age groups. Notably, all children completed at least one test, 95% completed 2 tests and nearly half (48%) completed 4 tests. Furthermore, the average completion time of the test battery for all age groups was 12.8 minutes with a range across age groups of 9.2 to 13.8 minutes. Thus, the present study was successful in demonstrating that children between the ages of 6-months and 3 years can be tested on several aspects of visual functioning in a fairly effective and efficient manner using a relatively comprehensive battery of tests. The promising results of the present study highlight the potential to screen children at a much younger age than is currently standard and represents an important step in the assessment and further development of childhood screening programs.

Vision screening in infants, children and youth.

Vision screening in infants, children and youth.

A new visual evoked potential system for vision screening in infants and young children

With a prevalence of 3-5%, amblyopia represents a major public health problem. Effective treatment depends on early detection, and a broad consensus of professional opinion supports vision screening of infants and young children. No single method of screening has been demonstrated to be superior in detecting amblyopia and all methods have significant limitations. We assessed a new, "child-friendly" visual evoked potential (VEP) system (ENFANTtrade mark II, Diopsys Corp., Metuchen, NJ) for use in screening. We studied 122 children, aged 6 months to 5 years, comparing test results in a masked fashion to results of standard ophthalmologic examinations. A statistical program analyzed VEP differences between fellow eyes to determine a "pass" or "fail" for each child. For verbal patients, clinical amblyopia was defined as an interocular difference of two or more lines in best-corrected visual acuity. For preverbal patients, clinical amblyopia was defined by the clinician's decision to treat with occlusion or atropine penalization. Preverbal children with significant refractive errors or structural eye pathology were also considered clinically abnormal. The test was completed by 94% of the study group, each child requiring an average of 10 minutes to complete testing of both eyes. The sensitivity was 0.973, the specificity 0.808, the positive predictive value 0.706, and the negative predictive value 0.984. With its easy electrode placement and rapid, attractive stimulus, the new system overcomes technical difficulties which were associated with older VEP techniques. The test shows promise as a screening tool for detecting amblyopia and other visual deficits in young children.

Non-cycloplegic refractive screening can identify infants whose visual outcome at 4 years is improved by spectacle correction

The Second Cambridge Population Infant Vision Screening Programme using the VPR-1 videorefractor without cycloplegia was undertaken in order to identify those infants with refractive errors who were potentially amblyogenic or strabismogenic. Infants identified at eight months were entered into a control trial of treatment with partial spectacle correction and underwent a long-term follow-up that monitored a wide range of visual, visuoperceptual, visuocognitive, visuomotor, linguistic and social development. In the present paper, the authors report on the outcome measures of visual acuity and strabismus. Poor acuity was defined as a best-corrected acuity of 6/12 or worse on crowded letters or 6/9 or worse on single letters, at age 4 years. Acuity was measured in 79 infants who were significantly hyperopic and/or anisometropic at 11-12 months of age, 23 who showed hyperopia of +3D but less than +3.5D, 196 control subjects, 14 controls with refractive errors, and 126 others who showed an accommodative lag on screening but were not significantly hyperopic on first retinoscopy. There was a poorer acuity outcome in the untreated group of hyperopes compared to controls (p < 0.0001) and to the children who were compliant in spectacle wear (p < 0.001) or who were prescribed spectacles (p < 0.05). Children who were significantly hyperopic at eight months were also more likely to be strabismic by 5.5 years compared to the emmetropic control group (p < 0.001). However, the present study did not find a significant difference in the incidence of strabismus between corrected and uncorrected hyperopic infants. Children who were not refractively corrected for significant hyperopia were four times more likely to have poor acuity at 5.5 years than infants who wore their hyperopic correction, supporting the findings of the First Cambridge Population Infant Vision Screening Programme.

Identification of infants with significant refractive error and strabismus in a population screening program using noncycloplegic videorefraction and orthoptic examination.

The second Cambridge Infant Vision Screening Program examined whether screening for accommodative errors by using videorefraction without cycloplegia could effectively serve as a first stage of screening for refractive errors, measured by standard cycloplegic retinoscopy. The screening also included an orthoptic examination for detection of strabismus. All infants born in the Cambridge (UK) Health District, over a 2-year period, were invited for screening. Of those 5142 (76%) with mean age 8.1 +/- 0.8 months (SD) attended and received noncycloplegic videorefraction and an orthoptic examination. All those with a focusing error or orthoptic problem, as well as a randomly selected sample of visually normal control subjects, were invited to follow-up a month later for cycloplegic retinoscopy, repeat noncycloplegic videorefraction and orthoptic examination. Of the 5142 screened, 514 had a focusing error or orthoptic problem (positives). Four hundred thirty-nine of these and 284 visually normal control subjects (negatives) attended follow-up. A refractive or orthoptic condition was confirmed in 59.0% of the positive cases, whereas infants in 96.8% of the negative cases were confirmed normal. Adjusting for the proportions of the population represented by those infants seen at follow-up, sensitivity for the screening procedure was calculated at 0.67 and specificity at 0.96. Detailed results are presented in terms of the different conditions detected at screening (far, near, and anisometropic focus and orthoptic error), distribution of greatest axes at screening, and a comparison of initial videorefraction with repeat videorefraction and cycloplegic retinoscopy. A noncycloplegic screening procedure, simpler to perform than cycloplegic screening, succeeded in detecting a large proportion of infants with significant ametropia, particularly those with significant hyperopia, which is considered to be a strabismogenic and amblyogenic risk factor.

Infant vision screening predicts failures on motor and cognitive tests up to school age

In a population-based infant vision screening programme, 5295 infants were screened and those with significant refractive errors were followed up. To assess the relationship between the development of vision and other domains, we report a longitudinal study comparing infants with significant hyperopia, identified at age 9 months (‘hyperopes’) with infants with normal refractions (‘controls’). Children are included who completed at each age a broad set of visual, cognitive, motor and language measures taken over a series of follow-up visits up to age 5.5 years. Hyperopes performed significantly worse than controls on the Atkinson Battery of Child Development for Examining Functional Vision at 14 months and 3.5 years and the Henderson Movement Assessment Battery for Children at 3.5 and 5.5 years. The Griffiths Child Development Scales, MacArthur Communicative Development Inventory and British Picture Vocabulary Scales showed no significant differences. Exclusion of those infants who became amblyopic and strabismic did not substantially alter these results, suggesting that the differences between groups were not a consequence of these disorders. These results indicate that early hyperopia is associated with a range of developmental deficits that persist at least to age 5.5 years. These effects are concentrated in visuocognitive and visuomotor domains rather than the linguistic domain.

Vision screening in infants and children

Vision screening in infants and children

Two infant vision screening programmes: Prediction and prevention of strabismus and amblyopia from photo- and videorefractive screening

Two infant vision screening programmes: Prediction and prevention of strabismus and amblyopia from photo- and videorefractive screening

Eye Examination and Vision Screening in Infants, Children, and Young Adults

Vision screening and eye examination are vital for the detection of conditions that distort or suppress the normal visual image, which may lead to inadequate school performance or, at worst, blindness in children. Retinal abnormalities, cataracts, glaucoma, retinoblastoma, eye muscle imbalances, and systemic disease with ocular manifestations may all be identified by careful examination. Examination of the eyes can be performed at any age, beginning in the newborn period, and should be done at all well infant and well child visits. Vision screening should be performed for a child at the earliest age that is practical, because a small child rarely complains that one eye is not seeing properly. Conditions that interfere with vision are of extreme importance, because visual stimuli are critical to the development of normal vision. Normal visual development requires the brain to receive equally clear, focused images from both eyes simultaneously for visual pathways to develop properly. Vision screening should be carried out as part of the regular plan for continuing care beginning at 3 years of age. Vision screening guidelines have been endorsed by the American Academy of Pediatrics (AAP), the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), and the American Academy of Ophthalmology (AAO). To achieve the most accurate testing possible, the most sophisticated test that the child is capable of performing should be used (see "Appendix 1").1 As with other specialty areas, it is important for the pediatrician to establish contact with an ophthalmologist who is experienced in treating children's eye problems and who practices in the same geographic area.