Pediatric Eye Care Research Articles

Services provided for preschool-aged children with suspected amblyopia

This study is based on a random survey of 542 ophthalmologists and 501 optometrists actively practicing in Michigan to evaluate variations in pediatric eye care services for preschool-aged children with abnormal vision screening tests. The response rate was 65% (optometrists, 75%; ophthalmologists, 57%). More optometrists than ophthalmologists evaluated preschool-aged children (97% vs 79%, ph 0.001). Optometrists reported that most of their preschool-aged patients were referred from community-based screening programs or by parent self-referral. Ophthalmologists reported that most of their preschool-aged patients were referred by primary care providers. Fewer optometrists than ophthalmologists dilated eyes routinely during the first evaluation of a preschool-aged child (39% vs 93%; ph 0.001). Most optometrists and ophthalmologists managed amblyopia themselves rather than referring to another specialist (80% vs 77%; p = 0.372). More ophthalmologists in nonurban setting practices managed amblyopia than did those in urban practice settings (90% vs 65%, ph 0.001), whereas no such difference was found between nonurban and urban optometrists (p = 0.289). More optometrists than ophthalmologists reported that they managed strabismus (89% vs 80%; p = 0.002), although optometrists were much less likely than ophthalmologists to treat non accommodative esotropia and exotropia (ph 0.009). As with amblyopia, more ophthalmologists in nonurban practices than in urban practices managed strabismus (89% vs 66%; ph 0.001), whereas no such differences were found between nonurban and urban optometrists (p =0.756). Michael D. Wagoner

The Kariapatti Pediatric Eye Evaluation Project: baseline ophthalmic data of children aged 15 years or younger in Southern India

Purpose To estimate the prevalence of ocular morbidity among children of rural southern India before developing a service delivery model for community-based pediatric eye care. Design Population-based cross sectional study. Methods Trained field-workers performed door-to-door enumeration in 74 randomly selected villages of the Kariapatti block in southern India to identify children aged 15 years or younger and performed visual acuity measurements using Cambridge crowded cards and external eye examination with torchlight. Pediatric ophthalmologists further examined subjects with ocular problems identified by the field-worker. The clinical team performed repeat visual acuity measurements with Cambridge crowded cards, refraction, slit-lamp anterior segment examinations, and dilated posterior segment examinations at the screening site. The ophthalmologist identified and recorded one major cause for each visually impaired eye. Results Field-workers screened 10,605 (94.6%) of 11,206 children enumerated, and identified 1,441 (13.6%) children as requiring further clinical examination. An additional 449 children identified as normal by the field-worker were randomly chosen for repeat examinations at the screening sites. In all, 1,578 (83.5%) of these 1,890 children were examined at the screening site. According to World Health Organization criteria, 6.2 of 10,000 children were blind; 42.9% of this blindness was potentially avoidable. Refractive errors (0.55%, 95% confidence interval: 0.41, 0.69) and strabismus (0.43%, 95% confidence interval: 0.30, 0.55) were the major ocular morbidity in this population. Conclusions Developing an appropriate service delivery model for this region will require a balance between the relatively low prevalence of morbidity and blindness and the need for service in this population.

Services provided for preschool-aged children with suspected amblyopia.

Little is known about the pattern and variation of care offered to preschool-aged children who have had an abnormal vision screening test. To evaluate the variations in pediatric eye care services and availability of optometrists and ophthalmologists for preschool-aged patients, referral patterns, and barriers to providing care as perceived by eye care specialists. A survey was mailed to 542 ophthalmologists and a random sample of 501 optometrists actively practicing in Michigan. The response rate was 65% (optometrists, 75%; ophthalmologists, 57%). More optometrists than ophthalmologists evaluated preschool-aged children (97% vs 79%; P < .001). Of these, most managed amblyopia (80% vs 77%; P = .372) and strabismus (89% vs 80%; P = .002) themselves. Fewer optometrists than ophthalmologists dilated eyes routinely during the first evaluation of a preschool-aged child (39% vs 93%; P < .001). The leading barrier to care for preschool-aged children reported by both optometrists and ophthalmologists was difficulty of the examination (25% vs 23%; P = .501). Optometrists reported that most of their patients were referred from community-based screening programs or by parent self-referral. Ophthalmologists reported that most of their preschool-aged patients were referred from primary care providers. There are different sources of referrals for optometrists and ophthalmologists. Although most eye care specialists treat amblyopia, the types of care offered by optometrists and ophthalmologists differ. Future studies should address the impact that these patterns have on outcomes and cost. The results of these studies should be shared with those responsible for screening.

Clinical research in pediatric ophthalmology: the Pediatric Eye Disease Investigator Group.

The Pediatric Eye Disease Investigator Group (PEDIG) is a network of university-based and community-based pediatric eye care practitioners that is conducting multiple clinical research studies. The group has conducted the Congenital Esotropia Observational Study, which assessed the early course of esotropia in infants, and the Amblyopia Treatment Studies, a series of randomized trials, the first of which compared atropine and patching for treatment of moderate amblyopia in children 3 to <7 years old. Herein, the results of these studies are summarized, and the current and future studies of the group are described.

Optometric co-management: A paradigm for pediatric eye care delivery: Fortenbacher DL. J Am Optom Assoc 1997;68:475

Optometric co-management: A paradigm for pediatric eye care delivery: Fortenbacher DL. J Am Optom Assoc 1997;68:475

Paediatric Vision and Optometry

Until recent times remarkably little attention has been paid to the visual problems of children. Few children seek professional eye care, and vision screening services provided by the school health authorities have been shown to be inadequate. National Children's Vision Week (NCVW) in 1979 was the first stage of an AOA programme to inform the public, particularly teachers, of optometrists' unique role in paediatric eye care and the importance of early intervention. The paper presents information resulting from optometry's participation in NCVW, and suggests strongly that all optometrists should be informed as to their responsibilities in paediatric eye care.