Pediatric Vision Research Articles

Barriers and facilitators of vision screening in the US pediatric primary care setting: a mixed methods systematic review protocol.

The objective of this review is to understand the barriers and facilitators of vision screening in the US primary care setting for children aged 3 to 17 years. Childhood vision screening is crucial because it detects children at risk of undiagnosed vision problems. Previous studies report low rates of appropriate vision screening in the primary care setting. We aim to identify barriers and facilitators of pediatric primary care vision screening to inform future interventions to improve childhood vision screening. Studies of all types that identify barriers and facilitators of vision screening in children aged 3 to 17 years in the pediatric primary care setting in the US will be considered for inclusion. We will search PubMed, CINAHL Complete (EBSCO), Scopus, Web of Science (SCI-EXPANDED, ESCI, CPCI-S, SSCI), Cochrane Library, and Embase. We will also search gray literature, including conference proceedings, professional organization reports, and clinical trials. We will use supplemental search strategies, including citation tracking and contacting authors for unpublished data. Titles and abstracts will be screened independently by 2 reviewers and selected for full-text screening based on prespecified inclusion criteria. Only studies in English will be considered. Each included study will be appraised using the mixed methods appraisal tool. Data will be extracted using a modified JBI mixed methods data extraction form. Qualitative and quantitative data will be integrated using a convergent integrated approach. Open Science Framework https://osf.io/nhf5d/.

Photoscreener: An effective tool for vision screening of preschool children in community setting

Background: Although studies compare the accuracy of spot photoscreeners, few evaluate photoscreeners in community settings. To our knowledge, all studies from India have been purely hospital based, particularly in children under 5 years. Aim: The aim was to evaluate the effectiveness of using a commercially available photoscreener for pediatric vision screening in a community setting. Settings and Design: This cross-sectional comparative study was conducted from December 2018 to February 2019 in a north-eastern district of Delhi. Methods: The automated Spot™ Vision Screener was used to screen the vision of preschoolers. A result displayed as “complete eye exam recommended” on the photoscreener was considered as screening positive and the child was referred to the pediatric ophthalmology unit of a tertiary eyecare institution, as per predefined international guidelines. Statistical Analysis: Referral rate and positive predictive value (PPV) of using the photoscreener were considered as primary outcome measures. Results: A total of 1205 children were screened using a photo-screener. Almost 16.4% of them were identified and referred a significantly higher referral rate than that in the historic control (2.7%, P < 0.001). Nearly 51.5% of the referred children reported to the unit. The PPV of pediatric eye screening done in a community setting by the photoscreener for refractive error (RE) was 81.4%. Fifty-nine percent of the children detected with REs were found to be at risk of amblyopia. Mean spherical equivalent, sphere, and cylinder of final glass prescription were significantly different from that of photoscreener refraction. Conclusion: Photoscreener improves the referral rate and has a high PPV. It could be a standard tool to screen preschoolers in community settings.

Clinical characteristics and causes of vision impairment in a paediatric population in a university-based low vision clinic

Paediatric vision impairment is a significant public health issue because of the associated health and economic consequences. This study aimed to determine the clinical characteristics and causes of vision impairment in paediatric patients who presented to a university-based low vision eye clinic in KwaZulu-Natal. The study used a retrospective design and included all paediatric patients with vision impairment who were younger than 18 years and presented to the university-based low vision eye clinic between January 2015 and December 2019. The sample consisted of 156 children with vision impairment with a similar proportion of males ( n = 82) and females ( n = 74). The mean age of the children was 13.5 ± 2.8 years, with a range of 5–17 years. Based on the best-corrected visual acuity (VA), most of the children ( n = 111) had moderate vision impairment (VA worse than 6/18 to 6/60). The most common causes of paediatric vision impairment included albinism ( n = 54), refractive error ( n = 11), cataract ( n = 10), and glaucoma ( n = 10). The retina ( n = 74) and normal globe ( n = 26) were the most affected anatomical sites. Spectacles were prescribed to almost half of the sample ( n = 76). A total of 126 optical and non-optical devices were recommended with telescopes ( n = 43) and sun-protective measures ( n = 20) being the most common. Paediatric vision impairment can have a negative impact on the quality of life. Local data related to the characteristics of children with vision impairment can be used to enhance the services provided in this university-based low vision clinic. This is important as efforts aimed at early identification, management, and rehabilitation will help minimise functional limitations and improve the quality of life of affected children.

Screening, Diagnosis, and Treatment of Pediatric Ocular Diseases.

Vision is an important aspect of a child's quality of life and intellectual, social, and emotional development. Disruptions to vision during infancy and early childhood can cause lifelong vision impairment or blindness. However, early identification and treatment of eye disease can prevent loss of sight and its consequent long-term effects. Therefore, screening guidelines exist to guide physicians in detecting the most common threats to sight in the different stages of infancy and childhood. This review describes common causes of pediatric vision impairment, the recommended screening guidelines for diagnosing them, and current treatment modalities.

What Evidence Exists on Intervention for Pediatric Cerebral Visual Impairment: A Review

<h3>Research Objectives</h3> Objective: To report and categorize intervention strategies for Cerebral Visual Impairment (CVI) that have been examined or are under investigation. Outcome measures also reported to illuminate all change effects considered and how they were assessed. <h3>Design</h3> CVI results from an array of etiologies and has become the primary cause of pediatric low vision, but best interventions remain unknown. Given underdeveloped stage of the field, a scoping review was deemed most appropriate. <h3>Setting</h3> Data Sources: Four databases searched, PubMed, Scopus, Embase, PsychInfo, with no date restriction. Sources had to be peer reviewed, available in English, targeting children (0-18 years chronological age) diagnosed with vision impairment meeting definition of CVI, and provide intervention detail. Indexing terms piloted and removed if retrieved sources didn't meet criteria. <h3>Participants</h3> Study Selection: PRISMA Extension for Scoping Reviews checklist used. Title/abstract selection (n=401) preceded full text review (n=56) resulting in 18 included sources. Most excluded sources solely reported prognosis, etiology, diagnostics, or assessment strategies. <h3>Interventions</h3> Data Extraction: Independent data extraction conducted, followed by consensus discussion among authors. Level of evidence was graded using the scale cited in the American Occupational Therapy Association Guidelines for Systematic Reviews. <h3>Main Outcome Measures</h3> Data Synthesis: Interventions were grouped into five categories: habilitation, visual stimulation, color tent, serious games, medical. <h3>Results</h3> Most sources (n=12) were lower level of evidence (3B, 4). Outcome measures ranged greatly, from subjective clinical observation, to objective, quantitative eye tracking data. <h3>Conclusions</h3> Further higher-level research needed to differentiate which interventions offer best outcomes for pediatric CVI and how interventions compare to standard care. Continued examination of interventions will necessitate identification of additional quantitative and objective measures that can be successfully used with this population. <h3>Author(s) Disclosures</h3> In relation to this poster, we declare no conflicts of interest.

Pediatric Low Vision Management in Case of Myopic Maculopathy Case Study

Pediatric Low Vision Management in Case of Myopic Maculopathy Case Study

School Vision Screening Data Informing a County-Based Community Health Needs Assessment

Purpose: The objective of this study was to (I) analyze Arkansas school nurse vision screening data, (II) provide a county-based pediatric vision care need assessment, and (III) evaluate eye care provider workforce in both rural and urban settings to overcome the vision screening follow-up care gap. Methods: Descriptive statistics and paired t-Tests (p &lt; 0.05) were calculated for the number of students receiving vision screening, number of students referred to an eyecare provider, number of students receiving follow-up vision care, the vision screening referral rate, and follow-up rate for all public and charter schools in the state of Arkansas. Findings: The mean number of students screened in rural counties (mean +/- SD; 1530.5 +/- 1170.9) was statistically significantly (t-Test 2-tail, p = 0.003) lower than the mean number of students screened in urban counties (7301.10 +/- 7663.45). The referral rate was comparable in rural counties (9.41% +/- 4.95%), compared to urban counties (9.29% +/- 5.16%). Nearly two-thirds of the children who failed their vision screening did not receive a follow-up comprehensive eye exam (rural: 68.26% +/- 17.48%; urban: 66.30% +/- 11.91%). Rural counties had just 1.03 +/- 0.86 eye care providers per 10,000 people, compared to urban counties which had 1.30 +/- 1.11 eye care providers per 10,000 people. Conclusions: The purpose of school nurses screening children for vision abnormalities is to recognize and treat ailments early to ensure students have the best opportunity to learn. This study unveiled that rural and urban Arkansas school children alike go without follow-up eye care after failing their school vision screening two-thirds of the time. Rural areas have less eye care providers per capita and have a greater burden placed on each eye care provider, however, the follow-up care rate is comparable in rural and urban areas. Keywords:Rural Eye Care, Amblyopia; Nurse Vision Screening DOI: https://doi.org/10.14574/ojrnhc.v22i2.713

9.N. Workshop: It Takes Two To Improve European Child Health (Care)

Abstract Many societal developments have an impact on health care in general and on child health care, in particular. Internationally challenges include an aging population, more cultural diversity and a rising prevalence of chronic diseases among children and adolescents, revealing potential risks for child health care. A strong focus must be placed on prevention strategies that are effective, sustainable and equitable. Planning and implementing prevention strategies may require shifts in the organization of care, such as the forging and strengthening of interdisciplinary and intersectoral partnerships within a country. A promising example of such partnerships is the collaboration of public health with paediatrics. Both professional groups acknowledge the call for greater integration since prevention strategies can only be achieved and sustained by working together. The objectives of this workshop are to: • Provide a selective overview of three partnerships and plans for cooperation between public health and paediatrics. • To exchange experiences and possibilities with the audience to pave the way for further successful partnerships. In this workshop, we outline the partnership and plans for cooperation between public health and paediatrics in three European countries: Netherlands, Finland and Switzerland. In the first presentation, Danielle Jansen and Károly Illy will share the new vision towards the year 2030 of the Dutch Paediatric Society in which building blocks are presented to guarantee accessible, high-quality, timely and effective care for every child. One of the building blocks to be highlighted is the interprofessional collaboration between paediatricians and public health professionals. In the second presentation, Julia Dratva and Susanne Stronski from Switzerland will present a shared paediatric and public health vision of a digital child health booklet. The digital booklet will empower parents and adolescents, provide access to personal health irrespective of place or time, improve sharing health information among care professionals, thus ensuring continuity of care and limiting redundancy of investigations and in addition, and provide data for public health research and monitoring. Challenges and solutions will be shared with the audience. In the third presentation, Silja Kosola from Finland will present a Finnish vision for school health care where professionals trained in public health and medicine collaborate with each other as well as with teachers for the benefit of children and adolescents. This multidisciplinary collaboration across governing bodies is especially important as Finland undergoes a national reform of social and health care services. After the three presentations, we engage the audience by asking for their experiences and sharing the examples of collaborations between public health and paediatrics, as well as barriers and facilitators. At the end of the workshop, we would like to summarize the results of the workshop in an overview of preliminary best practices. Key messages • Global climatic, societal and politic developments reveal potential risks for child health cand health care, which must be countered effectively, sustainably and equitably. • Greater integration of prevention across sectors is elemental and can be achieved through interprofessional partnerships.

Availability of data for cost-effectiveness comparison of child vision and hearing screening programmes.

For cost-effectiveness comparison of child vision and hearing screening programmes, methods and data should be available. We assessed the current state of data collection and its availability in Europe. The EUSCREEN Questionnaire, conducted in 2017-2018, assessed paediatric vision and hearing screening programmes in 45 countries in Europe. For the current study, its items on data collection, monitoring and evaluation, and six of eleven items essential for cost-effectiveness analysis: prevalence, sensitivity, specificity, coverage, attendance and loss to follow-up, were reappraised with an additional questionnaire. The practice of data collection in vision screening was reported in 36% (N = 42) of countries and in hearing screening in 81% (N = 43); collected data were published in 12% and 35%, respectively. Procedures for quality assurance in vision screening were reported in 19% and in hearing screening in 26%, research of screening effectiveness in 43% and 47%, whereas cost-effectiveness analysis was performed in 12% for both. Data on prevalence of amblyopia were reported in 40% and of hearing loss in 77%, on sensitivity of screening tests in 17% and 14%, on their specificity in 19% and 21%, on coverage of screening in 40% and 84%, on attendance in 21% and 37%, and on loss to follow-up in 12% and 40%, respectively. Data collection is insufficient in hearing screening and even more so in vision screening: data essential for cost-effectiveness comparison could not be reported from most countries. When collection takes place, this is mostly at a local level for quality assurance or accountability, and data are often not accessible. The resulting inability to compare cost-effectiveness among screening programmes perpetuates their diversity and inefficiency.

Five-Year Trends in Pediatric Vision Screening and Access in the United States

Analyses of the National Survey of Children's Health (2016-2020) demonstrated a 9.4% decrease in the proportion of children receiving eye screening from a specialist with an 85.7% increase in unmet vision care after the SARS-CoV-2 pandemic.

Comparative Analysis of Vision Screening Guidelines in the United States

Aims: To assess current school vision screening guidelines of states spread across different regions of the United States to inform quality guideline parameters and help combat preventable pediatric vision loss.&#x0D; Study Design: Cross-sectional comparative analysis.&#x0D; Methodology: States were first ordered alphabetically and then selected using an online random number generator (Alphabet Inc., Mountain View, California). States were selected until 13 available screening guidelines were identified. Each guideline was assessed using a 10-point multi-factorial scoring criteria detailed in Table 1. Descriptive statistics (mean and standard deviation) were calculated for each scoring criteria using Microsoft® Excel (version 16.63.1, Redmond, WA).&#x0D; Results: Most state guidelines included what ages to screen (84.62%, 11/13), how to screen (84.62%, 11/13), and how to follow-up with students to arrange (92.31%, 12/13) and confirm eye care delivery (76.92%, 10/13). Sadly, only the minority of state guidelines described at least two main causes of amblyopia (46.15%, 6/13), and a less than one-third of school nurse vision screening guidelines discussed the window of time to save vision in amblyopia (30.77%, 4/12). Worse yet, very few nurse vision screening guidelines explained that subjectively a child can’t tell you if they are at risk of developing amblyopia (15.38%, 2/13), or included two treatments for amblyopia (7.69%, 1/13) in the vision screening educational program.&#x0D; Conclusion: This study found that most of the assessed vision screening guidelines outlined the process of screening and follow-up but failed to emphasize why screening is important, causes, and treatment options for amblyopia. Gaps in these training guidelines may contribute to delayed recognition and treatment for amblyopia¾the leading cause of irreversible pediatric vision loss. Further improvements to vision screening guidelines are needed for school nurses and paraprofessional staff in the majority of the states evaluated.

Telemedicine in retinopathy of prematurity: Crossing borders in pediatric vision health. TELEROP study

General objectiveTo evaluate the accuracy and validity of images with smartphone compared to the RetCam® system for the diagnosis of retinopathy of prematurity (ROP). MethodologyObservational, longitudinal and masked study carried out at the Dr. Elías Santana hospital. Infants with birth weight ≤1500 g, gestational age ≤30 weeks and/or patients exposed to risk factors or complications linked to ROP were included. These subjects were screened using images with smartphone or RetCam®, both compared to conventional fundoscopy. The ICROP classification was used for staging. The main results analyzed were sensitivity, specificity, positive predictive values and kappa index. Results915 images (n = 121) were obtained, distributed in smartphone group (50.4%) and RetCam® group (49.6%) between August 2020 and March 2021. Subjects with ROP had lower gestational age (30.2 sem ± 2.8), birth weight (1361 g ± 398), and greater exposure to oxygen therapy (12.8 days ± 11.3). The RetCam® group presented sensitivity = 80%, specificity = 78%, positive predictive value = 90% and kappa index = 0.70. The smartphone group presented sensitivity = 88%, specificity = 90%, positive predictive value = 93.75% and kappa index = 0.81. ConclusionsBoth diagnostic methods were accurate to identify ROP. The smartphone group obtained superior results with excellent resolution, representing a cost-effective method to create a global impact on reducing preventable blindness in the pediatric population.

Out of sight: ROP screening in infants with significant corneal opacity

Retinopathy of prematurity (ROP) remains a leading cause of pediatric vision loss. Routine screening is therefore critical to prevent lifelong morbidity. However, limited literature exists on ROP screening in infants with severe corneal opacity and limited retinal view.

Rate of vision screening at well child checks for ages 3-5: optotype versus instrument based

Pediatric vision screening during well child checks is an integral part of determining a child's amblyopia risk. The screens are time consuming and technically difficult to perform, particularly for children ages 3-5, which can lead to a high rate of children who fail to receive a timely screen. We aim to compare the rate of successful vision screens performed with the SPOT instrument-based vision screener to traditional optotype-based visual acuity assessment. The rate of ophthalmology referral will also be evaluated.

Effectiveness of the vision screener using updated uniform 2021 AAPOS guidelines

In 2021 the AAPOS Vision Screening Committee updated the Uniform Guidelines for Instrument-Based Pediatric Vision Screen Validation. We evaluate the Spot Vision Screener in detecting amblyopia risk factors and visually significant refractive errors according to these new guidelines.

Advancing health equity in pediatric eye care: the role of school-based vision programs, community engagement, advocacy, research, and medical education

Disparities in access to pediatric vision care remain a pressing issue in the United States. School-based vision programs are regarded as a way to advance health equity, especially for disadvantaged students. While they can be beneficial, especially by providing glasses to students who need them, these programs are only part of the solution. This workshop will frame the role of school-based vision programs as part of a larger conversation about strengthening the pediatric eye care delivery system through advocacy, community engagement, research, and medical education.

Paediatric vision screening in Urban Lhasa from the Tibetan Plateau of Southwest China.

Few studies of vision screening in school-aged children were reported in Tibetan Plateau. We herein summarize the results of a mandatory vision screening conducted in young children in the Tibetan Plateau of Southwest China. The Lhasa Childhood vision Screening (LCVS) performed uncorrected distant visual acuity (UCVA) test on primary school students in urban Lhasa from July to September 2019. Pin-hole corrected VA (PCVA) was obtained for individuals with the UCVA less than 20/25. Decreased VA was defined for UCVA based on the American Academy of Pediatrics guidelines 2016 (UCVA < 20/32 for over 60 months). Visual impairment (VI), Mild VI, and moderate VI to blindness, defined as a PCVA less than 20/40, less than 20/40 to 20/63 and less than 20/63 in the better eye, respectively. Overall, 34,848 children aged 9.03 ± 1.87 years fulfilled the screening with a response rate of 98.5%. 18,412 (52.8%) of the participants were males, and 30,531(87.6%) were Tibetan. The prevalence of decreased VA, VI, Mild VI, and moderate VI to blindness was 35.6%, 4.4%, 3.5%, and 1.0%, respectively. The prevalence of decreased VA in grade 1-6 students was 28.8%, 20.8%, 26.9%, 40.7%, 50.8%, 59.5%, respectively. The prevalence of VI in grade 1 to 6 students was 1.5%, 1.4%, 2.4%, 5.6%, 7.7% and 9.9%, respectively. This study documented a relatively low prevalence of decreased VA and VI in Tibetan primary school students than other urban populations in China. An increasing trend of poor vision with grades was found.

Utilization and barriers to eye care following school-wide pediatric vision screening

ObjectifLe gouvernement ontarien lançait, en août 2018, le Protocole en matière de dépistage des problèmes de la vue et de santé visuelle chez les enfants, qui précise les modalités du dépistage des troubles visuels en milieu scolaire des enfants de la maternelle (4 à 6 ans). Nous avons examiné la prévalence des enfants à risque selon le dépistage réalisé dans une collectivité en Ontario et assuré un suivi afin de déterminer l'utilisation des ressources après le dépistage. MéthodesLes données sur le dépistage des troubles visuels (graphique oculaire HOTV, test stéréoscopique Randot, autoréfracteur) portaient sur 1127 enfants (41 écoles) examinés pendant les années scolaires 2018–2019 et 2019–2020. Un suivi téléphonique a été réalisé de 1 à 1,5 an après le dépistage afin de vérifier si un optométriste avait été consulté, si des lunettes avaient été prescrites et s'il existait des obstacles éventuels empêchant l'enfant d'avoir accès à des soins oculaires. Des tests t pour échantillons indépendants ont servi à comparer le délai avant le suivi entre les groupes, et le test du χ2 a été utilisé pour établir des liens entre la défavorisation matérielle et la défavorisation sociale. RésultatsLe dépistage s'est traduit par un taux d'orientation de 32,2 % dans notre région. D'après les enfants référés qui ont répondu, le taux de consultation d'un spécialiste de la vue après l'orientation s’élevait à 69,9 % (n = 64); 65,2 % de ces visites ont été motivées spécifiquement par le dépistage des troubles visuels; de plus, 34,4 % des enfants adressés à un spécialiste se sont fait prescrire des lunettes. On a noté un lien significatif entre le fait d’être adressé à un spécialiste et le fait de vivre dans un contexte plus défavorisé sur le plan matériel (p = 0,001) et sur le plan social (p = 0,006). Les obstacles les plus fréquents tenaient à une couverture d'assurance insuffisante en matière de soins oculaires ou d'achat de lunettes, à des problèmes en lien avec la COVID-19 et à des conflits d'horaire. ConclusionNotre programme de dépistage des troubles visuels a permis d'adresser plus du tiers des enfants qui ont fait l'objet d'un dépistage à un spécialiste en vue d'un examen de suivi; un plus grand nombre d'enfants provenant de quartiers défavorisés ont été adressés à un spécialiste. Environ les deux tiers des enfants adressés à un spécialiste ont consulté un médecin, et le tiers des sujets qui ont pris part à notre suivi se sont fait prescrire des lunettes.

The State of Patient-Reported Outcome Measures for Pediatric Patients with Inherited Retinal Disease.

Patient-reported outcome measures (PROMs) are questionnaires that assess health outcomes meaningful to the patient. PROMs have multiple applications, such as supporting clinicians’ decision-making for patient care, understanding the impact of disease on patient functioning, and evaluating the efficacy of therapeutics. Though PROMs were developed for various eye conditions, no PROM was tailored to pediatric patients with inherited retinal disease (IRD). Hence, a literature search was conducted using MEDLINE and Embase to identify PROMs potentially relevant to this patient population. This review evaluated selected pediatric PROMs against the US Food and Drug Administration (FDA) guidelines and found restricted use in the context of IRD. As there is a need for PROMs tailored to pediatric patients with IRD, we provide a perspective on applying the International Society for Pharmacoeconomics and Outcomes Research and FDA standards on the development of PROMs specific to IRD.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-022-00514-x.

Towards the development of a uniform screening guideline: Current status of paediatric vision screening in Abia State, Nigeria

Background: Vision screening is an important component of any child eye health system. Availability of standardised and broad screening guidelines is important to its success because it will allow for uniform and full utilisation of services through the system.Aim: This study aimed to evaluate the coverage, components, and referral criteria of the paediatric vision screening services in Abia State, Nigeria, towards the development of a uniform vision screening guideline.Methods: Eighty-three registered optometrists practising in Abia State for at least one year prior to the commencement of the study were invited to participate. Self-administered questionnaires were distributed directly or via email to the optometrists. The questionnaire covered areas such as the participation of optometrists in paediatric vision screening, coverage of the screening programmes, screening tools and referral criteria.Results: A response rate of 77.1% (64 participants) was recorded for the survey. Twenty-eight (43.8%) respondents offered more than one paediatric vision screening outside their practice in the last year before the survey. Among those respondents, 20 were from the private sector and 20 were based in urban cities. Only 10 respondents undertook more than four paediatric screening services within this period. Visual acuity measurement and ocular health assessment were the main components of the screening batteries of optometrists. While a child with any disease abnormality was referred for evaluation, the referral criteria for a full examination were inconsistent.Conclusion: The existing paediatric screening programmes in Abia State are inadequate. Of the few conditions that are screened for, varied referral criteria for further examination are applied. It therefore appears that the current screening programmes are not meeting the visual needs of the paediatric population and suggests the need for a new strategy to improve vision screening provisions to children in Abia State.