Pediatric Vision Research Articles

Screening of school children between age group of 5-15 years to detect the prevalence of amblyopia and type of amblyopia

Background: Amblyopia is the most common cause of monocular vision loss in children and as amblyopia is a major preventable and treatable cause of pediatric low vision, early detection and treatment of amblyopia is very important to reduce the prevalence of amblyopia. Materials and Methods: A cross sectional study was conducted during the school health check up visits conducted by ophthalmology department in tertiary care teaching hospital for screening of eye disorders in school children who belongs to the age group of 5-15 years over a period of 1 year in which 813 children underwent screening, among them 110 children with the reduced vision were referred to hospital for detailed ophthalmic evaluation which includes cycloplegic refraction and dilated fundus examination. Amblyopia was detected in children with reduced best corrected visual acuity. Results: A total of 813 study subjects were screened. Out of them 110 (13.5%) were found to have diminished vision. When the study subjects with diminished vision were subjected for further tests, 18 (2.2%), (p value is 0.494) of them were found to have amblyopia. Amblyopia was present in 10 (18.9%) females and 8 (14%) males. Anisometropic amblyopia was the most common type of amblyopia found in 10 (55.6%) study subjects, followed by meridional and strabismus type of amblyopia in 4 cases each (22.2%). Among strabismus, exotropia was seen in more study subjects 4(0.5%) than esotropia in 2 cases (0.2%). A higher number of moderate grade of amblyopia was seen than mild grade of amblyopia.Conclusion: The results indicate the importance of screening school going children for amblyopia and the importance of early detection and treatment.

Global burden of paediatric vision impairment: a trend analysis from 1990 to 2017.

To assess the trend of paediatric visual impairment and its disparities by year, sex, age and national socioeconomic levels using disability-adjusted life years (DALYs). It is a retrospective analysis of data from the Global Burden of Disease (GBD) 2017. Global and national DALY numbers and rates of vision impairment in three paediatric age groups of 1-4 (preschool children), 5-9 (school children) and 10-14 years (teenagers) years were obtained from the GBD 2017 database. The socioeconomic indices for 195 countries were derived from international open databases. Main outcome measures were comparison of DALYs due to paediatric vision impairment in different age groups by socioeconomic indicators in 2017 and analysis of the trend from 1990. The global prevalence of distance and/or near vision impairment for 1-14 years was 2.8% (95% uncertainty interval (UI): 2.5-3.1) in 2017. The highest DALYs for distance and/or near vision impairment [number=589.93 thousands (95%UI: 367.71-933.29), rate = 92.72 (95%UI: 57.79-146.68)] were observed in teenagers. DALY rate of distance and/or near vision impairment was not associated with socioeconomic indicators, however, DALY rate of refractive disorders had positive correlation with national socioeconomic development. The global trends of DALY numbers in distance and/or near vision impairment as well as refractive and other causes remained stable from 1990 to 2015 (0.128 ≤ P ≤ 0.738), however, DALY rates had a statistically significant trend of reduction in all paediatric age groups (0.003 ≤ P ≤ 0.024). The global health burden of paediatric vision impairment decreased from 1990. Refractive, near vision impairment and other causes were associated with socioeconomic development.

The Pediatric Workforce: Recent Data Trends, Questions, and Challenges for the Future.

The future of the pediatric workforce has been the subject of significant dialogue in the pediatric community and generated much discussion in the academic literature. There are significant concerns regarding the ability of pediatricians to meet the growing demands of our pediatric population. Over the past 5 years, there has been a decline in the percentage of doctor of osteopathic medicine students who pursue a career in pediatrics but an equally important increase in the number of pediatric positions that are filled by doctor of osteopathic medicine students and international medical graduates. Although there has been an increase in the number of pediatric positions offered in the National Resident Matching Program, the last 4 years have seen a significant increase in the number of unfilled pediatric positions. A number of pediatric subspecialties struggle to fill their training positions, and those with low match rates may have 20% to 40% fewer applicants than positions. The pediatric vision for the future must include a commitment to a comprehensive strategic planning process with the many organizations involved across the multiple stages of the educational continuum. It is time to elucidate and address the questions raised by the workforce data. Developing solutions to these questions will require a careful planning process and a thoughtful analysis of the pediatric workforce data. Establishing this as an important priority will require a major collaborative effort between pediatric academic and professional organizations, but the future benefit to the nation's children will be significant.

Diagnostic accuracy of the Parr vision test, single crowded Lea symbols and Spot vision screener for vision screening of preschool children aged 4-5years in Aotearoa/New Zealand.

Preschool children in New Zealand undergo vision screening to detect amblyopia at 4-5years of age. The current test, the Parr vision test, does not meet international visual acuity chart guidelines and has not been validated against other commonly used paediatric vision tests. New Zealand vision screening protocols are also not targeted for detecting other eye conditions such as uncorrected refractive error, which may affect school performance. We compared the Parr vision test with the single crowded Lea symbols and the Spot vision screener for detecting ocular pathology, refractive error and amblyopic risk factors in preschool children. A cross-sectional diagnostic accuracy study recruited children aged 4-5years via convenience sampling from the University of Auckland Optometry Clinic and through primary schools in Auckland, New Zealand. Participants received vision screening with the three different instruments administered by a lay screener. Comprehensive eye examinations were completed by a paediatric optometrist to determine the presence of vision disorders. Of 197 children who received a comprehensive eye examination, 14 (7.1%) had amblyopic risk factors and 43 (21.8%) had significant refractive error (15.7% with astigmatism, 9.1% with hyperopia). The sensitivity for detecting any ocular condition did not differ significantly between the tests (50.0% for Parr, 43.5% for Lea, 42.5% for Spot). Specificity was significantly lower for the Parr vision test (80.8%) than for the Lea symbols (93.4%) and Spot vision screener (98.0%). Adding the Spot vision screener to measurements of visual acuity significantly improved sensitivity in detecting any ocular condition with the Parr vision test (67.5% for Parr/Spot vs 50% for Parr alone), but not with the Lea symbols (52.5% for Lea/Spot vs 43.5% for Lea alone). The sensitivity of the Parr vision test for detecting ocular conditions in preschool children does not vary significantly from that achieved by the Lea symbols or the Spot vision screener. However, current New Zealand vision screening protocols could be improved by expanding the target conditions to include significant refractive error and incorporating the use of the Spot vision screener to increase the accuracy with which children with refractive error are identified. Future research should include longitudinal studies to determine the effect of preschool vision screening on later ocular and academic outcomes.

Prevalence and Factors Associated With Eyeglass Wear Compliance Among Preschoolers From Low-Income Families in San Francisco, California

Despite growing support for early school-based vision screening and eyeglass provision, few studies have rigorously monitored the compliance of eyeglass wear among preschool-aged children who receive eyeglasses through such programs. To assess the prevalence and factors associated with eyeglass wear compliance among preschoolers from low-income families who receive eyeglasses through the See Well to Learn program. Longitudinal cross-sectional study of eyeglass wear compliance patterns among 188 children 3 to 5 years of age from 51 Bay Area Head Start preschools in San Francisco, California. The study conducted during the 2017 to 2018 school year included students with a failed vision screening who met predetermined refractive criteria following cycloplegic refraction and received eyeglasses through the See Well to Learn program. Eyeglass distribution. Eyeglass wear compliance, measured by a school-year's worth of weekly teacher reports, was a longitudinal measure of consistent eyeglass wear, defined by eyeglass wear for more than 50% of every school day (compliance score of 4). Of 188 students (91 boys [49%]; 94 girls [51%]; mean [SD] age, 3.89 [0.5] years), 133 (71%; 95% CI, 64%-77%) maintained a mean compliance score throughout the school year of 4 or higher. Compliance prevalence was relatively stable throughout the school year, ranging from 139 students (74%) to 164 students (87%). Baseline uncorrected visual acuity in both the better-seeing and worse-seeing eyes was the only assessed factor that was associated with compliance. In the better-seeing eye, the mean uncorrected visual acuity of students with eyeglass wear compliance was 0.473 logMAR (95% CI, 0.433-0.514) (Snellen equivalent, 20/60) compared with 0.394 logMAR (95% CI, 0.334-0.454) (Snellen equivalent, 20/50) for students with noncompliance (P = .03). In the worse-seeing eye, the mean uncorrected visual acuity of students with compliance was 0.576 logMAR (95% CI, 0.530-0.623) (Snellen equivalent, 20/75) compared with 0.492 logMAR (95% CI, 0.433-0.551) (Snellen equivalent, 20/62) for students with noncompliance (P = .03). In the better-seeing eye, the difference between students with compliance vs noncompliance was 0.079 logMAR (95% CI, 0.009-0.150) (5 Snellen letter difference) compared with 0.084 logMAR (95% CI, 0.007-0.160) (5 Snellen letter difference) in the worse-seeing eye. This study found that nearly 3 of 4 preschool students consistently wore their glasses at school during their first year of use, supporting the continued implementation of preschool-based vision screening programs. These findings suggest that programs involving school-based screening and eyeglass delivery may lessen disparities in accessing pediatric vision care. Consistent with previous studies, students with poorer uncorrected baseline visual acuity were found to be more likely to wear eyeglasses compliantly.

Actual Visual Acuity Demands in the Classroom

Purpose: To address the knowledge gap regarding the actual acuity requirements needed in typical kindergarten through grade 12 classrooms by determining an actual logarithm of the minimum angle of resolution (logMAR) and contrast sensitivity requirements in a sample of classrooms for kindergarten through grade 12 in New York City. Methods: Measurements of classroom dimensions with specific attention to viewing distances were made in public and private school classrooms, at various grade levels from kindergarten through grade 12, in New York City. The dimensions of typical text shown to students on classroom smartboards and whiteboards was measured and the mean and range of logMAR values were calculated for various seating locations within the classrooms. Contrast between text and background was estimated by comparing digital images of actual classroom text to Pelli-Robson contrast sensitivity charts. Results: Fourteen classrooms in five schools were evaluated. Classroom dimensions varied from 8 × 10 feet to 23 × 23 feet. Mean logMAR values of lower case text on smartboards and whiteboards varied from 0.93 ± 0.29 (range: 0.83 to 1.32) in the center of the front row to 0.46 ± 0.21 (range: 0.10 to 0.79) in the center of the back row ( P < .001). Contrast was also variable, being highest for black markers on whiteboards (0.00) and lowest on smartboards (0.15 to 0.60). Neither logMAR nor contrast sensitivity values varied significantly by grade level or school ( P > .50 for both). Conclusions: The data reveal that logMAR demands and contrast vary substantially from classroom to classroom and within a classroom based on room dimensions and seating. Although generally supporting current acuity-based pediatric vision screening referral guidelines, the data also provide insight into the potential impact of reduced visual acuity and seating location on visual performance in the classroom. These findings suggest the need to develop logMAR and contrast standards that optimize visual content in classrooms while accommodating a wider range of visual capabilities. [ J Pediatr Ophthalmol Strabismus . 2021;58(1):48–54.]

‘Failure’ of laser prophylaxis in an eye with stickler syndrome

Background: Stickler syndrome is one of the most common inherited connective tissue disorders and is an important cause of pediatric vision loss due to a high risk of retinal detachment in these patients. Methods: Case report. Case summary: This case reports describes the clinical course of a 10 year old boy with Sticklers Syndrome who underwent bilateral peripheral laser prophylaxis. During routine follow up, he was found to have an asymptomatic giant retinal tear (GRT) with limited sub-retinal fluid expansion due to prior prophylactic laser. He underwent surgery with vitrectomy and scleral buckle with vision remaining at 20/25 at 6 month follow up. Conclusion: Although the utility of laser prophylaxis in Stickler patients is debated, this case demonstrates that after laser prophylaxis, even if GRT develops, expansion can be limited. Laser prophylaxis along with frequent examinations, can prevent development of PVR and complex detachments and preserve macular function with excellent visual outcome.

Benefits of consulting a certified orthoptist in a pediatric vision screening program

In Japan, all 3-year-old children undergo a three-step municipal vision screening that includes home-based screening, secondary screening at a health center, and comprehensive ophthalmologic examination, if warranted. We investigated whether screening by a certified orthoptist (CO) could improve the detection of visual dysfunctions, including amblyopia. Three-year-olds in Nobeoka City were invited to undergo primary and secondary screenings from April 2008 to March 2011. COs performed the secondary screening tests; children with a positive secondary screening received a comprehensive ophthalmologic examination. Of the 3,303 eligible children, 98 were positive on detailed examination. Of these, 25% were classified as false-negatives. Eight children with amblyopia in the false-negative group accounted for 24% of all 33 amblyopia cases detected on detailed examination.

Pediatric Eye Care: We Cannot Lose Sight of Its Importance despite the COVID-19 Pandemic

ABSTRACT Visual impairment affects over 19 million children globally and, if left untreated, can result in significant ocular morbidity. Due to the treatable nature of many childhood visual disturbances, pediatric vision screening is essential for optimization of health and developmental outcomes. The coronavirus disease 2019 (COVID-19) pandemic has inevitably disrupted the provision of routine pediatric health care as evidenced by reduced adherence to vaccination schedules. Further, the home environment, which many children have now become confined to, is known to pose risk for eye trauma which may result in irreversible vision loss. Therefore, it is imperative for pediatricians and pediatric ophthalmologists to focus on eye health and safety, despite the backdrop of a global pandemic.

Validation of the Pediatric Vision Scanner (PVS) in a normal preschool population

Purpose: The Pediatric Vision Scanner (PVS) is a binocular retinal birefringence scanner designed to identify young children with amblyopia and strabismus, two common causes of preventable vision loss. While the PVS has been shown to be highly sensitive and specific in an enriched population, validation is lacking in a general pediatric setting. We conducted a prospective clinical trial to assess the performance of the PVS in a non-enriched population. Methods: We recruited 300 children ages 2 to 5 years with no pre-existing eye conditions from Kaiser Permanente …

Validation of the Pediatric Vision Scanner (PVS) in a normal preschool population

Validation of the Pediatric Vision Scanner (PVS) in a normal preschool population

Implementation of Telehealth for Vision Therapy in an Academic Setting

In response to the COVID-19 pandemic, Midwestern University Eye Institute located in Glendale, Arizona rescheduled all nonessential eyecare, including the Vision Therapy services. Postponing weekly vision therapy sessions posed two primary problems for both the patients of the Eye Institute and the third- and fourth-year optometry students. First, it would disrupt the treatment plan for patients, many of whom were in the middle of their therapy program. Second, this would severely limit third- and fourth-year optometry student exposure to the field and reduce their overall patient encounter numbers. Therefore, the Arizona College of Optometry (AZCOPT) Pediatric and Binocular Vision faculty and staff developed a contingency plan to implement Telehealth Vision Therapy for approved patients with the goals of continuing weekly vision therapy sessions and increasing patient encounters for optometry students. This implementation proved to be successful, with patients continuing therapy at home with self-reported improvement in symptoms. The department’s implementation became a model for the Eye Institute’s overall rollout of telemedicine services.

Reliability and validity of the PedsQL 4.0 Generic Core Scales in pediatric vision impairment

The PedsQL 4.0 is a generic health-related quality-of-life (HRQoL) instrument that has been used across many pediatric health conditions. The purpose of this study was to investigate its use in children with vision impairment and to test its ability to distinguish between visually impaired and normally sighted children. Children with vision impairment and age-matched controls underwent vision testing, including binocular best-corrected distance visual acuity. They completed the PedsQL 4.0 Generic Core Scale Child Report (ages 8-12) or Teen Report (ages 13-18), as appropriate. Parents completed the Parent Proxy Report in a room separate from their children. Analyses included descriptive statistics, intraclass correlations, t tests, and determination of Cronbach's α for subscales. A total of 70 study subjects and 44 controls were included. Groups were similar with regard to age, race, and sex. PedsQL 4.0 subscales showed no floor effects; however, some scales had ceiling effects of up to 28% in certain groups. Cronbach's α was excellent (0.88) for all subscales and reports. PedsQL 4.0 total score for children with vision impairment differed significantly from that for normally sighted children for both age groups and for both parent and child reports. Total score was also significantly associated with visual acuity. Parent and child reports correlated poorly (ICC, <0.5), highlighting the importance of both perspectives. The PedsQL 4.0 can be used to assess HRQoL in children and teens with low vision. It has internal consistency reliability, and construct validity.

Parent and Teacher Perspectives on Factors Decreasing Participation in School-Based Vision Programs

ABSTRACTPurpose: To examine factors decreasing participation in school-based vision programs from parent and teacher perspectives.Methods: We conducted 41 semi-structured focus groups (20 parent groups, 21 teacher/staff groups), at 10 Baltimore and 11 Chicago public elementary and middle schools offering school-based vision programs. School-based vision programs provided vision screening, eye exams, and eyeglasses if needed. Focus groups ranged in size from 2–9 participants (median = 5). Sessions were recorded, transcribed, and coded through an iterative process to develop themes using inductive analysis.Results: Ninety parents and 117 teachers/staff participated. Participants identified five major factors decreasing participation in school-based vision programs: (1) challenges with the consent form, including distribution, collection, and literacy and language barriers; (2) having existing eye care; (3) misunderstandings about the program, especially related to cost and insurance; (4) difficulty raising parental awareness of the program; and (5) certain attitudes towards vision, eye care, and school-based programs, including low prioritization of eye care, mistrust of the program, fear of sharing private information, not believing their child needs glasses, and reluctance accepting ‘subsidized’ services.Conclusion: Parents and teachers identified important structural barriers to participation (i.e., consent form challenges and low parental awareness) and specific reasons for non-participation (i.e., attitudes, misunderstanding of the program, existing eye care) in school-based vision programs. Effective strategies are needed to facilitate return of consent forms and promote awareness of school-based vision programs among parents. Programs should also target services towards those currently without access to eye care and increase awareness about paediatric vision needs.

Evidence-Based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination

Republished with written permission granted from the American Optometric Association, October 2, 2020.

Evaluation of Amblyopia in School Going Children

Background and Objective: Amblyopia is the most common cause of monocular vision loss in children and as amblyopia is a major preventable and treatable cause of pediatric low vision, early detection and treatment of amblyopia is very important to reduce the prevalence of amblyopia. This study was done to determine the prevalence of amblyopia in school going children in the age group of 5-15 years in and around Jaipur and also to detect the types of amblyopia in these children.

Evaluation and management consideration for children who are visually impaired

Clinical low vision evaluations provided by optometrists or ophthalmologists trained and experienced in low vision rehabilitation care should be recommended for all children with a visual impairment, regardless of the cause of their vision loss, their age or the severity of their additional disabilities. This article discusses an effective model for pediatric vision rehabilitation service.

National consensus statement regarding pediatric eye examination, refraction, and amblyopia management.

Childhood blindness causes significant social and economic burden. Even though pediatric eye care has gained priority under Vision 2020, it continues to come under the purview of tertiary care centers due to lack of knowhow and facilities at primary and secondary level. Currently, India does not have standard guidelines on pediatric eye examination, refraction, and amblyopia management and therefore these are being managed inadequately or inappropriately. In view of this, an expert group of pediatric ophthalmologists from across the country met under the aegis of All India Ophthalmological Society, and deliberated to reach a consensus on the correct method of pediatric eye examination, treating refractive error in children and managing amblyopia. The purpose of the consensus statement was to enable all ophthalmologists to have a broad set of guidelines, which can form the basic framework for managing common pediatric eye conditions, in most ophthalmic setups. The consensus statement is divided into three broad categories: Pediatric eye examination, pediatric refraction, and amblyopia management. The pediatric eye exam subsection discusses the recommended clinical history, which should be taken and the essential components of an ophthalmic examination including pediatric vision assessment. Additionally, it discusses the role of special tests and investigations such as imaging and electrophysiology. The section on pediatric refraction emphasizes the correct use of cycloplegia and prescribing glasses in the Indian context. The final section on amblyopia management presents the various options of treating amblyopia and provides standard guidelines for the use of occlusion therapy and its weaning over time.

Evaluation of the PlusoptiX photoscreener in the examination of children with intellectual disabilities.

PURPOSE:This study aimed to determine whether the plusoptiX vision screener (PVS) can be used to detect amblyogenic risk factors (ARFs) as defined by the American Association for Paediatric Ophthalmology and Strabismus Vision Screening Committee guidelines (2013) for automated vision screening devices.METHODS:In this cross-sectional study, children attending a special needs school underwent screening with the PVS and complete ophthalmologic examinations. Ophthalmologic examinations were used as the gold standard to compute the prevalence, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and testability.RESULTS:Forty-four children with special needs (mean age, 8.5 years; range, 4–18 years) were included. The PVS recommended referral of 31 cases (referral rate 70%). Thirty-nine of the 44 children (89%) met the referral-positive threshold for strabismus, reduced vision and/or amblyogenic factors on examination. The plusoptiX had a sensitivity of 40% (confidence interval [CI] 7%–83%), specificity of 78% (CI 55%–85%), PPV of 15% (CI 3%–46%), and NPV of 90.3% (CI 73%–97%). The PVS underestimated refractive errors by 0.67 to 0.71 D in the right (P < 0.001) and left eyes (P = 0.002). Testability was relatively low, with the PVS at 75% compared to the gold standard examination at 100%.CONCLUSION:We found that although the plusoptiX photoscreener might be a useful tool in pediatric vision screening, it might not perform as well in children with intellectual disabilities. Utilization of the PVS as a single screening device may fail to identify a considerable proportion of young children with ARFs or amblyopia.

Comment on the Article: Comparison of the Pediatric Vision Screening Program in 18 Countries Across Five Continents.

Comment on the Article: Comparison of the Pediatric Vision Screening Program in 18 Countries Across Five Continents.