Screening For Refractive Errors Research Articles

Characteristics of refractive development in children aged 4 months to 8 years in urban China: A retrospective screening analysis.

To conduct a large retrospective study of screening refractive error in young children. This retrospective study included children aged from 4 months to 8 years in Daxing District, Beijing, who underwent refractive examinations without cycloplegia. It included a cross-sectional assessment of refractive error screening for all children, and a longitudinal component for a subgroup with data available for two to five visits. A total of 14,987 children were included in the cross-sectional study. In the group <1 year of age, the percentage of children with a spherical equivalent (SE) >+2.00 D or with cylinder <-1.50 D was 15.25% and 33.24%, respectively. These were significantly higher than for the 1- to 4-year-old group (SE 8.1% higher, cylinder 13.2% higher) (χ2 = 53.57, p < 0.001; χ2 = 790.39, p < 0.001). Furthermore, 34.83% of children in the 0-year-old group had amblyopia risk factors (ARFs). In the 4-year-old group, boys had a significantly longer axial length (AL) than girls (differences in the right and left eyes were 0.53 and 0.56 mm, respectively; z = 5.48 p < 0.001, z = 5.80, p < 0.001). AL increased with age, while the AL difference between boys and girls remained stable at 4-8 years of age. The percentage of children aged 5-8 years with myopia in 2020-2021 was significantly higher than that in 2018-2019 (H = 12.44, p = 0.006). In the longitudinal study of 4406 children (up to 12-month follow-up), annual changes in SE were -0.27, -0.06, 0.19 and 0.13 D between 0 and 3 years, and -0.38, -0.58, -0.70 and -0.75 D between 5 and 8 years. Children's refractive error varied significantly from ages 4 months to 1 year, with a high proportion having ARFs. Children aged 5-8 years showed a trend towards myopia. The prevalence of myopia in the cross-sectional analysis in 2020-2021 was greater than in 2018-2019. Screening refraction changed minimally over a 12-month period for children aged 1-3 years, but became more myopic for children aged 5-8 years.

Visual and Ocular Characteristics of Anisometropic Children.

To compare the demographic and ocular characteristics of patients with low and high levels of anisometropia compared with non-anisometropic individuals. This cross-sectional study was conducted on 1803 individuals (age range, 1 to 30 years) examined at strabismus clinics between January 2019 and December 2020. Of these, 203 subjects had anisometropia (11.2%); 66 cases were excluded due to the history of prior ocular surgery except from strabismus surgery. Finally, data from 137 subjects were analyzed. Spherical or cylindrical differences of 1.50 or 3.00D between the two eyes were defined as low or high anisometropia, respectively, and isometropic subjects (n = 1600) served as controls. No significant difference was observed between cases and controls regarding age (10.25 8.41 vs. 9.2 1.7 years; P = 0.133) and sex (P = 0.051). History of ocular surgery was present in 33% of anisometropic patients versus 0.8 % of isometropic cases. The rate of amblyopia was 83% and 2.3% in anisometropic and non-anisometropic groups, respectively. Best corrected visual acuity (BCVA) was comparable in amblyopic eyes in both study groups, while BCVA of non-amblyopic eyes of non-anisometropic subjects was better (non-anisometropic: 0.01 0.01 vs. anisometropic: 0.06 0.17 LogMAR; P = 0.001). Eye deviation was significantly more prevalent among anisometropic patients (36.5% vs. 3.25%, P 0.001) and exotropia was the common type of deviation. Anisohyperopia and anisomyopia were the most common refractive errors under low and high anisometropia categories, respectively. Simultaneous manifestation of amblyopia and strabismus were observed in 30.6% of anisometropic cases, while only 0.7% of subjects with isometropia had a similar status (P 0.001). High rates of amblyopia and strabismus in anisometropic subjects, especially with higher degrees of anomaly, indicate the necessity of early visual acuity and refractive error screening to improve detection and enhance the outcomes of treatment.

Evaluation of Hypertensive Disorder of Pregnancy and High Refractive Error in Offspring During Childhood and Adolescence

Growing evidence indicates that adverse prenatal or intrauterine environments might contribute to the development of high refractive error (RE) later in life. However, the association of maternal hypertensive disorder of pregnancy (HDP) with high RE in offspring during childhood and adolescence remains unknown. To investigate the association between maternal HDP and overall and type-specific high REs in offspring in childhood and adolescence. This nationwide population-based cohort study included live-born individuals born in Denmark from 1978 to 2018 in the Danish national health registers. Follow-up started at the date of birth and ended at the date of RE diagnosis, 18th birthday, death, emigration, or December 31, 2018, whichever came first. Data analyses were conducted from November 12, 2021, through June 30, 2022. Maternal HDP (n = 104 952), including preeclampsia or eclampsia (n = 70 465) and hypertension (n = 34 487). The main outcomes were the first occurrence of high RE (hyperopia, myopia, and astigmatism) in offspring. A Cox proportional hazards regression model was used to examine the association between maternal HDP and risk of high RE in offspring from birth until age 18 years, adjusting for multiple potential confounders. This study included 2 537 421 live-born individuals, 51.30% of whom were male. During the follow-up of up to 18 years, 946 offspring of 104 952 mothers with HDP (0.90%) and 15 559 offspring of 2 432 469 mothers without HDP (0.64%) were diagnosed with high RE. The cumulative incidence of high RE was higher in the exposed cohort (1.12%; 95% CI, 1.05%-1.19%) than in the unexposed cohort (0.80%; 95% CI, 0.78%-0.81%) at 18 years of age (difference: 0.32%; 95% CI, 0.25%-0.40%). Offspring born to mothers with HDP had a 39% increased risk of overall high RE (hazard ratio [HR], 1.39; 95% CI, 1.31-1.49). Sibling-matched analysis revealed an increased risk of overall high RE in half siblings (HR, 1.21; 95% CI, 1.05-1.39) and full siblings (HR, 1.15; 95% CI, 0.99-1.34), but the difference was not significant for the latter. The elevated risks were observed for hypermetropia (HR, 1.41; 95% CI, 1.30-1.52), myopia (HR, 1.30; 95% CI, 1.10-1.53), and astigmatism (HR, 1.45; 95% CI, 1.22-1.71). The increased risk of high RE persisted among offspring aged 0 to 6 years (HR, 1.51, 95% CI, 1.38-1.65), 7 to 12 years (HR, 1.28; 95% CI, 1.11-1.47), and 13 to 18 years (HR, 1.16; 95% CI, 0.95-1.41), but the difference was not significant for the oldest group. When considering both timing of diagnosis and severity of maternal preeclampsia, the highest risk was observed in offspring prenatally exposed to early-onset and severe preeclampsia (HR, 2.59; 95% CI, 2.17-3.08). In this cohort study of the Danish population, maternal HDP, especially early-onset and severe preeclampsia, was associated with an increased risk of high RE in offspring during childhood and adolescence. These findings suggest that early and regular RE screening should be recommended for children of mothers with HDP.

Towards Automating Retinoscopy for Refractive Error Diagnosis

Refractive error is the most common eye disorder and is the key cause behind correctable visual impairment, responsible for nearly 80% of the visual impairment in the US. Refractive error can be diagnosed using multiple methods, including subjective refraction, retinoscopy, and autorefractors. Although subjective refraction is the gold standard, it requires cooperation from the patient and hence is not suitable for infants, young children, and developmentally delayed adults. Retinoscopy is an objective refraction method that does not require any input from the patient. However, retinoscopy requires a lens kit and a trained examiner, which limits its use for mass screening. In this work, we automate retinoscopy by attaching a smartphone to a retinoscope and recording retinoscopic videos with the patient wearing a custom pair of paper frames. We develop a video processing pipeline that takes retinoscopic videos as input and estimates the net refractive error based on our proposed extension of the retinoscopy mathematical model. Our system alleviates the need for a lens kit and can be performed by an untrained examiner. In a clinical trial with 185 eyes, we achieved a sensitivity of 91.0% and specificity of 74.0% on refractive error diagnosis. Moreover, the mean absolute error of our approach was 0.75±0.67D on net refractive error estimation compared to subjective refraction measurements. Our results indicate that our approach has the potential to be used as a retinoscopy-based refractive error screening tool in real-world medical settings.

Predictive Value of Brückner Test in Detecting Refractive Errors among Children

Introduction: Uncorrected refractive errors form a major ocular morbidity in children. They often go unnoticed and affect child development. The prevalence of refractive error in Indian children is 10.8%. They are known to affect the overall development of children. However, if the error is high it could lead to amblyopia or strabismus. Snellen’s visual acuity along with cycloplegic refraction is an accepted method to detect refractive errors, but in children, it needs special skill, patience and understanding. The Brückner test is useful for early detection of refractive errors especially in children. Aim: To re-evaluate the results of Brückner test in the form of sensitivity, specificity and provide data about a simpler, easy, ergonomic technique for mass screening of refractive errors. Materials and Methods: This cross-sectional study was conducted at Bharati Hospital (tertiary care hospital), Pune, Maharashtra, India, among 532 children (1064 eyes) in the age group of 2-15 years visiting the Ophthalmology Outpatient Department from October 2018 to September 2020. Position and size of pupillary crescent was recorded among children with direct ophthalmoscope. Children were classified according to errors of refraction as Emmetropia (no crescent), Myopia {inferior crescent (mild (&lt;1/3), moderate (1/3-2/3), high (&gt;2/3)}, Hypermetropia {superior crescent (mild (&lt;1/3), moderate (1/3-2/3), high (&gt;2/3)}. Subsequently, cycloplegic refraction was performed using auto-refractometer. Sensitivity, specificity, positive predictive value and negative predictive value of the test for emmetropia, myopia and hypermetropia were calculated. Subjective refraction was prescribed to children diagnosed with refractive errors during the course of this study. Results: A 275 females and 257 males (mean age 8.3 years) were included in this study, out of which, the study found 354 Emmetropic eyes, 326 Myopic eyes and 384 Hypermetropic eyes. Sensitivity of Brückner for emmetropia was 86.4%, specificity was 95.2%. Whereas for myopia, sensitivity was 95.1% and specificity was 94.6%. Also for hyperopia sensitivity was 95.3% and specificity was 98.8%. The crescent size was found to be significant (p-value&lt;0.001) in diagnosing grades of myopia and hypermetropia as divided. Conclusion: The Brückner test has good sensitivity, specificity, positive and negative predictive value. It is a useful, accurate, and simple screening test.

Impact of Covid 19 pandemic on pattern of paediatric inpatient referral for ophthalmic consultation in a teaching institute hospital

Importance:Pediatric inpatient referral for Ophthalmology consultations are often requested to evaluate a variety of conditions at a teaching institute hospital. The on-going coronavirus disease (COVID-19) pandemic has affected every aspect of health care in general, including inpatient referrals that could result in long term adverse effect due to the delay in screening, management and providing of required care. Objective: To know the change in paediatric inpatient referral pattern for ophthalmic consultation from pre COVID to COVID times and the effect of the same on visual morbidity. Design, Setting, and Participants: This retrospective record review study included paediatric inpatient references for ophthalmology consultation in a teaching institute hospital from Dec 2019 to May 2020. Result: Of the total 67 inpatient referrals requested, 45 were during preCOVID-19 times (group 1) and 22 during COVID-19 pandemic (group 2). Mean age was 4.85 ±4.47 and 4.55 ± 4.35 years in group 1 and 2 respectively. Refractive error was the cause for referral in 10 patients in group 1 and none in group 2(P=0.019). Referral for optic disc oedema assessment was seen in 6 and 15 in group 1 and 2 respectively (P=0.000). 2 and 4 patients were referred in group 1 and 2 respectively to screen for cataract (P=0.069) of which a group 1 patient was diagnosed and treated for the same. While 10 and 2 patients were referred for ophthalmic screening (P=0.193), it was 3 and 1 for strabismus (P=0.732) respectively in group 1 and 2. Conclusion: COVID times adversely affected the inpatient refractive error screening, a cause of amblyopia in older patients. In patient referral for papilledema screening increased despite the pandemic as the condition is considered an emergency.

Improving Access to Refractive Services in Adults: A Health Examination Center-Based Model

Purpose: To assess the potential of a health examination center-based screening model in improving service for uncorrected refractive error.Methods: Individuals aged ≥18 years undergoing the routine physical examinations at a tertiary hospital in the northeast China were invited. Presenting visual acuity, noncycloplegic autorefraction, noncontact tonometry, fundus photography, and slit-lamp examination were performed. Refractive error was defined as having spherical equivalent ≤ -0.75 D or ≥ +1 D and uncorrected refractive error was considered as refractive error combined with presenting visual acuity < 6/12 in the better eye. Costs for the screening were assessed.Results: A total of 5,284 participants (61 ± 14 years) were included. The overall prevalence of myopia and hyperopia was 38.7% (95% CI, 37.4–40.0%) and 23.5% (95% CI, 22.3–24.6%), respectively. The prevalence of uncorrected refractive error was 7.85% (95% CI, 7.13–8.58%). Women (p < 0.001 and p = 0.003), those with age ≥ 70 years (p < 0.001 and p = 0.003), and myopia (p < 0.001 and p < 0.001) were at higher risk of uncorrected refractive error and uncorrected refractive error-related visual impairment. Spectacle coverage rate was 70.6% (95% CI, 68.2–73.0%). The cost to identify a single case of refractive error and uncorrected refractive error was US$3.2 and US$25.2, respectively.Conclusion: The prevalence of uncorrected refractive error is high in the urban Chinese adults. Health examination center-based refractive error screening is able to provide an efficient and low-cost model to improve the refractive services in China.

COMPARISON OF SMARTPHONE-BASED AND AUTOMATED REFRACTION WITH SUBJECTIVE REFRACTION FOR SCREENING OF REFRACTIVE ERRORS

ABSTRACT Purpose To compare Netra smartphone-based and automated refraction with subjective refraction for screening of refractive errors. Methods Cross-sectional study at the University of Malaya Medical Centre, Kuala Lumpur. Subjects underwent subjective refraction, then automated refraction, and finally Netra smartphone-based refraction. All results were converted to power vectors (M, J0 and J45) and were analysed using repeated-measures ANOVA and Bland-Altman plots. Sensitivity and specificity were determined. The best cut-off points were determined from ROC curve analysis. P < .05 was considered statistically significant. Results Data from the right eyes of 204 subjects were analysed. Mean age was 36.6 ± 15.7 years (range 16–78 years). Spherical equivalent [mean (95% CI)] from Netra and automated refraction were similar, and both more myopic than subjective refraction; −2.87 (−3.23 to −2.51), −2.85 (−3.21 to −2.49) and −2.46 (−2.83 to −2.10) respectively (p < .001). Differences in J0 and J45 between Netra and subjective refraction were not statistically significant (0.10 vs 0.11 and 0.01 vs −0.02 respectively, both p > .05), but those between automated and subjective refraction were (0.06 vs 0.11 and 0.07 vs −0.02, p = .004 and p < .001 respectively). Bland Altman plots showed the 95% limits of agreement with Netra refraction were wider than with automated refraction (−2.21D to 1.42D vs. −1.90D to 1.16D respectively). Conclusion Netra smartphone-based refraction gives similar readings to automated refraction, and both show myopic overestimation when compared to subjective refraction. However, due to non-insignificant practical usage issues, its use as a screening tool for refractive errors is limited.

Screening of refractive errors and ocular disorders of professional soccer players

To improve their performance, many athletes already invest a significant amount of time and effort in training camps, personal trainers, and equipment, while neglecting to invest in their vision. However, improving visual performance can help improve overall performance in a way that other training regiments cannot. Even for athletes without vision problems, improving visual performance - such as increasing dynamic visual acuity, decreasing reaction times, and improving eye-hand coordination - is an integral component of improving overall performance. To verify if the changes found in soccer players exceeded the 40% found in the literature. The athletes were all submitted to visual acuity (VA) tests without correction using the Snellen eye chart and the noncontact intraocular pressure (IOP) by means of a computerized tonometer. They also underwent a self-refraction examination through a self-refractor. Among the 54 athletes that presented to the screening (108 eyes) 93/108 (86%) had refractive errors in one or both eyes. In 108 eyes there was 50 (46%) hyperopic eye with astigmatism; 19/108 (18%) of myopic astigmatism, 15/108 (14%) with myopia, 6/108 (6%) with hypermetropy and 15/108 (14%) were emmetropes. The prevalence of refractive errors was hyperopic astigmatism followed by myopic astigmatism (50 vs 19 cases). The left eye was the one that presented more hyperopic and myopic astigmatism in relation to the right eye, 52% and 58%, respectively. There were no differences in mean VA and IOP between in the right and left eyes, respectively. The changes verified in the screening of the present study exceeded 40% of ophthalmological alterations found in soccer players and contemplates the hypothesis of the study.

Fluctuations of Steady-State Accommodation Is a Marker for Screening Spasm of Near Reflex.

PurposeTo determine the utility of root mean squared (RMS) deviations of steady-state accommodation as a noncycloplegic marker for spasm of near reflex (SNR) vis-à-vis regular refractive errors.MethodsBinocular steady-state responses of accommodation, pupil, and vergence of 20 patients with accommodative spasm subtype of SNR (SNR-A; 9–23 years) and 91 with regular refractive errors (29 emmetropes, 41 myopes, 21 hyperopes; 19–38 years) was recorded in the uncorrected refractive error state for 120 seconds using a dynamic (50 frames per second), infrared photorefractor. Mean and RMS deviation of raw data was calculated for three 20-second-long epochs and their diagnostic utility was determined using standard ROC curves.ResultsRMS deviations of accommodation increased with mean refractive error in SNR-A (y = −0.23x + 0.38; r2 = 0.69; P < 0.001) and regular refractive error (y = −0.02x + 0.10; r2 = 0.14; P = 0.002) cohorts, albeit with steeper slope and higher y-intercept in the former rather than the latter cohort. RMS deviation of 0.19D reliably distinguished SNR-A from regular refractive errors with a sensitivity and specificity of 95.2% and 92.2%, respectively [mean (±1 SEM) area under ROC curve: 0.98 ± 0.01]. The sensitivity, specificity, and area under ROC curve for RMS deviations of pupil (66.7%, 80%, and 0.70 ± 0.09) and vergence (52.4%, 84.6%, and 0.68 ± 0.08) were smaller than accommodation.ConclusionsRMS deviations of steady-state accommodation is a robust noncycloplegic marker for differentiating SNR-A from regular refractive errors. Pupil and vergence fluctuations have limited utility in this regard.Translational RelevanceRMS deviations of accommodation may be easily obtained using commercial photorefractors, and the cut-off values reported herein may be implemented to identify SNR-A during refractive error screening.

Difference of refractive status before and after cycloplegic refraction: the Lhasa Childhood Eye Study.

To compare the differences between cycloplegic and noncycloplegic refraction as well as associated factors in grade one students of primary schools, and explore the effectiveness of noncycloplegic refraction for refractive error screening. Cross-sectional study. A school-based study of 1856 students was conducted in Lhasa, Tibetan Plateau, China. Cycloplegia was achieved with two drops of 1% cyclopentolate and 1 drop of Mydrin P at a 5-min interval. Autorefraction was performed under both cycloplegic and noncycloplegic conditions. Bland-Altman analysis, receiver operating characteristic curve analysis, univariate and multiple linear regression models were used for analysis. Of the 1856 children enrolled, 1830 (98.60%) completed all procedures. The average age was 6.83 ± 0.46years. 965 (52.73%) children were boys and 1737 (94.92%) were Tibetan. Overall, there was a significant difference between cycloplegic and noncycloplegic SE of 0.90 ± 0.76D (P < 0.001). However, the intra-class coefficient correlation (ICC) for cylinder between these two methods was high (ICC = 0.941, 95% CI, 0.935-0.946). Larger differences between cycloplegic and noncycloplegic SE were associated with hyperopic RE and higher cylindrical value (P < 0.001). The prevalence of myopia, emmetropia and hyperopia with and without cycloplegia was (3.93% vs 14.59%), (9.95% vs 45.8%) and (86.21% vs 39.56%), respectively. Myopia, emmetropia and hyperopia based on noncycloplegic refraction was defined as SE ≤ -0.625D, -0.625 < SE ≤ 0D, and SE > 0D, respectively. Lack of cycloplegia leads to underestimation of hyperopia, with overestimation of myopia and emmetropia. Larger hyperopic refraction exhibited greater difference between cycloplegic and noncycloplegic refraction.

Epidemiological Findings of Refractive Errors and Amblyopia among the Schoolchildren in Hatta Region of the United Arab Emirates

Introduction: Uncorrected refractive errors and amblyopia pose a major problem affecting schoolchildren. We had previously observed that many schoolchildren in the Hatta region presented to the ophthalmology clinic with uncorrected refractive errors and amblyopia, which led us to undertake this research. As per the WHO, the term “visual impairment” can be “low vision” or “blindness.” Based on the presenting vision, “low vision” is defined for children who have vision of <6/18 to 3/60 or having visual field loss to <20° in the better-seeing eye. Children defined to have “blindness” have presenting vision of <3/60 or corresponding visual field of <10°. Purpose: To estimate the magnitude of uncorrected refractive errors and amblyopia among the schoolchildren aged 6–19 years and to assess the efficacy of school-based refractive error screening programs in the Hatta region of the United Arab Emirates. Methods: An epidemiological, cross-sectional, descriptive study was conducted on the entire student population studying in the government schools of the region. Those who failed the Snellen visual acuity chart test and those who were wearing spectacles were evaluated comprehensively by the researcher in the Department of Ophthalmology of the Hatta Hospital. Data were entered in the Refractive Error Study in School Children (RESC) eye examination form recommended by the WHO, and were later transferred to Excel sheets and analyzed by SPSS. Results: 1,591 students were screened and evaluated from the end of 2016 to mid-2017. About 21.37% (n = 340) had impaired vision with 20.9% (n = 333) refractive errors, of which 58% were uncorrected. Among the refractive error group, 19% (64 subjects) had amblyopia (4% of total students). The incidence of low vision was 9.5% and blindness was 0.38%. Low vision was found to be 9.5% and blindness 0.38%, taking in to account presenting visual acuity rather than best-corrected visual acuity for defining low vision and blindness. Conclusion: A significant number of students were detected to have uncorrected refractive errors among the vision impaired group (59%, n = 197) despite a school-based vision screening program in place. Seventy-eight percent of the amblyopia cases (n = 50) were found to be in the 11–19 years age group. Noncompliance with optical corrections was the reason for the high number of cases. A rigorous vision screening program and refractive services, complimented with awareness among parents and teachers, are recommended.

Utilization of Vision Corridor for Self-evaluation of Vision Among Secondary School Students in Igbo-Ora, Southwest Nigeria

Introduction: Uncorrected refractive errors have been identified as a major cause of visual impairment with a high magnitude in developing countries, due to the paucity of eye care workers. To overcome this, different approaches like screening by non-eye care workers and self-assessment have been explored. This study aims to determine the utilization, reliability, and factors affecting the utilization of vision corridors among secondary school students. Material and Methods: An observational cross-sectional study conducted among students of Lasogba High School, Igbo-Ora, Southwest Nigeria. All the students received training on visual acuity assessment with the 6-meter Snellen’s chart. Thereafter, the chart with graphic instruction “Vision Corridor” was provided with a 4-week exposure period. All students who utilized the vision corridor recorded visual acuity in a register maintained by a community health extension worker. The utilization and factors that may have affected utilization were assessed after the exposure. Data were analyzed with the Statistical Package for Social Science version 15. Results: A total of 373 students completed the study; males accounted for 48.8% and females 51.2%. The mean age of the students was 15.2 (±2.2) years. A total of 151 (40.5%) students utilized the vision corridor and factors associated with utilization included being female, age ≤15 years, and being in a junior class, all of which were statistically significant. Conclusion: A moderate proportion of the students utilized the vision corridor. This approach to refractive error screening appears promising, as self-evaluation may reduce the need for skilled manpower in refractive error screening in secondary school students. Therefore, this may effectively utilize skilled eye care manpower for other eye care services in developing countries where there is a paucity of eye care workers.

Performance of Plusoptix A09 Photo Screener in Refractive Error Screening in School Children Aged between 5 and 15 Years in the Southern Part of India.

Purpose:To evaluate the performance of Plusoptix A09 in detecting ametropia, warranted against frequently-used technique of retinoscopy in children attending school (5–15 years) and its probability as a screening tool.Methods:This study was the subset of a larger epidemiological study visual acuity refractive error squint conducted in schools to determine the prevalence of ocular morbidity among the 5–15 years' school children population. Every 7th student in the class (each school had mean value of 100 students) was randomly selected for this study after ascertaining their eligibility as per the inclusion criteria. A cohort of a total of 150 children within the age group of 5–15 (mean, 10.21 ± 2.83) years were recruited from 11 schools of Udupi district. Students with best corrected visual acuity of 20/20, refractive error within ±5.00 diopter (D), without any eccentric fixation, and no history of ocular pathology or seizures were recruited. Refractive error was tested by Plusoptix photorefractor followed by non-cycloplegic and cycloplegic retinoscopic techniques. The examiners performing these tests were masked and unware of the findings. Bland Altman plotted the agreement between the techniques, followed by the receiver operating characteristic curve (ROC), and sensitivity of Plusoptix.Results:One-way analysis of variance calculated statistical differences among Plusoptix, objective retinoscopy, and cycloplegic retinoscopy for mean spherical value (1.12 ± 1.16 D, 0.65 ± 0.69 D, and 0.8 ± 0.82 D), cylindrical value (−0.83 D ± 1.27, −0.32 D ± 0.86, and −0.34 D ± −0.93), and spherical equivalent value (0.71 D ± 1.06, 0.45 D ± 0.7, and 0.61 D ± 0.81), with P = 0.0001, 0.0001, and 0.097, respectively. Bland Altman plots showed good agreement for spherical equivalent values of Plusoptix and objective retinoscopy. However, the area under the ROC curve (0.386) suggests that lower diagnostic ability of this device in this age group population in comparison to retinoscopy (0.575) with the sensitivity and specificity of Plusoptix was 69.2% and 84.8%.Conclusions:This study fails to report ideal sensitivity mandated for a screening tool, although good specificity and agreement are observed. Along with retinoscopy, this tool will be effective in screening a children's population aged between the age group of 5 and 15 years.

SPECTACLE-WEAR

Background: Refractive errors are the most common cause of avoidable visual impairment in children worldwide. Importance of school screening of refractive errors is one of the most important initiatives outlined in WHO Vision 2025 targets. Corrected refractive errors visually rehabilitate the school going children. But the benefit depends on the compliance of the spectacle wear by children. Purpose: To study the compliance of spectacle wear and to highlight the reasons of non compliance in school going children of Multan. Study Design: Cross-sectional descriptive study. Setting: Ophthalmology Department, Nishtar Medical University Multan, Pakistan. Period: Jan 2009 to Oct 2012. Materials and Methods: 631 students. Among them 187 males and 175 female students were prescribed spectacles for constant wear during school screening program. Each student was given a pro forma indicating name, age, gender, prescription and column of reasons of non compliance. After six months, we conducted a follow-up visit where these students were accessed about spectacle compliance and reasons of non compliance on the given feedback pro forma from teachers. The data was collected and analyzed by SPSS version 20. Results: The overall non-compliance rate of spectacle wear in primary school children was 35.91%. A significantly higher proportion of boys 119 (57.14%) were not wearing their spectacles compared to girls 175 (54.86%). Themain reasons for non compliance in primary school boys and girls were casual in wearing their spectacles, does not like to wear spectacles, break their spectacles frequently and some children feel spectacles are not needed or cause headache. Conclusions: Poor compliance of using spectacles was noted in our study among children with refractive errors with main reason for not using these spectacles was that they did not like to wear them. So there is need to adopt aggressive awareness campaign among teachers and parents to enhance their knowledge for better outcomes and visual improvement of the children. Screening of primary school children with refractive error was difficult task in Multan. Limited information was available on the magnitude of the compliance for spectacle wear and their reasons of noncompliance. This information is crucial for establishing a program and will strengthen the efforts for a better eye care in school children.

Quality of life among Primary Schools Children with Refractive Errors in Menoufia, Egypt

Background: Refractive error is the powerlessness of the eye to light into focus on the retina resulting in nearsightedness (myopia), farsightedness (Hyperopia) or astigmatism. Uncorrected refractive error in children is connected with impaired quality of life, increased morbidity, and reduced educational opportunities. Objectives: This study aims to assess the impact of refractive errors on the quality of life (QOL) of Primary Schools Children. Methods: This cross sectional study was conducted on 960 ( 6–12 years old) primary school children in the first, second and third grades attended Munshaat Sultan primary school, Menouf district, Menoufia, Egypt from 1st October 2017 to the end of December 2017. The participants were assessed through a questionnaire which includes (socio-demographic data and comprehensive history), general and visual examination. QoL of participants with refractive errors was assessed using semi-structured questionnaire that consisted of 7 items. The reliability of questionnaires was tested using Cronbach’s alpha which was 0.953. Results: Out of 960 students 232 (24.1%) had a significant refractive error of ±0.50 in one or both eyes. There was a highly statistically significant difference between participated children with and without error of refraction regarding socioeconomic status and all parameters of QOL (p-value <0.001). Overall 45.5 % of students with an error of refraction had poor QOL. Conclusion: Screening for refractive errors in primary school children is mandatory to start corrective measures at the early stage, and improve their quality of life.

Visual Impairment in Preschool Children in the United States

Visual impairment (VI) in early childhood can significantly impair development. To determine demographic and geographic variations in VI in children aged 3 to 5 years in the United States in 2015 and to estimate projected prevalence through 2060. Descriptive study reporting statistics estimated based on prevalence data from 2 major population-based studies conducted in the United States between 2003 and 2011. Using US census projections, prevalence of VI and cause-specific VI in the better eye were reported by race/ethnicity, state and region, and per capita prevalence of VI by state. The study included preschool children in the United States. Analyses for this study were conducted between February 2016 and March 2017. Prevalence of VI among children aged 3 to 5 years in the United States. In 2015, more than 174 000 children aged 3 to 5 years in the United States were visually impaired. Almost 121 000 of these cases (69%) arose from simple uncorrected refractive error, and 43 000 (25%) from bilateral amblyopia. By 2060, the number of children aged 3 to 5 years with VI is projected to increase by 26%. In 2015, Hispanic white children accounted for the highest number of VI cases (66 000); this group will remain the most affected through 2060, with an increasingly large proportion of cases (37.7% in 2015 and 43.6% in 2060). The racial/ethnic group with the second most VI is projected to shift from non-Hispanic white children (26.3% in 2015 decreasing to 16.5% in 2060) to African American children (24.5% in 2015 and 22.0% in 2060). From 2015 to 2060, the states projected to have the most children with VI are California (26 600 in 2015 and 38 000 in 2060), Texas (21 500 in 2015 and 29 100 in 2060), and Florida (10 900 in 2015 and 13 900 in 2060). These data suggest that the number of preschool children with VI is projected to increase disproportionally, especially among minority populations. Vision screening for refractive error and related eye diseases may prevent a high proportion of preschool children from experiencing unnecessary VI and associated developmental delays.

Situational Analysis of Eye Care Services in South Sulawesi

Background: VISION 2020 as the global initiative program almost reaches the time limit. Every country in all over the world ran their programs in eye care services based on the strategic components of VISION 2020 including in Indonesia since the government declared it in 1999. The aim of this study is to report whether the condition in South Sulawesi as one of the province in east Indonesia sufficient to meet VISION 2020 target.Methods: This is a descriptive study with the qualitative and quantitative approach. Data were collected by interviewing and distributing semi-structured questionnaire to all stakeholders involved in eye care services in South Sulawesi, including ophthalmologists, ophthalmic nurses, Indonesian Ophthalmologists Association committee, provincial and district health office staffs.Results: South Sulawesi has population of 8,324,000, consists of 24 districts/city, 33 hospitals and 440primary health care (Puskesmas). Human resource data showed 67 ophthalmologists including subspecialists, 17 trained ophthalmic nurses, 6 refractionists, 3 optometrists, 1 orthoptist, and 3 counselours. Total number of cataract surgery in 2015 are 15,075 eyes. Complete data for refractive error screening and examination, glaucoma, diabetic retinopathy and corneal diseases are not available. Some advocacies and workshops had been held. Supported from government and NGO took role in building capacity for the services.Conclusion:According to VISION 2020 program, eye care services in our province is not yet ideal; but the process to build capacity, especially for 5 main focus eye disease, is still on the track. Keywords: VISION 2020, eye care services, cataract surgery, human resource, advocacy

Screening for refractive error among high school children

Screening for refractive error among high school children

Visual Impairment and Blindness in Adults in the United States: Demographic and Geographic Variations From 2015 to 2050.

The number of individuals with visual impairment (VI) and blindness is increasing in the United States and around the globe as a result of shifting demographics and aging populations. Tracking the number and characteristics of individuals with VI and blindness is especially important given the negative effect of these conditions on physical and mental health. To determine the demographic and geographic variations in VI and blindness in adults in the US population in 2015 and to estimate the projected prevalence through 2050. In this population-based, cross-sectional study, data were pooled from adults 40 years and older from 6 major population-based studies on VI and blindness in the United States. Prevalence of VI and blindness were reported by age, sex, race/ethnicity, and per capita prevalence by state using the US Census projections (January 1, 2015, through December 31, 2050). Prevalence of VI and blindness. In 2015, a total of 1.02 million people were blind, and approximately 3.22 million people in the United States had VI (best-corrected visual acuity in the better-seeing eye), whereas up to 8.2 million people had VI due to uncorrected refractive error. By 2050, the numbers of these conditions are projected to double to approximately 2.01 million people with blindness, 6.95 million people with VI, and 16.4 million with VI due to uncorrected refractive error. The highest numbers of these conditions in 2015 were among non-Hispanic white individuals (2.28 million), women (1.84 million), and older adults (1.61 million), and these groups will remain the most affected through 2050. However, African American individuals experience the highest prevalence of visual impairment and blindness. By 2050, the highest prevalence of VI among minorities will shift from African American individuals (15.2% in 2015 to 16.3% in 2050) to Hispanic individuals (9.9% in 2015 to 20.3% in 2050). From 2015 to 2050, the states projected to have the highest per capita prevalence of VI are Florida (2.56% in 2015 to 3.98% in 2050) and Hawaii (2.35% in 2015 and 3.93% in 2050), and the states projected to have the highest projected per capita prevalence of blindness are Mississippi (0.83% in 2015 to 1.25% in 2050) and Louisiana (0.79% in 2015 to 1.20% in 2050). These data suggest that vision screening for refractive error and early eye disease may reduce or prevent a high proportion of individuals from experiencing unnecessary vision loss and blindness, decrease associated costs to the US economy for medical services and lost productivity, and contribute to better quality of life. Targeted education and screening programs for non-Hispanic white women and minorities should become increasingly important because of the projected growth of these populations and their relative contribution to the overall numbers of these conditions.