Vision Screening In Children Research Articles

Refugee child vision screening curriculum for multidisciplinary trainees

Background: Conflicts, natural disasters, and persecution have led to growing refugee populations worldwide. Vision impairment within these populations is a significant concern. Eye conditions in refugee children appear to peak during times of resettlement. Future medical and nursing professionals need to be trained to detect treatable conditions that could lead to permanent vision loss and significant morbidity if undiagnosed. While curricula regarding refugee health exist, no curriculum exists on identifying common eye conditions in refugee children and performing pediatric eye screening. Methods: We created and delivered a virtual, single-session curriculum on pediatric refugee eye conditions and screening to medical and nursing trainees. A needs assessment survey assessing trainees’ knowledge and confidence in detecting eye conditions in children and refugees informed curriculum design. Pre- and post-test assessments evaluated participants’ knowledge and confidence before and after the module. A two-sided signed-rank test was used to compare pre- and post-test scores. Results: Twenty-seven respondents completed the needs assessment survey, which revealed low levels of confidence in performing vision screening, especially in evaluating the eye surface. Fourteen participants completed the module and pre- and post-test surveys. Mean knowledge test score improved from 52% to 75% (P<0.001). Discussion: As the global refugee population grows, this study supports the value of incorporating a refugee child eye curriculum into trainee education to empower providers to detect and address refugee eye conditions.

Critical appraisal of Australian and New Zealand paediatric vision screening clinical practice guidelines using the AGREE II tool

ABSTRACT Clinical Relevance Vision disorders in children impact health-related quality of life, with early detection and intervention improving outcomes and educational performance. Eye health professionals should be aware of paediatric vision screening guidelines and their development to understand the components of local programmes and the differences in sensitivity and specificity between protocols. Background High-quality clinical practice guidelines (CPGs) for vision screening enable the early detection of common vision disorders; however, they require rigorous development to ensure optimal accuracy in detecting vision disorders, enabling timely interventions. This study evaluated the quality of available vision screening CPGs on vision screening of children in Australia and New Zealand. Methods A systematic search of academic databases, guideline databases, professional associations and Google search engines was conducted to identify relevant paediatric vision screening CPGs. Four independent reviewers used the Appraisal of Guidelines, Research and Evaluation (AGREE II) instrument to assess the quality of individual guidelines and scores were aggregated and reported as the percentage of the total possible score across the six AGREE II domains: scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence. Results Initial 2,999 items were evaluated, with seven guidelines included. AGREE-II quality score agreement ranged from 43.3% to 95.8%. All guidelines scored >60.0% in the scope and purpose, however, most had poor scores of <26.5% in the rigour of development and <3.3% in editorial independence domains. All guidelines recommended screening using measures of habitual distance vision. Conclusion Of the guidelines developed for use in Australia and New Zealand, most guidelines scored poorly when assessed against the AGREE II tool, because of lack of editorial independence and rigour of development. Paediatric vision screening guidelines should prioritise systematic review of literature to inform practice and include statements regarding competing interests.

Two different autorefractors for vision screening in children and adolescents.

To compare the consistency of two autorefractors (Tianle RM-9000 and Topcon KR-800) for school-age myopia children, and to provide a basis for largescale data analysis and comparison. The refractive error in 909 subjects (age 4-18y) were measured using both autorefractors without cycloplegia. The data were analyzed using Fourier decomposition and the correlation coefficients, intraclass correlation coefficients (ICC), and Bland-Altman limits of agreement (LoA) for each parameter were calculated. There was a strong correlation between the spherical equivalent (SE), sphere diopter (DS), and cylinder diopter (DC) readings of the Tianle RM-9000 and those of the Topcon KR-800, with correlation coefficient values of 0.98, 0.98 and 0.83 and ICC values of 0.99, 0.99 and 0.93, respectively. However, the correlation coefficients and ICC values of J0 and J45 were unreliable (R=-0.004, -0.034; both ICC<0.10). Bland-Altman analysis revealed that SE, DS, and DC measured by the Tianle RM-9000 were significantly biased toward myopia compared with the Topcon KR-800, and the mean differences were -0.072, -0.026, -0.091 D, respectively (all P<0.01). The minimum absolute value of the difference within the 95% LoA for SE, DS, and DC was 0.63 D, 0.50 D, 0.62 D, respectively; all these values were in the clinically acceptable range. For J0 and J45, the mean differences were close to zero (P=0.43, 0.84); however, the 95% LoA were relatively wide (J0 SD: 0.53; 95%CI: -1.00, 1.10; J45 SD: 0.52; 95%CI: -1.00, 1.00). The two autorefractors are consistent with each other, as the differences in SE, DS, and DC were within the clinically acceptable range. Readers can compare the data measured by either device in different studies and use the two devices in the same study to generate a dataset that can be analyzed together. However, the J0 and J45 vectors are unreliable and should not be used to assess astigmatism.

Ophthalmic examination in children – comprehensive literature review

The proper functioning of the patient in the environment is made possible by the interaction of individual systems or single organs. The visual system is undoubtedly one of the most important; it is the one that enables us to find our way and acquire a range of skills to survive in the environment. Unfortunately, if neglected at a young age, complications may remain for the rest of life. A number of tests have now been introduced to check the development and efficiency of a child's eyesight; their cyclical repetition and appropriate identification of changes or lack of them enable an appropriate diagnosis to be made and treatment to be applied, thanks to which we can eliminate or reduce the defect and, more importantly, prevent the development of a new one.&#x0D; Contrary to appearances, vision screening in children does not take place in a single medical visit, it is an ongoing process, and the activities included in the screening should be carried out at each follow-up visit. This allows the practitioner to detect risk factors and eye abnormalities early on, which increases the chance of a positive outcome for the patient. It also enables the specialist to identify children who require more frequent eye checks, or patients who should be referred to a specialist qualified in children's eye examination.&#x0D; During the screening examination, the doctor begins by talking to the child and parent about conditions that run in the family. The aim is to detect and identify risk factors that need to be carefully analysed. These factors include, but are not limited to, premature birth, Down's syndrome, cerebral palsy, a family history of strabismus, visual impairment, retinoblastoma, childhood glaucoma, childhood cataract or eye disease and genetic systemic diseases.

Development and validation of a questionnaire for assessing parents’ health literacy regarding vision screening for children: a Delphi study

Preschool vision screening is recommended to reduce the incidence of amblyopia that persists into adulthood. However, parent’s perceptions regarding the importance of screening and early intervention may constitute a significant barrier to seeking vision exams and pursuing treatment. The aim of this study is to develop and validate a questionnaire for assessing parent’s awareness, perception and health literacy of children's vision tests. The questionnaire was developed using the Delphi method with experts from the fields of pediatric ophthalmology, optometry, orthoptics, pediatric medicine, social sciences and Mother and Child Health Care centers. Experts were provided with drafts of the questions iteratively in three rounds until a consensus was reached independently on the relevant items, coherently language and redundancies. For the first, second and third stages of the Delphi process, 17, 15 and 13 experts participated in the panel respectively. Validity was achieved by wide consensus among the panel on the relevance of each question, of 75%, 85% and 90%, for the three rounds respectively. Here we describe the final questionnaire, EYES: Evaluating Young-Children Eye health Survey, which includes 31 questions regarding demographics, ocular history, parental health literacy, and perceptions of vision and vison exams.

Vision outcomes in children with fetal alcohol spectrum disorders.

Previous studies demonstrated that children with Fetal Alcohol Spectrum Disorders (FASD) are more likely to have vision impairments. However, existing human clinical and epidemiological investigations are few and include limited sample sizes. This study aimed to explore the association between ophthalmologic abnormalities and FASD in a sample of 5-7 year old children in the general population. This was a cross-sectional study nested in a larger study intended to estimate the prevalence of FASD in San Diego, California, conducted between 2012 and 2014. Prenatal exposure to alcohol, dysmorphology examinations, and a neurobehavioral testing battery were collected for each child and an FASD diagnosis was assigned. Parents of participating children were asked to release their child's vision screening or diagnostic records. Vision records were obtained for 424 participants in the larger prevalence study. Of these, 53 children were classified as having FASD. A statistically significant association was found between FASD and a diagnosis of strabismus; 5/42 (11.9%) of children who were classified as having FASD had strabismus compared to 6/290 (2.1%) of children who were not classified as having FASD (p = .01). All five cases of strabismus in the FASD group occurred in 19 children classified as having partial fetal alcohol syndrome (pFAS). No association was found between FASD and vision impairment (p = .23), refractive errors (p = .66), glasses/contact lens prescription (p = .30), or having one or more ophthalmological abnormalities (p = .97). An association between strabismus and FASD, specifically partial FAS, suggests that the effect of alcohol exposure on risk of strabismus must be severe enough to result in facial features consistent with FASD. This emphasizes the importance of vision screening in children with FASD.

Educational attainment and trajectories at key stages of schooling for children with amblyopia compared to those without eye conditions: Findings from the Millennium Cohort Study.

Amblyopia is a neurodevelopmental condition resulting in reduced vision for which whole population child vision screening is undertaken. Cross-sectional studies have established an association between amblyopia and lower academic self-concept, slower reading speed. No difference has been found in educational performance in adolescence whilst there are mixed associations with educational attainment in adults. Educational trajectories and intentions have not been studied previously. We analyse if those treated for amblyopia have different educational performance and trajectories for core subjects during statutory schooling, or subsequent higher education (university) intentions than their peers without eye conditions. Data from the Millennium Cohort Study of children born in the United Kingdom in 2000-01 and followed-up to age 17 years (n = 9989). Using a validated approach drawing on parental self-report on eye conditions and treatment coded by clinical reviewers, participants were grouped into mutually exclusive categories: no eye conditions, strabismus alone, refractive amblyopia, strabismic/mixed (refractive plus strabismic) amblyopia. The outcomes were levels and trajectories of passing English, Maths, Science at ages 7-16 years, passing national exams at age 16, and intentions at ages 14-17 to pursue higher (university) education. Adjusted analyses showed that amblyopia status was not associated with performance in English, Maths, and Science at any key stage, attainment in national exams, or intending to go to university. Similarly, the age-related trajectories of performance in core subjects and higher education intentions did not differ between the groups. There were no significant differences in main reason for having or not having university intentions. We found no associations between a history of amblyopia and either adverse performance or age-related attainment trajectories in core subjects during key stages of statutory schooling as well as the absence of an association with intentions for higher education. These results should be reassuring to affected children and young people, and their families, teachers and physicians.

Disparities in Vision Screening in Primary Care for Young Children With Autism Spectrum Disorder.

To determine the rate of vision screening among children with and without autism spectrum disorder (ASD), the rate of photoscreening compared with visual acuity screening, and the effect of demographic factors on vision screening for children with ASD. Data from well visits for 3- to 5-year-olds between January 2016 and December 2019 were collected via PEDSnet. Billing codes for vision screening were a proxy for the completion of vision screening. χ2 analysis examined the relationship of age, sex, race, ethnicity, region, and socioeconomic status to vision screening rate and rate of photoscreening versus visual acuity screening. Multivariate logistic regression assessed factors that impacted the odds of vision screening. We analyzed 63 829 well-child visits. Children with ASD were less likely to have a vision screening (36.5%) compared with children without ASD (59.9%). The lowest rates of screening occurred during the 3-year visit. Of those with ASD, Black children had a lower screening rate (27.6%) than white (39.7%) and other/multiracial children (39.8%). The use of photoscreening was higher in Hispanic children, increasing the overall rate of vision screening greater than non-Hispanic children. Practice region influenced the rates of vision screening for children with ASD because of more photoscreening. Children with ASD are less likely to receive vision screening at well visits compared with typically developing children. This disparity was greatest among younger children and Black children. One practice region used more photoscreening and had higher rates of screening. Photoscreening is a useful tool to decrease disparity, especially among high-risk patient groups.

Vision Screening in Children: The New South Wales Statewide Eyesight Preschooler Screening Program.

The aim was to investigate universality of access, screening rate, and outcomes from the New South Wales (NSW) Statewide Eyesight Preschooler Screening (StEPS) over the period of 2009 to 2016. Cross-sectional, observational study. The StEPS program provides vision screening to 4-year-old children residing in NSW and is administered within Local Health Districts (LHDs). Visual acuity (VA) was examined by trained lay and nurse screeners using HOTV logMAR. Children who had VA <6/9-2 were referred to local practitioners while those with VA <6/18 were referred to public hospital pediatric ophthalmic outpatient clinics where available. Activity data were collected by NSW Health and screening rates determined from population projections of 4-year-olds per LHD based on adjusted 2014 Census data. To determine factors impacting screening and referral rates, a random effects panel analysis was undertaken. A total of 719,686 (96.4%) NSW 4-year-old children were offered StEPS vision screening between 2009 and 2016, 84% accepted and 564,825 children (75.6%) were screened. The screening rate increased from 67.3% in 2009 to 74.5% in 2016, with an 80% target reached for 3 consecutive years from 2013 to 2015. Of those screened, 19.2% were referred to an eye health professional or advised to have a vision retest in 12 months. This referral rate remained steady over the period studied, with little variation between metropolitan, and rural and regional LHDs. StEPS is an ideal service model for preschool vision screening providing coverage that is comparable to school-based screening programs and at an age likely to facilitate optimal treatment outcomes.

Commentary: Vision screening for children in special schools.

Commentary: Vision screening for children in special schools.

Clinical profile of amblyopia and outcome of occlusion therapy in pediatric populations attending a referral hospital

AIM: To study clinical profile of amblyopia and also the outcomes of occlusion therapy among the amblyopes. METHODS: This was a hospital-based longitudinal study by design. Data were collected from April 2015 to April 2016 in Ophthalmology Department of Dhulikhel Hospital. Presenting visual acuity, chief complaint at presentation, age at presentation, refractive status, binocularity and fixation patterns were assessed in all the children with amblyopia. Improvement in visual acuity was also noted in all the subjects after occlusion therapy, which is a most commonly used modality of treatment for amblyopia. RESULTS: Among 1092 children examined during the study period, 60 (5.49%) were amblyopic. Among them, 35 (58.30%) were females and 25 (41.70%) were males. The mean age at presentation was 8.87±3.29y. Meridional amblyopia was the most prevalent subtype seen in 43.3% (n=26) of children followed by anisohypermetropic amblyopia (20%, n=12). The most common refractive error was astigmatism accounting for 58.30% of the total cases followed by hypermetropia (22.5%) and myopia (7.5%). Compliance with spectacle wear combined with occlusion therapy and active vision therapy was 73.3% (n=44). There was a statistically significant improvement in visual acuity of the amblyopic eyes after the different treatment strategies after 3mo (P=0.002). CONCLUSION: Prevalence of amblyopia and associated visual impairment is still a public health issue in developing countries like Nepal. Lack of awareness and lack of community or preschool vision screening for children lead to late presentation and significant visual impairment associated with the condition. The burden can easily be reduced with screening camps, timely referrals and proper interventions.

Automated vision screening of children using a mobile graphic device

Background/ObjectiveCan measuring interocular brightness disparity, acuity, and colour vision classify children with amblyopia?Subjects/MethodsTwo hundred eight subjects (3–14 years) were recruited for a prospective, observational protocol to measure interocular brightness disparity, uniocular acuities with and without a pinhole, and colour vision using an iPad. Subjects looked through polarizing filters and chose the brighter of two spaceships to measure interocular brightness disparity. The differential brightness of image pairs was varied through a staircase algorithm until equal brightness was perceived. Acuities and colour vision were tested with tumbling Es and AO-HRR colour plates, respectively. Unilateral amblyopia was later confirmed in two subjects.ResultsBinocular brightness balance on the iPad detected amblyopes with 100% sensitivity and specificity. Using 20/30 as cutoff for normal acuity, 1 of the amblyopes was detected, and non-amblyopes were excluded by visual acuity pinhole testing. The mean difference between iPad and E-Chart visual acuities with pinhole was 0.02 logMAR with limits of agreement from −0.08 to +0.11 logMAR. iPad and printed plates Colour vision testing produced identical results. Testing times were brief and exit pleasure responses were positive. Mean and range testing times for Brightness Sense, Colour vision, and Visual Acuity were 32.7 s (range = 12–63 s), 52.8 min (range = 17–95 s), and 88.75 s (range = 41–188 s), respectively.ConclusionsInterocular brightness disparity, acuity, and colour vision can be measured in children as young as 3 years old solely through playing a game on a mobile device. Interocular brightness disparity is a sensitive and specific method to detect unilateral amblyopia.

Delayed Diagnosis of Amblyopia in Children of Lower Socioeconomic Families: The Hong Kong Children Eye Study

ABSTRACT Aims To determine the prevalence of amblyopia and the factors associated with delayed diagnosis among school-aged children in Hong Kong. Methods Completed comprehensive ophthalmoscopic examinations were conducted among 4.273 children aged 6–8 years in the population-based Hong Kong Children Eye Study. New and previous diagnoses of amblyopia were identified. Socioeconomic status was surveyed through questionnaires. Results According to criteria from the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS), amblyopia was present in 43 out of 4,273 children (1.01%; 95% CI, 0.71–1.31). Among them, 33 (0.77%) were newly detected cases that were more likely from families living in Public Rental Housing or subdivided flats (OR, 4.22; P = .012), with lower paternal (OR 6.68, P = .008) and maternal education levels (OR, 4.38; P = .039). Multivariate analysis revealed associations of amblyopia with hyperopia (≥+2.00D; OR, 6.23; 95% CI, 2.86–13.56, P < .001), astigmatism (≥+2.00D; OR, 24.88; 95% CI, 10.69–57.91, P < .001) and anisometropia (≥2.00D; OR, 14.49; 95% CI, 5.93–37.63, P < .001). Conclusion These children with delayed diagnoses of amblyopia were more likely to come from lower socioeconomic backgrounds. Public education aimed at increasing awareness and utilization of child vision screening among such families is needed.

Visual Health and its Relationship with Screen Time among School Children: A Cross-Sectional Study in Sarawak, Malaysia

&lt;p class="0abstract"&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study intended to determine visual health of the school children and investigate its relationship with screen time. &lt;strong&gt;Methods: &lt;/strong&gt;This was a school-based cross-sectional study using multistage cluster sampling. A self-reported and interviewer-administered questionnaire were used to compile screen time information. Children presenting visual acuity was evaluated with Snellen chart and non-cycloplegic refraction was performed to those acuities worse than 6/12. Data analysis was performed using SPSS version 22. A p-value ≤0.05 with 95% CI was considered as statistically significant. &lt;strong&gt;Results: &lt;/strong&gt;About 87% children had normal or near normal visual acuity and 13% had visual impairment. The prevalence of refractive error was 22.8%. Astigmatism was the most prevailing type of refractive error, 10%. The children spent on average of 13.82 hours per week on screen time. Television is the most popular electronic devices. Boy spent more time on gaming consoles than girl. There was no statistically significant relationship between refractive error and screen time (p=0.581). &lt;strong&gt;Conclusion: &lt;/strong&gt;The prevalence of refractive error among school children was 23%. The children spent nearly 14 hours per week on screen time. There was no statistically significant relationship between refractive error and screen time. Periodical children vision screening is paramount for early detection of vision impairment and provide possible intervention.&lt;/p&gt;

Impact of Persisting Amblyopia on Socioeconomic, Health, and Well-Being Outcomes in Adult Life: Findings From the UK Biobank

ObjectivesThis study aimed to investigate associations between persisting amblyopia into adulthood and its “real-life” impacts and inform the current debate about the value of childhood vision screening programs. MethodsAssociations between persisting amblyopia and diverse socioeconomic, health, and well-being outcomes were investigated in multivariable-adjusted (sex, age, ethnicity, deprivation) regression models, with 126 400 participants (aged 40-70 years) of the UK Biobank with complete ophthalmic data. Analysis by age group (cohort 1, 60-70 years; cohort 2, 50-59 years; cohort 3, 40-49 years) assessed temporal trends. ResultsOf 3395 (3%) participants with confirmed amblyopia, overall 77% (2627) had persisting amblyopia, declining from 78% in cohort 1 to 73% in cohort 3. The odds of persisting amblyopia were 5.91 (5.24-6.66) and 2.49 (2.21-2.81) times greater in cohort 1 and cohort 2, respectively, than cohort 3. The odds were also higher for more socioeconomically deprived groups and for white ethnicity. Reduced participation in sport, adverse general and mental health, and well-being were all independently associated with persisting amblyopia, with the strongest associations in the youngest cohorts. Associations with lower educational attainment and economic outcomes were only evident in the oldest cohort. ConclusionsThere has been a decline in the overall frequency of persisting amblyopia since the introduction of universal child vision screening in the United Kingdom. Nevertheless, most adults treated for amblyopia in childhood have persisting vision deficits. There was no evidence that persisting amblyopia has vision-mediated effects on educational, employment-related, or economic outcomes. The observed adverse outcomes were largely those not directly mediated by vision. Patients undergoing treatment should be counseled about long-term outcomes.

Comparison of Improvement of Quality of Life After Using Ready- Made Spectacles and Custom-Made Spectacles in Junior High School Students in Bandung District

Introduction: Uncorrected refractive error remains a leading cause of blindness and visual impairment among different population groups worldwide. In school children, it has a considerable impact on quality of life including social development, school performance and academic achievement that can affect their future. Management of refractive errors in developing countries is not adequate related to the cost, availability and distance of health and optical services. Hence, early detection and intervention with ready-made spectacles at the time of school children vision screening programs is expected to help solving these problems. Objective: To evaluate outcome measure of wearing ready-made spectacles (RMS) and custom-made spectacles (CS) on children’s quality of life.Method: A non-inferiority trial with a margin of 25%, cluster-randomized trial. Children aged 11-15 years in Bandung Regency, that meet the inclusion criteria were randomized to receive RMS and CS. Main study outcome was global score on the National Eye Institute Refractive Error Quality of Life- 42 after one month of wearing study glasses, comparing both group. Result: A total of 220 eligible subject were allocated to RMS (n = 110) and CS groups (n = 110) respectively. Baseline and end line score data were available for 220 (100%) of subjects. Improvement of quality of life in RMS group was 19.48±9.33 and CS was 24.14±9.68 with D = -18.11(CI 95% - 19.36 to -16.64). Conclusion: Improvement of quality of life in RMS group is non-inferior compare with CS group

A new visual acuity test on touchpad for vision screening in children.

To validate a visual acuity (VA) test application on touchpad in the screening of pediatric population by comparing VA results obtained with conventional tests. A cohort of 101 patients, 44 girls and 57 boys with a median of 6.5 years old (3-10 years of age), presenting for eye examinations in Ophthalmology Department (Strasbourg, France) between November 1st, 2018, and February 1st, 2019 were enrolled. Monocular and binocular VA testing was performed on the subject using both a standard test and the touchpad application (Monoyer, "E" or, Pigassou depending of children's capacities). Patients were excluded if they were physically or mentally unable to use the touchpad. The duration of each tests, the painfulness, the comprehension, the attention of children during the test and test's preferences were also evaluated. There was a good linear correlation and intra-class correlation coefficient [ICC=0.50 (0.34, 0.64) for binocular acuity, 0.74 (0.64, 0.82) for right eyes and 0.525 (0.37, 0.66) for left eye]. The standard errors of measurement were very low (0.08, 0.05, 0.08 for binocular VA, right eyes VA and left eyes VA, respectively). There was no difference between two tests for right eye (P=0.126), left eye (P=0.098) and binocular acuity (P=0.085). Non inferiority was proved for all binocular [-0.06 (-0.09, -0.03)], right eye [-0.04 (-0.07, -0.01)] and left eye [-0.06 (-0.09, -0.02)] VA. The sensitivity and specificity, which correspond to the ability for our app to detect amblyopia, were 92% and 80% respectively. Our touchpad application represents an efficient and valid test of VA in children with a high specificity to detect visual impairment.

Traditional and instrument-based vision screening in third-grade students

The American Association for Pediatric Ophthalmology and Strabismus recommends optotype-based vision screening for children >5years of age. Instrument-based screening for 3- to 4-year-old children is more time efficient and has a higher positive predictive value than traditional optotype screening. The purpose of this study was to directly compare instrument-based vision screening and traditional screening of third graders in a school-based setting. Third graders from 16 schools in Chesterfield County, Virginia, were screened by traditional methods (optotypes and stereoacuity) and using a photoscreener (Plusoptix S12). Children referred from either method were offered a comprehensive eye examination with cycloplegic refraction. Time to screen was recorded. Screening was performed on 1,593 children, of whom 516 (32.4%) were referred for a complete eye examination by either screening method. Traditional screening and photoscreening referred 287 and 398 children, respectively; 169 were referred by both methods. Cycloplegic examinations were completed on 247 children (47.9%). There was no statistical difference between the two methods for detecting visual acuity of <20/30 or the number of children requiring intervention. The average time to screen a child using the photoscreener and the traditional screening method was 30seconds and 120seconds, respectively. The positive predictive value for detecting a need for glasses in third-graders is not statistically significant between traditional and instrument-based screening. Instrument-based vision screening takes less time than traditional screening.

Is amblyopia associated with school readiness and cognitive performance during early schooling? Findings from the Millennium Cohort Study.

Amblyopia is a neurodevelopmental condition causing reduced vision, for which programmes of whole population child vision screening exist throughout the world. There is an ongoing debate about the value of screening due to the lack of evidence about meaningful functional impacts of amblyopia. Our objective was to determine whether amblyopia is associated with school readiness and early cognitive performance. Data from the prospective Millennium Cohort Study of children born in the United Kingdom in 2000-01 and followed-up to age 7 years (n = 13,967). Using parental self-report on eye conditions and treatment coded by clinical reviewers, participants were grouped into no eye conditions, strabismus alone, refractive amblyopia, or strabismic/mixed (refractive plus strabismic) amblyopia. The outcomes were poor school readiness using Bracken School Readiness Assessment <25th percentile (age 3); and cognitive tests and their age-related trajectories using British Ability Scale II Naming Vocabulary (ages 3/5) and Pattern Construction (ages 5/7). Multivariable analyses showed that compared to children without any eye conditions, only those with strabismic/mixed amblyopia had an increased risk of poor school readiness (OR = 2.04, 95%CI 1.09-3.82). Small differences in mean scores for NV and PC of children with amblyopia (all types) compared to those without any eye condition were not clinically significant (>10 points) irrespective of whether treatment had already started. The age-related cognitive trajectories of children with amblyopia did not differ from those without any eye conditions for either NV (p = 0.62) or PC (p = 0.51). These associations are at population rather than individual level, so it might be that some individuals with amblyopia did experience significant adverse outcomes that are not captured by summary statistics. Amblyopia is not significantly associated with adverse cognitive performance and trajectories in early schooling and there is no evidence that this is due to a mediating effect of treatment. Although amblyopia combined with strabismus is associated with poor school readiness, this is not translated into poor cognitive performance. These novel findings may explain the lack of association reported between amblyopia and educational outcomes in adult life and suggest that the impact of amblyopia on education is not of itself a justification for whole population child vision screening aimed at detecting this disorder.

Effect of a complex intervention to improve post-vision screening referral compliance among pre-school children in China: A cluster randomized clinical trial

BackgroundWe investigated whether specific appointments for quality-assured care could increase referral uptake, often low in China, in children's vision screening. MethodsWe randomized children aged 4–7 years in Yudu, Jiangxi, China, by school to Control (free school-based eye screening, parents of children failing screening recommended for further examination [usual practice]) or Intervention (identical examinations, with parents additionally provided with specific appointments for further examinations by quality-assured doctors at a designated local hospital). Both groups could select any hospital for referral exams, which were not free. Six months after screening, parents were interviewed on referral compliance at any hospital (primary outcome) and potential determinants. This trial is registered at the ClinicalTrials.gov, number NCT 03251456. FindingsAmong 9936 children at 63 schools randomized to Intervention (32 schools, 5053 [50·9%] children) or Control (31 schools, 4883 [49·1%] children), 1114 children (11·2%) failed screening. Among 513 referred Intervention children (46·1%, 32 schools, mean age 5·36 years, 53·0% boys) and 601 referred Control children (53·9%, 31 schools, mean age 5·30 years, 57·7% boys), 104 (20·3%) and 135 (22·5%) were lost to follow-up respectively. Under Intention to Treat analysis, assuming children lost to follow-up were non-compliant, Intervention children had significantly higher compliance than Controls (308/513 = 60·0% vs. 225/601 = 37·4%, P < 0·001). In regression models, Intervention group membership (Relative risk [RR] 1·53, 95% confidence interval, 1·36–1·72), travel time to hospital (RR: 0·97, 0·95–0·999), baseline glasses wear (RR: 1·37, 1·17–1·60), strabismus (RR: 1·17, 1·01–1·36) and worse uncorrected vision (RR: 1·41, 1·03–1·92) were associated with compliance. InterpretationProviding specific appointments for quality-assured eye care improved referral compliance in this setting.