Vision Screening In Preschool Children Research Articles

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

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

Automated screening devices for vision screening in preschool children: A comparison of the PlusoptiX S12C photoscreener and retinomax K+3 autorefractor.

Automated vision screening devices such as photoscreeners and autorefractors have been used to accurately identify amblyopia, refractive amblyopia risk factors (ARFs), and refractive error in young children; however, there is conflicting data about the effectiveness of different screening devices. We compared the performance of two commercially available screening devices in preschool children. Children aged 3 to 5 years attending 5 preschools in Anaheim Elementary School District were screened with the PlusoptiX S12C photoscreener using ROC 3 referral criteria and Retinomax K+3 autorefractor in March 2022. Screened children were offered free cycloplegic eye examinations performed by optometrists on the UCI EyeMobile for Children mobile clinic. Children were evaluated for the presence of refractive ARFs using 2021 American Association for Pediatric Ophthalmology and Strabismus age-based referral criteria guidelines for instrument-based screening. A total of 158 children were screened and 79 children received cycloplegic examinations. At least one refractive ARF was found in 20% of examined children, corresponding to a sensitivity/specificity/positive predictive value (PPV)/negative predictive value (NPV) of 94%/89%/68%/98% for the PlusoptiX and 100%/65%/42%/100% for the Retinomax. In detecting refractive ARFs, the PlusoptiX was found to have a higher specificity and PPV while the Retinomax had a higher sensitivity and NPV. While both devices demonstrated a high sensitivity and NPV, we found that the PlusoptiX performed better overall as a screening device for our program as the Retinomax referred too many children.

Early Detection of Refractive Errors by Photorefraction at School Age

Early detection and treatment of refractive defects during school age are essential to avoid irreversible future vision loss and potential school problems. Previously, vision screening of preschool children used methods based on subjective visual acuity; however, technologies such as photorefraction have promoted the detection of refractive errors quickly and easily. In this study, 1347 children from 10 schools in Madrid aged 4 to 12 years participated in a program of early detection of visual problems, which consisted of visual screening composed of anamnesis and photorefraction with a PlusOptix A12R. The prevalence of refractive errors was analyzed in terms of spherical equivalent, cylinder and its orientation, and potential cases of development of high myopia or amblyopia. Hyperopia predominates in the early years, but the number of myopic subjects is higher than that of hyperopic subjects from the age of ten onwards. At all ages, the predominant orientation of astigmatism was with-the-rule. On average, 80% of the myopic subjects were uncorrected. Potential high myopia increased with age, from 4 to 21% of the measured population. Potential amblyopia cases decreased across age groups, from 19 to 13.7%. There is a need to raise awareness of the importance of vision screening at school age to address vision problems.

Community based vision screening in preschool children; performance of the Spot Vision Screener and optotype testing

ABSTRACT Background Children’s vision screening children commonly uses optotype-based visual acuity or instrument-based methods measuring amblyogenic risk factors (ARFs). Objective To compare the performance of the Spot Vision Screener (SVS) (PediaVision, Welch Allyn, NY) and a nurse-administered visual acuity screen (NVAS) in identifying ARFs and decreased visual acuity. Methods A prospective, cross-sectional population-based study of preschool children in South-East Queensland, Australia. Eligible participants had both forms of screening by trained community nurses. All children with an abnormal result by either method as well as a cohort of randomly selected children who passed both assessments were assessed at a tertiary paediatric ophthalmology clinic. Results Over a 10 month period, 2237 children (mean age; 64.4 ± 4.0 months) were screened from 38 schools. 6.4% of children failed SVS and 8.3% failed NVAS (with 3.8% overlap, failing both). The positive predictive value (PPV) in identifying either ARFs and/or reduced VA for the SVS and NVAS was 70.4% (95% Confidence Interval (CI): 61.6%–78.2%) and 60.5% (95% CI: 52.6%–67.9%) respectively. Highest PPV to detect either ARFs and/or reduced VA was achieved by a ‘hybrid’ method by combining failed NVAS and failed SVS: 91.0% (95% CI: 82.4 to 96.3) but this would risk children with sight impairment being missed in the community. Conclusion To our knowledge, this is the first population-based study providing detailed comparative measures of diagnostic accuracy for NVAS and SVS in preschool children. One in ten preschool children failed one or both screens. A number of children who required ophthalmic intervention were missed if only one screening method was utilized.

Agreement and diagnostic accuracy of vision screening in preschool children between vision technicians and spot vision screener.

Purpose:Screening preschool children for vision-related disorders poses a challenge. This study is designed to determine the agreement and diagnostic accuracy of the spot vision screener (SVS) in screening preschool children compared to screening procedure by vision technicians (VT).Methods:This study was conducted as a part of the ongoing study titled “Initiative for Screening Children for Refractive Errors and other Eye Health Needs (I-SCREEN).” Children from 33 Anganwadis (preschools) in two districts, Adilabad district of Telangana and Krishna district of Andhra Pradesh, in South India, underwent eye health screening by a VT and by a trained community eye health workers (CEHW) using the SVS. Findings were compared for agreement and diagnostic accuracy of assessment.Results:A total of 976 preschool children were screened by the VT and separately by the CEHW using the SVS in Adilabad (15 schools) and Krishna (18 schools) districts. The overall mean age of these children was 2.5 years (SD ± 1.3 years). There were 48 (4.9%) referrals by VT compared to 105 (10.8%) referrals by CEHW using SVS. The overall sensitivity of SVS was 91.7% (95% CI: 80%–97.7%) and the specificity was 93.4% (95% CI: 91.6%–94.9%). Positive predictive value was 41.9% (95% CI: 32.3%–51.9%) and negative predictive value was 99.5% (95% CI: 98.8%–99.9%) with a moderate agreement (0.54; 95% CI 0.49–0.64) between VT screening and screening with SVS.Conclusion:The SVS showed good diagnostic accuracy and agreement in screening for possible vision-related disorders in preschool children.

Commentary: Agreement and diagnostic accuracy of vision screening in preschool children between vision technicians and spot vision screener.

Commentary: Agreement and diagnostic accuracy of vision screening in preschool children between vision technicians and spot vision screener.

Biometry: a tool for the detection of amblyopia risk factor in children

PurposeTo determine optical biometry data criteria for the detection of abnormal refraction in preschool children, and to evaluate the accuracy of these criteria for detecting amblyopia refractive risk factor (ARF), as defined in the 2013 guidelines of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS).MethodsThe present study included 200 eyes of 100 preschool children with normal eyes for the experimental determination of criteria and 142 eyes of 71 preschool children for validation of these criteria. Statistical data from normal eyes were used to determine both “high sensitivity failure criterion” and “high specificity failure criterion” associated with corneal astigmatism, interocular difference in axial length, and the prediction interval of a regression formula for predicting corneal power from axial length. Ophthalmological examination of children for validation included testing cycloplegic refraction and optical biometry testing. Outcomes from optical biometry criteria were compared with determination via ophthalmological examination, and the accuracy of the criteria for detecting ARF was evaluated.ResultsSensitivity of the “high sensitivity failure criterion” for detecting 2013 AAPOS ARF was 100%, while the specificity was 80.5%. The sensitivity of the “high specificity failure criterion” was 93.3%, while the specificity was 95.1%.ConclusionsThe criteria derived from optical biometry data in this study exhibited excellent sensitivity and specificity for detecting ARF. This study may lead to a new approach to vision screening in preschool children.

The impact of vision screening in preschool children on visual function in the Swedish adult population.

Amblyopia is the most common monocular visual impairment in Scandinavia. A visual screening programme for preschool children was introduced in Sweden in the 1970s to reduce the prevalence of amblyopia. The purpose of this study was to investigate the impact of this visual screening programme in adult men recruited to the armed forces in Sweden. The prevalence of amblyopia was compared in recruits born in 1956-1957 (n=1500), before the introduction of the visual screening programme (unscreened), and those born in 1977-1979 (n=2626), after the visual screening programme was introduced (screened). Amblyopia was defined as bilateral, if the bilateral best corrected visual acuity (BCVA) was <0.5 (20/40), and unilateral if there was a ≥2-line interocular difference and BCVA was <0.625 (20/32) in the worse eye. Subgroup analysis was performed on recruits with hyperopia, myopia and anisometropia. The prevalence of amblyopia was significantly lower after the introduction of the Swedish visual screening programme. Forty-seven (3.3%) of the unscreened and 23 (0.9%) of the screened recruits had unilateral amblyopia (p<0.0001, OR=0.26 (95%CI 0.16-0.43)). The risk for developing amblyopia was markedly reduced by screening in recruits with hyperopia (≥2D) (p<0.0001 and OR 0.034 (95% CI 0.003-0.207)) and anisometropia (≥1.5D interocular difference) (p<0.01 and OR 0.20 (95% CI 0.08-0.66)). Only a few recruits with myopia had amblyopia. The results demonstrate the value of the Swedish visual screening programme for preschool children in preventing amblyopia. Anisometropia or high hyperopic refractive errors can be identified by screening and corrected to prevent amblyopia.

Preschool Vision Screening: Where We Have Been and Where We Are Going

To discuss the evolution of instrument-based screening to detect amblyopia and its risk factors, and to summarize the importance of preschool vision screening. Expert commentary. Author experiences were supplemented by a review and interpretation of pertinent medical literature. Amblyopia remains a public health problem, as it is a common cause of monocular visual impairment. As a disease, amblyopia detection is best obtained by appropriate vision screening rather than by yearly mandated comprehensive eye examinations for all children; the US Preventative Services Task Force (USPSTF) recently reaffirmed their recommendations for vision screening in preschool children. Vision screening devices have evolved over the past 4 decades ranging from photoscreeners that use instantaneously developing film, to autorefractors that detect amblyopia risk factors, to nerve fiber layer scanners that detect the microtropia that nearly always accompanies amblyopia. When it is detected early, effective treatment for amblyopia can be initiated. Amblyopia is a reversible cause of vision loss in children. Vision screening devices and screening programs have been extensively studied-experts and literature agree: vision screening devices and programs are cost-effective, are efficient, and are effective methods for amblyopia detection. The authors support the regular use of instrument-based vision screening in the medical home for all children until they reach a developmental stage where they can participate reliably in optotype-based vision screening.

Vision Screening in Preschool Children: Should a child be admitted to the glaucoma screening?

The global initiative of World Health Organization (WHO), Vision 2020, The Right to Sight, has set the goal of prevention of blindness and visual impairment. The data of WHO are in favor of the fact that more than 45% of blindness in children is preventable. The etiology of blindness and visual impairment in children varies from country to country. The screening programs of visual impairment in children under the age of five exist in many countries of high or midle socioeconomic status. The screening programs of visual impairment of children are heterogonous with the respect of their goal, instruments, profile of professionals and the level of health care system where the screenings are performed. The Ministry of Health of Republic of Croatia has brought the decision on the implementation of screening of visual impairment in children aged over three years, according to the world practice. In the planning of visual impairment screening, it is important to define which visual will be screened in certain population of children and how. The instruments and the methods of visual impairment screening, depending on age of children, their development, compliance and interaction with the screener are presented. Primary goal of visual impairment screening was detection of ambliopia in children. But the etiology of visual impairment in children is much broader. The special emphasis in this paper is placed on glaucoma in children because of its broad presentation from birth to the adolescence, in the sense of congenital glaucoma or as a part of systematic diseases. In the conclusion it could be said that the standardization of visual impairment screening should be done on several levels such as exacts definition of the goal of screening according to the child’s age, professionals involved in screening program and the standardization of level of health care system where the screening should be performed.

Children With Problems at School

The Professional Association of German Ophthalmologists (Berufsverband der Augenarzte Deutschlands, BVA) and the Ophthalmologische Gesellschaft (DOG, the medical scientific association of ophthalmology in Germany) protested against IQWiG’s rejection of vision screening in preschool children, in some cases insulting and blaming the institute’s staff. As Professor Lagreze showed in his article, this was unjustified. Vision screening was intended to identify in particular amblyopia with strabismus, in order to prevent bilateral sight impairment in case additional eye disorders were to develop in old age. However, this should be completed if possible by the 3rd year of life because the chance of a cure notably decreases after that age. Transferring preventive eye investigations in early childhood from pediatricians to ophthalmologists would make sense. Screening measures at any later stage therefore hardly make any sense. In my long years’ experience with many thousands of affected children, something that really puts a burden on children after the 6th year of life, when they have entered school, are latent binocular vision impairments, which affect children’s ability to perform and thus endanger their academic and later professional careers. Severe asthenopic symptoms with headache/migraine, impaired gross and fine motor skills, difficulties in reading/spelling, and AD(H)D will then lead to severe performance impairments. Children with problems at school should therefore be investigated for associated heterophorias (latent strabismus in which one eye tends to deviate either medially or laterally) with the Pola-test according to Haase’s particularly effective measurement and correction method, in order to prevent maldevelopments. Ophthalmologists, pediatricians, psychologists, and optometrists, as well as educators have joined forces to be contacted under the umbrella of the International Association for Binocular Fullcorrection (IVBV).

Vision Screening in Preschool Children

Comprehensive, systematic reviews on the benefit of vision screening in preschool children were published in 2008 by major national organizations in both Germany and the United Kingdom. These reviews raised public interest in the topic. This article contains a discussion of the sensitivity, specificity, efficacy, and cost-effectiveness of preschool vision screening, on the basis of the two national reports mentioned above as well as relevant literature retrieved by a selective PubMed search. All studies that have been published to date on the efficacy of preschool visual screening suffer from methodological flaws. The available data suggest a benefit from screening, though this has not been proven. Model calculations reveal that the positive predictive value of screening tests performed in isolation is inadequate. The authors of the two national reports applied different methods and arrived at similar, but not identical conclusions. Preschool vision screening may also be cost-effective; whether this is the case or not depends on the probability of a long-term benefit--specifically, on the probability of preventing bilateral loss of vision in adulthood. To prevent one such case, it is estimated that 13 cases of childhood amblyopia must be identified and successfully treated (number needed to treat [NNT] = 13). The available data do not allow any firm conclusion about the efficacy and cost-effectiveness of preschool vision screening. Further clinical studies are needed to answer these questions.

Photo Screening Around the World: Lions Club International Foundation Experience

Purpose: To describe the use of photoscreening for preschool vision screening in several diverse locations throughout the world. Methods: The MTI photo screener was used to screen pre-verbal children; photographs were interpreted using standard criteria. Results: The Tennessee vision screening program remains successful, screening over 200,000 children during the past 8 years. Similar programs modeled across the United States have screened an additional 500,000 children. A pilot demonstration project in Hong Kong, Beijing, and Brazil screened over 5000 additional children with good success and appropriately low referral rates. Conclusion: Photoscreening can be an appropriate technique for widespread vision screening of preschool children throughout the world.

Vision screening of preschool children: evaluating the past, looking toward the future.

Vision problems of preschool children are detectable with a comprehensive eye examination; however, it is estimated that only 14% of children below the age of 6 years receive an eye examination. Screening is advocated as a cost-effective alternative to identify children in need of further vision care. Thirty-four states recommend or require vision screening of preschool children. Although laws and guidelines exist, only 21% of preschool children are actually screened for vision problems. There is little agreement concerning the best screening methods, and no validated, highly effective model for screening vision of preschool children. Newer screening tests have been designed specifically for preschool populations, and can be administered by lay screeners. Many have not been validated. Several are recommended by states or organizations without convincing scientific evidence of their effectiveness. This paper summarizes current laws and guidelines for preschool vision screening in the United States, reviews advantages and disadvantages of several test procedures, and provides recommendations for developing future preschool vision screening programs.

Validity and Reliability of the MTI Photoscreener

The prevalence and necessity for early detection of vision problems illustrate the need for improved methods of vision screening in preschool children. This study assessed the validity and reliability of a new device, the MTI photoscreener in a cross-sectional field study. An appropriate sample size (> 140) was calculated and recruited for the study. All children (N = 161) in a migrant workers summer education program were screened with the MTI Photoscreener. Simultaneously and in a masked design, disease status was determined by the Modified Clinic Technique, a well established method for diagnosing the conditions which the MTI screener was designed to detect. Validity measures revealed a sensitivity of 54%, specificity of 87%, phi coefficient of 0.40, and positive predictive value of 52%. Repeatability was assessed by the kappa coefficient, by a test for effect modification by examiner, and by comparison of sensitivity and specificity across 12 masked examiners. The kappa coefficient was 0.38. A test for effect modification suggested that differences existed among the examiners. Variability of sensitivity was high, but variability of specificity was low. Methods for vision screening in preschool children are limited. The MTI Photoscreener is an easy and efficient method, but the validity and reliability is a concern. Comparison of our results with other studies suggests future potential for this instrument provided protocols are refined and further field studies reveal efficacy.

Evaluation of vision screening practices of Illinois pediatricians.

A survey of vision screening practices of American Academy of Pediatrics physicians in Illinois is described. The response rate was 42%. Sixty percent of physicians tested visual acuity of children 5 years and older, and half of this group tested children 2 to 4 years old. The most common reasons for not testing visual acuity were inadequate time (42%), children too young (18%), or screening done at school (18%). The majority (88%) refer to an ophthalmologist after a single vision screening failure, while about half perform the cover-uncover test on infants and children. The results suggest many Illinois pediatricians do not perform vision screening of preschool children, though screening does occur at other sites.

Vision screening of preschool children in Italy.

Vision screening of preschool children is designed and performed to identify those affected by amblyopia or related, predisposing visual defects. In order to determine the prevalence of preschool vision screening in Italy, a questionnaire was mailed to the 635 regional health offices in which the country's national health system was organized at the time of the study. Results of this survey demonstrated that in 61.3% of the regions which responded, some form of preschool vision screening is performed. However, individual, non-standardized methods are used by the physicians or health care professionals responsible in each regional program. It is evident from this study that standardized procedures for preschool vision testing are lacking in Italy, and that the existing European Community guidelines should be disseminated and applied on a greater scale for the development of such a program on the national and European level.

Vision screening in preschool children.

Vision screening in preschool children.

Vision screening in preschool children: Authors' reply

Vision screening in preschool children: Authors' reply

Vision screening in preschool children.

Vision screening in preschool children.