Preschool children's vision screening in New Zealand: a retrospective evaluation of referral accuracy.
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ABSTRACT:
SUBMITTER: Langeslag-Smith MA
PROVIDER: S-EPMC4663450 | biostudies-literature | 2015
REPOSITORIES: biostudies-literature
Publications
Preschool children's vision screening in New Zealand: a retrospective evaluation of referral accuracy.
Langeslag-Smith Miriam A MA Vandal Alain C AC Briane Vincent V Thompson Benjamin B Anstice Nicola S NS
BMJ open 20151127 11
<h4>Objectives</h4>To assess the accuracy of preschool vision screening in a large, ethnically diverse, urban population in South Auckland, New Zealand.<h4>Design</h4>Retrospective longitudinal study.<h4>Methods</h4>B4 School Check vision screening records (n=5572) were compared with hospital eye department data for children referred from screening due to impaired acuity in one or both eyes who attended a referral appointment (n=556). False positive screens were identified by comparing screening ...[more]
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Project description:BackgroundThere are many causes of visual impairment, and even blindness, which are treatable or at least preventable. Two such conditions are strabismus (crossed-eye, squint) and refractive error (visual image not focused on the most sensitive part of the retina). If these are not detected and corrected at an early age, they can lead to an irreversible impairment known as amblyopia (lazy eye). Pediatric vision screening and subsequent treatment for amblyopia and amblyogenic risk factors are thus key to preventing vision loss. Furthermore, vision screening can detect moderate to high hyperopia, which has been found to be associated with poor school readiness. Evidence-based recommendations call for screening children at 3-5 years of age; they are old enough to cooperate, but still within the window of effective intervention. However, these recommendations have yet to be universally implemented as the standard of care.MethodsThis paper integrates a review of the literature and the international experience of preschool vision screening with the findings from a preliminary feasibility study of expanded screening in Israel to formulate a discussion of the current health policy challenge in Israel and the options for addressing it. The advantages and disadvantages of various venues for vision screening are discussed.FindingsScreening by optometrists in Mother and Child Health Centers, as implemented in a recent pilot project in the Jerusalem District, would allow the most comprehensive testing. Photo-screening in preschools would reach the most children, but at the cost of missing hyperopia (farsightedness). Either approach would probably constitute improvements over the current situation. The relative strengths of the two approaches depends in part on the ability to purchase automatic screening equipment (and the efficacy of that equipment) vs. the ongoing cost of paying trained personnel.ConclusionsFurther research should be conducted in Israel to determine the prevalence of refractive errors, so that best practices can be established for Israel's population and social needs. In the interim, the Ministry of Health should promptly implement the inclusion of preschool visions screening for children in the approved "basket of services" covered by the National Health Insurance Laws, using photo-screening, including collection of the clinical data.
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Project description:Vitamin D deficiency has adverse health effects in young children. Our aims were to determine predictors of vitamin D status and then to use these factors to develop a practical tool to predict low 25(OH)D concentrations in preschool New Zealand children. A cross-sectional sample of 1329 children aged 2 to <5?years were enrolled from throughout New Zealand in late-winter to spring 2012. 25-Hydroxyvitamin D (25(OH)D) was measured on dried blood spot (DBS) samples collected using finger-prick sampling. Caregivers completed a questionnaire. Mean (SD) DBS 25(OH)D concentration was 52(19)nmol/L. 25(OH)D?<?25?nmol/L was present in 86(7%), 25(OH)D?<?50?nmol/L in 642(48%), 25(OH)D 50-?<?75?nmol/L in 541(41%) and 25(OH)D?>?75?nmol/L in 146(11%) of children. Factors independently associated with the risk of 25(OH)D <?25?nmol/L were female gender (OR 1.92,95%CI 1.17-3.14), other non-European ethnicities (not including M?ori or Pacific) (3.51,1.89-6.50), had olive-dark skin colour (4.52,2.22-9.16), did not take vitamin D supplements (2.56,1.06-6.18), had mothers with less than secondary-school qualifications (5.00,2.44-10.21) and lived in more deprived households (1.27,1.06-1.53). Children who drank toddler milk (vitamin D fortified cow's milk formula marketed to young children) had a zero risk of 25(OH)D?<?25?nmol/L. The predictive tool identified children at risk of 25(OH)D?<?25?nmol/L with sensitivity 42%, specificity 97% and ROC area-under-curve 0.76(95%CI 0.67-0.86, p?<?0.001). Predictors of low vitamin D status were consistent with those identified in previous studies of New Zealand children. The tool had insufficient predictive ability for use in clinical situations, and suggests a need to promote safe, inexpensive testing to determine vitamin D status in preschool children.
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Project description:BackgroundNew Zealand (NZ) is considering transitioning from 3-yearly cervical cytology screening in women 20-69 years (current practice) to primary HPV screening. We evaluated HPV-based screening in both HPV-unvaccinated women and cohorts offered HPV vaccination in New Zealand (vaccination coverage ~50%).MethodsA complex model of HPV transmission, vaccination, cervical screening, and invasive cervical cancer was extensively validated against national population-based datasets. Sixteen potential strategies for HPV screening were considered.ResultsMost primary HPV strategies were more effective than current practice, for both unvaccinated women and cohorts offered vaccination. The optimal strategy for both groups was 5-yearly HPV screening in women aged 25-69 years with partial genotyping for HPV 16/18 and referral to colposcopy, and cytological triage of other oncogenic types. This is predicted to reduce cervical cancer incidence and mortality by a further 12-16% and to save 4-13% annually in program costs (excluding overheads). The findings are sensitive to assumptions about future adherence to initiating screening at 25 years.ConclusionPrimary HPV screening with partial genotyping would be more effective and less costly than the current cytology-based screening program, in both unvaccinated women and cohorts offered vaccination. These findings have been considered in a review of cervical screening in NZ.
| S-EPMC4871332 | biostudies-literature
Project description:BACKGROUND:Young children's vision screening, as part of a preventative health care service, produces great value for developing regions. Besides yielding a high return on investment from forestalling surgeries using a low-cost intervention at a young age, it improves school performance and thus boosts future labor force quality. Leveraging low-skilled health care workers with smartphones and automated diagnosis to offer such programs can be a scalable model in resource-limited areas. OBJECTIVE:This study aimed to develop and evaluate an effective, efficient, and comprehensive vision screening solution for school children in resource-limited areas. First, such an exam would need to cover the major risk factors of amblyopia and myopia, 2 major sources of vision impairment effectively preventable at a young age. Second, the solution must be integrated with digital patient record-keeping for long-term monitoring and popular statistical analysis. Last, it should utilize low-skilled technicians and only low-cost tools that are available in a typical school in developing regions, without compromising quality or efficiency. METHODS:A workflow for the screening program was designed and a smartphone app was developed to implement it. In the standardized screening procedure, a young child went through the smartphone-based photoscreening in a dark room. The child held a smartphone in front of their forehead, displaying pre-entered personal information as a quick response code that duplexed as a reference of scale. In one 10-second procedure, the child's personal information and interpupillary distance, relative visual axis alignment, and refractive error ranges were measured and analyzed automatically using image processing and artificial intelligence algorithms. The child's risk for strabismus, myopia, and anisometropia was then derived and consultation given. RESULTS:A preliminary evaluation of the solution was conducted alongside yearly physical exams in Luoyang, Henan, People's Republic of China. It covered 20 students with suspected strabismus and 80 randomly selected students, aged evenly between 8 and 10. Each examinee took about 1 minute, and a streamlined workflow allowed 3 exams to run in parallel. The 1-shot and 2-shot measurement success rates were 87% and 100%, respectively. The sensitivity and specificity of strabismus detection were 0.80 and 0.98, respectively. The sensitivity and specificity of myopia detection were 0.83 and 1.00, respectively. The sensitivity and specificity of anisometropia detection were 0.80 and 1.00, respectively. CONCLUSIONS:The proposed vision screening program is effective, efficient, and scalable. Compared with previously published studies on utilizing a smartphone for an automated Hirschberg test and photorefraction screening, this comprehensive solution is optimized for practicality and robustness, and is thus better ready-to-deploy. Our evaluation validated the achievement of the program's design specifications.
| S-EPMC7386401 | biostudies-literature
Project description:Nationwide in Japan, a community-based vision-screening program in 3.5-year-old children is conducted in three steps: questionnaires and home visual acuity testing as the primary screening; visual acuity testing by nurses and pediatricians' inspection in community health centers as the secondary screening; and examinations by ophthalmologists as the tertiary screening. In this study, we introduced photorefraction with a Spot vision screener in addition to visual acuity testing to answer the clinical question of whether photorefraction could better detect eye diseases and potentially replace visual acuity testing. Photorefraction was performed on 813 consecutive 3.5-year-old children in a center. The children were sent to tertiary examinations, which were based on the Spot vision screener standard, in addition to the visual acuity testing standard: failure in either eye to pass 0.5 visual acuity in a center. A notice to visit ophthalmologists was issued for 95 children (11%), and documents with the diagnosis were sent back to the Heath Office for 76 children (80%). The rate of children with anisometropic or ametropic amblyopia or accommodative esotropia as treatment-requiring diseases was highest in cases of no pass at both standards (10/15 = 66%), and higher in cases of no pass only at the Spot vision screener standard (13/45 = 28%), compared with cases of no pass only at the visual acuity testing standard (6/33 = 18%, p = 0.0031). Photorefraction, in addition to visual acuity testing and inspection led to additional eye diseases detection at 3.5 years. Visual acuity testing at home would not be omitted in the introduction of photorefraction.
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| S-EPMC7791401 | biostudies-literature
Project description:ObjectiveThe aim of this study was to investigate the association between preschool playground size, formalized physical activity (PA) policies, time spent outdoors and preschool teacher's levels of PA and children's objectively assessed levels of PA and sedentary time (ST) during preschool hours.MethodsIn total, 369 children and 84 preschool teachers from 27 preschools in Södermalm municipally, Stockholm Sweden wore an Actigraph GT3X+ accelerometer during 7 consecutive days. Preschool environmental and structural characteristics were measured via the Environment and Policy Evaluation Self-Report (EPAO-SR) instrument and time in- and outdoors was recorded by preschool teachers during the PA measurements. Weight and height of children were measured via validated scales and parents filled out a questionnaire on demographical and descriptive variables. Linear mixed models, nested on preschool level, were used to assess the association between predictors and outcomes.ResultsThe mean child age was 4.7 years (SD 0.8) and 45% were girls. We found that children were more active in preschools with a formalized PA policy, compared to preschools without such a policy, but not less sedentary. The association between policy and activity seemed to be more pronounced when accounting for other environmental factors. Similar associations were found in children spent most time outdoors (uppermost quartile) compared with children spent least time outdoors (Lowermost quartile). Preschool teachers' light PA (LPA) (ß = 0.25, P = 0.004) and steps (ß = 0.52, P<0.001) were associated with children's LPA and steps while the preschool playground size showed no association with PA in children, when accounting for other environmental factors.ConclusionThe current study showed that preschool structural characteristics such as formalized PA policies and more time spent outdoors were positively associated with children's PA. These findings suggest that formalized PA policies and time outdoors may be of importance for promoting children's PA during preschool hours.
| S-EPMC7561096 | biostudies-literature
Project description:BACKGROUND:Regardless of the importance of preschool vision screening (PSVS), there is limited data on the current state of these programs in Africa (particularly Ghana). This study sought to investigate the level of awareness and perception of stakeholders regarding PSVS, its availability and related policies/programmes in the Kumasi Metropolis, Ghana. METHODS:This descriptive cross-sectional study included 100 systematically sampled preschools in the metropolis (using probability proportional-to-size method); 72 private schools and 28 public schools. Convenience sampling was used to recruit stakeholders of preschools (teachers, head teachers, proprietors, administrators, directors, and educationists), and were interviewed using a well-structured questionnaire. Questionnaires were administered to all eligible respondents who were present at the time of data collection. RESULTS:A total of 344 respondents participated in the study; 123 (35.8%) males and 221 (64.2%) females. The overall mean age of respondents was 37.63 ±12.20 years (18-71 years). Of the respondents, 215 (62.5%), 94 (27.3%), and 35 (10.2%) were enrolled from private schools, public schools, and Metropolitan Education Directorate, respectively. 73.8% of respondents reported the absence of routine PSVS in schools whereas 90.1% reported no written policies for PSVS in schools. Only 63.6% of respondents were aware of PSVS whereas more than half (59.6%) of all respondents perceived PSVS to be very important for preschoolers. Private school ownership was significantly associated with availability of PSVS whereas age, teachers, private school ownership, and preschool experience > 10 years were significantly associated with awareness of PSVS (P < 0.05). However, there was no significant association between sociodemographic factors and perception of PSVS. CONCLUSION:PSVS is largely unavailable in most Ghanaian schools. Majority of stakeholders were aware of PSVS and agreed to its implementation and incorporation into schools' health programmes. There is the need to implement a national programme/policy on preschool vision screening in Ghana.
| S-EPMC7164614 | biostudies-literature
Project description:PurposeThe effectiveness of preverbal orthoptic tests at age 6, 9, 14 and 24 months in population-wide screening was assessed.MethodsTwo consecutive birth cohorts at 134 centres were compared. At general health screening visits, children born July-December 2011 were vision screened four times between 6 and 24 months with inspection, pupillary reflexes, eye motility, Hirschberg, cover test and monocular pursuit. Children born January-June 2012 were vision screened at general screening visits only in case of visually apparent abnormalities or positive family history. After referral, cause and severity of amblyopia were determined. Visual acuity was measured in all children at 36 and 45 months.ResultsThe control and intervention group comprised 5649 versus 5162 children. Amblyopia was diagnosed in 185 (3.3%) versus 159 children (3.1%), outside of screening in 21 (11.4%) versus 25 (15.7%). Between 6 and 24 months, 44 (23.8%) versus 27 (17%) (RR = 0.67 [95% CI 0.42, 1.09]) were referred and after visual acuity (VA) measurement 120 (64.9%) versus 107 (67.3%). Of 109 versus 108 children with refractive or bilateral amblyopia, 94 (86.2%) versus 92 (85.2%) were detected with VA measurements. Visual acuity of the amblyopic eye, after referral, was not significantly different between groups (p 0.896), nor was the time to amblyopia diagnosis (intention to screen [p 0.55]; per protocol [p 0.11]).ConclusionThe effectiveness of vision screening was not influenced by omission of orthoptic tests at general health screening at 6-24 months. Refractive and bilateral amblyopia were almost exclusively found by VA measurements.
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