Vision screening for correctable visual acuity deficits in school-age children and adolescents.
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SUBMITTER: Evans JR
PROVIDER: S-EPMC6491194 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:In clinical practice Cerebral Visual Impairment (CVI) is typically diagnosed by observation of abnormal visually guided behaviors which indicate higher visual function deficits (HVFDs) suggesting abnormal brain development or brain damage in a child with a suitable clinical history. HVFDs can occur even in the presence of good visual acuity and may remain undiagnosed because the good visual acuity does not prompt further investigation. This leads to a lack of understanding of the child's visual perceptual difficulties. In a prospective study, we determined the spectrum of HVFDs in a group of children with history suggestive of brain damage or disruption of brain development and an independent diagnosis of CVI in comparison with typically developing children with a structured 51 question inventory, the Higher Visual Function Question Inventory (HVFQI-51) adapted from the Cerebral Vision Impairment Inventory, CVI-I. Here, we show that the HVFQI-51 can detect a range of HVFDs in children with CVI with good visual acuity and clearly distinguishes these children from typically developing children. HVFDs in our study group could mostly be attributed to dorsal stream visual processing dysfunction though the spectrum varied between children. We report on the inclusion of the "not applicable" response option in analysis providing a picture of HVFDs more in tune with the overall disability of each child. We also propose a subset of 11 questions (Top-11) which discriminate between children with CVI vs. behaviors seen in typical children: this provides both a potential screening tool for initial assessment of HVFDs and a measure of CVI-related impairment, and needs further validation in a secondary independent sample.
| S-EPMC8636735 | biostudies-literature
Project description:BackgroundWe applied the National Screening Committee vision screening protocol [pass criterion monocular acuity ≤ 0.2 LogMAR in both eyes(BE)] to children four to five years old to investigate the visual profile of children who passed/failed. Previous studies have only evaluated those failing. The aim was to derive false positive and negative values, specificity/sensitivity of the vision screening protocol for detecting significant visual defects (strabismus and/or significant refractive error) and the utility of a 'plus blur test' in identifying hyperopia.MethodsParticipants included 294 children (5.2 ± 0.4 yrs). In addition to the vision screening protocol (monocular acuity-3 m crowded Keeler LogMAR letters), acuities were recorded through +2.50D and +4.00D lenses and ocular alignment and cycloplegic refractive error were assessed. Using acuity measures, participants were classed as passing/failing the screening protocol. Each participant was also classed as having a strabismus and/or significant refractive error (hyperopia ≥ +4.00DS; myopia ≤ -0.50DS; astigmatism ≤ -1.50DC; anisometropia ≥ +1.50DS) or no significant visual defects.ResultsOf the 284 children who completed all tests, 27.8% failed to achieve 0.2 LogMAR in BE. The acuity pass/fail criterion had a sensitivity of 70.4% and specificity of 82.2% for detecting strabismus and/or significant refractive error. Of those who failed, 51.9% (n = 41/79) had no strabismus and/or significant refractive error (false positives). Of those who passed, 7.8% (n = 16/205) had visual defects (false negatives). The 'plus blur tests' improved sensitivity in detecting significant refractive error (+2.50D & +4.00D 90.7%) but significantly reduced specificity (+2.50D = 65.2%; +4.00D = 60.9%).ConclusionsSchool-entry vision screening is reasonably sensitive and specific for detecting strabismus and/or significant refractive error. Most children with visions poorer than 0.2 LogMAR need refractive intervention, and the majority of the remainder are likely false positives for significant visual defects. One in 13 children who pass have either strabismus and/or significant refractive error (7.8%). The inclusion of a 'plus blur test' was not a useful addition to the vision screening protocol.
| S-EPMC7510406 | 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.
| S-EPMC9321534 | biostudies-literature
Project description:BackgroundEndotracheal intubation by direct laryngoscopy is a mainstay of advanced airway management performed both in the prehospital environment and in the Emergency Department. Many factors may affect the quality of view during direct laryngoscopy, one of them being the visual acuity (VA) of the intubator under these demanding conditions. While some individual variation in VA is to be expected in younger populations, VA naturally deteriorates in older populations particularly beyond the age of 40 years. This study aimed to describe VA in a younger (n=19) and an older (≥40 years of age, n=20) cohort of intubators at baseline and during simulated adult laryngoscopy, and to compare VA between these two age cohorts.MethodsA baseline near VA test was done using a Sloan Early Treatment Diabetic Retinopathy Study (EDTRS) near vision chart at 40 cm under ambient indoor light. Participants in both age cohorts were then requested to perform laryngoscopy using an airway simulator at 40 cm viewing distance and again at a viewing distance of their choice. Both binocular and monocular VA were tested using a near VA chart placed anterior to the vocal cords of the airway trainer. VA was quantified using the logarithm of the minimum angle of resolution (logMAR). Differences in VA between age cohorts were assessed using independent samples t-tests and differences within age cohorts were assessed using paired samples t-tests.ResultsBinocular and monocular near VA was significantly reduced in the older cohort compared to the younger cohort at baseline (both eyes -0.129 logMAR; p = 0.04, right eye -0.147 logMAR; p = 0.005, left eye -0.197 logMAR; p = 0.002). Within each age cohort VA was significantly reduced during laryngoscopy at a fixed viewing distance (younger; both eyes -0.111 logMAR; p < 0.001, right eye -0.095 logMAR; p < 0.001, left eye -0.105 logMAR; p < 0.001; older; both eyes -0,08 logMAR; p < 0.001, right eye -0.110 logMAR; p < 0.001, left eye -0.065 logMAR; p = 0.01) but this was improved by reducing viewing distance.ConclusionIncreased age was associated with a significant reduction in VA at baseline and during laryngoscopy, which can be partially compensated for by adjusting viewing distance. Although it is currently unknown to what extent this age-related reduction of VA might negatively affect time to place an endotracheal tube or success of placement under direct vision, older intubators should be aware of this effect and consider specialized corrective eyewear in order to maintain an adequate level of VA.
| S-EPMC7905451 | biostudies-literature
Project description:BackgroundVisual demands of school children tend to vary with diverse classroom environments. The study aimed to evaluate the distance and near Visual Acuity (VA) demand in Indian school classrooms and their comparison with the recommended vision standards.Materials and methodsThe distance and near VA demands were assessed in 33 classrooms (grades 4 to 12) of eight schools. The VA threshold demand relied on the smallest size of distance and near visual task material and viewing distance. The logMAR equivalents of minimum VA demand at specific seating positions (desk) and among different grades were evaluated. The near threshold was converted into actual near VA demand by including the acuity reserve. The existing dimensions of chalkboard and classroom, gross area in a classroom per student and class size in all the measured classrooms were compared to the government recommended standards.ResultsIn 33 classrooms assessed (35±10 students per room), the average distance and near logMAR VA threshold demand was 0.31±0.17 and 0.44±0.14 respectively. The mean distance VA demand (minimum) in front desk position was 0.56±0.18 logMAR. Increased distance threshold demand (logMAR range -0.06, 0.19) was noted in 7 classrooms (21%). The mean VA demand in grades 4 to 8 and grades 9 to 12 was 0.35±0.16 and 0.24±0.16 logMAR respectively and the difference was not statistically significant (p = 0.055). The distance from board to front desk was greater than the recommended standard of 2.2m in 27 classrooms (82%). The other measured parameters were noted to be different from the proposed standards in majority of the classrooms.ConclusionThe study suggests the inclusion of task demand assessment in school vision screening protocol to provide relevant guidance to school authorities. These findings can serve as evidence to accommodate children with mild to moderate visual impairment in the regular classrooms.
| S-EPMC5378392 | biostudies-literature
Project description:PurposeTo quantify the association between dark adaptation parameters and other clinical measures of visual function among people with and without early and intermediate age-related macular degeneration (AMD).MethodsIn this cross-sectional study, participants underwent multimodal imaging and visual function testing, including best-corrected visual acuity (BCVA), low-luminance visual acuity (LLVA), low-luminance deficit (LLD = BCVA - LLVA) and the 10-item Night Vision Questionnaire (NVQ-10). Dynamic and static dark-adapted chromatic perimetry (DACP) was performed. Sensitivity difference was defined as the difference in sensitivity between the 505-nm and 625-nm stimuli. Rod intercept time (RIT) was estimated as the time required to reach a threshold of -3 log candelas/meter2 with the 505-nm stimulus following bleaching. The magnitude of association between the DACP parameters and other clinical tests was estimated via mixed-effects regression.ResultsA total of 51 participants (aged 51-88 years, 65% female, 39% with AMD) were included. RIT was found to be negatively associated with BCVA (P < 0.001), LLVA (P = 0.005), and NVQ-10 score (P = 0.028) but not LLD (P = 0.763). There was no evidence of an association between sensitivity difference and any of the clinical measures (P ≥ 0.081).ConclusionsReduced rod function, as determined by RIT, was associated with lower NVQ-10 scores (designed to interrogate rod-mediated function) and with worse BCVA and LLVA (measures of cone function).Translational relevanceDecreasing rod function maybe indicative of more generalized photoreceptor dysfunction involving cones. Further development of questionnaires to target function in scotopic conditions may provide an easier to administer test without the need to perform perimetric tests of rod function.
| S-EPMC7409161 | biostudies-literature
Project description:Children aged 7-17 years and adults aged 18-22 years were tested on three aspects of visual attention: the ability to distribute visual attention across the field to search for a target, the time required for attention to recover from being directed towards a target, and the number of objects to which attention can be simultaneously allocated. The data suggested different developmental trajectories for these components of visual attention within the same set of participants. This suggests that, to some extent, spatial, temporal and object-based attentional processes are subserved by different neural resources which develop at different rate. In addition, participants who played action games showed enhanced performance on all aspects of attention tested as compared to non-gamers. These findings reveal a potential facilitation of development of attentional skills in children who are avid players of action video games. As these games are predominantly drawing a male audience, young girls are at risk of under-performing on such tests, calling for a careful control of video game usage when assessing gender differences in attentional tasks.
| S-EPMC2824025 | biostudies-literature
Project description:PurposeTo compare improvements in visual acuity (VA) and stereoacuity between active vision therapy (AVT) and conventional patching therapy in children with amblyopia.MethodsThis study included 65 children aged 5 to 16 years (mean age±SD, 11.00±3.29 years) with unilateral amblyopia. Among them, 31 children underwent active vision therapy (AVT group), and 34 children underwent conventional patching therapy (patching group). AVT group underwent three sequential phases of AVT: Monocular phase (pursuit, saccades, fixation, visuomotor, eye-hand coordination, and central peripheral activities), biocular phase (diplopia awareness, antisuppression, monocular fixation in a binocular field, accommodative activities, bilateral integration, and fine motor activities) and binocular phase (fusion and stereopsis). Patching group patched their fellow eyes as per guidelines by Pediatric Eye Disease Investigator Group. Best-corrected monocular VA and stereoacuity were measured at baseline and after three months of therapy in both groups.ResultsThere were significant improvements in the mean acuities in amblyopic eye (AE) in both AVT (0.32±0.11 logMAR, p <0.001) and patching groups (0.27±0.19 logMAR, p ˂ 0.001). However, there was no significant difference in mean acuity gains in AE between AVT and patching groups (p = 0.059). Mean gains in stereoacuities (log seconds of arc) were statistically significant in both AVT (0.81±0.34, p < 0.001) and patching groups (0.32±0.34, p < 0.001). The stereoacuity gain in the AVT group was significantly higher compared to patching group (p < 0.001).ConclusionActive vision therapy had a better impact than conventional patching therapy in terms of improvement of stereoacuity but not in terms of VA when used for treating children with amblyopia.
| S-EPMC10785416 | biostudies-literature
Project description:PurposeTo describe the development and validation of a smartphone-based visual acuity (VA) test called Vision at home (V@home).MethodsThree study populations (elderly Chinese, adolescent Chinese, and Australian groups) underwent distance and near VA testing using standard Early Treatment Diabetic Retinopathy Study (ETDRS) charts and the V@home device; all VA tests used tumbling E optotypes. VA tests were repeated with one eye, selected randomly. Distance VA was measured monocularly at 2 m, and near VA was measured binocularly at 40 cm. Participants also completed a questionnaire about their satisfaction with the device. V@home VA (logMAR) was compared to VA for ETDRS charts at distance and near and test-retest reliability.ResultsThe mean difference between V@home and ETDRS distance VA across all groups ranged from -0.010 to -0.100 logMAR. Tolerant weighted kappa (TWK) agreement ranged from substantial (0.742) in the Australian group to almost perfect (0.950) in the adolescent Chinese group. There was high agreement of V@home with near ETDRS VA across all groups, with a mean difference of -0.092 to -0.042 logMAR and a TWK of 0.736 to 0.837. Test-retest reliability was also high (difference: -0.018 to 0.026) for both distance and near VA tests (95% limits of agreement: -0.289 to 0.258 for distance and -0.235 to 0.199 for near). The majority of participants were satisfied with V@home.ConclusionsV@home could accurately and reliably measure both distance and near VA and is well accepted by participants.Translational relevanceThe V@home system could potentially serve as a useful tool to improve eye care accessibility, especially in underdeveloped areas with limited eye care personnel and resources.
| S-EPMC6701871 | biostudies-literature
Project description:Vision loss from age-related macular degeneration (AMD) has a profound effect on vision-related quality of life (VRQoL). The pupose of this study is to identify clinical factors associated with VRQoL using the Rasch- calibrated NEI VFQ-25 scales in bilateral advanced AMD patients.We retrospectively reviewed 47 patients (mean age 83.2 years) with bilateral advanced AMD. Clinical assessment included age, gender, type of AMD, high contrast visual acuity (VA), history of medical conditions, contrast sensitivity (CS), central visual field loss, report of Charles Bonnet Syndrome, current treatment for AMD and Rasch-calibrated NEI VFQ-25 visual function and socioemotional function scales. The NEI VFQ visual function scale includes items of general vision, peripheral vision, distance vision and near vision-related activity while the socioemotional function scale includes items of vision related-social functioning, role difficulties, dependency, and mental health. Multiple regression analysis (structural regression model) was performed using fixed item parameters obtained from the one-parameter item response theory model.Multivariate analysis showed that high contrast VA and CS were two factors influencing VRQoL visual function scale (β = -0.25, 95% CI-0.37 to -0.12, p<0.001 and β = 0.35, 95% CI 0.25 to 0.46, p<0.001) and socioemontional functioning scale (β = -0.2, 95% CI -0.37 to -0.03, p = 0.023, and β = 0.3, 95% CI 0.18 to 0.43, p = 0.001). Central visual field loss was not assoicated with either VRQoL visual or socioemontional functioning scale (β = -0.08, 95% CI-0.28 to 0.12,p = 0.44 and β = -0.09, 95% CI -0.03 to 0.16, p = 0.50, respectively).In patients with vision impairment secondary to bilateral advanced AMD, high contrast VA and CS are two important factors affecting VRQoL.
| S-EPMC5944956 | biostudies-literature