Search

Introduction: There is a growing body of evidence that children with special needs are more likely to have visual problems, be that visual impairment, visual processing problems or refractive error. While there is widespread provision of vision screening in mainstream schools, patchy provision exists in special schools. The aim of the study was to determine the unmet need and undiagnosed visual problems of children attending primary special schools in Bradford, England., Methods: Children attending special schools who were not currently under the care of the hospital eye service were identified. Assessments of visual function and refractive error were undertaken on site at the schools by an experienced orthoptist and/or paediatric ophthalmologist., Results: A total of 157 children were identified as eligible for the study, with a mean age of 7.8 years (range 4-12 years). Of these, 33% of children were found to have visual impairment, as defined by WHO and six children were eligible for severe sight impairment certification., Discussion: The study demonstrates significant unmet need or undiagnosed visual impairment in a high-risk population. It also highlights the poor uptake of hospital eye care for children identified with significant visual needs and suggests the importance of providing in-school assessment and support, including refractive correction, to fully realise the benefits of a visual assessment programme., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Aim: To assess the effects of vision screening, and subsequent management of visual impairment, on visual acuity and vision-related quality of life among frail older people., Design: Randomised controlled trial., Setting: Community in Sydney, Australia., Participants: 616 men and women aged 70 years and over (mean age 81 years) recruited mainly from people attending outpatient aged care services., Control: No vision assessment or intervention, Interventions: Comprehensive vision and eye examinations conducted by an optometrist. Three hundred subjects were seen by the study optometrist, with 146 judged to need treatment for a vision or eye problem. The optometrist arranged new glasses for 92 subjects; 24 were referred for a home visit by an occupational therapist; 17 were referred for glaucoma management; and 15 were referred for cataract surgery., Main Outcome Measure: Distance and near visual acuity (logMAR) and composite scores on the 25-item version of the National Eye Institute Visual Function Questionnaire, both assessed at a 12-month follow-up home visit., Results: After 12 months' follow-up, the mean (logMAR) distance visual acuity was 0.27 in the intervention group and 0.25 in the control group (p = 0.32). The mean (logMAR) near visual acuities were -0.01 in the intervention group and -0.03 in the control group (p = 0.26). The mean composite score on the National Eye Institute Visual Function Questionnaire was 84.3 in the intervention group and 86.4 in the control group (p = 0.49)., Conclusions: Vision screening by an optometrist for frail older people living in the community in Australia does not lead to improvements in vision or vision-related quality of life after 1 year's follow-up.

Aims/background: Population-based information is useful for future strategic planning of healthcare resources. We wished to describe and cost the provision of eye services, beyond those of basic primary and emergency care, for the paediatric population of a single primary care trust., Methods: Data from healthcare purchaser and provider records were collected for the year 2004/5 on provision and costing of hospital eye services, provision of spectacle vouchers, orthoptic screening, social services and visual-impairment team services to children in the Huntingdonshire Primary Care Trust population., Results: In the year of study, in a population of 33,564 aged under 18 years, 1870 (5.6%) children underwent screening by an orthoptist. 1970 (5.9%) children required outpatient appointments, 445 (1.3%) were prescribed spectacles, and 87 (0.3%) children needed surgical procedures. A small proportion (69, 0.2%) of children were visually impaired. The total cost of providing comprehensive eye services to children within Hunts PCT was pound 366,727., Conclusion: Although the prevalence of significant visual impairment is low in childhood, overall, eye conditions are common in children and may have lifelong implications. The resources required to provide a comprehensive paediatric eye service, to screen for and manage common eye conditions, and support those with serious eye conditions or visual impairment, are significant. This study aids quantified prediction of future service usage, and facilitates decision-making on resource allocation and workforce organisation for children's eye care in the UK.

Aims: Retinopathy of prematurity (ROP) is a major cause of blindness in children in middle-income countries. In 1995, it accounted for 10.6% of blindness in children in schools for the blind in South Africa. This study was undertaken to estimate the number of premature babies at risk and to investigate policies, practices and screening programmes., Materials and Methods: 17 level 1-3 neonatal units were visited in four provinces. Published literature reports were reviewed and staff interviewed., Results: 13,000-15,000 surviving premature babies are at risk of ROP each year. Shortage of equipment precluded continuous oxygen monitoring in public units. Nursing levels were often below recommendations, and most nurses were unaware of target oxygen saturations. Private units were well staffed and adequately equipped. Ophthalmologists were only visiting four units on a regular basis for screening, using the birth weight criterion of <1500 g for ROP screening. ROP needing treatment rates were low (1.6-2.9%), as were rates of follow-up., Conclusions: Primary prevention of ROP requires meticulous neonatal care and adequately equipped and staffed units. Secondary prevention requires efficient screening and treatment programmes. Competing demands and limited resources in the public sector in South Africa have precluded prioritizing the prevention of ROP. This should be re-evaluated.

Purpose: To compare whether free spectacles or only a prescription for spectacles influences wearing rates among Tanzanian students with un/undercorrected refractive error (RE)., Design: Cluster randomised trial., Setting: 37 secondary schools in Dar es Salaam, Tanzania., Participants: Distance visual acuity was measured in 6,904 year-1 students (90.2% response rate; median age 14 years; range 11-25 years) using a Snellen E-chart. 135 had RE requiring correction., Interventions: Schools were randomly allocated to free spectacles (arm A) or prescription only (arm B)., Primary Outcome: Spectacle use at 3 months., Results: The prevalence of un/undercorrected RE was 1.8% (95% CI: 1.5 to 2.2%). At 3 months, 27/58 (47%) students in arm A were wearing spectacles or had them at school compared with 13/50 (26%) in arm B (adjusted OR 2.4, 95% CI 1.0 to 6.7). Free spectacles and myopia were independently associated with spectacle use., Conclusions: The low prevalence of un/undercorrected RE and poor uptake of spectacles, even when provided free, raises doubts about the value of vision-screening programmes in Tanzanian secondary schools. Policy decisions on school vision screening in middle- and low-income countries should take account of the cost-effectiveness as well as competing demands for scarce resources.

Aim: To test a method for the rapid assessment of cataract blindness in South Africa., Design: Randomised cluster-based cross-sectional survey (20 clusters of 50 each)., Setting: Pension pay points in Moretele district, North West Province, South Africa., Subjects: Female pensioners aged >or=60 years, and male pensioners aged >or=65 years., Outcome Measures: (1) Prevalence of cataract requiring surgery; (2) prevalence of blindness due to cataract; (3) cataract surgical coverage; (4) cataract surgery outcome; and (5) barriers to cataract surgery., Results: 1000 pensioners were screened (681 women and 319 men). 17.2% of pensioners had operable cataract (visual acuity <6/60); 95% CI -3.4% to 3.4%); 15.6% of pensioners were blind due to cataract (95% CI -3.1% to 3.4%); and 5.6% of pensioners had had previous cataract surgery, 55.4% with intraocular lens implant and 44.6% without intraocular lens implant. The cataract surgical coverage was 24.6%. 80% of people who had had surgery were satisfied with the result, but 26.8% had a poor outcome according to the World Health Organization criteria. The main barrier to uptake of surgery was a lack of awareness of the availability of the surgery., Conclusions: Rapid assessment of cataract at pension pay points is a useful and effective tool for our district Vision 2020 programmes in South Africa. Steps need to be taken to raise awareness of the availability of cataract surgery among indigent pensioners, and to improve the quality of visual outcome after surgery by ensuring routine monitoring of postoperative visual acuity.

Aim: To determine the percentage of the population at risk of developing glaucoma, which can potentially be reached by conducting glaucoma screening during regular optician visits., Methods: 1,200 inhabitants aged >40 years were randomly selected from Dutch community population databases. A questionnaire was mailed to these inhabitants with questions on their latest optician visit and risk factors for glaucoma. A second questionnaire was sent to their opticians, who were asked about their willingness to conduct an additional glaucoma screening programme in the future., Results: The questionnaire was returned by 959 of 1,200 inhabitants and 37 of 50 opticians. The percentage of inhabitants who visited an optician during a 5-year period was 83% (95% confidence interval (CI) 80% to 85%). This percentage was adjusted for the presence of risk factors for glaucoma to obtain the percentage of the population at risk of developing glaucoma. The percentage of opticians willing to cooperate in a glaucoma screening programme extended beyond a non-contact tonometry measurement alone was 91% (95% CI 77% to 98%)., Conclusion: By conducting glaucoma screening during regular optician visits, a large section of the population at risk of developing glaucoma can be reached.

Aim: To survey existing ophthalmic follow up protocols in the United Kingdom for very low birthweight (VLBW) children. In addition, relative risk analysis was performed using data from a cohort study to assess which factors (birth weight, gestational age, retinopathy of prematurity (ROP) status) led to a high risk of developing amblyogenic factors., Methods: Questionnaires were sent to every orthoptic department in the United Kingdom (n = 288) for information on their policy on the follow up of VLBW children., Results: Responses were received from 125 departments (43%). There was a large variation in criteria used for follow up; 21% of respondents using birth weight (BW) and gestational age (GA), 22% using stage 3 or treated ROP, the remainder using a combination of these factors. There was no consensus regarding when follow up should commence (from 3 months to 3 years) or cease (1-8 years). Relative risk analysis revealed that birth weight under 1500 g, GA under 33 weeks, and the presence of severe ROP were significant risk factors for developing one or more amblyogenic factors., Conclusion: There is no consensus on whether VLBW children need to be reviewed. There is a greatly increased risk of ophthalmic deficits in those with severe ROP or severe neurological disorders, and also in those with mild or no ROP. Children in the latter group who are not routinely followed up, have a high risk of developing treatable refractive errors and strabismus. This raises the question of whether an additional screening examination is merited.

Aims: To determine how the workload of an ophthalmology department changed following the introduction of an organised retinal screening programme., Methods: Information was collected from the hospital medical record of people with diabetes attending eye clinics over 4 years. The first year was before screening, the next 2 years the first round, and the fourth year the second round., Results: The total number of people with diabetes referred each year over the 4 year period was 853, 954, 974, 1051 consecutively. The number of people with diabetes in the county rose by 1400 per annum. The total number of referrals for an opinion about diabetic retinopathy was 227, 333, 363, 368, for cataract was 64, 57, 77, 93, and for glaucoma was 57, 62, 61, 68. The total number of patients referred for laser treatment over the 4 years was 77, 124, 111, and 63, Conclusion: This study suggests that the workload in the eye clinic increases in the first round of screening but in subsequent rounds it does not fall below the pre-screening level, except for laser treatment. This may be partly because of increasing numbers of people with diabetes. With the introduction of a national screening programme, this has significant workload implications for the National Health Service.

Background/aims: Preschool screening for amblyopia has controversially been abandoned in some localities within the United Kingdom, on the basis that there is no clear evidence of benefit to support its continuation. Data collected within a birth cohort study were used to examine visual outcomes at 7(1/2) years in children who did or did not receive preschool vision screening., Methods: Monocular logMAR visual acuity with and without a pinhole was assessed by orthoptists. Contemporary records were used to identify children who had been offered and/or received preschool screening., Results: Of 6081 children, 24.9% had been offered preschool screening and 16.7% had attended. The prevalence of amblyopia was approximately 45% lower in the children who received preschool screening than in those who did not (1.1% v 2.0%, p = 0.05). The mean acuity in the worse seeing eyes after patching treatment was better for amblyopic children who received preschool screening than for those who did not; 0.14 v 0.20 logMAR (p <0.001). These effects did not persist in an intention to screen analysis., Conclusions: Preschool screening at 37 months was associated with an improved treatment outcome for individuals with amblyopia. However, the improvement was clinically small and disappeared when considering all children offered screening rather than only those who received it. Further research is needed into improving the effectiveness of vision screening for preschool children, while in the interim these data do not conflict with current recommendations for school entry screening by orthoptists.