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Purpose To compare neonatal eye screening using the red reflex test (RRT) versus the wide-field digital imaging (WFDI) system. Methods Prospective cohort study. Newborns (n = 380, 760 eyes) in the Maternity Ward of Irmandade Santa Casa de Misericordia de Sao Paulo hospital from May to July 2014 underwent RRT by a paediatrician and WFDI performed by the authors. Wide-field digital imaging (WFDI) images were analysed by the authors. Validity of the paediatrician's RRT was assessed by unweighted kappa [κ] statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results While WFDI showed abnormalities in 130 eyes (17.1%), RRT was only abnormal in 13 eyes (1.7%). Wide-field digital imaging (WFDI) detected treatable retina pathology that RRT missed including hyphema, CMV retinitis, FEVR and a vitreous haemorrhage. The sensitivity of the paediatrician's RRT to detect abnormalities was poor at 0.77% (95% confidence interval, CI, 0.02%-4.21%) with a PPV of only 7.69% (95% CI, 1.08%-38.85%). Overall, there was no agreement between screening modalities (κ = -0.02, 95% CI, -0.05 to 0.01). The number needed to screen to detect ocular abnormalities using WFDI was 5.9 newborns and to detect treatable abnormalities was 76 newborns. Conclusion While RRT detects gross abnormalities that preclude visualization of the retina (i.e. media opacities and very large tumours), only WFDI consistently detects subtle treatable retina and optic nerve pathology. With a higher sensitivity than the current gold standard, universal WFDI allows for early detection and management of potentially blinding ophthalmic disease missed by RRT.

IMPORTANCE The novel intervention was effective at improving compliance to appropriate tertiary eye care after community eye screening. BACKGROUND Elderly individuals from low socio-economic background with visual impairment (VI) often do not attend tertiary care, even if significant eye diseases are detected while in the community. We evaluate a novel incentive care scheme (ICS) to improve compliance to appropriate follow-up after community eye screening. DESIGN Randomized controlled trial in a population-based setting was conducted. PARTICIPANTS A total of 140 elderly individuals with VI (visual acuity 0.05). Identified barriers for tertiary healthcare access included patient attitudes and financial- and health-related barriers. CONCLUSION AND RELEVANCE Our pilot RCT found that ICS improved adherence to appropriate tertiary eye care referrals after community eye screening in elderly people with VI.

Aims To investigate the relationships between age at diagnosis of diabetes, age at diabetic eye screening and severity of diabetic retinopathy at first and subsequent screenings in children aged 12 or 13 years. Methods Data were extracted from four English screening programmes and from the Scottish, Welsh and Northern Irish programmes on all children with diabetes invited for their first and subsequent screening episodes from the age of 12 years. Retinopathy levels at first and subsequent screens, time from diagnosis of diabetes to first screening and age at diagnosis in years were calculated. Results Data were available for 2125 children with diabetes screened for the first time at age 12 or 13 years. In those diagnosed with diabetes at 2 years of age or less, the proportion with retinopathy in one or both eyes was 20% and 11%, respectively, decreasing to 8% and 2% in those diagnosed between 2 and 12 years (P < 0.0001). Only three children (aged 8, 10 and 11 years at diagnosis of diabetes) had images graded with referable retinopathy and, of these, two had non‐referable diabetic retinopathy at all subsequent screenings. Of 1703 children with subsequent images, 25 were graded with referable diabetic retinopathy over a mean follow‐up of 3.1 years, an incidence rate of 4.7 (95% confidence interval, 3.1–7.0) per 1000 per year. Conclusions In this large cohort of children, the low prevalence and incidence rates of referable diabetic retinopathy suggest that screening earlier than age 12 is not necessary., What's new? This is the largest reported study in the literature of baseline levels of diabetic retinopathy in the age group 12 or 13 years.This is the largest reported study showing the rate of progression of diabetic retinopathy in adolescents.Of 2125 children with diabetes screened for the first time at age 12 or 13 years, three were found to have referable disease.The absence of referable disease in subsequent screens in two of the children and of pre‐proliferative changes in the third child suggest that it is unlikely that any treatment is required.

Diabetic retinopathy is the progressive pathological alterations in the retinal microvasculature that very often causes blindness. Because of its clinical significance, it will be helpful to have regular cost-effective eye screening for diabetic patients by developing algorithms to perform retinal image analysis, fundus image enhancement, and monitoring. The two cost-effective algorithms are proposed for exudates detection and optic disk extraction aimed for retinal images classification and diagnosis assistance. They represent the effort made to offer a cost-effective algorithm for optic disk identification, which will enable easier exudates extraction, exudates detection and retinal images classification aimed to assist ophthalmologists while making diagnoses. The proposed algorithms apply mathematical modeling, which enables light intensity levels emphasis, easier optic disk and exudates detection, efficient and correct classification of retinal images. The algorithm is robust to various appearance changes of retinal fundus images and shows very promising results. Fundus images are classified into those that are healthy and those affected by diabetes, based on the detected optic disk and exudates. The obtained results indicate that the proposed algorithm successfully and correctly classifies more than 98% of the observed retinal images because of the changes in the appearance of retinal fundus images typically encountered in clinical environments. Copyright © 2014 John Wiley & Sons, Ltd.

The association between blood groups (ABO, Rh, Kell, Duffy) and pseudo-exfoliation syndrome, simple, and capsular glaucoma have been evaluated. The findings were: 1). No statistically significant abnormalities regarding blood group distribution in persons with pseudo-exfoliation syndrome. 2). In contrast to simple glaucoma, capsular glaucoma showed an abnormal distribution in the ABO- and the Kell-system. There was less glaucoma prevalence in the capsular A1-group compared to the O-group (p = 0.013), and less in the K1 negative group compared to the K1 positive one (p = 0.005). This trend was even escalated when combining the two systems: Among the K1 negative persons the glaucoma prevalence was lower in the A1-group compared to the O-group (p = 0.003). In the K1 negative group only 9 of 61 A1-persons developed glaucoma, in contrast to the K1 positive group where 4 of 4 A1-persons had glaucoma. This difference gave p < or = 0.00038, whereas the corresponding difference for the O-groups showed p = 0.65. It is concluded that once a person with blood group A1 has developed pseudo-exfoliation syndrome, the risk that capsular glaucoma will occur is about 7 times higher when that person is K1 positive compared to K1 negative. Perhaps this observation may be used as a prognostic factor for non-glaucomatous PE positive persons.

In this population-based screening study, dealing with 1941 persons above 64 years of age from three different municipalities, the overall open-angle glaucoma prevalence was found to be 8.3%. The prevalence in the separate areas (7.0%, 8.6%, and 9.5%) were not statistically different. Roughly 30% of the population with pseudo-exfoliation syndrome had glaucoma, and 4.2% had ocular hypertension, whereas the corresponding figures for those without pseudo-exfoliation were 4% and 0.8%, respectively. The high glaucoma rates are partly due to the high pseudo-exfoliation prevalence in the area. The prevalence of the capsular glaucoma increased towards a maximum between 75 and 79 years of age, whereafter the curve declined. This may indicate reduced survival time of glaucomatous patients.

The association between blood groups (ABO, Rh, Kell, Duffy) and pseudo-exfoliation syndrome, simple, and capsular glaucoma have been evaluated. The findings were: 1). No statistically significant abnormalities regarding blood group distribution in persons with pseudo-exfoliation syndrome. 2). In contrast to simple glaucoma, capsular glaucoma showed an abnormal distribution in the ABO- and the Kell-system. There was less glaucoma prevalence in the capsular A1-group compared to the O-group (p = 0.013), and less in the K1 negative group compared to the K1 positive one (p = 0.005). This trend was even escalated when combining the two systems: Among the K1 negative persons the glaucoma prevalence was lower in the A1-group compared to the O-group (p = 0.003). In the K1 negative group only 9 of 61 A1-persons developed glaucoma, in contrast to the K1 positive group where 4 of 4 A1-persons had glaucoma. This difference gave p = 0.00038, whereas the corresponding difference for the O-groups showed p = 0.65. It is concluded that once a person with blood group A1 has developed pseudo-exfoliation syndrome, the risk that capsular glaucoma will occur is about 7 times higher when that person is K1 positive compared to K1 negative. Perhaps this observation may be used as a prognostic factor for non-glaucomatous PE positive persons.

To evaluate the efficacy of two different Swedish screening procedures for early detection of congenital cataracts in comparison with no screening.Children born between January 1992 and December 1998 in Swedish regions with an established eye-screening routine procedure, diagnosed with congenital cataract, and operated on before 1 y of age, were included in a retrospective study. Age at referral and age at time of the operation were compared between regions using different screening procedures: screening in the maternity wards (Region 1), at the well-baby clinics (Region 2) and one region without any screening (Region 3).Seventy-two children were included in the study. Concerning early diagnosis and surgery, Region 1 differed significantly from Regions 2 and 3, which were more similar and were combined for further analysis. The difference in detected cases was greatest at 21 d of age (55% vs 18%; p0.001), but persisted even at 100 d of age (78% vs 64%; p0.02). Region 1 screening resulted in more and earlier cases detected than the other two regions (22 vs 15 per 100,000 births). In 72% of all cases, surgery was performed in response to referrals from either the maternity wards (36%), or the well-baby clinics (36%). However, half of the cases from the well-baby clinics were detected too late, i.e. at100 d.Eye screening in the maternity ward is preferable to well-baby clinic screening and to no screening at all, since it leads to early detection. Screening should also be performed routinely at well-baby clinics within the period when successful treatment is possible.

Aim: To estimate, on a national basis in Sweden, the costs versus consequences of combined maternity ward and well-baby clinic eye screening compared to well-baby clinic screening alone. Methods: Two scenarios were created and compared regarding healthcare costs: visual acuity development and quality-adjusted life-years (QALYs). One scenario represented early management ( combined maternity ward and well-baby clinic screening); the other represented less early management (well-baby clinic screening only). Each scenario was based on 100 000 births, and the healthcare costs were calculated from detection until age 18 y. All estimates of prevalence, visual outcome, postoperative complications and screening procedures were based on previous, recently published studies. Estimated costs were obtained from St. Erik's Eye Hospital in Stockholm and the University Hospital of Lund, at 2001 prices. Results: Total cost of the maternity ward/well-baby clinic screening scenario was 7.9 million SEK, and that of the maternity ward screening scenario was 6.9 million SEK. The incremental cost-effectiveness ratio was estimated at 234 000 SEK/QALY provided three more children per year were detected in Sweden by mandatory maternity ward/well-baby clinic screening. Conclusion: The incremental expense of introducing combined maternity ward/well-baby clinic eye screening on a nationwide basis is cost effective and within acceptable levels of cost/QALY when compared with other widely accepted therapies across diverse medical specialties.

The National Service Framework for Diabetes is working towards a national programme for diabetic retinopathy screening. The digital retinal cameras that will be used very easily detect red dots near the fovea. In a consecutive series of 175 patients undergoing eye screening, 25/175 (14%) had macula red dots but no other significant lesions. In the case report presented here, on digital retinal photography a 46-year-old man with type 2 diabetes and a normal visual acuity had four red dots within a disc diameter of the centre of the fovea but little other diabetic retinopathy. Repeat photography seven months later showed progression to well-established exudative maculopathy. This patient's case was considered in the light of the European referral criteria, the grading system in the report of the UK National Screening Committee, the National Institute for Clinical Excellence guidelines, the guidelines of the Royal College of Ophthalmologists, the Welsh Community Diabetic Retinopathy Study grading system, the Scottish Intercollegiate Guidelines Network guidelines and the Scottish Diabetic Retinopathy Grading System. The results showed that the guidelines are inconsistent and could lead, at the time of the first eye screening, to the patient being referred to an ophthalmologist, re-screened in 12 months or ‘observed at regular intervals’ depending on which guidelines are followed and whether the screener believes the red dots are microaneurysms or dot haemorrhages. In conclusion, the natural history of retinopathy in patients with red dots near the fovea needs to be systematically studied. Pending the outcome of such studies, all patients with red dots clearly visible on retinal photographs within a disc diameter of the centre of the fovea, with normal visual acuity and without other retinopathy suggesting that they should be referred, should be re-screened at least six monthly. Copyright © 2004 John Wiley & Sons, Ltd.

Purpose: To compare the Frequency Doubling Technology (FDT) C20-1 screening algorithm and the Humphrey Field Analyser II (HFA) 24−2 SITA-FAST in a large eye screening. Methods: In a non-randomized, prospective, free eye screening, the FDT Screening Protocol (C20-1 Screening Algorithm) was administered to 574 attendees (422 men and 152 women, average age 64, range 17−89 years) of the 1998 Veterans of Foreign Wars (VFW) Convention in San Antonio, Texas. Individuals who failed the FDT (two or more misses out of 17 locations) immediately underwent white-on-white threshold visual field perimetry (HFA 24-2, SITA-FAST). Humphrey visual field analysis included STATPAC and masked evaluations by three glaucoma specialists. Results: Approximately one-tenth of the VFW conference attendees voluntarily presented themselves for screening. Among these 574 volunteers, 69 (12%) failed the FDT and underwent HFA analysis. Eighty-one per cent (56/69) of these FDT failures had abnormal HFA Glaucoma Hemifield Tests. Eighty-eight per cent (61/69) were judged to have nerve fibre type visual field loss on HFA by at least two of three masked examiners. A positive correlation existed between the number of FDT locations missed and the HFA mean deviation (r = 0.5, P = 0.0001). A similar association was observed when FDT and HFA results were analysed by quadrant (r = 0.5, P

Purpose To assess results of a vision screening programme in schools in India, 5 years after its introduction. Material Questionnaires on school eye screening activities were sent to 200 randomly selected districts. Methods Data from 61 districts were analysed, using process indicators to assess performance at different stages of the screening procedure. Results Teachers screened 5.39 million children in 61 districts. Refraction was done on 205,082 children (3.8%) and 43,922 children (0.8%) were provided with spectacles. Children of 10-15 years have more refractive errors. Different stages in the procedure are evaluated. Conclusion Vision screening in schools has been taken up successfully in many districts in India. This has reduced the workload of eye care staff and increased the coverage. The simplicity of the procedure facilitates widespread application. Many parents take their children to the private sector for services. Monitoring and reporting needs to be improved.

This study examined the ophthalmic screening practices for diabetic patients conducted by general practitioners throughout one health region of the United Kingdom. A malled questionnaire was despatched to 1,481 GPs in Wessex and achieved a response rate of 48%. Visual acuity checks were performed on a regular basis by 60% of the responders. Of these, 76% of the GPs performed fundoscopy although 41% of them failed to dilate the pupils before examination. This study indicates that optimum eye screening is not being carried out by GPs in Wessex and it could be likely that the study is representative of other regions in the United Kingdom.

In 1991, the clinical notes of 203 consecutively treated people with diabetes were Audited and 56 (28%) judged to have retinopathy. Ten had hypertensive (HT) change and 46, typical diabetic changes (DR). Twenty six referrals from the DR group resulted in laser therapy in 17 but none were made from the HT group. In 32 of 35 people attending a special clinic, an independent consultant ophthalmologist's findings agreed. Early circinate maculopathy1 and macroaneurysm in a preproliferative eye were missed. No immediate change in therapy resulted. Screening frequency was inadequate. All patients had visual acuity and fundoscopy through dilated pupils, but only 41% had every examination within 12 months of the preceding visit, rising to 74% within 15 months and 87% within 18 months. In 51 (25%), failure to attend affected the longest interval between screening. Twenty nine and 22 patients were respectively absent for >6 and >12 months. Five years later, in a randomly selected totally separate subgroup of 100 patients, annual screening frequency over 5 years had risen to 82%.

Purpose: Presentation of a paediatric eye screening program which is based on the educators’ performance Methods: 4400 children(n1=2200 3-3 ½ y.o., n2=2200 4-6 y.o.),10 ophthalmologists and 20 teachers participated in this study.Children were tested for visual acuity(Va),using the NK test and manifest horizontal strabismus,using the Hirschberg test.Criteria for further evaluation:n1: Va

Hospital optometrists are involved in the care of diabetic patients in a variety of ways, e.g. performing screening as well as training, coordinating and acting in an advisory capacity in local schemes involving GOS optometrists. In response to local need and purchaser interest, an optometrically led diabetic eye screening service has been set up at Walton Hospital. All patients are referred from the Walton Hospital Diabetic Centre, screened by the hospital optometrists and either reviewed by the optometrists or referred to an ophthalmologist routinely for review or referred immediately if it is considered that laser treatment may be required. This paper reports on the protocols, implementation and first year of operation of the service. Patients referred to the clinic were those who had not had an eye examination within the last 12 months (excluding newly diagnosed insulin-dependent patients) and all newly diagnosed non-insulin dependent diabetics. An audit was performed over the first 3 months (n = 85). At the same visit, each patient was examined by an HES optometrist using a Volk lens with dilation, the patient was assessed by a consultant ophthalmologist with a specialty interest in diabetics and retinal photography was performed. The same consultant also assessed the slides. The mean age of the patients was 64 years (SD 12 years) and only 6.0% were frank type 1 insulin-dependent patients. Laser treatment for retinopathy was required in 7.1% of patients and other treatable pathology was found in 9.4% of patients. When compared with the consultant's assessment, the optometrists' examination showed a sensitivity of 87.5% and specificity of 93.5% in the detection and appropriate referral of diabetic eye disease. Peripheral new vessels were missed in one patient due to the presence of lens opacities, and thus the patient was referred routinely instead of immediately. Using the photographic technique, a significant number of images were ungradeable due to poor quality, and the sensitivity was only 66.7%. The lower sensitivity resulted from the inability to detect macula oedema in the absence of hard exudates and peripheral proliferative retinopathy outside the field photographed. In addition, inadequate resolution confounded the detection of microaneurysms in non-referrable cases. Over the following 9 months a further 182 patients were examined. Laser treatment for retinopathy was required in 6.6% of patients and other treatable pathology was found in 8.2% of patients. Additional funding to expand the service in 1995 has been successfully sought from the purchasers. The results and experiences from this study will be considered in relation to the HES optometrist working within a trust, the St Vincent's declaration and some economic aspects of diabetic healthcare.