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Purpose: To investigate the agreement between an online nurse‐assisted eye‐screening tool and reference tests in older adults receiving home healthcare and to collect user experiences. Methods: Older adults (65+) receiving home healthcare were included. Home healthcare nurses assisted in administering the eye‐screening tool at participants' homes. Approximately 2 weeks later, a researcher administered reference tests at participants' homes. Experiences from participants and home healthcare nurses were collected. Agreement in outcomes (distance and near visual acuity, with the latter being measured using two different optotypes, and macular problems) between the eye‐screening tool and reference clinical testing was compared. A difference of less than ±0.15 logMAR was considered acceptable. Results: A total of 40 participants were included. Here, we describe the results for the right eye; results for the left eye were similar. The mean difference between the eye‐screening tool and reference tests for distance visual acuity was 0.02 logMAR. The mean difference between the eye‐screening tool and reference tests using two different optotypes for near visual acuity was 0.06 and 0.03 logMAR, respectively. The majority of the individual data points were within the ±0.15 logMAR threshold (75%, 51% and 58%, respectively). The agreement between tests for macular problems was 75%. Participants and home healthcare nurses were generally satisfied with the eye‐screening tool, although remarks for further improvements were made. Conclusions: The eye‐screening tool is promising for nurse‐assisted eye screening in older adults receiving home healthcare, with the mostly satisfactory agreement. After implementing the eye‐screening tool in practice, cost‐effectiveness needs to be investigated. [ABSTRACT FROM AUTHOR]

Purpose: The effectiveness of preverbal orthoptic tests at age 6, 9, 14 and 24 months in population‐wide screening was assessed. Methods: Two 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. Results: The 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]). Conclusion: The 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. [ABSTRACT FROM AUTHOR]

Purpose: Early detection of ocular abnormalities in newborns is essential for timely diagnosis and treatment. This study aimed to assess the 1‐year result of a multicentre prospective neonatal eye examination programme with wide‐field digital imaging system in China. Methods: A multicentre collaborative prospective study group for neonatal eye screening was established in nine hospitals, including eight Maternal and Children's Hospitals, and one general hospital across China from July 2016 to June 2017. Ocular examinations were performed on newborns within 28 days after birth using a wide‐field digital imaging system. Data were reviewed and analysed. The primary outcome was the prevalence of ocular abnormalities in neonates. Results: We detected 13 514 (20.91%) abnormal cases in 64 632 newborns. The most frequent abnormality was retinal haemorrhage (RH; 11.83%). Most of mild RH resolved spontaneously. Among those who were beyond retinopathy of prematurity (ROP) screening criteria of China (gestational age ≥32 w and birthweight ≥2000 g), the total number of neonates with ocular abnormality was 12 218/62 799(19.45%). 59.44% of neonatal ocular abnormalities detected (accounting for 11.56% of all the screened population) needed further interference or observation. Among them, 258 patients (0.41% of all the screened population) needed immediate or timely intervention, including congenital cataract, retinal detachment, retinoblastoma and other ocular abnormalities. One thousand and ninety‐eight patients (1.75% of all the screened neonates) should be followed up closely and needed further diagnosis or intervention if necessary, such as ROP or ROP‐like retinopathy, familial exudative vitreoretinopathy and persistent hyperplasia of primary vitreous. Five thousand nine hundred and six patients (9.4%) with minor clinical significance needed short‐term follow‐up. Conclusions: This prospective multicentre study of newborn ocular examination showed a relatively high prevalence of ocular abnormalities. There are a relatively high percentage of congenital eye pathology that required further referral and treatment in those neonates who were not screened routinely. According to the benefits and risks associated with neonatal eye examinations, neonatal ocular screening programme can detect ocular abnormalities at the very early stage and may play a positive role in promoting paediatric eye health. [ABSTRACT FROM AUTHOR]

Importance Screening for diabetic retinopathy for early detection and treatment can prevent vision loss. Background: We aimed to assess rates of eye examination of people with diabetes, adherence with national guidelines and investigate characteristics of those who do not adhere. Design We used data from the 45 and Up Study, a cohort study of 267 153 randomly selected residents aged ≥45 years from New South Wales, Australia. Individual survey data collected in 2006 to 2009 were linked to corresponding national Medicare Benefits Schedule claims data for 2006 to 2016. Participants: The study sample included 24 832 participants who reported having diabetes and at least 5 years of observation. Methods: Claims for visits to optometrists or ophthalmologists were assessed to estimate rates of eye examination. Poisson regression models were used to investigate factors associated with non‐adherence. Main outcome measure: Participants were classified as adherent if the average time between eye care claims was consistent with national guideline of having an eye exam every 2 years. Results: Of 50% to 75% people with diabetes met the biennial eye examination guidelines and only 21% to 28% with diabetes duration ≥10 years were adherent to the annual eye examination guideline. Characteristics associated with greatest (~1.3‐fold) risk of non‐adherence were smoking, age <60 years and higher income. Conclusions and relevance: There is a clear need to improve rates of adherence to eye examination guidelines among people with diabetes to reduce the personal and societal burden of diabetic retinopathy. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the prevalence of potential age‐related eye conditions in elderly who are assisted by home healthcare nurses. The number of referrals to the general practitioner (GP), feasibility of screening and associations between vision loss and health outcomes were also studied. Methods: Cross‐sectional study in which trained home healthcare nurses screened the eyes of 151 patients [mean age 80 (50–96 years)] using their available correction, with VISION 2020 Netherlands screeners (e.g. acuity/field loss). Health outcomes were assessed with questionnaires. Results: Distance decimal visual acuity was ≤0.3 in 20.5% (unilateral) and 19.9% (bilateral) of patients, and near visual acuity was ≤0.4 in 17.7% (unilateral) and 33.3% (bilateral). Macular dysfunction was present in 21.5% (unilateral) and 8.3% (bilateral) and peripheral field problems in 11.4% (unilateral) and 7.9% (bilateral). GP referrals were proposed in 21.5%; in 40%, the GP or ophthalmologist was already aware of eye problems. Although health problems were prominent in participants (8.6% fractures, 22% depression and 18% anxiety), no significant associations were found between vision loss and self‐reported outcomes. Conclusion: Sixty per cent of frail elderly home healthcare patients had an ophthalmologic condition. Although a large number was already known in eye health care, >20% was referred with an unrecognized ophthalmologic problem. Basic ophthalmologic screening by home healthcare nurses might be a potentially relevant tool to reduce the burden of age‐related vision loss, contributing to the joint World Health Organization – VISION 2020 initiative to eliminate avoidable blindness. Relevant health outcomes do not seem to be clearly related to having visual impairment, but rather to having general health problems. [ABSTRACT FROM AUTHOR]

Abstract: 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 <6/12, mean age ± SD = 66.6 ± 8.9 years, 46.4% female) were included. Methods: Participants were randomized to either ICS (N = 72) or usual care (UC; N = 68). ICS incorporated patient education, social support and financial assistance to assist individuals in attending tertiary eye care. UC comprised of a standard referral letter and advice. Main outcome measure: Primary outcome included compliance to eye care referral. Secondary outcomes included best‐corrected visual acuity and vision‐related quality of life assessed at baseline and 3 months. Results: Participants receiving the ICS intervention had higher rates of compliance to tertiary eye care attendance compared to UC (31.9% vs. 16.2%, respectively, P = 0.027). While we observed an overall significant improvement in best‐corrected visual acuity at 3 months in both groups (P < 0.05), we found no significant differences in Rasch‐transformed vision‐related quality of life scores between groups (all P > 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. [ABSTRACT FROM AUTHOR]

Purpose To investigate omission of population-based eye screening at age 6-9 months in the Netherlands. Methods Prospective population-based consecutive birth cohort study was used. In two consecutive birth cohorts, children were eye screened at 1-2 and 3-4 months, but at general-health screening at 6-9 months, the second cohort was not eye screened, unless anything conspicuous was noted or in case of positive family history. Data were collected from screening records and anonymous questionnaires. Semi-structured daylong observations were made of physicians examining children aged 0-4 years, including children from the cohorts, by two orthoptic students. Results 58 of 6059 children (0.96%), in the screened, and 48 of 5482 children (0.88%) in the unscreened group were referred to orthoptist or ophthalmologist, mostly for observed strabismus. Amblyopia, all combined with strabismus, was diagnosed in ten screened (0.17%) versus six unscreened children (0.11%). Most physicians found preverbal examinations and decisions to refer difficult. The observations by orthoptic students revealed that cover test, pupillary reflexes, pursuit movements and eye motility were frequently performed inadequately, contrary to the Hirschberg test, at this age. Conclusion The screened and unscreened group differed little regarding the number of children referred and found to have amblyopia. Referral was mostly based on observed strabismus. [ABSTRACT FROM AUTHOR]

SummaryAims A community diabetes eye screening service using slit-lamp biomicroscopy and colour fundus photography was set up in 1993 at the Barnsley District General Hospital Diabetes Centre with a foot screening service being added in 1994. The service is available for all diabetic patients in the Barnsley health district (encompassing 220 000 people). After 4½ years, a survey was carried out to establish the uptake of this service. Methods All diabetic patients on the local diabetes register were checked for attendance at the eye screening service or the Barnsley District General Hospital Eye Department. Questionnaires were sent to general practitioners to establish what screening was received by those attending neither of these services. Results More than 10% of patients were found to be incorrectly registered. Of the 4000 correctly registered diabetic patients, 62% were screened annually by this service and 25% were under the care of the Department of Ophthalmology. Half of the remaining 13% were screened at other hospitals or by opticians or general practitioners and the other half were either too old or ill to be screened or were non-compliant. Conclusions This service has a high uptake, and is recommended for a circumscribed urban population. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the prevalence of potential age-related eye conditions in elderly who are assisted by home healthcare nurses. The number of referrals to the general practitioner (GP), feasibility of screening and associations between vision loss and health outcomes were also studied., Methods: Cross-sectional study in which trained home healthcare nurses screened the eyes of 151 patients [mean age 80 (50-96 years)] using their available correction, with VISION 2020 Netherlands screeners (e.g. acuity/field loss). Health outcomes were assessed with questionnaires., Results: Distance decimal visual acuity was ≤0.3 in 20.5% (unilateral) and 19.9% (bilateral) of patients, and near visual acuity was ≤0.4 in 17.7% (unilateral) and 33.3% (bilateral). Macular dysfunction was present in 21.5% (unilateral) and 8.3% (bilateral) and peripheral field problems in 11.4% (unilateral) and 7.9% (bilateral). GP referrals were proposed in 21.5%; in 40%, the GP or ophthalmologist was already aware of eye problems. Although health problems were prominent in participants (8.6% fractures, 22% depression and 18% anxiety), no significant associations were found between vision loss and self-reported outcomes., Conclusion: Sixty per cent of frail elderly home healthcare patients had an ophthalmologic condition. Although a large number was already known in eye health care, >20% was referred with an unrecognized ophthalmologic problem. Basic ophthalmologic screening by home healthcare nurses might be a potentially relevant tool to reduce the burden of age-related vision loss, contributing to the joint World Health Organization - VISION 2020 initiative to eliminate avoidable blindness. Relevant health outcomes do not seem to be clearly related to having visual impairment, but rather to having general health problems., (© 2018 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)