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D. E. MacNeil, C. N. Dove, M. L. Courage, R. J. Adams; Testing the Limits of Eye and Vision Screening in Preschool Children: An Evaluation of the Feasibility of Screening Infants. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3139. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
In recent years, we (ARVO 2005, 2006) and others have reported on the success of screening programs for the detection of eye and visual dysfunction in preschool children. Emerging technologies now raise the possibility that a comprehensive screening program (ie tests to evaluate optics, ocular health, and visual functioning) may be extended to children under 2 years. Here, we attempt a program for 6- and 12-mo-old infants, patients who are still within the most critical phase of visual and CNS plasticity, and for whom detection of pathology and subsequent treatment would have maximal benefits.
In a single session, both eyes of 6-and-12-mo infants (n=70) were assessed with tests optical refractive error (Welch Allyn SureSight non-cycloplegic autorefractor), visual acuity (Teller Cards), and contrast sensitivity (Adams CS cards and Precision Vision low contrast faces). In addition, a full ocular alignment/motility examination was conducted. For comparison, 2- and 3-year-olds (n = 120) were assessed with an equivalent battery of tests.
Excluding the CS card test, most infants and preschoolers completed all tests for each eye [83% (6 months), 70% (12 months), 62% (2 years) and 71% (3 years)], in a mean time ranging from 9.2 - 14.6 min. Those who did not complete testing most often refused to wear the monocular eye patch during the acuity and/or CS tests. Despite the number of tests, mean acuity, CS, and refractive error agreed very well with previous normative data for all ages.
For a patient population so young, this was an ambitious test battery, especially as children had to wear monocular occlusion for most tests. Surprisingly, the majority of infants (especially 6-mo-olds) completed the entire evaluation for each eye which included an assessment of the key amblyogenic conditions, namely refractive status, spatial vision, and orthoptics. Moreover, in settings that infants attend regularly and that more than one test session can be scheduled easily (e.g., a daycare, public health or breast-feeding clinic), it should be feasible for infants to complete all tests and thus undergo a full vision screening during this critical developmental period.
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