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Ari Z Zivotofsky, Liat Gantz, Sabreen Sheik, Ariela Gordon Shaag, Naomi Zivotofsky; Expanded Early Childhood Vision Screening. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4130. doi: https://doi.org/.
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Early childhood screening for visual deficits is essential for early detection and treatment and for prevention of amblyopia. However, the effectiveness of basic screening tests performed in a public health setting is unclear. In Israel, children receive free preventive health care from birth through age six in “maternal child health clinics” (tipat chalav), including a rudimentary vision exam, and first graders receive vision screening. Both are often limited to distance visual acuity (VA). We hypothesized that including additional basic exams is technically feasible and could identify children at risk for amblyopia better than VA alone.
First graders from a Bet Tzafafa Jerusalem school participated in vision screenings at their school conducted by optometry students under the supervision of an optometrist. The exam included: VA at 3 meters and at 40 cm, stereopsis testing, cover-uncover and alternate cover test, near point of convergence, amplitude of accommodation test, Bruckner Test, and color vision.
177 children aged 6 and 7 (N=13 for 7 yo; 91 male, 86 female) were examined. Using a cutoff ratio for VA of 6/9.6 (0.625), 12 (6.8%) of the children had decreased VA at distance in at least one eye and a different three showed a decreased near VA. 17 of the children failed the cover test. Eight children failed stereopsis. Of the children who failed the cover test, 13 of the 17 did not show a decrease in VA. The Bruckner test was failed by nine children (5%), of whom three had decreased VA. One of those who failed the Bruckner test, but not VA, also failed the CT.
Measuring VA in young children is important for initiating treatment and helping them in their schooling. However, additional screening tests can detect other ophthalmologic deficits which could be precursors to amblyopia or other visual deficits. For example, failing the CT, i.e., having strabismus, can be a risk factor for developing amblyopia. In this sample, 7% of the children failed the CT but did not fail VA and 3% who passed both VA and CT failed the Bruckner test. Thus, expanded screening at this age with such feasible tests as CT and Bruckner could be more sensitive in detecting amblyogenic risk factors.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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