Need for refractive errors screening in school-age children by objective methods


Need for refractive errors screening in school-age children by objective methods

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Title: Need for refractive errors screening in school-age children by objective methods
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Article_Title: Need for refractive errors screening in school-age children by objective methods
Authors: Luminita Turcin, Afilon Jompan
Affiliation: “Vasile Goldiş” Western University Arad, Faculty of Medicine, Pharmacy and Dentistry, Romania
Abstract: We emphasize the importance of a correct vision in school-age children. Vision screening is not enough. We propose as a method for determining the exact refraction: computerized photoretinoscopy. Methods: We examined 1121 students, aged 6 to 11 years from 5 primary schools in Arad County, in September 2011 March 2012. My attention was focused on the following parameters: age, gender, objective refraction, visual acuity. Refraction was measured with an autorefractometru Potek 5000. Visual acuity was assessed by Snellen test. Its values less than or equal to 0.8 (80%) are considered pathological. Were considered pathological values as follows: myopia – minimum-1.0DS refractive error (spherical diopters), hyperopia refractive error of +1.5 SD, and 1.0 DC astigmatism (cylindrical diopters). Results: Of the 1121 students enrolled in our study 315 had refractive errors, 48 myopia, hyperopia 159 and 108 astigmatism. Using as reference the visual acuity of 4/5 (80%) we found 275 cases with vision problems. Using computerized refractometer we found 315 cases of children with refractive errors. Conclusion: Getting in the screening results of visual acuity of above 0.8 indicates no emmetrop eye status. Hypermetropia, astigmatism and myopia may even be sources of ocular discomfort. To identify these refractive errors computerized testing is required under cycloplegic refractometry.
Keywords: visual acuity, schoolchildren, screening
References: Afilon Jompan- “Ghid De Medicina Preventica”Ed. Eurostampa, Timisoara, 2000 214 Pag., Isbn 973-8027-87-X.
Afilon Jompan-“Medicina Familiei” Ed Iv-A,Revazuta Si Adaugita Ed. Eurostampa, Timisoara 2003, Isbn 973-687-092-8, 263 Pagp
Amruta S. Padhye, Rajiv Khandekar,1 Sheetal Dharmadhikari, Kuldeep Dole, Parikshit Gogate, and Madan Deshpande, Prevalence of Uncorrected Refractive Error and Other Eye Problems Among Urban and Rural School Children, Middle East Afr J Ophthalmol. 2009 Apr-Jun; 16(2): 69–74
Hendrickson K, Bleything W., The visual profile of Romanian children and adults assessed through vision screenings. Pacific University, College of Optometry, Forest Grove, Oregon, USA. Optometry. 2001 Jun;72(6):388-96.
Budău M,Gamaniuc E,Moise C, Korbuly. Study of refractive changes in Timiş County. B. Oftalmologia. 2003;58(3):64-9
Bucşă D, Gavăt V, Albu, Aspects of child and youth health revealed by medical check-up in Botosani County, Romania]. A.Rev Med Chir Soc Med Nat Iasi. 2011 Oct-Dec;115(4):1225-30.
Dandona R, Dandona L. Refractive error blindness. Bull World Health Organ. 2001;79:237–243.
Doshi NR, and Rodriguez MLF. Amblyopia. Am Fam Physician 2007; 75:361-7.
Chang CH,Tsai RK, Sheu MM. Screening amblyopia of preschool children with uncorrected vision and stereopsis tests in Eastern Taiwan. Eye 2007;21:1482-8. 184 Mohammad Khalaj, Mohammadreza Gasemi and Isa Mohammdi Zeidi
Woodruff G, Hiscox F, Thompson JR, Smith LK. Factors affecting the outcome of children treated for amblyopia. Eye. 1994;8:627-631
The Pediatric Eye Disease Investigator Group. The Clinical Profile of Moderate Amblyopia in Children Younger Than 7 Years. Arch Ophthalmol. 2002;120:281-287.
Shaw DE, Fielder AR, Minshull C, Rosenthal AR. Amblyopia: factors influencing age of presentation. Lancet 1988;2:207-209.
Prevalence of Refractive Errors in Primary School Children [7-15 Years] of Qazvin City, European Journal of Scientific Research,ISSN 1450-216X Vol.28 No.2 (2009), pp.174-185
Dandona R, Dandona L, Srinivas M, Sahare P, Narsaiah S, Muñoz SR, Pokharel GP, Ellwein LB, Refractive error in children in a rural population in India, Invest Ophthalmol Vis Sci. 2002 Mar; 43(3):615-22.
Marsh-Tootle WL, Wall TC, Tootle JS, Person SD, Kristofco RE. Quantitative pediatric vision screening in primary care settings in Alabama. Optom Vis Sci. 2008; 85: 849 – 856.
Lim HT, Yu YS, Park SH, Ahn H, Kim S, Lee M, et al. The Seoul metropolitan preschool vision screening programme: results from South Korea. Br J Ophthalmol. 2004; 88: 929 – 933.
Newman DK, East MM. Preschool vision screening: negative predictive value for amblyopia. Br J Ophthalmol. 1999; 83: 676 – 679.
Donahue SP, Arnold RW, Ruben JB. Preschool vision screening: what should we be detecting and how should we report it? Uniform guidelines for eporting results of preschool vision screening studies. J AAPOS. 2003; 7: 314 – 316.
Evans J, Smeeth L, Fletcher A. Vision screening. Br J Ophthalmol.2009; 93: 704 – 705.
Preslan MW, Novak A. Baltimore Vision Screening Project. Phase 2. Ophthalmology. 1998; 105: 150 – 153.
Ehrlich MI, Reinecke RD, Simons K. Preschool vision screening for amblyopia and strabismus. Programs, methods, guidelines, 1983. Surv Ophthalmol. 1983; 28: 145 – 163.
Spierer A, Royzman Z, Chetrit A, Novikov I, Barkay A. Vision screening of preverbal children with Teller acuity cards. Ophthalmology.1999; 106: 849 – 854.
Chui L, Fraser T, Hoar K, LaRoche GR. Negative predictive value of a vision screening program aimed at children aged 3 to 4 years old. JAAPOS. 2004; 8: 566 – 570.
Cunningham F. Preschool vision screening. Am J Public Health Nations Health. 1959; 49: 762 – 765.
Luminita Turcin, Afilon Jompan, Prevalence of refractice errors in schoolchildren in rural environment. Medicine in Evolution, vol XVIII nr. 3, 2012,
Luminita Turcin, Afilon Jompan, Prevalence of refractice errors in schoolchildren in urban environment, Physiology, vol 23 nr. 3 (75), 2012.
Robinson B, Bobier WR, Martin E, Bryant L. Measurement of the validity of a preschool vision screening program. Am J Public Health.1999; 89: 193 – 198.
Khandekar R, Al Harby S, Abdulmajeed T, Helmi SA, Shuaili IS. Validity of vision screening by school nurses in seven regions of Oman. East Mediterr Health J. 2004; 10: 528 – 536.
Fotouhi A, Khabazkhoob M, Hashemi H, Mohammad K. Sensitivity and specicity of visual screening tests in Dezful Schoolchildren, 2004. Iran J Epidemiol. 2007; 2: 11 – 17.
Wick B, O’Neal M, Ricker P. Comparison of vision screening by lay and professional personnel. Am J Optom Physiol Opt. 1976; 53: 474 – 478.
Salomao SR, Cinoto RW, Berezovsky A, Mendieta L, Nakanami CR, Lipener C, et al. Prevalence and causes of visual impairment in lowmiddle income school children in Sao Paulo, Brazil. Invest Ophthalmol Vis Sci. 2008; 49: 4308 – 4313.
Lu Q, Zheng Y, Sun B, Cui T, Congdon N, Hu A, et al. A populationbased study of visual impairment among pre-school children in Beijing: the Beijing study of visual impairment in children. Am J Ophthalmol. 2009; 147: 1075 – 1081.
Ajaiyeoba AI, Isawumi MA, Adeoye AO, Oluleye TS. Prevalence and causes of blindness and visual impairment among school children in south-western Nigeria. Int Ophthalmol. 2005; 26: 121 – 125.
Preslan MW, Novak A. Baltimore Vision Screening Project. Ophthalmology. 1996; 103: 105 – 109.
Mintz-Hittner HA, Fernandez KM. Successful amblyopia therapy initiated after age 7 years: compliance cures. Arch Ophthalmol. 2000; 118:1535 – 1541.
Scott WE, Kutschke PJ, Keech RV, Pfeifer WL, Nichols B, Zhang L. Amblyopia treatment outcomes. JAAPOS. 2005; 9: 107 – 111.
Negrel AD, Maul E, Pokharel GP, Zhao J, Ellwein LB. Refractive error study in children: sampling and measurement methods for a multicountry survey. Am J Ophthalmol. 2000; 129: 421 – 426.
Gilbert C, Foster A. Childhood blindness in the context of VISION 2020–the right to sight. Bull World Health Organ. 2001; 79: 227 – 232.
Ore L, Garzozi HJ, Tamir A, Cohen-Dar M. Vision screening among northern Israeli Jewish and Arab schoolchildren. Isr Med Assoc J.2009; 11: 160 – 165.
Fotouhi A, Hashemi H, Khabazkhoob M, Mohammad K. The prevalence of refractive errors among schoolchildren in Dezful, Iran. Br J Ophthalmol. 2007; 91: 287 – 292.
Hartmann EE, Dobson V, Hainline L, Marsh-Tootle W, Quinn GE, Ruttum MS, et al. Preschool vision screening: summary of a task force report. Ophthalmology. 2001; 108: 479 – 486.
Newman DK, East MM. Prevalence of amblyopia among defaulters of preschool vision screening. Ophthalmic Epidemiol. 2000; 7: 67 – 71.
Kerr C. Vision screening of primary school children. Nurs Stand. 1997; 12: 46 – 48.
Newman DK, Hitchcock A, McCarthy H, Keast-Butler J, Moore AT. Preschool vision screening: outcome of children referred to the hospital eye service. Br J Ophthalmol. 1996; 80: 1077 – 1082.
Pokharel GP, Negrel AD, Munoz SR, Ellwein LB. Refractive error study in children: results from Mechi Zone, Nepal. Am J Ophthalmol.2000; 129: 436 – 444.
He M, Zeng J, Liu Y, Xu J, Pokharel GP, Ellwein LB. Refractive error and isual impairment in urban children in southern China. Invest Ophthalmol Vis Sci. 2004; 45: 793 – 799.
Dobson V, Miller JM, Harvey EM, Mohan KM. Amblyopia in astigmatic preschool children. Vision Res. 2003; 43: 1081 – 1090.
Villegas EA, Alcon E, Artal P. Optical quality of the eye in subjects with normal and excellent visual acuity. Invest Ophthalmol Vis Sci.2008; 49: 4688 – 4696.
World Health Organization. Elimination of avoidable visual disability due to refractive error. pp. 6–10. WHO/PBL/00.79. Geneva, 2000.
Read_full_article: pdf/23-2013/23-3-2013/SU23-3-2013-Turcin2.pdf
Correspondence: Luminita Turcin, “Vasile Goldiş” Western University Arad, Faculty of Medicine, Pharmacy and Dentistry, Romania

Read full article
Article Title: Need for refractive errors screening in school-age children by objective methods
Authors: Luminita Turcin, Afilon Jompan
Affiliation: “Vasile Goldiş” Western University Arad, Faculty of Medicine, Pharmacy and Dentistry, Romania
Abstract: We emphasize the importance of a correct vision in school-age children. Vision screening is not enough. We propose as a method for determining the exact refraction: computerized photoretinoscopy. Methods: We examined 1121 students, aged 6 to 11 years from 5 primary schools in Arad County, in September 2011 March 2012. My attention was focused on the following parameters: age, gender, objective refraction, visual acuity. Refraction was measured with an autorefractometru Potek 5000. Visual acuity was assessed by Snellen test. Its values less than or equal to 0.8 (80%) are considered pathological. Were considered pathological values as follows: myopia – minimum-1.0DS refractive error (spherical diopters), hyperopia refractive error of +1.5 SD, and 1.0 DC astigmatism (cylindrical diopters). Results: Of the 1121 students enrolled in our study 315 had refractive errors, 48 myopia, hyperopia 159 and 108 astigmatism. Using as reference the visual acuity of 4/5 (80%) we found 275 cases with vision problems. Using computerized refractometer we found 315 cases of children with refractive errors. Conclusion: Getting in the screening results of visual acuity of above 0.8 indicates no emmetrop eye status. Hypermetropia, astigmatism and myopia may even be sources of ocular discomfort. To identify these refractive errors computerized testing is required under cycloplegic refractometry.
Keywords: visual acuity, schoolchildren, screening
References: Afilon Jompan- “Ghid De Medicina Preventica”Ed. Eurostampa, Timisoara, 2000 214 Pag., Isbn 973-8027-87-X.
Afilon Jompan-“Medicina Familiei” Ed Iv-A,Revazuta Si Adaugita Ed. Eurostampa, Timisoara 2003, Isbn 973-687-092-8, 263 Pagp
Amruta S. Padhye, Rajiv Khandekar,1 Sheetal Dharmadhikari, Kuldeep Dole, Parikshit Gogate, and Madan Deshpande, Prevalence of Uncorrected Refractive Error and Other Eye Problems Among Urban and Rural School Children, Middle East Afr J Ophthalmol. 2009 Apr-Jun; 16(2): 69–74
Hendrickson K, Bleything W., The visual profile of Romanian children and adults assessed through vision screenings. Pacific University, College of Optometry, Forest Grove, Oregon, USA. Optometry. 2001 Jun;72(6):388-96.
Budău M,Gamaniuc E,Moise C, Korbuly. Study of refractive changes in Timiş County. B. Oftalmologia. 2003;58(3):64-9
Bucşă D, Gavăt V, Albu, Aspects of child and youth health revealed by medical check-up in Botosani County, Romania]. A.Rev Med Chir Soc Med Nat Iasi. 2011 Oct-Dec;115(4):1225-30.
Dandona R, Dandona L. Refractive error blindness. Bull World Health Organ. 2001;79:237–243.
Doshi NR, and Rodriguez MLF. Amblyopia. Am Fam Physician 2007; 75:361-7.
Chang CH,Tsai RK, Sheu MM. Screening amblyopia of preschool children with uncorrected vision and stereopsis tests in Eastern Taiwan. Eye 2007;21:1482-8. 184 Mohammad Khalaj, Mohammadreza Gasemi and Isa Mohammdi Zeidi
Woodruff G, Hiscox F, Thompson JR, Smith LK. Factors affecting the outcome of children treated for amblyopia. Eye. 1994;8:627-631
The Pediatric Eye Disease Investigator Group. The Clinical Profile of Moderate Amblyopia in Children Younger Than 7 Years. Arch Ophthalmol. 2002;120:281-287.
Shaw DE, Fielder AR, Minshull C, Rosenthal AR. Amblyopia: factors influencing age of presentation. Lancet 1988;2:207-209.
Prevalence of Refractive Errors in Primary School Children [7-15 Years] of Qazvin City, European Journal of Scientific Research,ISSN 1450-216X Vol.28 No.2 (2009), pp.174-185
Dandona R, Dandona L, Srinivas M, Sahare P, Narsaiah S, Muñoz SR, Pokharel GP, Ellwein LB, Refractive error in children in a rural population in India, Invest Ophthalmol Vis Sci. 2002 Mar; 43(3):615-22.
Marsh-Tootle WL, Wall TC, Tootle JS, Person SD, Kristofco RE. Quantitative pediatric vision screening in primary care settings in Alabama. Optom Vis Sci. 2008; 85: 849 – 856.
Lim HT, Yu YS, Park SH, Ahn H, Kim S, Lee M, et al. The Seoul metropolitan preschool vision screening programme: results from South Korea. Br J Ophthalmol. 2004; 88: 929 – 933.
Newman DK, East MM. Preschool vision screening: negative predictive value for amblyopia. Br J Ophthalmol. 1999; 83: 676 – 679.
Donahue SP, Arnold RW, Ruben JB. Preschool vision screening: what should we be detecting and how should we report it? Uniform guidelines for eporting results of preschool vision screening studies. J AAPOS. 2003; 7: 314 – 316.
Evans J, Smeeth L, Fletcher A. Vision screening. Br J Ophthalmol.2009; 93: 704 – 705.
Preslan MW, Novak A. Baltimore Vision Screening Project. Phase 2. Ophthalmology. 1998; 105: 150 – 153.
Ehrlich MI, Reinecke RD, Simons K. Preschool vision screening for amblyopia and strabismus. Programs, methods, guidelines, 1983. Surv Ophthalmol. 1983; 28: 145 – 163.
Spierer A, Royzman Z, Chetrit A, Novikov I, Barkay A. Vision screening of preverbal children with Teller acuity cards. Ophthalmology.1999; 106: 849 – 854.
Chui L, Fraser T, Hoar K, LaRoche GR. Negative predictive value of a vision screening program aimed at children aged 3 to 4 years old. JAAPOS. 2004; 8: 566 – 570.
Cunningham F. Preschool vision screening. Am J Public Health Nations Health. 1959; 49: 762 – 765.
Luminita Turcin, Afilon Jompan, Prevalence of refractice errors in schoolchildren in rural environment. Medicine in Evolution, vol XVIII nr. 3, 2012,
Luminita Turcin, Afilon Jompan, Prevalence of refractice errors in schoolchildren in urban environment, Physiology, vol 23 nr. 3 (75), 2012.
Robinson B, Bobier WR, Martin E, Bryant L. Measurement of the validity of a preschool vision screening program. Am J Public Health.1999; 89: 193 – 198.
Khandekar R, Al Harby S, Abdulmajeed T, Helmi SA, Shuaili IS. Validity of vision screening by school nurses in seven regions of Oman. East Mediterr Health J. 2004; 10: 528 – 536.
Fotouhi A, Khabazkhoob M, Hashemi H, Mohammad K. Sensitivity and specicity of visual screening tests in Dezful Schoolchildren, 2004. Iran J Epidemiol. 2007; 2: 11 – 17.
Wick B, O’Neal M, Ricker P. Comparison of vision screening by lay and professional personnel. Am J Optom Physiol Opt. 1976; 53: 474 – 478.
Salomao SR, Cinoto RW, Berezovsky A, Mendieta L, Nakanami CR, Lipener C, et al. Prevalence and causes of visual impairment in lowmiddle income school children in Sao Paulo, Brazil. Invest Ophthalmol Vis Sci. 2008; 49: 4308 – 4313.
Lu Q, Zheng Y, Sun B, Cui T, Congdon N, Hu A, et al. A populationbased study of visual impairment among pre-school children in Beijing: the Beijing study of visual impairment in children. Am J Ophthalmol. 2009; 147: 1075 – 1081.
Ajaiyeoba AI, Isawumi MA, Adeoye AO, Oluleye TS. Prevalence and causes of blindness and visual impairment among school children in south-western Nigeria. Int Ophthalmol. 2005; 26: 121 – 125.
Preslan MW, Novak A. Baltimore Vision Screening Project. Ophthalmology. 1996; 103: 105 – 109.
Mintz-Hittner HA, Fernandez KM. Successful amblyopia therapy initiated after age 7 years: compliance cures. Arch Ophthalmol. 2000; 118:1535 – 1541.
Scott WE, Kutschke PJ, Keech RV, Pfeifer WL, Nichols B, Zhang L. Amblyopia treatment outcomes. JAAPOS. 2005; 9: 107 – 111.
Negrel AD, Maul E, Pokharel GP, Zhao J, Ellwein LB. Refractive error study in children: sampling and measurement methods for a multicountry survey. Am J Ophthalmol. 2000; 129: 421 – 426.
Gilbert C, Foster A. Childhood blindness in the context of VISION 2020–the right to sight. Bull World Health Organ. 2001; 79: 227 – 232.
Ore L, Garzozi HJ, Tamir A, Cohen-Dar M. Vision screening among northern Israeli Jewish and Arab schoolchildren. Isr Med Assoc J.2009; 11: 160 – 165.
Fotouhi A, Hashemi H, Khabazkhoob M, Mohammad K. The prevalence of refractive errors among schoolchildren in Dezful, Iran. Br J Ophthalmol. 2007; 91: 287 – 292.
Hartmann EE, Dobson V, Hainline L, Marsh-Tootle W, Quinn GE, Ruttum MS, et al. Preschool vision screening: summary of a task force report. Ophthalmology. 2001; 108: 479 – 486.
Newman DK, East MM. Prevalence of amblyopia among defaulters of preschool vision screening. Ophthalmic Epidemiol. 2000; 7: 67 – 71.
Kerr C. Vision screening of primary school children. Nurs Stand. 1997; 12: 46 – 48.
Newman DK, Hitchcock A, McCarthy H, Keast-Butler J, Moore AT. Preschool vision screening: outcome of children referred to the hospital eye service. Br J Ophthalmol. 1996; 80: 1077 – 1082.
Pokharel GP, Negrel AD, Munoz SR, Ellwein LB. Refractive error study in children: results from Mechi Zone, Nepal. Am J Ophthalmol.2000; 129: 436 – 444.
He M, Zeng J, Liu Y, Xu J, Pokharel GP, Ellwein LB. Refractive error and isual impairment in urban children in southern China. Invest Ophthalmol Vis Sci. 2004; 45: 793 – 799.
Dobson V, Miller JM, Harvey EM, Mohan KM. Amblyopia in astigmatic preschool children. Vision Res. 2003; 43: 1081 – 1090.
Villegas EA, Alcon E, Artal P. Optical quality of the eye in subjects with normal and excellent visual acuity. Invest Ophthalmol Vis Sci.2008; 49: 4688 – 4696.
World Health Organization. Elimination of avoidable visual disability due to refractive error. pp. 6–10. WHO/PBL/00.79. Geneva, 2000.
*Correspondence: Luminita Turcin, “Vasile Goldiş” Western University Arad, Faculty of Medicine, Pharmacy and Dentistry, Romania