Investigation of current guidelines for prescribing spectacles to children using a modified Delphi approach and the AGREE II tool.

PURPOSE: This study aimed to identify clinical guidelines that provide recommendations on prescribing refractive error correction in children, evaluate the overall quality of these guidelines using the Appraisal of Guidelines for REsearch and Evaluation II (AGREE II) tool and subsequently gain consensus on the prescribing recommendations from high-quality guidelines using the modified Delphi technique. METHODS: A comprehensive search for prescribing guidelines was conducted using databases and professional websites. The quality appraisal of eligible guidelines was undertaken by scoring the six AGREE II domains. Subsequently, the modified Delphi technique was used by 10 experts (sub-specialist optometrists, ophthalmologists and orthoptists) to gain consensus on the prescribing recommendation statements extracted from guidelines that had been identified as high quality. Three rounds were conducted in which agreement of these statements were scored using a 9-point Likert scale with a free-text option for any additional comments. RESULTS: Five eligible guidelines were identified. The AGREE II tool demonstrated that the guidelines varied substantially in quality, with only one guideline identified as being of high quality. A total of 168 prescribing statements were reviewed in the Delphi procedure. Of these, 95 statements reached expert consensus as being appropriate prescribing recommendations. CONCLUSION: There is significant scope for improving current guidelines for prescribing refractive error correction in children. We used the modified Delphi technique to find points of agreement on prescribing recommendations to support professionals prescribing refractive error correction in children. We recommend that further work is needed to address gaps in the guidelines.

Efficacy of coloured lenses for patients diagnosed with visual stress.

CLINICAL RELEVANCE: Colour overlays and lenses are used to relieve symptoms in some patients diagnosed with visual stress, but evidence to support this practice is lacking. In this small randomised crossover trial, a range of colours are beneficial and precise colour specification does not enhance this effect. BACKGROUND: This randomised, double-masked crossover trial aimed to test effectiveness of precisely selected lens tints for visual stress. METHODS: Twenty-nine participants aged 11 to 72 (mean 30) years diagnosed with visual stress were issued with their selected coloured overlay then with tinted lenses at two colour settings. An eye examination and coloured overlay test were followed by intuitive colorimetry to select a colour to minimise symptoms (optimal tint) and the closest setting at which the symptoms returned (sub-optimal, or placebo tint). The tints were worn for one month each in randomised order. Reading speed was measured using the Wilkins Rate of Reading Test, a subjective scale was used to gauge symptoms, and the patient was asked to indicate whether one of the tints alleviated their symptoms more than the other. RESULTS: Reading speed was significantly higher with colour than without (p < 0.001), but was similar with the overlay and both tints (p = 1.0). Discomfort/distortion rating (1-7) was lower with colour than without (p < 0.001), but no difference was found between the overlay and both tints (p > 0.1). About half (47%) of the patients preferred/strongly preferred their optimal tint, and 39% preferred/strongly preferred their sub-optimal tint, while 14% had no preference. CONCLUSIONS: While our patients read more quickly and were more comfortable when using a tint, there was no difference in outcome between the optimal and sub-optimal tints. These results suggest that for patients diagnosed with visual stress, precision tints are no more helpful than sub-optimal, placebo tints.

Prevalence of presenting bilateral visual impairment associated with refractive error - findings from the See4School, pre-school vision screening programme in NHS Scotland.

BACKGROUND/OBJECTIVES: The See4School programme in Scotland is a pre-school vision screening initiative delivered by orthoptists on a national scale. The primary objective of any vision screening programme is to identify amblyopia, given the common understanding that this condition is unlikely to be detected either at home or through conventional healthcare channels. The target condition is not bilateral visual impairment, as it is believed that most children will be identified within the first year of life either through observations at home or as part of the diagnosis of another related disorder. This belief persists even though bilateral visual impairment is likely to have a more detrimental impact on a child's day-to-day life, including their education. If this hypothesis were accurate, the occurrence of bilateral visual impairment detected through the Scottish vision screening programme would be minimal as children already under the hospital eye service are not invited for testing. The overarching aim of this study was therefore to determine the prevalence of presenting bilateral visual impairment associated with refractive error detected via the Scottish preschool screening programme. SUBJECTS/METHODS: Retrospective anonymised data from vision screening referrals in Scotland from 2013-2016 were collected. Children underwent an assessment using a crowded logMAR vision test and a small number of orthoptic tests. RESULTS: During the 3-year period, out of 165,489 eligible children, 141,237 (85.35%) received the vision screening assessment. Among them, 27,010 (19.12%) failed at least one part of the screening and were subsequently referred into the diagnostic pathway, where they received a full sight test. The prevalence of bilateral visual impairment associated with refractive error and detected via the vision screening programme (≥ 0.3LogMAR) was reported to range between 1.47% (1.37-1.59) and 2.42% (2.29-2.57). CONCLUSIONS: It is estimated that up to 2.42% (2.29-2.57) of children living Scotland have poorer than driving standard of vision (6/12) in their pre-school year, primarily due to undetected refractive error. Reduced vision has the potential to impact a child's their day-to-day life including their future educational, health and social outcomes.

STEAM-SASHA: a novel approach for blood- and fat-suppressed native T1 measurement in the right ventricular myocardium.

OBJECTIVE: The excellent blood and fat suppression of stimulated echo acquisition mode (STEAM) can be combined with saturation recovery single-shot acquisition (SASHA) in a novel STEAM-SASHA sequence for right ventricular (RV) native T1 mapping. MATERIALS AND METHODS: STEAM-SASHA splits magnetization preparation over two cardiac cycles, nulling blood signal and allowing fat signal to decay. Breath-hold T1 mapping was performed in a T1 phantom and twice in 10 volunteers using STEAM-SASHA and a modified Look-Locker sequence at peak systole at 3T. T1 was measured in 3 RV regions, the septum and left ventricle (LV). RESULTS: In phantoms, MOLLI under-estimated while STEAM-SASHA over-estimated T1, on average by 3.0% and 7.0% respectively, although at typical 3T myocardial T1 (T1 > 1200 ms) STEAM-SASHA was more accurate. In volunteers, T1 was higher using STEAM-SASHA than MOLLI in the LV and septum (p = 0.03, p = 0.006, respectively), but lower in RV regions (p > 0.05). Inter-study, inter-observer and intra-observer coefficients of variation in all regions were < 15%. Blood suppression was excellent with STEAM-SASHA and noise floor effects were minimal. DISCUSSION: STEAM-SASHA provides accurate and reproducible T1 in the RV with excellent blood and fat suppression. STEAM-SASHA has potential to provide new insights into pathological changes in the RV in future studies.