Ontario Cataract Quality Outcome Initiative: appropriateness and prioritization of cataract surgery.

OBJECTIVE: To explore the utility of the Catquest 9SF visual function (VF) questionnaire along with visual acuity (VA) for determining appropriateness and priority for cataract surgery. To evaluate the feasibility of administering the Catquest-9SF in a clinical setting using web-based electronic data capture and interpretation. DESIGN: Prospective multicentred interventional observational study. PARTICIPANTS: Subjects undergoing sequential cataract surgery in both eyes at 4 sites in Ontario. METHODS: We recorded best-corrected VA (BCVA) and VA with current correction (CCVA) in each eye and both eyes (OU) and Catquest-9SF responses on a tablet before and after cataract surgery. Linear regression models were employed to test for associations between VA and visual function (VF). RESULTS: Preoperative BCVA and CCVA in the worse eye were significant predictors of change in VF (p = 0.006 and p = 0.008, respectively); subjects with worse VA had a greater improvement in VF after surgery. There was a significant association between improvement in VF and improvement in CCVA OU (p = 0.001). Fourteen of 151 subjects (9%) had no improvement or worse VF scores after surgery. Within this group, 10 of 14 subjects had a preoperative score ≤-3, which is suggestive of minimal visual disability. Within this subset, 4 of 14 subjects (2.6%) had a preoperative BCVA of 20/30 or better in their worse eye. CONCLUSIONS: For patient groups with equal VA, the Catquest-9SF score can help determine priority for surgery. Web-based data capture and interpretation allow for efficient virtual assessments of VF. A BCVA in the worse eye of 20/30 or better combined with a Catquest-9SF score <-3 can be used as a guideline for lowest priority.

Guide de pratique clinique fondé sur des données probantes pour l'examen périodique de la vue chez les enfants de 0 à 5 ans au Canada.

CONTEXTE: Étant donné que les maladies oculaires avant l'âge de 5 ans sont courantes, une certaine forme de dépistage des troubles de la vision devrait être effectuée chez les enfants avant qu'ils ne fréquentent l'école primaire. Cependant, l'absence de recommandations nationales cohérentes crée de la confusion chez les patients, les professionnels des soins oculovisuels et les gouvernements. MéTHODES: L'objectif de ce document est de fournir des recommandations quant aux types d'examens oculaires à pratiquer chez les enfants en bonne santé de 0 à 5 ans ainsi que sur le moment et la périodicité de tels examens. Une recension des écrits a produit 403 articles. Un comité d'experts multidisciplinaire (composé de deux optométristes, d'un ophtalmologiste effectuant des examens complets de la vue, d'un ophtalmologiste pratiquant en pédiatrie, d'un médecin de famille et d'un pédiatre) a établi de façon indépendante les articles jugés essentiels à la question clinique. Les articles se prêtant à un classement [n = 16] ont ensuite été soumis à une évaluation critique indépendante par un groupe externe, lequel a fourni un profil « GRADE ¼ des articles à utiliser et leur a attribué une cote. RECOMMANDATIONS: En plus du dépistage de routine effectué par les professionnels de première ligne, un examen complet de la vue mené par un professionnel possédant l'expertise nécessaire à la détection des facteurs de risque de l'amblyopie (comme un ophtalmologiste ou un optométriste) est requis durant la petite enfance. Les conclusions confirment l'importance de la détection précoce de l'amblyopie avant 36 mois et au plus tard 48 mois par le dépistage assorti d'au moins un examen complet de la vue avant l'âge de 5 ans. CONCLUSIONS: Le dépistage de la vue effectué chez les bébés et les enfants par les fournisseurs de soins de première ligne au cours des consultations de routine et des vaccinations périodiques est un élément essentiel de la détection des maladies oculaires. Toutefois, le potentiel de détection précoce est limité et un examen oculovisuel complet est également recommandé avant que l'enfant n'entre à l'école. Si l'amblyopie, le strabisme ou une autre pathologie oculaire est détecté ou soupçonné, et que le problème dépasse le champ de compétences du professionnel qui examine le patient, celui-ci peut être dirigé vers le spécialiste approprié, ce qui permet d'amorcer le traitement en temps opportun.

Evidence-based clinical practice guidelines for the periodic eye examination in children aged 0-5 years in Canada.

BACKGROUND: As eye disease before age 5 years is common, some form of vision screening should be performed on children before attending primary school. However, the lack of consistent national recommendations creates confusion for patients, eye care professionals, and governments alike. METHODS: The objective of this document is to provide guidance on the recommended timing, intervals, and types of ocular assessments for healthy children aged 0-5 years. A literature search yielded 403 articles. A multidisciplinary expert committee (comprising 2 optometrists, a comprehensive ophthalmologist, a pediatric ophthalmologist, a family physician, and a pediatrician) independently determined those articles deemed to be key to the clinical question. Articles that were gradable (n = 16) were then submitted for independent critical appraisal by an external review group, which provided a Grading of Recommendations Assessment, Development and Evaluation profile of the reviewed articles to use for assigning a grade of evidence. RECOMMENDATIONS: In addition to routine screening by a primary health care professional, a comprehensive eye examination by an individual with the expertise to detect risk factors for amblyopia-such as an ophthalmologist or optometrist-is required in early childhood. The findings support the importance of early detection of amblyopia before 36 months and no later than 48 months of age via screening with at least 1 comprehensive eye examination before age 5 years. CONCLUSIONS: Vision screening performed by primary health care providers during routine well-baby/child visits and scheduled vaccinations is an essential part of the detection of ocular disease. However, this early detection potential is limited, and a full oculovisual assessment is also recommended before the child entering the school system. If amblyopia, strabismus, or other eye pathology is detected or suspected that is beyond the scope of the eye care professional examining the patient, a referral to the appropriate specialist can be made, allowing treatment to be initiated in a timely fashion.

Aviation signal light gun: variations in photometric and colorimetric properties among airports.

PURPOSE: The aviation signal light gun (LG) is believed by some to be the only color-critical task in aviation without redundant coding. However, there are questions regarding its practicality as a test of color vision given that the brightness and colors may vary between airports. METHODS: The chromaticity coordinates and relative intensities of five LGs were measured with a portable spectroradiometer. Four of the LGs were measured at airports in southern Ontario and compared with a newly purchased LG (ATI Avionics). The air traffic controllers (ATCs) were also surveyed regarding the frequency of LG use. RESULTS: Only 40% of the LGs at the airports were in good working condition. All working LGs met the ICAO standards for airport signal lights. However, differences did exist between models which were related to the date of manufacture. Older LG lights were dimmer and their green and white lights were more yellow than the newer LGs. ATCs reported that they used the LG primarily for pilot instruction and demonstration. However, in two locations, the LG was used to signal pilots who were flying their aircraft in for radio repair. This occurred about once or twice a month. DISCUSSION: The LG is used primarily for instructional purposes. However, if a radio repair shop is at the airport, then the LG will be used about once to twice a month. There is sufficient variability in the light colors and intensity across airports so that any given LG cannot be used as valid practical test of color vision in aviation.

Aviation-relevent epidemiology of color vision deficiency.

INTRODUCTION: The Colour Vision Study Group of Transport Canada undertook a prevalence review to ascertain the degree and type of color vision deficiency (CVD) common in different populations. This was performed as a first step toward establishing whether a bone fide occupational requirement for color vision in aviation can be determined. LITERATURE SEARCH: Peer-reviewed articles with large populations and appropriate methodology for measuring CVD were assessed. Those pertaining to congenital CVD were cross-sectional prevalence studies with greater than 100 subjects assessed with a combination of pseudoisochromatic plates (PIPs) and Farnsworth D15 and/or an anomaloscope. Of 162 papers reviewed, 36 met these criteria for inclusion in the congenital CVD section. Acquired CVD papers were included based on the quality of color vision tests employed. CONGENITAL CVD: Data on congenital and acquired CVD are presented separately in parts 1 and 2. Part 1 demonstrates that although the prevalence numbers for North American and European populations are consistent with those reported in reference texts, congenital CVD is actually less prevalent in Asian, African, and Native populations. Therefore, the reported overall 8% prevalence of CVD in men applies only to Euro-Caucasians and is significantly lower in other racial groups. Possible evolutionary implications of dichromatism in humans are explored. ACQUIRED CVD: In this section the current understanding of acquired color vision deficiency, with an estimated prevalence ranging from 5 to 15% (51,95), is reviewed. Acquired CVD is frequently associated with significant impairment of visual acuity and/or visual field. However, many ocular diseases and drugs do primarily affect color vision, independent of other visual function, and one must remain vigilant to their presence. CONCLUSION: Congenital CVD is present in a consequential percentage of men, but considerable variability exists in different populations (2-8%). Acquired CVD may elude detection, but if severe is also associated with loss of visual acuity and/or visual field. Senescence remains the most common and increasingly prevalent cause for acquired CVD.