Effectiveness of a Recertification Vision Screening Training Module for Preschool Teachers.

Background: Certified training must be provided for lay vision screeners prior to their conduct of a vision screening programme. However, the effectiveness of trained lay screeners does deteriorate over time. This study aims to evaluate the effectiveness of a recertification vision screening training module using the KieVision™ Preschool Vision Screening Kit for preschool teachers in Malaysia. Methods: This was a randomised control trial. Fifty-nine preschool teachers previously enrolled in a Knowledge Transfer Programme were divided into a Study Group (n = 31) to receive recertification training and a Control Group (n = 28) to attend briefing sessions. Subjects was then asked to perform vision screening on 15 preschool children aged 4 years old-6 years old at their respective premises, then verified by optometrists after 2 weeks from the initial screening on the same children. Results: A total of 894 children were screened, with the Study Group and Control Group screened 49.7% and 50.3%, respectively. There was higher validity in vision screening findings from the Study Group (sensitivity = 66.7%, positive predictive value (PPV) = 61.5%) compared to the Control Group (sensitivity = 36.0 %, PPV = 40.9%). Conclusion: Teachers who received recertification training were more competent in detecting children's vision impairment using KieVision™ Preschool Vision Screening Kit. Thus, timely recertification training should be emphasised to ensure sustainable consistency and reliability of vision screening programmes conducted by lay vision screeners.

Status of visual impairment among indigenous (Orang Asli) school children in Malaysia.

BACKGROUND: School children are considered a high-risk group for visual impairment because uncorrected refractive errors and problems such as amblyopia can seriously affect their learning abilities and their physical and mental development. There are many studies reporting the prevalence of refractive errors among school children of different ethnic groups in Malaysia, however, studies concerning the prevalence of refractive errors among indigenous or Orang Asli children are very limited. Therefore, the objective of this study was to determine the prevalence and causes of visual impairment among Orang Asli children. METHODS: One hundred ten Orang Asli children aged 7 to 12 years old in Negeri Sembilan, Malaysia were selected. 51% of these children were boys while the remainders were girls. They underwent visual acuity test, cover test, Hirschberg's test, ocular external assessment and ophthalmoscopy. Children who failed the vision screening were then referred for further eye examination. RESULTS: Of these 110 Orang Asli children, 46 failed the vision screening and subsequently 45 of them were confirmed to have visual problems (40.9% of the total subjects). The main cause of visual impairment in this study was refractive error (34.5% of the total subjects) where the main refractive error found was hyperopia (28.2%) followed by amblyopia (2.7%), strabismus (1.8%) and ocular abnormalities (1.8%). CONCLUSION: Hence, vision screening and a comprehensive eye examination is very important and needs to be done on all Orang Asli children so that any visual problems can be detect at an early stage to avoid the development of learning difficulties among these already disadvantaged children.

Comparison of Lea Symbols chart and Sheridan Gardiner chart in assessing vision screening among pre-school children: a Malaysia perspective.

OBJECTIVE: Compare the performance of Lea Symbols and Sheridan Gardiner charts against the standard test chart used to determine reduced VA during vision screening among pre-schoolers. MATERIAL AND METHOD: Seven hundred seventy five pre-school participated where 389 subjects were boys and 386 subjects were girls were tested using the Lea Symbols chart and the Sheridan Gardiner chart. The mean age of the pre-school children was 5.3 +/- 0.7 years old. RESULTS: The Lea Symbols chart showed a higher sensitivity (97.5%) compared to the Sheridan Gardiner chart (57.1%). While the Sheridan Gardiner chart showed higher specificity (92.0%) compared to the Lea Symbols chart (45.0%). CONCLUSION: The Lea Symbols chart offers a better pick-up rate of visual impairment during a vision-screening program especially cases of amblyopia among pre-school children compared to the Sheridan Gardiner chart in Malaysia.

Sustainability of the effect of optical intervention on the reading performance of children with dyslexia.

Background: Dyslexia is a learning disability associated with reading difficulties in children. Due to the potential of poor school outcomes interventions have been employed to help students with dyslexia read. This study was aimed at identifying the sustainability of the effect of combined Visual Tracking Magnifier (VTM) and Ministry of Education (MOE) interventions and MOE intervention alone on the reading performance of school children with dyslexia after discontinuation of intervention. Methods: This prospective, interventional study was conducted on primary school children with dyslexia aged 8 - 11 years. The participants underwent comprehensive ophthalmic and optometric examinations and were categorized into groups A, B, and C, comprising primary school children at level 1 or 2. Groups A and B received combined VTM and MOE interventions for 12 and 24 weeks, respectively, and group C received MOE intervention alone. The reading performance was assessed at baseline and 12, 24, and 36 weeks post-intervention. Results: Both components of the reading performance improved significantly for school children at both levels in all study groups (all P < 0.05). However, the reading performance improvement was only approximately 28% in group C and 38% - 50% in groups A and B. In group A, students at level 1 showed significantly improved reading speed from baseline to 12 weeks post-VTM intervention and reading rate from baseline to 24 weeks post-VTM intervention (both P < 0.05). Students at level 2 showed significantly improved reading speed and rate from baseline to 12 and 24 weeks post-VTM intervention (all P < 0.05). In group B, students at both levels showed significantly improved reading speed and rate from baseline to 24 and 36 weeks post-VTM intervention (all P < 0.05). Students at level 2 showed significantly improved reading speed 12 weeks after cessation of intervention (at 36 weeks post-VTM intervention) compared to 24 weeks post-VTM intervention (P < 0.05). The improvement remaining stable 12 weeks after discontinuation of intervention indicated a sustained effect. Conclusions: Combined or individual intervention improved the reading performance of school children with dyslexia at levels 1 and 2. However, combined intervention showed a better reading improvement effect. Improvement in the reading performance was maintained after discontinuation of the VTM intervention. Further interventional studies with a longer study period after discontinuation of this optical intervention are required to confirm the long-term sustainability of its positive effects on the reading performance of school children with dyslexia.

Distribution of refractive error among chinese primary school children in a rural area in Pahang, Malaysia.

Purpose: This study aimed to determine the prevalence and status of refractive error among Chinese primary school children in a rural area in Pahang. Methods: This investigation entailed a cross-sectional retrospective study design involving case file analyses. The study site was a Chinese medium primary school in a rural locality within Bentong district. A total of 82 school children met the B40 classification and selection criteria; therefore, universal sampling was done. Analyses were done according to age group: Level 1 included ages 7 to 9 years, while Level 2 comprised 10- to 12-year-olds. Results: The mean age of the 82 Chinese school children was 9.72±1.5 years; the percentage of refractive errors found was 80.48%. A total of 53 (64.63%) children had myopia. Two-way ANOVA showed a significant difference (P=0.038) in the refractive error between age groups Level 1 and 2, but no significant difference (P=0.947) was observed in refractive error between genders. The chi-square test and Fishers exact test showed no significant association between the type of refractive error with gender (P>0.05) and age group (P=0.319). Conclusion: Myopia was the most common type of refractive error among Chinese school children in a rural area in Pahang. Refractive error severity was influenced by age group but not by gender. Types of refractive error were not associated with age group and gender. Hence, it is recommended that Chinese school children in rural areas seek an annual vision screening or eye test.

Validity of vision screening program conducted by preschool teachers: An interventional study.

Background: Clear vision is crucial for effective learning among preschool children. Hence, early detection of vision impairment and prompt treatment are required to improve prognosis. Currently, limited information is available, and no program exists to screen for vision impairment among preschoolers in Bangladesh. This study aimed to validate the KieVision™ Preschool Vision Screening Kit, translated into the Bengali language, to improve vision impairment detection among preschool children. Methods: In this prospective case-control study, 60 preschool teachers from Chittagong were randomly selected. The study group was trained to conduct vision screening among preschool children using the translated kit, whereas the control group was trained using the Chittagong Eye Infirmary and Training Complex (CEITC) School Teachers' Training Module. Fifteen preschool children aged 4-6 years were screened by each preschool teacher and again by the optometrist. Results: Sixty preschool teachers screened 900 children. The results showed a higher validity of vision screening findings by the preschool teachers in the study group (sensitivity, 68.00%; specificity, 92.75%) than in the control group (sensitivity 47.37%, specificity 70.39%). The level of agreement between the preschool teachers and optometrists was high for all tests (first-order agreement coefficient [AC1] ≥ 0.80 in the study group). The sensitivity and specificity of the visual acuity test for the study group were 59.65% and 94.15%, respectively, while in the control group it was 13.33% and 62.54%, respectively. A similar trend was noted in the general observation component and Hirschberg's test. Conclusions: The Bengali Language KieVision™ Preschool Vision Screening Kit can be used effectively by preschool teachers in vision screening programs to improve the identification of vision impairment among preschool children in Bangladesh.

Characteristics of eye injuries, medical cost and return-to-work status among industrial workers: a retrospective study.

OBJECTIVE: The aim of this study is to determine the characteristics of eye injuries, medical costs and return-to-work status among industrial workers to provide better vision rehabilitative services. SETTING: Nationwide data from the Social Security Organisation (SOCSO) of Malaysia. PARTICIPANTS: A stratified random sample of workers registered with the SOCSO of Malaysia with documentation of eye injury. PRIMARY AND SECONDARY OUTCOME MEASURES: Characteristics of eye injuries and medical costs related to eye injury (primary) and return-to-work status (secondary). RESULTS: A total of 884 from 8861 case files workplace accidents involving eye injury registered with Social Security Services (SOCSO) were identified. The mean age was 35±10 years and the highest incidence of work-related eye injury occurred in the age group 30-39 years and among Malay ethnics. Males are affected more than females' workers. The highest cause of eye injury was the impact from a moving object excluding falling objects (89.2%) and anterior segment injuries occurred more than posterior segment injuries. The total direct and Indirect medical cost was RM1 108 098.00 (US$316 599.40) and RM4 150 140.00 (US$1 185 754.20) for 884 cases. CONCLUSION: The majority of workers suffered from the low level of eye injury. A significant relationship was found between the severity of eye injury and employee work status. The indirect cost of medical and vision rehabilitation was higher than the direct cost. Awareness and vision rehabilitation programmes at the workplace need to be addressed for better prevention and rehabilitative service.

Review of Evidence for the Usage of Antioxidants for Eye Aging.

Oxidative stress is one of the common factors leading to age-related eye diseases in older adults. Factors such as high oxygen consumption, high concentration of polyunsaturated fatty acids, and cumulative exposure to high-energy visible light in the eyes, lead to excessive generation of reactive oxygen species, hence triggering apoptosis of ocular cells and giving rise to ophthalmic diseases. Dietary supplements such as carotenoids, anthocyanins, and vitamins have antioxidant properties which may be of benefit in retaining better vision or reversing vision impairment; thus, studies have been conducted to understand the role of dietary supplements in the treatment or prevention of ophthalmic diseases. While high concentration of carotenoids such as lutein and zeaxanthin decrease the risk of developing age-related macular disease, anthocyanins and vitamins play a role in the treatment and prevention of other ophthalmic diseases: saffron extract reduced intraocular pressure in glaucoma patients; bilberry extract prevented impairments in lenses and retina, as well as alleviate symptoms of dry eye disease; high concentration of beta-carotene may reduce the risk of developing cataract. Further studies with clinical measurements are required to investigate the effectiveness of antioxidants on visual function and ophthalmic diseases.

The Relationship Between Choroidal and Photoreceptor Layer Thickness With Visual Acuity in Highly Myopic Eyes.

PURPOSE: The aim of this study was to evaluate the choroidal and photoreceptor thickness in highly myopic eyes and its correlation with visual acuity. METHODS: This is a cross-sectional, observational study involving 57 eyes of 57 highly myopic subjects [spherical equivalent ≥ -6 diopters (D) or axial length ≥ 26 mm] seen in a tertiary institutional center. Eyes with any clinical evidence of maculopathy or amblyopia were excluded. All subjects underwent a refraction assessment, visual acuity, axial length measurement using the IOL Master, and full ocular assessment. Eyes were imaged using Spectralis Optical Coherence Tomography by one experienced operator. Two independent investigators manually measured subfoveal choroidal thickness (SFCT) and foveal photoreceptor thickness (FPT). RESULTS: The mean SFCT was 195.88 ± 87.63 µm (range: 32-373) and mean FPT was 96.68 ± 11.23 µm (range: 67-100), after correction for ocular magnification. The best corrected visual acuity (BCVA) in LogMAR was negatively correlated with SFCT (r = -0.510, p = 0.001) and FPT (r = -0.397, p = 0.002) and positively correlated with age (r = 0.418, p = 0.001) and axial length (r = 0.551, p = 0.001). Multiple linear regression analysis showed that age, axial length, and corrected FPT were significant risk factors for poorer BCVA (p = 0.021, < 0.001, and 0.02, respectively). CONCLUSION: FPT, age, and axial length are significant moderate predictive factors for poorer visual acuity in highly myopic eyes without myopic maculopathy. Thinner SFCT does not translate into poorer vision.

A situational analysis of clinical refraction services in the capital city of the Maldives.

Background: Uncorrected refractive error is a leading cause of visual impairment globally. This study aimed to determine the current state of clinical refraction services and barriers to service provision in the capital city of the Maldives. Methods: This cross-sectional, descriptive-analytical study used a purposive sampling technique. The list of facilities providing refraction services in the city of Malé was compiled through a desk review and finalized after verification by personnel from the Ministry of Health. The availability of human resources and infrastructure was measured using a pre-coded questionnaire that also listed barriers to service provision, followed by on-site observations and subsequent data analysis. Results: Three clinical ophthalmology departments within hospitals, two ophthalmology hospitals, and nine primary eye care centers were selected for this study. The private sector (n = 12, 85.7%) was the primary provider of refractive error services. All facilities possessed the essential equipment required for refraction. Only optometrists and ophthalmologists conducted refraction. Contact lens assessment and low vision services were not available at any facility. The number of refractions conducted in Malé annually was 145,392. Human resources and management-related factors were the major barriers to the provision of clinical refraction services (n = 21, 44.7%). Conclusions: Accessibility to refractive error management and low vision services is needed in Malé to meet current population needs. Existing resources, including humans and equipment, require augmentation regarding service provision and enhancement. Knowledge of these barriers could lead to the upscaling of refraction services in Malé, Maldives by health policy makers.

Refractive amblyopia among children aged 4-12 years in a hospital-based setting in Gaza Strip, Palestine.

Background: Refractive amblyopia is the most common cause of amblyopia in the Gaza Strip. However, the pattern of this condition has not yet been studied in this region. This study aimed to determine the pattern of refractive amblyopia in Gazan children aged 4‒12 years. Methods: This was a hospital-based cross-sectional study using a purposive sampling method. Children aged 4‒12 years who attended the Children's Unit at Gaza Ophthalmic Hospital, Gaza Strip, Palestine from September 2019 to July 2020, were examined. A comprehensive eye test was conducted for all participants. Those who failed the eye examinations and were diagnosed with refractive amblyopia were included in the study. Demographic data and amblyopic refractive error patterns were analyzed accordingly. Results: Of the 107 children, 72.9% were newly diagnosed with refractive amblyopia. The mean (standard deviation [SD]) of age of the children who participated was 7.85 (1.55) years. Approimately two-thirds of the patients were female (57.9%). Unilateral amblyopia was predominant in 60.7% of the cases. Moderate amblyopia was common (81.9%). A total of 149 amblyopic eyes were examined in total, with a mean (SD) (range) of best-corrected distance visual acuity and spherical equivalent of 0.45 (0.19) (0.2 to 1.3) logarithm of the minimum angle of resolution and + 0.76 (4.51) diopters (- 10.25 to + 11.50). Astigmatism was the most common amblyogenic factor (53.7%) among children with amblyopia. Conclusions: The frequency of refractive amblyopia was 72.9%, and meridional amblyopia accounted for the highest percentage. Girls were more commonly affected than boys. The majority were in the 7-year-old age group. Most cases were unilateral with moderate refractive amblyopia. Our study yields insights into the patterns of refractive amblyopia among children in the Gaza Strip.

Visual efficiency among teenaged athletes and non-athletes.

AIM: To compare visual efficiency, specifically accom-modation, vergence, and oculomotor functions among athletes and non-athletes. METHODS: A cross-sectional study on sports vision screening was used to evaluate the visual skills of 214 elementary students (107 athletes, 107 non-athletes), aged between 13 and 16y. The visual screening assessed visual parameters such as ocular motor alignment, accommodation, and vergence functions. RESULTS: Mean visual parameters were compared between age-group matched athletes (mean age 14.82±0.98y) and non-athletes (mean age 15.00±1.04y). The refractive errors of all participants were corrected to maximal attainable best corrected visual acuity of logMAR 0.0. Accommodation function assessment evaluated amplitude of accommodation and accommodation facility. Vergence functions measured the near point of convergence, vergence facility, and distance fusional vergence at break and recovery point. Ocular motor alignment was not statistically significant between both groups. Athletes had a statistically significant amplitude of accommodation for both the right eye (t=2.30, P=0.02) and the left eye (t=1.99, P=0.05). Conversely, non-athletes had better accommodation facility (t=-2.54, P=0.01) and near point of convergence (t=4.39, P<0.001) when compared to athletes. Vergence facility was found to be better among athletes (t=2.47, P=0.01). Nevertheless, non-athletes were significantly better for both distance negative and positive fusional vergence. CONCLUSION: Although the findings are still inconclusive as to whether athletes had superior visual skills as compared to non-athletes, it remains important to identify and elucidate the key visual skills needed by athletes in order for them to achieve higher performance in their sports.

Quantification of dark adaptation dynamics in retinitis pigmentosa using non-linear regression analysis.

PURPOSE: Non-linear regression analysis was used to determine dark adaptation indices in people with retinitis pigmentosa and in control subjects. METHODS: Dark adaptation data were collected for 13 people with retinitis pigmentosa and 21 controls using the Goldmann-Weekers Dark Adaptometer. Data were analysed using an exponential non-linear regression model and dark adaptation indices derived. The results were compared to age-related values. RESULTS: The mean cone threshold of the group with RP (4.73 +/- 0.19 log units) was significantly greater than that found in the control group (3.69 +/- 0.12 log units). The rate of cone dark adaptation in the RP group was not significantly different from that of the control group. The a break in the RP group (6.46 +/- 0.70 minutes) was delayed when compared to the control group (4.29 +/- 0.21 minutes) and the rate of rod dark adaptation in the RP group was slower (10 +/- 2 per cent per minute) than that of the control group (15 +/- 1 per cent per minute). CONCLUSIONS: This study has shown that a relatively simple data analysis can provide a more quantitative and intuitive description of dark adaptation rates in people with retinal disease. This technique will enable more effective use of dark adaptometry as a supplement to objective electrophysiology, when monitoring people with retinitis pigmentosa.

Mental health state and quality of life questionnaire in low vision assessment: a case report.

BACKGROUND: Vision impairment associated with diabetic retinopathy, is well known and low vision rehabilitation is always recommended. In this report, the importance of objective measure of mental health and quality of life screening in diabetic retinopathy low-vision assessment is discussed. CASE PRESENTATION: We describe the case of a 43-year-old Asian female who has mild vision impairment due to tractional retinal detachment secondary to diabetic retinopathy and how mental health screening and quality of life screening during low vision rehabilitation can improve in the management of this patient. CONCLUSION: Although vision impairment was mild, the psychological impact was enormous and affected her quality of life substantially. This case report illustrates that recognition of the mental health and quality of life impact on visual impairment is critical to the rehabilitation management of low vision patients with diabetic retinopathy.

Management of visual disturbances in albinism: a case report.

INTRODUCTION: A number of vision defects have been reported in association with albinism, such as photophobia, nystagmus and astigmatism. In many cases only prescription sunglasses are prescribed. In this report, the effectiveness of low-vision rehabilitation in albinism, which included prescription of multiple visual aids, is discussed. CASE PRESENTATION: We present the case of a 21-year-old Asian woman with albinism and associated vision defects. Her problems were blurring of distant vision, glare and her dissatisfaction with her current auto-focus spectacle-mounted telescope device, which she reported as being heavy as well as cosmetically unacceptable. We describe how low-vision rehabilitation using multiple visual aids, namely spectacles, special iris-tinted contact lenses with clear pupils, and bi-level telemicroscopic apparatus devices improved her quality of life. Subsequent to rehabilitation our patient is happier and continues to use the visual aids. CONCLUSIONS: Contact lenses with a special iris tint and clear pupil area are useful aids to reduce the glare experienced by albinos. Bi-level telemicroscopic apparatus telemicroscopes fitted onto our patient's prescription spectacles were cosmetically acceptable and able to improve her distance vision. As a result these low-vision rehabilitation approaches improved the quality of life of our albino patient.