National survey of paediatric vision screening programs across Canada: Identifying major gaps and call to action.

OBJECTIVE: Paediatric vision screening programs identify children with ocular abnormalities who would benefit from treatment by an eye care professional. A questionnaire was conducted to assess existence and uptake of school-based vision screening programs across Canada. A supplementary questionnaire was distributed among Ontario's public health units to determine implementation of government mandated vision screening for senior kindergarten children. METHODS: Chief Medical Officers of Health for each province and territory, and Ontario's thirty-four public health units were sent a questionnaire to determine: 1) whether school-based vision screening is being implemented; 2) what age groups are screened; 3) personnel used for vision screening; 4) the type of training provided for vision screening personnel; and 5) vision screening tests performed. RESULTS: Of the thirteen provinces/territories in Canada, six perform some form of school-based vision screening. Two provinces rely solely on non-school-based programs offering eligible children an eye examination by an optometrist and three rely on ocular assessment conducted by a nurse at well-child visits. In Ontario, where since 2018 vision screening for all senior kindergarten students is government mandated, only seventeen public health jurisdictions are implementing universal vision screening programs using a variety of personnel ranging from food safety workers to optometrists. CONCLUSION: Good vision is key to physical and emotional development. There is an urgent need for a universal, evidence-based and cost-effective multidisciplinary approach to standardize paediatric vision screening across Canada and break down barriers preventing children from accessing eye care.

The Effect of Reactive Balance Training on Falls in Daily Life: An Updated Systematic Review and Meta-Analysis.

OBJECTIVE: Reactive balance training (RBT) is an emerging approach to reducing falls risk in people with balance impairments. The purpose of this study was to determine the effect of RBT on falls in daily life among individuals at increased risk of falls and to document associated adverse events. METHODS: Databases searched were Ovid MEDLINE (1946 to March 2022), Embase Classic and Embase (1947 to March 2022), Cochrane Central Register of Controlled Trials (2014 to March 2022), and Physiotherapy Evidence Database (PEDro; searched on 22 March 2022). Randomized controlled trials of RBT were included. The literature search was limited to the English language. Records were screened by 2 investigators separately. Outcome measures were number of participants who reported falls after training, number of falls reported after training, and the nature, frequency, and severity of adverse events. Authors of included studies were contacted to obtain additional information. RESULTS: Twenty-nine trials were included, of which 17 reported falls and 21 monitored adverse events. Participants assigned to RBT groups were less likely to fall compared with control groups (fall risk ratio = 0.76; 95% CI = 0.63-0.92; I2 = 32%) and reported fewer falls than control groups (rate ratio = 0.61; 95% CI = 0.45-0.83; I2 = 81%). Prevalence of adverse events was higher in RBT (29%) compared with control groups (20%). CONCLUSION: RBT reduced the likelihood of falls in daily life for older adults and people with balance impairments. More adverse events were reported in RBT than control groups. IMPACT: Balance training that evokes balance reactions can reduce falls among people at increased risk of falls. Older adults and individuals with balance problems were less likely to fall in daily life after participating in RBT compared with traditional balance training. LAY SUMMARY: If you are an older adult and/or have balance problems, your physical therapist may prescribe reactive balance training rather than traditional balance training in order to reduce your likelihood of falling in daily life.

Video interpretation and diagnosis of pediatric amblyopia and eye disease.

AIM: The aim of this study was to assess the potential of using video screening to interpret the results of paediatric eye examinations. DESIGN: Prospective multi-centred, blinded study. METHODS: Children aged 5 months to 11 years referred to a paediatric ophthalmology centre were enrolled in the study. Outcome measures included the degree of agreement between examiners for assessment of various aspects of paediatric eye examination. In Phase 1, children were individually assessed in the clinic by three different examiners to determine the level of agreement. In Phase 2 a video recording was made of the first ophthalmologist examining the children. The other two examiners viewed the video recordings to make their diagnoses. Areas of assessment included lid function, pupillary function, ocular motility, strabismus, nystagmus, torticollis and facial asymmetry. Agreement between examiners was measured using Gwet's agreement coefficient (AC1). RESULTS: A total of 27 patients in Phase 1 (mean age 4.0 years) and 160 children in Phase 2 (mean age 4.8 years) underwent clinical and video-recorded screening. In Phase 1, all but one area of ocular examination (heterotropia) achieved ≥84% agreement between three examiners. In Phase 2, there was greater variation between direct clinical examination and interpretation of video findings, ranging from 55-100% agreement. CONCLUSION: Using experienced clinicians and changing only one variable in Phase 2 (the method of assessment - direct examination versus video interpretation), the results show the possible usefulness of video-recorded screening as a means of assessing children. Further research is indicated to assess the accuracy of ophthalmologists interpreting video recordings of eye examinations performed by trained non-eye-care professionals.

Assessment of the visual function of partially sighted and blind Canadian youth using the VFQ-25 questionnaire: a preliminary study.

OBJECTIVE: Young people are a relatively underrepresented group in literature on poor vision and blindness. This study assessed the quality of life and function of young people who have poor vision or blindness by asking directly about their personal experiences. METHODS: A modified version of the VFQ-25 was administered to 47 students at a school for blind youth. All students who received the test had visual acuity scores of 20/100 or worse. The VFQ-25 scoring system was used, and results from additional qualitative questions were themed and ranked. Further analysis was performed, using Spearman's rank correlation coefficient to check for correlation between duration of blindness and VFQ score. RESULTS: Participants recorded a composite VFQ score of 65, showing that poor vision had a self-perceived moderate effect on their daily function. Proportion of participant's life spent with visual impairment correlated with higher composite scores. In general, lower scores were reported by participants with worse visual acuity. However, variations were observed in the mental health category. CONCLUSIONS: Young people have a more optimistic and nuanced view of their function than expected based on VFQ scores of other groups. Larger studies, particularly ones including youth in non-specialized schools would be useful to expand these findings.