Referral outcomes from a vision screening program for school-aged children.

OBJECTIVE: To assess ocular diagnoses and follow-up patterns of children referred for a comprehensive eye examination after a school-based vision screening program. DESIGN: Retrospective chart review. PARTICIPANTS: Students in grades K-5 from the School District of Philadelphia public schools screened by The Wills Eye Vision Screening Program for Children between January 2014 and June 2015. METHODS: Children with subnormal best-corrected visual acuity or other ocular conditions were referred to the Wills Eye pediatric ophthalmology service. A social worker assisted parents/guardians of referred children in scheduling an appointment and navigating insurance/payment issues. Measured outcomes included demographic information, ocular diagnoses, treatments, and follow-up patterns. RESULTS: Of 10 726 children screened, 509 (5%) were referred for a follow-up eye examination. Of these 509 children, only 127 (25%) completed a referral eye examination with parental consent. Most children (58%) were diagnosed with more than one eye condition, including refractive error (76%), amblyopia (43%), strabismus (16%), and anisometropia (13%). Other conditions included macular hypoplasia, ptosis, and other congenital anomalies. CONCLUSIONS: This program discovered and addressed potentially vision-threatening conditions in underserved children susceptible to amblyopia by offering social worker services and financial support to enable referred children to complete an eye examination. Contact by the social worker required consent. Obtaining such consent proved to be a barrier to connecting children with the recommended consultation.

Impact of eyeglasses on academic performance in primary school children.

OBJECTIVE: To assess the impact of eyeglass administration after a vision-screening program on standardized testing scores in school-aged children. DESIGN: Retrospective study of children who participated in a vision-screening program that provided free eyeglasses where indicated. PARTICIPANTS: Students in kindergarten through grade 5 in a large urban school district in North America. METHODS: Children in kindergarten through grade 3 were administered the Developmental Reading Assessment (DRA), and children in grades 3 through 5 were administered the Pennsylvania System of School Assessment (PSSA). Classroom teachers completed eyeglass adherence questionnaires. RESULTS: A total of 4523 children participated in the vision-screening program. Eyeglasses were worn most of the time (>75%) by 67.4% of the children and never or rarely worn (<25%) by 18.6% of children. DRA results were available for 2226 children. When eyeglasses were prescribed and worn, initially high reading performances (DRA level 3) were less likely to decline (odds ratio [OR] = 4.36, p < 0.001). Improvement was not observed for children who initially scored DRA level 1 or 2 (OR = 0.29, p < 0.001 and OR = 1.00, p = 0.986, respectively). PSSA reading results were available for 847 children. When eyeglasses were prescribed and worn, Asian children were more likely to score higher PSSA reading levels (OR = 2.53, p = 0.004). This trend was also observed in black and Hispanic children without reaching statistical significance (OR = 1.70, p = 0.061; OR = 2.67, p = 0.067, respectively). CONCLUSIONS: In some children, wearing eyeglasses was associated with maintenance in standardized reading scores. High adherence to wearing eyeglasses suggests that children perceive a benefit, perhaps beyond that which these standardized test results were able to document.

Efficacy and outcomes of a summer-based pediatric vision screening program.

PURPOSE: To investigate the prevalence of decreased visual acuity and uncorrected refractive error in school-aged children participating in summer programs. METHODS: During the summers of 2014-2016, Wills Eye Hospital collaborated with summer programs in Philadelphia to provide vision screenings for underserved children. Parental consent was obtained prior to vision screening. Fail criteria included children in grades K-1 (ages 5-6) with visual acuity worse than 20/40 in either eye, children in grades 2-6 (ages 7-13) with visual acuity worse than 20/30 in either eye, or children with ≥2 lines of interocular difference. If decreased visual acuity was correctable to ≥20/30 by the onsite optometrist, two pairs of free eyeglasses were provided. Children with other ocular abnormalities were referred to pediatric ophthalmology. RESULTS: Of 1,627 children screened, 360 children (22.1%) did not pass vision screening, and 64 (3.9%) were referred. The prevalence of decreased distance visual was 34.1%. Younger children were more likely to have worse visual acuity than older children (OR = 0.943; P = 0.023; 95% CI, 0.896-0.992). Myopia (73%), astigmatism (56.8%), hyperopia (15.5%), spherical anisometropia (12.5%), and cylindrical anisometropia (11.9%) presented in the 303 children who underwent a manifest refraction. Myopia increased with age (OR = 0.818; P = 0.001; 95% CI, 0.724-0.922), whereas astigmatism decreased (OR = 0.817; P < 0.001; 95% CI, 0.728-0.913) with age. Two pairs of glasses were provided to 301 children. CONCLUSIONS: Partnership with summer programs and other community initiatives to provide vision screenings facilitates access to eye care ultimately aimed at improving social functioning and academic performance.

Prevalence of uncorrected refractive errors among school-age children in the School District of Philadelphia.

PURPOSE: To determine the prevalence and severity of uncorrected refractive errors in school-age children attending Philadelphia public schools. METHODS: The Wills Eye Vision Screening Program for Children is a community-based pediatric vision screening program designed to detect and correct refractive errors and refer those with nonrefractive eye diseases for examination by a pediatric ophthalmologist. Between January 2014 and June 2016 the program screened 18,974 children in grades K-5 in Philadelphia public schools. Children who failed the vision screening were further examined by an on-site ophthalmologist or optometrist; children whose decreased visual acuity was not amenable to spectacle correction were referred to a pediatric ophthalmologist. RESULTS: Of the 18,974 children screened, 2,492 (13.1%) exhibited uncorrected refractive errors: 1,776 (9.4%) children had myopia, 459 (2.4%) had hyperopia, 1,484 (7.8%) had astigmatism, and 846 (4.5%) had anisometropia. Of the 2,492 with uncorrected refractive error, 368 children (14.8%) had more than one refractive error diagnosis. In stratifying refractive error diagnoses by severity, mild myopia (spherical equivalent of -0.50 D to < -3.00 D) was the most common diagnosis, present in 1,573 (8.3%) children. CONCLUSIONS: In this urban population 13.1% of school-age children exhibited uncorrected refractive errors. Blurred vision may create challenges for students in the classroom; school-based vision screening programs can provide an avenue to identify and correct refractive errors.

Improving access to vision screening in urban Philadelphia elementary schools.

BACKGROUND: The Wills Eye Vision Screening Program for Children is a community-based vision screening program for children in urban Philadelphia elementary schools that aims to provide vision screening, remedy refractive error by providing glasses, and refer children with suspected nonrefractive eye disease for eye care. METHODS: Children in grades K-5 from 45 Philadelphia elementary schools were screened for distance and near visual acuity, stereopsis, and color vision from January 2014 to June 2015. Children who failed were assessed by an on-site optometrist. Two pairs of eyeglasses were provided at no cost. Children with suspected, nonrefractive disease were referred to Wills Eye Hospital Pediatric Ophthalmology and contacted by a social worker to schedule an appointment. RESULTS: Over 84 days, 10,726 children were screened for vision problems at 45 schools. A total of 1,321 children (12%) had refractive error and 1,015 children (77%) returned the consent form and received two pairs of glasses. Of the 509 children (5%) referred to Wills Eye, 177 returned consent forms and were not being followed by an ophthalmologist. Of these, 127 children (72%) completed an eye examination at Wills. CONCLUSIONS: The program described herein can provide comprehensive vision screening, with eyeglasses and/or referrals, to children within an underserved community.

The Effectiveness of a Mobile Clinic in Improving Follow-up Eye Care for At-Risk Children.

PURPOSE: To investigate the potential of a mobile ophthalmic unit in the schoolyard to improve the follow-up rate for children who have failed an optometric in-school screening program. Previously, the optometric program made referrals to the center and only 53% of students attended the desired ophthalmology consultation. METHODS: This was a cohort study of students conducted in elementary school lots in socioeconomically disadvantaged communities. The mobile ophthalmic unit visited schools where students with parental consent who needed examination had been identified by an in-school optometric vision care program. RESULTS: A total of 132 students were referred by the optometric program, of whom 95 (72%) had complete signed consent forms. Eighty-two patients (62%, confidence interval: 54% to 70%) were successfully seen by the mobile unit. Compared to the historical rate of successful completion of ophthalmology consultation (53%), a statistically significant improvement in follow-up was noted (P = .036). On a Likert scale of 1 to 5, the mean school nurse satisfaction rating was 4.8. CONCLUSIONS: The findings demonstrate the potential impact of mobile eye clinics at schools in connecting children with ophthalmic care. [J Pediatr Ophthalmol Strabismus. 2016;53(6):344-348.].

Mechanical axis following staple epiphysiodesis for limb-length inequality.

BACKGROUND: Staple epiphysiodesis is an option for the treatment of limb-length discrepancies, but it is not without complications. The purpose of this study was to review the outcomes of staple epiphysiodesis, including changes in the mechanical axis. METHODS: The study included patients who underwent, between 1990 and 2005, staple epiphysiodesis of the femur or tibia, or both, to address limb-length discrepancy. We reviewed preoperative, postoperative, and final long standing anteroposterior radiographs of fifty-four patients to assess limb-length discrepancy, shifts in the mechanical axis, changes in the mechanical axis zone, and changes in the anatomic lateral distal femoral angle and the medial proximal tibial angle. Postoperative radiographs were also reviewed to assess the adequacy of staple placement. RESULTS: Three staple epiphysiodesis groups were identified: fifteen patients who underwent a distal femoral staple epiphysiodesis, eighteen who underwent a proximal tibial procedure, and twenty-one who underwent combined distal femoral and proximal tibial procedures. Fifty percent (twenty-seven) of the fifty-four patients showed a shift in the mechanical axis of > or =1 cm as compared with the preoperative measurement. Eighty-nine percent of these large shifts were varus in nature. The proximal tibial and combined epiphysiodeses resulted in significantly larger shifts in the mechanical axis (p = 0.002 and p = 0.006, respectively) and zone changes (p = 0.009 and p = 0.006, respectively) than did the distal femoral procedures. Six patients ultimately underwent a high tibial osteotomy to correct a post-stapling varus deformity. The proximal-lateral aspect of the tibia was by far the most common location for inadequate staple placement. CONCLUSIONS: Mechanical axis deviation is common following staple epiphysiodesis for the treatment of limb-length discrepancy. Proximal tibial and combined distal femoral and proximal tibial staple epiphysiodeses, even if done well technically, lead to clinically relevant shifts in the mechanical axis of the lower extremity more than half of the time. Distal femoral staple epiphysiodesis may still be a safe option for the treatment of limb-length discrepancy, but we advise caution when utilizing proximal tibial staple epiphysiodesis to treat limb-length inequality.