Optical Coherence Tomography-Derived Measurements of the Optic Nerve Head Structure of Aboriginal and Torres Strait Islander Children.

PRCIS: This study demonstrated significant differences in optic nerve head characteristics in Aboriginal and Torres Strait Islander children compared with non-Indigenous children, which has implications for glaucoma risk and diagnosis in Aboriginal and Torres Strait Islander populations. PURPOSE: The purpose of this study was to examine the optic nerve head (ONH) characteristics of visually normal Aboriginal and Torres Strait Islander children and non-Indigenous Australian children. MATERIALS AND METHODS: Spectral domain optical coherence tomography imaging was performed on the right eye of 95 Aboriginal and Torres Strait Islander children and 149 non-Indigenous Australian children (5-18 years). Horizontal and vertical line scans, centered on the ONH, were analyzed to determine the dimensions of the ONH (Bruch membrane opening diameter), optic cup diameter, Bruch membrane opening minimum rim width, and the peripapillary retinal nerve fiber layer thickness. RESULTS: The vertical but not horizontal Bruch membrane opening diameter of Aboriginal and Torres Strait Islander children was significantly larger than non-Indigenous children (mean difference: 0.09 mm, P = 0.001). The horizontal (mean difference: 0.12 mm, P = 0.003) and vertical cup diameter (mean difference: 0.16 mm, P < 0.001) were also significantly larger in Aboriginal and Torres Strait Islander children, as were the horizontal and vertical cup-to-disc ratios (both P < 0.01). Aboriginal and Torres Strait Islander children also had a significantly thinner Bruch membrane opening minimum rim width in the superior, nasal, and temporal meridians (all P < 0.001). Peripapillary retinal nerve fiber layer thickness did not differ between groups. CONCLUSIONS: Differences exist in the ONH structure between Aboriginal and Torres Strait Islander children and non-Indigenous children, which may have implications for the detection and monitoring of ocular disease in this population and highlights the need to extend this research to the adult population.

Hyperopia in schoolchildren: Investigating the impact on vision and determining appropriate methods for screening.

INTRODUCTION: Hyperopia is associated with reduced vision and educational outcomes in schoolchildren. This study explored the impact of clinically significant hyperopia (≥+2.00 D) on visual function in schoolchildren and compared the ability of different screening tests (alone and in combination) to detect this level of hyperopia. METHODS: Vision testing including monocular logMAR visual acuity (VA) measured to threshold (distance [DVA], near [NVA] and DVA through a plus lens [+2.50 D]), stereoacuity and cycloplegic autorefraction (tropicamide 1%) were undertaken on 263 schoolchildren (mean age: 11.76 years ± 3.38) in Queensland, Australia. Vision measures were compared between children with clinically significant hyperopia in at least one meridian (≥+2.00 D) and emmetropia/low hyperopia (>0.00 and <+2.00 D). Receiver operating curve (ROC) analysis was performed to identify optimal pass/fail criteria for each test and the diagnostic accuracy of individual and combinations of tests. RESULTS: Thirty-two children had clinically significant hyperopia and 225 had emmetropia/low hyperopia. DVA and NVA were worse (p < 0.01), while the difference in DVA through a plus lens was less in children with clinically significant hyperopia (p < 0.01). ROC analysis for individual tests resulted in areas under the curve (AUCs) ranging from 0.65 to 0.85. Combining screening tests revealed that failing one or more of the following tests was most effective for detecting hyperopia: DVA, NVA and difference in DVA through a plus lens, resulting in a sensitivity and specificity of 72% and 81%, respectively. CONCLUSION: Significant differences in visual function existed between schoolchildren with clinically significant hyperopia and emmetropia/low hyperopia. Combining measures of DVA and NVA and the difference in DVA through a plus lens demonstrated good discriminative ability for detecting clinically significant hyperopia in this population.

Ocular biometry measures and their correlation with refractive error in Aboriginal and Torres Strait Islander children.

CLINICAL RELEVANCE: The ocular biometry measures of the eye determine the refractive status, and while most refractive error develops during childhood, the ocular biometry measures of Aboriginal and Torres Strait Islander children have not previously been reported. BACKGROUND: To investigate the ocular biometry of Aboriginal and Torres Strait Islander children, including measures important in determining refractive error and those which relate to the risk of ocular disease. METHODS: Participants included 252 primary and secondary school children (Aboriginal and Torres Strait Islander: 101; non-Indigenous: 151), aged between 4 and 18 years. Habitual monocular distance visual acuity, cycloplegic autorefraction, and ocular optical biometry were measured in all participants and intraocular pressure measured in secondary school children using rebound tonometry. RESULTS: The mean (±SD) spherical equivalent refractive error of Aboriginal and Torres Strait Islander children was significantly less hyperopic than non-Indigenous children (Aboriginal and Torres Strait Islander: +0.52 ± 0.80 D; non-Indigenous: +0.86 D ±0.58 D; p < 0.001). There were no differences in axial length or axial length/corneal radius ratio between the two groups, however the mean lens power of Aboriginal and Torres Strait Islander children was significantly greater than that of non-Indigenous children (Aboriginal and Torres Strait Islander: 23.62 D; non-Indigenous: 22.51 D; p < 0.001). Aboriginal and Torres Strait Islander children had a thinner central corneal thickness (Aboriginal and Torres Strait Islander: 534 ± 37 µm; non-Indigenous: 543 ± 35 µm; p = 0.04), and lower intraocular pressure compared with non-Indigenous children (Aboriginal and Torres Strait Islander: 14.7 ± 3.8 mmHg; non-Indigenous: 16.0 ± 3.7; p = 0.02). CONCLUSION: Differences exist in the refractive error, lens power, central corneal thickness, and intraocular pressure of Aboriginal and Torres Strait Islander children compared to non-Indigenous Australian children which have potential implications for the development of refractive error and ocular disease later in life.

Prevalence of vision conditions in children in a very remote Australian community.

CLINICAL RELEVANCE: Understanding the prevalence of vision conditions in a population is critical for determining the most appropriate strategies for detecting and correcting eye conditions in a community. This is particularly important in very remote regions where access to vision testing services is limited. BACKGROUND: Although recent studies have provided detailed analyses of the prevalence of vision conditions in Aboriginal and/or Torres Strait Islander children in urban and regional areas of Australia, there is a paucity of research examining vision conditions in children in remote regions. Importantly, a significant proportion of the population in remote and very remote regions identify as Aboriginal and/or Torres Strait Islander people. METHODS: Comprehensive eye examinations were provided to 193 primary school children in a very remote Australian region. Ninety eight percent of children identified as Aboriginal and/or Torres Strait Islander. The eye examination included measures of visual acuity, cycloplegic autorefraction, binocular vision and accommodative function, ocular health and colour vision. Previous history of eye examinations and refractive correction were assessed through parental questionnaire. RESULTS: Although the average unaided vision in the population was good (mean: 0.02 ± 0.13 logMAR) and the prevalence of reduced unaided visual acuity (>0.3 logMAR in either eye) was low (4%), vision conditions were detected in 32% of children. The most common conditions were clinically significant refractive errors (18% of children) and binocular vision or accommodative disorders (16%). Of the total population of children tested, 10% had previously had an eye examination, and 2% were reported to have previously been prescribed spectacles. CONCLUSIONS: In this population of children in a very remote Australian region, up to 1 in 3 children had a vision condition, with many of these conditions being uncorrected and undetected. These findings highlight the important need for additional resources to be made available to very remote communities for the detection and correction of vision conditions in childhood.

Educator perspectives on implementing the Optometry Aboriginal and Torres Strait Islander health curriculum framework.

CLINICAL RELEVANCE: Aboriginal and Torres Strait Islander Peoples have the right to the highest attainable standard of health and access to health services without discrimination. To uphold these rights, it is important that optometry students are educated in Aboriginal and Torres Strait Islander health and culturally safe practice. BACKGROUND: An Aboriginal and Torres Strait Islander health curriculum framework is now mandatory for optometry programs to implement. This study explores the experiences of those involved in implementing this framework and, from their perspectives, what is and is not working. METHODS: Heads and educators involved in Aboriginal and Torres Strait Islander health curriculum at Australian optometry programs participated in a mixed-methods study. Information about pedagogy and contextual issues impacting curriculum implementation was collected through surveys and interviews. The design and analysis were underpinned by constructivist grounded theory. RESULTS: Most programs had at least partially implemented components of the curriculum framework. While partnerships were considered essential to success, this remains a work in progress. Authentic learning through clinical placement was considered a priority. Assessment was described as complex and not yet adequately addressed. Only 37% of educators felt fully prepared to teach and 6% to assess this curriculum. More workload allocation, funding and recruitment of Aboriginal and Torres Strait Islander staff and students through institutional commitment and leadership were perceived requirements. CONCLUSION: Further developing sustainable partnerships where there is reciprocity between optometry programs and Aboriginal and Torres Strait Islander educators and communities is critical to effectively implementing Aboriginal and Torres Strait Islander health curriculum. While clinical placement was considered an important learning experience, the type of experience and whether or not all students should attend require further consideration. Additionally, educators need support for professional development and sharing resources in this emerging field. This will contribute to improving culturally safe practice in optometry.

Developing culturally safe education practices in optometry schools across Australia and Aotearoa New Zealand.

Access to culturally safe health services is a basic human right, however through the lasting effects of colonisation, oppression, and systemic racism, the individual and community health of Indigenous peoples in Australia and Aotearoa New Zealand have been severely impacted. The Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy of the Australian Health Practitioners Regulation Agency, and the Standards of Cultural Competence and Cultural Safety of the Optometrists and Dispensing Opticians Board of New Zealand, recognise the importance of access to safe health care for Aboriginal, Torres Strait Islander and Maori patients, which encompasses both clinical competency and cultural safety. Universities have an ongoing responsibility to ensure their learning and teaching activities result in graduates being able to provide culturally safe practice. This article highlights the emergence of culturally safe practices in the Australian and Aotearoa New Zealand optometry curricula over the last five years incorporating Indigenous ways of knowing, being and doing into the curricula, understanding the local Indigenous histories and contexts, the adoption of online cultural education modules, and clinical placement partnerships with local Indigenous communities. Whilst there is still much work to do to achieve the goal of graduating culturally safe optometrists, this paper focuses on features that enable or impede progress in the development of culturally safe practices within the optometry programmes to improve eye health equity for Indigenous recognise the diversity of Indigenous cultures across Australia and NZ.

Retinal thickness in healthy Australian Aboriginal and Torres Strait Islander children.

BACKGROUND: Understanding normative retinal thickness characteristics is critical for diagnosis and monitoring of pathology, particularly in those predisposed to retinal disease. The macular retinal layer thickness of Australian Aboriginal and/or Torres Strait Islander children was examined using spectral-domain optical coherence tomography. METHODS: High-resolution macular optical coherence tomography imaging was performed on 100 Aboriginal and/or Torres Strait Islander children and 150 non-Indigenous visually healthy children aged 4-18 years. The imaging protocol included a 6-line radial scan centred on the fovea. Images were segmented using semi-automated software to derive thickness of the total retina, inner and outer retina, and individual retinal layers across the macular region. Repeated measures ANOVAs examined variations in thickness associated with retinal region, age, gender and Indigenous status. RESULTS: Retinal thickness showed significant topographical variations (p < 0.01), being thinnest in the foveal zone, and thickest in the parafovea. The retina of Aboriginal and/or Torres Strait Islander children was significantly thinner than non-Indigenous children in the foveal (p < 0.001), parafoveal (p = 0.002), and perifoveal zones (p = 0.01), with the greatest difference in the foveal zone (mean difference: 14.2 µm). Inner retinal thickness was also thinner in Aboriginal and/or Torres Strait Islander children compared to non-Indigenous children in the parafoveal zone (p < 0.001), and outer retinal thickness was thinner in the foveal (p < 0.001) and perifoveal zone (p < 0.001). Retinal thickness was also significantly greater in males than females (p < 0.001) and showed a statistically significant positive association with age (p = 0.01). CONCLUSION: There are significant differences in macular retinal thickness between Aboriginal and/or Torres Strait Islander children and non-Indigenous children, which has implications for interpreting optical coherence tomography data and may relate to risk of macula disease in this population.

Eye movement patterns and reading ability in children.

PURPOSE: Eye movements are integral to the reading process. This study characterised the eye movement patterns of children differentiated by their reading ability, while completing a saccadic eye movement test with irregular target spacing (Development Eye Movement (DEM) test) using a novel eye movement classification algorithm. METHODS: Participants included 196 Grade 2 Australian schoolchildren (mean age: 7.9 ± 0.3 years) who completed a computerised version of the DEM test, while their eye movements were recorded (Tobii TX300 eye-tracker). Children also completed a standardised reading comprehension test, which categorised them into below average and average or above reading ability groups. A novel eye movement classification algorithm was developed that considered the vertical and horizontal eye movements of each child. RESULTS: Compared to children with average or above reading ability, the below average reading group displayed poor vertical eye movement control, demonstrated by a significantly greater proportion of interline eye movements (vertical eye movements away from the current line) (p < 0.001). Differences in horizontal eye movements were also observed, with below average readers demonstrating a smaller proportion of expected forward saccades (p < 0.001) (within-line forward saccades with horizontal amplitude between the minimum and maximum horizontal spacing between digits), while this group also displayed longer fixation durations (p = 0.001). The below average reading group demonstrated significantly poorer results on all standard DEM metrics than the average or above reading ability group: horizontal subtest time (p < 0.001), vertical subtest time (p = 0.004) and ratio (p = 0.004). CONCLUSIONS: Children exhibiting below average reading ability were poorer at maintaining control of vertical (interline), as well as horizontal, eye movements compared to children with average or above reading ability. Future studies should explore the mechanisms underlying these differences, particularly in vertical eye movements, given that reading paragraphs (involving multiple lines of text) requires accurate eye movements in both the vertical and horizontal direction.

High Rates of Uncorrected Vision Conditions among Schoolchildren in Rural Queensland, Australia.

SIGNIFICANCE: This study is the first to report high rates of uncorrected vision conditions among Australian secondary schoolchildren living in a rural area and to comment on the rate of eye examinations undertaken on Australian Indigenous children. Uncorrected vision problems that continue throughout the school years have significant implications for children's quality of life and education. PURPOSE: This study aimed to investigate the prevalence of uncorrected vision conditions among Australian schoolchildren. METHODS: Participants included 280 students from rural primary and secondary schools (aged 4 to 18 years), of whom 40% identified as being of Aboriginal and/or Torres Strait Islander descent (Indigenous). All participants underwent an eye examination including measurements of monocular distance and near visual acuity, assessment of accommodative and vergence function, stereoacuity, color vision, and cycloplegic autorefraction. A parental questionnaire was used to determine whether the child had previously had his/her eyes examined. RESULTS: The overall prevalence of uncorrected vision conditions in this population was 35%. The odds of previously having had an eye examination were 2.3× higher for non-Indigenous compared with Indigenous children despite both groups exhibiting high rates of uncorrected vision conditions (Indigenous, 31 [29%]; non-Indigenous, 66 [40%]; χ21 = 3.24, P = .07). Of the children who had significant refractive error (Indigenous, 23 [21%]; non-Indigenous, 49 [30%]; χ21 = 2.70, P = .10), 82% were uncorrected, and only 39% of Indigenous children and 54% of non-Indigenous children had previously had an eye examination. CONCLUSIONS: These findings suggest that high rates of uncorrected vision conditions are present among Australian primary and secondary schoolchildren from a rural area and highlight that Indigenous children are much less likely to have had an eye examination. Understanding factors that affect the rate of eye examinations and compliance with spectacle correction must be addressed given the potential impact of these vision conditions.

Choroidal Thickness in Indigenous Australian Children.

Purpose: This study aimed to examine the choroidal thickness profiles in visually normal Australian Indigenous children, given the important role of the choroid in refractive error and a range of ocular diseases. Methods: Choroidal thickness was assessed across the central 5 mm macular region using enhanced depth imaging spectral domain optical coherence tomography, in 250 children enrolled in an elementary school and a secondary school in rural Queensland, Australia. One hundred (40%) of these children identified as Indigenous Australians. Results: The subfoveal choroid was significantly thicker in Indigenous children (mean 369 ± 75 µm), compared to non-Indigenous children (355 ± 73 µm; P = 0.03). Subfoveal choroidal thickness was also significantly associated with age (ß = +7.6, r2 = 0.105, P = 0.003), and axial length (ß = -19.9, r2 = 0.030, P < 0.001). A significantly thicker choroid in Indigenous children was also found in analyses across the central 5 mm macular region (P = 0.008). A significant interaction between Indigenous status and meridian was observed (P = 0.007) with the largest differences between Indigenous and non-Indigenous children being in the nasal and inferonasal meridians. Conclusions: This study establishes the normative characteristics of macular choroidal thickness in Indigenous Australian children and demonstrates a significantly thicker choroid compared to non-Indigenous children from the same geographic region. These results may have implications for our understanding of factors predisposing or protecting Australian Indigenous people from a range of conditions associated with choroidal thickness. Translational Relevance: The significantly thicker choroid in Australian Indigenous children should be considered in clinical diagnoses and management of conditions associated with choroidal changes.

Involving patients in the development of interpersonal skills of optometry students.

BACKGROUND: Providing patients an opportunity to give feedback to optometry students on their communication and interpersonal skills allows for a unique learning opportunity. The aim of the current project was to determine if the Doctors' Interpersonal Skills Questionnaire (DISQ) was suitable for use with optometry students in a large teaching clinic and if it provided useful feedback to the students for learning purposes. METHODS: The DISQ is a 12-item questionnaire that utilises a five-point Likert scale; a higher score indicates better performance. The DISQ was modified for an optometry context and developed into an online questionnaire. Patients were invited to complete the survey following their consultation with a final year student. Patients provided feedback on the interpersonal skills of the student optometrist who conducted the consultation under supervision. Students were provided with both individual and collated feedback obtained for the entire student group; strategies for improving communication were discussed. This activity did not form part of the grades of the students. RESULTS: Patients were very satisfied with the interpersonal skills of final year optometry students. Highest scores were given for questions relating to the warmth of greeting, respect shown and time given. Lowest scores were for questions relating to explanations, reassurance and confidence. There was a significant improvement in the communication and interpersonal skills of students following the provision of patient feedback and strategies for improving these skills, and an additional period of clinical experience. CONCLUSION: Patients can provide feedback on the interpersonal skills of optometry students using the DISQ. This feedback results in further skill development for students and makes patients feel valued within the teaching clinic environment. This activity assisted in ensuring that graduating optometrists have the interpersonal skills required to communicate clearly and effectively with patients, a requirement for practising with a patient-centred focus.

Do reduced visual acuity and refractive error affect classroom performance?

The role of visual acuity and refractive errors in the academic performance of children is controversial due to the variable quality of the research in this area and the mixed findings reported. This review aims to provide clarity by reviewing and critiquing relevant peer-reviewed publications and also summarises what is known regarding the visual demands of modern classroom environments. The outcomes of this review suggest that while a number of studies have investigated the role of vision in relation to children's academic performances, the veracity of the evidence obtained from the majority of these studies is undermined by methodological limitations. Comparisons between studies are constrained by differences in experimental designs, instrumentation and sample characteristics. Despite these limitations, the weight of evidence suggests there is an association between academic performance and both visual acuity and refractive error in children. However, well-designed experimental studies are necessary to further understand the relationship between these parameters.

Visual information processing skills are associated with academic performance in Grade 2 school children.

PURPOSE: This study evaluated the association between performance on visual information processing tests and academic performance in school children. METHODS: Visual-motor integration (VMI), the Developmental Eye Movement (DEM) test, visual acuity and stereoacuity were assessed in 222 Grade 2 children (mean age: 7.90 ± 0.33 years). Academic performance was assessed using standardized tests of reading and mathematics (PAT-R and PAT-M). Linear regression analyses examined associations between visual information processing (VMI and DEM) and academic measures, adjusting for school socio-economic background and age. Receiver operating characteristic (ROC) analysis was used to assess the ability of the tests to identify children with below average academic performance. RESULTS: Visual-motor integration (VMI) and DEM (horizontal time) were most strongly associated with PAT-R and PAT-M. Linear regression models explained 28.6% of variance in PAT-R (VMI: standardized regression coefficient = 0.31, p < 0.01; DEM horizontal time: -0.28, p < 0.01) and 24.1% of variance in PAT-M (VMI: standardized regression coefficient = 0.29, p < 0.01; DEM horizontal time: -0.16, p = 0.02). Receiver operating characteristic (ROC) curve analysis indicated that VMI was most strongly associated with below average PAT-R (area under curve [AUC] of 0.74 [95% CI: 0.67-0.81]) and PAT-M (AUC of 0.73 [95% CI: 0.66-0.81]). CONCLUSION: Visual-motor integration (VMI) was most strongly associated with reading and mathematics scores in school children. A child's academic performance can be an important factor in their optometric management. The ability of clinical tests to identify children at risk of underachieving academically provides additional support to clinicians in managing their patients.

Validity of the +1.50 plus lens screening test as a predictor of uncorrected moderate hyperopia.

PURPOSE: Screening for uncorrected hyperopia in school children is important given its association with poorer visual function and academic performance. However, standard distance visual acuity screening may not detect low to moderate hyperopia. The plus lens test is used to screen for hyperopia in many school screening protocols, but has not been well validated. The current study investigated the effectiveness of the plus lens test to identify hyperopia in school children. METHODS: Participants included Grade 2 school children. Monocular distance visual acuity (logMAR letter chart) was measured unaided, and then through a +1.50D lens, known as the plus lens test. Cycloplegic refraction was undertaken to classify moderate hyperopia (≥+2.00D). Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated for commonly used cut-offs for the plus lens test: 6/6, 6/9 and less than two lines difference between unaided acuity and acuity through the plus lens test. RESULTS: The sample included 59 children (mean age 7.2 ± 0.4 years). Fourteen (24%) children were classified as having uncorrected hyperopia. The sensitivity and specificity of the +1.50 plus lens test for identifying hyperopia were 0% and 98% respectively for a 6/6 cut-off, 29% and 91% for 6/9 cut-off, and 50% and 76% for a <2 line reduction between unaided acuity and acuity through the plus lens test. Receiver Operating Curve (ROC) analysis revealed area under curves of 0.69 based on acuity through the plus lens test, and 0.65 for a reduction in acuity through the plus lens test. CONCLUSIONS: The plus lens test has low sensitivity for detecting uncorrected hyperopia using traditional cut-offs of 6/9 or better. This raises questions about the role of the plus lens test in school screening batteries.

Vision and academic performance in primary school children.

PURPOSE: Vision is considered important for academic performance in children; however, the evidence in this area tends to be inconsistent and inconclusive. This study explored the association between vision function and visual information processing measures and standardised academic achievement scores in Grade 3 Australian children. METHODS: Participants included 108 Grade 3 primary school children (M = 8.82 ± 0.32 years) from three state primary schools in South-East Queensland. All participants underwent a standard vision screening, including distance visual acuity (VA), binocular vision testing and stereoacuity (SA). A computer-based battery of visual information processing tests including the Development Eye Movement (DEM) test, Visual Sequential Memory (VSM) and Symbol Search (SS) was also administered. Australian National Assessment Program for Literacy and Numeracy (NAPLAN) scores across five subtests of academic performance were obtained for each child: Reading, Writing, Spelling, Grammar/Punctuation and Numeracy. RESULTS: The DEM adjusted horizontal and vertical times were most strongly associated with all of the NAPLAN subtest scores (p < 0.01), adjusted for age and the socio-economic status of the school; the DEM ratio was not significantly associated with any of the NAPLAN subtests. VSM and SS scores were significantly associated with one or more NAPLAN subtests, as were worse and better eye VA; SA showed no significant association with any of the NAPLAN subtests. CONCLUSIONS: Performance on the horizontal and vertical DEM subtests was most strongly associated with academic performance. These data, in conjunction with other clinical data, can provide useful information to clinicians regarding their prescribing and management philosophy for children with lower levels of uncorrected refractive error and binocular vision anomalies.

Vision Problems and Reduced Reading Outcomes in Queensland Schoolchildren.

PURPOSE: To assess the relationship between vision and reading outcomes in Indigenous and non-Indigenous schoolchildren to determine whether vision problems are associated with lower reading outcomes in these populations. METHODS: Vision testing and reading assessments were performed on 508 Indigenous and non-Indigenous schoolchildren in Queensland, Australia divided into two age groups: Grades 1 and 2 (6-7 years of age) and Grades 6 and 7 (12-13 years of age). Vision parameters measured included cycloplegic refraction, near point of convergence, heterophoria, fusional vergence range, rapid automatized naming, and visual motor integration. The following vision conditions were then classified based on the vision findings: uncorrected hyperopia, convergence insufficiency, reduced rapid automatized naming, and delayed visual motor integration. Reading accuracy and reading comprehension were measured with the Neale reading test. The effect of uncorrected hyperopia, convergence insufficiency, reduced rapid automatized naming, and delayed visual motor integration on reading accuracy and reading comprehension were investigated with ANCOVAs. RESULTS: The ANCOVAs explained a significant proportion of variance in both reading accuracy and reading comprehension scores in both age groups, with 40% of the variation in reading accuracy and 33% of the variation in reading comprehension explained in the younger age group, and 27% and 10% of the variation in reading accuracy and reading comprehension, respectively, in the older age group. The vision parameters of visual motor integration and rapid automatized naming were significant predictors in all ANCOVAs (P < .01). The direction of the relationship was such that reduced reading results were explained by reduced visual motor integration and rapid automatized naming results. CONCLUSIONS: Both reduced rapid automatized naming and visual motor integration were associated with poorer reading outcomes in Indigenous and non-Indigenous children. This is an important finding given the recent emphasis placed on Indigenous children's reading skills and the fact that reduced rapid automatized naming and visual motor integration skills are more common in this group.

A Visual Profile of Queensland Indigenous Children.

PURPOSE: Little is known about the prevalence of refractive error, binocular vision, and other visual conditions in Australian Indigenous children. This is important given the association of these visual conditions with reduced reading performance in the wider population, which may also contribute to the suboptimal reading performance reported in this population. The aim of this study was to develop a visual profile of Queensland Indigenous children. METHODS: Vision testing was performed on 595 primary schoolchildren in Queensland, Australia. Vision parameters measured included visual acuity, refractive error, color vision, nearpoint of convergence, horizontal heterophoria, fusional vergence range, accommodative facility, AC/A ratio, visual motor integration, and rapid automatized naming. Near heterophoria, nearpoint of convergence, and near fusional vergence range were used to classify convergence insufficiency (CI). RESULTS: Although refractive error (Indigenous, 10%; non-Indigenous, 16%; p = 0.04) and strabismus (Indigenous, 0%; non-Indigenous, 3%; p = 0.03) were significantly less common in Indigenous children, CI was twice as prevalent (Indigenous, 10%; non-Indigenous, 5%; p = 0.04). Reduced visual information processing skills were more common in Indigenous children (reduced visual motor integration [Indigenous, 28%; non-Indigenous, 16%; p < 0.01] and slower rapid automatized naming [Indigenous, 67%; non-Indigenous, 59%; p = 0.04]). The prevalence of visual impairment (reduced visual acuity) and color vision deficiency was similar between groups. CONCLUSIONS: Indigenous children have less refractive error and strabismus than their non-Indigenous peers. However, CI and reduced visual information processing skills were more common in this group. Given that vision screenings primarily target visual acuity assessment and strabismus detection, this is an important finding as many Indigenous children with CI and reduced visual information processing may be missed. Emphasis should be placed on identifying children with CI and reduced visual information processing given the potential effect of these conditions on school performance.

Review of guidelines for children's vision screenings.

The aim of children's vision screenings is to detect visual problems that are common in this age category through valid and reliable tests. Nevertheless, the cost effectiveness of paediatric vision screenings, the nature of the tests included in the screening batteries and the ideal screening age has been the cause of much debate in Australia and worldwide. Therefore, the purpose of this review is to report on the current practice of children's vision screenings in Australia and other countries, as well as to evaluate the evidence for and against the provision of such screenings. This was undertaken through a detailed investigation of peer-reviewed publications on this topic. The current review demonstrates that there is no agreed vision screening protocol for children in Australia. This appears to be a result of the lack of strong evidence supporting the benefit of such screenings. While amblyopia, strabismus and, to a lesser extent refractive error, are targeted by many screening programs during pre-school and at school entry, there is less agreement regarding the value of screening for other visual conditions, such as binocular vision disorders, ocular health problems and refractive errors that are less likely to reduce distance visual acuity. In addition, in Australia, little agreement exists in the frequency and coverage of screening programs between states and territories and the screening programs that are offered are ad hoc and poorly documented. Australian children stand to benefit from improved cohesion and communication between jurisdictions and health professionals to enable an equitable provision of validated vision screening services that have the best chance of early detection and intervention for a range of paediatric visual problems.

Refraction in children: a comparison of two methods of accommodation control.

PURPOSE: The prevalence of refractive errors in children has been extensively researched. Comparisons between studies can, however, be compromised because of differences between accommodation control methods and techniques used for measuring refractive error. The aim of this study was to compare spherical refractive error results obtained at baseline and using two different accommodation control methods-extended optical fogging and cycloplegia-for two measurement techniques-autorefraction and retinoscopy. METHODS: Participants included 25 school children aged 6 to 13 years (mean age, 9.52 ± 2.06 years). The refractive error of one eye was measured at baseline and again under two different accommodation control conditions: extended optical fogging (+2.00DS for 20 minutes) and cycloplegia (1% cyclopentolate). Autorefraction and retinoscopy were both used to measure the most plus spherical power for each condition. RESULTS: A significant interaction was demonstrated between measurement technique and accommodation control method (p = 0.036), with significant differences in spherical power evident between accommodation control methods for each of the measurement techniques (p < 0.005). For retinoscopy, refractive errors were significantly more positive for cycloplegia compared with optical fogging, which were in turn significantly more positive than baseline; whereas for autorefraction, there were significant differences between cycloplegia and extended optical fogging and between cycloplegia and baseline only. CONCLUSIONS: Determination of refractive error under cycloplegia elicits more plus than using extended optical fogging as a method to relax accommodation. These findings support the use of cycloplegic refraction compared with extended optical fogging as a means of controlling accommodation for population-based refractive error studies in children.