The newborn screening tests in Brazil: regional and socioeconomic prevalence and inequalities in 2013 and 2019.

OBJECTIVE: To analyze the prevalence evolution of Guthrie, hearing, and eye screening testing among newborns in Brazil, between 2013 and 2019, according to demographic and socioeconomic characteristics. METHODS: This is a cross-sectional study with data from 5231 infants from the Pesquisa Nacional de Saúde (PNS), in 2013, and 6637 infants, in 2019, for the Guthrie test, hearing, and red reflex tests. The authors analyzed the outcomes according to the region of residence, self-reported color/race, having health insurance, and per capita household income. By using bivariate and multivariate Poisson regression models, the prevalence ratios and their respective 95 % Confidence Intervals (CI95%) were calculated for each year. RESULTS: In 2013, Guthrie test, hearing, and red reflex tests were performed in 96.5 % (95%CI 95,8;97,0), 65.8 % (95%CI 63,9;67,7), and 60.4 % (95%CI 58,5;62,3) of infants, respectively. In 2019, the prevalence was 97.8 % (95%CI 97,3;98,2) in the Guthrie test, 81.6 % (95%CI 80,3;82,9) in the hearing test, and 78.6 % (95%CI 77,1;79,9) in the red reflex test. The testing frequency was higher among residents of the Southeast and South regions of Brazil, among infants whose mother or guardian was white, had health insurance, and was in the higher income strata; and the most evident differences were in the eye and hearing testing. CONCLUSIONS: The coverage inequalities according to the region of residence, income, and having health insurance highlight the need to use strategies that enable exams to be carried out, with more information about their importance, encompassing actions from primary care, prenatal care to the puerperium, aiming at universal access and equity.

Clinical correlation between automated vision screening under cycloplegia and retinoscopy in young children.

PURPOSE: To evaluate the clinical performance of the Spot Vision Screener and establish clinical correlations between automated screening and retinoscopy following induction of cycloplegia in preverbal children. METHODS: In this prospective, cross-sectional study, children aged 6-36 months were evaluated using the Spot Vision Screener. A complete ophthalmologic examination, including cycloplegic refraction assessment, was performed, followed by repeat spot vision screening and retinoscopy in all cases to establish correlations regarding hypermetropia, myopia, and astigmatism following induction of induction cycloplegia. RESULTS: The study included 185 children. The sensitivity of the automated screener after cycloplegia was 100% (95%CI: 85.18-100%), and specificity was 87.04% (95%CI: 80.87-91.79%). Positive and negative predictive values were 52.27% (42.36-62.01%) and 100%, respectively. Compared to retinoscopy, the Spot Vision Screener overestimated spherical values by 0.62 D (95%CI: 0.56-0.69) in the right eye and by 0.60 (95%CI: 0.54-0.66) in the left eye and cylindrical values by -0.38 D in the right eye (95%CI: -0.42--0.33) and by -0.39 D in the left eye (95%CI: -0.43--0.34). For overall spherical and cylindrical values, the difference was 0.61 D (95%CI: 0.57-0.65) and -0.38 D (95%CI: -0.41--0.35) in the left and right eyes, respectively. CONCLUSION: A substantial correlation was found between retinoscopy and objective data captured by the device. This shows that technology can be used in conjunction, reaching a more accurate diagnosis and identifying amblyopia risk factors as early as possible. Photoscreening may make a difference at the population level for early screening and intervention.

Vision screening using a smartphone platform.

OBJECTIVE: The main aim of this study was to evaluate the performance of a platform designed for pediatricians to screen amblyopia using a smartphone. METHODS: The medical records of consecutive children who received visual screening using a smartphone platform were retrospectively reviewed. The smartphone was used with a flash concentrator case and a software for capturing images of both eyes simultaneously by a photorefraction mechanism. The platform performance was compared to the comprehensive ophthalmological examination, which is considered the gold standard for detecting amblyopia. Sensitivity, specificity, positive predictive value, and negative predictive value of the software in detecting amblyopia risk factors were calculated. RESULTS: A total of 157 children were included, with a mean age of 6.0±.5 years (range 5-7). In 94% of the cases, the software was able to analyze the images and release a result, determining whether or not the child presented with amblyopia risk factors. Compared to the ophthalmological examination, the smartphone platform sensitivity in detecting amblyopia risk factors was 84%, the specificity was 74%, the positive predictive value was 86%, and the negative predictive value was 70%. CONCLUSIONS: The sensitivity and specificity of the smartphone photoscreening platform to detect amblyopia risk factors were within the range of traditional instrument-based vision screening technology. A smartphone photorefraction platform appears to be a promising cost-effective alternative to assist pediatricians and minimize obstacles to vision screening and amblyopia detection. Future studies are needed to gather additional comparative data.

Access to school-based eye health programs: a qualitative case study, Bogotá, Colombia

[ABSTRACT]. Objectives. To identify barriers and enablers to accessing school-based eye health programs in Bogotá, Colombia. Methods. We undertook a qualitative case study that explored how structural factors, and social and cultural norms influence access to school-based eye health programs. We conducted focus groups discussions and interviews with a purposive sample of 37 participants: government stakeholders (n = 4), representatives from nongovernmental organizations (n = 3), and an eye-care practitioner, as well as teachers (n = 7), a school nurse, parents (n = 7), and children (n = 14) from private and public schools. Data were analyzed using a priori themes from the availability, accessibility, acceptability and quality framework. Results. Routine vision screening in schools is not currently provided nor is there a budget to support it. Lack of collaboration between the health and education ministries and the absence of national planning affected the delivery of eye care in schools. Factors related to acceptability of school-based eye health programs included: poor acceptance of training teachers as vision screeners; stigma related to wearing spectacles; and distrust of health services. The cost of spectacles and poor access to eye health information were identified as barriers to positive child eye health outcomes by socioeconomically disadvantaged parents and children. Conclusion. Our findings suggest the need for a national school eye health plan and improved cooperation between health and education ministries. Interventions to improve trust in health services, tackle the lack of human resources while respecting professional qualifications, and raise awareness of the importance of eye health are recommended.

[RESUMEN]. Objetivo. Determinar los obstáculos y los elementos facilitadores para acceder a los programas de salud ocular en las escuelas en Bogotá (Colombia). Métodos. Se llevó a cabo un estudio cualitativo de casos que exploró cómo influyen los factores estructurales y las normas sociales y culturales en el acceso a la atención oftalmológica. Se realizaron entrevistas y grupos de opinión con una muestra intencionada de 37 participantes: interesados directos gubernamentales (n = 4), representantes de organizaciones no gubernamentales (n = 3) y un profesional de atención oftalmológica, así como docentes (n = 7), una enfermera escolar, padres (n = 7) y niños (n = 14) de escuelas privadas y públicas. Se analizaron los datos empleando temas determinados a priori sobre la disponibilidad, la accesibilidad, la aceptabilidad y el marco de calidad. Resultados. Actualmente, no se proporciona un tamizaje sistemático de la visión en las escuelas, ni se dispone de presupuesto para respaldarlo. La falta de colaboración entre los ministerios de salud y de educación, y la falta de planificación a nivel nacional tuvo repercusiones sobre la prestación de atención oftalmológica en las escuelas. Entre los factores relacionados con la aceptabilidad de los programas de salud ocular en las escuelas se encuentran una escasa aceptación de la posibilidad de capacitar a los docentes para que examinen la visión; el estigma relacionado con el uso de anteojos y la desconfianza de los servicios de salud. Los padres y los niños en una situación socioeconómica desfavorable indicaron que el costo de las gafas y el acceso limitado a la información sobre la salud ocular eran obstáculos para obtener resultados positivos de salud ocular en los niños. Conclusiones. Los resultados indican la necesidad de un plan nacional de salud ocular en las escuelas y una mejor cooperación entre los ministerios de salud y de educación. Se recomiendan intervenciones para mejorar la confianza en los servicios de salud, abordar la falta de recursos humanos al tiempo que se respetan las cualificaciones profesionales y concientizar sobre la importancia de la salud ocular.

[RESUMO]. Objetivos. Identificar barreiras e facilitadores para o acesso a programas escolares de saúde ocular em Bogotá, Colômbia. Métodos. Estudo de caso qualitativo que explorou como fatores estruturais e normas socioculturais influenciam o acesso aos cuidados com a visão. Realizamos discussões em grupos focais e entrevistas com uma amostra intencional de 37 participantes: partes interessadas do governo (n = 4), representantes de organizações não governamentais (n = 3) e um oftalmologista, bem como professores (n = 7), uma enfermeira escolar, pais de alunos (n = 7) e alunos (n = 14) de escolas públicas e particulares. Os dados foram analisados de acordo com temas escolhidos a priori, a partir do marco de disponibilidade, acessibilidade, aceitabilidade e qualidade. Resultados. O exame de visão de rotina não é realizado atualmente nas escolas, nem há espaço orçamentário para fazê-lo. A falta de colaboração entre os Ministérios da Saúde e da Educação e a ausência de planejamento em escala nacional afetaram a prestação de cuidados oftalmológicos nas escolas. Fatores relacionados à aceitabilidade dos programas escolares de saúde ocular incluíram baixa aceitação do treinamento de professores para realizar triagem de problemas visuais, estigma relacionado ao uso de óculos e desconfiança nos serviços de saúde. O custo dos óculos e o acesso limitado a informações sobre saúde ocular foram identificados como barreiras para desfechos positivos de saúde ocular infantil em pais e crianças em situação de desvantagem socioeconômica. Conclusão. Os resultados sugerem a necessidade de um plano nacional de saúde ocular nas escolas e de uma melhor cooperação entre os Ministérios da Saúde e da Educação. Recomendam-se intervenções para aumentar a confiança nos serviços de saúde, combater a falta de recursos humanos (respeitando as qualificações profissionais) e aumentar a conscientização sobre a importância da saúde ocular.

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.

Ação social para detecção e resolução de baixa de acuidade visual em adolescentes / Social action to detect and solve low visual acuity in adolescents

RESUMO Objetivo Verificar a prevalência e as principais causas de baixa acuidade visual encontradas em estudantes; resolver as alterações refracionais por meio de correção óptica e estabelecer uma relação entre visão e desempenho escolar. Métodos Estudo transversal, quantitativo, de ação social realizada em uma escola pública de ensino fundamental e médio de Araçatuba (SP). A avaliação especializada foi indicada aos estudantes que, em triagem visual, apresentaram acuidade visual ≤0,7 em um ou em ambos os olhos, com ou sem correção óptica prévia. Foram entregues óculos a todos que necessitavam, para melhorar visão. Foi realizada análise pela ficha de atendimento e pela nota escolar dos alunos, pelos programas Excel e BioEstat. Resultados Dos 503 alunos triados, 75 (15%) apresentaram baixa de acuidade visual. Compareceram à consulta agendada 66 (88%), e 50 (80,65%) receberam óculos prontos. A média de idade foi de 152 anos, e houve predominância do sexo feminino (64,5%). As alterações refracionais foram a principal causa da baixa visual (90,3%), e miopia, associada ou não a astigmatismo, foi a mais prevalente (63%). Dentre os casos, 13 (21%) tinham anisometropia. Não houve diferença estatisticamente significativa (p=0,5479) entre as médias anuais dos alunos com baixa de acuidade visual e aqueles com visão normal. Conclusão Projetos sociais de triagem visual são facilmente executáveis, têm baixo custo e alta resolutividade, uma vez que os transtornos refracionais são a principal causa e facilmente corrigidos com óculos. A baixa de acuidade visual detectada nos alunos não interferiu no desempenho escolar.

ABSTRACT Objective To verify the prevalence and the main causes of low visual acuity among students, to correct refractive errors with eyewear, and to establish a relation between vision and school performance. Methods This is a cross-sectional, quantitative study of a social action carried out in a public elementary and high school in the city of Araçatuba (SP). Specialized evaluation was indicated to students who presented visual acuity ≤0.7 in one or both eyes, with or without prior optical correction, upon triage. Glasses were delivered to everyone who needed better vision. The analysis was performed based on screening record and student's school grade, using Excel and BioEstat software. Results Out of 503 students screened, 75 (15%) presented low visual acuity. Sixty-six (88%) attended the scheduled visit and 50 (80.65%) received ready-made glasses. The mean age was 15±2 years, and there was a predominance of females (64.5%). Refractive errors were the main cause of visual impairment (90.3%) and myopia, associated or not to astigmatism, was the most prevalent condition (63%). Thirteen (21%) students had anisometropia. There was no statistically significant difference (p=0.5479) in annual average grade of students with low visual acuity and those with normal vision. Conclusion Social projects for visual triage are carried out without effort, have a low cost and high problem-solving capacity, since refractive errors are the most frequent diagnoses and easily corrected with glasses. The low visual acuity detected in students did not interfere in their school performance.

Anterior chamber depth and axial length affect clinical performance of Spot Vision Screener / A profundidade da câmara anterior e o comprimento axial afetam o desempenho clínico do Spot Vision Screener

ABSTRACT Purpose: The aim of this study was to evaluate the effect of anterior chamber depth and axial length on clinical performance of the Spot Vision Screener in detecting amblyopia risk factors in children aged 3-10 years. Methods: A total of 300 eyes from 150 patients aged 3-10 years were prospectively tested with Spot Vision Screener (firmware version 3.0.02.32, software version 3.0.04.06) and a standard autorefractometer (Nidek ARK-1). The anterior chamber depth and axial length were measured with an optical biometer (Nidek AL-Scan). The sensitivity and specificity values for detecting significant refractive errors using the referral criteria of the American Association for Pediatric Ophthalmology and Strabismus were determined. Pearson's correlation analysis was employed to evaluate the relationship between the Spot Vision results and the anterior chamber depth and axial length. Results: Compared with the standard autorefractometer results, the Spot Vision Screener's sensitivity and specificity was 59% and 94%, respectively. The differences between the cycloplegic autorefractometer and the Spot Vision Screener spherical equivalents were negatively correlated with anterior chamber depth (r=-0.48; p<0.001) and axial length (r=-0.45; p<0.001). Conclusion: The Spot Vision Screener has moderate sensitivity and high specificity, using the criteria of the American Association for Pediatric Ophthalmology and Strabismus. The anterior chamber depth and axial length affect the Spot Vision results.

RESUMO Objetivo: O objetivo deste estudo foi avaliar o efeito da profundidade da câmara anterior e do comprimento axial sobre o desempenho clínico do Spot Vision Screener, na deteção de fatores de risco para a ambliopia em crianças de 3 a 10 anos de idade. Métodos: Um total de 300 olhos de 150 pacientes de 3-10 anos de idade foram prospectivamente testados com o Spot Vision Screener (firmware: 3.0.02.32, software: 3.0.04.06) e com autorefratómetro padrão (Nidek ARK-1). Todas as medições de profundidade e comprimento axial da câmara anterior dos pacientes foram realizadas através de Nidek AL Scan. A sensibilidade e especificidade para a deteção de erros refrativos significativos foram determinadas de acordo com os critérios de referência da Associação Americana de Oftalmologia e Estrabismo Pediátricos. A análise da Correlação de Pearson foi utilizada para avaliar a correlação entre os resultados do Spot Vision e a profundidade ou comprimento axial da câmara anterior dos pacientes. Resultados: Em comparação com os resultados do autorefratómetro padrão, a sensibilidade do Spot foi de 59% e a especificidade de 94%. As diferenças entre os equivalentes esféricos do autorefratómetro cicloplégico e o Spot Vision Screener foram correlacionados negativamente com a profundidade (r=-0,48; p<0,001) e o comprimento axial (r=-0,45; p<0,001) da câmara anterior dos casos. Conclusão: O Spot Vision Screener possui uma sensibilidade moderada e uma especificidade elevada utilizando os critérios da Associação Americana de Oftalmologia Pediátrica e Estrabismo; a profundidade da câmara anterior e o comprimento axial dos pacientes afetam os resultados do Spot Vision.

Anterior chamber depth and axial length affect clinical performance of Spot Vision Screener.

PURPOSE: The aim of this study was to evaluate the effect of anterior chamber depth and axial length on clinical performance of the Spot Vision Screener in detecting amblyopia risk factors in children aged 3-10 years. METHODS: A total of 300 eyes from 150 patients aged 3-10 years were prospectively tested with Spot Vision Screener (firmware version 3.0.02.32, software version 3.0.04.06) and a standard autorefractometer (Nidek ARK-1). The anterior chamber depth and axial length were measured with an optical biometer (Nidek AL-Scan). The sensitivity and specificity values for detecting significant refractive errors using the referral criteria of the American Association for Pediatric Ophthalmology and Strabismus were determined. Pearson's correlation analysis was employed to evaluate the relationship between the Spot Vision results and the anterior chamber depth and axial length. RESULTS: Compared with the standard autorefractometer results, the Spot Vision Screener's sensitivity and specificity was 59% and 94%, respectively. The differences between the cycloplegic autorefractometer and the Spot Vision Screener spherical equivalents were negatively correlated with anterior chamber depth (r=-0.48; p<0.001) and axial length (r=-0.45; p<0.001). CONCLUSION: The Spot Vision Screener has moderate sensitivity and high specificity, using the criteria of the American Association for Pediatric Ophthalmology and Strabismus. The anterior chamber depth and axial length affect the Spot Vision results.

Prevalência de fatores predisponentes de baixa visual em uma população de jovens do Colégio Universitário Geraldo Reis em Niterói - RJ / Prevalence of predisposing factors of low visual acuity in a youth population of the Geraldo Reis University College in Niterói - RJ

Resumo Objetivo: Determinar a prevalência de fatores predisponentes de baixa acuidade visual entre os alunos do Colégio Universitário Geraldo Reis em Niterói-RJ. Métodos: Trata-se de um estudo observacional transversal realizados em duas etapas. A primeira realizou-se a medida da acuidade visual dos alunos voluntários que aderiram ao termo de assentimento. Na segunda etapa foram selecionados aqueles alunos cuja acuidade visual não ultrapassaram 0,8 em pelo menos um dos olhos ou que apresentaram diferença de acuidade visual entre os olhos de duas linhas ou mais na tabela de Snellen, sendo encaminhados para avaliação oftalmológica completa no Serviço de Oftalmologia do Hospital Universitário Antônio Pedro / Universidade Federal Fluminense. Resultados: Do total de 325 alunos matriculados, 134 (41,2%) participaram da primeira etapa do estudo e, destes, apenas 39 (29%) apresentaram baixa visão. Dos 39 alunos selecionados para a segunda etapa do estudo, apenas 14 (36%) se voluntariaram a prosseguir para avaliação oftalmológica completa, tendo as ametropias (57,14%), a ambliopia (21,42%) e o estrabismo (14,28%) como as principais causas de baixa visual identificadas. Conclusão: A prevalência de baixa visão(low vision=baixa visão tem definição, não se chama baixa visual) para essa comunidade foi de 29% e as principais causas identificadas foram as ametropias, as ambliopias e o estrabismo. Campanhas de conscientização e os problemas de adesão aos programas de triagem devem ser considerados em novos estudos.

Abstract Purpose: To determine the prevalence of predisposing factors of low visual acuity among the students of the Geraldo Reis University College in Niterói-RJ. Methods: This was a cross-sectional observational study during which the visual acuity of the volunteer students who adhered to the assent term was measured. Those students whose visual acuity did not exceed 0.8 in at least one eye or who presented a difference between the eyes of two lines or more in the Snellen table were selected for the next stage of the study and were referred for complete ophthalmologic evaluation in the Service of Ophthalmology of the Antônio Pedro University Hospital / Fluminense Federal University. Results: Of the total of 325 students enrolled, 134 (41.2%) participated in the first stage of the study and of these, only 39 (29%) presented visual impairment. Of the 39 students selected for the second phase of the study, only 14 (36%) volunteered to proceed for a complete ophthalmologic evaluation, with ametropias (57.14%), amblyopia (21.42%) and strabismus (14, 28%) as the main causes of visual impairment identified. Conclusion: The prevalence of visual impairment for this community was 29% and the main causes identified were ametropias, amblyopia and strabismus. Awareness campaigns and problems of adherence to screening programs should be considered in new studies.

Uso de retinógrafo portátil como ferramenta no rastreamento de retinopatia diabética / Use of a handheld fundus camera as a screening tool for diabetic retinopathy

Resumo Objetivo: Determinar a concordância do retinógrafo portátil Pictor Plus, na ausência de midríase, com a retinografia digital e avaliar a sua acurácia como método de rastreio da retinopatia diabética (RD). Métodos: Estudo transversal, mascarado para o observador, avaliando 100 olhos de 51 pacientes diabéticos. Foram realizadas retinografias com o Pictor Plus com e sem midríase, seguidos de retinografia convencional com o retinógrafo IMAGEnet por técnico treinado. As imagens obtidas foram analisadas por oftalmologista especialista em retina e classificadas normais, presença de edema macular diabético, retinopatia não proliferativa (inicial, moderada e grave) e retinopatia proliferativa, além de análise inviável. A concordância entre os resultados foi avaliada via coeficiente Kappa. As imagens foram agrupadas em normais e alteradas e estas em RD de alto risco e RD de baixo risco. Avaliou-se ainda a sensibilidade, especificidade, valores preditivos positivos e negativos, em relação à retinografia convencional. Resultados: Oitenta e nove por cento das imagens foram consideradas viáveis para classificação. Pouco mais de 31% dos olhos avaliados foram considerados como normais pelas três tecnologias. O exame com Pictor na ausência de midríase apresentou altos índices de sensibilidade e especificidade para a classificação normal (92,9% e 93,4%) e RD de alto risco (82,9% e 97,9%) e bons resultados para RD de baixo risco (75,0% e 87,0%). Conclusão: O Pictor Plus apresentou altos níveis de concordância com a retinografia digital ao discriminar exames normais de alterados e portadores de RD de baixo e alto risco. Foram verificadas ainda altas sensibilidade e especificidade desta ferramenta, se comparados à retinografia padrão.

Abstract Purpose: Determine the effectiveness of the use a portable handheld fundus camera as a screening method for diabetic retinopathy, compared to regular digital retinography. Methods: This is a cross-sectional, observer-masked study, evaluating 100 eyes of 51 diabetic patients undergoing a routine dilated retinography for diabetic retinopathy. Fundus images pre and post-dilation we captured by Pictor Plus (Volk Optical Inc., Mentor, USA), followed by routine digital retinography by IMAGEnet (Topcon Medical Systems, New Jersey, USA). All exams were performed by a trained technician on the same occasion. The images were analyzed and graded by a masked retina specialist and classified as normal, presence of diabetic macular edema, nonproliferative diabetic retinopathy (initial, moderate and severe) and proliferative diabetic retinopathy. The ungradable images were recorded and excluded from analyses. The agreement between results obtained by the three methods was evaluated via Kappa coefficient. Sensitivity, specificity, positive and negative predictive values in relation to IMAGEnet images were also determined. Results: Images were gradable in 89% of pre-dilation photos. Pictor Plus pre-dilation images had high sensitivity and specificity in identifying normal eyes (92.9% and 93.4%) and in vision-threatening DR (82.9% and 97.9%) both when compared to IMAGEnet results. Conclusion: Pictor can capture retinal images of sufficient quality to screen for DR with and without dilation. Single retinal images obtained using Pictor can identify eyes with vision-threatening DR with high sensitivity and specificity compared to routine IMAGEnet images.

Triagem de acuidade visual reduzida em uma unidade de Atenção Primária à Saúde / Reduced visual acuity screening in a Primary Care Unit

Resumo Objetivo: Determinar a frequência de acuidade visual reduzida em crianças e adolescentes que frequentam o programa de puericultura de uma unidade de atenção primária à saúde. Métodos: Estudo transversal com 290 crianças e adolescentes na faixa etária dos 5 aos 18 anos, atendidos em uma unidade básica de saúde da cidade de Ribeirão Preto (SP) durante o primeiro semestre de 2018. Para as avaliações foram utilizados um questionário estruturado e a tabela de acuidade visual de Snellen. Resultados: Foram avaliados 290 indivíduos, sendo 53,2% do sexo feminino. Desse total, 66 (22,7%) foram encaminhados para consulta com oftalmologista, sendo 34 (51,5%) do sexo masculino e 32 (48,5%) do sexo feminino. Foram confirmados 31 casos de erros refracionais: astigmatismo (35,5%), astigmatismo associado (25,8%), hipermetropia (29%) e miopia (9,6%). 24 (77,4%) dos pacientes com acuidade visual reduzida receberam prescrição para uso de lentes corretivas. Conclusões: A prevalência de baixa acuidade visual na amostra estudada foi de 10,7%, com predomínio de astigmatismo, e sem diferença estatisticamente significativa entre os sexos. Destaque-se a importância de se realizarem avaliações completas nos programas de Atenção Básica à Saúde, principalmente a triagem oftalmológica como uma das ferramentas mais importantes para a prevenção da cegueira.

Abstract Objective: to determine the frequency of reduced visual acuity in children and adolescents attending the child care program of a primary health care unit. Methods: A cross-sectional study was carried out with 290 children and adolescents aged 5 to 18 years attending a primary health unit in the city of Ribeirão Preto (SP) during the first half of 2018. A structured questionnaire Snellen's visual acuity table. Results: 290 subjects were evaluated, 53.2% female. Of these, 66 (22.7%) were referred to ophthalmologists, 34 (51.5%) were male and 32 (48.5%) were female. We confirmed 31 cases of refractive errors: astigmatism (35.5%), associated astigmatism (25.8%), hypermetropia (29%) and myopia (9.6%). 24 (77.4%) of patients with reduced visual acuity received prescription for corrective lenses. Conclusions: the prevalence of low visual acuity in the studied sample was 10.7%, with a predominance of astigmatism, and with no statistically significant difference between the sexes. It is important to emphasize the importance of performing comprehensive evaluations in the Primary Health Care programs, especially ophthalmologic screening as one of the most important tools for blindness prevention.

Evaluation of the color vision acuity pattern of undergraduates of health courses in a Brazilian university / Avaliação do padrão de acuidade visual para cores de acadêmicos da área de saúde em Universidade brasileira

ABSTRACT Objective: The goal of the study is to analyze the color vision acuity pattern in undergraduates of health courses and to discuss the impact of these diseases in this population. Color deficiencies interfere significantly in the daily routine of professionals in the health area who need to discern different color hues in several situations of their everyday practice. Methods: Sixty-four volunteers, undergraduates of health courses of the Federal University of Alfenas (UNIFAL-MG), participated in the study. One man was excluded because he did not fit the inclusion criteria. Two groups were analyzed according to sex with the Farnsworth Munsell 100-Hue test. Results: There were no significant differences between the eyes and between the groups analyzed. The color vision acuity pattern is between 35 and 40, according to the Total Error Score. The gender issue does not influence the general pattern of the color vision acuity of the health courses undergraduates when those with color vision disorders are removed. Conclusion: Screenings and guidance should be given to undergraduates of health courses so that, aware of their condition of presenting some type of color disorder, they shall make the appropriate decision on which career to follow so that such limitation does not interfere with the quality of their daily life.

RESUMO Objetivo: O objetivo do estudo é analisar a acuidade visual média para cores de estudantes da área de saúde e discutir o impacto das doenças que a afetam nessa população. Deficiências cromáticas interferem de forma significativa no dia a dia de profissionais da área da saúde que necessitam de discernir diferentes matizes em diversas situações de sua prática profissional. Métodos: Participaram da pesquisa 64 voluntários, estudantes de cursos da área de saúde da Universidade Federal de Alfenas, sendo que 1 homem foi excluído por não se adequar aos critérios de inclusão. Dois grupos foram analisados, de acordo com o sexo, com o teste de Farnsworth Munsell 100-Hue. Resultados: Não houve diferenças significativas entre os olhos e entre os grupos analisados. O padrão de visão de cores encontra-se entre 35 e 40, de acordo com a Pontuação do Erro Total. A questão de gênero não influencia no padrão geral da qualidade de visão de cores de estudantes da área de saúde, quando retirados aqueles que apresentam distúrbios da visão cromática. Conclusão: Devem ser realizadas triagens e orientação para estudantes de cursos da área de saúde para que, cientes da sua condição de apresentar algum tipo de distúrbio cromático, possam tomar a decisão adequada sobre qual carreira seguir para que tal limitação não interfira na qualidade de sua vida diária.

Visual Acuity Assessment and Vision Screening Using a Novel Smartphone Application.

OBJECTIVES: To evaluate a smartphone-based application's (Peek Acuity) ability to assess visual acuity and screen for ocular conditions in children, we compared visual acuity assessment between Peek Acuity and the pediatric ophthalmology examination and evaluated Peek Acuity's ability to identify children with referable ocular conditions. STUDY DESIGN: We prospectively recruited 111 children age 3-17 years, presenting to a pediatric ophthalmology clinic, who could follow instructions. Monocular visual acuity assessments by Peek Acuity and standard clinical methods were performed in randomized order. We compared visual acuity assessments between methods using intraclass correlation coefficient (ICC) and evaluated Peek Acuity's ability to identify children with referable ocular conditions. RESULTS: ICC comparing visual acuity assessed between methods was 0.88 (95% CI 0.83-0.92) for first and 0.85 (95% CI 0.78-0.89) for second eyes examined. ICC among 3 to 5-year-olds (preschool-age children) was 0.88 (95% CI 0.77-0.94) for first and 0.45 (95% CI 0.13-0.68) for second eyes examined. Peek Acuity had a sensitivity of 83%-86% for decreased vision and 69%-83% for referable ocular disease. Sensitivity was highest among 3 to 5-year-olds with decreased vision, 93%-100%. CONCLUSIONS: Overall, Peek Acuity visual acuity assessment correlated well with visual acuity assessed by standard clinical methods, though preschool-age children appeared more susceptible to examination fatigue. Peek Acuity performed adequately as a screening tool and had the greatest sensitivity among those with decreased vision and preschool-age children. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03212222.

Avaliação e triagem da acuidade visual em escolares da primeira infância / Evaluation and screening of visual acuity in early childhood schoolchildren

Resumo Objetivo: Identificar a prevalência de alterações visuais em crianças de cinco anos em escolas públicas de Curitiba-PR. Métodos: As escolas foram selecionadas aleatoriamente dentro do município de Curitiba. As crianças com cinco anos completos em 2017 foram avaliadas com a tabela de Snellen, através de distância mínima correta para nitidez de imagem e teste de Hirschberg. Os pais responderam um questionário sobre uso de telas, sintomas oculares e histórico familiar da criança. Os resultados das avaliações foram analisados estatisticamente considerando nível de significância p≤0,05. Resultados: Em uma população de 459 crianças triadas, 219 (47,7%) pertenciam ao sexo feminino e 240 (52,3%) masculino, sendo que do total, 100 foram encaminhadas para avaliação oftalmológica especializada. A partir da triagem observou-se a prevalência de miopia de 10,7%, hipermetropia de 17,6% e estrabismo de 0,9%. Houve relação entre genitores com miopia e filhos míopes (p<0,05). Dentre as queixas oftalmológicas predominaram cefaleia (30,4%) e franzir de testa (10%). Conclusão: A prevalência de alterações visuais encontrada foi de 21,8%. A relação entre distúrbios visuais e o histórico familiar se mostrou estatisticamente significativa. Entretanto, apenas o tempo médio em frente à televisão apresentou influência, dentre os hábitos de vida, sobre as alterações da AV (p=0,028). Queixas oftalmológicas apesar de frequentes, não apresentaram correlação expressiva com a diminuição da acuidade visual.

Abstract Objective: To identify the incidence of visual impairment in 5-year-old children in public schools from Curitiba-PR. Methods: A selection of schools has been choosen randomly from Curitiba. The children, with completed 5 years at end of 2017 have been evaluated using Snellen table, trough minimum distance for image sharpness and Hirschberg test. Parents answered a questionnaire about the use of screens, ocular symptoms and family history of the child. Significance levels were defines as begin p≤0,05. Results: The results have shown that four hundred fifty-nine children were screened. Two hundred nineteen are female (47,7%) and two hundred fourty (52,3%), male. From all screened patients, one hundred were refered to specialized oftalmic evaluation. After trial completing, has been attained a prevalence value of 10,7% for myopia, 17,6% of hyperopia and 0,9% of strabismus. Strong correlation between parents and children has been undiscovered (p<0,05). From listed oftalmic complaints, headache (30,4%) and frown (10%) where most prevalent. Conclusion: It has been attained that the prevalence of visual acuity is 21,8%. The relation between visual acuity alteration and familiar history has been shown to be significant related. On the other side, the average time in front of television has been shown the only habit that has correlation with visual acuity reduction (p=0,028). Vision complaints, although very frequent, doesn't translate into increased probability of visual acuity alteration.

Visual Impairment and Eye Disease Among Children of Migrant Farmworkers.

PURPOSE: To determine the prevalence of reduced visual acuity and ocular disease in the children of migrant farmworkers in Georgia. METHODS: A retrospective chart review of data acquired by a vision screening was performed on 156 Haitian and Hispanic children of migrant farmworkers attending a summer school in Georgia. Reduced visual acuity at presentation was analyzed and stratified by ethnicity, type of ocular disease, and immediate resolution with refractive correction. RESULTS: The authors found that 20% of migrant farmworker children have a high prevalence of reduced visual acuity in the worse eye. Of those with worse-eye reduced visual acuity, 83% had uncorrected refractive error. The prevalence of uncorrected refractive error from astigmatism and high astigmatism was significantly higher among Hispanics than Haitians. The prevalence of amblyopia suspects among migrant farmworker children was 3%. Of the amblyopia suspects, 80% were anisometropic. CONCLUSIONS: Children of migrant farmworkers in Georgia have a higher rate of reduced visual acuity, largely from uncorrected refractive error, when compared to other Hispanic and African American children in the United States with a prevalence more aligned to children in Asian and Latin American countries than school children in the United States. This illustrates the need for improved access to screening and care in this vulnerable population. [J Pediatr Ophthalmol Strabismus. 2019;56(1):28-34.].

Triagem oftalmológica em 510 alunos de escolas públicas: desenvolvimento de um projeto social de grande abrangência / Ophthalmologic screening in 510 students of public schools: development of a comprehensive social project

Resumo Objetivo: Avaliar a prevalência de crianças com dificuldade visual em triagens realizadas em 3 escolas públicas de Aracaju-SE, estimar a distribuição dos erros refrativos e usar os dados para planejamento de uma ação social mais extensa em todas as escolas públicas da cidade. Métodos: Estudo transversal, com medida da acuidade visual (AV), na forma de triagem. Foram analisados idade, gênero, AV, frequência dos principais erros refrativos, médias de equivalente esférico e cilindro das crianças com AV pior ou igual a 0,7 em qualquer olho, diferença superior a 0,2 entre os olhos, sinais de doenças oculares ou se já fizessem uso de óculos. Resultados: Foram avaliadas 510 crianças nas 3 escolas. A idade média foi 9,1 ± 1,6 anos. Gênero masculino correspondeu a 50,4%. Das 154 crianças (30%) que necessitaram de consulta mais detalhada, 97 se dirigiram à consulta. Destas, 51 tiveram indicação de uso de óculos. Míopes corresponderam a 44,1% dos olhos, hipermetropia a 15,6% e astigmatismo a 82,3%. A idade média das crianças com indicação de uso de óculos foi 9,5 ± 1,7 anos. Considerando-se que há em torno de 15 mil crianças entre o 1º e o 3º anos do ensino fundamental matriculadas nas escolas públicas de Aracaju, pode-se estimar que aproximadamente 30% delas necessitarão de consulta oftalmológica, correspondendo a 4500 atendimentos (2000 a 2500 destas deverão precisar de óculos). Conclusão: Conclui-se que aproximadamente um terço das crianças em idade escolar neste estudo apresentou dificuldade visual durante a triagem. Após avaliação oftalmológica, foram prescritos óculos para pouco mais da metade. Astigmatismo foi o erro de refração mais prevalente. Os dados obtidos foram utilizados para o planejamento de importante ação social a ser desenvolvida pela Sociedade Sergipana de Oftalmologia.

Abstract Purpose: To evaluate the prevalence of visually impaired children at screening in three public schools in Aracaju-SE, to estimate the distribution of refractive errors and to use the data to develop a more comprehensive social project in all public schools of town. Methods: Cross-sectional study with visual acuity (VA) measurement at screening. Age, gender, VA, frequency of the main refractive errors, spherical equivalent and cylinder of those children with VA lower than or equal to 0.7 in any eye, difference greater than 0.2 between the eyes, signs of eye diseases or if they already wore glasses. Results: A total of 510 children were evaluated in 3 schools. Mean age was 9.1 ± 1.6 years. Males were 50.4%. Of the 154 children (30%) who required a more detailed examination, 97 went to the office. Of these, 51 had a prescription of glasses. Myopes accounted for 44.1% of the eyes, hypermetropia to 15.6% and astigmatism to 82.3%. Mean age of children with glasses was 9.5 ± 1.7 years. Considering that there are 15 thousand children between the 1st and 3rd years of elementary school, it can be estimated that approximately 30% will require ophthalmological consultation, corresponding to 4500 consultations (2000 to 2500 of these should need glasses). Conclusion: We conclude that approximately one-third of school-age children in this study had visual impairment during screening. After ophthalmological evaluation, glasses were prescribed for just over half. Astigmatism was the most prevalent refractive error in the 3 schools of the study. The data obtained were used for the planning of important social project to be developed by Sergipe's Society of Ophthalmology.