Ophthalmic manifestations in children with Down Syndrome in Bogotá, Colombia.

BACKGROUND: To describe the ocular features of a cohort of children with Down Syndrome (DS) in Bogotá, Colombia. METHODS: We performed a cross-sectional study, evaluating 67 children with DS. A pediatric ophthalmologist performed a complete optometric and ophthalmological evaluation of each child, including visual acuity, ocular alignment, external eye examination, biomicroscopy, auto-refractometry, retinoscope in cycloplegia, and fundus examination. Results were reported as frequency distribution tables with percentages for categorical variables and means and standard deviation or median and interquartile ranges for continuous variables, according to their distribution. We used the Chi-square test or Fisher's exact test for categorical variables and ANOVA or Kruskal-Wallis for continuous variables when indicated. RESULTS: A total of 134 eyes from 67 children were evaluated. Males represented 50.7%. The children's age ranged from 8-16 years, with a mean of 12.3 (SD 2.30). The most frequent refractive diagnosis per eye was hyperopia (47%), followed by myopia (32.1%) and mixed astigmatism (18.7%). The most frequent ocular manifestations were oblique fissure (89.6%), followed by amblyopia (54.5%) and lens opacity (39.4%). Female sex was associated with strabismus (P = 0.009) and amblyopia (P = 0.048). CONCLUSION: Our cohort had a high prevalence of disregarded ophthalmological manifestations. Some of these manifestations, such as amblyopia, can be irreversible and severely affect the neurodevelopment of DS children. Therefore, ophthalmologists and optometrists should be aware of the visual and ocular affection of children with DS to assess and provide appropriate management. This awareness could improve rehabilitation outcomes for these children.

Preverbal visual photo screening Project implementation in Portugal / Implementação de projeto de foto rastreio visual pré-verbal em Portugal

Abstract Purpose: To present the design and implementation of an amblyopia risk factors screening project, in a large based Portuguese population. Methods: Two referral centers have been enrolled to assess all children aged 2 under their direct referral area. The photoscreener used was PlusOptix ® A09. At this age, the cut-off defined for referral was: ≥1 Diopter (D) of anisometropia, ≥1.5D of astigmatism, ≥2D of myopia and ≥1.5D of hyperopia. The results were reported to a reading platform that allowed the ophthalmologist to see all exams, and provide timely appointment with a complete ophthalmologic assessment for those who needed. Results: A total of 2867 photo screens were made to the population eligible to both referral centers, which comprises a coverage rate of 55%. Out of 2611 children under one of the referral area, 53% (n=1395) adhered to the screening. Within these children, 17.5% (n=245) were referred and 15.3 % (n=214) appointments were performed. The comparison of refraction between PlusOptix ® and cycloplegic refraction showed a strong correlation regarding the sphere and cylinder values. From the 214 children observed in consultation, glasses were prescribed in 25.7% (n=55), corresponding to 3.9% of all screened children under one of the referral area. This screening method showed a positive predictive value of 58.4%. Conclusion: This screening program may be highly relevant to eradicate untreated amblyopia from our population. The results may lead to the implementation of this project to the whole country.

Resumo Objetivo: Apresentação da implementação de um projeto de rastreio de fatores de risco de ambliopia, numa população alargada portuguesa. Métodos: dois centros de referência foram selecionados para avaliar todas as crianças de 2 anos, na sua área de referenciação direta. Para o foto rastreio foi utilizado o PlusOptix ® A09. Nesta idade, os valores definidos para referenciação foram: ≥1 Dioptria (D) de anosimetropia, ≥1.5 D de astigmatismo, ≥2 D de miopia e ≥1.5 D de hipermetropia. Os resultados foram reportados a uma plataforma de leitura que permitiu ao oftalmologista ver todos os exames e providenciar uma consulta oportuna com uma avaliação oftalmológica completa para aqueles que precisavam. Resultados: Foram realizados 2867 foto rastreios na população elegível para ambos os centros de referência, perfazendo uma taxa de cobertura de 55%. Das 2611 crianças sob uma área de referência, 53% (n = 1395) aderiram ao rastreio. Dentro desse grupo, 17,5% (n = 245) foram referenciadas e 15,3% (n = 214) consultas foram realizadas. Verificou-se uma forte correlação entre a refração do PlusOptix® e a refração cicloplégica. Das 214 crianças observadas em consulta, foram prescritos óculos em 25,7% (n = 55), correspondendo a 3,9% de todas as crianças sob uma área de referência. Este método de triagem mostrou um valor preditivo positivo de 58,4%. Conclusão: Este programa de rastreio pode ser altamente relevante para erradicar a ambliopia não tratada na nossa população. Os resultados podem levar à implementação deste projeto em todo o país.

Associação entre hiperopia e outros erros refrativos e visuais em crianças / Associations between hyperopia and others refractive and visual errors in children

RESUMO Objetivo: Investigar a associação da hipermetropia com ambliopia, estrabismo, anisometropia e astigmatismo. Métodos: A hiperopia foi classificada em Grupo 1: maior ou igual a +5.00D; Grupo 2: maior que +3.25D e menor que +5.00D, com diferença de equivalente esférico maior ou igual a 0.50D; Grupo 3: maior que +3.25D e menor que +5.00D, com diferença de equivalente esférico menor que 0.50D e Grupo 4: com equivalente esférico maior e igual a +2.00D. O Grupo controle pertencente ao equivalente esférico menor que +2.00D. Resultados: A presença de hipermetropia maior e igual a SE+2.00D foi significativamente associada à maior proporção de crianças com ambliopia (27,2 vs. 14,8%, OR = 2,150, p<0,001) e estrabismo (70,8 vs. 39,3%, OR = 3,758, p<0,0001. A presença de hipermetropia também foi significativamente associada à maior proporção de anisometropia nos grupos com hipermetropia maior e igual a SE+2.00 (29,1 vs. 9,9%, OR = 3,708, p<0,0001) e astigmatismo (24 vs. 9,9%, OR = 2,859 p<0,0001). Conclusão: A presença e magnitude da hipermetropia entre crianças foram associadas à maior proporção de erros refrativos e visuais, como estrabismo, ambliopia, astigmatismo e anisometropia.

RESUMO Objective: Evaluate ocular trauma cases related to falling in elderly patients e compare the prevalence and severity of the cases. Methods: A series of cases was made with 52 patients aging 60 or more within the period of 36 months presenting ocular trauma related to falling, whereas the prevalence between the gender, the need for hospitalization or surgery and subsequent visual deficit were evaluated, as well as the severity of the cases. Results: Thirty-three (63.5%) of 52 patients were from the female gender, over which 30.3% had need for surgery and 18.2% developed visual deficit and 19 (36.5%) were from the male gender where 42.1% needed surgery and 26.3% developed visual deficit. Conclusions: The study has shown a higher prevalence of cases in the female gender, although the severity was higher in the male gender.

Evaluation of the Spot Vision Screener in young children in Costa Rica.

BACKGROUND: The Spot Vision Screener has demonstrated good sensitivity and specificity in the pediatric ophthalmology clinic setting. We sought to evaluate the updated Spot (version 2.0.16) in a general pediatric population through a collaboration of the Storm Eye Institute of the Medical University of South Carolina, the Clinica Dr Clorito Picado, and National Children's Hospital of Costa Rica. We compared results of screening with the Spot and pediatric ophthalmologic examination and determined sensitivity and specificity of the Spot in detecting amblyogenic risk factors (ARFs) according to the 2013 AAPOS Vision Screening Committee guidelines for automated vision screeners. METHODS: Children were screened with the Spot followed by a pediatric ophthalmologic examination. Cycloplegic refraction and motility findings were analyzed by age group to determine ARFs. RESULTS: A total of 219 subjects, averaging 60 months of age (range, 20-119 mo) were included. The prevalence of ARFs in our population was 12.3% (27/219). The most common risk factor was astigmatism, with a prevalence of 8.7% (19/219). The Spot referred 43 children (19.6%). Sensitivity of the Spot was 92.6%; specificity, 90.6%. The positive predictive value was 58.1%; the negative predictive value, 98.9%. CONCLUSIONS: The Spot demonstrated good sensitivity and specificity in detecting amblyopia risk factors in this general pediatric population.

Congenital eyelid ptosis: onset and prevalence of amblyopia, associations with systemic disorders, and treatment outcomes.

OBJECTIVES: To determine the age at onset of amblyopia, the response to occlusion therapy, and the association with systemic disorders in children with congenital eyelid ptosis. STUDY DESIGN: Retrospective chart review of children seen at Seattle Children's Hospital with moderate or severe congenital ptosis. Assessments were longitudinal visual acuity development using objective methods, definition of ptosis severity by eyelid margin to pupillary light reflex distance (margin reflex distance [MRD]), age at amblyopia diagnosis, correlation between amblyopia and MRD, and associated systemic disorders. RESULTS: Eighty-four children with moderate-to-severe congenital ptosis met inclusion criteria; the mean longitudinal follow-up was 49.1 months. Fifteen (18%) of these children had amblyopia, of which 9 had deprivation amblyopia (mean age 17.3 months ± 11.2) and 6 had anisometropic or strabismic amblyopia (mean age 60 months ± 11.8). Eleven (73%) of the children with amblyopia were successfully treated with occlusion therapy. Amblyopia was not correlated with MRD. A systemic disorder was identified in 29 (35%) of the children, the most common being genetic, chromosomal, or neurologic conditions. Patients with systemic disorders and developmental delay have significantly lower visual acuity bilaterally compared with patients without systemic disorders (P ≤ .003). CONCLUSIONS: Using longitudinal and objective visual acuity assessments, the incidence of amblyopia was 18% in children with moderate to severe congenital ptosis. Visual deprivation was the predominant risk factor that was reliably distinguished by its earlier onset in young children. The best indicator of amblyopia in children is visual acuity rather than MRD measurements. Systemic disorders are frequent in children with moderate to severe congenital ptosis.

Análisis colorimétrico computarizado del color de la piel palpebral: un potencial método No Invasivo para monitorizar el cumplimiento de la terapia con parche en ambliopía / Computerized colorimetric analysis of skin palpebral color. A potential non invasive method for monitoring patch Compliance in the Treatment of amblyopia

Objetivo: evaluar el análisis colorimétrico computarizado del color de la piel del párpado antes y después de realizar oclusión, con el fin de determinar qué cambios en el color de la piel permiten conocer el cumplimiento de la terapia oclusiva en el tratamiento de la ambliopía. Métodos: se analizó el cambio de coloración de la piel tomando fotografías estandarizadas, antes y después de 48 horas de aplicación del parche. Los análisis se hicieron con el programa PS CS2 de Adobe Systems que proporciona discriminación de los colores primarios en una imagen determinada y permite analizar y comparar numéricamente las intensidades. Resultados: el promedio basal de intensidades fue de 52.50 con un rango entre 42.11 y 72.87. La desviación estándar fue de 37.34. El promedio después de 48 horas oclusión fue de 102.33 con un rango de entre 96.32 y 109.28 y una desviación estándar de 62.49. (P≤0.05). Al comparar el cambio de la piel ocluida en los párpados con la piel de la mejilla, expuesta a la luz pero no ocluida, se demostraron cambios igualmente significativos. Conclusiones: el análisis colorimétrico computarizado no invasivo de los cambios en la coloración de la piel de los pacientes en tratamiento con ambliopía puede convertirse en un método estándar para monitorizar el cumplimiento de la terapia con oclusión. Los resultados del presente trabajo son claros en evidenciar que tan rápidamente se inducen cambios colorimétricos en la piel, incluso antes de que éstos sean detectables a simple vista. Saber qué tan disciplinado ha sido el tratamiento da la posibilidad de conocer exactamente en qué situación está el paciente y estimulará a padres y pacientes para cumplir la terapia.

Objective: to evaluate the colorimetric computerized analysis of palpebral skin color before and after occluding the eye, in order to determine what changes in skin color allow to understand the compliance with patching treatment while treating amblyopia. Methods: skin color change was analyzed taking standardized pictures before and after 48 hours occlusion. Analysis was done with the program PS CS2 from Adobe Systems that gives color discrimination from an image and allows numerical comparison between intensities. Results: palpebral skin mean basal intensity was 52.50 (between 42-11 and 72-87). SD was 37.34. Average after 48 hours occlusion was 102.33 (96.32 to 109.28) and SD of 62.49 (P≤0.05). When comparing occluded skin color with cheek color, exposed to light but not occluded, there were also significant changes. Conclusions: Noninvasive colorimetric computerized analysis from changes in skin color in amblyopic patients treated with patching, could become a standard method for monitoring compliance with occlusion therapy. Results of this experiment are clear and evidence that changes in skin color occur quickly after starting the patch, even before they are visible to the bare eye. Knowing how disciplined has been the patient with his treatment gives the opportunity of knowing the exact situation of the patient and will stimulate parents and patients to improve patch compliance.

Características clínicas y epidemiológicas de ambliopía en pacientes atendidos en el Servicio de Oftalmología del Hospital Nacional Arzobispo Loayza en el periodo Enero - Setiembre 2010 / Clinical and epidemiological characteristics of amblyopia in patients treated in the Service of Ophthalmology at the National Hospital Arzobispo Loayza in the period January-September 2010

La investigación tiene como objetivo determinar las características clínicas y epidemiológicas de Ambliopía en pacientes atendidos en el Servicio de Oftalmología del Hospital Nacional Arzobispo Loayza. El Estudio es retrospectivo, observacional, de corte transversal, la muestra estará conformada por 56 pacientes que ingresaron al Servicio de Oftalmología del Hospital Nacional Arzobispo Loayza que fueron diagnosticados clínicamente de Ambliopía en el periodo de enero a setiembre 2010. De los resultados tenemos que la Ambliopía en varones se presentaron 16 casos (28.6 por ciento) y en mujeres 40 casos (71.4 por ciento). Del total de pacientes varones con Ambliopía el 28,6 por ciento presentaron Hallazgos normales de Párpados, vías lagrimales y conjuntivas; el 28.6 por ciento presentaron motilidad ocular conservada y del total de pacientes mujeres con Ambliopía el 66 por ciento presentaron Hallazgos normales de Párpados, vías lagrimales, conjuntivas y el 5.4 por ciento patológico, los pacientes de 5 a 10 años con Ambliopía el 12.5 por ciento presentaron hallazgos normales de Párpados, vías lagrimales y conjuntivas; de 10 a 15 años el 23.2 por ciento presentaron hallazgos normales de Párpados, vías lagrimales y conjuntivas; los pacientes de 15 a mas años el 58.9 por ciento presentaron hallazgos normales de Párpados, vías lagrimales y conjuntivas. El 17.9 por ciento presentan Ambliopía Estrábica; el 35.7 por ciento Ambliopía Ametrópica; el 46.4 por ciento presentan Ambliopía Anisometrópica. El principal síntoma es la disminución de agudeza visual (100 por ciento). EI 62.5 por ciento presentan Ambliopía unilateral y el 37.5 por ciento Ambliopía bilateral. El 17.9 por ciento presentan déficit visual leve; el 37.5 por ciento presentan déficit visual moderado y el 44.6 por ciento presentan déficit visual severo.

The research aims to determine the clinical and epidemiological characteristics of Amblyopia in patients treated at the Department of Ophthalmology at the National Hospital Archbishop Loayza. The study is retrospective, observational, cross-sectional, the sample will consist of 56 patients admitted to the Department of Ophthalmology Arzobispo Loayza National Hospital who were clinically diagnosed with Amblyopia in the period January to September 2010. The results we have that Amblyopia in males are presented 16 cases (28.6 per cent) and female 40 cases (71.4 per cent). Of the male patients with Amblyopias in 28,6 per cent findings Normal eyelids, tear ducts and conjuntival, 28.6 per cent had ocular motility preserved and women of all patients with Amblyopia showed 66 per cent findings Normal eyelids, tear ducts, and conjuntival and 5.4 per cent pathological, the patients 5 to 10 years with Amblyopia showed 12.5 per cent findings Normal eyelids, tear duct and conjuntival, and patients 10 to 15 years with 23.2 per cent had Amblyopia findings Normal eyelids, tear duct and conjuntival, those patients with more than 15 years with Amblyopia showed 58.9 per cent findings Normal eyelids, tear ducts, conjuntival. Conclusions 17.9 per cent have strabismic Amblyopia, 35.7 per cent ametropic Amblyopia, 46.4 per cent have anisometric Amblyopia. The main symptom is decreased visual acuity (100 per cent). 62.5 per cent presented unilateral Amblyopia and 37.5 per cent bilateral Amblyopia, 17.9 per cent have level visual deficit, 37.5 per cent have moderate visual deficit and 44.6 per cent develop severe visual deficit.

Prevalencia de ambliopía en la escuela primaria Augusto Cesar Sandino de Ciego de Ávila / Prevalence of amblyopia at Augusto Cesar Sandino primary school in Ciego de Avila

La ambliopía se define como una disminución de la agudeza visual sin existir ninguna lesión orgánica que la justifique. Se identificó la prevalencia de la ambliopía en los estudiantes de la escuela primaria Augusto César Sandino del municipio de Ciego de Ávila, en el período comprendido desde marzo de 2008 a marzo de 2009. Se estudió el total de niños matriculados (557); se realizó un estudio observacional descriptivo de corte transversal en busca de ambliopía, se les realizó un examen físico ocular completo que fue la fuente de información. El 2.33 porciento de los escolares presentó ambliopía. El 46.15 porciento de los pacientes pertenecieron al grupo de edad de 6 a 4 años, predominó el sexo femenino 69.23 porciento. La ambliopía refractiva y la forma ligera fueron las más frecuentes (53.85 y 61.54 porciento). En el 76.92 porciento de los niños el desconocimiento de los padres fue la principal causa del diagnóstico tardío. El valor de ambliopes obtenido se encuentra dentro de la cifra promedio de prevalencia a nivel mundial, predominó el grupo de edad de 4 a 6 años, el sexo femenino, la ambliopía refractiva y la forma ligera; el desconocimiento de los padres o tutores fue la causa fundamental de diagnóstico tardío.

Amblyopia is defined as a decrease in visual acuity without existing any organic lesion to justify it. It was identified the prevalence of amblyopia in Primary School "Augusto Cesar Sandino” in Ciego de Avila municipality from March 2008 to March 2009. It was studied the total of children enrolled (557) where an observational descriptive cross-sectional study was carried out in search of amblyopia, they underwent a complete ocular physical examination that was the source of information. 2.33 percent of the students had amblyopia, 46.15 percent of patients were from 6 to 4 years old, females were the predominant sex (69.23 percent). Refractive and small amblyopia were the most frequent (53.85 and 61.54 percent). In 76.92 percent of children, their parents’ ignorance was the main cause of late diagnosis. The obtained value of amblyopes is in the average number of prevalence worldwide, dominated ages from 4 to 6 years, female sex, refractive and small amblyopia; the ignorance of parents or guardians was fundamental causes of late diagnosis.

Detecção de ambliopia, ametropias e fatores ambliogênicos em comunidade assistida por Programa da Saúde da Família no Rio de Janeiro, Brasil / Amblyopia, ametropia and amblyogenic factors detection in a community assisted by Health Family Program in Rio de Janeiro, Brazil

OBJETIVO: Estimar a prevalência dos fatores ambliogênicos e ambliopia na área adscrita do Programa Saúde da Família (PSF) da Lapa (RJ) e estimar na mesma área a sensibilidade/especificidade entre os métodos de medida da acuidade visual (tabelas ETDRS e LEA) para triagem em crianças pré-escolares (três a seis anos). MÉTODOS: Estudo transversal de 93 crianças entre três e seis anos da área adscrita do PSF Lapa, RJ. Todas as crianças foram submetidas a avaliação oftalmológica completa que incluiu: anamnese dirigida, ectoscopia, medida da acuidade visual com tabela de ETDRS e LEA de forma duplo cega, reflexo vermelho, teste de Titmus, refração objetiva sob cicloplegia, refração subjetiva, avaliação da motilidade ocular, biomicroscopia do segmento anterior, fundoscopia sob midríase.Os dados foram coletados na Policlínica Ronaldo Gazolla, da Universidade Estácio de Sá. RESULTADOS: A prevalência dos fatores ambliogênicos foi encontrada e distribuída em: 8,4 por cento de estrabismo, 11,86 por cento de anisometropia e 15,2 por cento de ametropia. O teste de acuidade visual ETDRS apresentou sensibilidade de 100 por cento e especificidade de 18 por cento para detecção de ambliopia. O teste de acuidade visual LEA apresentou sensibilidade de 100 por cento e especificidade de 30,9 por cento para detecção de ambliopia. CONCLUSÃO: Ambas tabelas ETDRS e LEA podem ser usadas para a triagem de ambliopia porque tiveram 100 por cento de sensibilidade. A especificidade foi maior para a tabela LEA. Porém, ainda em nível baixo. Portanto, há necessidade da complementação com o exame oftalmológico completo para confirmar e ratificar a presença de fatores ambliogênicos em pacientes triados positivamente. A triagem visual feita pelos agentes comunitários de saúde pode identificar crianças com distúrbios visuais, referenciando para exame oftalmológico completo; em um grupo etário onde a resolução dos problemas visuais se apresenta como prioridade...

OBJECTIVES: To determine amblyogenic factors and amblyopia prevalence in a Health Family assisted community área of Lapa (RJ); and to estimate in the same area the sensiblity and specificity among visual acuity methods ( ETDRS versus LEA optotypes) in pre-school children. METHODS: Cross section study of 93 children from three to six years old. All the children were submitted to complete ophthalmological evaluation which included: anamnesis, ectoscopy, double blind visual acuity measurements with LEA and ETDRS optotypes, red reflex, Titmus Test, objective cycloplegic refraction, subjective refraction, ocular motility evaluation, anterior segment biomicroscopy, fundoscopy. The data were collected in Ronaldo Gazolla Policlinic of Estacio de Sá University. RESULTS: The amblyogenic factors prevalence were : 8,4 percent of strabismus, 11,86 percent of anisometropia and 15,2 percent of ametropia. The ETDRS visual acuity test had 100 percent of sensibility and 18 percent of specificity for amblyopia detection. Lea visual acuity test had 100 percent sensibility and 30,9 percent specificity for amblyopia detection. CONCLUSION: Both optotype tests ETDRS and LEA can be used for amblyopia screening because they had 100 percent sensibility. The specificity was higher for LEA optotypes. However, the specificity still remained in a low level. Therefore, it is necessary to complement the visual acuity screening with a complete ophthalmological exam in the individuals screened to have amblyopia. Visual screening performed by Health Community Agents could identify children with visual acuity problems, and they could be referred to an ophthalmological complete exam, in an age group that visual acuity problems resolution is a priority. Helth Family Program can be used to evaluate visual acuity children status and it would be useful that this evaluation could be a statiscal SUS mark.

Tamización de salud visual en población infantil: prevención de la ambliopía / Vision screening in childhood: prevention of amblyopia

Estudio descriptivo en la institución Aldeas Infantiles del barrio Las Cruces de Bogotá DC. (Colombia). Tuvo por objeto describir y confirmar la frecuencia de alteraciones visuales en niños entre seis meses y once años de edad. Se aplicaron pruebas de tamizaje para defectos visuales a 101 niños de estrato socioeconómico uno y dos, según su edad (seis meses a dos años, tres a cuatro años, cinco a seis años y mayores de seis años). Los resultados indican que esta población tiene una prevalencia de defectos visuales similar a la encontrada en otros estudios y que los niños enfermos no tienen la corrección ni el tratamiento apropiados para prevenir defectos mayores en el futuro. Se pretende incentivar la realización de tamizaje en niños por personal médico entrenado para la detección temprana de alteraciones visuales prevenibles.

This was a descriptive study carried out at the Small Towns for Children of the Las Cruces neighborhood at Bogotá DC. (Colombia). Its purpose was to describe and confirm the frequency of visual impairments in children aged 0.6 months to 11 years. Age-appropriate screening vision tests were applied to 101 boys/girls (0.6 months to 2 years, 3 to 4 years, 5 to 6 years and 6 years and older), belonging to socio-economic status one and two. Results revealed that the prevalence of visual impairments in this population is similar to that found in other studies and that these children remain untreated thus failing to prevent greater future consequences. We pretend to boost vision screening in childhood delivered by qualified medical professionals to provide early detection of preventable visual alterations.

[Prevalence of low visual acuity and ophthalmological disorders in six-year-old children from Santa Fe city]. / Prevalencia de agudeza visual baja y trastornos oftalmológicos en niños de seis años de la ciudad de Santa Fe.

INTRODUCTION: Changes in children visual acuity that are not treated carry a high risk of irreversible consequences. OBJECTIVES: To determine the prevalence of low visual acuity and to diagnose the ophthalmologic diseases that cause it in six-year-old children from Santa Fe City, Argentina. METHODS: Observational, descriptive and transversal design. Visual acuity is defined as the eye's capacity to distinguish separate points and to recognize shapes. It was determined using the Snellen table for farsighted vision on 177 six-year-old children who attended four elementary schools in Santa Fe City. An ophthalmologic examination was performed on those who had low visual acuity and their mothers were interviewed to ascertain the pathological background of their children. RESULTS: The prevalence of low visual acuity was 10.7% (n= 19). The prevalence of amblyopia was 3.9%. Refraction errors were the only cause of low visual acuity. Astigmatism was predominantly frequent. The most frequent pathological backgrounds were: ocular infections, premature birth, history of malnutrition and maternal use of tobacco. CONCLUSIONS: The prevalence of low visual acuity found in this study is lower than the one informed in most other studies. This data require confirmation by further studies.

["Vision through the hands": experience of a project]. / Experiência em projeto: "Enxergando através das mãos"

PURPOSE: The Project "Vision through the hands" was performed by the Altino Ventura Foundation, with the purpose of investigating the present child situation with multiple disabilities in the state of Pernambuco, Brazil. METHODS: Birth and social conditions, social problems, and difficulty in accessing the specialized services were evaluated, aiming to collect relevant data with the goal of posterior implantation of a specialized diagnosis and treatment center. Ophthalmologic care and proper treatment were offered. RESULTS: Three hundred and nine children from five reference institutions in disabilities were attended, on six non consecutive days. All cases underwent ophthalmologic examinations and parent interviews. During the waiting time between the ophthalmologic visits and parent interviews the patients performed activities with artists. A multidisciplinary team of 31 professionals was available. According to parent information 83.1% of the patients were considered included in the society and only 45.4% attended school (normal or special). The difficulty to get access to ophthalmologic service was reported by 51.1%. Two hundred and seventy children with multiple disabilities were identified, 154 (56.2%) of whom underwent an ophthalmologic examination for the first time, and 33.0% had low visual acuity (inferior to 20/60 Snellen). The most frequent diagnoses were: refraction error, strabismus, ambliopia, alterations of optic nerve (glaucoma and atrophy), and cataract. Eighty-four glasses were prescribed. CONCLUSION: This project was pioneer in the region, allowing to obtain the information about important problems regarding multiple disabilities, and making possible ophthalmologic care and specialized treatment to the children.

Experiência em projeto: "Enxergando através das mãos" / \"Vision through the hands\": experience of a project

OBJETIVO: A Fundação Altino Ventura realizou o projeto "Enxergando através das mãos", com o objetivo de investigar a situação atual da múltipla deficiência no estado de Pernambuco, verificar a demanda reprimida nesta área e analisar relevância para implantação de um centro especializado de referência para o diagnóstico e tratamento desses pacientes. MÉTODOS: Foi avaliado o perfil de um grupo de pacientes atendidos em cinco serviços de referência do grande Recife. Os casos foram avaliados quanto a ocorrências perinatais, inclusão social e dificuldades de acesso aos serviços especializados. Promoveu-se o atendimento oftalmológico especializado e o tratamento indicado para cada caso. O projeto foi desenvolvido de forma prospectiva, seguindo protocolo e organograma previamente elaborados. Os atendimentos foram realizados em seis dias não consecutivos, durante os quais todos os casos passavam pelas etapas de entrevista dos genitores e exame oftalmológico completo. Durante o período de espera entre entrevista e exame oftalmológico os pacientes realizavam atividades lúdicas com artistas plásticas. Contou-se com equipe multidisciplinar de 31 profissionais. RESULTADOS: Foram atendidos 309 pacientes. Estavam incluídos na sociedade 83,1 por cento dos pacientes, apenas 45,4 por cento freqüentavam escola (normal ou especial). A dificuldade de acesso aos serviços na área de oftalmologia foi relatada por 51,1 por cento dos casos. Foram identificadas 274 crianças com múltiplas deficiências, destas, 154 (56,2 por cento) nunca haviam sido examinadas pelo oftalmologista e 33 por cento tinham baixa de visão (inferior à 20/60 na tabela de Snellen). Os diagnósticos oftalmológicos mais freqüentes foram: erro refracional, estrabismo, ambliopia, alterações do nervo óptico (glaucoma e atrofia), e catarata. Foram prescritos e doados 84 óculos. CONCLUSÃO: O projeto foi pioneiro na região, permitindo a obtenção de importantes dados quanto à problemática da deficiência...

PURPOSE: The Project "Vision through the hands" was performed by the Altino Ventura Foundation, with the purpose of investigating the present child situation with multiple disabilities in the state of Pernambuco, Brazil. METHODS: Birth and social conditions, social problems, and difficulty in accessing the specialized services were evaluated, aiming to collect relevant data with the goal of posterior implantation of a specialized diagnosis and treatment center. Ophthalmologic care and proper treatment were offered. RESULTS: Three hundred and nine children from five reference institutions in disabilities were attended, on six non consecutive days. All cases underwent ophthalmologic examinations and parent interviews. During the waiting time between the ophthalmologic visits and parent interviews the patients performed activities with artists. A multidisciplinary team of 31 professionals was available. According to parent information 83.1 percent of the patients were considered included in the society and only 45.4 percent attended school (normal or special). The difficulty to get access to ophthalmologic service was reported by 51.1 percent. Two hundred and seventy children with multiple disabilities were indentified, 154 (56.2 percent) of whom underwent an ophthalmologic examination for the first time, and 33.0 percent had low visual acuity (inferior to 20/60 Snellen). The most frequent diagnoses were: refraction error, strabismus, ambliopia, alterations of optic nerve (glaucoma and atrophy), and cataract. Eighty-four glasses were prescribed. CONCLUSION: This project was pioneer in the region, allowing to obtain the information about important problems regarding multiple disabilities, and making possible ophthalmologic care and specialized treatment to the children.

Determinants of pediatric cataract program outcomes and follow-up in a large series in Mexico.

PURPOSE: To report determinants of outcomes and follow-up in a large Mexican pediatric cataract project. SETTING: Hospital Luis Sanchez Bulnes, Mexico City, Mexico. METHODS: Data were collected prospectively from a pediatric cataract surgery program at the Hospital Luis Sanchez Bulnes, implemented by Helen Keller International. Preoperative data included age, sex, baseline visual acuity, type of cataract, laterality, and presence of conditions such as amblyopia. Surgical data included vitrectomy, capsulotomy, complications, and use of intraocular lenses (IOLs). Postoperative data included final visual acuity, refraction, number of follow-up visits, and program support for follow-up. RESULTS: Of 574 eyes of 415 children (mean age 7.1 years +/- 4.7 [SD]), IOLs were placed in 416 (87%). At least 1 follow-up was attended by 408 patients (98.3%) (mean total follow-up 3.5 +/- 1.8 months); 40% of eyes achieved a final visual acuity of 6/18 or better. Children living farther from the hospital had fewer postoperative visits (P = .04), while children receiving program support had more visits (P = .001). Factors predictive of better acuity included receiving an IOL during surgery (P = .04) and provision of postoperative spectacles (P = .001). Predictive of worse acuity were amblyopia (P = .003), postoperative complications (P = .0001), unilateral surgery (P = .0075), and female sex (P = .045). CONCLUSIONS: The results underscore the importance of surgical training in reducing complications, early intervention before amblyopia (observed in 40% of patients) can develop, and vigorous treatment if amblyopia is present. The positive impact of program support on follow-up is encouraging, although direct financial support may pose a problem for sustainability. More work is needed to understand reasons for worse outcomes in girls.

Epidemiologic study of anisometropia in students of Natal, Brazil.

PURPOSE: To perform an epidemiologic study in students in Natal/Brazil, with relation to refractional anisometropia, evaluating criteria such as: gender, age, and association with strabismus and amblyopia. METHODS: A study of 1,024 students randomly selected from several districts of Natal/Brazil was undertaken by the Department of Ophthalmology of the Federal University of Rio Grande do Norte (UFRN), observing the following criteria of > or =2 spherical or cylindrical diopter refractional anisometropia relating it to sex, age, association with strabismus, amblyopia and anisometropia classification. RESULTS: We found a prevalence of 2% (N=21) anisometropia in the students. The female gender predominated with 81% (N=17). In students with anisometropia, we observed an association with strabismus in 9.5% of cases (N=2), both with exotropia. The association of anisometropia with amblyopia occurred in 47.6% of the cases (N=10), with 8 cases of unilateral amblyopia and 2 cases of bilateral amblyopia. CONCLUSIONS: There was a predominance of anisometropia in females, and an increased prevalence of strabismus and amblyopia in students with anisometropia.

Rastreo de ambliopía en niños / Amblyopia screening in children

La ambliopía es la disminución de la agudeza visual generalmente en uno, pero a veces en ambos ojos, no atribuible a una patología anatómica del globo ocular o del nervio óptico, sino a una alteración del desarrollo de la vía visual central. Es la causa más común de pérdida visual irreversible y prevenible en los niños. El desarrollo visual normal requiere que la imagen recibida por cada ojo sea nítida para poder fusionarse en una única imagen a nivel cerebral. Cualquier problema que interfiera con este proceso durante los primeros 8 a 10 años puede producir ambliopía. Es por ello que a este intervalo se lo conoce con el nombre de "período crítico" y el tratamiento adecuado durante este período permite la reversión del cuadro. La ambliopía se produce por tres mecanismos diferentes: deprivación, estrabismo o alteraciones de la refracción. El estrabismo es la causa más común de ambliopía en la población pediátrica y su prevalencia en menores de seis años varía entre 3 y 4,5 por ciento. El 40 por ciento de los niños con estrabismo desarrolla ambliopía

Pesquisa de ambliopía en preescolares del Centro de Salud familiar Bernardo Leighton / Screening for amblyopia in pre-school children in the Family Health Centre, Bernardo Leighton

Introducción: La ambliopía corresponde a una disminución de la agudeza visual sin causa orgánica conocida y tiene una prevalencia estimada entre 1 a 5 por ciento de la población general. Objetivos: Cuantificar la prevalencia y determinar las causas de ambliopía en preescolares de 4 a 5 años. Material y Métodos: Se realizó examen oftalmológico completo a 94 niños derivados en forma aleatoria desde el programa control de niño sano del Centro de Salud Familiar Bernardo Leighton y se registraron la agudeza visual y refracción con mejor visión corregida, determinándose la existencia de ambliopía. Resultados: Se encontró ambliopía en 9,6 por ciento, siendo bilateral en 5,3 por ciento y asociándose principalmente a astigmatismo. El 93,3 por ciento de los ojos con agudeza visual sin corrección menor o igual a 0,5 tenían ambliopía. Conclusiones:La alta prevalencia de ambliopía encontrada hace necesario instaurar programas de screening visual para su detección precoz. Presentar agudeza visual sin corrección de 0,5 o inferior sería un factor de riesgo de esta patología.

Visual acuity, amblyopia, and ocular pathology in 12- to 13-year-old children in Northern Mexico.

PURPOSE: The aim of this study was to establish visual acuity (VA) and the prevalence of amblyopia and other ocular disorders in a population of 12- to 13-year-old children in Mexico who have not been vision screened. METHODS: A total of 1,035 12- to 13-year-old children were examined in a field study. The examination included VA, stereopsis, cover testing, refractive retinoscopy, and examination of the red reflex and posterior pole. In cases with unexplained subnormal VA, visually evoked potential/visually evoked response was also performed. RESULTS: A >or=20/20 in at least one eye was found in 93% of the subjects. Bilateral VA