Towards a national pre-school vision screening programme.

The aim of the study is to examine common approaches to pre-school vision screening, including the current New South Wales model which is known as Statewide Eyesight Preschooler Screening (StEPS) to determine whether the criteria set by the World Health Organization are fulfilled by StEPS, and therefore, whether there is sufficient justification to deploy a similar model nationally. A literature review was conducted to answer four key questions related to vision screening. The authors sought to review (i) the justification for vision screening of a pre-school population; (ii) the principles and best approaches to vision screening such as how, where and who should conduct vision screening; (iii) the conditions that are targeted in vision screening; and (iv) the acceptable pass/fail vision screening criteria. The StEPS vision screening model is an accurate, reliable and economical way of screening for reduced vision at a time when neural plasticity allows improvement in vision following intervention. It fulfils World Health Organization criteria for a successful screening programme. StEPS has very high participation rates compared to other screening methods in Australia due to its unique model whereby screeners utilise early childhood settings to recruit and screen 4-year-old children. Due consideration should be given to deploying the StEPS vision screening model nationally.

Aetiology and outcome of open and closed globe eye injuries in children.

BACKGROUND: This paper reports on the aetiology and outcome of childhood open and closed globe eye injuries presenting to the Children's Hospital at Westmead, Sydney, Australia from January 2000 to December 2008. DESIGN: Hospital-based retrospective study. PARTICIPANTS: Two hundred three cases of childhood eye injuries identified in a nine-year period, comprising 81 open globe and 122 closed globe injuries. METHODS: Hospital records were examined for demographic data and injuries were classified into open globe and closed globe, based on the Ocular Trauma Classification. MAIN OUTCOME MEASURES: Parameters affecting the final visual outcome such as type of injury, zone of injury, initial visual acuity, wound length (only in open globe injuries) and lens injury were assessed. RESULTS: Most of the eye injuries resulted from the child poking itself or being poked accidentally (26%), with the home being the most common place of injury. A favourable visual outcome was noted with closed globe injuries as compared with open globe injuries (P < 0.01). Parameters that indicated a poor visual outcome included globe ruptures, zone 3 injuries, poor initial visual acuity, wound length >10 mm and lens trauma. Final visual acuity of 6/12 or better was observed in 68% of injured eyes. CONCLUSIONS: This study demonstrated improved visual outcomes when compared with previous studies. However, many unsalvageable childhood eye injuries with little useful vision were evident, and most disconcerting is that the majority of childhood eye injuries in this study were preventable.

Current licensing authority standards for peripheral visual field and safe on-road senior aged automobile driving performance.

BACKGROUND: The current licensing authority's (Austroads) visual field standards are met when a person demonstrates an intact visual field extending horizontally at least 120 degrees within 10 degrees above and below the horizontal midline. A person cannot be licensed unconditionally if they have a hemianopia, quadrantanopia or any significant visual field loss (scotoma) that is likely to impede driving performance. Despite fairly rigorous implementation of these vision standards by licensing authorities, there is little scientific evidence available to demonstrate that a driver will or will not be safe on road depending on the extent of their visual field. METHODS: This study was developed to examine if the current licensing authority vision standards predict safe on-road driver performance in a cohort of 100 senior drivers. The study consisted of four stages in which participants underwent on-road assessment by a multidisciplinary team including a driving instructor, orthoptist and occupational therapist; off-road occupational therapy cognitive skills assessment using the Visual Recognition Slide Test (VRST-USyd); off-road orthoptic assessment including history, visual acuity and visual fields; and feedback from the team regarding the participant's visual and driving status. Visual fields were assessed using both the Goldmann and Esterman tests. Correlations were calculated to determine the relationship between visual field results and on-road driving performance. RESULTS: Generally it was found that visual field test results did not predict driving performance accurately for both participants with and without visual field loss. CONCLUSION: The results bring into question the current Austroads visual field standards for safe driving.