Prevalence of refractive error among preschool children in an urban population: the Baltimore Pediatric Eye Disease Study.

PURPOSE: To determine the age-specific prevalence of refractive errors in white and African-American preschool children. DESIGN: The Baltimore Pediatric Eye Disease Study is a population-based evaluation of the prevalence of ocular disorders in children aged 6 to 71 months in Baltimore, Maryland. PARTICIPANTS: Among 4132 children identified, 3990 eligible children (97%) were enrolled and 2546 children (62%) were examined. METHODS: Cycloplegic autorefraction was attempted in all children with the use of a Nikon Retinomax K-Plus 2 (Nikon Corporation, Tokyo, Japan). If a reliable autorefraction could not be obtained after 3 attempts, cycloplegic streak retinoscopy was performed. MAIN OUTCOME MEASURES: Mean spherical equivalent (SE) refractive error, astigmatism, and prevalence of higher refractive errors among African-American and white children. RESULTS: The mean SE of right eyes was +1.49 diopters (D) (standard deviation [SD] = 1.23) in white children and +0.71 D (SD = 1.35) in African-American children (mean difference of 0.78 D; 95% confidence interval [CI], 0.67-0.89). Mean SE refractive error did not decline with age in either group. The prevalence of myopia of 1.00 D or more in the eye with the lesser refractive error was 0.7% in white children and 5.5% in African-American children (relative risk [RR], 8.01; 95% CI, 3.70-17.35). The prevalence of hyperopia of +3 D or more in the eye with the lesser refractive error was 8.9% in white children and 4.4% in African-American children (RR, 0.49; 95% CI, 0.35-0.68). The prevalence of emmetropia (<-1.00 D to <+1.00 D) was 35.6% in white children and 58.0% in African-American children (RR, 1.64; 95% CI, 1.49-1.80). On the basis of published prescribing guidelines, 5.1% of the children would have benefited from spectacle correction. However, only 1.3% had been prescribed correction. CONCLUSIONS: Significant refractive errors are uncommon in this population of urban preschool children. There was no evidence for a myopic shift over this age range in this cross-sectional study. A small proportion of preschool children would likely benefit from refractive correction, but few have had this prescribed.

Prevalence of decreased visual acuity among preschool-aged children in an American urban population: the Baltimore Pediatric Eye Disease Study, methods, and results.

OBJECTIVE: To determine the age- and ethnicity-specific prevalence of decreased visual acuity (VA) in white and black preschool-aged children. DESIGN: Cross-sectional study. PARTICIPANTS: The Baltimore Pediatric Eye Disease Study is a population-based evaluation of the prevalence of ocular disorders in children 6 through 71 months of age in Baltimore, Maryland, United States. Among 4132 children identified, 3990 eligible children (97%) were enrolled and 2546 children (62%) were examined. This report focuses on 1714 of 2546 examined children (67%) who were 30 through 71 months of age. METHODS: Field staff identified 63 737 occupied dwelling units in 54 census tracts. Parents or guardians of eligible participants underwent an in-home interview, and eligible children underwent a comprehensive eye examination including optotype visual acuity (VA) testing in children 30 months of age and older, with protocol-specified retesting of children with VA worse than an age-appropriate standard. MAIN OUTCOME MEASURES: The proportion of children 30 through 71 months of age testable for VA and the proportion with decreased VA as defined by preset criteria. RESULTS: Visual acuity was testable in 1504 of 1714 children (87.7%) 30 through 71 months of age. It was decreased at the initial test (wearing glasses if brought to the clinic) in both eyes of 7 of 577 white children (1.21%; 95% confidence interval [CI], 0.49-2.50) and 13 of 725 black children (1.79%; 95% CI, 0.95-3.08), a difference that is not statistically significant. Decreased VA in both eyes after retesting was found in 3 of 598 white children (0.50%; 95% CI, 0.10-1.48) and in 8 of 757 black children (1.06%, 95% CI = 0.45, 2.10), also not statistically significantly different. Uncorrected ametropia explained the decreased VA on initial testing in 10 of the 20 children. CONCLUSIONS: Decreased VA in both eyes of children 30 through 71 months of age at presentation in urban Baltimore was 1.2% among white children and 1.8% among black children. After retesting within 60 days of the initial examination and with children wearing best refractive correction, the rate of decreased VA in both eyes was 0.5% among white children and 1.1% among black children.

Bethesda hospitals' emergency preparedness partnership: a model for transinstitutional collaboration of emergency responses.

The events of September 11, 2001 identified a need for health care institutions to develop flexible, creative, and adaptive response mechanisms in the event of a local, regional, or national disaster. The 3 major health care institutions in Bethesda, MD-the National Naval Medical Center (NNMC), the Suburban Hospital Healthcare System (SHHS), and the National Institutes of Health Clinical Center (NIHCC)-have created a preparedness partnership that outstrips what any of the institutions could provide independently by pooling complementary resources. The creation of the partnership initially was driven by geographic proximity and by remarkably complementary resources. This article describes the creation of the partnership, the drivers and obstacles to creation, and the functioning and initial accomplishments of the partnership. The article argues that similar proximity and resource relationships exist among institutions at academic centers throughout the United States and suggests that this partnership may serve as a template for other similarly situated institutions.