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Published on: October 18, 2024
Referral rates for a functional vision screening among a large cosmopolitan sample of Australian children
Barbara Junghans1, Patricia M Kiely, David P Crewther
1School of Optometry, The University of New South Wales, Sydney, Australia. b.junghans@unsw.edu.au
Insights
This study assessed functional vision in 2697 Australian children, finding low strabismus rates but identifying 20% needing further vision assessment. Referrals often relied on clinical judgment over strict criteria.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Public Health Vision Screening
Background:
- Functional vision problems in children can impact learning and development.
- Screening programs aim to detect vision issues early in school-aged populations.
- Standardized criteria are essential for consistent vision screening outcomes.
Purpose of the Study:
- To determine the incidence of functional vision problems in Australian primary school children.
- To evaluate the consistent application of clinical criteria by practitioners during vision screenings.
- To analyze refractive errors, binocular vision, and stereopsis in a diverse pediatric cohort.
Main Methods:
- A large-scale, unselected population of 2697 children aged 3-12 years in Australia was screened.
- Assessed parameters included refractive error, near point of convergence, stereopsis, strabismus, heterophoria, and accommodative facility.
- Referral criteria included specific thresholds for stereopsis, accommodative facility, near point of convergence, phorias, and refractive errors.
Main Results:
- The prevalence of strabismus was low at 0.3%.
- Refractive errors showed a skew towards hypermetropia (mean +0.54 D).
- Twenty percent of children were referred, with analysis suggesting referrals were based on clinical intuition rather than strict adherence to set criteria.
Conclusions:
- While strabismus is uncommon, a significant proportion of children required further vision assessment.
- The study highlights variability in applying standardized clinical criteria for functional vision problems in pediatric screenings.
- Future screenings should emphasize consistent application of defined criteria to ensure equitable assessment and referral.
Abstract:
The aim of this study was to investigate the incidence of functional vision problems in a large unselected cosmopolitan population of primary school-age children and to investigate whether constant clinical criteria for functional vision problems would be implemented by the practitioners involved in the screening. Refractive errors, near point of convergence, stereopsis, strabismus, heterophoria and accommodative facility were assessed for 2697 children (3-12 years) of varying racial backgrounds living in Australia. The spherical component of the refractive error ranged from -7.75 to +9.50 D (mean +0.54 D, +/-0.79) with a distribution skewed towards hypermetropia; astigmatism ranged from 0 to 4.25 D (mean -0.16 D, +/-0.35). There was a trend towards less hypermetropia and slightly more astigmatism with age. Mean near point of convergence was 5.4+/-2.9 cm, heterophoria at far and near was 0.12+/-1.58delta exophoria and 1.05+/-2.53delta exophoria, respectively, 0.55% of children exhibited vertical phoria at near >0.5delta, accommodative facility ranged from 0 to 24 cycles per minute (cpm) (mean 11.2 cpm, +/-3.7), stereopsis varied from 20 to 800 s (") of arc with 50% of children having 40" or better. The prevalence of strabismus was particularly low (0.3%). Twenty percent of the children were referred for further assessment based on criteria of one or more of: stereopsis >70", accommodative facility <8 cpm, near point of convergence (NPC) >9 cm, near exophoria >10delta or near esophoria >5delta, shift in eso or exophoria > or = 4delta between distance and near, astigmatism > or = 1 D, myopia more than -0.75 D, or hyperopia >+1.50 D. Post-hoc analysis of the record cards seeking the reason for further assessment indicates that referrals appear to have been based upon clinical intuition rather than on a set number of borderline or unsatisfactory results.
