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Published on: October 18, 2024
Prevalence of, and risk factors for, presenting visual impairment: findings from a vision screening programme based
Alison Bruce1,2, Gillian Santorelli3, John Wright3
1Department of Health Sciences, University of York, York, UK. alison.bruce@bthft.nhs.uk.
Insights
Vision screening in UK children found a high prevalence of presenting visual impairment (PVI), particularly in ethnic minority groups. Ethnicity, maternal age, and birth weight were key factors associated with PVI.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Vision screening in early childhood is crucial for identifying and managing potential sight problems.
- Understanding factors influencing vision screening outcomes in diverse populations is essential for targeted interventions.
Purpose of the Study:
- To determine presenting visual acuity (VA) levels in 4-5-year-old UK children.
- To explore factors associated with failing vision screening and presenting visual impairment (PVI) in a multi-ethnic cohort.
Main Methods:
- Population-based vision screening of 16,541 children aged 4-5 years using the logMAR Crowded Test.
- Referral criteria based on national recommendations (>0.20 logMAR).
- Multivariable logistic regression to analyze associations with ethnicity, maternal, and early-life factors.
Main Results:
- 15% failed screening; 4.4% had PVI (VA >0.3 logMAR).
- Increased odds of PVI observed in children of Pakistani (OR: 2.49) and other ethnicities (OR: 2.00) compared to white children.
- Higher odds of PVI also linked to older maternal age and low birth weight.
Conclusions:
- A significant prevalence of PVI exists in this UK cohort.
- Ethnicity is a strong predictor of failing vision screening and PVI.
- The vision screening program demonstrated good positive predictive value for identifying true cases.
Purpose:
To determine presenting visual acuity levels and explore the factors associated with failing vision screening in a multi-ethnic population of UK children aged 4-5 years.
Methods:
Visual acuity (VA) using the logMAR Crowded Test was measured in 16,541 children in a population-based vision screening programme. Referral for cycloplegic examination was based on national recommendations (>0.20logMAR in one or both eyes). Presenting visual impairment (PVI) was defined as VA >0.3logMAR in the better eye. Multivariable logistic regression was used to assess the association of ethnicity, maternal, and early-life factors with failing vision screening and PVI in participants of the Born in Bradford birth cohort.
Results:
In total, 2467/16,541 (15%) failed vision screening, 732 (4.4%) had PVI. Children of Pakistani (OR: 2.49; 95% CI: 1.74-3.60) and other ethnicities (OR: 2.00; 95% CI: 1.28-3.12) showed increased odds of PVI compared to white children. Children born to older mothers (OR: 1.63; 95% CI: 1.19-2.24) and of low birth weight (OR: 1.52; 95% CI: 1.00-2.34) also showed increased odds. Follow-up results were available for 1068 (43.3%) children, 993 (93%) were true positives; 932 (94%) of these had significant refractive error. Astigmatism (>1DC) (44%) was more common in children of Pakistani ethnicity and hypermetropia (>3.0DS) (27%) in white children (Fisher's exact, p < 0.001).
Conclusions:
A high prevalence of PVI is reported. Failing vision screening and PVI were highly associated with ethnicity. The positive predictive value of the vision screening programme was good, with only 7% of children followed up confirmed as false positives.
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