Canadian Association of Optometrists/Canadian Ophthalmological Society Joint Position Statement: Effects of Electronic Screens on Children’s Vision and Recommendations for Safe Use

The prevalence of electronic screen-related ocular symptoms in adult users is estimated to be as high as 50–90%. While the corresponding statistic in children is not known, the use of electronic screens by children has become more commonplace (at both home and school), begins earlier in childhood than in the past, and can last for long periods of time. The prevalence of electronic-screen symptoms in adults and the resultant guidelines for safe use should not be automatically applied to children. The visual and physical systems of children are different than those of adults, and still developing. In addition, children use screens differently and for different tasks. This policy reviews the current literature on ocular and visual symptoms related to electronic-screen use in children and provides evidence-based guidelines for safe use. The effect of screen-time on other cognitive and developmental milestones is beyond the scope of this statement

The content of optometric eye examinations for a presbyopic patient presenting with symptoms of flashing lights

Background:  Standardised patients (SPs) are the gold standard methodology for evaluating clinical care. This approach was used to investigate the content of optometric eyecare for a presbyopic patient who presented with recent photopsia. Methods:  A total of 102 community optometrists consented to be visited by an actor for a recorded eye examination. This actor received extensive training to enable accurate reporting of the content of the eye examinations, via an audio recording and a checklist completed for each clinical encounter. The actor presented unannounced (incognito) as a 59-year-old patient seeking a private eye examination and complaining of recent onset flashing lights. The results of each clinical encounter were recorded on a pre-designed checklist based on evidence-based reviews on photopsia, clinical guidelines and the views of an expert panel. Results:  The presence of the symptom of photopsia was proactively detected in 87% of cases. Although none of the optometrists visited asked all seven gold standard questions relating to the presenting symptoms of flashing lights, 35% asked four of the seven questions. A total of 85% of optometrists asked the patient if he noticed any floaters in his vision and 36% of optometrists asked if he had noticed any shadows in his vision. The proportion of the tests recommended by the expert panel that were carried out varied from 33 to 100% with a mean of 67%. Specifically, 66% recommended dilated fundoscopy to be carried out either by themselves or by another eyecare practitioner, and 29% of optometrists asked the patient to seek a second opinion regarding the photopsia. Of those who referred, 70% asked for the referral to be on the same day or within a week. Conclusion:  SP encounters are an effective way of measuring clinical care within optometry and should be considered for further comparative measurements of quality of care. As in research using SPs in other healthcare disciplines, our study has highlighted substantial differences between different practitioners in the duration and depth of their clinical investigations. This highlights the fact that not all eye examinations are the same but inherently different and that there is no such thing as a ‘standard sight test’. Future optometric continuing education could focus on history taking, examination techniques and referral guidelines for patients presenting with symptoms of posterior vitreous detachment, retinal breaks and secondary retinal detachment

The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives

Background: The prevalence of visual impairment (VI) and dementia increases with age and these conditions may coexist, but few UK data exist on VI among people with dementia. Objectives: To measure the prevalence of eye conditions causing VI in people with dementia and to identify/describe reasons for underdetection or inappropriate management. Design: Stage 1 – cross-sectional prevalence study. Stage 2 – qualitative research exploring participant, carer and professional perspectives of eye care. Setting: Stage 1 – 20 NHS sites in six English regions. Stage 2 – six English regions. Participants: Stage 1 – 708 participants with dementia (aged 60–89 years): 389 lived in the community (group 1) and 319 lived in care homes (group 2). Stage 2 – 119 participants. Interventions: Stage 1 gathered eye examination data following domiciliary sight tests complying with General Ophthalmic Services requirements and professional guidelines. Cognitive impairment was assessed using the Standardised Mini-Mental State Examination (sMMSE) test, and functional ability and behavior were assessed using the Bristol Activities of Daily Living Scale and Cambridge Behavioural Inventory – Revised. Stage 2 involved individual interviews (36 people with dementia and 11 care workers); and separate focus groups (34 optometrists; 38 family and professional carers). Main outcome measures.: VI defined by visual acuity (VA) worse than 6/12 or worse than 6/18 measured before and after refraction. Results: Stage 1 – when participants wore their current spectacles, VI prevalence was 32.5% [95% confidence interval (CI) 28.7% to 36.5%] and 16.3% (95% CI 13.5% to 19.6%) for commonly used criteria for VI of VA worse than 6/12 and 6/18, respectively. Of those with VI, 44% (VA 80% of participants. There was no evidence that the management of VI in people with dementia differed from that in older people in general. Exploratory analysis suggested significant deficits in some vision-related aspects of function and behaviour in participants with VI. Stage 2 key messages – carers and care workers underestimated how much can be achieved in an eye examination. People with dementia and carers were unaware of domiciliary sight test availability. Improved communication is needed between optometrists and carers; optometrists should be informed of the person’s dementia. Tailoring eye examinations to individual needs includes allowing extra time. Optometrists wanted training and guidance about dementia. Correcting VI may improve the quality of life of people with dementia but should be weighed against the risks and burdens of undergoing examinations and cataract surgery on an individual basis. Limitations: Sampling bias is possible owing to quota-sampling and response bias. Conclusions: The prevalence of VI is disproportionately higher in people with dementia living in care homes. Almost 50% of presenting VI is correctable with spectacles, and more with cataract surgery. Areas for future research are the development of an eye-care pathway for people with dementia; assessment of the benefits of early cataract surgery; and research into the feasibility of specialist optometrists for older people

Review of school vision screening guidelines

Abstract: Background: Vision screenings are important in identifying visual anomalies likely to disrupt the physical, intellectual, social and emotional development of children. School health services globally include vision screenings, complementing a variety of associated screening services. Aim: This review article provides evidence for content, provision and efficacy of the vision screening services for children of school-going age and reports on the current practice of children’s vision screenings worldwide including in South Africa. Methods: Studies were identified from PubMed, Ebscohost and Science Direct with the search terms utilised during the selection of electronic articles and journals for the review. The target population includes children of school-going age from 6 to 19 years without previously known conditions associated with visual anomalies and learning-related problems. The quality of vision screening programmes and policies for the school-going age children in different countries were evaluated using Wilson and Jungner criteria.1 Results: Vision screening programmes worldwide appear to support comprehensive vision screening methods among pre-schoolers (from birth to ≤ 6 years vs. children of school-going age). The development of vision screening procedures in some countries in the United States of America (USA) was found to be grounded on epidemiologic findings and principles. These may have contributed towards the formulation of national vision screening guidelines for preschoolers that supported the detection of amblyopia and its associated conditions such as strabismus, anisometropia and myopia. School-going children’s vision screenings are not supported worldwide as research has shown that there is lack of benefits for detecting other visual anomalies such as vergence and accommodative dysfunctions. This is despite evidence provided by the literature reviewed that an association exists between prevalent accommodation and vergence dysfunctions including poor ocular motilities and poor near-vision, among children of school-going age with poor academic performance. Conclusion: The guidelines worldwide support school vision screenings, especially for the pre-schoolers by the school health nurses, with other programs having considered the teachers, optometrists or orthoptists as the appropriate personnel to conduct the school vision screenings. There is still a need for the effectiveness of the school vision-screening programmes to be investigated related to the importance of detecting convergence and accommodative dysfunctions for the school going age children

Canadian Association of Optometrists/Canadian Ophthalmological Society Joint Position Statement

The prevalence of electronic screen-related ocular symptoms in adult users is estimated to be as high as 50–90%. While the corresponding statistic in children is not known, the use of electronic screens by children has become more commonplace (at both home and school), begins earlier in childhood than in the past, and can last for long periods of time.&#x0D; The prevalence of electronic-screen symptoms in adults and the resultant guidelines for safe use should not be automatically applied to children. The visual and physical systems of children are different than those of adults, and still developing. In addition, children use screens differently and for different tasks. This policy reviews the current literature on ocular and visual symptoms related to electronic-screen use in children and provides evidence-based guidelines for safe use. The effect of screen-time on other cognitive and developmental milestones is beyond the scope of this statement.</jats:p