Pinhole Does Not Increase Screening Accuracy of Detecting Decreased Best Corrected Visual Acuity in Schoolchildren

Overview

Journal BMC Ophthalmol

Publisher Biomed Central

Specialty Ophthalmology

Date 2021 Dec 3

PMID 34856946

Citations 2

Authors

Weiwei Chen

Jing Fu

Ali Sun

Lei Li

Yunyun Sun

Zhaojun Meng

Affiliations

Soon will be listed here.

Abstract

Background: Decreased best corrected visual acuity among children should be treated early in life, and vision screening in schoolchildren is an efficient and feasible selection for developing countries. Thus, the screening accuracy of different visual acuity tests is the key point for making vision screening strategies. The present study aims to explore the screening accuracy of uncorrected visual acuity (UCVA) and pin-hole corrected visual acuity (PCVA) using different vision chart in the detection of decreased best-corrected visual acuity (BCVA) among schoolchildren.

Methods: Grade one primary schoolchildren in urban Lhasa with data of UCVA using tumbling E chart (UCVAE), PCVA using tumbling E chart (PCVAE), UCVA using Lea Symbols chart (UCVAL), PCVA using Lea Symbols chart (PCVAL) and BCVA using Lea Symbols chart were reviewed. Decreased BCVA was defined as BCVA≤20/32(≥0.2 logMAR). Difference, reliability, and diagnostic parameters in the detection of decreased BCVA of different visual acuity results were analyzed.

Results: Overall, 1672 children aged 6.58 ± 0.44 years fulfilling the criteria. The prevalence of decreased BCVA was 6.8%. Although no significant differences were found between UCVAE vs UCVAL (p = .84, paired t-test) as well as PCVAE vs PCVAL (p = .24), the ICC between them was low (0.68 and 0.57, respectively). The average difference between BCVA and UCVAE, UCVAL, PCVAE, PCVAL was logMAR -0.08 (- 0.37, 0.21), - 0.08 (- 0.29, 0.17), - 0.05 (- 0.30, 0.19), - 0.06 (- 0.23, 0.12) using Bland-Altman method. The area under the receiver operating characteristic curve of UCVAE, PCVAE, UCVAL, PCVAL for the detection of decreased BCVA was 0.78 (0.73, 0.84), 0.76 (0.71, 0.82), 0.95 (0.94, 0.96), 0.93 (0.91, 0.95), respectively.

Conclusion: Pinhole does not increase the screening accuracy of detecting decreased BCVA in grade one primary schoolchildren. Visual acuity test using Lea Symbols is more efficient than Tumbling E in the screening of that age.

Trial Registration: Data were maily from the Lhasa Childhood Eye Study which has finished the clinical registration on ( ChiCTR1900026693 ).

Citing Articles

Validity and Reliability of Vis-Screen Application: A Smartphone-Based Distance Vision Testing for Visual Impairment and Blindness Vision Screening.

Abdul Rahman S, Naing N, Othman A, Mohamad Z, Ibrahim T, Hashim S Medicina (Kaunas). 2023; 59(5).

PMID: 37241144 PMC: 10224196. DOI: 10.3390/medicina59050912.

Results of the Pinhole Test Correlate with Hybrid Contact Lens Visual Acuity in Patients with Visual Impairment due to Corneal Diseases.

Kanclerz P J Ophthalmol. 2022; 2022:4932856.

PMID: 35783341 PMC: 9249474. DOI: 10.1155/2022/4932856.

References

Mactaggart I, Limburg H, Bastawrous A, Burton M, Kuper H . Rapid Assessment of Avoidable Blindness: looking back, looking forward. Br J Ophthalmol. 2019; 103(11):1549-1552. PMC: 6855783. DOI: 10.1136/bjophthalmol-2019-314015. View

Zhao L, Stinnett S, Prakalapakorn S . Visual Acuity Assessment and Vision Screening Using a Novel Smartphone Application. J Pediatr. 2019; 213:203-210.e1. DOI: 10.1016/j.jpeds.2019.06.021. View

Paul C, Sathyan S . Comparison of the efficacy of Lea Symbol chart and Sheridan Gardiner chart for preschool vision screening. Indian J Ophthalmol. 2018; 66(7):924-928. PMC: 6032748. DOI: 10.4103/ijo.IJO_1078_17. View

Graf M, Becker R, Kaufmann H . Lea symbols: visual acuity assessment and detection of amblyopia. Graefes Arch Clin Exp Ophthalmol. 2000; 238(1):53-8. DOI: 10.1007/s004170050009. View

Silverstein E, Donahue S . Preschool Vision Screening: Where We Have Been and Where We Are Going. Am J Ophthalmol. 2018; 194:xviii-xxiii. DOI: 10.1016/j.ajo.2018.07.022. View

Kumar R, Rackenchath M, Sathidevi A, Nagaraj S, Moe C, Stamper R . Accuracy of pinhole visual acuity at an urban Indian hospital. Eye (Lond). 2018; 33(2):335-337. PMC: 6367369. DOI: 10.1038/s41433-018-0237-6. View

Marmamula S, Madala S, Rao G . Rapid assessment of visual impairment (RAVI) in marine fishing communities in South India--study protocol and main findings. BMC Ophthalmol. 2011; 11:26. PMC: 3184277. DOI: 10.1186/1471-2415-11-26. View

Hunter D, Cotter S . Early diagnosis of amblyopia. Vis Neurosci. 2018; 35:E013. DOI: 10.1017/S0952523817000207. View

Pilling R, Outhwaite L . Are all children with visual impairment known to the eye clinic?. Br J Ophthalmol. 2016; 101(4):472-474. DOI: 10.1136/bjophthalmol-2016-308534. View

10.

Atowa U, Hansraj R, Wajuihian S . Visual problems: a review of prevalence studies on visual impairment in school-age children. Int J Ophthalmol. 2019; 12(6):1037-1043. PMC: 6580204. DOI: 10.18240/ijo.2019.06.25. View

11.

Jin J . Vision Screening in Children. JAMA. 2017; 318(9):878. DOI: 10.1001/jama.2017.11386. View

12.

Tailor V, Bossi M, Greenwood J, Dahlmann-Noor A . Childhood amblyopia: current management and new trends. Br Med Bull. 2016; 119(1):75-86. PMC: 5862311. DOI: 10.1093/bmb/ldw030. View

13.

Thomas J, Rajashekar B, Kamath A, Gogate P . Diagnostic accuracy and agreement between visual acuity charts for detecting significant refractive errors in preschoolers. Clin Exp Optom. 2019; 103(3):347-352. DOI: 10.1111/cxo.12962. View

14.

Fu Z, Hong H, Su Z, Lou B, Pan C, Liu H . Global prevalence of amblyopia and disease burden projections through 2040: a systematic review and meta-analysis. Br J Ophthalmol. 2019; 104(8):1164-1170. DOI: 10.1136/bjophthalmol-2019-314759. View

15.

Marmamula S, Keeffe J, Narsaiah S, Khanna R, Rao G . Population-based assessment of sensitivity and specificity of a pinhole for detection of significant refractive errors in the community. Clin Exp Optom. 2014; 97(6):523-7. DOI: 10.1111/cxo.12172. View

16.

Good W . Vision Screening in Very Young Children-Making Sense of an Inexorable Diagnostic Process. JAMA Pediatr. 2017; 171(11):1046-1047. DOI: 10.1001/jamapediatrics.2017.2389. View

17.

Moganeswari D, Thomas J, Srinivasan K, Jacob G . Test Re-Test Reliability and Validity of Different Visual Acuity and Stereoacuity Charts Used in Preschool Children. J Clin Diagn Res. 2015; 9(11):NC01-5. PMC: 4668442. DOI: 10.7860/JCDR/2015/14407.6747. View

18.

Sanker N, Dhirani S, Bhakat P . Comparison of visual acuity results in preschool children with lea symbols and Bailey-Lovie E chart. Middle East Afr J Ophthalmol. 2013; 20(4):345-8. PMC: 3841955. DOI: 10.4103/0974-9233.120020. View

19.

Solebo A, Cumberland P, Rahi J . Whole-population vision screening in children aged 4-5 years to detect amblyopia. Lancet. 2014; 385(9984):2308-19. DOI: 10.1016/S0140-6736(14)60522-5. View

20.

Ben Margines J, Huang C, Young A, Mehravaran S, Yu F, Mondino B . Refractive Errors and Amblyopia Among Children Screened by the UCLA Preschool Vision Program in Los Angeles County. Am J Ophthalmol. 2019; 210:78-85. DOI: 10.1016/j.ajo.2019.10.013. View