Development and validation of a novel questionnaire regarding vision screening among preschool teachers in Malaysia

AIM:To develop and evaluate the validity and reliability of a knowledge,attitude,and practice questionnaire related to vision screening(KAP-VST)among preschool teachers in Malaysia.METHODS:The questionnaire was developed through a literature review and discussions with experts.Content and face validation were conducted by a panel of experts(n=10)and preschool teachers(n=10),respectively.A pilot study was conducted for construct validation(n=161)and test-retest reliability(n=60)of the newly developed questionnaire.RESULTS:Based on the content and face validation,71 items were generated,and 68 items were selected after exploratory factor analysis.The content validity index for items(I-CVI)score ranged from 0.8-1.0,and the content validity index for scale(S-CVI)/Ave was 0.99.Internal consistency was KR^(2)0=0.93 for knowledge,Cronbach’s alpha=0.758 for attitude,and Cronbach’s alpha=0.856 for practice.CONCLUSION:The KAP-VST is a valid and reliable instrument for assessing knowledge,attitude,and practice in relation to vision screening among preschool teachers in Malaysia.

Comparison between two autorefractor performances in large scale vision screening in Chinese school age children

AIM:To evaluate the effectiveness of Grand Seiko Ref/Keratometer WAM-5500 compared to Topcon KR800 autorefractor in detecting refractive error in large scale vision screening for Chinese school age children with the WHO criteria.METHODS:A total of 886 participants were enrolled with mean age of 9.49±1.88 y from Tianjin,China.Spherical equivalent(SE)was obtained from un-cycloplegic autorefraction and cycloplegic autorefraction.Topcon KR 800(Topcon)and Grand Seiko WAM-5500(WAM)autorefractors were used.Bland-Altman Plot and regression were generated to compare their performance.The overall effectiveness of detecting early stage refractive error was analyzed with receiver operating characteristic(ROC)curves.RESULTS:The mean SE was-0.98±1.81 diopter(D)and the prevalence of myopia was 48.9%defined by WHO criteria according to the result of cycloplegic autorefraction.The mean SE of un-cycloplegic autorefraction with Topcon and WAM were-1.21±1.65 and-1.20±1.68 D respectively.There was a strong linear agreement between result obtained from WAM and cycloplegic autorefraction with an R2 of 0.8318.Bland-Altman plot indicated a moderate agreement of cylinder values between the two methods.The sensitivity and specificity for detecting hyperopia were 90.52%and 83.51%;for detecting myopia were 95.60%and 90.24%;for detecting astigmatism were 79.40%and 90.21%;for detecting high myopia were 98.16%and 98.91%respectively.CONCLUSION:These findings suggest that both Grand Seiko and Topcon autorefractor can be used in large-scale vision screening for detecting refractive error in Chinese population.Grand Seiko gives relatively better performance in detecting myopia,hyperopia,and high myopia for school age children.

Enhancing diabetic retinopathy screening:Non-mydriatic fundus photography-assisted telemedicine for improved clinical management

The utilization of non-mydriatic fundus photography-assisted telemedicine to screen patients with diabetes mellitus for diabetic retinopathy provides an accurate,efficient,and cost-effective method to improve early detection of disease.It has also been shown to correlate with increased participation of patients in other aspects of diabetes care.In particular,patients who undergo teleretinal imaging are more likely to meet Comprehensive Diabetes Care Healthcare Effectiveness Data and Information Set metrics,which are linked to preservation of quality-adjusted life years and additional downstream healthcare savings.

Risk evaluation for diabetic retinopathy in Chinese renalbiopsied type 2 diabetes mellitus patients

AIM:To investigate diabetic retinopathy(DR)prevalence in Chinese renal-biopsied type 2 diabetes mellitus(T2DM)patients with kidney dysfunction,and to further evaluate its relationship with diabetic nephropathy(DN)incidence and the risk factors for DR development in this population.METHODS:A total of 84 renal-biopsied T2DM patients were included.Fundus and imaging examinations were employed for DR diagnosis.Demographic information and clinical measures along with renal histopathology were analyzed for comparisons between the DR and non-DR groups.Risk factors on DR development were analyzed with multiple logistic regression.RESULTS:DR prevalence was 50%in total.The incidences of DN,non-diabetic renal disease(NDRD)and mixed-type pathology were 47.6%,19.0%and 33.3%in the DR group respectively,while 11.9%,83.3%and 4.8%in the non-DR group.Systolic blood pressure,ratio of urinary albumin to creatine ratio,urinary albumin,24-hours urinary protein,the incidence and severity of DN histopathology were found statistically increased in the DR group.Multiple logistic regression analysis showed histopathological DN incidence significantly increased the risk of DR development[odds ratio(OR)=21.664,95%confidential interval(CI)5.588 to 83.991,P<0.001 for DN,and OR=45.475,95%CI 6.949 to 297.611,P<0.001 for mixed-type,respectively,in reference to (NDRD)],wherein DN severity positively correlated.CONCLUSION:Renal histopathological evidence indicates DN incidence and severity increases the risk of DR development in Chinese T2DM patients inexperienced of regular fundus examinations.

Screening for amblyopia among grade-1 students in primary school with uncorrected vision and stereopsis test in central China

Background Screening for amblyopia at earliest is important for early treatment and better prognosis. This study aimed to evaluate the validity of uncorrected distant and near visual acuity （VA） and stereoacuity for screening amblyopia in grade-1 students in primary school in central China. Methods By stratified cluster sampling, 3112 grade-1 students from 11 Anyang primary schools were selected for the study. All the participants underwent uncorrected distant and near VA, stereopsis test, cycloplegic refraction, best corrected VA （BCVA）, cover test, and ocular movement examination. VA was measured with a logarithm of the minimum angle of resolution （IogMAR） chart. Stereoacuity was measured with the Lang II stereo card and TNO test. Amblyopia was defined as the BCVA less than or equal to 0.1 IogMAR units of any eye in the absence of significant pathological abnormalities. The sensitivity, specificity, and 3ositive and negative predictive value of uncorrected VA and stereoacuity for amblyopia were analyzed. Results Out of the 3112 eligible students 2893 （92.96%） completed the examinations. The average age of the students was （7.10±0.41） years. Screened by distant VA with low cutoff （IogMAR 0.1）, high cutoff （IogMAR 0.0）, and near VA （IogMAR 0.0）, 31.64%, 73.18%, and 50.23% students were abnormal, respectively. Screened by stereopsis test, only 4.69% students were abnormal. Diagnosed by a senior pediatric ophthalmologist, 61 students had amblyopia. The sensitivities of distant VA with low/high cutoff and near VA were 92.31%, 100%, and 80.77%, respectively, whereas that of stereoacuity by TNO test was 15.38%. Simultaneous testing of either two of the three tests improved the sensitivity. Conclusions Distant VA test of high cutoff alone displays a high sensitivity but a low specificity. Simultaneous testing of distant VA of low cutoff and stereoacuity is a better choice to balance between sensitivity and specificity.

Comparison of computer photoscreening with non cycloplegic retinoscopy for amblyopiogenic risk factors in children

To determine the sensitivity and specificity of using a computer photoscreener and non cycloplegic retinoscopy in the detection of amblyopiogenic factors in nine to fifty months old infants and children Methods Three hundred children, nine to fifty months old, were screened with the computer photoscreener and non cycloplegic retinoscopy With a blinded standardized clinical assessment as the standard, an overall comparison of the sensitivity of and specificity results obtained with the two techniques was made Photoscreen images on the computer monitor screen were reviewed and analyzed immediately by two independent observers for indicators of amblyopiogenic risk factors Simultaneously, the results were compared to the findings of a full ophthalmologic examination Results The computer photoscreener revealed a sensitivity of 94 6% and specificity of 90 1%, and the non cycloplegic retinocopy revealed a sensitivity of 85 7% and specificity of 81 0% for the detection of amblyopiogenic risk factors, including hyperopia (+2 75 D or more), myopia (-1 50 D or more), astigmatism (1 75 D or more), anisometropia (2 00 D or more), ocular misalignment (5 degrees or more), and media opacity (1 5?mm or more) Conclusions The computer photoscreener offers an opportunity to identify problems that limit vision, and could provide a feasible and sufficiently reliable screening technique in infants and preschool children to be screened successfully for amblyopiogenic risk factors

Design,methodology,and baseline of whole city‑million scale children and adolescents myopia survey(CAMS)in Wenzhou,China

Background:Myopia is the most common visual impairment in children and adolescents worldwide.This study described an economical and effective population-based screening pipeline and performed the project of a million scale children and adolescents myopia survey(CAMS),which will shed light on the further study of myopia from the level of epidemiology and precision medicine.Methods:We developed a novel population-based screening pattern,an intelligent screening process and internetbased information transmission and analysis system to carry out the survey consisting of school children in Wenzhou,China.The examination items include unaided distance visual acuity,presenting distance visual acuity,and noncycloplegic autorefraction.Myopia and high myopia were defined as spherical equivalent(SE)≤−1.00 diopters(D)and SE≤−6.00 D,respectively.Next,the reports of the vision checking were automatically sent to parents and the related departments.The CAMS project will be done two to four times annually with the support of the government.An online eyesight status information management system(OESIMS)was developed to construct comprehensive and efficient electronic vision health records(EVHRs)for myopia information inquiry,risk pre-warning,and further study.Results:The CAMS completed the first-round of screening within 30 days for 99.41%of Wenzhou students from districts and counties,in June 2019.A total of 1,060,925 participants were eligible for CAMS and 1,054,251(99.37%participation rate)were selected through data quality control,which comprised 1305 schools,and 580,609,251,050 and 170,967 elementary,middle,and high school students.The mean age of participants was 12.21±3.32 years(6-20 years),the female-to-male ratio was 0.82.The prevalence of myopia in elementary,middle,and high school students was 38.16%,77.52%,and 84.00%,respectively,and the high myopia incidence was 0.95%,6.90%,and 12.98%.Conclusions:The CAMS standardized myopia screening model involves automating large-scale information collection,data transmission,data analysis and early warning,thereby supporting myopia prevention and control.The entire survey reduced 90%of staff,cost,and time consumption compared with previous surveys.This will provide new insights for decision support for public health intervention.