Major Article
Testability of refraction, stereopsis, and other ocular measures in preschool children: The Sydney Paediatric Eye Disease Study

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Purpose

To determine the testability and lower age limits for applying common eye tests to preschool children.

Methods

Investigators from the Sydney Paediatric Eye Disease Study examined 2,461 children aged 6 to 72 months between 2007 and 2009. Cycloplegic autorefraction was measured with Retinomax and Canon autorefractors. Ocular biometry was measured by the use of IOLMaster in children aged >30 months. The Randot Preschool Stereoacuity test, Lang-Stereotest II, and the Stereo Smile II test were administered to assess stereoacuity. Fundus photography was performed with the subjects' pupils dilated. Testability was defined as the ability to successfully complete tests in both eyes.

Results

There were 2,189 children with complete data. Most were testable with the Retinomax (71.8%) and Canon (66.0%) autorefractors. Testability improved with age (P for trend <0.0001) for both, and Retinomax achieved >70% testability when a subject was 24 months of age, half the age limit (48 months) found for Canon. IOLMaster was mostly testable in children aged 48+ months. Lang-Stereotest II could be used in children aged 6 months and achieved the greatest testability (94.4%) of all stereotests. White children performed better than children of some other ethnicities on Randot (P = 0.007), with girls performing better than boys (P = 0.01). Bilateral photography was achieved in >70% of preschool children 48 months of age.

Conclusions

The testability of all measures was strongly age related, with mostly no sex or ethnicity effects found. The handheld Retinomax could be tested in >70% of children aged 24 months, younger than that found for the stationary Canon autorefractor (48 months). Testability measures for most eye tests in this preschool sample are comparable to other preschool studies.

Section snippets

Subjects and Methods

The Sydney Paediatric Eye Disease Study (SPEDS) was conducted between 2007 and 2009. The Australian Bureau of Statistics data (2006) was used to identify 3,333 eligible children between the ages of 6 and 72 months. Study subjects were recruited via door-to-door census in four randomly selected postcodes in metropolitan Sydney. These postcodes were selected by the use of random cluster sampling, stratified by socioeconomic status, to represent each of the 3 major strata in Sydney (inner city,

Results

After children with incomplete or missing data were excluded, a total of 2,189 children were included in this report. Their mean age was 36.9 ± 19.7 (SD) months, with slightly more children in the youngest age bracket (6 to <12 months, 13.2%) than in the other age groups (Table 1). There were slightly more boys (53.7%) than girls in this sample, but there were no overall significant differences between the sexes across age groups (P = 0.42). White was the dominant ethnic group (45.8%), followed

Refraction

The handheld Retinomax was testable in 71.8% of our 6- to 72-month-old participants. In previous studies, investigators have shown that more than 95.4% of children 36 months of age or older could achieve confidence readings of 8 or greater in either eye without cycloplegia when used by professionals.24 In a study in which the authors used cycloplegia, an overall 89% of children 6 to 72 months of age could complete the test in both eyes.22 By comparison, our Retinomax testability was slightly

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  • Cited by (0)

    Financial support: National Health and Medical Research Council (NHMRC) grant number 402425 and Westmead Millennium Institute, University of Sydney.

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