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Objective School-based vision programs (SBVPs) are one approach to increase access to vision care by providing vision screenings, eye examinations, and eyeglasses directly in schools. Few studies report on the perspectives of teachers and staff, who are important stakeholders, on SBVPs. We examined teacher and staff perspectives on their involvement in SBVPs. Design Qualitative study using focus groups. Participants Teachers and staff at Baltimore and Chicago public schools served by SBVPs between 2016 and 2018. Methods We conducted 21 semistructured focus groups with 117 teachers and staff in 10 Baltimore and 11 Chicago public preK–12 schools that participated in SBVPs. Sessions were recorded, transcribed, and coded using inductive thematic analysis. Results Participants identified 2 main themes regarding teacher and staff involvement in SBVPs: (i) program outreach, including using multiple communication modalities to engage parents, explaining program details to families, and helping with program consent form return and (ii) promoting vision health, including identifying vision problems in the classroom, encouraging eyeglasses wear, and supporting eyeglasses maintenance. Participants also discussed limitations in capacity to partake in these activities. Conclusion Teachers interact with parents and students throughout the SBVP process, undertaking important roles in outreach and health promotion to ensure uptake of SBVP services. SBVPs and other school-based health programs should explore strategies to support teachers in the roles they fill to optimize program impact.

To evaluate differences between autorefraction measurements with and without cycloplegia among school-aged individuals and to explore factors associated with significant differences.Cross-sectional, retrospective study.Individuals between 3 and 22 years of age evaluated at the Illinois College of Optometry from September 2016 through June 2019 who underwent same-day noncycloplegic and cycloplegic autorefraction of the right eye.Demographic information including age, sex, and race or ethnicity were collected during the eye examination. Autorefraction was performed before and after cycloplegia. Myopia, defined as at least -0.50 diopter (D) spherical equivalent (SE), hyperopia, defined as at least +0.50 D SE, and astigmatism of at least 1.00 D cylinder were determined using noncycloplegic and cycloplegic autorefractions. Factors associated with at least 1.00 D more myopic SE or at least 0.75 D cylindrical difference by noncycloplegic autorefraction were assessed using logistic regression models.Differences between noncycloplegic and cycloplegic autorefraction measurements.The mean age was 10.8 ± 4.0 years for the 11 119 individuals; 52.4% of participants were female. Noncycloplegic SE measured 0.65 ± 1.04 D more myopic than cycloplegic SE. After adjusting for demographic factors and refractive error, individuals with at least 1.00 D of more myopic SE refraction by noncycloplegic autorefraction (25.9%) were more likely to be younger than 5 years (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.18-1.79) and 5 to younger than 10 years (OR, 1.32; 95% CI, 1.18-1.48) than those 10 to younger than 15 years. This difference of at least 1.00 D of more myopic SE was more likely to be observed in Hispanic people (OR, 1.23; 95% CI, 1.10-1.36) and those with hyperopia (OR range, 4.20-13.31). Individuals with 0.75 D or more of cylindrical difference (5.1%) between refractions were more likely to be younger than 5 years, to be male, and to have mild-moderate-high myopia or moderate-high hyperopia.Three quarters of school-aged individuals had1 D of myopic SE difference using noncycloplegic compared with cycloplegic autorefraction. Understanding measurement differences obtained for refractive error and associated factors may provide useful information for future studies or programs involving refraction in school-aged children.

Objective We describe the Baltimore Reading and Eye Disease Study, report baseline ocular findings, and explore the feasibility of eye examinations in the school setting. Design Prospective, school-based cohort study. Participants Students in second and third grades. Methods Baseline eye examinations, including near and distance presenting visual acuity (VA), stereopsis, ocular alignment, dilated retinal examination, and cycloplegic refraction, were performed in 12 Baltimore public schools during the 2014–15 school year. Main outcome measures Presenting VA, prevalence of refractive error, and other ocular findings. Results Among the 1054 eligible students, 321 participated. There were 271 (84.4%) African American and 186 (57.9%) female students; mean age was 7.9 ± 0.8 years. Cycloplegia was achieved in 308. The mean presenting distance and near VA was 0.1 ± 0.2 logMAR (range −0.1 to 1.5) and 0.1 ± 0.2 logMAR (range 0.0–1.6) in the better-seeing eye, respectively. The most common ocular findings were +1.00 diopter (D) or greater hyperopia (34.7%), −0.50 D or greater myopia (29.5%), 1.00 D or greater astigmatism (23.4%), and convergence insufficiency (7.2%). Thirty-seven (11.5%) children needed referral to an eye care provider; 10% of students required glasses full-time. Conclusions Whereas the majority of second and third grade students in this study have good VA and minimal refractive error, 1 in 9 have an ocular finding necessitating further evaluation. It was feasible to conduct cycloplegic eye examinations in the school setting.

Web-based survey data collection has become increasingly popular, and limitations on in-person data collection during the COVID-19 pandemic have fueled this growth. However, the anonymity of the online environment increases the risk of fraud, which pose major risks to data integrity. As part of a study of COVID-19 and the return to in-person school, we implemented a web-based survey of parents in Maryland, USA, between December 2021 and July 2022. Recruitment relied, in part, on social media advertisements. Despite implementing many existing best practices, the survey was challenged by sophisticated fraudsters. In this paper, we describe efforts to identify and prevent fraudulent online survey responses and provide specific, actionable recommendations for identifying and preventing online survey fraud. Some strategies can be deployed within the web-based data collection platform such as Internet Protocol address logging to identify duplicate responses and comparison of client-side and server-side time stamps to identify responses that may have been completed by respondents outside of the survey’s target geography. Additional approaches include the use of a 2-stage survey design, repeated within-survey and cross-survey validation questions, the addition of “speed bump” questions to thwart careless or computerized responders, and the use of optional open-ended survey responses to identify irrelevant responses. We describe best practices for ongoing survey data review and verification, including algorithms to simplify aspects of this review.

To report refractive error findings in Baltimore City schoolchildren who failed school-based vision screenings.In this cross-sectional analysis, students pre-kindergarten through 8Of 7520 students who failed screening, 6627 (88%) were analyzed. Clinically significant refractive error and any refractive error were found in 2352 (35.5%) and 5952 (89.8%) students, respectively. Mild myopia (45%, -0.50 D to-3.00 D SE) and low astigmatism (47%, 1.00 D to3.00 D cylinder) were the most prevalent types of refractive error. Proportions of students with myopia increased with higher grade levels (PA Baltimore school-based vision program identified a substantial number of students with refractive error in a high-poverty urban community. Over 1/3 students who failed vision screening had clinically significant refractive error, with black and Latinx students at higher risk of having myopia and astigmatism.

The concept of Just-In-Time Training (JITT) is to provide critical information specific to a public health crisis, allowing individuals to understand and respond to an urgent situation. The design of the JITT curriculum appropriate for school-aged children during the COVID-19 pandemic is vital, as every individual has a role to play in mitigating the spread of SARS-CoV-2. When working with various communities, considering culture and religion is essential, as aligning values and beliefs with the JITT curriculum’s objectives may significantly change the community’s behavior toward a public health crisis. In this narrative, we describe how a JITT curriculum for the COVID-19 pandemic, created in Maryland, US, and implemented in a Catholic school system, aligned with core Catholic social teachings. This alignment allowed for implementing and delivering the COVID-19 curriculum in Maryland’s Archdiocese Catholic school system, culminating in a medical-religious partnership that serves as a model for future public health crises.

Objective: School-based vision programs provide care directly in schools. Parental consent is typically required for student participation. In this paper, we examine school-level factors associated with consent form return. Methods: We included 123 schools served by a vision program in Baltimore, Maryland between the 2016-17 and 2018-19 school years. Multiple linear regression modeling was used to examine the associations between consent return rate and school type (elementary, elementary/middle or middle school), school size, student attendance, student mobility, percent of students in special education, poverty (percent eligible for free and reduced-price lunch), teacher qualifications, parent response rate to annual school climate survey, vision screening failure rate, and year of vision program participation (cohort). Results: The final model explained 26.2% of variability in consent return rate. Overall consent return rate was 57.8% (range 9.4%-100%). School size (β = -2.419, p < .01) and cohort (βCohort2 = 11.988, p < .01) were significantly associated with consent rate. Whereas poverty (β = 0.225, p < .10) and mobility (β = -0.647, p < .10) were relevant, they did not reach statistical significance. Conclusions: School-level factors are significantly associated with consent form return rates. School-based vision programs should consider additional measures to increase consent form return, especially in larger schools and schools with high rates of student mobility.

Objective This study assesses a new departmental role—a professionalism mentor—who receives sexual harassment reporting, liaisons with campus resources, and organizes educational sessions. Study Design Multicenter randomized controlled survey study. Methods Academic ophthalmology departments in the United States were randomized to a professionalism mentor group (n = 9) and a control group (n = 7). Among both pre- and postsurveys, 605 faculty and trainee responses were received and 546 were complete. The intervention group was assigned a professionalism mentor with educational session for a 6- to 10-month period. Sexual harassment and reporting rate change over time were compared between the two groups. Results Among 546 anonymous responses, 16% experienced workplace sexual harassment during the prior 10 months. Location in the South or Midwest was a risk factor (p Conclusion This study identified a high sexual harassment rate in academic ophthalmology departments over a brief period. The presence of a professionalism mentor was viewed favorably and may lead to increased reporting.

Background While ethics and professionalism are important components of graduate medical education, there is limited data about how ethics and professionalism curricula are taught or assessed in ophthalmology residency programs. Objective This study aimed to determine how U.S. ophthalmology residency programs teach and assess ethics and professionalism and explore trainee preparedness in these areas. Methods Directors from accredited U.S. ophthalmology residency programs completed an online survey about components of programs' ethics and professionalism teaching curricula, strategies for assessing competence, and trainee preparedness in these areas. Results Directors from 55 of 116 programs (46%) responded. The most common ethics and professionalism topics taught were informed consent (38/49, 78%) and risk management and litigation (38/49, 78%), respectively; most programs assessed trainee competence via 360-degree global evaluation (36/48, 75%). While most (46/48, 95%) respondents reported that their trainees were well or very well prepared at the time of graduation, 15 of 48 (31%) had prohibited a trainee from graduating or required remediation prior to graduation due to unethical or unprofessional conduct. Nearly every program (37/48, 98%) thought that it was very important to dedicate curricular time to teaching ethics and professionalism. Overall, 16 of 48 respondents (33%) felt that the time spent teaching these topics was too little. Conclusion Ophthalmology residency program directors recognized the importance of an ethics and professionalism curriculum. However, there was marked variation in teaching and assessment methods. Additional work is necessary to identify optimal strategies for teaching and assessing competence in these areas. In addition, a substantial number of trainees were prohibited from graduating or required remediation due to ethics and professionalism issues, suggesting an impact of unethical and unprofessional behavior on resident attrition.

Congenital corneoscleral epithelial cysts can be associated with scleral thinning secondary to pressure from the expanding cyst. We report a congenital scleral epithelial cyst associated with a likely primary partial-thickness scleral defect. The defect appeared as a full-thickness communication between the cyst and posterior chamber on ultrasound biomicroscopy, most likely because the scleral remnant was too thin to be appreciated on imaging. The cyst was treated surgically by aspiration, excision of the anterior wall, and fibrin glue closure of the cyst cavity, with no recurrence after 14 months of follow-up.

Purpose: To examine factors decreasing participation in school-based vision programs from parent and teacher perspectives.Methods: We conducted 41 semi-structured focus groups (20 parent groups, 21...

Current guidelines recommend against neurodiagnostic testing for the evaluation of simple febrile seizures.(1) Assess overall and institutional rates of neurodiagnostic testing and (2) establish achievable benchmarks of care (ABCs) for children evaluated for simple febrile seizures at children's hospitals.Cross-sectional study of children 6 months to 5 years evaluated in the emergency department (ED) 2016-2019 with simple febrile seizures at 38 children's hospitals in Pediatric Health Information System database. We excluded children with epilepsy, complex febrile seizures, complex chronic conditions, and intensive care.Proportions of children who received neuroimaging, electroencephalogram (EEG), or lumbar puncture (LP) and rates of hospitalization for study cohort and individual hospitals. Hospital-specific outcomes were adjusted for patient demographics and severity of illness. We utilized hospital-specific values for each measure to calculate ABCs.We identified 51,015 encounters. Among the study cohort 821 (1.6%) children had neuroimaging, 554 (1.1%) EEG, 314 (0.6%) LP, and 2023 (4.0%) were hospitalized. Neurodiagnostic testing rates varied across hospitals: neuroimaging 0.4%-6.7%, EEG 0%-8.2%, LP 0%-12.7% in patients1-year old and 0%-3.1% in patients ≥1 year. Hospitalization rate ranged from 0%-14.5%. Measured outcomes were higher among hospitalized versus ED-only patients: neuroimaging 15.3% versus 1.0%, EEG% 24.7 versus 0.1% (p .001). Calculated ABCs were 0.6% for neuroimaging, 0.1% EEG, 0% LP, and 1.0% hospitalization.Rates of neurodiagnostic testing and hospitalization for simple febrile seizures were low but varied across hospitals. Calculated ABCs were 0%-1% for all measures, demonstrating that adherence to current guidelines is attainable.

In an effort to address health care disparities in pediatric eye care, school-based vision programs have been established. These programs, while not universally available, have been established at individual schools or across school districts in at least 20 states in the United States (US). They play a critical role for students who are not accessing eye care, especially in disadvantaged communities. In the US, school-based vision programs often provide vision screenings, eye exams, and eyeglasses directly in the school setting. The rationale for involving schools in vision care delivery is the recognition of the inter-relatedness between health and education, including how poor vision can impact learning. Vision for Baltimore is a citywide school-based vision program that provides vision care for all Baltimore City Public Schools elementary and middle school students (age range 4 to 16 years). The goal of this paper is to summarize lessons learned from our work on clinical outcomes from screenings and eye exams, the academic impact of Vision for Baltimore, and qualitative work about consent challenges and stakeholder engagement. While school-based vision programs may vary in operations, we hope the lessons learned through our work may help demonstrate the transformative impact on vision and learning, as well as the importance of addressing stakeholder needs to maximize impact and ensure program sustainability.

To investigate the relationship between neighbourhood disadvantage and vision screening failure rates. This analysis uses aggregate data from pre-kindergarten to eighth grade schools participating in a school-based vision programme in Baltimore, Maryland, from 2016 to 2019. Data on number of students screened and number of students who failed vision screening per grade level were recorded for each school. The Area Deprivation Index (ADI) was obtained for each school using the school’s ZIP+4 code. The association between vision screening failure rates by grade and school ADI was analysed using negative binomial regression models, adjusted for grade level and accounting for clustering by school. Nine hundred seventy-two grades across 117 schools were included in this analysis. Median national ADI percentile across the sample was 71 [interquartile range (IQR): 48–85] (100 = most deprived). The median grade-level screening failure rate across the entire sample was 33% [IQR: 26–41%]. School ADI was not associated with vision screening failure rate (incidence rate ratio (IRR) = 1.01 per 10 percentage point increase in ADI, 95% CI: 0.99, 1.03, p = 0.217). In this study, there was no association between vision screening failure rates and school ADI. With one in three students failing screening in a high poverty public school district, these findings suggest a high need for vision services across schools in all neighbourhoods. Future work should investigate the impact of students’ home ADI and socioeconomic status on vision screening outcomes.

The burden of childhood visual impairment and disparities in access to pediatric vision care remain pressing issues in the United States. School-based vision programs (SBVPs) serve as one approach to advancing health equity. Operating at the intersection of schools and healthcare, SBVPs can increase access to pediatric vision services, improve academic performance, and facilitate referrals to community vision care providers. To maximize their impact, SBVPs must tailor their services to the individual needs and resources of local school communities. School nurses, who have strong ties to school health care services and the school community, are trusted partners in building SBVPs. This article aims to facilitate SBVP development, implementation, and sustainability processes by offering guidance for school nurses and other stakeholders who aim to build a SBVP, support local programs, or learn more about how SBVPs operate.

Pediatric vision screening detects children at risk for visual conditions with the goal of connecting those in need with an eye care provider for evaluation and treatment. The primary aim for vision screening in younger children is the detection of those at risk for amblyopia, which can result in irreversible vision loss if left untreated. In older children, screening goals broaden to include the detection of risk for uncorrected refractive error. In the United States, professional organization guidelines and state-mandated requirements for vision screening vary widely across both the timing and components of screening. In this article, we describe the goals and components of pediatric vision screenings, current challenges, novel approaches to providing follow-up services through school-based vision programs, and future directions.

IMPORTANCE: Uncorrected refractive error in school-aged children may affect learning. OBJECTIVE: To assess the effect of a school-based vision program on academic achievement among students in grades 3 to 7. DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized clinical trial was conducted in Baltimore City Public Schools during school years from 2016 to 2019 among 2304 students in grades 3 to 7 who received eye examinations and eyeglasses. INTERVENTION: Participating schools were randomized 1:1:1 to receive eye examinations and eyeglasses during 1 of 3 school years (2016-2017, 2017-2018, and 2018-2019). MAIN OUTCOMES AND MEASURES: The primary outcome was 1-year intervention impact, measured by effect size (ES), defined as the difference in score on an academic test (i-Ready or Partnership for Assessment of Readiness for College and Careers tests on reading and mathematics) between intervention and control groups measured in SD units, comparing cohort 1 (intervention) with cohorts 2 and 3 (control) at the end of program year 1 and comparing cohort 2 (intervention) with cohort 3 (control) at the end of program year 2. The secondary outcome was 2-year intervention impact, comparing ES in cohort 1 (intervention) with cohort 3 (control) at the end of program year 2. Hierarchical linear modeling was used to assess the impact of the intervention. Analysis was performed on an intention-to-treat basis. RESULTS: Among the 2304 students included in the study, 1260 (54.7%) were girls, with a mean (SD) age of 9.4 (1.4) years. The analysis included 964 students (41 schools) in cohort 1, 775 students (41 schools) in cohort 2, and 565 students (38 schools) in cohort 3. There were 1789 Black students (77.6%), 388 Latinx students (16.8%), and 406 students in special education (17.6%). There was an overall 1-year positive impact (ES, 0.09; P = .02) as assessed by the i-Ready reading test during school year 2016-2017. Positive impact was also observed among female students (ES, 0.15; P

Purpose To explore stakeholders' perceptions of a school-based vision programme (SBVP). Methods We conducted 20 focus groups with 105 parents and teachers at schools in Baltimore, MD, that participated in a SBVP. Facilitators used a semi-structured interview guide to discuss participants' perceptions of the SBVP. Focus groups were audio-recorded, transcribed, and coded using inductive thematic analysis. Results Participant perceptions fell into three categories: benefits of school-based eye care, limitations of school-based eye care, and observation of impact. The majority of participants had positive comments about the programme; benefits included convenience (location, time, and cost), the comprehensive nature of the programme, the quality of the eyeglasses and ability to receive replacements, and a positive screening/exam experience. Limitations of programme impact were related to communication and organisation, the time to receive the glasses, missed instructional time, and uncertainty about screenings. Observations of impact included academic and classroom improvements, as well as visual and other health improvements. Conclusion Parents and teachers reported mostly positive perceptions regarding the SBVP. Their appreciation for the convenience underscores that location, cost, time, and comprehensive services are crucial aspects for implementing a successful programme. To maximize impact, programs must also implement robust communication campaigns that integrate into the schools' workflow to help parents and teachers stay engaged in the process from start to finish.

Approximately 25% of school-aged children in the United States have vision abnormalities, most commonly refractive error that can be corrected with spectacles. Limited follow-up adherence after failed school-based vision screening led to an increase in school-based eye care programs that provide screening, eye examinations, and spectacle prescription at the school. These programs address the access barrier and often provide the first point of contact between children and eye care. Nevertheless, several lower prevalence conditions, such as amblyopia, strabismus, and glaucoma, cannot be adequately treated in the school setting, and some require frequent and long-term follow-up, necessitating referral to eye care providers in the community. We conducted a literature review and identified 10 programs that provided school-based screening, examinations, and spectacle prescription and reviewed their referral rates, criteria, mechanisms, adherence, ocular findings at referral, and long-term care plans. Most programs referred 1% to 5% of screened children. Most communicated with parents or guardians through referral letters and used various strategies to incentivize adherence. Referral adherence was 20-50% in the four programs that reported these data. School-based eye care programs rarely referred children for long-term follow-up care needs, such as updating spectacle prescriptions annually.

Background/aimsFetal haemoglobin (HbF) has an oxyhaemoglobin dissociation curve that may affect systemic oxygenation and the development of retinopathy of prematurity (ROP). The study aim is to characterise the effects of HbF levels on systemic oxygenation and ROP development.MethodsProspective study conducted from 1 September 2017 through 31 December 2018 at the Johns Hopkins NICU. Preterm infants with HbF measured at birth, 31, 34 and 37 weeks post-menstrual age (PMA), complete blood gas and SpO2recorded up to 42 weeks PMA, and at least one ROP exam were included.ResultsSixty-four preterm infants were enrolled. Higher HbF was associated with significantly higher SpO2, lower PCO2, lower FiO2from birth to 31 weeks PMA and 31 to 34 weeks PMA (rs=0.51, rs=−0.62 and rs=−0.63; ps=0.71, rs=−0.58 and rs=−0.79; p2was required for HbF in the lowest tercile from birth compared with HbF in the highest tercile to 31 weeks and 31 to 34 weeks PMA; FiO2=35 (21–100) versus 21 (21–30) p2=30 (28–100) versus 21 (21–30) p2, and lower levels of HbF (pConclusionLow HbF levels correlated with poor oxygenation indices and increased risk for ROP. O2saturation goals to prevent ROP may need to incorporate relative amount of HbF.

Background Health care delivery in schools is a frequently adopted approach to reduce health care inequalities. Lack of parental trust has been identified as impacting participation in school-based health care programs (SBHPs). The aim of our systematic review is to outline themes related to parental trust in SBHPs. Methods We searched MEDLINE, Embase, CINHAL, ERIC, PsycInfo, and Web of Science for articles published between 1969 and 2019. Eligible studies (1) were peer-reviewed primary research articles; (2) were school-based health interventions or screening programs; (3) included parental trust data; and (4) were carried out on schoolchildren from pre-K to grade 12. Study location, data collection date, number of participants, demographics, intervention type, study aim and methodology, and all trust themes mentioned, were extracted. Studies were critically appraised using the CASP checklist for qualitative research. Results We identified 9 themes related to parental trust in SBHPs: (1) safety; (2) effectiveness; (3) health professionals' training and credentials; (4) communication; (5) confidentiality; (6) providers; (7) government, authorities, and health service; (8) the pharmaceutical industry; and (9) research and data sharing. Conclusions The themes identified provide a framework for examining trust in SBHPs, and may guide the development of interventions to increase trust and engagement in SBHPs.

For the past decade, school‐based health centers (SBHCs) have become one important solution for increasing access to care for children from disadvantaged backgrounds in the United States 1, 2 This is especially critical given that children in underserved communities have higher rates of asthma, obesity, mental health disorders, and are less likely to receive routine care from community providers 1 With the onset of the COVID‐19 pandemic and the resultant nationwide K‐12 school closures, SBHCs have had to adopt alternate strategies to continue providing care to school children in need, with some not having the capacity to remain open at all 3

Objective There are unmet needs for refractive correction in the pediatric population, especially in high-poverty communities. We reported the impact of refractive correction on vision outcomes over a 2-year follow-up in the Baltimore Reading and Eye Disease Study. Design Prospective, school-based cohort study. Participants Students of second and third grades who were prescribed glasses during baseline assessment. Methods We conducted baseline eye exams in 12 Baltimore public schools during the fall of school year 2014–15 with follow-up visits in the spring of school year 2014–15 (first follow-up) and school year 2015–16 (second follow-up). Visual acuity (VA) was measured at distance and near with correction. Refractive status was determined based on the eye with the larger refractive error and categorized as myopia, hyperopia, and astigmatism. Main outcome measures VA in better-seeing and worse-seeing eye at first and second follow-up, and acuity improvement from baseline. Results In the 206 students (84% African American) who completed the first follow-up, both distance (from 0.14 ± 0.20 to 0.05 ± 0.10 logMAR) and near presenting VA (from 0.08 ± 0.16 to 0.03 ± 0.06 logMAR) improved from the baseline assessment; children with more severe hyperopia showed improvement in near VA by 0.05 ± 0.16 logMAR. Children who were prescribed glasses through a school-based research study had improved vision, which was sustained into the following school year. Conclusions Many second and third graders in Baltimore Schools needed refractive correction and benefited from provision of glasses with sustained vision improvement over the 2-year observation.

PURPOSE To compare the vision needs of children wearing and not wearing eyeglasses who failed school-based vision screening. METHODS Students aged 4 to 16 years in 41 Baltimore City schools were screened using distance visual acuity (VA) and photoscreening. Students failing screening underwent school-based non-cycloplegic examination. We compared students who were wearing eyeglasses at failed screening with those not wearing eyeglasses with respect to age, sex, right-eye refractive error, right-eye presenting, and best-corrected VA (BCVA). RESULTS A total of 2176 students failed screening and completed the examination; 94 (4.3%) failed while wearing eyeglasses. Students wearing eyeglasses were older (mean age 10.2 vs 8.8 years, p

Vision screenings of a school-based program were conducted in state-mandated grades (pre-kindergarten [pre-K] or kindergarten [K], 1st and 8th grade), and nonmandated grades (2nd to 7th).During school years 2016-19, 51,593 pre-K to 8th grade students from 123 Baltimore City Public Schools underwent vision screenings, with 85% of the schools qualifying for Free and Reduced Price Meals. Assessments included distance visual acuity, Spot photoscreening, stereopsis, and cover testing. Screening failures were analyzed by grade using aggregate data. Failure rates for mandated and nonmandated grades were compared using a logistic regression model, and visual acuity distributions were analyzed using individual data.Over the 3-year period, 17,414 (34%) of students failed vision screening. Failure rates by grade ranged from 28% to 38%. Children in kindergarten and 3rd grade and higher were statistically more likely to fail screening than those in 1st grade. Reduced visual acuity was the most common reason for failure (91%). Failure rates were significantly higher in nonmandated grades than in state-mandated testing grades (34.7% vs 32.5% [P 0.001]). Mean visual acuity of all students who failed vision screening was 20/50 in the worse-seeing eye and was 20/40 in the better-seeing eye.One-third of students failed vision screening. High screening failure rates across all grades suggest that screening in select grade levels, as currently mandated in Maryland schools, is inadequate for detecting vision problems in the low-income communities served by this program.

Faculty and students have long complained about the prohibitive costs of textbooks. The National Bureau of Labor Statistics has found that the price of textbooks has risen more than 1000 percent since the 1970s and a study by Public Research Interest Group found that of all students have skipped purchasing a textbook because of the cost. This problem is acute at Prairie View A&M University (PVAMU), an HBCU located northwest of Houston, TX. This study uses survey and grade distribution data to examine the effectiveness a pilot program designed to increase student accessibility to textbooks as well as improve students’ academic performance. We found statistically significant impacts on early assignments and positive increases in student attitudes towards their classes.

Objective: In this investigation, we identify the questions youth in a low-income urban community asked healthcare providers about COVID-19 Methods:This formative qualitative study consisted of analyzing data collected using Poll Everywhere as part of 3 phone town halls with a pulmonary and critical care medicine physician and youth Results: During the 3 town halls, there were 143 participants who asked 43 questions that were divided into 4 codes: Healthcare, Cure, General COVID-19, and Prevention Conclusion: Youth have questions about healthy behaviors and treatment that can be answered in a low technology forum engagement with health professionals These results also underscore the need to continue health education discussions either through traditional school-based or alternate formats, especially as we anticipate COVID-19 to last during the next academic year

Supplemental Digital Content is available in the text., Grateful patients provide substantial philanthropic funding for health care institutions, resulting in important societal benefits. Although grateful patient fundraising (GPFR) is widespread, it raises an array of ethical issues for patients, physicians, development professionals, and institutions. These issues have not been described comprehensively, and there is insufficient guidance to inform the ethical practice of GPFR. Consequently, the authors convened a “Summit on the Ethics of Grateful Patient Fundraising,” with the goal of identifying primary ethical issues in GPFR and offering recommendations regarding how to manage them. Participants were 29 experts from across the United States who represented the perspectives of bioethics, clinical practice, development, law, patients, philanthropy, psychology, and regulatory compliance. Intensive discussions resulted in articulating ethical issues for physicians and other clinicians (discussions with patients about philanthropy; physician-initiated discussions; clinically vulnerable patients; conflicts of obligation and equity regarding physician’s time, attention, and responsiveness and the provision of special services; and transparency and respecting donor intent) as well as for development officers and institutions (transparency in the development professional–donor relationship; impact on clinical care; confidentiality and privacy; conflicts of interest; institution–patient/donor relationship; concierge services for grateful patients; scientific merit and research integrity; transparency in use of philanthropic gifts; and institutional policies and training in responsible GPFR). While these recommendations promise to mitigate some of the ethical issues associated with GPFR, important next steps include conducting research on the ethical issues in GPFR, disseminating these recommendations, developing standardized training for clinicians regarding them, and revising them as warranted.

Many disadvantaged students with refractive errors, such as myopia (nearsightedness) and hyperopia (farsightedness), do not have eyeglasses, and their reduced vision may impact reading proficiency....

Purpose We report visual acuity improvement and refractive profiles in children prescribed glasses by a school-based vision program (SBVP) in Baltimore, Maryland. Methods In this cross-sectional analysis, pre-kindergarten through 8th grade students who failed vision screening underwent an eye examination. Students prescribed glasses are included. Visual acuity improvement was the difference between presenting and best-corrected visual acuity based on noncycloplegic manifest refraction. Clinically significant refractive error (CSRE) was defined as ≥0.75 D myopia, ≥2.00 D hyperopia without strabismus, ≥1.00 D hyperopia with esodeviation, or ≥1.50 D astigmatism AND presenting visual acuity ≤20/40 or ≥2-line difference with the better-seeing eye ≤20/30. Characteristics associated with greater visual acuity improvement were explored. Results Of the 4,972 students, mean age was 9.4 ± 2.7 years; 77% were black, and 18% were Hispanic. Myopia, hyperopia, astigmatism, and CSRE were found in 65%, 24%, 60%, and 46% students, respectively. In the better-seeing eyes, 70% gained ≥2 lines. Of students with CSRE, improvement of at least 5 lines in the worse-seeing eye increased from 30.9% in pre-kindergarten and kindergarten to 77.3% in 7th and 8th grade (Ptrend Conclusions Most students prescribed glasses from our SBVP had clinically significant visual deficits corrected.

Understanding provider perspectives on telemedicine adoption during the COVID-19 pandemic can help inform best practices for delivering pediatric ophthalmic care safely and remotely. In this online survey distributed to two national pediatric ophthalmology list-servs, respondents in July-August 2020 (n = 104) compared with respondents in March-April 2020 (n = 171) were more likely to report not using and not planning on using telemedicine. The July-August respondents who did not use telemedicine were concerned about the limitations in care provided, challenges with implementation, and perceived negative effects on the doctor-patient relationship. These findings demonstrate a lack of sustained uptake of telemedicine in the first 6 months of the pandemic and concerns that should be addressed to facilitate integration of this approach in pediatric ophthalmic care.

The purpose of this article is to compare alignment outcomes following pediatric strabismus surgery for simple horizontal strabismus in patients with state-based aid, used as a proxy for lower socioeconomic status (SES) with those with private insurance. Medical records of all children treated with horizontal strabismus surgery over a period from 2014-17 were retrospectively reviewed. Medical assistance was used as a proxy for lower SES. Patients were compared to a control population undergoing similar surgery by same surgeons in the same time period. Data points were collected at preoperative and postoperative month 6 visits. Improvement in alignment was the primary outcome variable. Improvement in fusion, amblyopia, and stereopsis were also examined. Demographic information and compliance with treatment recommendations were recorded. 69 patients met inclusion criteria from a total population of 105 patients; 36 were excluded due to loss to follow-up. This was compared to a control group with private insurance; 34 patients were identified out of a total of 38, 4 patients were lost to follow-up. Overall rate of operative success was 71.0% at POM6. Overall rate of success for control group was 73.5%. The difference failed to be statistically significant (p = 0.37). Race, sex, age at time of surgery, and type of strabismus (esotropia, exotropia) failed to correlate with success rate of surgery. Poor compliance with prescribed treatments (glasses, patching/atropine) in both groups correlated with surgical failure. 68.1% of study patients and 70.6% of control reported good compliance with treatment. We present the first analysis of the impact of SES on strabismus surgery outcomes. Overall surgical success rate in our study population failed to differ significantly from a control population and were comparable to that reported in the literature. We found that compliance with treatment influenced surgical success rates in our study population. The high rate of lost to follow-up in the study population is an important factor influencing our conclusion that no difference exists between our groups.

Importance Philanthropy is an increasingly important source of support for health care institutions. There is little empirical evidence to inform ethical guidelines. Objective To assess public attitudes regarding specific practices used by health care institutions to encourage philanthropic donations from grateful patients. Design, Setting, and Participants Using the Ipsos KnowledgePanel, a probability-based sample representative of the US population, a survey solicited opinions from a primary cohort representing the general population and 3 supplemental cohorts (with high income, cancer, and with heart disease, respectively). Exposures Web-based questionnaire. Main Outcomes and Measures Descriptive analyses (with percentages weighted to make the sample demographically representative of the US population) evaluated respondents’ attitudes regarding the acceptability of strategies hospitals may use to identify, solicit, and thank donors; perceptions of the effect of physicians discussing donations with their patients; and opinions regarding gift use and stewardship. Results Of 831 individuals targeted for the general population sample, 513 (62%) completed surveys, of whom 246 (48.0%) were women and 345 (67.3%) non-Hispanic white. In the weighted sample, 47.0% (95% CI, 42.3%-51.7%) responded that physicians giving patient names to hospital fundraising staff after asking patients’ permission was definitely or probably acceptable; 8.5% (95% CI, 5.7%-11.2%) endorsed referring without asking permission. Of the participants, 79.5% (95% CI, 75.6%-83.4%) reported it acceptable for physicians to talk to patients about donating if patients have brought it up; 14.2% (95% CI, 10.9%-17.6%) reported it acceptable when patients have not brought it up; 9.9% (95% CI, 7.1%-12.8%) accepted hospital development staff performing wealth screening using publicly available data to identify patients capable of large donations. Of the participants, 83.2% (95% CI, 79.5%-86.9%) agreed that physicians talking with their patients about donating may interfere with the patient-physician relationship. For a hypothetical patient who donated $1 million, 50.1% (95% CI, 45.4%-54.7%) indicated it would be acceptable for the hospital to show thanks by providing nicer hospital rooms, 26.0% (95% CI, 21.9%-30.1%) by providing expedited appointments, and 19.8% (95% CI, 16.1%-23.5%) by providing physicians’ cell phone numbers. Conclusions and Relevance In this survey study of participants drawn from the general US population, a substantial proportion did not endorse legally allowable approaches for identifying, engaging, and thanking patient-donors.

This study examined the impact of video-based and live standardized patient scenarios on attitudes toward and readiness for interprofessional education (IPE) in occupational therapy (OT) and physical therapy (PT) students. In academic health programs, IPE is used to teach the knowledge and skills to develop interprofessional teamwork abilities; however, research is limited on the impact of standardized patient scenario experiences (SPSE) on the effectiveness of IPE in OT and PT students.The study involved 49 participants: 23 OT and 26 PT students.A descriptive quantitative pilot study measured attitudes and readiness for IPE using a repeated-measures design and the Readiness for Inter-Professional Learning Scale (RIPLS), a 19-item Likert scale. Students completed the RIPLS prior to an interprofessional team assignment, following an interprofessional team meeting to plan the standardized patient evaluation, and after a live SPSE. A 3 x 2 repeated-measures MANOVA analyses was used to determine differences between groups and change over time.Statistically significant changes occurred in Teamwork and Professional Identify subscales of the RIPLS for both groups after the live SPSE.Findings support the use of team-based, live SPSE to improve OT and PT students' readiness for and attitudes toward IPE.

To determine the effect of oral chloral hydrate (CH) sedation on intraocular pressure (IOP) in an outpatient pediatric population.Prospective, noncomparative case series.Children aged 1 month to 5 years undergoing CH sedation for ocular imaging/evaluation at a tertiary eye hospital were included. IOP was measured using an Icare tonometer prior to sedation (in some, not all), at 25 minutes after sedation, and then every 10 minutes until sedation completion. Change in IOP over time was assessed using mixed model linear regression to account for correlation of IOP readings.A total of 112 children were enrolled, 50.9% were female, and mean age was 2.1 (standard deviation [SD]: 1.3) years. Of the total, 83 (74.1%) participants had IOP measurement attempted prior to sedation, with 64 having presedation IOP completed. Among those completing presedation IOP, 46.9% were asleep/calm, and the rest (53.1%) were slightly/more distressed (IOP did not differ by level of agitation). Those with and without presedation IOP available had similar demographics and health status (P.05). Heart rate, respiratory rate, and oxygen saturation all declined after sedation (P.001). The mean dose of CH administered was 80.9 (SD: 13.2) mg/kg, and sedation was deemed "adequate" in 97.3% after a single dose. Mean IOP among those with presedation IOP was 19.5 mm Hg and, although not significant, declined to 18.7 mm Hg at 25 minutes (P = .12). There was no trend toward further decline in IOP over time (P.05).CH sedation for outpatient pediatric ophthalmic procedures as administered in this prospective assessment had no impact on IOP.

Pediatric patients with craniofacial abnormalities face unique challenges requiring early intervention and longitudinal care for their ocular and systemic problems. Non-syndromic and syndromic craniosynostoses involve asymmetric development of the cranial vault and facial bones, which frequently leads to ophthalmic manifestations, including strabismus, refractive error, and visual field losses. In recent years, ophthalmologists, craniofacial surgeons, and pediatricians involved in caring for craniosynostosis patients have found that timely surgery and monitoring, using refined devices such as spectral-domain optical coherence tomography, can lead to improved quality of life and prognosis for these patients. We review relevant literature from the past 5 years describing and managing ocular symptoms of craniosynostosis.

Background The USee device is a new self-refraction tool that allows users to determine their own refractive error. We evaluated the ease of use of USee in adults, and compared the refractive error correction achieved with USee to clinical manifest refraction. Methods Sixty adults with uncorrected visual acuity