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Objective Paediatric vision screening programs identify children with ocular abnormalities who would benefit from treatment by an eye care professional. A questionnaire was conducted to assess existence and uptake of school-based vision screening programs across Canada. A supplementary questionnaire was distributed among Ontario’s public health units to determine implementation of government mandated vision screening for senior kindergarten children. Methods Chief Medical Officers of Health for each province and territory, and Ontario’s thirty-four public health units were sent a questionnaire to determine: 1) whether school-based vision screening is being implemented; 2) what age groups are screened; 3) personnel used for vision screening; 4) the type of training provided for vision screening personnel; and 5) vision screening tests performed. Results Of the thirteen provinces/territories in Canada, six perform some form of school-based vision screening. Two provinces rely solely on non-school-based programs offering eligible children an eye examination by an optometrist and three rely on ocular assessment conducted by a nurse at well-child visits. In Ontario, where since 2018 vision screening for all senior kindergarten students is government mandated, only seventeen public health jurisdictions are implementing universal vision screening programs using a variety of personnel ranging from food safety workers to optometrists. Conclusion Good vision is key to physical and emotional development. There is an urgent need for a universal, evidence-based and cost-effective multidisciplinary approach to standardize paediatric vision screening across Canada and break down barriers preventing children from accessing eye care.

PurposeRetinopathy of prematurity (ROP) is a potentially blinding condition affecting premature infants for which less than 10% of babies undergoing screening require treatment. This study assessed and validated predictors of developing clinically significant ROP (type 2 or worse) and ROP requiring treatment.DesignNationwide retrospective cohort study.MethodsThis study included infants born between January 2014 and June 2016, admitted to level 3 neonatal intensive care units across Canada who underwent ROP screening. Data were derived from the Canadian Neonatal Network database. Predefined ≥ 1% risk for clinically significant retinopathy or prematurity and ROP requiring treatment was set as threshold for screening. Thirty-two potential predictors were analyzed, to identify and validate the most important ones for predicting clinically significant ROP. The predictors were determined on a derivation cohort and tested on a validation cohort. Multivariable logistic regression modeling was used for analysis.ResultsUsing a sample of 4,888 babies and analyzing 32 potential predictors, capturing babies with ≥1% risk of developing clinically significant ROP equated to screening babies with birth weight (BW) ConclusionsThe Canadian ROP screening criteria can be modified to screen babies with BW

Objective To examine current level three Neonatal Intensive Care Unit (NICU) practices related to ROP screening and treatment. Study design A cross-sectional survey was sent to 29 level three NICU's across Canada to survey current screening inclusion criteria, treatment options, supportive care and post-screening events for ROP. Result 22/29 (76%) level three NICU's responded. Ten different ROP screening inclusion criteria were found to be in use with significant variation in gestational age and birth weight criteria. Many other national variations also exist regarding the supportive and procedural protocols surrounding ROP screening as well as mode of treatment for ROP. Conclusion Despite national guidelines, significant variation in ROP screening inclusion criteria practices exist among neonatal units in Canada. Therefore, there is an urgent need for better evidence-based screening guidelines as well as a need to standardize supportive measures surrounding ROP screening and treatment.

Retinopathy of prematurity (ROP) is a potentially blinding condition affecting premature infants for which less than 10% of babies undergoing screening require treatment. This study assessed and validated predictors of developing clinically significant ROP (type 2 or worse) and ROP requiring treatment.Nationwide retrospective cohort study.This study included infants born between January 2014 and June 2016, admitted to level 3 neonatal intensive care units across Canada who underwent ROP screening. Data were derived from the Canadian Neonatal Network database. Predefined ≥ 1% risk for clinically significant retinopathy or prematurity and ROP requiring treatment was set as threshold for screening. Thirty-two potential predictors were analyzed, to identify and validate the most important ones for predicting clinically significant ROP. The predictors were determined on a derivation cohort and tested on a validation cohort. Multivariable logistic regression modeling was used for analysis.Using a sample of 4,888 babies and analyzing 32 potential predictors, capturing babies with ≥1% risk of developing clinically significant ROP equated to screening babies with birth weight (BW)1,300 g or gestational age (GA)30 weeks while capturing babies with ≥1% risk of requiring ROP treatment equated to screening babies with BW1,200 g or GA29 weeks.The Canadian ROP screening criteria can be modified to screen babies with BW1,200 g or GA30 weeks. Using these criteria, babies requiring treatment would be identified while reducing the number of babies screened unnecessarily.

Background The purpose of this study was to test the sensitivity and specificity of eight undergraduate volunteer examiners conducting vision screening tests in a community setting, in order to determine if non-eye care professionals were able to be trained to an appropriate level of skill. Methods Eight undergraduate volunteer examiners were trained to conduct vision screening tests to address a gap in pediatric community eye care. Phase I of the study was implemented in the pediatric ophthalmology clinic, and phase II was conducted in nine local schools. Phase I consisted of 40 h of training for each volunteer regarding specific vision tests. Phase II consisted of screening children at nine local schools. Results A total of 690 children from nine local schools were screened by both the volunteer examiners and the optometrist during the course of this study. Volunteer examiners had a screening sensitivity of 0.80 (95%CI 0.66–0.90) and screening specificity of 0.75 (95%CI 0.71–0.78) when compared to the study optometrist. The overall accuracy of volunteer examiners was 75%. The resulting positive likelihood ratio was 3.24 (95%CI 2.6–3.9), indicating that a child with vision impairment was 3.2 times more likely to fail the vision test performed by the volunteer examiners compared to a child with no vision impairment. Conclusions Non-healthcare professionals can be trained to an acceptable degree of accuracy to perform vision screening tests on children, which may assist in mitigating existing gaps in paediatric eye care.

PurposeThe purpose of the study was to evaluate the feasibility and acceptability of utilizing elbow splints as a method of increasing amblyopic patching compliance in pediatric ophthalmology patients who fail to comply with prescribed patching regimens.Patients and methodsPatients6 years of age who were not adhering to pre-specified patching guidelines were prescribed elbow splints in order to increase patching compliance at the discretion of a pediatric ophthalmologist. If the child was non-compliant (patching50% of specified time or consistently removing patch), parents were asked to try using the elbow splints until patching compliance was achieved. Non-parametric Wilcoxon signed-rank tests were used to compare patching time pre- and post-splints.Results41/48 children who were prescribed elbow splints to increase patching compliance for amblyopia were included for analysis. Seven children were excluded due to patching and splints being prescribed at the outset (n=4), and for not using the splinting intervention (n=3). Median age at being prescribed elbow splints was 37 (12-68) months. Mean daily patching prior to splints was 1.5±1.7 h, whereas mean prescribed daily patching was 4.95±1.5 h. Following splinting, 34/41 (83%) became compliant with patch alone, and visual acuity increased in 39/41 (95%) patients, with no patients developing amblyopia in the fellow eye. Median amount of time splints was required to improve compliance was 7 (1-240) days.ConclusionElbow splinting seems to be a viable alternative method to increase pediatric amblyopic patching compliance when patching alone fails to achieve satisfactory compliance.

We present a case of a 3-year-old girl with a positive family history of neurofibromatosis type-1 (NF1) presented with best corrected visual acuity of 20/40 in the right eye and

Purpose To survey the different methods used in the management of corneal abrasions (including iatrogenic cases) nationally. Method A questionnaire survey of all 162 ophthalmic units in the UK was carried out in 1997. Results The response rate was 134 of 162 (83%). The majority of units do not have an established policy for the treatment of corneal abrasions. Topical antibiotic alone and antibiotic together with a cycloplegic are the commonest immediate treatments, whilst the most common treatment course is topical antibiotic. Padding and patient follow-up is practised some of the time by most units and all of the time by the remaining minority. Use of a soft bandage contact lens is uncommon. There is no statistically significant difference (p

Pneumocystis jiroveci is a commensal found in the respiratory tract of healthy individuals. It can cause infections of almost any organ in immunocompromised hosts. P jiroveci choroiditis, featuring multifocal choroidal lesions, has been reported in immunocompromised patients despite prophylactic use of inhaled pentamidine. We report a post-transplant leukaemic patient whose posterior segment findings demonstrate an atypical picture of recurrent P jiroveci choroiditis. A 20 year old woman presented with a 1 week history of bilateral blurred vision, dyspnoea, and dry cough. Visual acuity was reduced to 6/36 bilaterally with posterior subcapsular cataracts. Funduscopy disclosed multifocal, creamy-yellow choroidal lesions at both posterior poles with exudative retinal detachments at the maculae (fig 1). Optic discs …

PURPOSE. To assess the impact of amblyopia, strabismus and glasses on subjective visual and psychological function among amblyopes. METHODS. Questionnaires were administered to 120 teenagers with amblyopia (cases), with residual amblyopia after treatment, or with or without strabismus and 120 control subjects (controls) Cases underwent ophthalmic examination including cycloplegic refraction. Two questionnaires (visual function 14 [VF-14] and a newly designed eight-item questionnaire) were administered to assess the psychological impact score of general daily life, having a weaker eye, glasses wear, and current noticeable strabismus. Questionnaires were validated in 60 subjects in each group by a second administration of the questionnaire. The VF-14 scores, psychological impact scores, and clinical data were compared. RESULTS. The VF-14 and psychological impact scores were highly reproducible. The mean VF-14 score for the control group was 95.5 and for the cases was 78.9 (P < 0.0001), but the scores did not correlate with the severity of amblyopia. The psychological impact score in general daily life was sensitive in discriminating between mild (median score 31) and moderate to severe (median score 56) amblyopes (P < 0.02). The cases segregated into two clear groups; those who scored high (large detrimental psychological impact) on psychological impact, with subjectively noticeable manifest strabismus, and those who scored low (low detrimental psychological impact), without noticeable strabismus. The subjective experience of patching treatment differentiated the two groups best of all. CONCLUSIONS. Subjective visual and psychological functions are altered compared with normal subjects due to amblyopia, strabismus, and a previous unpleasant patching experience. The mean VF-14 score was similar to that previously published for patients with glaucoma. The study underlines that amblyopia and/or strabismus have an impact on teenagers' subjective visual function and well-being.