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Gui-shuang Ying - One of the best experts on this subject based on the ideXlab platform.
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Authors’ Response: Stereoacuity of Preschool Children with and without Vision Disorders
Optometry and Vision Science, 2014Co-Authors: Elise Ciner, Lynn Cyert, Marjean Taylor Kulp, Gui-shuang Ying, Maureen G. Maguire, Graham E. Quinn, Deborah Orel-bixler, Bruce Moore, Jiayan HuangAbstract:We thank Dr. Cooper for taking the time to write a thoughtful Letter to the Editor on our paper ‘Stereoacuity of Preschool Children with and without Vision Disorders’.1 We also appreciate his work as a pioneer in the area of stereopsis testing which helped lay the foundation for random dot stereo testing of children. We did in fact acknowledge and cite his related work with preschool children in the introduction of our paper.2 The purpose of our paper was to evaluate the association between stereoacuity as measured with the Stereo Smile II and the presence, type and severity of Vision Disorders in preschool Head Start children and to determine testability and expected levels of stereoacuity in an exam setting for this test. Dr. Cooper questioned our choice of 20/40 as within the range of normal Vision for preschool children. Our choice is well supported by the work of the Vision in Preschoolers (VIP) Study as well as the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS) and others.3–6 Our paper looked at stereoacuity with regard to four major categories of Vision Disorders; amblyopia, strabismus, significant refractive error and reduced visual acuity. Dr. Cooper raises questions with regard to the specific type of strabismus or amblyopia present. Our results showed that, overall, children classified with strabismus or amblyopia did in fact perform more poorly on stereoacuity testing than children without Vision Disorders1,7. However, a small subset of children (~9%) with these Disorders was able to achieve the best stereoacuity level of 60 sec arc.1 It is possible that one or more of these children may have had intermittent deviations or other anomalies sometimes associated with better levels of stereoacuity. Furthermore, the findings presented in our paper showed that most children without Vision Disorders were more likely to have one of the two best levels of stereopsis on the Stereo Smile II test. In contrast, children with one or more Vision Disorders detected during a comprehensive Vision exam had significantly worse stereoacuity and children with the most severe Vision Disorders had worse stereoacuity than children with milder Disorders. Children who could only complete the demonstration card were 16 times more likely to have a Vision Disorder. Overall testability for all children was greater than 99%.1 We agree that improvement of stereopsis with age is not new and indeed stated this in our paper. We reported the results of stereoacuity testing using the Stereo Smile II from a large sample of 3- to 5-year children without Vision Disorders in order to establish normative data for each age group using this particular test. Our data showed improvement in stereopsis with age; whether this is due to continued development or other factors related to use of this test is not known. Dr. Cooper also questioned our choice of stereoacuity levels for testing, as the VIP study did not include finer degrees of disparity, specifically 20 sec arc. While stereo thresholds of 20 sec arc may have been established for adult populations using the Randot and other tests, this is not the case for stereo thresholds in the preschool population. Our choice was reasonable based on results from earlier studies using the Stereo Smile and other tests supporting a 60 sec arc threshold.2,8–15 Dr. Cooper concluded his Letter to the Editor by stating that ‘all one needs to pick up the time sensitive visual anomalies is a Cycloplegic automated refraction and a large disparity RDS. Fast, inexpensive, and sensitive’. The VIP Study evaluated tests of visual acuity, stereopsis and refraction in a large scale study of over 4000 preschool children with and without Vision Disorders at five clinical centers throughout the country. All children underwent a comprehensive cycloplegic Vision examination by study trained and certified pediatric optometrists and pediatric ophthalmologists to ascertain the sensitivity and specificity of each screening test as well as combination of tests.7,16,17 Non-cycloplegic autorefraction (using the Retinomax or SureSight Vision Screener) or a 5 foot LEA crowded symbol test were among the best tests with sensitivity for strabismus increased by adding the Stereo Smile. These and other findings from the VIP study are reported in a number of papers.1,3,4,7,16–18
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Prevalence of Vision Disorders by racial and ethnic group among children participating in head start.
Ophthalmology, 2013Co-Authors: Gui-shuang Ying, Lynn Cyert, Marjean Taylor Kulp, Elise Ciner, Maureen G. Maguire, Graham E. Quinn, Deborah Orel-bixler, Bruce MooreAbstract:Objective To compare the prevalence of amblyopia, strabismus, and significant refractive error among African-American, American Indian, Asian, Hispanic, and non-Hispanic white preschoolers in the Vision In Preschoolers study. Design Multicenter, cross-sectional study. Participants Three- to 5-year old preschoolers (n = 4040) in Head Start from 5 geographically disparate areas of the United States. Methods All children who failed the mandatory Head Start screening and a sample of those who passed were enrolled. Study-certified pediatric optometrists and ophthalmologists performed comprehensive eye examinations including monocular distance visual acuity (VA), cover testing, and cycloplegic retinoscopy. Examination results were used to classify Vision Disorders, including amblyopia, strabismus, significant refractive errors, and unexplained reduced VA. Sampling weights were used to calculate prevalence rates, confidence intervals, and statistical tests for differences. Main Outcome Measures Prevalence rates in each racial/ethnic group. Results Overall, 86.5% of children invited to participate were examined, including 2072 African-American, 343 American Indian (323 from Oklahoma), 145 Asian, 796 Hispanic, and 481 non-Hispanic white children. The prevalence of any Vision Disorder was 21.4% and was similar across groups ( P = 0.40), ranging from 17.9% (American Indian) to 23.3% (Hispanic). Prevalence of amblyopia was similar among all groups ( P = 0.07), ranging from 3.0% (Asian) to 5.4% (non-Hispanic white). Prevalence of strabismus also was similar ( P = 0.12), ranging from 1.0% (Asian) to 4.6% (non-Hispanic white). Prevalence of hyperopia >3.25 diopter (D) varied ( P = 0.007), with the lowest rate in Asians (5.5%) and highest in non-Hispanic whites (11.9%). Prevalence of anisometropia varied ( P = 0.009), with the lowest rate in Asians (2.7%) and highest in Hispanics (7.1%). Myopia >2.00 D was relatively uncommon ( 1.50 D varied ( P = 0.01), with the lowest rate among American Indians (4.3%) and highest among Hispanics (11.1%). Conclusions Among Head Start preschool children, the prevalence of amblyopia and strabismus was similar among 5 racial/ethnic groups. Prevalence of significant refractive errors, specifically hyperopia, astigmatism, and anisometropia, varied by group, with the highest rate of hyperopia in non-Hispanic whites, and the highest rates of astigmatism and anisometropia in Hispanics.
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Sensitivity of screening tests for detecting Vision in preschoolers-targeted Vision Disorders when specificity is 94%.
Optometry and vision science : official publication of the American Academy of Optometry, 2005Co-Authors: Gui-shuang Ying, Lynn Cyert, Marjean Taylor Kulp, Maureen Maguire, Elise Ciner, Paulette SchmidtAbstract:PURPOSE: To compare the sensitivity of 11 preschool Vision screening tests administered by licensed eye care professionals for the detection of the 4 Vision in Preschoolers (VIP)-targeted Vision Disorders when specificity is 94%. METHODS: This study consisted of a sample (n = 2588) of 3- to 5-year-old children enrolled in Head Start programs, 57% of whom had failed an initial Head Start Vision screening. Screening results from 11 tests were compared with results from a standardized comprehensive eye examination that was used to classify children with respect to the four VIP-targeted Vision Disorders: amblyopia, strabismus, significant refractive error, and unexplained reduced visual acuity (VA). With overall specificity set to 94%, we calculated the sensitivity for the detection of each targeted Vision Disorder. RESULTS: With the overall specificity set to 94%, the most accurate tests for detection of amblyopia were noncycloplegic retinoscopy (NCR) (88% sensitivity), the SureSight Vision Screener (80%), and the Retinomax Autorefractor (78%). For detection of strabismus, the most accurate tests were the MTI Photoscreener (65%), the cover-uncover test (60%), the Stereo Smile II stereoacuity test (58%), the SureSight Vision Screener (54%), and the Retinomax Autorefractor (54% in year 1, 53% in year 2). The most accurate tests for detection of significant refractive error were NCR (74%), the Retinomax Autorefractor (66%), the SureSight Vision Screener (63%), and the Lea Symbols VA test (58%). For detection of reduced VA, the most accurate tests were the Lea Symbols Distance VA test (48%), the Retinomax Autorefractor (39%), and NCR (38%). CONCLUSIONS: Similar to the previously reported results at 90% specificity, the screening tests vary widely in sensitivity with specificity set at 94%. The rankings of the sensitivities for detection of the 4 VIP-targeted Vision Disorders are similar to those with specificity set to 90%.
Pan Xiaoping - One of the best experts on this subject based on the ideXlab platform.
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analysis of two cases of Vision Disorder as a primary symptom of melas syndrome
Journal of Tropical Medicine, 2012Co-Authors: Pan XiaopingAbstract:Objective To discuss the clinical imaging and pathological characteristics of 2 cases of MELAS syndrome.Methods The clinical data of 2 patients with MELAS syndrome were retrospectively analyzed.Results The patient's initial presentation was Vision Disorder accompanied with headache,nausea,vomit,developed retard and elevated serum lactate lever.Image examination showed occipital lobe cortex edema and basal ganglia calcification.Muscle biopsy showed ragged red fibers.Electron microscopic analysis showed abnormal mitochondrial increased under myolemma.Conclusion Younger patients with initial symptom of Vision Disorder may have MELAS syndrome.
Elise Ciner - One of the best experts on this subject based on the ideXlab platform.
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Authors’ Response: Stereoacuity of Preschool Children with and without Vision Disorders
Optometry and Vision Science, 2014Co-Authors: Elise Ciner, Lynn Cyert, Marjean Taylor Kulp, Gui-shuang Ying, Maureen G. Maguire, Graham E. Quinn, Deborah Orel-bixler, Bruce Moore, Jiayan HuangAbstract:We thank Dr. Cooper for taking the time to write a thoughtful Letter to the Editor on our paper ‘Stereoacuity of Preschool Children with and without Vision Disorders’.1 We also appreciate his work as a pioneer in the area of stereopsis testing which helped lay the foundation for random dot stereo testing of children. We did in fact acknowledge and cite his related work with preschool children in the introduction of our paper.2 The purpose of our paper was to evaluate the association between stereoacuity as measured with the Stereo Smile II and the presence, type and severity of Vision Disorders in preschool Head Start children and to determine testability and expected levels of stereoacuity in an exam setting for this test. Dr. Cooper questioned our choice of 20/40 as within the range of normal Vision for preschool children. Our choice is well supported by the work of the Vision in Preschoolers (VIP) Study as well as the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS) and others.3–6 Our paper looked at stereoacuity with regard to four major categories of Vision Disorders; amblyopia, strabismus, significant refractive error and reduced visual acuity. Dr. Cooper raises questions with regard to the specific type of strabismus or amblyopia present. Our results showed that, overall, children classified with strabismus or amblyopia did in fact perform more poorly on stereoacuity testing than children without Vision Disorders1,7. However, a small subset of children (~9%) with these Disorders was able to achieve the best stereoacuity level of 60 sec arc.1 It is possible that one or more of these children may have had intermittent deviations or other anomalies sometimes associated with better levels of stereoacuity. Furthermore, the findings presented in our paper showed that most children without Vision Disorders were more likely to have one of the two best levels of stereopsis on the Stereo Smile II test. In contrast, children with one or more Vision Disorders detected during a comprehensive Vision exam had significantly worse stereoacuity and children with the most severe Vision Disorders had worse stereoacuity than children with milder Disorders. Children who could only complete the demonstration card were 16 times more likely to have a Vision Disorder. Overall testability for all children was greater than 99%.1 We agree that improvement of stereopsis with age is not new and indeed stated this in our paper. We reported the results of stereoacuity testing using the Stereo Smile II from a large sample of 3- to 5-year children without Vision Disorders in order to establish normative data for each age group using this particular test. Our data showed improvement in stereopsis with age; whether this is due to continued development or other factors related to use of this test is not known. Dr. Cooper also questioned our choice of stereoacuity levels for testing, as the VIP study did not include finer degrees of disparity, specifically 20 sec arc. While stereo thresholds of 20 sec arc may have been established for adult populations using the Randot and other tests, this is not the case for stereo thresholds in the preschool population. Our choice was reasonable based on results from earlier studies using the Stereo Smile and other tests supporting a 60 sec arc threshold.2,8–15 Dr. Cooper concluded his Letter to the Editor by stating that ‘all one needs to pick up the time sensitive visual anomalies is a Cycloplegic automated refraction and a large disparity RDS. Fast, inexpensive, and sensitive’. The VIP Study evaluated tests of visual acuity, stereopsis and refraction in a large scale study of over 4000 preschool children with and without Vision Disorders at five clinical centers throughout the country. All children underwent a comprehensive cycloplegic Vision examination by study trained and certified pediatric optometrists and pediatric ophthalmologists to ascertain the sensitivity and specificity of each screening test as well as combination of tests.7,16,17 Non-cycloplegic autorefraction (using the Retinomax or SureSight Vision Screener) or a 5 foot LEA crowded symbol test were among the best tests with sensitivity for strabismus increased by adding the Stereo Smile. These and other findings from the VIP study are reported in a number of papers.1,3,4,7,16–18
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Prevalence of Vision Disorders by racial and ethnic group among children participating in head start.
Ophthalmology, 2013Co-Authors: Gui-shuang Ying, Lynn Cyert, Marjean Taylor Kulp, Elise Ciner, Maureen G. Maguire, Graham E. Quinn, Deborah Orel-bixler, Bruce MooreAbstract:Objective To compare the prevalence of amblyopia, strabismus, and significant refractive error among African-American, American Indian, Asian, Hispanic, and non-Hispanic white preschoolers in the Vision In Preschoolers study. Design Multicenter, cross-sectional study. Participants Three- to 5-year old preschoolers (n = 4040) in Head Start from 5 geographically disparate areas of the United States. Methods All children who failed the mandatory Head Start screening and a sample of those who passed were enrolled. Study-certified pediatric optometrists and ophthalmologists performed comprehensive eye examinations including monocular distance visual acuity (VA), cover testing, and cycloplegic retinoscopy. Examination results were used to classify Vision Disorders, including amblyopia, strabismus, significant refractive errors, and unexplained reduced VA. Sampling weights were used to calculate prevalence rates, confidence intervals, and statistical tests for differences. Main Outcome Measures Prevalence rates in each racial/ethnic group. Results Overall, 86.5% of children invited to participate were examined, including 2072 African-American, 343 American Indian (323 from Oklahoma), 145 Asian, 796 Hispanic, and 481 non-Hispanic white children. The prevalence of any Vision Disorder was 21.4% and was similar across groups ( P = 0.40), ranging from 17.9% (American Indian) to 23.3% (Hispanic). Prevalence of amblyopia was similar among all groups ( P = 0.07), ranging from 3.0% (Asian) to 5.4% (non-Hispanic white). Prevalence of strabismus also was similar ( P = 0.12), ranging from 1.0% (Asian) to 4.6% (non-Hispanic white). Prevalence of hyperopia >3.25 diopter (D) varied ( P = 0.007), with the lowest rate in Asians (5.5%) and highest in non-Hispanic whites (11.9%). Prevalence of anisometropia varied ( P = 0.009), with the lowest rate in Asians (2.7%) and highest in Hispanics (7.1%). Myopia >2.00 D was relatively uncommon ( 1.50 D varied ( P = 0.01), with the lowest rate among American Indians (4.3%) and highest among Hispanics (11.1%). Conclusions Among Head Start preschool children, the prevalence of amblyopia and strabismus was similar among 5 racial/ethnic groups. Prevalence of significant refractive errors, specifically hyperopia, astigmatism, and anisometropia, varied by group, with the highest rate of hyperopia in non-Hispanic whites, and the highest rates of astigmatism and anisometropia in Hispanics.
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Sensitivity of screening tests for detecting Vision in preschoolers-targeted Vision Disorders when specificity is 94%.
Optometry and vision science : official publication of the American Academy of Optometry, 2005Co-Authors: Gui-shuang Ying, Lynn Cyert, Marjean Taylor Kulp, Maureen Maguire, Elise Ciner, Paulette SchmidtAbstract:PURPOSE: To compare the sensitivity of 11 preschool Vision screening tests administered by licensed eye care professionals for the detection of the 4 Vision in Preschoolers (VIP)-targeted Vision Disorders when specificity is 94%. METHODS: This study consisted of a sample (n = 2588) of 3- to 5-year-old children enrolled in Head Start programs, 57% of whom had failed an initial Head Start Vision screening. Screening results from 11 tests were compared with results from a standardized comprehensive eye examination that was used to classify children with respect to the four VIP-targeted Vision Disorders: amblyopia, strabismus, significant refractive error, and unexplained reduced visual acuity (VA). With overall specificity set to 94%, we calculated the sensitivity for the detection of each targeted Vision Disorder. RESULTS: With the overall specificity set to 94%, the most accurate tests for detection of amblyopia were noncycloplegic retinoscopy (NCR) (88% sensitivity), the SureSight Vision Screener (80%), and the Retinomax Autorefractor (78%). For detection of strabismus, the most accurate tests were the MTI Photoscreener (65%), the cover-uncover test (60%), the Stereo Smile II stereoacuity test (58%), the SureSight Vision Screener (54%), and the Retinomax Autorefractor (54% in year 1, 53% in year 2). The most accurate tests for detection of significant refractive error were NCR (74%), the Retinomax Autorefractor (66%), the SureSight Vision Screener (63%), and the Lea Symbols VA test (58%). For detection of reduced VA, the most accurate tests were the Lea Symbols Distance VA test (48%), the Retinomax Autorefractor (39%), and NCR (38%). CONCLUSIONS: Similar to the previously reported results at 90% specificity, the screening tests vary widely in sensitivity with specificity set at 94%. The rankings of the sensitivities for detection of the 4 VIP-targeted Vision Disorders are similar to those with specificity set to 90%.
Lynn Cyert - One of the best experts on this subject based on the ideXlab platform.
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Authors’ Response: Stereoacuity of Preschool Children with and without Vision Disorders
Optometry and Vision Science, 2014Co-Authors: Elise Ciner, Lynn Cyert, Marjean Taylor Kulp, Gui-shuang Ying, Maureen G. Maguire, Graham E. Quinn, Deborah Orel-bixler, Bruce Moore, Jiayan HuangAbstract:We thank Dr. Cooper for taking the time to write a thoughtful Letter to the Editor on our paper ‘Stereoacuity of Preschool Children with and without Vision Disorders’.1 We also appreciate his work as a pioneer in the area of stereopsis testing which helped lay the foundation for random dot stereo testing of children. We did in fact acknowledge and cite his related work with preschool children in the introduction of our paper.2 The purpose of our paper was to evaluate the association between stereoacuity as measured with the Stereo Smile II and the presence, type and severity of Vision Disorders in preschool Head Start children and to determine testability and expected levels of stereoacuity in an exam setting for this test. Dr. Cooper questioned our choice of 20/40 as within the range of normal Vision for preschool children. Our choice is well supported by the work of the Vision in Preschoolers (VIP) Study as well as the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS) and others.3–6 Our paper looked at stereoacuity with regard to four major categories of Vision Disorders; amblyopia, strabismus, significant refractive error and reduced visual acuity. Dr. Cooper raises questions with regard to the specific type of strabismus or amblyopia present. Our results showed that, overall, children classified with strabismus or amblyopia did in fact perform more poorly on stereoacuity testing than children without Vision Disorders1,7. However, a small subset of children (~9%) with these Disorders was able to achieve the best stereoacuity level of 60 sec arc.1 It is possible that one or more of these children may have had intermittent deviations or other anomalies sometimes associated with better levels of stereoacuity. Furthermore, the findings presented in our paper showed that most children without Vision Disorders were more likely to have one of the two best levels of stereopsis on the Stereo Smile II test. In contrast, children with one or more Vision Disorders detected during a comprehensive Vision exam had significantly worse stereoacuity and children with the most severe Vision Disorders had worse stereoacuity than children with milder Disorders. Children who could only complete the demonstration card were 16 times more likely to have a Vision Disorder. Overall testability for all children was greater than 99%.1 We agree that improvement of stereopsis with age is not new and indeed stated this in our paper. We reported the results of stereoacuity testing using the Stereo Smile II from a large sample of 3- to 5-year children without Vision Disorders in order to establish normative data for each age group using this particular test. Our data showed improvement in stereopsis with age; whether this is due to continued development or other factors related to use of this test is not known. Dr. Cooper also questioned our choice of stereoacuity levels for testing, as the VIP study did not include finer degrees of disparity, specifically 20 sec arc. While stereo thresholds of 20 sec arc may have been established for adult populations using the Randot and other tests, this is not the case for stereo thresholds in the preschool population. Our choice was reasonable based on results from earlier studies using the Stereo Smile and other tests supporting a 60 sec arc threshold.2,8–15 Dr. Cooper concluded his Letter to the Editor by stating that ‘all one needs to pick up the time sensitive visual anomalies is a Cycloplegic automated refraction and a large disparity RDS. Fast, inexpensive, and sensitive’. The VIP Study evaluated tests of visual acuity, stereopsis and refraction in a large scale study of over 4000 preschool children with and without Vision Disorders at five clinical centers throughout the country. All children underwent a comprehensive cycloplegic Vision examination by study trained and certified pediatric optometrists and pediatric ophthalmologists to ascertain the sensitivity and specificity of each screening test as well as combination of tests.7,16,17 Non-cycloplegic autorefraction (using the Retinomax or SureSight Vision Screener) or a 5 foot LEA crowded symbol test were among the best tests with sensitivity for strabismus increased by adding the Stereo Smile. These and other findings from the VIP study are reported in a number of papers.1,3,4,7,16–18
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Prevalence of Vision Disorders by racial and ethnic group among children participating in head start.
Ophthalmology, 2013Co-Authors: Gui-shuang Ying, Lynn Cyert, Marjean Taylor Kulp, Elise Ciner, Maureen G. Maguire, Graham E. Quinn, Deborah Orel-bixler, Bruce MooreAbstract:Objective To compare the prevalence of amblyopia, strabismus, and significant refractive error among African-American, American Indian, Asian, Hispanic, and non-Hispanic white preschoolers in the Vision In Preschoolers study. Design Multicenter, cross-sectional study. Participants Three- to 5-year old preschoolers (n = 4040) in Head Start from 5 geographically disparate areas of the United States. Methods All children who failed the mandatory Head Start screening and a sample of those who passed were enrolled. Study-certified pediatric optometrists and ophthalmologists performed comprehensive eye examinations including monocular distance visual acuity (VA), cover testing, and cycloplegic retinoscopy. Examination results were used to classify Vision Disorders, including amblyopia, strabismus, significant refractive errors, and unexplained reduced VA. Sampling weights were used to calculate prevalence rates, confidence intervals, and statistical tests for differences. Main Outcome Measures Prevalence rates in each racial/ethnic group. Results Overall, 86.5% of children invited to participate were examined, including 2072 African-American, 343 American Indian (323 from Oklahoma), 145 Asian, 796 Hispanic, and 481 non-Hispanic white children. The prevalence of any Vision Disorder was 21.4% and was similar across groups ( P = 0.40), ranging from 17.9% (American Indian) to 23.3% (Hispanic). Prevalence of amblyopia was similar among all groups ( P = 0.07), ranging from 3.0% (Asian) to 5.4% (non-Hispanic white). Prevalence of strabismus also was similar ( P = 0.12), ranging from 1.0% (Asian) to 4.6% (non-Hispanic white). Prevalence of hyperopia >3.25 diopter (D) varied ( P = 0.007), with the lowest rate in Asians (5.5%) and highest in non-Hispanic whites (11.9%). Prevalence of anisometropia varied ( P = 0.009), with the lowest rate in Asians (2.7%) and highest in Hispanics (7.1%). Myopia >2.00 D was relatively uncommon ( 1.50 D varied ( P = 0.01), with the lowest rate among American Indians (4.3%) and highest among Hispanics (11.1%). Conclusions Among Head Start preschool children, the prevalence of amblyopia and strabismus was similar among 5 racial/ethnic groups. Prevalence of significant refractive errors, specifically hyperopia, astigmatism, and anisometropia, varied by group, with the highest rate of hyperopia in non-Hispanic whites, and the highest rates of astigmatism and anisometropia in Hispanics.
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Sensitivity of screening tests for detecting Vision in preschoolers-targeted Vision Disorders when specificity is 94%.
Optometry and vision science : official publication of the American Academy of Optometry, 2005Co-Authors: Gui-shuang Ying, Lynn Cyert, Marjean Taylor Kulp, Maureen Maguire, Elise Ciner, Paulette SchmidtAbstract:PURPOSE: To compare the sensitivity of 11 preschool Vision screening tests administered by licensed eye care professionals for the detection of the 4 Vision in Preschoolers (VIP)-targeted Vision Disorders when specificity is 94%. METHODS: This study consisted of a sample (n = 2588) of 3- to 5-year-old children enrolled in Head Start programs, 57% of whom had failed an initial Head Start Vision screening. Screening results from 11 tests were compared with results from a standardized comprehensive eye examination that was used to classify children with respect to the four VIP-targeted Vision Disorders: amblyopia, strabismus, significant refractive error, and unexplained reduced visual acuity (VA). With overall specificity set to 94%, we calculated the sensitivity for the detection of each targeted Vision Disorder. RESULTS: With the overall specificity set to 94%, the most accurate tests for detection of amblyopia were noncycloplegic retinoscopy (NCR) (88% sensitivity), the SureSight Vision Screener (80%), and the Retinomax Autorefractor (78%). For detection of strabismus, the most accurate tests were the MTI Photoscreener (65%), the cover-uncover test (60%), the Stereo Smile II stereoacuity test (58%), the SureSight Vision Screener (54%), and the Retinomax Autorefractor (54% in year 1, 53% in year 2). The most accurate tests for detection of significant refractive error were NCR (74%), the Retinomax Autorefractor (66%), the SureSight Vision Screener (63%), and the Lea Symbols VA test (58%). For detection of reduced VA, the most accurate tests were the Lea Symbols Distance VA test (48%), the Retinomax Autorefractor (39%), and NCR (38%). CONCLUSIONS: Similar to the previously reported results at 90% specificity, the screening tests vary widely in sensitivity with specificity set at 94%. The rankings of the sensitivities for detection of the 4 VIP-targeted Vision Disorders are similar to those with specificity set to 90%.
Marjean Taylor Kulp - One of the best experts on this subject based on the ideXlab platform.
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Authors’ Response: Stereoacuity of Preschool Children with and without Vision Disorders
Optometry and Vision Science, 2014Co-Authors: Elise Ciner, Lynn Cyert, Marjean Taylor Kulp, Gui-shuang Ying, Maureen G. Maguire, Graham E. Quinn, Deborah Orel-bixler, Bruce Moore, Jiayan HuangAbstract:We thank Dr. Cooper for taking the time to write a thoughtful Letter to the Editor on our paper ‘Stereoacuity of Preschool Children with and without Vision Disorders’.1 We also appreciate his work as a pioneer in the area of stereopsis testing which helped lay the foundation for random dot stereo testing of children. We did in fact acknowledge and cite his related work with preschool children in the introduction of our paper.2 The purpose of our paper was to evaluate the association between stereoacuity as measured with the Stereo Smile II and the presence, type and severity of Vision Disorders in preschool Head Start children and to determine testability and expected levels of stereoacuity in an exam setting for this test. Dr. Cooper questioned our choice of 20/40 as within the range of normal Vision for preschool children. Our choice is well supported by the work of the Vision in Preschoolers (VIP) Study as well as the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS) and others.3–6 Our paper looked at stereoacuity with regard to four major categories of Vision Disorders; amblyopia, strabismus, significant refractive error and reduced visual acuity. Dr. Cooper raises questions with regard to the specific type of strabismus or amblyopia present. Our results showed that, overall, children classified with strabismus or amblyopia did in fact perform more poorly on stereoacuity testing than children without Vision Disorders1,7. However, a small subset of children (~9%) with these Disorders was able to achieve the best stereoacuity level of 60 sec arc.1 It is possible that one or more of these children may have had intermittent deviations or other anomalies sometimes associated with better levels of stereoacuity. Furthermore, the findings presented in our paper showed that most children without Vision Disorders were more likely to have one of the two best levels of stereopsis on the Stereo Smile II test. In contrast, children with one or more Vision Disorders detected during a comprehensive Vision exam had significantly worse stereoacuity and children with the most severe Vision Disorders had worse stereoacuity than children with milder Disorders. Children who could only complete the demonstration card were 16 times more likely to have a Vision Disorder. Overall testability for all children was greater than 99%.1 We agree that improvement of stereopsis with age is not new and indeed stated this in our paper. We reported the results of stereoacuity testing using the Stereo Smile II from a large sample of 3- to 5-year children without Vision Disorders in order to establish normative data for each age group using this particular test. Our data showed improvement in stereopsis with age; whether this is due to continued development or other factors related to use of this test is not known. Dr. Cooper also questioned our choice of stereoacuity levels for testing, as the VIP study did not include finer degrees of disparity, specifically 20 sec arc. While stereo thresholds of 20 sec arc may have been established for adult populations using the Randot and other tests, this is not the case for stereo thresholds in the preschool population. Our choice was reasonable based on results from earlier studies using the Stereo Smile and other tests supporting a 60 sec arc threshold.2,8–15 Dr. Cooper concluded his Letter to the Editor by stating that ‘all one needs to pick up the time sensitive visual anomalies is a Cycloplegic automated refraction and a large disparity RDS. Fast, inexpensive, and sensitive’. The VIP Study evaluated tests of visual acuity, stereopsis and refraction in a large scale study of over 4000 preschool children with and without Vision Disorders at five clinical centers throughout the country. All children underwent a comprehensive cycloplegic Vision examination by study trained and certified pediatric optometrists and pediatric ophthalmologists to ascertain the sensitivity and specificity of each screening test as well as combination of tests.7,16,17 Non-cycloplegic autorefraction (using the Retinomax or SureSight Vision Screener) or a 5 foot LEA crowded symbol test were among the best tests with sensitivity for strabismus increased by adding the Stereo Smile. These and other findings from the VIP study are reported in a number of papers.1,3,4,7,16–18
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Prevalence of Vision Disorders by racial and ethnic group among children participating in head start.
Ophthalmology, 2013Co-Authors: Gui-shuang Ying, Lynn Cyert, Marjean Taylor Kulp, Elise Ciner, Maureen G. Maguire, Graham E. Quinn, Deborah Orel-bixler, Bruce MooreAbstract:Objective To compare the prevalence of amblyopia, strabismus, and significant refractive error among African-American, American Indian, Asian, Hispanic, and non-Hispanic white preschoolers in the Vision In Preschoolers study. Design Multicenter, cross-sectional study. Participants Three- to 5-year old preschoolers (n = 4040) in Head Start from 5 geographically disparate areas of the United States. Methods All children who failed the mandatory Head Start screening and a sample of those who passed were enrolled. Study-certified pediatric optometrists and ophthalmologists performed comprehensive eye examinations including monocular distance visual acuity (VA), cover testing, and cycloplegic retinoscopy. Examination results were used to classify Vision Disorders, including amblyopia, strabismus, significant refractive errors, and unexplained reduced VA. Sampling weights were used to calculate prevalence rates, confidence intervals, and statistical tests for differences. Main Outcome Measures Prevalence rates in each racial/ethnic group. Results Overall, 86.5% of children invited to participate were examined, including 2072 African-American, 343 American Indian (323 from Oklahoma), 145 Asian, 796 Hispanic, and 481 non-Hispanic white children. The prevalence of any Vision Disorder was 21.4% and was similar across groups ( P = 0.40), ranging from 17.9% (American Indian) to 23.3% (Hispanic). Prevalence of amblyopia was similar among all groups ( P = 0.07), ranging from 3.0% (Asian) to 5.4% (non-Hispanic white). Prevalence of strabismus also was similar ( P = 0.12), ranging from 1.0% (Asian) to 4.6% (non-Hispanic white). Prevalence of hyperopia >3.25 diopter (D) varied ( P = 0.007), with the lowest rate in Asians (5.5%) and highest in non-Hispanic whites (11.9%). Prevalence of anisometropia varied ( P = 0.009), with the lowest rate in Asians (2.7%) and highest in Hispanics (7.1%). Myopia >2.00 D was relatively uncommon ( 1.50 D varied ( P = 0.01), with the lowest rate among American Indians (4.3%) and highest among Hispanics (11.1%). Conclusions Among Head Start preschool children, the prevalence of amblyopia and strabismus was similar among 5 racial/ethnic groups. Prevalence of significant refractive errors, specifically hyperopia, astigmatism, and anisometropia, varied by group, with the highest rate of hyperopia in non-Hispanic whites, and the highest rates of astigmatism and anisometropia in Hispanics.
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Sensitivity of screening tests for detecting Vision in preschoolers-targeted Vision Disorders when specificity is 94%.
Optometry and vision science : official publication of the American Academy of Optometry, 2005Co-Authors: Gui-shuang Ying, Lynn Cyert, Marjean Taylor Kulp, Maureen Maguire, Elise Ciner, Paulette SchmidtAbstract:PURPOSE: To compare the sensitivity of 11 preschool Vision screening tests administered by licensed eye care professionals for the detection of the 4 Vision in Preschoolers (VIP)-targeted Vision Disorders when specificity is 94%. METHODS: This study consisted of a sample (n = 2588) of 3- to 5-year-old children enrolled in Head Start programs, 57% of whom had failed an initial Head Start Vision screening. Screening results from 11 tests were compared with results from a standardized comprehensive eye examination that was used to classify children with respect to the four VIP-targeted Vision Disorders: amblyopia, strabismus, significant refractive error, and unexplained reduced visual acuity (VA). With overall specificity set to 94%, we calculated the sensitivity for the detection of each targeted Vision Disorder. RESULTS: With the overall specificity set to 94%, the most accurate tests for detection of amblyopia were noncycloplegic retinoscopy (NCR) (88% sensitivity), the SureSight Vision Screener (80%), and the Retinomax Autorefractor (78%). For detection of strabismus, the most accurate tests were the MTI Photoscreener (65%), the cover-uncover test (60%), the Stereo Smile II stereoacuity test (58%), the SureSight Vision Screener (54%), and the Retinomax Autorefractor (54% in year 1, 53% in year 2). The most accurate tests for detection of significant refractive error were NCR (74%), the Retinomax Autorefractor (66%), the SureSight Vision Screener (63%), and the Lea Symbols VA test (58%). For detection of reduced VA, the most accurate tests were the Lea Symbols Distance VA test (48%), the Retinomax Autorefractor (39%), and NCR (38%). CONCLUSIONS: Similar to the previously reported results at 90% specificity, the screening tests vary widely in sensitivity with specificity set at 94%. The rankings of the sensitivities for detection of the 4 VIP-targeted Vision Disorders are similar to those with specificity set to 90%.
