Health screening is an important aspect of health promotion and disease prevention in women over 65 years of age. Screening efforts should address conditions that cause significant morbidity and mortality in this age group. In addition to screening for cardiovascular disease, cerebrovascular disease and cancer, primary care physicians should identify risk factors unique to an aging population. These factors include hearing and vision loss, dysmobility or functional impairment, osteoporosis, cognitive and affective disorders, urinary incontinence and domestic violence. Although screening for many conditions cannot be proved to merit an "A" recommendation (indicating conclusive proof of benefit), special attention to these factors can decrease morbidity and improve quality of life in aging women. (+info)
Measuring visual symptoms in British cataract patients: the cataract symptom scale.
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AIMS: To develop and validate a scale for the measurement of visual symptoms and functional disability due to cataract in older UK residents. METHODS: In depth semistructured interviews were undertaken with 44 consecutive patients awaiting cataract surgery. Patients were asked to describe visual symptoms and problems with social functioning which were then incorporated into a questionnaire, the cataract symptom scale (CSS). The CSS was further examined in a cohort of 118 consecutive cataract patients awaiting surgery. Further assessments in these patients included visual acuity, visual function using an existing scale (the VF-14), activities of daily living, perceived health status, anxiety and depression, and a global assessment of how much patients felt their visual symptoms affected their daily life. RESULTS: A 15 item scale was derived which was simple to administer to older patients and had a high internal consistency. The test-retest correlation coefficient for the total instrument score was r = 0.91 (p<0.0001). The CSS correlated well with the VF-14 and to a lesser extent with visual acuity in the better eye, activities of daily living, perceived health status, anxiety and depression, and the patients' global assessment of visual symptoms. CONCLUSION: The CSS provides information regarding the symptomatic and functional status of older cataract patients resident in the UK which cannot be obtained by measurement of visual acuity alone. (+info)
Natural history of diabetic macular streak exudates: evidence from a screening programme.
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BACKGROUND/AIMS: Diabetic retinopathy screening guidelines recommend referral to an ophthalmologist if there is exudate within one disc diameter of the fovea. Many of these patients, however, have resolution of small amounts of exudate without treatment. This study aimed to assess whether patients with minimal streak or dot exudates within one disc diameter of the fovea can be monitored in a screening programme without compromising visual acuity. METHODS: A retrospective review of records and Polaroid photographs obtained by one screening centre over a 10 year period was performed. Outcomes measured were referral rates, alteration of Snellen visual acuity, and the need for macular photocoagulation treatment. RESULTS: 55 patients (74 eyes) fulfilled entry criteria (37 streak and 37 dot exudates). Mean follow up was 56.1 months (range 12-127 months). Twenty five patients (30 eyes) were referred to an ophthalmologist. 13 eyes (17.6%) required macular photocoagulation treatment. Four eyes (5.4%) lost two or more lines of Snellen acuity over the follow up period (three from macular oedema and one from macular ischaemia). There was no relation between the presence or resolution of minimal exudate and visual loss (p>0.2). CONCLUSION: It is appropriate to monitor eyes with streak or dot macular exudates at 6-9 monthly intervals in a screening programme. (+info)
Preschool vision screening: negative predictive value for amblyopia.
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BACKGROUND/AIMS: Single optotype tests of visual acuity are widely used for preschool vision screening in order to optimise cooperation with testing. These tests may, however, underestimate the visual acuity deficit in amblyopia because they lack visual crowding. This study assessed the resultant negative predictive value (NPV) for amblyopia. METHODS: Cohort study of 936 children in the Cambridge Health District selected by date of birth. The presence of amblyopia among children who had passed preschool vision screening was determined using Snellen line acuity as the reference test. Preschool vision screening was conducted at 3.5 years of age by community orthoptists. The screening assessment comprised Sheridan-Gardiner single optotype test of visual acuity (referral criterion 6/9 or worse in either eye), cover test, ocular movements, 20(Delta) prism test, and TNO stereotest. RESULTS: The overall NPV of preschool vision screening for amblyopia was 100% (95% CI 99.4% to 100%). Most children with amblyopia were detected by the Sheridan-Gardiner single optotype test of visual acuity, but the other screening tests were necessary to prevent any false negatives. In isolation, the Sheridan-Gardiner single optotype test of visual acuity has a NPV for amblyopia of only 99.6% (95% CI 98.7% to 99.9%). CONCLUSION: Preschool vision screening using a single optotype test of visual acuity does achieve a high NPV for amblyopia, but only under certain conditions. These comprise a low threshold for referral (6/9 or worse in either eye) and the inclusion of a cover test and tests of binocular function in the screening assessment. (+info)
Determinants of attendance and patient satisfaction at eye clinics in south-western Uganda.
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PURPOSE: To identify the reasons for subjects deciding to attend or not attend local and referral ophthalmology clinics in south-west Uganda, and to establish the levels of satisfaction of clinic attenders with the services they received. METHODS: A population survey identified subjects with ocular conditions who were referred to the local clinic or the district hospital. All non-attenders and a group of attenders were interviewed at home. RESULTS: 31% of those referred did not attend the local clinic. The most common reasons were 'too busy' (29%) or 'unwilling to buy spectacles' (17%). Less than half of attenders were satisfied, mainly because of no perceived clinical improvement or having to buy spectacles. Only 13% of those referred to the district hospital clinic attended. The main reasons for non-attendance were high transport cost and fear of the clinic. CONCLUSION: Attendance and satisfaction with the community ophthalmology service could be improved by more intensive motivation and explanation for patients, and assistance with spectacle and transport costs. The use of aphakic motivators should be tested in this context. (+info)
Screening in child health.
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Screening programmes in child health have evolved on the basis of individual enthusiasm and professional consensus, rather than being based on objective evidence of benefit. Three reviews have been carried out in the UK over the past 10 years. The only programmes which show robust evidence of effectiveness are those for PKU and hypothyroidism. The value of screening for hearing loss and vision defects is widely accepted, but there are many unresolved issues. Programmes for detection of congenital dislocation of the hip, congenital heart disease and growth disturbances are of doubtful value. Early identification of developmental problems is stressed by parents, but screening may not be the best way to achieve this. The UK programme of well-child care places increasing emphasis on promotion of physical and emotional health; screening tests should either be subjected to quality monitoring, or removed from the programme if they cannot fulfil the classic criteria of Wilson and Jungner. (+info)
Creation and testing of a practical visual function assessment for use in Africa: correlation with visual acuity, contrast sensitivity, and near vision in Malawian adults.
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AIM: To develop and test a practical visual function assessment for use in developing countries. METHODS: Using focus group discussions and interviews with eyecare workers and low vision specialists in Malawi, 13 questions related to visual characteristics of activities of daily living were designed. Patients presenting to an eye clinic were recruited and interviewed. Visual acuity, near vision, and contrast sensitivity were measured. Analysis sought to determine the degree of correlation between the vision indices and visual function. RESULTS: The visual function questionnaire was easy to administer. Visual function correlated with visual acuity, contrast sensitivity, near vision, and patient reported visual problem. People with a higher frequency of "not applicable" responses had lower visual function scores. Multivariate modelling revealed that visual acuity and number of questions felt to be applicable were independently associated with visual function. Reducing the questionnaire to nine questions did not affect the degree of correlation with any of the visual indices. CONCLUSION: The authors' visual function assessment correlates well with different measures of visual acuity. People with reduced vision for a prolonged period may no longer consider doing certain tasks and the number of questions considered appropriate by an individual may be an additional measure of visual function. Assessment of visual function by health workers may be a valuable tool in improving surgical uptake by encouraging both health personnel and patients to recognise that they have difficulties undertaking activities of daily living as well as a measure of monitoring and evaluating cataract outcomes. (+info)
Screening for refractive errors in children: accuracy of the hand held refractor Retinomax to screen for astigmatism.
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AIMS: To assess the reliability of the hand held automated refractor Retinomax in measuring astigmatism in non-cycloplegic conditions. To assess the accuracy of Retinomax in diagnosing abnormal astigmatism in non-cycloplegic refractive screening of children between 9 and 36 months. METHODS: Among 1205 children undergoing a non-cycloplegic refractive screening with Retinomax, 299 (25%) had repeated non-cycloplegic measurements, 302 (25%) were refracted under cycloplegia using the same refractor, and 88 (7%) using retinoscopy or an automated on table refractor. The reproducibility of non-cycloplegic cylinder measurement was assessed by comparing the cylindrical power and axis values in the 299 repeated measurements without cycloplegia. The influence of the quick mode on cylinder measurement was analysed by comparing the cylinder and axis value in 93 repeated measurements without cycloplegia where normal mode was used in one measurement and quick mode in the other. Predictive values of the refractive screening were calculated for three different thresholds of manifest astigmatism (> or = 1.5, > or = 1.75, and > or = 2 D) considering as a true positive case an astigmatism > or = 2 D under cycloplegic condition (measured by retinoscopy, on table, or hand held refractor). RESULTS: The 95% limits of agreement between two repeated manifest cylinder measurements with Retinomax attained levels slightly less than plus or minus 1 D. The 95% limits of agreement for the axis were plus or minus 46 degrees. The comparison of non-cycloplegic measurements in the quick and normal mode showed no significant difference and 95% limits of agreement plus or minus 0.75 D. The mean difference between non-cycloplegic and cycloplegic cylinder values measured by Retinomax reached 0.17 D and was statistically significant. Manifest thresholds of > or = 1.5 D, > or = 1.75 D, > or = 2 D cylinder value diagnosed 2 D of astigmatism under cyclplegia respectively with 71-84%, 59-80%, 51-54% of sensitivity (right eye-left eye) and 90-92%, 95%, 98% of specificity. CONCLUSION: Without cycloplegia, Retinomax is able to measure cylinder power with the same reproducibility as cycloplegic retinoscopy. No significant difference was found in the cylinder values obtained with the quick and the normal modes. Therefore, the quick mode of measurement is recommended as it is more feasible in children. No difference, which is significant from a screening point of view, exists between the non-cycloplegic and the cycloplegic cylinder value (< 0.25 D). Retinomax diagnoses abnormal astigmatism (> or = 2 D) in a non-cycloplegic refractive screening at preschool ages with 51-84% sensitivity rates and 98-90% specificity rates, depending on the chosen threshold of manifest astigmatism. If 2 D of manifest astigmatism is chosen as a positive test, the positive predictive value of the screening reaches 81-84% and the negative predictive value 91-90% (right eye-left eye). (+info)