Visual acuity measures do not reliably detect childhood refractive error - an epidemiological study

Lisa O'Donoghue, Alicja R. Rudnicka, Julie F. McClelland, Nicola S. Logan, Kathryn J. Saunders

Research output: Contribution to journalArticle

Abstract

Purpose
To investigate the utility of uncorrected visual acuity measures in screening for refractive error in white school children aged 6-7-years and 12-13-years.
Methods
The Northern Ireland Childhood Errors of Refraction (NICER) study used a stratified random cluster design to recruit children from schools in Northern Ireland. Detailed eye examinations included assessment of logMAR visual acuity and cycloplegic autorefraction. Spherical equivalent refractive data from the right eye were used to classify significant refractive error as myopia of at least 1DS, hyperopia as greater than +3.50DS and astigmatism as greater than 1.50DC, whether it occurred in isolation or in association with myopia or hyperopia.
Results
Results are presented from 661 white 12-13-year-old and 392 white 6-7-year-old school-children. Using a cut-off of uncorrected visual acuity poorer than 0.20 logMAR to detect significant refractive error gave a sensitivity of 50% and specificity of 92% in 6-7-year-olds and 73% and 93% respectively in 12-13-year-olds. In 12-13-year-old children a cut-off of poorer than 0.20 logMAR had a sensitivity of 92% and a specificity of 91% in detecting myopia and a sensitivity of 41% and a specificity of 84% in detecting hyperopia.
Conclusions
Vision screening using logMAR acuity can reliably detect myopia, but not hyperopia or astigmatism in school-age children. Providers of vision screening programs should be cognisant that where detection of uncorrected hyperopic and/or astigmatic refractive error is an aspiration, current UK protocols will not effectively deliver.
Original languageEnglish
Article numbere34441
Number of pages7
JournalPLoS ONE
Volume7
Issue number3
DOIs
Publication statusPublished - 28 Mar 2012

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Refractive Errors
Hyperopia
childhood
epidemiological studies
Visual Acuity
Myopia
Epidemiologic Studies
Northern Ireland
school children
screening
Screening
Astigmatism
eyes
Vision Screening
Mydriatics
Refraction
myopia
Sensitivity and Specificity

Bibliographical note

© 2012 O'Donoghue et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cite this

O'Donoghue, Lisa ; Rudnicka, Alicja R. ; McClelland, Julie F. ; Logan, Nicola S. ; Saunders, Kathryn J. / Visual acuity measures do not reliably detect childhood refractive error - an epidemiological study. In: PLoS ONE. 2012 ; Vol. 7, No. 3.
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abstract = "PurposeTo investigate the utility of uncorrected visual acuity measures in screening for refractive error in white school children aged 6-7-years and 12-13-years.MethodsThe Northern Ireland Childhood Errors of Refraction (NICER) study used a stratified random cluster design to recruit children from schools in Northern Ireland. Detailed eye examinations included assessment of logMAR visual acuity and cycloplegic autorefraction. Spherical equivalent refractive data from the right eye were used to classify significant refractive error as myopia of at least 1DS, hyperopia as greater than +3.50DS and astigmatism as greater than 1.50DC, whether it occurred in isolation or in association with myopia or hyperopia.ResultsResults are presented from 661 white 12-13-year-old and 392 white 6-7-year-old school-children. Using a cut-off of uncorrected visual acuity poorer than 0.20 logMAR to detect significant refractive error gave a sensitivity of 50{\%} and specificity of 92{\%} in 6-7-year-olds and 73{\%} and 93{\%} respectively in 12-13-year-olds. In 12-13-year-old children a cut-off of poorer than 0.20 logMAR had a sensitivity of 92{\%} and a specificity of 91{\%} in detecting myopia and a sensitivity of 41{\%} and a specificity of 84{\%} in detecting hyperopia.ConclusionsVision screening using logMAR acuity can reliably detect myopia, but not hyperopia or astigmatism in school-age children. Providers of vision screening programs should be cognisant that where detection of uncorrected hyperopic and/or astigmatic refractive error is an aspiration, current UK protocols will not effectively deliver.",
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Visual acuity measures do not reliably detect childhood refractive error - an epidemiological study. / O'Donoghue, Lisa; Rudnicka, Alicja R.; McClelland, Julie F.; Logan, Nicola S.; Saunders, Kathryn J.

In: PLoS ONE, Vol. 7, No. 3, e34441, 28.03.2012.

Research output: Contribution to journalArticle

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T1 - Visual acuity measures do not reliably detect childhood refractive error - an epidemiological study

AU - O'Donoghue, Lisa

AU - Rudnicka, Alicja R.

AU - McClelland, Julie F.

AU - Logan, Nicola S.

AU - Saunders, Kathryn J.

N1 - © 2012 O'Donoghue et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2012/3/28

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N2 - PurposeTo investigate the utility of uncorrected visual acuity measures in screening for refractive error in white school children aged 6-7-years and 12-13-years.MethodsThe Northern Ireland Childhood Errors of Refraction (NICER) study used a stratified random cluster design to recruit children from schools in Northern Ireland. Detailed eye examinations included assessment of logMAR visual acuity and cycloplegic autorefraction. Spherical equivalent refractive data from the right eye were used to classify significant refractive error as myopia of at least 1DS, hyperopia as greater than +3.50DS and astigmatism as greater than 1.50DC, whether it occurred in isolation or in association with myopia or hyperopia.ResultsResults are presented from 661 white 12-13-year-old and 392 white 6-7-year-old school-children. Using a cut-off of uncorrected visual acuity poorer than 0.20 logMAR to detect significant refractive error gave a sensitivity of 50% and specificity of 92% in 6-7-year-olds and 73% and 93% respectively in 12-13-year-olds. In 12-13-year-old children a cut-off of poorer than 0.20 logMAR had a sensitivity of 92% and a specificity of 91% in detecting myopia and a sensitivity of 41% and a specificity of 84% in detecting hyperopia.ConclusionsVision screening using logMAR acuity can reliably detect myopia, but not hyperopia or astigmatism in school-age children. Providers of vision screening programs should be cognisant that where detection of uncorrected hyperopic and/or astigmatic refractive error is an aspiration, current UK protocols will not effectively deliver.

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