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Analysis of the readability of patient education materials in pediatric ophthalmology
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142 Br€uckner test: a novel technique for the rapid detection of refractive errors in children by the pediatricians. Piyush Jain, Vaibhav Gode, Mihir Kothari Introduction: The purpose of this study was to assess the efficiency of the Br€ uckner test in detection of ametropia when used by a pediatrician. Methods: In this prospective double masked cohort study, a paediatrician performed the Br€ uckner test in class room of a school in dark lighting condition using a direct ophthalmoscope followed by the same test being performed by a masked ophthalmologist. Findings of the test were noted as emmetropia, hyperopia or myopia. For the purpose of the analysis, the data of hyperopia and myopia was clubbed into a single category—ametropia. The sensitivity, specificity, predictive value and clinical agreement were calculated from a 22 Bayesian table. The findings of the pediatric ophthalmologists were considered gold standard. The technique of the Br€ uckner test used in this study has been already validated against the cycloplegic refraction and vision assessment and published previously. Results: A total of 236 eyes of 118 subjects were examined. The time taken to complete this test was \10 seconds per subject. Ophthalmologist identified 59 eyes as ametropic (12 hyperopic and 47 myopic eyes) and 177 as emmetropic compared to 61 eyes as ametropic and 175 emmetropic by paediatrician. At prevalence of 25.9%, the sensitivity of the Br€uckner test by pediatrician was 90.2%, specificity was 97.7%, predictive value of the positive test was 93.2%, and predictive value of the negative test was 96.6%. Clinical agreement (kappa) between the ophthalmologist and the pediatrician was 0.9. Conclusions: The Br€uckner test is an excellent tool for the detection of significant refractive errors in the hands of pediatrician to rapidly screen the children for ametropia.
143 The Newcastle Control Score—a predictor of surgical outcome in distance intermittent exotropia? Hugh Jewsbury, Patrick Watts Introduction: The Newcastle Control Score (NCS) is used to quantify observed control of distance intermittent exotropia(1). It has been demonstrated as a valuable tool in predicting those likely to require surgical intervention when compared to historical criteria for listing(2). However, whether the NCS predicts actual surgical outcome is unclear. This study aims to investigate if a relationship exists. Methods: Retrospective analysis of patients notes undergoing strabismus surgery for distance intermittent exotropia at a UK teaching hospital between February 2002 and February 2014. The primary end point was the magnitude of deviation for near and distance at 3 months post operatively. Results: A total of 67 patients (35 males) were included. Mean age 12.3 5.19 years. The differences in preoperative NCS for distance, near, home and total control were compared between patients achieving an excellent result (within 10 D of orthophoria) and those achieving a poor outcome (.10 D of orthophoria). There was no statistical difference between any groups (P . 0.3). There was no statistical difference in the number of patients achieving an excellent result (within 10 D of orthophoria) when divided into those with a low (#5) preoperative NCS and a high ($6) preoperative score (c2 statistic, 0.042; P 5 0.84).
Volume 19 Number 4 / August 2015
Discussion: While the NCS may predict those that are likely to undergo surgery, it does not appear to predict successful outcomes. Conclusions: Additional tools need to be developed to help predict surgical outcomes in patients with intermittent exotropia in order to better inform surgeons, patients and families of the need for surgery and likely success.
144 Analysis of the readability of patient education materials in pediatric ophthalmology. Ann M. John, Elizabeth S. John, David R. Hansberry, Suqin Guo Introduction: Patients increasingly utilize online resources for healthcare information. Studies show that over eight in ten caregivers have Internet access, and 84% of them search online for health information. The American Medical Association (AMA) and National Institute of Health (NIH) recommend that online patient resources be written between a 3rd and 7th grade level for sufficient patient comprehension. This study assesses whether online health information in pediatric ophthalmology abides by these guidelines. Methods: Ten pediatric ophthalmology conditions were entered into a commonly used search engine, Google.com. Conditions included amblyopia, cataract, conjunctivitis, corneal abrasion, nystagmus, retinoblastoma, retinopathy of prematurity, sty, and glaucoma. The first 10 patient information articles for each condition were assessed using 10 validated readability scales: FleschReading Ease, Flesch-Kincaid Grade-Level, SMOG Grading, Coleman-Liau Index, Gunning-Fog Index, New Dale-Chall, FORCAST, Fry graph, Raygor-Estimate, and New Fog-Count. Scientific articles and articles written on patient forums were excluded. Common sources of articles were aapos.org, aoa.org, kidshealth. org, and geteyesmart.org. Results: The majority of articles were written above recommended guidelines. Across all scales, the 100 articles were written at a mean grade-level of 12.1 1.8. Only 12% of articles were written below a 9th grade-level and only 2% met recommended criteria. Discussion: The readability of online patient education material exceeds NIH and AMA guidelines. This can adversely affect caregiver comprehension of such resources, contributing to poor decision making. Conclusions: Pediatric ophthalmology online articles are generally written at a level too high for caregiver comprehension. Revision of the level of articles may increase patient education, improve health outcomes, and facilitate the patient–physician relationship. 145 Effect on blink rate during videogame related activities and reading in school-aged children. Catherine O. Jordan, David L. Rogers Introduction: This study compared blink rate per minute (B/m) during an interview, reading a book and playing a videogame. Methods: Children aged 5 to 17 were recruited for a pilot study. Participants were individually videotaped for five minutes during each of these activities: being interviewed for dry eye symptoms, reading a book and playing a handheld videogame. The videos were reviewed and B/m was recorded. A two-tailed matched pairs t test was used for statistical analysis.
Journal of AAPOS
142 Br€uckner test: a novel technique for the rapid detection of refractive errors in children by the pediatricians. Piyush Jain, Vaibhav Gode, Mihir Kothari Introduction: The purpose of this study was to assess the efficiency of the Br€ uckner test in detection of ametropia when used by a pediatrician. Methods: In this prospective double masked cohort study, a paediatrician performed the Br€ uckner test in class room of a school in dark lighting condition using a direct ophthalmoscope followed by the same test being performed by a masked ophthalmologist. Findings of the test were noted as emmetropia, hyperopia or myopia. For the purpose of the analysis, the data of hyperopia and myopia was clubbed into a single category—ametropia. The sensitivity, specificity, predictive value and clinical agreement were calculated from a 22 Bayesian table. The findings of the pediatric ophthalmologists were considered gold standard. The technique of the Br€ uckner test used in this study has been already validated against the cycloplegic refraction and vision assessment and published previously. Results: A total of 236 eyes of 118 subjects were examined. The time taken to complete this test was \10 seconds per subject. Ophthalmologist identified 59 eyes as ametropic (12 hyperopic and 47 myopic eyes) and 177 as emmetropic compared to 61 eyes as ametropic and 175 emmetropic by paediatrician. At prevalence of 25.9%, the sensitivity of the Br€uckner test by pediatrician was 90.2%, specificity was 97.7%, predictive value of the positive test was 93.2%, and predictive value of the negative test was 96.6%. Clinical agreement (kappa) between the ophthalmologist and the pediatrician was 0.9. Conclusions: The Br€uckner test is an excellent tool for the detection of significant refractive errors in the hands of pediatrician to rapidly screen the children for ametropia.
143 The Newcastle Control Score—a predictor of surgical outcome in distance intermittent exotropia? Hugh Jewsbury, Patrick Watts Introduction: The Newcastle Control Score (NCS) is used to quantify observed control of distance intermittent exotropia(1). It has been demonstrated as a valuable tool in predicting those likely to require surgical intervention when compared to historical criteria for listing(2). However, whether the NCS predicts actual surgical outcome is unclear. This study aims to investigate if a relationship exists. Methods: Retrospective analysis of patients notes undergoing strabismus surgery for distance intermittent exotropia at a UK teaching hospital between February 2002 and February 2014. The primary end point was the magnitude of deviation for near and distance at 3 months post operatively. Results: A total of 67 patients (35 males) were included. Mean age 12.3 5.19 years. The differences in preoperative NCS for distance, near, home and total control were compared between patients achieving an excellent result (within 10 D of orthophoria) and those achieving a poor outcome (.10 D of orthophoria). There was no statistical difference between any groups (P . 0.3). There was no statistical difference in the number of patients achieving an excellent result (within 10 D of orthophoria) when divided into those with a low (#5) preoperative NCS and a high ($6) preoperative score (c2 statistic, 0.042; P 5 0.84).
Volume 19 Number 4 / August 2015
Discussion: While the NCS may predict those that are likely to undergo surgery, it does not appear to predict successful outcomes. Conclusions: Additional tools need to be developed to help predict surgical outcomes in patients with intermittent exotropia in order to better inform surgeons, patients and families of the need for surgery and likely success.
144 Analysis of the readability of patient education materials in pediatric ophthalmology. Ann M. John, Elizabeth S. John, David R. Hansberry, Suqin Guo Introduction: Patients increasingly utilize online resources for healthcare information. Studies show that over eight in ten caregivers have Internet access, and 84% of them search online for health information. The American Medical Association (AMA) and National Institute of Health (NIH) recommend that online patient resources be written between a 3rd and 7th grade level for sufficient patient comprehension. This study assesses whether online health information in pediatric ophthalmology abides by these guidelines. Methods: Ten pediatric ophthalmology conditions were entered into a commonly used search engine, Google.com. Conditions included amblyopia, cataract, conjunctivitis, corneal abrasion, nystagmus, retinoblastoma, retinopathy of prematurity, sty, and glaucoma. The first 10 patient information articles for each condition were assessed using 10 validated readability scales: FleschReading Ease, Flesch-Kincaid Grade-Level, SMOG Grading, Coleman-Liau Index, Gunning-Fog Index, New Dale-Chall, FORCAST, Fry graph, Raygor-Estimate, and New Fog-Count. Scientific articles and articles written on patient forums were excluded. Common sources of articles were aapos.org, aoa.org, kidshealth. org, and geteyesmart.org. Results: The majority of articles were written above recommended guidelines. Across all scales, the 100 articles were written at a mean grade-level of 12.1 1.8. Only 12% of articles were written below a 9th grade-level and only 2% met recommended criteria. Discussion: The readability of online patient education material exceeds NIH and AMA guidelines. This can adversely affect caregiver comprehension of such resources, contributing to poor decision making. Conclusions: Pediatric ophthalmology online articles are generally written at a level too high for caregiver comprehension. Revision of the level of articles may increase patient education, improve health outcomes, and facilitate the patient–physician relationship. 145 Effect on blink rate during videogame related activities and reading in school-aged children. Catherine O. Jordan, David L. Rogers Introduction: This study compared blink rate per minute (B/m) during an interview, reading a book and playing a videogame. Methods: Children aged 5 to 17 were recruited for a pilot study. Participants were individually videotaped for five minutes during each of these activities: being interviewed for dry eye symptoms, reading a book and playing a handheld videogame. The videos were reviewed and B/m was recorded. A two-tailed matched pairs t test was used for statistical analysis.
Journal of AAPOS