- Email: [email protected]
New trends in childhood vision impairment in a developed country
Accepted Manuscript New trends in childhood vision impairment in a developed country Chengde Pham, MBBS, Shivanand J. Sheth, MS, FRANZCO, Jill E. Keeffe, OAM, PhD, Susan M. Carden, FRANZCO, PhD PII:
S1091-8531(16)30743-1
DOI:
10.1016/j.jaapos.2017.08.002
Reference:
YMPA 2695
To appear in:
Journal of AAPOS
Received Date: 9 December 2016 Revised Date:
16 June 2017
Accepted Date: 28 August 2017
Please cite this article as: Pham C, Sheth SJ, Keeffe JE, Carden SM, New trends in childhood vision impairment in a developed country, Journal of AAPOS (2017), doi: 10.1016/j.jaapos.2017.08.002. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
New trends in childhood vision impairment in a developed country Chengde Pham, MBBS,a Shivanand J Sheth, MS, FRANZCO,a Jill E Keeffe, OAM, PhD,b,c and Susan M Carden, FRANZCO, PhD,a,d,e
RI PT
Author affiliations: aThe Royal Victorian Eye and Ear Hospital, Melbourne; bMelbourne School of Population Health, University of Melbourne; cLV Prasad Eye Institute, Hyderabad; d Department of Ophthalmology, The Royal Children’s Hospital, Melbourne; eDepartment of Paediatrics, University of Melbourne
SC
Submitted December 9, 2016. Revision accepted August 21, 2017.
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Presented in part at 41st Annual Meeting of the American Associate for Pediatric Ophthalmology and Strabismus, New Orleans, March 25-29, and at the 46th Annual Scientific Congress of The Royal Australian and New Zealand College of Ophthalmologists, Brisbane, November 2014. Correspondence: Susan M. Carden, FRANZCO, PhD, The Royal Victorian Eye and Ear Hospital, 32 Gisborne St, East Melbourne, VIC 3002, Australia (email: [email protected]).
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Word count: 1,500 Abstract only: 249 words
ACCEPTED MANUSCRIPT
Abstract Background The Education Vision Assessment Clinic (EVAC) is a unique statewide service that reviews
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school children 4-18 years of age with low vision in Victoria, Australia, to determine their
eligibility for educational support. The purpose of this study was to identify causes of vision impairment in students in Victoria using data from the EVAC.
SC
Methods
Data collected from students who attended the EVAC at the Royal Victorian Eye and Ear
M AN U
Hospital, Melbourne, between the years 2003 and 2012 inclusive, were analyzed retrospectively. Participants were identified through the EVAC schedule of medical appointments. Medical records were reviewed for clinical and demographic information, including diagnosis of vision impairment and best-corrected visual acuity and/or visual fields.
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Results
Of 543 students, 355 (65%) were eligible for educational assistance. Of those, 249 (70%) had best-corrected visual acuity between 20/60 and 20/200 and/or a field of vision of <20° to 10°,
EP
and 106 (30%) had a best-corrected visual acuity worse than 20/200 and/or a field of vision of <10°. Common causes of vision impairment were retinal dystrophies (24%), optic nerve
AC C
pathology (14%), albinism (14%) ,and infantile motor nystagmus (10%). Conclusions
Treatable and potentially preventable causes of vision impairment, such as retinopathy of prematurity and cataract, caused <10% of vision impairment cases in Victorian school children. Analysis of demographic trends is essential to supporting efforts to ensure that students with low vision, from any socioeconomic background, receive specialist teaching services.
ACCEPTED MANUSCRIPT
Vision impairment in school-age students significantly affects their education.1-4 The Educational Vision Assessment Clinic (EVAC) examines students 4-18 years of age with vision impairment in the state of Victoria, Australia, in order to determine their eligibility for
RI PT
educational support.5 In 2013 there were 883,550 students in primary and secondary schools (including special schools) in Victoria.6 The EVAC likely captures most students with significant vision impairment in Victoria and provides a valuable source of statistical information.
SC
The clinic is conducted at The Royal Victorian Eye and Ear Hospital, Melbourne, and is staffed by a multidisciplinary team of professionals, including a pediatric ophthalmologist,
M AN U
orthoptist, education officer, and educational psychologist. The EVAC provides information about the nature and degree of students’ vision impairment and helps to identify those who have significant vision impairment requiring adaptations of curriculum delivery and alternative-format learning materials, including visiting teacher services, for their inclusive education.
TE D
Referrals are received statewide and include students from any location or socioeconomic background. The referrals can be received from multiple sources, including medical and allied health providers.
EP
Criteria for eligibility to receive educational support were established in conjunction with the Victorian State Government Department of Education and Early Childhood Development.
AC C
There are two levels of support. Moderate support is available for those students with a bestcorrected visual acuity worse than 20/60 in the better-seeing eye and/or visual fields constricted to <20°. Higher-level support is available for students who have a best-corrected visual acuity worse than 20/200 in the better-seeing eye and/or a field of vision of <10°. Supporting a student with low vision through their schooling years is an interdisciplinary effort between medical, educational, and government services. The EVAC plays a critical role in
ACCEPTED MANUSCRIPT
determining the need for specialist services and provision of information to teachers of students with vision impairment. It also ensures that resources are appropriately used and allocated
of vision impairment in school-aged students were examined. Methods
RI PT
toward students with educationally significant low vision. Using the data from EVAC, the causes
This study was approved by the Human Research Ethics Committee of the Royal Victorian Eye
SC
and Ear Hospital, East Melbourne, Australia. The EVAC schedule of medical appointments from January 2003 to December 2012 inclusive was reviewed retrospectively to identify all potential
M AN U
participants. Paper medical records were accessed and reviewed for data collection. Demographic data (age, sex, school, area of residence), best-corrected visual acuity, and underlying ophthalmic diagnoses were collected.
Etiologies were categorized into retinal dystrophies/other retinal conditions, optic nerve
TE D
pathology, albinism (ocular and oculocutaneous), infantile motor nystagmus, cortical visual impairment, retinopathy of prematurity (ROP), cataract/cataract surgery related/inflammatory, high refractive error or amblyopia, and congenital glaucoma. Non-ROP-related retinal conditions
EP
included Stargardt disease, retinitis pigmentosa, achromatopsia, cone dystrophies, cone-rod dystrophies, Leber congenital amaurosis, Norrie disease, retinal detachments, retinoschisis,
AC C
familial exudative vitreoretinopathy, retinoblastoma, nonspecific retinal, and macular dystrophies. Cataract/cataract surgery–related/inflammatory pathologies included congenital cataracts, aphakia, aphakic glaucoma, pseudophakia, cataract-related amblyopia, post-cataract surgery uveitis, and uveitis causing cataracts and vision impairment. Diagnoses not falling in any of these categories were classified as miscellaneous and included structural eye deformities (colobomas, microphthalmia, anterior segment dysgenesis, aniridia, congenital corneal opacities)
ACCEPTED MANUSCRIPT
and systemic syndromes with known poor vision and eye malformations. Visual acuity in the EVAC was tested with age-appropriate tests such as Kay Pictures or Snellen charts at 20 feet and 10 feet. The final visual acuity was converted to Snellen equivalent.
RI PT
Data were recorded onto a Excel (Microsoft, Redmond, WA) spreadsheet. Results
Of 595 students identified as being registered in the EVAC between 2003 to 2012 inclusive, 543
SC
paper medical records were retrieved (age range, 4-18 years; 326 males). Fifty-two files (8.7%) were not located, including nonattendees and unlocated paper records. Of the 543, 355 students
M AN U
(65%; 206 males [58%]) were eligible for educational assistance. Of these, 249 (70%) were eligible for moderate support, and 106 (30%) were eligible for higher-level support (Table 1). Of the 543, 188 students (35%) students were ineligible for teaching assistance, because they had best-corrected visual acuity of better than 20/60 in the better-seeing eye and a field of
TE D
vision >20°.
Of the 355 students who were eligible for educational assistance, the most common causes of vision impairment were retinal dystrophies (n = 86 [24%]), optic nerve pathology (n =
EP
51 [14%]), albinism (n = 49 [14%]), infantile motor nystagmus (n = 34 [10%]), cortical vision impairment (n = 20 [6%]), retinopathy of prematurity (n = 19 [5%]), congenital cataract–related
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low vision or inflammation-related low vision (n = 16 [5%]), and miscellaneous (n = 66 [19%]). Discussion
The most common diagnoses identified in school-age students eligible for educational assistance were retinal dystrophies, optic nerve atrophy/hypoplasia, albinism, and infantile motor nystagmus. Although albinism and infantile motor nystagmus were highly represented, they were more often associated with vision impairment eligible for moderate rather than for higher-level
ACCEPTED MANUSCRIPT
support (Table 2). This contrasts with what are thought to be the main causes of childhood blindness in the United States, which are cortical visual impairment, optic nerve hypoplasia, and retinopathy of prematurity.1
RI PT
Irreversible conditions such as retinal dystrophies, albinism, and infantile motor
nystagmus do not currently have accessible means of treatment and in many cases are essentially unpreventable.7 Vision and visual functioning can often be improved with a low-vision
SC
assessment for potential prescription of low-vision devices. The other treatable and potentially preventable causes of vision impairment, such as retinopathy of prematurity and pediatric
M AN U
cataract, make up <10% of causes of vision impairment in school-age students in Victoria, Australia.
Vision impairment was more common in males than females in our study. It is noteworthy that more males than females were referred to and attended the EVAC. It may be that
TE D
vision impairment is more common in males, especially given that certain retinal dystrophies are X-linked. However, there may also be a gender-based disparity in the healthcare-seeking behavior of parents.8
EP
A potential limitation of our study is that some children with visual impairment within our region may not have presented to EVAC, despite its being a free service for school-age
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students of any socioeconomic background. The EVAC aims to review all students with vision impairment, including those who may have other severe disabilities. Some of those students may already receive aid from other governmental or organizational sources and hence may not specifically seek vision-related assistance. The growing diversity of ethnic patients in Victoria potentially carries cultural variations in care-seeking attitudes with regard to the stigma of developmental delay and poor vision, although this effect is not easily quantifiable. Nonetheless,
ACCEPTED MANUSCRIPT
it is expected that most Victorian schoolchildren with significant vision impairment attend the EVAC and are subsequently captured in our audit. Also, it is possible that students from remote areas may be under-represented.
RI PT
Acknowledgements
We acknowledge the multidisciplinary staff from the Education Vision Assessment Clinic, The Royal Victorian Eye and Ear Hospital, and others who helped with this research study, including
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EP
TE D
M AN U
Hicks, Berlin Patag, and Karishma Thakkar.
SC
Annette Godfrey-Magee, Marion Blasé, Geoff Bowen, Vicky Staikos, Hector Maclean, Amanda
ACCEPTED MANUSCRIPT
References 1.
Kong L, Fry M, Al-Samarraie M, Gilbert C, Steinkuller P. An update on progress and the changing epidemiology of causes of childhood blindness worldwide. J AAPOS
2.
RI PT
2012;16:501-7.
Rahi J, Cable N. Severe visual impairment and blindness in children in the UK. Lancet 2003;362:1359-65.
Gilbert C, Muhit M. Twenty years of childhood blindness: what have we learnt? Community Eye Health 2008;21:46-7.
Cochrane G, Lamoureux E, Keeffe J. Defining the content for a new quality of life
M AN U
4.
SC
3.
questionnaire for students with low vision (The Impact of Vision Impairment on Children: IVI_C). Ophthalmic Epidemiol 2008;15:114-20. 5.
Statewide Vision Resource Centre. Eligibility & EVAC. Available at
6.
TE D
http://svrc.vic.edu.au/about/eligibility/. Accessed June 21, 2017. Department of Education and Early Childhood Development. Summary Statistics Victorian Schools. February 2013. Available at
EP
http://www.education.vic.gov.au/Documents/about/department/2013summarystats.pdf. Accessed June 21, 2017.
Rudanko S, Laatikainen L. Visual impairment in children born at full term from 1972
AC C
7.
through 1989 in Finland. Ophthalmology 2004;111:2307-12.
8.
Willis J, Kumar V, Mohanty S, Singh P, Singh V, et al. Gender differences in perception and care-seeking for illness of newborns in rural Uttar Pradesh, India. J Health Popul Nutr 2009;27.
ACCEPTED MANUSCRIPT
Table 1. Number of students eligible for assistance Male (%) Female (%) 120 (22.09) 68 (12.52) 150 (27.62) 99 (18.23) 56 (10.31) 50 (9.20) 326 (63.72) 217 (39.96)
Total (%) 188 (34.62) 249 (45.85) 106 (19.52) 543
a
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EP
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Best-corrected visual acuity (BCVA) better than or equal to 20/60 in the better-seeing eye and/or visual fields >20°. b BCVA worse than 20/60 to 20/200 in the better-seeing eye and/or visual fields constricted to <20° to 10°. c BCVA worse than 20/200 in the better eye and/or field of vision less than 10°.
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Level of support a Not eligible b Moderate support c Higher-level support Total
ACCEPTED MANUSCRIPT
Table 2. Number of students eligible for assistance in each diagnostic category Total
Retinal disease (non-ROP)c Optic nerve pathology Albinism Infantile motor nystagmus Cortical vision impairment Retinopathy of prematurity d Cataract related Refractive error/amblyopia Congenital glaucoma Miscellaneouse Total
55 26 31 21 12 9 9 4 4 35 206
Female 31 25 18 13 8 10 7 6 0 31 149
Support eligibility (%) a b Moderate Higher level 52 (14.64) 34 (9.57) 28 (7.88) 23 (6.47) 48 (13.52) 1 (0.28) 32 (9.01) 2 (0.56) 12 (3.38) 8 (2.25) 10 (2.81) 9 (2.53) 11 (3.09) 5 (1.40) 10 (2.81) 0 (0.00) 2 (0.56) 2 (0.56) 44 (12.39) 22 (6.19) 249 (70.14) 106 (29.85)
SC
86 51 49 34 20 19 16 10 4 66 355
Male
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Diagnosis
a
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EP
TE D
M AN U
BCVA worse than 20/60 to 20/200 in the better-seeing eye and/or visual fields constricted to <20° to 10°. b BCVA worse than 20/200 in the better-seeing eye and/or field of vision <10°. c Includes Stargardt disease, retinitis pigmentosa, achromatopsia, cone dystrophies, cone-rod dystrophies, Leber congenital amaurosis, Norrie disease, retinal detachments, retinoschisis, familial exudative vitreoretinopathy, retinoblastoma, undiagnosed retinal and macular dystrophies. d Includes congenital cataracts, aphakia, aphakic glaucoma, pseudophakia, cataract related amblyopia, post-cataract surgery uveitis, uveitis-causing cataracts and vision loss. e Includes structural eye deformities (colobomas, microphthalmia, anterior segment dysgenesis, aniridia, congenital corneal opacities), systemic syndromes with known poor vision, and eye malformations.
S1091-8531(16)30743-1
DOI:
10.1016/j.jaapos.2017.08.002
Reference:
YMPA 2695
To appear in:
Journal of AAPOS
Received Date: 9 December 2016 Revised Date:
16 June 2017
Accepted Date: 28 August 2017
Please cite this article as: Pham C, Sheth SJ, Keeffe JE, Carden SM, New trends in childhood vision impairment in a developed country, Journal of AAPOS (2017), doi: 10.1016/j.jaapos.2017.08.002. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
New trends in childhood vision impairment in a developed country Chengde Pham, MBBS,a Shivanand J Sheth, MS, FRANZCO,a Jill E Keeffe, OAM, PhD,b,c and Susan M Carden, FRANZCO, PhD,a,d,e
RI PT
Author affiliations: aThe Royal Victorian Eye and Ear Hospital, Melbourne; bMelbourne School of Population Health, University of Melbourne; cLV Prasad Eye Institute, Hyderabad; d Department of Ophthalmology, The Royal Children’s Hospital, Melbourne; eDepartment of Paediatrics, University of Melbourne
SC
Submitted December 9, 2016. Revision accepted August 21, 2017.
M AN U
Presented in part at 41st Annual Meeting of the American Associate for Pediatric Ophthalmology and Strabismus, New Orleans, March 25-29, and at the 46th Annual Scientific Congress of The Royal Australian and New Zealand College of Ophthalmologists, Brisbane, November 2014. Correspondence: Susan M. Carden, FRANZCO, PhD, The Royal Victorian Eye and Ear Hospital, 32 Gisborne St, East Melbourne, VIC 3002, Australia (email: [email protected]).
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EP
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Word count: 1,500 Abstract only: 249 words
ACCEPTED MANUSCRIPT
Abstract Background The Education Vision Assessment Clinic (EVAC) is a unique statewide service that reviews
RI PT
school children 4-18 years of age with low vision in Victoria, Australia, to determine their
eligibility for educational support. The purpose of this study was to identify causes of vision impairment in students in Victoria using data from the EVAC.
SC
Methods
Data collected from students who attended the EVAC at the Royal Victorian Eye and Ear
M AN U
Hospital, Melbourne, between the years 2003 and 2012 inclusive, were analyzed retrospectively. Participants were identified through the EVAC schedule of medical appointments. Medical records were reviewed for clinical and demographic information, including diagnosis of vision impairment and best-corrected visual acuity and/or visual fields.
TE D
Results
Of 543 students, 355 (65%) were eligible for educational assistance. Of those, 249 (70%) had best-corrected visual acuity between 20/60 and 20/200 and/or a field of vision of <20° to 10°,
EP
and 106 (30%) had a best-corrected visual acuity worse than 20/200 and/or a field of vision of <10°. Common causes of vision impairment were retinal dystrophies (24%), optic nerve
AC C
pathology (14%), albinism (14%) ,and infantile motor nystagmus (10%). Conclusions
Treatable and potentially preventable causes of vision impairment, such as retinopathy of prematurity and cataract, caused <10% of vision impairment cases in Victorian school children. Analysis of demographic trends is essential to supporting efforts to ensure that students with low vision, from any socioeconomic background, receive specialist teaching services.
ACCEPTED MANUSCRIPT
Vision impairment in school-age students significantly affects their education.1-4 The Educational Vision Assessment Clinic (EVAC) examines students 4-18 years of age with vision impairment in the state of Victoria, Australia, in order to determine their eligibility for
RI PT
educational support.5 In 2013 there were 883,550 students in primary and secondary schools (including special schools) in Victoria.6 The EVAC likely captures most students with significant vision impairment in Victoria and provides a valuable source of statistical information.
SC
The clinic is conducted at The Royal Victorian Eye and Ear Hospital, Melbourne, and is staffed by a multidisciplinary team of professionals, including a pediatric ophthalmologist,
M AN U
orthoptist, education officer, and educational psychologist. The EVAC provides information about the nature and degree of students’ vision impairment and helps to identify those who have significant vision impairment requiring adaptations of curriculum delivery and alternative-format learning materials, including visiting teacher services, for their inclusive education.
TE D
Referrals are received statewide and include students from any location or socioeconomic background. The referrals can be received from multiple sources, including medical and allied health providers.
EP
Criteria for eligibility to receive educational support were established in conjunction with the Victorian State Government Department of Education and Early Childhood Development.
AC C
There are two levels of support. Moderate support is available for those students with a bestcorrected visual acuity worse than 20/60 in the better-seeing eye and/or visual fields constricted to <20°. Higher-level support is available for students who have a best-corrected visual acuity worse than 20/200 in the better-seeing eye and/or a field of vision of <10°. Supporting a student with low vision through their schooling years is an interdisciplinary effort between medical, educational, and government services. The EVAC plays a critical role in
ACCEPTED MANUSCRIPT
determining the need for specialist services and provision of information to teachers of students with vision impairment. It also ensures that resources are appropriately used and allocated
of vision impairment in school-aged students were examined. Methods
RI PT
toward students with educationally significant low vision. Using the data from EVAC, the causes
This study was approved by the Human Research Ethics Committee of the Royal Victorian Eye
SC
and Ear Hospital, East Melbourne, Australia. The EVAC schedule of medical appointments from January 2003 to December 2012 inclusive was reviewed retrospectively to identify all potential
M AN U
participants. Paper medical records were accessed and reviewed for data collection. Demographic data (age, sex, school, area of residence), best-corrected visual acuity, and underlying ophthalmic diagnoses were collected.
Etiologies were categorized into retinal dystrophies/other retinal conditions, optic nerve
TE D
pathology, albinism (ocular and oculocutaneous), infantile motor nystagmus, cortical visual impairment, retinopathy of prematurity (ROP), cataract/cataract surgery related/inflammatory, high refractive error or amblyopia, and congenital glaucoma. Non-ROP-related retinal conditions
EP
included Stargardt disease, retinitis pigmentosa, achromatopsia, cone dystrophies, cone-rod dystrophies, Leber congenital amaurosis, Norrie disease, retinal detachments, retinoschisis,
AC C
familial exudative vitreoretinopathy, retinoblastoma, nonspecific retinal, and macular dystrophies. Cataract/cataract surgery–related/inflammatory pathologies included congenital cataracts, aphakia, aphakic glaucoma, pseudophakia, cataract-related amblyopia, post-cataract surgery uveitis, and uveitis causing cataracts and vision impairment. Diagnoses not falling in any of these categories were classified as miscellaneous and included structural eye deformities (colobomas, microphthalmia, anterior segment dysgenesis, aniridia, congenital corneal opacities)
ACCEPTED MANUSCRIPT
and systemic syndromes with known poor vision and eye malformations. Visual acuity in the EVAC was tested with age-appropriate tests such as Kay Pictures or Snellen charts at 20 feet and 10 feet. The final visual acuity was converted to Snellen equivalent.
RI PT
Data were recorded onto a Excel (Microsoft, Redmond, WA) spreadsheet. Results
Of 595 students identified as being registered in the EVAC between 2003 to 2012 inclusive, 543
SC
paper medical records were retrieved (age range, 4-18 years; 326 males). Fifty-two files (8.7%) were not located, including nonattendees and unlocated paper records. Of the 543, 355 students
M AN U
(65%; 206 males [58%]) were eligible for educational assistance. Of these, 249 (70%) were eligible for moderate support, and 106 (30%) were eligible for higher-level support (Table 1). Of the 543, 188 students (35%) students were ineligible for teaching assistance, because they had best-corrected visual acuity of better than 20/60 in the better-seeing eye and a field of
TE D
vision >20°.
Of the 355 students who were eligible for educational assistance, the most common causes of vision impairment were retinal dystrophies (n = 86 [24%]), optic nerve pathology (n =
EP
51 [14%]), albinism (n = 49 [14%]), infantile motor nystagmus (n = 34 [10%]), cortical vision impairment (n = 20 [6%]), retinopathy of prematurity (n = 19 [5%]), congenital cataract–related
AC C
low vision or inflammation-related low vision (n = 16 [5%]), and miscellaneous (n = 66 [19%]). Discussion
The most common diagnoses identified in school-age students eligible for educational assistance were retinal dystrophies, optic nerve atrophy/hypoplasia, albinism, and infantile motor nystagmus. Although albinism and infantile motor nystagmus were highly represented, they were more often associated with vision impairment eligible for moderate rather than for higher-level
ACCEPTED MANUSCRIPT
support (Table 2). This contrasts with what are thought to be the main causes of childhood blindness in the United States, which are cortical visual impairment, optic nerve hypoplasia, and retinopathy of prematurity.1
RI PT
Irreversible conditions such as retinal dystrophies, albinism, and infantile motor
nystagmus do not currently have accessible means of treatment and in many cases are essentially unpreventable.7 Vision and visual functioning can often be improved with a low-vision
SC
assessment for potential prescription of low-vision devices. The other treatable and potentially preventable causes of vision impairment, such as retinopathy of prematurity and pediatric
M AN U
cataract, make up <10% of causes of vision impairment in school-age students in Victoria, Australia.
Vision impairment was more common in males than females in our study. It is noteworthy that more males than females were referred to and attended the EVAC. It may be that
TE D
vision impairment is more common in males, especially given that certain retinal dystrophies are X-linked. However, there may also be a gender-based disparity in the healthcare-seeking behavior of parents.8
EP
A potential limitation of our study is that some children with visual impairment within our region may not have presented to EVAC, despite its being a free service for school-age
AC C
students of any socioeconomic background. The EVAC aims to review all students with vision impairment, including those who may have other severe disabilities. Some of those students may already receive aid from other governmental or organizational sources and hence may not specifically seek vision-related assistance. The growing diversity of ethnic patients in Victoria potentially carries cultural variations in care-seeking attitudes with regard to the stigma of developmental delay and poor vision, although this effect is not easily quantifiable. Nonetheless,
ACCEPTED MANUSCRIPT
it is expected that most Victorian schoolchildren with significant vision impairment attend the EVAC and are subsequently captured in our audit. Also, it is possible that students from remote areas may be under-represented.
RI PT
Acknowledgements
We acknowledge the multidisciplinary staff from the Education Vision Assessment Clinic, The Royal Victorian Eye and Ear Hospital, and others who helped with this research study, including
AC C
EP
TE D
M AN U
Hicks, Berlin Patag, and Karishma Thakkar.
SC
Annette Godfrey-Magee, Marion Blasé, Geoff Bowen, Vicky Staikos, Hector Maclean, Amanda
ACCEPTED MANUSCRIPT
References 1.
Kong L, Fry M, Al-Samarraie M, Gilbert C, Steinkuller P. An update on progress and the changing epidemiology of causes of childhood blindness worldwide. J AAPOS
2.
RI PT
2012;16:501-7.
Rahi J, Cable N. Severe visual impairment and blindness in children in the UK. Lancet 2003;362:1359-65.
Gilbert C, Muhit M. Twenty years of childhood blindness: what have we learnt? Community Eye Health 2008;21:46-7.
Cochrane G, Lamoureux E, Keeffe J. Defining the content for a new quality of life
M AN U
4.
SC
3.
questionnaire for students with low vision (The Impact of Vision Impairment on Children: IVI_C). Ophthalmic Epidemiol 2008;15:114-20. 5.
Statewide Vision Resource Centre. Eligibility & EVAC. Available at
6.
TE D
http://svrc.vic.edu.au/about/eligibility/. Accessed June 21, 2017. Department of Education and Early Childhood Development. Summary Statistics Victorian Schools. February 2013. Available at
EP
http://www.education.vic.gov.au/Documents/about/department/2013summarystats.pdf. Accessed June 21, 2017.
Rudanko S, Laatikainen L. Visual impairment in children born at full term from 1972
AC C
7.
through 1989 in Finland. Ophthalmology 2004;111:2307-12.
8.
Willis J, Kumar V, Mohanty S, Singh P, Singh V, et al. Gender differences in perception and care-seeking for illness of newborns in rural Uttar Pradesh, India. J Health Popul Nutr 2009;27.
ACCEPTED MANUSCRIPT
Table 1. Number of students eligible for assistance Male (%) Female (%) 120 (22.09) 68 (12.52) 150 (27.62) 99 (18.23) 56 (10.31) 50 (9.20) 326 (63.72) 217 (39.96)
Total (%) 188 (34.62) 249 (45.85) 106 (19.52) 543
a
AC C
EP
TE D
M AN U
SC
Best-corrected visual acuity (BCVA) better than or equal to 20/60 in the better-seeing eye and/or visual fields >20°. b BCVA worse than 20/60 to 20/200 in the better-seeing eye and/or visual fields constricted to <20° to 10°. c BCVA worse than 20/200 in the better eye and/or field of vision less than 10°.
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Level of support a Not eligible b Moderate support c Higher-level support Total
ACCEPTED MANUSCRIPT
Table 2. Number of students eligible for assistance in each diagnostic category Total
Retinal disease (non-ROP)c Optic nerve pathology Albinism Infantile motor nystagmus Cortical vision impairment Retinopathy of prematurity d Cataract related Refractive error/amblyopia Congenital glaucoma Miscellaneouse Total
55 26 31 21 12 9 9 4 4 35 206
Female 31 25 18 13 8 10 7 6 0 31 149
Support eligibility (%) a b Moderate Higher level 52 (14.64) 34 (9.57) 28 (7.88) 23 (6.47) 48 (13.52) 1 (0.28) 32 (9.01) 2 (0.56) 12 (3.38) 8 (2.25) 10 (2.81) 9 (2.53) 11 (3.09) 5 (1.40) 10 (2.81) 0 (0.00) 2 (0.56) 2 (0.56) 44 (12.39) 22 (6.19) 249 (70.14) 106 (29.85)
SC
86 51 49 34 20 19 16 10 4 66 355
Male
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Diagnosis
a
AC C
EP
TE D
M AN U
BCVA worse than 20/60 to 20/200 in the better-seeing eye and/or visual fields constricted to <20° to 10°. b BCVA worse than 20/200 in the better-seeing eye and/or field of vision <10°. c Includes Stargardt disease, retinitis pigmentosa, achromatopsia, cone dystrophies, cone-rod dystrophies, Leber congenital amaurosis, Norrie disease, retinal detachments, retinoschisis, familial exudative vitreoretinopathy, retinoblastoma, undiagnosed retinal and macular dystrophies. d Includes congenital cataracts, aphakia, aphakic glaucoma, pseudophakia, cataract related amblyopia, post-cataract surgery uveitis, uveitis-causing cataracts and vision loss. e Includes structural eye deformities (colobomas, microphthalmia, anterior segment dysgenesis, aniridia, congenital corneal opacities), systemic syndromes with known poor vision, and eye malformations.