lessons learned implementing preschool-based vision screening with eye-mobile follow-up

e34 Volume 18 Number 4 / August 2014

as an intraocular pressure (IOP) of 21 m mHg or less without compli-cations.

Results:Median patient age was 10.1 years (range, 0-17 years), witha follow-up of 1 month to 7 years (mean, 23 months). Before ex-change from Ahmed to Baerveldt, the IOP was 29.5 � 3.19 mm Hg(t test, P 5 0.25) with an average of 3.5 � 0.7 medications, with nostatistical different in IOP since the beginning of Ahmed placement.After replacement of Baerveldt for the failed Ahmed, eyes had alower mean postoperative IOP of 20.4 � 1.04 mm Hg IOP (P 55.0*10-5, t test) at 1 month 7 years follow-up with fewer glaucomamedications (mean, 2.9 � 0.7 medications). Cumulative probabilitiesof success by Kaplan-Meier analysis were of 88.9% at 12 monthsand 74.4% at 36 months. In addition, there was no additional reportsof pain or infection (0/20 patients); corneal clarity was similar in pa-tients during all visits (t test, P 5 0.75).

Discussion:Within the 7 year time period after the novel implantationof a Baerveldt-350, patients consistently showed higher success ratein lowering IOP with fewer glaucoma medications.

Conclusion: This data suggests that an exchange of a failed Ahmedfor a Baerveldt aqueous shunt is a safe and efficacious surgical op-tion for control of intraocular pressures in patients with glaucoma.

References

1. Outcomes of sequential tube shunts in complicated glaucoma. Ophthal-mology 2000;107:309-14.

108 Lessons learned implementing preschool-based visionscreening with Eye-Mobile follow-up. Eugene A. Lowry, Eda Dou,Alejandra G. de Alba Campomanes

Introduction: The challenge of obtaining follow-up in childrenreferred from preschool vision screening has led more organizationsto offer eye examinations at the preschool to referred children.1,2

Factors that create a more successful integrated program have notbeen previously investigated.

Methods: We reviewed a preschool vision screening program con-ducted across five major preschool organizations in San Franciscoand Oakland during the 2012-2013 academic year. The programoffered preschool-based screening and free onsite comprehensiveeye examinations to referred children at a later date. We determinedfactors that influenced the screening and follow-up rate amongeligible children.

Results: A total of 7,544 children were targeted for screening ofwhich 6,430 (85%) were successfully screened. The most commonreason for failure to screen was absenteeism with 9.6% of all tar-geted children absent on the day of screening. Absent-rates didnot vary by day of week or month, but were significantly different be-tween programs (P\ 0.05 [c2]). 1,020 children were referred frominitial screening of whom 616 (60%) were examined at the plannedfollow-up appointment. Follow-up rate varied significantly betweenpreschool programs and was lower in schools with a longer timefrom referral to follow-up (P\ 0.05 [c2]).

Discussion: Screening and follow-up rates were significantlydifferent between preschool programs. Follow-up rates were lowerwhen time to follow-up was higher.

Conclusion: Differences between preschool programs may impactthe efficiency of preschool vision screening programs. Maintaininga short time from screening to follow-up may increase follow-uprates.

References

1. Hartmann EE, Bradford GE, Chaplin PK, et al. Project universal preschoolvision screening: A demonstration project. Pediatrics 2006;117:e226-37.

2. Traboulsi EI, Cimino H, Mash C, Wilson R, Crowe S, Lewis H. Vision first, aprogram to detect and treat eye diseases in young children: the first fouryears. Trans Am Ophthalmol Soc 2008;106:179-85. discussion 185–6.

109 Comprehensive pediatric low-vision rehabilitation: effectiveevaluations and treatment for very young children. Kelly E. Lusk,Rebecca Coakley, Terry L. SchwartzIntroduction: For children, much early learning happens through inci-dental visual observation that speeds the learning of new tasks, as-sists in performance of learned tasks, guides movement, andprovides social cues. Through developmentally appropriate evalua-tions, it is hypothesized that even very young children (as young asage 2) can be successfully evaluated, and proficient in optical deviceuse by age 3-4.Methods: Patients with low vision ages 2-6 (n 5 22) were assessedover 2 years (2011-2013). Measures included visual acuity (VA), visualfield, contrast sensitivity, color perception and discrimination, andthe ability to use an optical device for near and/or distance magnifi-cation.Results: Accurate measures were successfully obtained in thefollowing categories: distance VA, 91% (n 5 20); near VA, 86.4%(n 5 19); visual field, 95.5% (n 5 21); contrast sensitivity, 95.5% (n 521), and color perception/discrimination, 68.2% (n5 15). When deter-mining the appropriateness of optical devices, 14 of 22 children ages2-6 (63.6%) were prescribed an optical device (50% (n5 11) near de-vice, 54.6% (n5 12) distance device, 40.9% (n5 9) both near and dis-tance device, and 27.3% (n 5 6) start premagnification instruction).Discussion: Effective use of vision impacts many prereading skills,including matching, rhyming, letter skills, directional concepts, motorskills, concepts of print, and language skills. Beyond reading skills,there are implications for middle/high school level and adult life inthe areas of social, educational, and career expectations, as wellas life/work balance.Conclusion: These data show promise for successfully evaluatingand treating this population of very young children with low vision,and increasing the functional use of vision for increased educationaloutcomes.

110 Does adding randot stereo testing to plusoptiXphotoscreening improve sensitivity? Noelle S. Matta, David I. SilbertIntroduction: To determine if adding Randot stereoacuity to the plu-soptiX photoscreening improves sensitivity.Methods: 136 children had a plusoptiX A09 photoscreening and Ran-dot stereoacuity performed in our office. All children also underwenta comprehensive pediatric ophthalmology examination. Childrenwere determined to have amblyopia risk factors based on the 2013AAPOS referral criteria. Children were considered to pass the Ran-dot stereo test if they had any measurable stereoacuity.Results: 136 patients ages 3-17 were included, 57% of children werefound to have amblyopia risk factors. Randot Stereo test alone had asensitivity of 12% and specificity of 96%. plusoptiX alone was foundto have a sensitivity of 91% and specificity of 74%. Assuming that allchildren who passed both plusoptiX and the stereo were a pass, butany child that was a refer on either or both tests was a refer, wefound a sensitivity unchanged at 91% but the specificity decreasedto 71%.Discussion: Randot stereoacuity had excellent sensitivity and wasable to rule out amblyopia risk factors, but the specificity of an

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