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Use of visual acuity to screen for significant refractive errors in adolescents

Leone, Jody F; Mitchell, Paul; Morgan, Ian; Kifley, Annette; Rose, Kathryn A

Description

Objective: To detect significant refractive error in a population-based random cluster sample of 12-year-old schoolchildren by using sensitivity and specificity of uncorrected visual acuity (VA). Methods: The Sydney Myopia Study randomly selected 21 secondary schools stratified by socioeconomic status. All year 7 students (mean age, 12.7 years) were invited to participate. We tested VA monocularly, unaided at 2.44 m, using a retroilluminated logMAR chart. Cycloplegic autorefraction (induced...[Show more]

dc.contributor.authorLeone, Jody F
dc.contributor.authorMitchell, Paul
dc.contributor.authorMorgan, Ian
dc.contributor.authorKifley, Annette
dc.contributor.authorRose, Kathryn A
dc.date.accessioned2015-12-08T22:27:09Z
dc.identifier.issn0003-9950
dc.identifier.urihttp://hdl.handle.net/1885/33951
dc.description.abstractObjective: To detect significant refractive error in a population-based random cluster sample of 12-year-old schoolchildren by using sensitivity and specificity of uncorrected visual acuity (VA). Methods: The Sydney Myopia Study randomly selected 21 secondary schools stratified by socioeconomic status. All year 7 students (mean age, 12.7 years) were invited to participate. We tested VA monocularly, unaided at 2.44 m, using a retroilluminated logMAR chart. Cycloplegic autorefraction (induced with instillation of cyclopentolate hydrochloride, 1%) was used to define clinically significant refractive error as a spherical equivalent of -1.00 diopters (D) or less for myopia; at least + 2.00 D for hyperopia; and -1.00 D or less cylinder power for astigmatism. Results: Data for both eyes were pooled for a total of 4497 observations. The sensitivity and specificity for all clinically significant refractive errors at the best VA cutoff level of 53 letters (6/6-2) were 72.2% and 93.3%, respectively. Myopia had the highest sensitivity and specificity of any of the refractive errors for detection using VA (97.8% and 97.1%, respectively, for a 45-letter VA cutoff [6/9.5]). The best VA cutoffs for hyperopia and astigmatism were 57 (6/ 6+2) and 55 (6/6) letters, respectively, with sensitivities of 69.2% and 77.4%, respectively, and specificities of 58.1% and 75.4%, respectively. Conclusions: In this adolescent group, a VA cutoff of 6/9.5 or less detects myopic refractive error reliably. However, there is no reliable VA cutoff for clinically significant hyperopia or astigmatism. Improved VA screening methods are required to improve detection of these conditions. Even so, with the methods described herein, the prevalence of uncorrected VA may provide a reasonably accurate estimate of the prevalence of myopia.
dc.publisherAmerican Medical Association
dc.sourceArchives of Ophthalmology
dc.subjectKeywords: cyclopentolate; accuracy; adolescent; article; astigmatism; child; female; high school; human; hypermetropia; major clinical study; male; monocular vision; myopia; population; prevalence; priority journal; school child; screening; sensitivity and specific
dc.titleUse of visual acuity to screen for significant refractive errors in adolescents
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume128
dc.date.issued2010
local.identifier.absfor111301 - Ophthalmology
local.identifier.ariespublicationu8611701xPUB107
local.type.statusPublished Version
local.contributor.affiliationLeone, Jody F, University of Sydney
local.contributor.affiliationMitchell, Paul, University of Sydney
local.contributor.affiliationMorgan, Ian, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationKifley, Annette, University of Sydney
local.contributor.affiliationRose, Kathryn A, University of Sydney
local.description.embargo2037-12-31
local.bibliographicCitation.issue7
local.bibliographicCitation.startpage894
local.bibliographicCitation.lastpage899
local.identifier.doi10.1001/archophthalmol.2010.134
local.identifier.absseo920107 - Hearing, Vision, Speech and Their Disorders
dc.date.updated2016-02-24T11:40:55Z
local.identifier.scopusID2-s2.0-77954966045
CollectionsANU Research Publications

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