Abstract
Purpose To test the potential ability of the MTI photoscreener to facilitate screening for significant refractive errors in children and young adults with severe learning disabilities.
Methods Thirty-eight patients with severe learning disabilities from a special school were examined with the photoscreener, and underwent cycloplegic refraction, an ophthalmological and an orthoptic examination. The age at examination, the cause of learning disability, the pupil size, the number of photographs required for accurate interpretation, the co-operation of the subject and the presence or absence of strabismus were recorded. An educational psychologist had performed a psychological assessment on all the children. The results of the cycloplegic retinoscopy were compared with the photorefraction results.
Results A photorefraction was possible in 37 patients and cycloplegic refraction in all the patients. The patients had severe learning difficulties with an intelligence quotient of less than 50. All the patients had behavioural problems, 9 patients had associated cerebral palsy, 8 had chronic epilepsy, 1 patient was brain damaged from a non-accidental injury and 1 from a road traffic accident. The mean age of the patients was 10.0 ± 4.9 years (range 3-18 years), the average pupil diameter during photoscreening was 6.1 ± 0.9 mm (range 4-8 mm) and the average number of photographs required for each subject was 2.1 ± 0.9 (range 1-4). The photoscreener detected 10 patients with a manifest strabismus. There was one false positive and one false negative result giving a sensitivity of 92.8% and a specificity of 90%.
Conclusion The examination of children with severe learning disabilities for refractive errors can be extremely difficult. The MTI photoscreener is an effective means of screening such children and young adults for refractive errors and strabismus so that the children with these abnormalities may be targeted for a more detailed evaluation.
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Tuppurainen K . Ocular findings among mentally retarded children in Finland. Acta Ophthalmol (Copenh) 1983;61:634–44.
Ottar WL, Scott WE, Holgado SI . Photoscreening for amblyogenic factors. J Pediatr Ophthalmol Strabismus 1995;32:289–95.
Oldfield A, Adams M . The effects of music therapy on a group of profoundly mentally handicapped adults. J Ment Defic Res 1990;34:107–25.
Howland HC, Braddick O, Atkinson J, Howland B . Optics of photorefraction: orthogonal and isotropic methods. J Opt Soc Am 1983;73:1701–8.
Hamer RD, Norcia AM, Day SH, Haegerstrom-Portnoy G, Lewis D, Hsu-Winges C . Comparison of on- and off-axis photorefraction with cycloplegic retinoscopy in infants. J Pediatr Ophthalmol Strabismus 1992;29:232–9.
Bobier WR, Braddick OJ . Eccentric photorefraction: optical analysis and empirical measures. Am J Optom Physiol Optics 1985;62:614–20.
Wesemann W, Norcia AM, Allen D . Theory of eccentric photorefraction (photoretinoscopy): astigmatic eyes. J Opt Soc AM 1991;8:2038–47.
Atkinson J, Braddick O, Bobier B, Anker S, Ehrlich D, King J, et al. Two infant vision screening programmes: prediction and prevention of strabismus and amblyopia from photo-and videorefractive screening. Eye 1996;10:189–98.
Morgan KS, Kennemer JC . Off-axis photorefractive eye screening in children. J Cataract Refract Surg 1997;23:423–8.
Atkinson J, Braddick OJ, Durden K, Watson PG, Atkinson S . Screening for refractive errors in 6-9 month old infants by photorefraction. Br J Ophthalmol 1984;68:105–12.
Morgan KS, Johnson WD . Clinical evaluation of a commercial photorefractor. Arch Ophthalmol 1987;105:1528–31.
Cooper CD, Bowling FG, Hall JE, Colville DJ, Dortmans RJ, Munch J, et al. Evaluation of photoscreener instruments in a childhood population. 1. Otago. Aust NZ J Ophthalmol 1996;24:347–55.
Kennedy RA, Sheps SB . A comparison of photoscreening techniques for amblyogenic factors in children. Can J Ophthalmol 1989;24:259–64.
Tong PY, Enke-Miyazaki E, Bassin RE, Tielsch JM, Stager DR, Beauchamp GR, et al. The National Children's Eye Care Foundation Vision Screening Study Group. Screening for amblyopia in preverbal children. Ophthalmology 1998;105:856–63.
Howland HC, Sayles N . Photorefractive studies of normal and handicapped infants and children. Behav Brain Res 1983;10:81–5.
Mackie RT, McCulloch DL, Saunders KJ, Day RE, Phillips S, Dutton GN . Relation between neurological status, refractive error, and visual acuity in children: a clinical study. Dev Med Child Neurol 1998;40:31–7.
Kennerley Bankes JL . Eye defects in mentally handicapped children. BMJ 1974;II:533–5.
Black P . Visual disorders associated with cerebral palsy. Br J Ophthalmol 1982;66:46–52.
Harvey EM, Miller JM, Wagner LK, Dobson V . Reproducibility and accuracy of measurements with a hand held autorefractor in children. Br J Ophthalmol 1997;81:941–8.
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The authors have no financial or commercial interest in the photoscreener used in this study
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Watts, P., Walker, K. & Beck, L. Photoscreening for refractive errors in children and young adults with severe learning disabilities using the MTI photoscreener. Eye 13, 363–368 (1999). https://doi.org/10.1038/eye.1999.92
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DOI: https://doi.org/10.1038/eye.1999.92
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