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Background: Refractive errors, including myopia, hyperopia, and astigmatism, are the leading causes of visual impairment in school-aged children and can significantly impact their academic performance and quality of life. This study aimed to assess the prevalence of refractive errors among school children from economically disadvantaged areas in Northwest México, using a consistent methodology to facilitate comparison with global data. Methods: We adopted the Refractive Error Study in Children (RESC) protocol by the World Health Organization to examine the prevalence of myopia, hyperopia, and astigmatism. The study comprised a systematic sampling of children aged 6 to 18 years from diverse schools in Northwest México. Trained optometrists conducted visual acuity testing and autorefraction, while ophthalmologists performed cycloplegic refraction to ensure accuracy. Results: The study found a myopia (SE ≤-1.50 D at least one eye) prevalence of 14.55% (95% CI: 13.27-15.91), with a higher incidence in females (6.92%) compared to males (6.00%) in at least one eye. Hyperopia (SE ≥ +1.00 D at least one eye) was less common, at 3.23% (95% CI: 2.61-3.95), with a slightly higher occurrence in males in at least one eye. Astigmatism (Cylinder ≥ 0.75 D at least one eye) was present in 18.63% (95% CI: 17.21-20.12) of the students in at least one eye, with no significant difference between genders. These findings are consistent with other studies in regions such as Puerto Rico and Iran, indicating widespread refractive error issues among schoolchildren. Conclusions: The high prevalence of refractive errors, particularly myopia and astigmatism, highlights the critical need for regular vision screenings in schools and the implementation of public health interventions to provide corrective eyewear. Our study confirms the importance of utilizing standardized methodologies like the RESC protocol to compare refractive error prevalence across different geographical and socio-economic contexts, thereby informing global public health strategies.

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Introducción. La evaluación de la visión en los niños durante el periodo preverbal, con un método fácil de usar y basado en la evidencia, permitiría el diagnóstico temprano y la intervención en los trastornos visuales. El objetivo del estudio fue determinar la utilidad y confiabilidad de la versión en idioma turco del cuestionario Preverbal Visual Assessment (PreViAs), desarrollado para evaluar la visión en niños preverbales. Población y métodos. El cuestionario PreViAs se administró a los cuidadores primarios de niños nacidos de término, antes de los 24 meses de edad. Se registraron sus respuestas. Resultados. Se analizaron los datos de 278 participantes para evaluar la consistencia interna del cuestionario PreViAs. Se encontró un alto nivel de consistencia con un alfa de Cronbach de 0,958 para el puntaje total, lo que sugiere una fuerte coherencia interna. Los valores del alfa de Cronbach para cada dominio fueron: 0,890 ­ 0,913 ­ 0,951 y 0,922 para la atención visual, la comunicación visual, el procesamiento visual y la coordinación visomotora respectivamente; esto indica una buena consistencia interna para cada subdominio. Conclusión. La versión en idioma turco del cuestionario PreViAs es útil y confiable para evaluar la visión durante el periodo preverbal.

Introduction: Evaluating the visual functions of children with an easy-to-use and evidence-based method during the preverbal period will enable early diagnosis and intervention of visual impairments. The aim of this study is to determine the utility and reliability of the Turkish version of the Preverbal Visual Assessment (PreViAs) questionnaire, which was developed to evaluate the visual functioning of preverbal infants. Population and Methods: The PreViAs questionnaire was administered to primary caregivers of term infants under 24 months of age, and their responses were recorded. Results: Data from the 278 participating infants were analyzed to assess the internal consistency of the PreViAs questionnaire. Results showed a high level of consistency with Cronbach's alpha value of 0.958 for the total score, suggesting strong internal coherence. In addition, the Cronbach's alpha values for each domain were 0.890, 0.913, 0.951, and 0.922 for visual attention, visual communication, visual processing, and visual-motor coordination, respectively, indicating good internal consistency for each subdomain. Conclusion: The Turkish version of the PreViAs questionnaire is useful and reliable for assessing functional vision during the preverbal period.

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BACKGROUND: Premature newborns have a higher risk of abnormal visual development and visual impairment. OBJECTIVE: To develop a computational methodology to help assess functional vision in premature infants by tracking iris distances. METHODS: This experimental study was carried out with children up to two years old. A pattern of image capture with the visual stimulus was proposed to evaluate visual functions of vertical and horizontal visual tracking, visual field, vestibulo-ocular reflex, and fixation. The participants' visual responses were filmed to compose a dataset and develop a detection algorithm using the OpenCV library allied with FaceMesh for the detection and selection of the face, detection of specific facial points and tracking of the iris positions is done. A feasibility study was also conducted from the videos processed by the software. RESULTS: Forty-one children of different ages and diagnoses participated in the experimental study, forming a robust dataset. The software resulted in the tracking of iris positions during visual function evaluation stimuli. Furthermore, in the feasibility study, 8 children participated, divided into Pre-term and Term groups. There was no statistical difference in any visual variable analyzed in the comparison between groups. CONCLUSION: The computational methodology developed was able to track the distances traveled by the iris, and thus can be used to help assess visual function in children.

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Introduction: Evaluating the visual functions of children with an easy-to-use and evidence-based method during the preverbal period will enable early diagnosis and intervention of visual impairments. The aim of this study is to determine the utility and reliability of the Turkish version of the Preverbal Visual Assessment (PreViAs) questionnaire, which was developed to evaluate the visual functioning of preverbal infants. Population and Methods: The PreViAs questionnaire was administered to primary caregivers of term infants under 24 months of age, and their responses were recorded. Results: Data from the 278 participating infants were analyzed to assess the internal consistency of the PreViAs questionnaire. Results showed a high level of consistency with Cronbach's alpha value of 0.958 for the total score, suggesting strong internal coherence. In addition, the Cronbach's alpha values for each domain were 0.890, 0.913, 0.951, and 0.922 for visual attention, visual communication, visual processing, and visual-motor coordination, respectively, indicating good internal consistency for each subdomain. Conclusion: The Turkish version of the PreViAs questionnaire is useful and reliable for assessing functional vision during the preverbal period.

Introducción. La evaluación de la visión en los niños durante el periodo preverbal, con un método fácil de usar y basado en la evidencia, permitiría el diagnóstico temprano y la intervención en los trastornos visuales. El objetivo del estudio fue determinar la utilidad y confiabilidad de la versión en idioma turco del cuestionario Preverbal Visual Assessment (PreViAs), desarrollado para evaluar la visión en niños preverbales. Población y métodos. El cuestionario PreViAs se administró a los cuidadores primarios de niños nacidos de término, antes de los 24 meses de edad. Se registraron sus respuestas. Resultados. Se analizaron los datos de 278 participantes para evaluar la consistencia interna del cuestionario PreViAs. Se encontró un alto nivel de consistencia con un alfa de Cronbach de 0,958 para el puntaje total, lo que sugiere una fuerte coherencia interna. Los valores del alfa de Cronbach para cada dominio fueron: 0,890 ­ 0,913 ­ 0,951 y 0,922 para la atención visual, la comunicación visual, el procesamiento visual y la coordinación visomotora respectivamente; esto indica una buena consistencia interna para cada subdominio. Conclusión. La versión en idioma turco del cuestionario PreViAs es útil y confiable para evaluar la visión durante el periodo preverbal.

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ABSTRACT Purpose: To assess the anterior and posterior segments of full-term neonates over a 1.5-year period. Methods: The findings of full-term neonates who underwent ophthalmological examinations between June 2019 and December 2020 were analyzed, and the results were retrospectively recorded. Results: The study comprised 2972 neonates with a mean birth week of 38.7 ± 1.2 weeks and a mean birth weight of 3235 ± 464 g. The neonates were examined on an average of 49.3 ± 18.9 postnatal days. Of the examined neonates, 185 (6.2%) showed abnormal ophthalmological findings, the most prevalent of which were retinal hemorrhage in 2.3% (n=68) and white changes in the peripheral retina in 1.9% (n=55) of the neonates. Cases of optic disc pathologies (n=20), choroidal nevus (n=10), iris-choroidal coloboma (n=5), subconjunctival hemorrhage (n=6), non-specific retinal pigmentary change (n=4), congenital cataract (n=3), posterior synechia (n=3), iris nevus (n=3), corneal opacity (n=1), choroidal coloboma (n=1), iris coloboma (n=1), buphthalmos (n=1), anophthalmos (n=1), microphthalmia (n=1), lid hemangioma (n=1), and vitreous hemorrhage (n=1) collectively accounted for approximately 2% of all neonates. Pathologies that could potentially impair vision, which were detected by ophthalmological examination, accounted for 1.2% of all neonates (n=37). Conclusion: The most prevalent finding of the ophthalmological examinations of neonates in the present study was retinal hemorrhage. Ophthalmological examinations of neonates can help in identifying diseases that may affect their vision and are curable or may lead to amblyopia in the long term.

RESUMO Objetivo: Avaliar os segmentos anterior e posterior em recém-nascidos a termo durante um período de 1,5 anos. Métodos: Foram analisados recém-nascidos a termo que tiveram os olhos examinados entre junho de 2019 e dezembro de 2020, e os resultados foram registrados retrospectivamente. Resultados: O estudo foi composto por 2.972 recém-nascidos com média de uma semana de nascimento de 38,7 ± 1,2 semanas e um peso médio ao nascer de 3235 ± 464 g. Os recém-nascidos foram examinados em média pós-natal de 49,3 ± 18,9 dias. Dos recém-nascidos, 185 (6,2%) apresentaram resultados oculares anormais. Os achados oculares anormais mais prevalentes foram hemorragia da retina em 2,3% (n=68) e alterações brancas na retina periférica em 1,9% (n=55) dos recém-nascidos. Casos de patologias de disco óptico (n=20), nevo de coroide (n=10), coloboma iris-coroide (n=5), hemorragia subconjuntival (n=6), alteração pigmentar da retina não específica (n=4), catarata congênita (n=3), Sinequia posterior (n=3), nevo da íris (n=3), opacidade da córnea (n=1), coloboma de coroide (n=1), coloboma de íris (n=1), buftalmos (n=1), anoftalmia (n=1), microftalmia (n=1), hemangioma de pálpebra (n=1) e hemorragia vítrea (n=1) contabilizaram coletivamente cerca de 2% dos recém-nascidos. As patologias que potencialmente prejudicam a visão, detectadas por exame ocular, representaram 1,2% dos recém-nascidos (n=37). Conclusão: O achado mais prevalente de exames oculares de recém-nascidos neste estudo foi hemorragia da retina. Exames oftalmológicos em recém-nascidos podem ser úteis na identificação de doenças que podem impactar a visão deles, podendo ser curáveis ou levar à ambliopia no longo prazo.

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ABSTRACT Purpose: Timely screening and treatment are essential for preventing diabetic retinopathy blindness. Improving screening workflows can reduce waiting times for specialist evaluation and thus enhance patient outcomes. This study assessed different screening approaches in a Brazilian public healthcare setting. Methods: This retrospective study evaluated a telemedicine-based diabetic retinopathy screening implemented during the COVID-19 pandemic and compared it with in-person strategies. The evaluation was conducted from the perspective of a specialized referral center in an urban area of Central-West Brazil. In the telemedicine approach, a trained technician would capture retinal images by using a handheld camera. These images were sent to specialists for remote evaluation. Patient variables, including age, gender, duration of diabetes diagnosis, diabetes treatment, comorbidities, and waiting time, were analyzed and compared. Results: In total, 437 patients with diabetes mellitus were included in the study (mean age: 62.5 ± 11.0 years, female: 61.7%, mean diabetes duration: 15.3 ± 9.7 years, insulin users: 67.8%). In the in-person assessment group, the average waiting time between primary care referral and specialist evaluation was 292.3 ± 213.9 days, and the referral rate was 73.29%. In the telemedicine group, the average waiting time was 158.8 ± 192.4 days, and the referral rate was 29.38%. The telemedicine approach significantly reduced the waiting time (p<0.001) and significantly lowered the referral rate (p<0.001). Conclusion: The telemedicine approach significantly reduced the waiting time for specialist evaluation in a real-world setting. Employing portable retinal cameras may address the burden of diabetic retinopathy, especially in resource-limited settings.

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RESUMEN Objetivo: Obtener la frecuencia de fatiga visual digital (FVD) mediante dos cuestionarios entre los estudiantes de una universidad privada en Lima, Perú; para estimar el grado de concordancia entre ambos métodos. Métodos: Se realizó un estudio transversal en una muestra de 345 participantes mayores de 18 años, estudiantes de una universidad en Lima, Perú y que completaron el instrumento de recogida de datos. Los dos métodos usados para la medición de FVD fueron el cuestionario de Hayes que define un caso positivo para FVD con un puntaje igual o mayor a 20; y el cuestionario CVS-Q de Seguí, que define como positivo para FVD con un puntaje mayor a 6. Se estimó el coeficiente kappa de Cohen con su intervalo de confianza al 95% para medir la concordancia global y por estratos. Resultados: El cuestionario de Hayes identificó a 167 (48,4%) participantes con un diagnostico presuntivo de FVD, el cuestionario de Seguí identificó a 247 (71,6%) estudiantes. En el análisis de concordancia, el coeficiente Kappa de Cohen fue 0,45 (IC95%; 0,37 - 0,53) (p < 0,01) en el análisis global, considerado como moderado. Conclusiones: El grado de concordancia entre ambos métodos fue moderado, el instrumento de Seguí identificó una mayor proporción de estudiantes universitarios con FVD.

ABSTRACT Objective: To obtain the frequency of digital visual fatigue (DVF) using two questionnaires among students of a private university in Lima, Peru; to estimate the degree of agreement between both methods. Methods: A cross-sectional study was conducted in a sample of 345 participants over 18 years old, students of a university in Lima, Peru and who completed the data collection instrument. The two methods used for the measurement of DVF were the Hayes questionnaire, which defines a positive case for DVF with a score equal to or greater than 20; and the Seguí CVS-Q questionnaire, which defines a positive case for DVF with a score greater than 6. The Cohen's kappa coefficient with its 95% confidence interval was estimated to measure the overall agreement and by strata. Results: The Hayes questionnaire identified 167 (48.4%) participants with a presumptive diagnosis of DVF, the Seguí questionnaire identified 247 (71.6%) students. In the concordance analysis, Cohen's Kappa coefficient was 0.45 (95%CI; 0.37 - 0.53) (p < 0.01) in the overall analysis, considered moderate. Conclusion: The degree of concordance between both methods was moderate, the Seguí instrument identified a higher proportion of university students with DVF.

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Resumen La retinopatía diabética es uno de los grandes problemas que enfrenta la salud pública en el siglo XXI. La prevalencia mundial se encuentra en constante aumento; sin embargo, poco se conoce sobre la frecuencia de esta enfermedad en la Argentina. Los programas de tele-oftalmología han ayudado a combatir y a comprender mejor esta enfermedad, principalmente en áreas rurales. El objetivo del siguiente tra bajo fue estimar la prevalencia de la retinopatía diabética en la provincia de La Pampa. Se realizó un estudio observacional de corte transversal, evaluando las características de la población asistida por un programa de tele-oftalmología en la zona rural de la provincia. Se evaluaron imágenes de retina obtenidas con un retinógrafo no midriático, la presión intraocular y características generales de la población. Se estimó una prevalencia del 21.5% y un 14.1% de estas personas tenían una amenaza visual grave. Además, se observó que el 5.0% tenían glaucoma, 63.4% hipertensión arterial y 42.6% dislipemia. Estos resultados son similares a los presentados en otros países del mundo. Son datos fundamentales para comprender detalles de la situación epidemiológica en esta región y poder armar estrategias sanitarias para enfrentar a esta enfermedad.

Abstract Diabetic retinopathy is one of the major problems public health is facing in the 21st century. The worldwide prevalence is increasing; however, little is known about the frequency of this disease in Argentina. Tele-ophthalmology programs have helped to face and to better understand this disease, mainly in rural areas. The aim of this study was to estimate the prevalence of diabetic retinopathy in the province of La Pampa. A cross-sectional observational study was carried out, evaluating the characteristics of the population assisted by a tele-ophthalmology program in a rural area of the province. The images, taken with a non-mydriatic retinal camera, the intraocular pressure and general characteristics of the population were evaluated. A disease prevalence of 21.5% was estimated and 14.1% of them had a vision-threatening diabetic retinopathy. In addition, it was observed that 5.0% had glaucoma, 63.4% hypertension and 42.6% dyslipidemia. These findings are similar to those reported in other countries around the world. These data are fundamental to understand the details of the epidemiological situation in this region and to be able to develop health strategies to deal with this disease.

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Diabetic retinopathy is one of the major problems public health is facing in the 21st century. The worldwide prevalence is increasing; however, little is known about the frequency of this disease in Argentina. Tele-ophthalmology programs have helped to face and to better understand this disease, mainly in rural areas. The aim of this study was to estimate the prevalence of diabetic retinopathy in the province of La Pampa. A cross-sectional observational study was carried out, evaluating the characteristics of the population assisted by a tele-ophthalmology program in a rural area of the province. The images, taken with a non-mydriatic retinal camera, the intraocular pressure and general characteristics of the population were evaluated. A disease prevalence of 21.5% was estimated and 14.1% of them had a vision-threatening diabetic retinopathy. In addition, it was observed that 5.0% had glaucoma, 63.4% hypertension and 42.6% dyslipidemia. These findings are similar to those reported in other countries around the world. These data are fundamental to understand the details of the epidemiological situation in this region and to be able to develop health strategies to deal with this disease.

La retinopatía diabética es uno de los grandes problemas que enfrenta la salud pública en el siglo XXI. La prevalencia mundial se encuentra en constante aumento; sin embargo, poco se conoce sobre la frecuencia de esta enfermedad en la Argentina. Los programas de tele-oftalmología han ayudado a combatir y a comprender mejor esta enfermedad, principalmente en áreas rurales. El objetivo del siguiente trabajo fue estimar la prevalencia de la retinopatía diabética en la provincia de La Pampa. Se realizó un estudio observacional de corte transversal, evaluando las características de la población asistida por un programa de tele-oftalmología en la zona rural de la provincia. Se evaluaron imágenes de retina obtenidas con un retinógrafo no midriático, la presión intraocular y características generales de la población. Se estimó una prevalencia del 21.5% y un 14.1% de estas personas tenían una amenaza visual grave. Además, se observó que el 5.0% tenían glaucoma, 63.4% hipertensión arterial y 42.6% dislipemia. Estos resultados son similares a los presentados en otros países del mundo. Son datos fundamentales para comprender detalles de la situación epidemiológica en esta región y poder armar estrategias sanitarias para enfrentar a esta enfermedad.

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ABSTRACT Introduction Blood donor screening is an important stage of quality control in blood banks. Turbidity caused by increased levels of triglycerides is detected by visual inspection, but there is no consensus on its threshold at which plasma should be considered inappropriate for donation. Objective Compare triglycerides dosage and visual turbidity in decision making for the disposal of plasma. Material and methods Plasma bags (n=205) were classified by visual inspection as clear, moderately turbid or turbid and triglyceride concentration were determined in serum and plasma with enzimatic-colorimetric methodology by automation. Results Our results show a positive correlation between serum and plasma triglycerides levels (r=0,94) but we observed a higher concentration in serum when compared to plasma samples (p<0,03). Most of the plasma were classified as moderately turbid or turbid (75%). Visual inspection and triglycerides levels were moderately correlated in serum (rb=0,57) and plasma (rb=0,52). However, moderately turbid samples showed discordance between serum or plasma triglyceride levels and the visual inspection. Discussion Our findings corroborate with the literature data, supporting the subjectivity of the visual inspection. We recommend further studies to determine which triglyceride threshold should be used for the disposal of plasma bags combined with automated methods to enhance visual classification accuracy. Conclusion Quality improvement actions are critical for standardization of the screening in order to avoid unnecessary disposal of the plasma bags.

RESUMO Introdução A triagem das bolsas de plasma é uma etapa importante do controle de qualidade nos hemocentros. A turbidez causada pelo aumento de triglicerídeos é detectada por inspeção visual, mas não há consenso acerca do limite no qual o plasma deve ser considerado inadequado para doação. Objetivo Comparar a dosagem de triglicerídeos e a turbidez visual na tomada de decisão para o descarte do plasma. Material e métodos As bolsas de plasma (n=205) foram classificadas pela inspeção visual como límpidas, moderadamente turvas ou turvas e as concentrações de triglicerídeos foram determinadas no soro e plasma com metodologia enzimática-colorimétrica por automação. Resultados Nossos resultados mostraram uma correlação positiva entre soro e plasma (r=0,94) mas observamos que a concentração de triglicerídeos foi mais alta no soro do que no plasma (p<0,03). A maioria das bolsas foi classificada como moderadamente turva ou turva (75%). A inspeção visual e a concentração de triglicerídeos apresentaram uma correlação moderada para o soro (rb=0,57) e plasma (rb=0,52). Entretanto, no grupo moderadamente turvo, houve uma divergência significativa entre as concentrações de triglicerídeos no soro/plasma e a inspeção visual. Discussão Nossos achados corroboram com a literatura, reforçando a subjetividade da inspeção visual. Nós recomendamos a realização de estudos futuros para determinar o limite dos níveis de triglicerídeos para o descarte de plasma em conjunto com a combinação de métodos automatizados para aumentar a acurácia da classificação visual. Conclusão As ações voltadas para a melhoria da qualidade são críticas para a padronização da triagem e evitar o descarte desnecessário de plasma.

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ABSTRACT Objective: The main aim of this study was to evaluate the performance of a platform designed for pediatricians to screen amblyopia using a smartphone. Methods: The medical records of consecutive children who received visual screening using a smartphone platform were retrospectively reviewed. The smartphone was used with a flash concentrator case and a software for capturing images of both eyes simultaneously by a photorefraction mechanism. The platform performance was compared to the comprehensive ophthalmological examination, which is considered the gold standard for detecting amblyopia. Sensitivity, specificity, positive predictive value, and negative predictive value of the software in detecting amblyopia risk factors were calculated. Results: A total of 157 children were included, with a mean age of 6.0±.5 years (range 5-7). In 94% of the cases, the software was able to analyze the images and release a result, determining whether or not the child presented with amblyopia risk factors. Compared to the ophthalmological examination, the smartphone platform sensitivity in detecting amblyopia risk factors was 84%, the specificity was 74%, the positive predictive value was 86%, and the negative predictive value was 70%. Conclusions: The sensitivity and specificity of the smartphone photoscreening platform to detect amblyopia risk factors were within the range of traditional instrument-based vision screening technology. A smartphone photorefraction platform appears to be a promising cost-effective alternative to assist pediatricians and minimize obstacles to vision screening and amblyopia detection. Future studies are needed to gather additional comparative data.

RESUMO Objetivo: Avaliar a performance de uma plataforma desenvolvida para pediatras para triagem de ambliopia utilizando um smartphone. Métodos: Os prontuários consecutivos de crianças submetidas a triagem visual usando uma plataforma no smartphone foram analisados retrospectivamente. Uma capa concentradora de flash foi utilizada no smartphone com um software para capturar imagens simultâneas dos dois olhos por um mecanismo de fotorrefração. A performance da plataforma foi comparada ao exame oftalmológico completo, considerado o padrão ouro para detecção de ambliopia. Foram calculados sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo do software em detectar fatores de risco para ambliopia. Resultados: Foram incluídas 157 crianças com idade média de 6.0±0.5 anos (variação de 5 a 7 anos). Em 94% dos casos, o software foi capaz de analisar as imagens e fornecer um resultado, determinando se a criança apresentava ou não fatores de risco para ambliopia. Comparados ao exame oftalmológico, a sensibilidade da plataforma no smartphone em detectar fatores de risco para ambliopia foi de 84%, a especificidade foi de 74%, o valor preditivo positivo foi de 86% e o valor preditivo negativo foi de 70%. Conclusões: A plataforma de triagem por fotorrefração usando o smartphone apresentou sensibilidade e especificidade para detectar fatores de risco para ambliopia semelhantes às encontradas em instrumentos tradicionais de triagem por fotorrefração. Uma plataforma no smartphone é uma alternativa custo-efetiva promissora para auxiliar pediatras a minimizar os obstáculos para triagem visual e detecção da ambliopia. Estudos futuros são necessários a fim de reunir dados comparativos adicionais.

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OBJECTIVES: To identify barriers and enablers to accessing school-based eye health programs in Bogotá, Colombia. METHODS: We undertook a qualitative case study that explored how structural factors, and social and cultural norms influence access to school-based eye health programs. We conducted focus groups discussions and interviews with a purposive sample of 37 participants: government stakeholders (n = 4), representatives from nongovernmental organizations (n = 3), and an eye-care practitioner, as well as teachers (n = 7), a school nurse, parents (n = 7), and children (n = 14) from private and public schools. Data were analyzed using a priori themes from the availability, accessibility, acceptability and quality framework. RESULTS: Routine vision screening in schools is not currently provided nor is there a budget to support it. Lack of collaboration between the health and education ministries and the absence of national planning affected the delivery of eye care in schools. Factors related to acceptability of school-based eye health programs included: poor acceptance of training teachers as vision screeners; stigma related to wearing spectacles; and distrust of health services. The cost of spectacles and poor access to eye health information were identified as barriers to positive child eye health outcomes by socioeconomically disadvantaged parents and children. CONCLUSION: Our findings suggest the need for a national school eye health plan and improved cooperation between health and education ministries. Interventions to improve trust in health services, tackle the lack of human resources while respecting professional qualifications, and raise awareness of the importance of eye health are recommended.

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ABSTRACT Purpose: To provide guidance on the frequency and components of eye examinations for healthy children aged 0 to 5 years. Methods: These guidelines were developed based on the medical literature and clinical experience of an expert committee. PubMed/Medline searches were performed, with selected publications not restricted to systematic reviews, randomized controlled trials, or observational studies. The Grading of Recommendations Assessment, Development, and Evaluation profile was applied when suitable, and for issues without scientific evidence, recommendations were based on expert consensus. Recommendations by the American Academy of Pediatrics, American Association of Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology, Royal College of Ophthalmologists, and Canadian Ophthalmological Society were also reviewed. The final guideline document was approved by the Brazilian Pediatric Ophthalmology Society and by the Brazilian Pediatric Society. Results: Newborns must undergo the red reflex test and inspection of the eyes and adnexa by a pediatrician within 72 hours of life. The red reflex test should be repeated by the pediatrician during childcare consultations at least three times per year during the first 3 years of life. If feasible, a comprehensive ophthalmologic examination may be performed between 6 and 12 months of age. Until 36 months of age, the pediatrician should assess the infant's visual development milestones, age-appropriate assessment of visual function, ocular fixation, and eye alignment. At least one comprehensive ophthalmologic examination should be performed at 3 to 5 years of age. The examination should minimally include inspection of the eyes and adnexa, age-appropriate visual function assessment, evaluations of ocular motility and alignment (cover tests), cycloplegic refraction, and dilated fundus. Conclusions: Guidelines concerning the frequency of ophthalmic assessment are important tools for directing physicians regarding best practices that avoid treatable vision problems that affect children's development, school, and social performance and cause unnecessary permanent vision loss.

RESUMO Objetivo: Fornecer orientações sobre a frequência e os componentes dos exames oftalmológicos para crianças saudáveis de 0 a 5 anos. Métodos: Essas diretrizes foram desenvolvidas com base em revisão bibliográfica e experiência clínica de um comitê de especialistas. Foram realizadas buscas PubMed/Medline; documentos selecionados não se restringiram a revisões sistemáticas, ensaios clínicos randomizados e estudos observacionais. Quando adequado, o perfil GRADE foi aplicado para graduá-los e o consenso de especialistas foi usado nos tópicos sem evidência científica. Também foram revisadas as recomendações pela Academia Americana de Pediatria, Associação Americana de Oftalmologia Pediátrica e Estrabismo, Academia Americana de Oftalmologia, Royal College of Ophthalmologist e Sociedade Canadense de Oftalmologia. O documento final foi aprovado pela Sociedade Brasileira de Oftalmologia Pediátrica e Sociedade Brasileira de Pediatria. Resultados: Os recém-nascidos devem ser submetidos ao teste do reflexo vermelho e inspeção dos olhos e anexos pelo pediatra dentro de 72 horas de vida ou antes da alta da maternidade. O teste do reflexo vermelho deve ser repetido pelo pediatra durante as consultas de puericultura pelo menos três vezes ao ano durante os primeiros 3 anos de vida. Se factível, um exame oftalmológico completo pode ser feito entre 6 a 12 meses de vida. Até os 36 meses de idade, os marcos visuais, função visual apropriada para a idade, fixação e alinhamento ocular também devem ser avaliados pelo pediatra ou médico da família. Pelo menos um exame oftalmológico completo deve ser realizados entre 3 e 5 anos de idade. O exame deve conter pelo menos inspeção dos olhos e anexos, avaliação da função visual apropriada para a idade, avaliação da motilidade e alinhamento ocular (testes de cobertura), refração sob cicloplegia e avaliação do fundo de olho dilatado. Conclusões: As diretrizes sobre a frequência da avaliação oftalmológica são ferramentas importantes para orientar os médicos sobre a melhor prática a fim de evitar problemas visuais tratáveis na infância, que poderiam comprometer seu desenvolvimento social, escolar e global, além de causar perda permanente da visão.

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Among children born with laboratory-confirmed Zika virus (ZIKV) infection, visual impairment (VI) can occur despite normal ocular structure. The objective of this report is to describe ocular findings and visual function among children examined during the Department of Health Zika Health Brigade (ZHB) in the United States Virgin Islands in March 2018. This analysis is based on a retrospective chart review of children eligible to participate in the ZHB (i.e., part of the US Zika Pregnancy and Infant Registry) and who were examined by ophthalmologists. Eighty-eight children attended the ZHB. This report includes 81 children [48 (59.3%) males] whose charts were located [average gestational age = 37.6 weeks (range: 27.6-41.3) and average adjusted age at examination = 9.1 months (range: 0.9-21.9)]. Of those examined, 5/81 (6.2%) had microcephaly at birth, 2/81 (2.5%) had a structural eye abnormality, and 19/72 (26.4%) had VI. Among children with normal ocular structure and neurologic examination, 13/51 (25.5%) had VI. Despite a low incidence of abnormal ocular structure and microcephaly, about a quarter of children examined had VI. Our findings emphasize that ophthalmological examinations should be performed in all children with suspicion for antenatal ZIKV infection, even children with normal ocular structure and neurologic examination.

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RESUMEN Objetivo: Valorar la efectividad del vídeojuego en educandos que padecen ambliopía funcional. Métodos: Se confeccionó la historia clínica de cada paciente, la cual incluyó la revisión oftalmológica completa, la evaluación de la agudeza visual con la prueba adecuada a cada edad, y se evaluó la presencia de supresión mediante la prueba de filtro rojo y las luces de Worth. Cada prueba se realizó de forma individual según el tipo y la severidad de la ambliopía, y se le indicó la refracción correspondiente. Los pacientes se dividieron en dos grupos: al grupo A se le aplicó la terapia tradicional de la ambliopía, y al grupo B se le siguió la misma pauta que un tratamiento tradicional de ambliopía, pero con la introducción de vídeojuegos. Resultados: Se observó en el grupo A un predominio de los pacientes con agudeza visual inicial entre 0,2 - 0,4 (50 %), la cual se incrementó en dos líneas o más en el (55 %); sin embargo, en el grupo B la agudeza inicial entre 0,2 - 0,4 fue de 56,5 %. Los resultados sensoriales seis meses posteriores al tratamiento, según cada grupo de estudio, mostraron en el grupo B una reducción de la supresión en el 91,3 %, y en el grupo A de un 75 %. Conclusión: La terapia visual combinada con vídeojuego es efectiva; mejora la agudeza visual; elimina y reduce la supresión, por lo que constituye una herramienta que complementa la terapia visual tradicional de la ambliopía.

ABSTRACT Objective: Assess the effectiveness of videogames for students suffering from functional amblyopia. Methods: A clinical record was developed for each patient, which included complete ophthalmological examination, visual acuity evaluation with the suitable test for each age, and determination of the presence of suppression by the red filter test and the Worth lights test. Each test was conducted individually according to the type and severity of amblyopia, and the corresponding refraction was indicated. The patients were divided into two groups: Group A received traditional amblyopia therapy, whereas Group B underwent traditional amblyopia treatment combined with the incorporation of videogames. Results: Group A showed a predominance of patients with initial visual acuity between 0.2 - 0.4 (50%), which increased two lines or more in 55%. However, in Group B initial visual acuity ranged between 0.2 - 0.4 in 56.5%. Six months after treatment, sensory results were 91.3% suppression reduction in Group B and 75% in Group A. Conclusion: Visual therapy proved effective when combined with videogames: visual acuity improved and suppression was reduced. It is thus a suitable tool to complement the traditional visual therapy for amblyopia.

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ABSTRACT Purpose: The aim of this study was to evaluate the effect of anterior chamber depth and axial length on clinical performance of the Spot Vision Screener in detecting amblyopia risk factors in children aged 3-10 years. Methods: A total of 300 eyes from 150 patients aged 3-10 years were prospectively tested with Spot Vision Screener (firmware version 3.0.02.32, software version 3.0.04.06) and a standard autorefractometer (Nidek ARK-1). The anterior chamber depth and axial length were measured with an optical biometer (Nidek AL-Scan). The sensitivity and specificity values for detecting significant refractive errors using the referral criteria of the American Association for Pediatric Ophthalmology and Strabismus were determined. Pearson's correlation analysis was employed to evaluate the relationship between the Spot Vision results and the anterior chamber depth and axial length. Results: Compared with the standard autorefractometer results, the Spot Vision Screener's sensitivity and specificity was 59% and 94%, respectively. The differences between the cycloplegic autorefractometer and the Spot Vision Screener spherical equivalents were negatively correlated with anterior chamber depth (r=-0.48; p<0.001) and axial length (r=-0.45; p<0.001). Conclusion: The Spot Vision Screener has moderate sensitivity and high specificity, using the criteria of the American Association for Pediatric Ophthalmology and Strabismus. The anterior chamber depth and axial length affect the Spot Vision results.

RESUMO Objetivo: O objetivo deste estudo foi avaliar o efeito da profundidade da câmara anterior e do comprimento axial sobre o desempenho clínico do Spot Vision Screener, na deteção de fatores de risco para a ambliopia em crianças de 3 a 10 anos de idade. Métodos: Um total de 300 olhos de 150 pacientes de 3-10 anos de idade foram prospectivamente testados com o Spot Vision Screener (firmware: 3.0.02.32, software: 3.0.04.06) e com autorefratómetro padrão (Nidek ARK-1). Todas as medições de profundidade e comprimento axial da câmara anterior dos pacientes foram realizadas através de Nidek AL Scan. A sensibilidade e especificidade para a deteção de erros refrativos significativos foram determinadas de acordo com os critérios de referência da Associação Americana de Oftalmologia e Estrabismo Pediátricos. A análise da Correlação de Pearson foi utilizada para avaliar a correlação entre os resultados do Spot Vision e a profundidade ou comprimento axial da câmara anterior dos pacientes. Resultados: Em comparação com os resultados do autorefratómetro padrão, a sensibilidade do Spot foi de 59% e a especificidade de 94%. As diferenças entre os equivalentes esféricos do autorefratómetro cicloplégico e o Spot Vision Screener foram correlacionados negativamente com a profundidade (r=-0,48; p<0,001) e o comprimento axial (r=-0,45; p<0,001) da câmara anterior dos casos. Conclusão: O Spot Vision Screener possui uma sensibilidade moderada e uma especificidade elevada utilizando os critérios da Associação Americana de Oftalmologia Pediátrica e Estrabismo; a profundidade da câmara anterior e o comprimento axial dos pacientes afetam os resultados do Spot Vision.

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Resumo Objetivo: Determinar a concordância do retinógrafo portátil Pictor Plus, na ausência de midríase, com a retinografia digital e avaliar a sua acurácia como método de rastreio da retinopatia diabética (RD). Métodos: Estudo transversal, mascarado para o observador, avaliando 100 olhos de 51 pacientes diabéticos. Foram realizadas retinografias com o Pictor Plus com e sem midríase, seguidos de retinografia convencional com o retinógrafo IMAGEnet por técnico treinado. As imagens obtidas foram analisadas por oftalmologista especialista em retina e classificadas normais, presença de edema macular diabético, retinopatia não proliferativa (inicial, moderada e grave) e retinopatia proliferativa, além de análise inviável. A concordância entre os resultados foi avaliada via coeficiente Kappa. As imagens foram agrupadas em normais e alteradas e estas em RD de alto risco e RD de baixo risco. Avaliou-se ainda a sensibilidade, especificidade, valores preditivos positivos e negativos, em relação à retinografia convencional. Resultados: Oitenta e nove por cento das imagens foram consideradas viáveis para classificação. Pouco mais de 31% dos olhos avaliados foram considerados como normais pelas três tecnologias. O exame com Pictor na ausência de midríase apresentou altos índices de sensibilidade e especificidade para a classificação normal (92,9% e 93,4%) e RD de alto risco (82,9% e 97,9%) e bons resultados para RD de baixo risco (75,0% e 87,0%). Conclusão: O Pictor Plus apresentou altos níveis de concordância com a retinografia digital ao discriminar exames normais de alterados e portadores de RD de baixo e alto risco. Foram verificadas ainda altas sensibilidade e especificidade desta ferramenta, se comparados à retinografia padrão.

Abstract Purpose: Determine the effectiveness of the use a portable handheld fundus camera as a screening method for diabetic retinopathy, compared to regular digital retinography. Methods: This is a cross-sectional, observer-masked study, evaluating 100 eyes of 51 diabetic patients undergoing a routine dilated retinography for diabetic retinopathy. Fundus images pre and post-dilation we captured by Pictor Plus (Volk Optical Inc., Mentor, USA), followed by routine digital retinography by IMAGEnet (Topcon Medical Systems, New Jersey, USA). All exams were performed by a trained technician on the same occasion. The images were analyzed and graded by a masked retina specialist and classified as normal, presence of diabetic macular edema, nonproliferative diabetic retinopathy (initial, moderate and severe) and proliferative diabetic retinopathy. The ungradable images were recorded and excluded from analyses. The agreement between results obtained by the three methods was evaluated via Kappa coefficient. Sensitivity, specificity, positive and negative predictive values in relation to IMAGEnet images were also determined. Results: Images were gradable in 89% of pre-dilation photos. Pictor Plus pre-dilation images had high sensitivity and specificity in identifying normal eyes (92.9% and 93.4%) and in vision-threatening DR (82.9% and 97.9%) both when compared to IMAGEnet results. Conclusion: Pictor can capture retinal images of sufficient quality to screen for DR with and without dilation. Single retinal images obtained using Pictor can identify eyes with vision-threatening DR with high sensitivity and specificity compared to routine IMAGEnet images.

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OBJECTIVES: To evaluate a smartphone-based application's (Peek Acuity) ability to assess visual acuity and screen for ocular conditions in children, we compared visual acuity assessment between Peek Acuity and the pediatric ophthalmology examination and evaluated Peek Acuity's ability to identify children with referable ocular conditions. STUDY DESIGN: We prospectively recruited 111 children age 3-17 years, presenting to a pediatric ophthalmology clinic, who could follow instructions. Monocular visual acuity assessments by Peek Acuity and standard clinical methods were performed in randomized order. We compared visual acuity assessments between methods using intraclass correlation coefficient (ICC) and evaluated Peek Acuity's ability to identify children with referable ocular conditions. RESULTS: ICC comparing visual acuity assessed between methods was 0.88 (95% CI 0.83-0.92) for first and 0.85 (95% CI 0.78-0.89) for second eyes examined. ICC among 3 to 5-year-olds (preschool-age children) was 0.88 (95% CI 0.77-0.94) for first and 0.45 (95% CI 0.13-0.68) for second eyes examined. Peek Acuity had a sensitivity of 83%-86% for decreased vision and 69%-83% for referable ocular disease. Sensitivity was highest among 3 to 5-year-olds with decreased vision, 93%-100%. CONCLUSIONS: Overall, Peek Acuity visual acuity assessment correlated well with visual acuity assessed by standard clinical methods, though preschool-age children appeared more susceptible to examination fatigue. Peek Acuity performed adequately as a screening tool and had the greatest sensitivity among those with decreased vision and preschool-age children. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03212222.

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RESUMEN Introducción: el tamizaje visual en niños es una evaluación que debería ser realizada por el médico de cuidado primario para detectar disminución de la agudeza visual o factores de riesgo que puedan interferir en el desarrollo adecuado del ojo y el sistema visual. En este se debe valorar la agudeza visual, el alineamiento ocular y la presencia de anomalías oculares estructurales. Métodos: se revisó en la literatura las estrategias para realizar un adecuado examen visual pediátrico por médicos generales y pediatras, para identificar de forma temprana los problemas visuales de los niños. Resultados: las alteraciones visuales son una de las causas más importantes de discapacidad en los niños, cuyos factores principales de riesgo son los trastornos refractivos no corregidos, estrabismo y cataratas congénitas, identificables mediante el tamizaje visual; no detectarlas a tiempo puede dejar secuelas irreversibles. Conclusiones: siempre que se detecte en el examen una agudeza visual por debajo de la esperada para la edad del paciente, pobre fijación y/o seguimiento después de los 3 meses, alteración del balance muscular, alteración del reflejo rojo, etc., se debe remitir el niño a un profesional de la salud visual para prevenir pérdida visual permanente.

SUMMARY Introduction: Visual screening in children is an assessment that should be performed by the primary care physician to detect diminished visual acuity or risk factors that may interfere with an appropriate development of the eye and visual system. In the visual screening, visual acuity, ocular alignment and the presence of structural ocular anomalies should be assessed. Methods: A literature review about strategies to perform an adequate pediatric visual examination by general physicians and pediatricians for early detection of visual problems in children was carried out. Results: Visual disorders are one of the main causes of disability in children, being the main risk factors uncorrected refractive errors, strabismus and congenital cataracts, that can leave irreversible sequels if they are not detected on time, being those disorders identified through visual screening. Conclusions: Whenever the visual acuity is detected below the expected for the patient's age, poor fixation and/or follow after 3 months, muscle imbalance, alteration of the red reflex, etc., the child should be referred to a visual health professional to prevent permanent visual loss.

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