Purpose: The aim was to investigate universality of access, screening rate, and outcomes from the New South Wales (NSW) Statewide Eyesight Preschooler Screening (StEPS) over the period of 2009 to 2016. Design: Cross-sectional, observational study. Methods: The StEPS program provides vision screening to 4-year-old children residing in NSW and is administered within Local Health Districts (LHDs). Visual acuity (VA) was examined by trained lay and nurse screeners using HOTV logMAR. Children who had VA <6/9⁻² were referred to local practitioners while those with VA <6/18 were referred to public hospital pediatric ophthalmic outpatient clinics where available. Activity data were collected by NSW Health and screening rates determined from population projections of 4-year-olds per LHD based on adjusted 2014 Census data. To determine factors impacting screening and referral rates, a random effects panel analysis was undertaken. Results: A total of 719,686 (96.4%) NSW 4-year-old children were offered StEPS vision screening between 2009 and 2016, 84% accepted and 564,825 children (75.6%) were screened. The screening rate increased from 67.3% in 2009 to 74.5% in 2016, with an 80% target reached for 3 consecutive years from 2013 to 2015. Of those screened, 19.2% were referred to an eye health professional or advised to have a vision retest in 12 months. This referral rate remained steady over the period studied, with little variation between metropolitan, and rural and regional LHDs. Conclusions: StEPS is an ideal service model for preschool vision screening providing coverage that is comparable to school-based screening programs and at an age likely to facilitate optimal treatment outcomes.

Both visual conditions and communication impairments are common in populations worldwide (Atlaw et al., 2022; Hashemi, Khabazkhoob, Rezvan, & Yekta, 2022; Kahiel, Aubin, Buhrmann, Kergoat, & Freema...

Aims: To survey orthoptists’ confidence in communicating with patients with communication impairments and to investigate resources orthoptists are currently using to aid assessment and management and to explore future resources that may be beneficial. Methods and Procedures: Practicing orthoptists (n = 63; median age range: 31–35 years old) completed an online survey with quantitative and qualitative questions which investigated approaches to adult and paediatric patients with communication impairments and any communication tools used. Analysis of quantitative survey responses was conducted using IBM SPSS v27. Content analysis of qualitative responses was done. Outcomes and Results: Simple communication strategies (e.g., eye contact and body language, repeating/rephrasing sentences) were commonly used with both adult and paediatric patients while more complex strategies (e.g., electronic visual aids, writing key words/concepts) were rarely used. Usage of communication strategies was not affected by length of work experience, workplace clinical speciality or training during their clinical degree or after graduation (p < 0.05). Most participants (71.2%) reported being unaware of resources available for orthoptists to assist in the assessment and management of patients with communication impairments. Conclusions and Implications: Orthoptists have adopted some communication strategies to improve their interactions with patients with communication impairments, despite limited resources. With proper resources, such as training in supportive communication techniques, they can provide optimal patient care, making it essential to identify what kind of resources would be most appropriate.

Purpose: To determine the prevalence and causes of reduced vision in childhood. Methods: Cross-sectional analysis included five cohorts aged; 3–5 years old ( n = 986) from the Sydney Paediatric Eye Disease Study (SPEDS), 6 years ( n = 1739) and 12 years ( n = 2345) from the Sydney Myopia Study (SMS) and the 5 year follow-up of SMS at 12 years ( n = 1111) and 17 years ( n = 1649) in the Sydney Adolescent and Vascular Eye disease Study (SAVES). All children had a comprehensive ocular examination, including visual acuity (VA) with and without refractive correction. Reduced uncorrected VA was defined as worse than 6/12 (logMAR 0.30). A longitudinal analysis was also conducted to identify incident cases of reduced vision between SMS baseline and SAVES follow-up among children assessed at both time points. Results: The overall prevalence of reduced vision based on unaided visual acuity increased with age from 4.5% in SPEDS 3–5 year olds to 17.7% in SAVES 17 year olds ( p < 0.001). The proportion of reduced vision caused by refractive error, amblyopia, strabismus and pathology also varied between cohorts. In the younger cohorts, amblyopia accounted for 21% of SPEDS 3–5 year olds and 28% of SMS 6 year olds with reduced vision. There was a substantial decline in the proportion of reduced vision attributed to amblyopia in the older cohorts, while refractive error increased. Myopia contributed to 18% of children with reduced vision in SPEDS 3–5 years and SMS 6-year-olds and increased to over 80% in SMS 12-year-olds, SAVES 12-year-olds and 17-year-olds. Conclusions: Targeted preschool screening for amblyopia is supported as it occupied a higher proportion of the younger ages. Community education to promote wearing glasses in adolescence for those with myopia is warranted.

Purpose: Pseudomyopia is an accommodative disorder that can be identified by the difference between pre- and post-cycloplegic refractive error. The current study aimed to evaluate whether the axial length to corneal curvature (AL/CR) ratio, in conjunction with non-cycloplegic refractive error, can reliably identify pseudomyopia in children, thus avoiding the need for cycloplegia. Methods: Refractive error and biometry data from longitudinal studies based in Denmark ( n = 645; age 7–17 years) and China (Anyang Childhood Eye Study; n = 2487; age 6–13 years) were used to train separate linear mixed models for children of European or East Asian ancestry, respectively, with AL/CR ratio as outcome and cycloplegic spherical equivalent refractive error (SER), age and sex as predictors. The models could be used to calculate the AL/CR 95% prediction interval in a child of known age, sex and non-cycloplegic SER; if the child’s AL/CR fell below the lower limit of the AL/CR 95% prediction interval, then the child was classified as pseudomyopic. The European and East Asian models were externally validated using data from participants of the Ireland Eye Study (IES; n = 92) and Sydney Myopia Study (SMS; n = 686) cohorts, and the Hong Kong Children Eye Study (HKCES; n = 9519) and Vietnam ( n = 1165) cohorts, respectively. Results: The European model demonstrated moderate detection accuracy for pseudomyopia: sensitivity = 0.82 (IES) and 0.81 (SMS); specificity = 0.75 in both cohorts. By contrast, the East Asian model performed poorly: sensitivity = 0.22 (HKCES) and 0.13 (Vietnam); specificity = 0.99 in both cohorts. Conclusions: Despite moderate diagnostic performance in European samples, the current AL/CR-based models lacked sufficient accuracy for screening and performed poorly in East Asian children, suggesting that AL/CR is not a reliable non-cycloplegic marker of pseudomyopia. Further studies incorporating additional ocular biometric parameters and employing a more rigorous definition of pseudomyopia may build on these initial findings.