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CORRESPONDENCE
Year : 2020  |  Volume : 32  |  Issue : 1  |  Page : 119

Comment on the article: Comparison of the pediatric vision screening program in 18 countries across five continents


1 Department of Ophthalmology, University Hospital “Sveti Duh”, Zagreb; Faculty of Medicine; Faculty of Dental Medicine and Health Care Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
2 Department of Ophthalmology, University Hospital “Sveti Duh”, Zagreb, Croatia

Date of Submission06-Oct-2019
Date of Acceptance10-Nov-2019
Date of Web Publication23-Mar-2020

Correspondence Address:
Mirjana Bjeloš
Department of Ophthalmology, University Hospital gSveti Duhh, Sveti Duh 64, Zagre
Croatia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JOCO.JOCO_51_20

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How to cite this article:
Busic M, Bjeloš M, Elabjer BK, Križanović A. Comment on the article: Comparison of the pediatric vision screening program in 18 countries across five continents. J Curr Ophthalmol 2020;32:119

How to cite this URL:
Busic M, Bjeloš M, Elabjer BK, Križanović A. Comment on the article: Comparison of the pediatric vision screening program in 18 countries across five continents. J Curr Ophthalmol [serial online] 2020 [cited 2020 Nov 26];32:119. Available from: http://www.jcurrophthalmol.org/text.asp?2020/32/1/119/281256



Dear Editor,

We read with great interest the article by Chen et al., “Comparison of the pediatric vision screening program in 18 countries across five continents,” in Journal of Current Ophthalmology.[1]

We would like to congratulate the authors for this valuable and interesting paper because vision disorders are acknowledged to be the leading cause of handicapping conditions in childhood. However, we would also like to comment on a few points. Zagreb Amblyopia Preschool Screening (ZAPS) study[2] performed visual acuity (VA) testing both at near (40 cm) and distance (3 m), and this should be documented in [Table 4],[1] presented on page 5, as this is the essential contributor for the study outcomes. ZAPS study tested VA at near as well as at distance, due to following considerations: (1) hypermetropia is the most common refractive error in preschool children; hence, near VA should more reliably detect the presence of hypermetropia; (2) the greater the distance, the shorter the attention span is; and (3) to increase the accuracy of the test. The reason for high sensitivity (100%)[2] and specificity (97%)[2] levels as specified on page 7[1] could be attributed to the trained professional,[1] but is evidenced to be the result of using both near and distance VA testing. If performed alone, near VA testing would have a sensitivity of 74.5% and a specificity of 43.5%.[2] Sensitivity of the distance vision test using Lea Symbols in lines chart for distance, if tested alone, would reach 96.4%; however, specificity would be only 11.7%.[2]{Table 4}

Moreover, when testing VA, it should be emphasized that isolated single optotypes without crowding can overestimate VA. Thus, if vision in preschool children in particular is evaluated and analyzed, it is always important and beneficial to address whether the optotypes are presented as single, single surrounded with flankers, in a single line surrounded with crowding bars, or in lines of optotypes, assembled on Snellen or gold standard logMAR principle, as different test charts can yield different VA results, and in such a way underestimate the burden of the disease. Across five continents, differences are found in this aspect likewise.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chen AH, Abu Bakar NF, Arthur P. Comparison of the pediatric vision screening program in 18 countries across five continents. J Curr Ophthalmol 2019;31:357-65.  Back to cited text no. 1
    
2.
Bušić M, Bjeloš M, Petrovečki M, Kuzmanović Elabjer B, Bosnar D, Ramić S, et al. Zagreb Amblyopia Preschool Screening Study: Near and distance visual acuity testing increase the diagnostic accuracy of screening for amblyopia. Croat Med J 2016;57:29-41.  Back to cited text no. 2
    




 

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