Alaska Blind Child Discovery

MEPEDS

Multi-Ethnic Pediatric Eye Disease Study (MEPEDS)
(MEPEDS is a federally-funded, large American study that could help objective preschool vision screening. Unfortunately the authors, and reviewers of these manuscripts have chosen to NOT report the simple validation statistics consistent with AAPOS vision screening guidelines)
MEPEDS (2008). "Prevalence of amblyopia and strabismus in African American and Hispanic children ages 6 to 72 months the multi-ethnic pediatric eye disease study." Ophthalmology 115(7): 1229-1236. OBJECTIVE: To determine the age- and ethnicity-specific prevalences of strabismus in African American and Hispanic/Latino children ages 6 to 72 months and of amblyopia in African American and Hispanic/Latino children 30 to 72 months. DESIGN: Cross-sectional study. PARTICIPANTS: The Multi-ethnic Pediatric Eye Disease Study is a population-based evaluation of the prevalence of vision disorders in children ages 6 to 72 months in Los Angeles County, California. A comprehensive eye examination was completed by 77% of eligible children. This report focuses on results from 3007 African American and 3007 Hispanic/Latino children. METHODS: Eligible children in all enumerated households in 44 census tracts were identified. Participants underwent an in-home interview and were scheduled for a comprehensive eye examination and in-clinic interview. The examination included evaluation of ocular alignment, refractive error, and ocular structures, as well as determination of optotype visual acuity (VA) in children 30 months and older. MAIN OUTCOME MEASURES: The proportion of 6- to 72-month-olds with strabismus on ocular examination and proportion of 30- to 72-month-olds with optotype VA deficits and amblyopia risk factors consistent with predetermined definitions of amblyopia. RESULTS: Strabismus was detected in 2.4% of Hispanic/Latino children and 2.5% of African American children (P = 0.81), and was more prevalent in older children than in younger children. Amblyopia was detected in 2.6% of Hispanic/Latino children and 1.5% of African American children, a statistically significant difference (P = 0.02), and 78% of cases of amblyopia were attributable to refractive error. Amblyopia prevalence did not vary with age. CONCLUSIONS: Among Hispanic/Latino and African American children in Los Angeles County, strabismus prevalence increases with age, but amblyopia prevalence appears stable by 3 years of age. Amblyopia is usually caused by abnormal refractive error. These findings may help to optimize the timing and modality of preschool vision screening programs.

MEPEDS (2010). "Prevalence of myopia and hyperopia in 6- to 72-month-old african american and Hispanic children: the multi-ethnic pediatric eye disease study." Ophthalmology 117(1): 140-147. PURPOSE: To determine the age-, gender-, and ethnicity-specific prevalence of myopia and hyperopia in African American and Hispanic children aged 6 to 72 months. DESIGN: Population-based cross-sectional study. PARTICIPANTS: The Multi-Ethnic Pediatric Eye Disease Study is a population-based evaluation of the prevalence of vision disorders in children aged 6 to 72 months in Los Angeles County, California. Seventy-seven percent of eligible children completed a comprehensive eye examination. This report focuses on results from 2994 African American and 3030 Hispanic children. METHODS: Eligible children in 44 census tracts were identified during an in-home interview and scheduled for a comprehensive eye examination and in-clinic interview. Cycloplegic autorefraction was used to determine refractive error. MAIN OUTCOME MEASURES: The proportion of children with spherical equivalent (SE) myopia </= -1.00 diopter (D) and SE hyperopia >/= +2.00 D in the worse eye. Prevalence of myopia and hyperopia is also reported using alternative threshold definitions. RESULTS: Prevalence of myopia was higher in African American (6.6%) compared with Hispanic children (3.7%; P<0.001). Hispanics showed a higher prevalence of hyperopia than African American children (26.9% vs. 20.8% respectively, P<0.001). The prevalence of myopia showed a significant decreasing trend with age (P<0.001). Hyperopia prevalence reached a low point at approximately 24 months of age but increased and remained higher than that thereafter. No significant gender differences were found in the prevalence of refractive error for either ethnic group. CONCLUSIONS: We observed ethnicity-related differences in both hyperopia and myopia prevalence in preschool children. The age-related decrease in myopia prevalence in preschool children could reflect early emmetropization and contrasts with the increase in myopia prevalence known to occur in older school-aged children. The limits of emmetropization are evident, however, in the persistently elevated prevalence of hyperopia beyond 24 months of age. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

MEPEDS, M. Borchert, et al. (2010). "Anisometropia in Hispanic and african american infants and young children the multi-ethnic pediatric eye disease study." Ophthalmology 117(1): 148-153. PURPOSE: To determine anisometropia prevalence and associated risk factors in Hispanic and African American preschoolers. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: We included 3030 Hispanic and 2994 African American children aged 6 to 72 months from Inglewood, California. METHODS: Retinomax autorefraction was performed on all participants after cycloplegia. Anisometropia was defined by difference in spherical equivalent (SE), by difference in plus cylinder in any axis (cylindrical), and by difference in cylinder axis vectors (vertical Jackson cross cylinder vector [J0] and oblique Jackson cross cylinder vector [J45] between the eyes. Strabismus was determined by prism-cover testing. A parental questionnaire explored potential risk factors including developmental delay, prematurity, prenatal exposure, and family history. MAIN OUTCOME MEASURES: Anisometropia prevalence stratified by age, gender, and ethnicity. The association of anisometropia with strabismus and other biological risk factors was assessed. RESULTS: The prevalence of SE anisometropia > or =1.0 diopter (D) was 4.3% for Hispanics and 4.2% for African Americans. Prevalence of cylindrical anisometropia > or =1.0 D was 5.6% and 4.5%, respectively. Prevalence of cylindrical or SE anisometropia > or =3.0 D was < or =0.4% for both ethnic groups. Cylinder vector anisometropia > or =0.5 was twice as common as cylindrical anisometropia > or =1.0 D. The SE anisometropia decreased at age 1 year in Hispanics (P = 0.0016) but not African Americans. Cylindrical anisometropia decreased in the first year of life in both ethnic groups (P < or = 0.001). There was no trend in SE or cylindrical anisometropia beyond 1 year of age, but cylinder vector anisometropia steadily decreased beyond 1 year of age in both ethnic groups. Cylinder vector anisometropia was more prevalent among African Americans, but there was no difference in other measurements of anisometropia between ethnic groups. Anisometropia did not vary by gender. Strabismus was associated with all types of anisometropia. No association of anisometropia with gestational age, birth weight, cerebral palsy, family history, or prenatal exposure could be identified. CONCLUSIONS: Spherical and cylindrical anisometropia (> or =1.0 D) each affect 4% to 6% of Hispanic and African American preschoolers. Anisometropia > or =3.0 D is rare. Except for cylinder axis vector, the prevalence of anisometropia does not diminish beyond 1 year of age. Strabismus is associated with all forms of anisometropia. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

MEPEDS, M. Borchert, et al. (2008). "Testability of the Retinomax Autorefractor and IOLMaster in Preschool Children The Multi-ethnic Pediatric Eye Disease Study." Ophthalmology 115(8): 1422-5, 1425. PURPOSE: To determine the testability of Retinomax and IOLMaster ocular biometry in preschool children. DESIGN: Population-based study of inner city preschool children in Los Angeles County. PARTICIPANTS: Two thousand five hundred forty-five Hispanic and 2178 African American children 6 to 72 months old. METHODS: Subjects were identified by door-to-door screening within previously identified contiguous census tracts. Pediatric ophthalmologists or optometrists performed comprehensive eye examinations on all subjects. Refractive error and keratometry measurements were attempted on all subjects with the Retinomax autorefractor after cycloplegia. Axial length measurements with the IOLMaster partial coherence interferometer were attempted on those subjects ages 30 to 72 months. MAIN OUTCOME MEASURES: Ability to obtain high confidence autorefraction readings or axial length measurements on both eyes. RESULTS: Overall, 89% were testable in both eyes with the Retinomax device, and 91% of the children were testable with the IOLMaster. Testability rose sharply with age, so that by age 36 months 98% of children were testable with the Retinomax device and 90% were testable with IOLMaster. There were no consistent gender- or ethnicity-related differences in testability overall or when stratified by age for either device. CONCLUSIONS: Young children can be reliably tested for ocular biometry with the Retinomax and IOLMaster devices. This may impact strategies for management of cataracts and refractive errors in preschool children.

MEPEDS, S. A. Cotter, et al. (2007). "Visual Acuity Testability in African-American and Hispanic Children: The Multi-Ethnic Pediatric Eye Disease Study." Am J Ophthalmol 144(5): 663-667. PURPOSE: To compare the age- and gender-specific testability rates for the Amblyopia Treatment Study (ATS) HOTV visual acuity testing protocol using the electronic visual acuity (EVA) tester in African-American and Hispanic preschool children. DESIGN: Population-based, cross-sectional study. METHODS: Measurement of presenting monocular distance visual acuity using the ATS HOTV protocol was attempted in all African-American and Hispanic children aged 30 to 72 months from the population-based Multi-Ethnic Pediatric Eye Disease Study (MEPEDS). Children able to be tested monocularly in both eyes were considered able. Age-, gender-, and ethnicity-specific testability rates were calculated. Comparisons of testability among different groups were performed using Chi-square analyses and the Cochran trend test. RESULTS: Testing was attempted on 3,126 children (1,471 African-American, 1,655 Hispanic; 50% female). Overall, 84% (83% African-American, 85% Hispanic; 86% female, 82% male) were testable. Older children were more likely to complete testing successfully than younger children (P < .0001). Age-specific testability in children 30 to 36 months of age, 37 to 48 months of age, 49 to 60 months of age, and 61 to 72 months of age was 39%, 84%, 98%, and 100%, respectively. After stratifying by age, there were no ethnicity-related differences in children testable (P = .12). Girls (86%) were slightly more likely to be testable than boys (82%; P > .003). CONCLUSIONS: Monocular threshold visual acuity testing using the ATS HOTV protocol on the EVA tester (Jaeb Center for Health Research, Tampa, Florida, USA) can be completed by most African-American and Hispanic preschool children, particularly those older than 36 months of age. This protocol therefore may be used in minority preschool children as an integral part of the diagnosis and management of amblyopia and other forms of visual impairment.

MEPEDS, K. Tarczy-Hornoch, et al. (2008). "Stereoacuity testability in African-American and Hispanic pre-school children." Optom Vis Sci 85(3): 158-63.
PURPOSE: To determine testability using the Randot Pre-school Stereoacuity Test in black and Hispanic children 30 to 72 months of age. METHODS: A population-based cohort of children 30 to 72 months of age was administered the Randot Pre-school Stereoacuity Test, with presenting refractive correction, and before cover testing, visual acuity testing, or refraction. Children who could not point to specified two-dimensional demonstration pictures, and children who would not try to name or match random dot figures to the corresponding two-dimensional pictures, were classified as unable to perform the test. Children who were able to perform the task but could not correctly identify at least two 800-arcsecond random dot figures were classified as having no stereopsis, and were retested by another examiner. RESULTS: Stereoacuity testing was attempted in 1662 Hispanic and 1470 black children. Overall, 80% of children were able to be tested; 33% of children 30 to 36 months of age, 73% of children 37 to 48 months of age, 96% of children 49 to 60 months of age, and 98% of children 61 to 72 months of age were testable. Older children were significantly more likely to complete testing successfully than younger children (p < 0.0001). After adjusting for age, there was no significant ethnicity-related difference in testability (p = 0.19); however, there was a small but significant gender-related difference (p = 0.0002) with more girls (82%) than boys (77%) able to complete testing. CONCLUSIONS: Eighty percent of children aged 30 to 72 months can be tested using the Randot Pre-school Stereoacuity test. Testability increases steadily with age, and 97% of children over 48 months of age can complete the test. Testability does not differ between children of Hispanic and black ethnicity.

MEPEDS, R. Varma, et al. (2006). "The multi-ethnic pediatric eye disease study: design and methods." Ophthalmic Epidemiol 13(4): 253-62. PURPOSE: To summarize the study design of the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS). METHODS: The objectives of the MEPEDS are to: (1) estimate age- and ethnicity-specific prevalence of strabismus, amblyopia, and refractive error; (2) evaluate the association of selected risk factors with these ocular disorders; and (3) evaluate the association of ocular conditions on limitations in health-related functional status in a population-based sample of 12,000 children aged 6-72 months from four ethnic groups--African-American, Asian-American, Hispanics/Latinos and non-Hispanic White. Each eligible child undergoes an eye examination, which includes an interview with his/her parent. The interview includes an assessment of demographic, behavioral, biological, and ocular risk factors and health-related functional status. The examination includes fixation preference testing, visual acuity, stereoacuity, axial length measurement, cycloplegic refraction, keratometry, eye alignment, and anterior and posterior segment examination.