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ABCD Summary of MEPEDS so far:
Design: 12,000 from four American ethnic groups: Asian, African, Hispanic-Latinos and White. Age 6-72 months. Interview then comprehensive exam with fixation preference, visual acuity, stereoacuity, axial length, cycloplegic refraction, keratometry, eye alignment and anterior/posterior exam.
Retinomax and IOL Master:
Testability from Age 6-72 months: cycloplegic: exam.
Overall 89% testable with Retinomax and 91% with IOL Master.
By age 30 months, 98% testable with Retinomax and 90% with IOLMaster.
EVA ability: age 30-72 months: 3126 children:
Ability by age group: 30-36 mo –39%, 37-48 mo- 84%, 49-60 mo- 98%, 61-72% 100% (? Developmental delays?) Overall 84% testable.
AMBLYOPIA: 6014 children aged 30-72 months examined.
6 excluded since alignment not measurable
Already treated = 9, glasses = 0.9%,
Parent reported strabismus 1.7% (PPV 62%)
Untestable acuity: 467: 311 age 30-35 mo (9.3% risk factors (2x))
Untestable 36-48 mo 133, age 48-60 mo 17 and age 61-72 mo just 6.
Strabismus: 149 1% ET (3/4 tropic) and 1.5% XT (10% tropic),
Hyperdeviations 3%, Small-angle 12%.
Esotropia increases with age.
Amblyopia defined as repeat EVA acuity less than 20/32 or 2 lines IOD.
Pure anisometropia 39(57%), bilat ametropic 15(22%) = 78% refractive
Strabismic amblyopia 13 (19%)
Total amblyopia 69 (2.1%) + 2 with retinal pathology too.
Black 1.5% and Hispanic 2.6%
Age, perhaps less age 30-35 mo but less testable
Age prevalence steady from 36-72 months.
Risk factors: any strabismus or prior, deprivation or…
Refraction: aniso hyper ≥ 1.00 D, aniso myopia ≥ 3.00 D, anisoastigmatism ≥1.50 D
Bilateral refractive: hyperopia ≥ 4.00, myopia ≥ 6.00 D, astig ≥ 2.50 :
MEPEDS DESIGN: 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.(1)
Retinomax and IOL Master:
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.(2)
EVA ABILITY:
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.(3)
AMBLYOPIA:
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.(4)
References:
1. MEPEDS, Varma R, Deneen J, et al. The multi-ethnic pediatric eye disease study: design and methods. Ophthalmic Epidemiol 2006;13(4):253-62.
2. Borchert M, Wang Y, Tarczy-Hornoch K, et al. Testability of the Retinomax Autorefractor and IOLMaster in Preschool Children The Multi-ethnic Pediatric Eye Disease Study. Ophthalmology 2007.
3. MEPEDS, Cotter SA, Tarczy-Hornoch K, et al. Visual Acuity Testability in African-American and Hispanic Children: The Multi-Ethnic Pediatric Eye Disease Study. Am J Ophthalmol 2007;144(5):663-7.
4. MEPEDS, Tarczy-Hornoch K, Varma R, et al. Prevalence of Amblyopia and Strabismus in African American and Hispanic Children Ages 6 to 72 Months The Multi-ethnic Pediatric Eye Disease Study. Ophthalmology 2008;115(7):1229-36 e1.

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