Although the DEM is widely used in optometric practice, the results of this study suggest that clinicians should be cautious about using the DEM test in isolation for reaching a diagnosis or monitoring the effectiveness of treatment for saccadic dysfunction.

Purpose-To evaluate the psychometric properties of the original Parent and new Child Amblyopia Treatment Index (ATI), questionnaires that assess the burden of amblyopia treatment in children and families, and to compare scores between children treated with atropine or patching.Methods-Parent ATI and Child ATI were administered to 233 children 7 to <13 years old and their parents as part of a randomized trial comparing patching and atropine for amblyopia treatment. For each ATI version, construct validity was assessed using factor analysis; internal consistency reliability was assessed using Cronbach's alpha. Data from the Parent ATI and Child ATI were correlated and scores for each version were compared between treatment groups.Results-We analyzed the three subscales found in prior Parent ATI studies in younger children and confirmed subscales for adverse effects and treatment compliance, but not for social stigma, in both parent and child versions. Overall and subscale scores on the Parent ATI and Child ATI were moderately to well correlated except for the social stigma subscale. For both the Parent ATI and Child ATI, children treated with atropine had better scores than those treated with patching, both overall and on treatment compliance and social stigma subscales (all p-values ≤ 0.01).

Background: Risk models in the private insurance setting may systematically underpredict in the socially disadvantaged. In this study, we sought to determine whether US minority Medicare beneficiaries had disproportionately low costs compared with their clinical outcomes and whether adding social determinants of health (SDOH) into risk prediction models improves prediction accuracy. Methods and Results: Retrospective observational cohort study of 2016 to 2017 Medicare Current Beneficiary Survey data (n=3614) linked to Medicare fee-for-service claims. Logistic and linear regressions were used to determine the relationship between race/ethnicity and annual costs of care, all-cause hospitalization, cardiovascular hospitalization, and death. We calculated the observed-to-expected (O:E) ratios for all outcomes under 4 risk models: (1) age+sex, (2) model 1+clinical comorbidity adjustment, (3) model 2+SDOH, and (4) SDOH alone. Our sample was 44% male and 11% black or Hispanic. Among minorities, adverse clinical outcomes were inversely related to cost. After multivariable adjustment, blacks/Hispanics had higher rates of cardiovascular hospitalization (incidence rate ratio, 1.78; P =0.012) but similar annual costs ($−336, P =0.77) compared with whites. Among whites, models 1 to 4 all showed similar O:E ratios, suggesting high accuracy in risk prediction using current models. Among minorities, adjustment for age, sex, and comorbidities underpredicted all-cause hospitalization by 20% (O:E, 1.20) and cardiovascular hospitalization by 70% (O:E, 1.70) and overpredicted death by 21% (O:E, 0.79); adding SDOH brought O:E near 1 for all outcomes. Among both groups, the SDOH risk model alone performed with equal or superior accuracy to the model based on clinical comorbidities. Conclusions: A paradoxical relationship was observed between clinical outcomes and costs among racial and ethnic minorities. Because of systematic differences in access to care, cost may not be an appropriate surrogate for predicting clinical risk among vulnerable populations. Adjustment for SDOH improves the accuracy of risk models among racial and ethnic minorities and could guide use of prevention strategies.

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Vision screenings are intended to efficiently identify students with possible visual impairment and initiate a referral for diagnosis and treatment. In many cases, at-risk students do not access the recommended care or experience delays in receiving care. The purpose of this article is to report the effect on adherence to vision screening recommendations by providing the eye examination at the students' school and at no cost. Of the 1,306 students screened, 382 (29.2%) were identified with possible visual impairment. Parental consent for examination was obtained for 198 (51.8%) students. Our vision screening and examination program yielded similar adherence to follow-up as stand-alone vision screening programs. Future program considerations should address perceptual barriers that may be contributing to parental nonadherence to vision screening recommendations.