the vision of adolescent boys*
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1746 ALBERT E. SLOANE AND J. ROSWELL GALLAGHER
3. Loewenstcin, A., and Foster, J.: Malignant melanoma of limbus and spontaneous cyst of pig-mented layer of iris in same sector. Arch. Ophth., 37 :8-17 (Jan.) 1947.
4. Frangois, J.: Kystes des proces ciliares, observes par la gonioscopie apres enclavement de l'iris. Ophthalmologica, 116:313, 1948.
5. Dunnington, J. H.: Personal communication. 6. Greeff, R.: Befund am Corpus ciliare nach Punction der vorderen Kammer. Arch. f. Augenh.
28:178,1894. 7. Wintersteiner, H.: Ueber primare (idiopathische) pigmentierte Cysten der Irishinterflache. Ber.
d. Ophth. Ges (Heidelberg), 33:345-359, 1906. 8. Pagenstecher, H. E.: Multiple Zysten an der Irishinterflache und am Corpus ciliare. Arch. f.
Ophth., 74:290-293, 1910. 9. Meek, R. E.: Sarcoma of the iris (complicated by a cyst). Arch. Ophth., 8:864-870, 1932. 10. Elschnig, H.: Ziliarkorperzyste. Klin. Monatsbl. f. Augenh., 74:476-483, 1925. 11. Villard, H., and Dejean, C.: Les kystes de l'iris. Arch, d'opht., 50 :91-121, 1933. 12. Dunnington, J. H.: Personal communication.
T H E V I S I O N O F A D O L E S C E N T B O Y S
ALBERT E. SLOANE, + M.D. Boston, Massachusetts
J. ROSWELL GALLAGHER,* M.D. Middletown, Connecticut
Both school1 '6 and industry7 '8 have, within the past few years, become increasingly aware of the importance of vision testing and consequently several screening devices8
have been developed. The purpose of these screening devices is to select those persons whose vision requires professional eye care ; the value of such a device is appraised on the basis of its ability to pick out all those who really need this extra examination without needlessly referring many others.
Recently studies of the relative efficiency of several screening devices have been undertaken.8"10 One part of the general problem of developing good screening methods is the determination of the ranges of visual data which one finds when an unselected group is examined. A study of such data will assist in determining what should be accepted as the normal limits for any given test and will also
* From the Department of Health, Phillips Academy, Andover, Massachusetts. This study was aided by a grant from The Grant Foundation, Inc.
t Director, Department of Refraction, Massachusetts Eye and Ear Infirmary.
| College physician, Wesleyan University.
permit an advance estimate of what the examination of any group is likely to reveal.
I t is to be remembered, however, that a high frequency of any particular finding does not necessarily indicate that it is the optimum condition: naked vision of 20/20 occurs in a much higher percentage of adolescents than does any other figure, but this is not incontrovertible evidence per se that 20/20 vision is optimal or necessary for all persons.
M E T H O D
This paper presents data obtained at the screening eye examinations of 1,129 different adolescent males ranging in age from 13 to 19 years. None of these individuals was included in a previous report6 so the data in that report may suitably be compared with the present findings. All the data were obtained over a three-year period at the time of the annual health examination of students at a preparatory school. The same technician did all these screening tests, and all were carried out using a modification of the Massachusetts Vision Test.9 The efficiency of this screening device has previously been
V I S I O N O F A D O L E S C E N T BOYS 1747
discussed8'9 and will be the subject of a future report.11 The slight variation in visual acuity which is found at each age in the 13-to 19-year period1'4,1Z makes the division of these data into separate age groups unnecessary. In the Massachusetts Vision Test a cyclopegic is not used.
RESULTS AND COMMENTS
VISUAL ACUITY Visual acuity was determined without
glasses if these were worn. A properly il-
20/ 20 20/ 25 20 / 30 2 0 / 40 20 / 50 20 / 70 20/100 20/200 20/200 plus Eye absent
681 92 54 45 32 36 57 83 48
60.3 8.2 4 .8 4 .0 3.0 3.2 5.0 7.3 4.2 0.09
luminated American Optical Company chart No. 1,930 at 20 feet from the subject was used. More than two errors in the 20/20, 20/25, and 20/30 lines and more than one error in the 20/40, 20/50, and 20/70 lines was considered a failure of that line.
Table 1 indicates that 72.0 percent of this group had 20/20 binocular vision. This figure is similar (76.5 percent) to that obtained with the same test upon a different group of 797 boys9 and to that reported (80.06 percent) on a group of 715 boys;6 and similar to that of Collins and Britten1 who found 69 percent of boys in the 13- through 16-year period to have 20/20 vision or better in both eyes. The lower figure for the last group can be explained on the basis of its referring to 20/20 vision in each eye, while the other reports refer to 20/20 vision when both
of a eyes are used together to read the chart. isual On the basis of referring for a further ex-e 13- amination all those who had less than 20/25 ision vision in one eye, about 30 percent of the ; un- group described in Table 1 would have been Test selected; if the basis were less than 20/25
vision in both eyes, 26 percent would be referred; if only those whose vision was less than 20/30 in one or 20/30 in both eyes were considered, about 25 and 21 percent respec-
thout tively would be referred. It is to be remem-ly il- bered that 350 members of this group (31
724 79 37 38 33 41 43 87 47
64.1 7.0 3.3 3.3 3.0 3.6 3.8 7.7 4.2 0
811 50 25 37 36 30 44 65 30
72.0 4 .4 2.2 3.3 3.2 2 .6 3.9 5.8 2.6 0.09
chart percent) already had glasses; only 19 boys : was out of the 1,129 failed the plus-1.50 test so 0/20, we may assume that the majority who were I one wearing glasses were doing so because of lines myopia or astigmatism. With this in mind, a
referral figure of 30 percent does not seem f this excessive. s fig- It is generally believed that the visual ained acuity rating obtained in a school vision-test-jroup ing program tends to be lower than that sub-> per- sequently found by the eye specialist. This milar is probably due to the poorer illumination of id 69 the school charts, the poorer condition of the -year school charts, the fact that the school ex-both aminer is more pressed for time and also
p can tends to give a line-lower rating in case of rig to any doubt than does the specialist. other These factors did not operate in a signifi-both cant degree in the testing described here and,
TABLE 1 VISUAL ACUITY WITHOUT GLASSES
1,129 different male adolescents ranging from 13 to 19 years of age
O.D. O.S. O.U.
Number of Percent of Number of Percent of Number of Percent of Cases Cases Cases Cases Cases Cases
1748 ALBERT E. SLOANE AND J. ROSWELL GALLAGHER
therefore, it is possible that a considerably higher percentage of these students would have failed the 20/30 line had the tests been done in the usual sort of school situation. If this is true, it might be well to consider failure of the 20/40 line the proper level for referral in school screening test rather than the 20/30 line; on this basis about 18 percent would be referred.
The presence of hypermetropia was determined by instructing the examinee to attempt to read the 20/20 line on the Snellen chart through a pair of plus 1.5D. sph. Ability to read this line with either or both eyes was scored as a failure.
In a previous study of 797 boys9 there were 518 who did not wear glasses; 36 of these (6.9 percent) had 20/20 vision in one or both eyes through plus 1.5D. sph. and were therefore rated as failing the test for hypermetropia.
Another group,6 similarly tested, showed that 10 percent of 466 boys who did not have glasses failed this test. The significance of the data relating to this group is no more than an indication of the number of failures this test may produce when members of this age group and socio-economic level are ex-
TABLE 2 DISTRIBUTION OF HYPERPHORIA MEASUREMENTS
Glasses were worn by the 350 individuals
who owned them
Right hyperphoria 5 4 3 2 1
1 0 1 2
22 Left hyperphoria
5 4 3 2 1
Unable to do Orthophoria
2 0 0 3 7 3
Number Tested with
2 1 1 1
1 0 1 3
Total Number Tested
3 1 2 3
3 0 1 6
amined. There were only about two percent of the 779 who did not have glasses who failed this test. A considerable number of the 350 who already had glasses undoubtedly had hypermetropia, but these data do not permit an estimate of what that number might be. In a similar series 16 out of 62 boys who were wearing glasses at the time of their first screening examination were known to be wearing them because of hyper-opia, hypermetropic astigmatism, and so forth. On the basis of that small series, one might expect to find that about 25 percent of such a group wear glasses because of some type to hypermetropia.
Measurements for heterophoria (distant) were determined at 20 feet. The subject viewed letters and numbers which formed a Maddox cross and a one centimeter light through spectacles in one pair of which a red multiple Maddox rod was mounted horizontally for the right eye and in the other pair of which a red multiple Maddox rod was mounted vertically for the right eye.9 The examinee wore his own gla