The Vision of Adolescent Boys*

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    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.


    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,


    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


    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-


    Glasses were worn by the 350 individuals

    Prism Diopters

    who owned them

    Number Tested

    without Glasses

    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

    15 2



    Total Number Tested

    3 1 2 3


    3 0 1 6

    22 5



    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 glasses under these spectacles if he had glasses.


    Table 2 gives the distribution of Maddox-rod measurements. Five boys were unable to give a response which could be interpreted and 19 (1.69 percent) had more than one prism diopter of hyperphoria. These figures are similar to those in two other surveys9'6

    utilizing the same test, which reported more than one prism diopter of hyperphoria in 1.5 percent out of 797 boys in one group, and 2.5 percent in the other group of 715 boys.


    Only 1.2 percent of this group were found to have more than six prism diopters of esophoria (distance) with the Maddox-rod test; 1.9 percent had more than four prism diopters of exophoria (table 3) . This total of 3.1 percent having an excess of the standards9 set for esophoria and exophoria (distance) is similar to the finding of 3.1 percent and 5.7 percent in two other groups.9'6


    In a study13 of 100 candidates for submarine school, two individuals were found to have more than six diopters of esophoria and one had more than four diopters exophoria (distance). A phorometer with Risley prisms and Maddox rods was used and a one-centimeter light was viewed without glasses at 20 feet.


    Heterophoria for near vision was measured by use of a calibrated card held at 16 inches and viewed through 3.0D. prisms mounted base-up for the right eye and base-down for the left eye.9

    A total of 22 (two percent of the group) boys failed to meet the standards set for this test; about 0.5 percent of the 1,129 boys in this group were found to have more than six diopters of esophoria (near) and 1.5 percent to have more than eight diopters exophoria, near (table 4) . Twenty out of 797


    MEASUREMENTS AT DISTANCE Glasses were worn by the 350 individuals

    who owned them

    Number Number Prism Tested Tested

    Diopters without with Glasses Glasses

    Total Number Tested

    Esophoria 1 2 3 4 5 6 7 8 9

    10 or more Exophoria

    1 2 3 4 5 6 7 8 9

    10 or more Unable to do Orthophoria

    157 70 34 12 6 7 6 0 3 0

    57 16 8 3 2 2 2 1 3 0 2


    36 27 12 4 5 4 0 2 3 0

    31 11 10 3 3 2 3 1 3 0 3


    193 97 46 16 11 11 6 2 6 0

    88 27 18 6 5 4 5 2 6 0 5



    MEASUREMENTS (NEAR) Glasses were worn by the 350 individuals

    who owned them

    Prism Diopters

    Number Tested without Glasses

    Number Tested

    with Glasses

    Total Number Tested

    Esophoria 1 2 3 4 5 6 7 8 9

    10 11 12 13 13 plus

    Exophoria 1 2 3 4 5 6 7 8 9

    10 11 12 13 13 plus

    Unable to do Orthophoria

    70 32 16 7

    10 3 2 0 0 1 0 0 0 0

    88 39 24

    6 12 4

    10 5 2 4 1 0 3 0 8


    42 19 3 8 1 0 2 0 0 0 0 0 1 0

    37 15 9 3 7 4 5 5 2 3 0 0 1 0

    17 166

    112 51 19 15 11 3 4 0 0 1 0 0 1 0

    125 54 33

    9 19 8

    15 10 4 7 1 0 4 0

    25 598

    Total 779 350 1,129

    Total 779 350 1,129

    boys in another group (2.5 percent) tested in the same manner9 had more than six diopters esophoria or more than eight diopters exophoria; in another similar survey6 of 715 boys, 2.7 percent exceeded those degrees of heterophoria. In the study of submarine candidates,13 the subject's gaze was directed at the light bulb of an ophthalmoscope fixed at eye level at 13-inches distance and attached to a phorometer.

    With these three methods, and a re-test of each, the number exceeding six diopters of esophoria varied from zero to three percent and those exceeding eight diopters exophoria varied from 15 to 34 percent. The variability of heterophoria tests both in amount and kind is well known;14 that these data show as much similarity as they do (except in the


    instance of the submarine candidates' exo-phoria at near) is surprising and suggests that the results are reasonably reliable.

    The desirability of including tests for heterophoria has been reported9. In that survey, 25 boys out of a group of 518 who did not have glasses failed these tests but passed the tests for visual acuity and hypermetropia.

    S U M M A R Y

    1. One obstacle in the development and use of proper visual-screening tests in schools and industry has been the difficulty of determining normal (or, better, optimal) limits for the findings each test produces. This report provides the distribution of various test results at the vision examination of 1,129 boys ranging in age from 13 to 19 years. The vision examination was part of these adolescents' annual health examination and the screening method used was a modification of the Massachusetts Vision Test.

    2. About 72 percent of this group had 20/20 naked binocular vision.

    3. If the basis for referral was set at fail

    ure to read the 20/30 line with one eye, the usual acuity test would have selected about 25 percent; if the basis was failure to read 20/30 with both eyes, about 21 percent; if the basis was failure to read the 20/40 line with both eyes, 18 percent would be referred to a specialist.

    4. The test for hypermetropia was done with glasses, if the subject had them; 350 members of this group already had glasses. Two percent of those who did not have glasses (779) failed this test.

    5. More than one prism diopter of hyper-phoria was found in 1.69 percent; more than six prism diopters of esophoria in 1.2 percent ; more than four prism diopters exo-phoria in 3.2 percent. At near there was more than six prism diopters esophoria in 0.5 percent and more than eight prism diopters exophoria in 1.5 percent.

    6. Attention is called to the desirability of including tests for hypermetropia a...