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Vision in Children


Vision_in_children

Between 1 in 10 and 1 in 20 New Zealand children have some form of vision problem which, if left untreated, could affect literacy and academic performance. Screening for vision problems in childhood is important because many children, and their parents, may not realise there is anything wrong.  Most childhood vision problems aren’t obvious – the eyes look and feel perfectly normal – but left untreated vision problems can lead to permanent visual loss which may be impossible to correct in adulthood.  Poor vision may limit future career choices such as joining the police force, becoming a pilot or even getting a commercial driver’s licence.  Children’s vison screening helps with the diagnosis of:

  • Refractive error – short-sightedness, long-sightedness and astigmatism that require correction with spectacles
  • Amblyopia (‘lazy eye’) – which can lead to permanent vision loss because the eyes and brain are not working together
  • Strabismus (‘turned eye’) – where the two eyes are misaligned.

For all of these conditions early intervention is the key to successful treatment.

Completed projects


Retrospective analysis of B4 School Check Vision screening data in South Auckland, New Zealand.

This study provided the first assessment of the efficacy of the B4 School Check vision screening that was implemented in New Zealand in 2008.  Results from this analysis showed that the current B4 School Check vision screening produced high numbers of false positive referrals that resulted in a poor positive predictive value.  However, the negative predictive value was high (good) suggesting most children with a vision problem are successfully detected as part of the preschool vision screening.

Does conventional amblyopia (lazy eye) therapy improve more than just visual acuity?

Amblyopia is a neurodevelopmental disorder of vision which affects 2-5% of children and is the leading cause of vision loss in 2-70 year olds.  Current treatment primarily involves patching the ‘good’ eye to force the lazy eye to work.  This treatment is very effective at improving visual acuity in the amblyopic eye and also appears to be associated with improvements in stereopsis (3D vision) and motion detection.  This suggests that patching, even when only done in one eye, improves binocular coordination skills possibly through reduced interocular inhibition.

Neonatal hypoglycaemia and vision at 2 and 4.5 years of age (the CHYLD study).

Low blood glucose (hypoglycaemia) is a common problem in new-borns and may affect up to 50% of children born with risk factors.  The CHYLD study was a multidisciplinary study investigating the longitudinal development of children born at risk of neonatal hypoglycaemia.  At 2 years of age we found that moderate hypoglycaemia, when managed according to current clinical guidelines, was not associated with poorer visual outcomes.  For a further explanation of the full study findings please click here:

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Current projects


  1. Optimizing children’s vision screening in New Zealand using currently available clinical tests.
  2. Children’s vision screening using a novel tablet-based device.
  3. Assessing the vision of 7 year old children enrolled in the Growing Up in New Zealand study.
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Our staff


  • Dr Nicola Anstice
  • Dr Joanna Black
  • Dr Lucy Goodman
  • Mrs Miriam Langeslag-Smith
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Publications


Yu, T. Y., Jacobs, R. J., Anstice, N. S., Paudel, N., Harding, J. E., & Thompson, B. (2013). Global Motion Perception in 2-Year-Old Children: A Method for Psychophysical Assessment and Relationships With Clinical Measures of Visual Function Global Motion Perception in 2-Year-Old Children. Investigative ophthalmology & visual science54(13), 8408-8419.

Anstice, N. S., & Phillips, J. R. (2011). Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmology118(6), 1152-1161.

Anstice, N. S., & Thompson, B. (2014). The measurement of visual acuity in children: an evidence‐based update. Clinical and Experimental Optometry,97(1), 3-11.

McKinlay, C. J., Alsweiler, J. M., Ansell, J. M., Anstice, N. S., Chase, J. G., Gamble, G. D., ... & Signal, M. (2015). Neonatal glycemia and neurodevelopmental outcomes at 2 years. New England Journal of Medicine,373(16), 1507-1518.

Chakraborty, A., Anstice, N. S., Jacobs, R. J., LaGasse, L. L., Lester, B. M., Wouldes, T. A., & Thompson, B. (2015). Prenatal exposure to recreational drugs affects global motion perception in preschool children. Scientific reports5.

Langeslag-Smith, M. A., Vandal, A. C., Briane, V., Thompson, B., & Anstice, N. S. (2015). Preschool children's vision screening in New Zealand: a retrospective evaluation of referral accuracy. BMJ open5(11), e009207.

Chakraborty, A., Anstice, N. S., Jacobs, R. J., Paudel, N., LaGasse, L. L., Lester, B. M., ... & Thompson, B. (2015). Global motion perception is independent from contrast sensitivity for coherent motion direction discrimination and visual acuity in 4.5-year-old children. Vision research115, 83-91.

Anstice, N., Spink, J., & Abdul‐Rahman, A. (2012). Review of preschool vision screening referrals in South Auckland, New Zealand. Clinical and Experimental Optometry95(4), 442-448.

Hess, R. F., Babu, R. J., Clavagnier, S., Black, J., Bobier, W., & Thompson, B. (2014). The iPod binocular home‐based treatment for amblyopia in adults: efficacy and compliance. Clinical and Experimental Optometry97(5), 389-398.

Black, J. M., Hess, R. F., Cooperstock, J. R., To, L., & Thompson, B. (2012). The measurement and treatment of suppression in amblyopia. J Vis Exp70, e3927.

Hamm, L. M., Black, J., Dai, S., & Thompson, B. (2014). Global processing in amblyopia: a review. Frontiers in psychology5.

Hess, R. F., Thompson, B., Black, J. M., Machara, G., Zhang, P., Bobier, W. R., & Cooperstock, J. (2012). An iPod treatment of amblyopia: an updated binocular approach. Optometry (St. Louis, Mo.)83(2), 87-94.

Black, J. M., Jacobs, R. J., Phillips, G., Chen, L., Tan, E., Tran, A., & Thompson, B. (2013). An assessment of the iPad as a testing platform for distance visual acuity in adults. BMJ open3(6), e002730.

Goodman, L. K., Black, J. M., Phillips, G., Hess, R. F., & Thompson, B. (2011). Excitatory binocular interactions in two cases of alternating strabismus. Journal of American Association for Pediatric Ophthalmology and Strabismus15(4), 345-349.

Black, J., Browning, S. R., Collins, A. V., & Phillips, J. R. (2008). A canine model of inherited myopia: familial aggregation of refractive error in labrador retrievers. Investigative ophthalmology & visual science49(11), 4784-4789.

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Available projects


Summer student projects

Improving children’s vision screening in New Zealand – test-retest variability of commonly used clinical measures

Masters projects

The influence of refractive error on measures of visual-motor integration (VMI)
VMI assesses the extent to which children and adults can integrate their visual and motor abilities and refers to the co-ordination of visual perception and fine motor output. Good VMI is needed for hand-eye coordination tasks, accurate copying of information, handwriting and drawing. Very little is known about the effect of refractive error (long-sightedness, short-sightedness and astigmatism) on visual motor and visual perceptual skills and how this may affect academic performance. This study aims to investigate the influence of simulated refractive error on the results of the Berry VMI test and examines the implications blurred vision in children may have on learning to read and write.

PhD projects

Improving children’s vision screening in New Zealand
Between 1 in 10 and 1 in 20 New Zealand children have some form of vision problem which, if left untreated, could affect literacy and academic performance. Screening for vision problems in childhood is important because many children, and their parents, may not realize there is anything wrong. Most childhood vision problems aren’t obvious – the eyes look and feel perfectly normal – but left untreated vision problems can lead to permanent visual loss which may be impossible to correct in adulthood. Poor vision may limit future career choices such as joining the police force, becoming a pilot or even getting a commercial driver’s licence.
Almost all screening programmes measure vision using pictures or letters on eye charts specially designed for use with children. In NZ we use a letter-matching chart (the Parr Vision test) and perform preschool vision screening as part of the B4 School Check. The B4 School Check vision screen measures how well children see in the distance (4 metres) and if the results of this screening suggest a problem, the child will be referred to a specialist eye care provider for a comprehensive eye examination. Recent evidence from overseas suggests that there may be better tests to use for children's vision screening programmes and this project aims to explore the reliability and variability of a variety of potential tests for preschool vision screening in NZ. The specific objectives of the study are to:

  1. Compare the current NZ vison screening test with alternative tests that have been identified as having high sensitivity and specificity for detecting vision disorders.
  2. Explore the test-retest variability of vision screening measures to better understand the reliability of the proposed tests.
  3. Evaluate the effect of different referral criteria on the positive and negative predictive values of each of the screening tests.
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Contact us


Dr Nicola Anstice
Building 503, Room 367
85 Park Road, Grafton
Phone +64 9 923 2956
Email: n.anstice@auckland.ac.nz

Dr Joanna Black
Building 503, Room 361
85 Park Road, Grafton
Phone +64 9 923 2405
Email: j.black@auckland.ac.nz

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