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Hong JD, Choi EH, Suh S, Bui JH, Storch AM, Walker KR, Shahraki K, Yanez C, Torres D, Espinoza J, Molina I, Suh DW. UCI EyeMobile Exam Findings from School Children Following on-Site Screening. Clin Ophthalmol 2024; 18:1667-1678. [PMID: 38860118 PMCID: PMC11164085 DOI: 10.2147/opth.s460879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/30/2024] [Indexed: 06/12/2024] Open
Abstract
Purpose Uncorrected refractive errors (REs) and amblyopia can lead to visual impairment with deleterious effects on quality of life and academic performance. Early detection and treatment by community vision care programs, such as the UCI EyeMobile for Children, can aid in addressing preventable vision loss. Methods A total of 5074 children between the ages of 3 and 10 years were screened at 153 locations, including preschools, head start programs, and elementary schools within Orange County (OC), California (CA). Subsequently, 1024 children presented for comprehensive eye examinations. A retrospective analysis of all examined children was conducted, determining the frequency and severity of REs and amblyopia and the spectacle prescription rate by age. Propensity score matching analysis evaluated the effect of median household income on RE and amblyopia frequency. Results Among those who failed initial screening and were subsequently examined, significant rates of REs and amblyopia were detected: myopia (24.4%), hyperopia (35.4%), astigmatism (71.8%), anisometropia (8.9%), amblyopia (7.0%), and amblyopia risk (14.4%). A majority (65.0%) of those examined received prescription spectacles from UCI EyeMobile, with around a third requiring a new or updated prescription. The frequency of REs and amblyopia and the spectacle prescription rate were uniform across OC congressional districts. Myopia and amblyopia risk was positively and negatively associated with household income, respectively. Conclusion The UCI EyeMobile for Children serves as a vital vision care program, providing free vision screening, comprehensive eye examinations, and spectacles. A significant number of children required examination, and a high frequency of REs and amblyopia were detected in examined children, with subsequent provision of prescription spectacles to most children.
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Affiliation(s)
- John D Hong
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Elliot H Choi
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Susie Suh
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Joseph H Bui
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Annabelle M Storch
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Kimberly R Walker
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Kourosh Shahraki
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Carolina Yanez
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Diana Torres
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Jennifer Espinoza
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Iliana Molina
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, CA, USA
| | - Donny W Suh
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
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AlHarkan DH, AlRubaysh NS, Aldekhail MI, Alayidi SA, Alashgar MS, Almishali FF. Knowledge, Attitude, and Practice Regarding Vision and Eye Screening of Preschool Children Among Primary Health Center Staff in the Qassim Region, Saudi Arabia. Cureus 2024; 16:e52743. [PMID: 38406065 PMCID: PMC10884783 DOI: 10.7759/cureus.52743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Purpose To study the knowledge, attitude, and practice (KAP) regarding vision and eye screening of preschool children among primary health center (PHC) staff in Qassim, Saudi Arabia. Methods A survey of PHC staff was conducted in 2023. The questionnaire included knowledge (10), attitude (five), and practice (five)-related questions associated with preschool vision and eye screening. A five-graded Likert scale was used for responses. Cronbach's alpha score of the questionnaire was 0.776. The KAP score was correlated with the demographic variables of participants. The current and desired sources of information were also collected. Results We surveyed 101 health staff (66 doctors and 35 nurses). The median (interquartile range) knowledge, attitude, and practice scores of participants were 4.1 (3.8; 4.3), 4.2 (4.0; 4.6), and 3.6 (3.0; 4.0), respectively. The doctors had better knowledge (Mann-Whitney U test (MW), P = 0.016) and attitude (MW, P = 0.019) than the nurses. Staff above 40 years had better knowledge (Kruskal-Wallis H test (KW), P = 0.035), attitude (KW, P = 0.017), and practice (KW, P < 0.001). The primary source of information about preschool vision screening was their medical education (51%). Other sources were eye care professionals (11.9%), Google and computers (12.9%), and social media (14.9%). Their preferred sources of information were medical journals (25.7%), eyecare training (22.8%), and eye professionals (33.7%). Conclusions Knowledge and attitude for eye and vision screening of preschool children was high, but practices were less among PHC staff. Providing information through their preferred mode could further strengthen eye care for preschool children.
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Affiliation(s)
- Dora H AlHarkan
- Ophthalmology, Medical College, Qassim University, Buraydah, SAU
| | | | | | - Saleh A Alayidi
- General Practitioner, Buraydah Central Hospital, Buraydah, SAU
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Oke I, Lutz SM, Hunter DG, Galbraith AA. Vision Screening Among Children With Private Insurance: 2010-2019. Pediatrics 2023; 152:e2023062114. [PMID: 37605872 DOI: 10.1542/peds.2023-062114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVES To describe trends in vision screening based on insurance claims for young children in the United States. METHODS This cross-sectional study used administrative claims data from the 2010-2019 IBM MarketScan Commercial Claims and Encounters Database. We included children aged 1 to <5 years at the beginning of each calendar year. The primary outcome was a vision screening claim within 12 months for chart-based or instrument-based screening. Linear regression was used to evaluate trends over time in vision screening claims and practitioner payment. RESULTS This study included a median of 810 048 (interquartile range, 631 523 - 1 029 481) children between 2010 and 2019 (mean [standard deviation] age, 2.5 [1.1] years; 48.7% female). The percentage of children with vision screening claims increased from 16.7% in 2010 to 44.3% in 2019 (difference, 27.5%; 95% confidence interval, 27.4% to 27.7%). Instrument-based screening claims, which were identified in <0.2% of children in 2010, increased to 23.4% of children 1 to <3 years old and 14.4% of children 3 to <5 years old by 2019. From 2013 to 2018, the average of the median practitioner payment for instrument-based screening was $23.70, decreasing $2.10 per year during this time (95% confidence interval, $0.85 to $3.34; P = .009). CONCLUSIONS Vision screening claims among young children nearly tripled over the last decade, and this change was driven by increased instrument-based screening for children aged <3 years. Further investigation is needed to determine whether the decreasing trends in practitioner payment for screening devices will reduce the adoption of vision screening technology in clinical practice.
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sharon M Lutz
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alison A Galbraith
- Department of Pediatrics, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Oke I, Lutz SM, Hunter DG, Galbraith AA. Use and Costs of Instrument-Based Vision Screening for US Children Aged 12 to 36 Months. JAMA Pediatr 2023; 177:728-730. [PMID: 37213124 PMCID: PMC10203963 DOI: 10.1001/jamapediatrics.2023.0808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/26/2023] [Indexed: 05/23/2023]
Abstract
This cohort study examines patterns and out-of-pocket costs of instrument-based screening among children 12 to 36 months.
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sharon M. Lutz
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - David G. Hunter
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alison A. Galbraith
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Now with Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Massachusetts
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Tien C, Johns AL, Choi DG, de Castro-Abeger A, Buswell N, McComb JG, Durham SR, Urata MM. Early Ophthalmology Findings in Nonsyndromic Craniosynostosis. J Craniofac Surg 2023; 34:1259-1261. [PMID: 37101323 DOI: 10.1097/scs.0000000000009330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/19/2023] [Indexed: 04/28/2023] Open
Abstract
Craniosynostosis (CS) occurs 1 in 2500 births and surgical intervention is indicated partly due to risk for elevated intracranial pressure (EICP). Ophthalmological examinations help identify EICP and additional vision concerns. This study describes preoperative and postoperative ophthalmic findings in CS patients (N=314) from chart review. Patients included nonsyndromic CS: multisuture (6.1%), bicoronal (7.3%), sagittal (41.4%), unicoronal (22.6%), metopic (20.4%), and lambdoidal (2.2%). Preoperative ophthalmology visits were at M =8.9±14.1 months for 36% of patients and surgery was at M =8.3±4.2 months. Postoperative ophthalmology visits were at age M =18.7±12.6 months for 42% with follow-up at M =27.1±15.1 months for 29% of patients. A marker for EICP was found for a patient with isolated sagittal CS. Only a third of patients with unicoronal CS had normal eye exams (30.4%) with hyperopia (38.2%) and anisometropia (16.7%) at higher rates than the general population. Most children with sagittal CS had normal exams (74.2%) with higher than expected hyperopia (10.8%) and exotropia (9.7%). The majority of patients with metopic CS had normal eye exams (84.8%). About half of patients with bicoronal CS had normal eye exams (48.5%) and findings included: exotropia (33.3%), hyperopia (27.3%), astigmatism (6%), and anisometropia (3%). Over half of children with nonsyndromic multisuture CS had normal exams (60.7%) with findings of: hyperopia (7.1%), corneal scarring (7.1%), exotropia (3.6%), anisometropia (3.6%), hypertropia (3.6%), esotropia (3.6%), and keratopathy (3.6%). Given the range of findings, early referral to ophthalmology and ongoing monitoring is recommended as part of CS care.
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Affiliation(s)
| | - Alexis L Johns
- Keck School of Medicine, University of Southern California
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
| | - Dylan G Choi
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
| | - Alexander de Castro-Abeger
- Keck School of Medicine, University of Southern California
- The Vision Center, Ophthalmology, Children's Hospital Los Angeles
| | - Nichole Buswell
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
| | - J Gordon McComb
- Keck School of Medicine, University of Southern California
- Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Susan R Durham
- Keck School of Medicine, University of Southern California
- Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Mark M Urata
- Keck School of Medicine, University of Southern California
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
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Monahan SR, Smith SM, Gammeltoft ET, Trivedi RH, Wilson ME, Bowsher JD, Peterseim MMW. The blinq™ Vision Screener in Detection of Amblyopia and Strabismus. Am J Ophthalmol 2023; 250:20-24. [PMID: 36682517 DOI: 10.1016/j.ajo.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE The blinq (Rebion Inc) is a new screening device designed to directly detect amblyopia and strabismus rather than amblyopia risk factors. We performed an independent assessment of the effectiveness of the blinq in detecting amblyopia and strabismus. DESIGN Prospective clinical validity analysis of a screening device based on sensitivity and specificity. METHODS Children presenting for examination in the pediatric ophthalmology clinic underwent screening with the blinq before examination by a pediatric ophthalmologist blinded to the screening results. Results of the blinq and examination findings of strabismus or amblyopia were compared. RESULTS In our cohort of 267 children with an average age of 6.3 years, the sensitivity of the blinq to detect amblyopia or any constant strabismus was 87.5% (78.2%-93.8%) and specificity was 51.3% (43.9%-58.7%). Using the previously described "appropriate referral gold standard" criteria, including children with intermittent strabismus and high refractive error, the sensitivity increased to 91.3% and the specificity to 63.2%. We found a high number of children (44 [16%]) upon whom the blinq timed out and were included as automatic referrals. CONCLUSIONS Our results support use of the blinq as a screening device to detect amblyopia and strabismus in children.
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Affiliation(s)
- Savannah Reaves Monahan
- From the Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - Samantha M Smith
- From the Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | | | - Rupal H Trivedi
- From the Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - M Edward Wilson
- From the Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - James D Bowsher
- From the Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
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Krüger K, Lapstich AM, Reber KC, Sehlen S, Liersch S, Krauth C. The effectiveness of additional screening examinations for children and adolescents in Germany: a longitudinal retrospective cohort study. BMC Pediatr 2023; 23:164. [PMID: 37038135 PMCID: PMC10088104 DOI: 10.1186/s12887-023-03988-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/03/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Continuous medical care is particularly important in childhood and adolescence. Since there are gaps in regular care in Germany, various health insurance providers offer to cover additional examinations (e.g., U10, U11, J2) to ensure ongoing paediatrician visits. However, the question arises as to whether these examinations are effective. Thus, the main objective of this study is to determine whether participation in the U10, U11 or J2 examinations leads to more frequent and earlier diagnosis and treatment of age-specific diseases. METHODS The analyses are based on administrative claims data from a statutory health insurance fund. For each examination, an intervention group (IG) is formed and matched with a corresponding control group (CG). Descriptive analyses include proportion with diagnosis and treatment, average age of diagnosis and treatment initiation. Hypothesis testing is performed using methods appropriate to each. In addition, subgroup analyses and binominal logistic regression models are conducted. RESULTS More diagnoses are detected in IG, irrespective of subgroups. Additionally, diagnoses are made slightly earlier on average in IG. In the total samples, more therapies are initiated in IG, and slightly earlier. Considering only diagnosed cases, more therapies are initiated in CG but continue to be started earlier in IG. Regression models show that participation in the examinations has the highest predictive power for detecting a diagnosis. The presence of a chronic disease and sex - male at the U10 and U11 and female at the J2 - are also significantly associated. The models further show that nationality, unemployment of parents and region also have a significant influence in some cases, whereas school-leaving qualification, vocational qualification and income of parents do not. Considering the initiation of treatment in overall samples, the models show similar results, but here the presence of a chronic illness has the highest predictive power. CONCLUSION The results indicate that participation in the examinations leads to significantly more diagnoses and, in the overall samples, significantly more treatments. In addition, diagnoses were made somewhat earlier and therapies were initiated somewhat earlier. In the future, it would be useful to investigate the U10, U11 and J2 examinations over a longer time horizon to determine whether the statistically significant difference found is also clinically relevant, i.e., earlier diagnosis and initiation of therapy lead to prevention of manifestation or progression of the diagnosed diseases and to avoidance of secondary diseases. TRIAL REGISTRATION German Clinical Trials Register (DRKS), DRKS-ID: DRKS00015280. Prospectively registered on 18 March 2019.
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Affiliation(s)
- Kathrin Krüger
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
- Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Straße 7, 30159, Hanover, Germany.
| | - Anne-Marie Lapstich
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
- Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Straße 7, 30159, Hanover, Germany
| | - Katrin Christiane Reber
- AOK Nordost. Die Gesundheitskasse, Health Services Management, Wilhelmstr. 1, 10963, Berlin, Germany
| | - Stephanie Sehlen
- AOK Nordost. Die Gesundheitskasse, Health Services Management, Wilhelmstr. 1, 10963, Berlin, Germany
| | - Sebastian Liersch
- AOK Nordost. Die Gesundheitskasse, Health Services Management, Wilhelmstr. 1, 10963, Berlin, Germany
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
- Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Straße 7, 30159, Hanover, Germany
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8
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Peterseim MMW, Trivedi RH, Monahan SR, Smith SM, Bowsher JD, Alex A, Wilson ME, Wolf BJ. Effectiveness of the Spot Vision Screener using updated 2021 AAPOS guidelines. J AAPOS 2023; 27:24.e1-24.e7. [PMID: 36642243 PMCID: PMC10251219 DOI: 10.1016/j.jaapos.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate the Spot Vision Screener according to updated 2021 AAPOS Vision Screening Committee guidelines for instrument-based pediatric vision screen validation. METHODS As part of an IRB-approved ongoing prospective study, children were screened with the Spot prior to a complete examination. RESULTS Spot screening was successful in 1,036 of 1,090 children (95%). Forty-eight percent of participants were referred for further screening using the Spot manufacturer guidelines, and 40% of all children were found to have a 2021 amblyopia risk factor or visually significant refractive error by gold standard examination. The Spot recommendation compared reasonably well to the 2021 criteria, with an overall sensitivity of 0.88 and a specificity of 0.78. Applying updated guidelines to the Spot for hyperopia, anisometropia, and astigmatism yielded moderate-to-poor sensitivity (0.27-0.77) but excellent specificity (>0.9). The area under the curve of the receiver operating characteristic analysis demonstrates overall good prediction performance for the Spot for each diagnosis-myopia, hyperopia, astigmatism, anisometropia (range, 0.87-0.97). Results of our study suggest increasing the instrument referral criterion for astigmatism from 1.5 D (manufacturer thresholds of the screener used in this study) to 2 D in older children. Decreasing the anisometropia cut-off from 1 D to 0.75 D would improve sensitivity from 0.59 to >0.8. CONCLUSIONS In our study population, the overall predictive ability of the Spot is good, with a sensitivity of 0.88 and a specificity of 0.78. We recommend specific device refractive referral criteria to maximize screening effectiveness using the updated AAPOS guidelines.
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Affiliation(s)
| | - Rupal H Trivedi
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Samantha M Smith
- Medical University of South Carolina, Charleston, South Carolina
| | - James D Bowsher
- Medical University of South Carolina, Charleston, South Carolina
| | - Anastasia Alex
- Medical University of South Carolina, Charleston, South Carolina
| | - M Edward Wilson
- Medical University of South Carolina, Charleston, South Carolina
| | - Bethany J Wolf
- Medical University of South Carolina, Charleston, South Carolina
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Sapkota A, Sitaula S, Shrestha GS, Joshi ND, Koirala B, Paudel N. Agreement between Lea Symbols and Patti Pics visual acuity in children and adults. JOURNAL OF OPTOMETRY 2023:S1888-4296(23)00003-1. [PMID: 36717317 DOI: 10.1016/j.optom.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/25/2022] [Accepted: 01/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Patti Pics (PP) and Lea Symbols (LS) are commonly used by eye care practitioners worldwide. Although the relationship between the two tests is fairly well understood, the availability of different chart designs (single optotypes, multiple optotypes, multiple optotypes with crowding box) merits futher understanding. The purpose of this study is to explore the agreement between the acuity measures obtained with Patti Pics and Lea Symbols in children and adults and compare their performance with the Sloan Letter (SL) chart in adults. METHODS Monocular visual acuity was obtained from ninety-three 3 to 5-year-old children using Patti Pics and Lea Symbols. Acuities were also obtained from 113 adults using the same tests under identical conditions. Acuity results obtained with the pediatric tests were compared with the gold-standard Sloan Letter chart in adults. The Bland-Altman method was implemented to compare the level of agreement between tests. RESULTS Patti Pics yielded worse visual acuity than the Lea Symbols by approximately half a logMAR line in both children (mean difference: -0.07 ± 0.07 logMAR, p <0.01) and adults (Mean difference: -0.05 ± 0.06 logMAR, p <0.01). The 95% limits of agreement between Lea Symbol acuity and Patti pics acuity in children was ± 0.14 logMAR. Mean difference between the Sloan Letter chart and Lea Symbols acuity was not statistically significant (p = 0.08) in adults but the difference was statistically significant between PP and SL (p<0.001). The 95% limits of agreement between LS and SL and between PP and SL was ± 0.19 logMAR and ± 0.22 logMAR, respectively. CONCLUSION Patti Pics consistently underestimated visual acuity as compared to Lea Symbols both in children and adults although the differences were not clinically significant. The LS and PP did not yield clinically significant differences in acuities when compared with Sloan letters in adults.
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Affiliation(s)
| | - Sanjeeta Sitaula
- Department of Ophthalmology, B.P.Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Kathmandu, Nepal
| | - Gauri Shankar Shrestha
- Department of Ophthalmology, B.P.Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Kathmandu, Nepal
| | - Niraj Dev Joshi
- Department of Ophthalmology, B.P.Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Kathmandu, Nepal
| | | | - Nabin Paudel
- Center for Eye Research Ireland, Technological University Dublin, Ireland
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10
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Hunter SC, Suh DW, Molina I, Espinoza J. Automated screening devices for vision screening in preschool children: A comparison of the PlusoptiX S12C photoscreener and retinomax K+3 autorefractor. FRONTIERS IN OPHTHALMOLOGY 2022; 2:1049622. [PMID: 38983509 PMCID: PMC11182206 DOI: 10.3389/fopht.2022.1049622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/05/2022] [Indexed: 07/11/2024]
Abstract
Introduction Automated vision screening devices such as photoscreeners and autorefractors have been used to accurately identify amblyopia, refractive amblyopia risk factors (ARFs), and refractive error in young children; however, there is conflicting data about the effectiveness of different screening devices. We compared the performance of two commercially available screening devices in preschool children. Methods Children aged 3 to 5 years attending 5 preschools in Anaheim Elementary School District were screened with the PlusoptiX S12C photoscreener using ROC 3 referral criteria and Retinomax K+3 autorefractor in March 2022. Screened children were offered free cycloplegic eye examinations performed by optometrists on the UCI EyeMobile for Children mobile clinic. Children were evaluated for the presence of refractive ARFs using 2021 American Association for Pediatric Ophthalmology and Strabismus age-based referral criteria guidelines for instrument-based screening. Results A total of 158 children were screened and 79 children received cycloplegic examinations. At least one refractive ARF was found in 20% of examined children, corresponding to a sensitivity/specificity/positive predictive value (PPV)/negative predictive value (NPV) of 94%/89%/68%/98% for the PlusoptiX and 100%/65%/42%/100% for the Retinomax. Discussion In detecting refractive ARFs, the PlusoptiX was found to have a higher specificity and PPV while the Retinomax had a higher sensitivity and NPV. While both devices demonstrated a high sensitivity and NPV, we found that the PlusoptiX performed better overall as a screening device for our program as the Retinomax referred too many children.
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Affiliation(s)
- Stephen C Hunter
- University of California Riverside School of Medicine, Riverside, CA, United States
| | - Donny W Suh
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine School of Medicine, Irvine, CA, United States
| | - Iliana Molina
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine School of Medicine, Irvine, CA, United States
| | - Jennifer Espinoza
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine School of Medicine, Irvine, CA, United States
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11
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Asare AO, Wong AMF, Maurer D, Kulandaivelu Y, Saunders N, Ungar WJ. Economic evaluations of vision screening to detect amblyopia and refractive errors in children: a systematic review. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:297-311. [PMID: 34755325 PMCID: PMC8577413 DOI: 10.17269/s41997-021-00572-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/20/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To synthesize and appraise economic evaluations of vision screening to detect vision impairment in children. METHODS Literature searches were conducted on seven electronic databases, grey literature, and websites of agencies conducting health technology assessments. Studies were included if they (1) were full, comparative economic evaluations that used cost-utility, cost-benefit, cost-effectiveness, cost-consequence, or cost-analysis methods; (2) described screening services designed to detect amblyopia, strabismus, or uncorrected refractive errors in children under 6 years of age; and (3) published after 1994. High-quality studies were synthesized descriptively. Currencies were reported in 2019 Canadian dollars. Quality was assessed with the Pediatric Quality Appraisal Questionnaire (PQAQ). RESULTS Vision screening services were conducted by paid staff, volunteers, or health care professionals in schools or clinics. Thirteen studies were published from five countries: China (n = 1), United States (n = 4), United Kingdom (n = 1), Canada (n = 1), and Germany (n = 6). Analytical techniques included cost-utility/cost-effectiveness combination (n = 2), cost-effectiveness analysis (n = 7), cost-utility analysis (n = 1), cost-benefit analysis (n = 1), cost-consequence analysis (n = 1), and cost analysis (n = 1). Incremental cost-effectiveness ratios ranged from C$1,056 to C$151,274 per additional case detected/prevented and from C$9,429 to C$30,254,703 per additional QALY gained, depending on the type of screening service and comparator. Six studies were determined to be of high quality. CONCLUSION Vision screening to detect amblyopia for young children may be cost-effective compared with no screening if amblyopia reduced quality of life. Studies varied significantly in the type of screening services and comparators used. Methodological limitations were common. Future studies would be aided immensely by prospective studies on the impact of amblyopia on the health-related quality of life of young children and guidelines on the effective conduct of vision screening.
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Affiliation(s)
- Afua O Asare
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Agnes M F Wong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Daphne Maurer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- McMaster University, Hamilton, ON, Canada
| | - Yalinie Kulandaivelu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Natasha Saunders
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- The Hospital for Sick Children, Toronto, ON, Canada.
- ICES, Toronto, ON, Canada.
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, 686 Bay St., Toronto, ON, M5G 0A4, Canada.
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Maguire MG, Ying GS, Ciner EB, Kulp MT, Candy TR, Moore B. Detection of Significant Hyperopia in Preschool Children Using Two Automated Vision Screeners. Optom Vis Sci 2022; 99:114-120. [PMID: 34889862 PMCID: PMC8816853 DOI: 10.1097/opx.0000000000001837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
SIGNIFICANCE Moderate to high uncorrected hyperopia in preschool children is associated with amblyopia, strabismus, reduced visual function, and reduced literacy. Detecting significant hyperopia during screening is important to allow children to be followed for development of amblyopia or strabismus and implementation of any needed ophthalmic or educational interventions. PURPOSE This study aimed to compare the sensitivity and specificity of two automated screening devices to identify preschool children with moderate to high hyperopia. METHODS Children in the Vision in Preschoolers (VIP) study were screened with the Retinomax Autorefractor (Nikon, Inc., Melville, NY) and Plusoptix Power Refractor II (Plusoptix, Nuremberg, Germany) and examined by masked eye care professionals to detect the targeted conditions of amblyopia, strabismus, or significant refractive error, and reduced visual acuity. Significant hyperopia (American Association for Pediatric Ophthalmology and Strabismus definition of hyperopia as an amblyopia risk factor), based on cycloplegic retinoscopy, was >4.00 D for age 36 to 48 months and >3.50 D for age older than 48 months. Referral criteria from VIP for each device and from a distributor (PediaVision) for the Power Refractor II were applied to screening results. RESULTS Among 1430 children, 132 children had significant hyperopia in at least one eye. Using the VIP referral criteria, sensitivities for significant hyperopia were 80.3% for the Retinomax and 69.7% for the Power Refractor II (difference, 10.6%; 95% confidence interval, 7.0 to 20.5%; P = .04); specificities relative to any targeted condition were 89.9 and 89.1%, respectively. Using the PediaVision referral criteria for the Power Refractor, sensitivity for significant hyperopia was 84.9%; however, specificity relative to any targeted condition was 78.3%, 11.6% lower than the specificity for the Retinomax. Analyses using the VIP definition of significant hyperopia yielded results similar to when the American Association for Pediatric Ophthalmology and Strabismus definition was used. DISCUSSION When implementing vision screening programs for preschool children, the potential for automated devices that use eccentric photorefraction to either miss detecting significant hyperopia or increase false-positive referrals must be taken into consideration.
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Affiliation(s)
| | - Gui-Shuang Ying
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elise B Ciner
- Pennsylvania College of Optometry at Salus University, Elkins Park, Pennsylvania
| | | | - T Rowan Candy
- Indiana University School of Optometry, Bloomington, Indiana
| | - Bruce Moore
- New England College of Optometry, Boston, Massachusetts
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Arnold R, Silbert D, Modjesky H. Instrument Referral Criteria for PlusoptiX, SPOT and 2WIN Targeting 2021 AAPOS Guidelines. Clin Ophthalmol 2022; 16:489-505. [PMID: 35250260 PMCID: PMC8893268 DOI: 10.2147/opth.s342666] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/04/2022] [Indexed: 12/27/2022] Open
Abstract
Background Methods Results Conclusion ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/cPqIFE1_Eqo
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Affiliation(s)
- Robert Arnold
- Alaska Blind Child Discovery, Alaska Children’s Eye & Strabismus, Anchorage, Alaska, USA
- Correspondence: Robert Arnold, Alaska Blind Child Discovery, Alaska Children’s Eye & Strabismus, 3500 Latouche #280, Anchorage, Alaska, 99508, USA, Tel +1 907 561-1917, Fax +1 907 563-5373, Email
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Hunter SC, He J, Han M, Suh DW. The UCI EyeMobile Preschool Vision Screening Program: Refractive Error and Amblyopia Results from the 2019-2020 School Year. Clin Ophthalmol 2022; 16:4249-4255. [PMID: 36573233 PMCID: PMC9789699 DOI: 10.2147/opth.s382899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/18/2022] [Indexed: 12/30/2022] Open
Abstract
Purpose To introduce the University of California Irvine (UCI) EyeMobile for Children preschool vision screening program and describe the ophthalmic examination results of children who failed screening with the PlusoptiX S12C photoscreener during one school year. Patients and Methods Children aged 30-72 months were screened with the PlusoptiX using ROC mode 3 during the 2019-2020 school year. Children who failed screening were referred for comprehensive eye examination on the EyeMobile mobile clinic. Presence of amblyopia risk factors (ARFs), amblyopia, and refractive error was determined via retrospective review of records. Amblyopia was defined as unilateral if there was ≥ 2-line interocular difference in the best-corrected visual acuity (BCVA) and as bilateral if BCVA was < 20/50 for children < 4 years old and < 20/40 for children ≥ 4 years old. ARFs were defined using 2021 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) instrument-based screening guidelines. Results 5226 children were screened during the study period. Of the 546 children who failed screening, 350 (64%) obtained consent and were examined. Mean age of examined children was 4.45 years. Amblyopia was found in 8% of examined children, with unilateral amblyopia seen in 79% of amblyopic subjects. Glasses were prescribed to 246 (70.3%) children. Of the 240 children who received cycloplegic examinations, 43% had hyperopia and 30% had myopia. The positive predictive value (PPV) of the PlusoptiX screening for ARFs in children who received cycloplegic examinations was 70.4%. Conclusion A significant proportion of Orange County preschoolers with refractive errors and amblyopia have unmet refractive correction needs. The PlusoptiX S12C photoscreener is an adequate screening device for the UCI EyeMobile for Children program, although modification of device referral criteria may lead to increased PPV. Further research is necessary to understand and overcome the barriers to childhood vision care in our community.
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Affiliation(s)
- Stephen C Hunter
- University of California Riverside School of Medicine, Riverside, CA, USA
| | - Jody He
- Department of Ophthalmology, Jamaica Hospital, New York City, NY, USA
| | - Michael Han
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
| | - Donny W Suh
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
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Musch DC, Andrews CA, Schumann RA, Baker JD. A Comparative Study of Two Photoscreening Devices With Manual Vision Screening Involving Preschool Children. J Pediatr Ophthalmol Strabismus 2022; 59:46-52. [PMID: 34435901 DOI: 10.3928/01913913-20210610-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare referral results from two photoscreening devices that are in wide use relative to a manual screening test protocol in preschool children. METHODS Children aged 3 to 5 years who attended preschools in two counties within the State of Michigan (N = 1,085) took part in the State's vision screening program, which included the Lea Symbols and Stereo Butterfly tests, during a 3-month period. All who failed this screening or were unable to be tested, and 20% of those who passed, were then invited to undergo testing with the Plusoptix Vision Screener Model S-12C (Plusoptix, Inc) and Welch Allyn SPOT Vision Screener Model VS-100 (Hill-Rom, Inc) photoscreening devices. Screening was conducted by State-trained technicians. With the State's test results considered the gold standard for screening, sensitivity and specificity of the two photo-screening devices were calculated. McNemar's test and logistic regression were used to evaluate the findings. RESULTS A total of 1,085 children took part in the State's screening program. Their mean ± standard deviation age was 48.8 ± 7.2 months, with a 51:49 female-to-male ratio, and a similar percentage were Black (34.1%) or White (33.3%). The sensitivity of the SPOT and Plusoptix screening was 61.0% and 65.2%, respectively. The specificity of the SPOT and Plusoptix screening was 92.9% and 82.4%, respectively. For 84 children who were unable to be tested by the State's screening, the SPOT and Plusoptix devices completed the screening on the majority (86.9% and 73.8%, respectively). CONCLUSIONS The photoscreening devices yielded numerous false-negative results and fewer false-positive results. Their ability to screen many children who could not be screened by manual testing indicates a useful application. [J Pediatr Ophthalmol Strabismus. 2022;59(1):46-52.].
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Debert I, Costa DRD, Polati M, Falabretti JG, Susanna Junior R. Vision screening using a smartphone platform. REVISTA PAULISTA DE PEDIATRIA 2022; 40:e2020021. [PMID: 35544901 PMCID: PMC9095063 DOI: 10.1590/1984-0462/2022/40/2020021in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/06/2021] [Indexed: 12/02/2022]
Abstract
Objective: The main aim of this study was to evaluate the performance of a platform designed for pediatricians to screen amblyopia using a smartphone. Methods: The medical records of consecutive children who received visual screening using a smartphone platform were retrospectively reviewed. The smartphone was used with a flash concentrator case and a software for capturing images of both eyes simultaneously by a photorefraction mechanism. The platform performance was compared to the comprehensive ophthalmological examination, which is considered the gold standard for detecting amblyopia. Sensitivity, specificity, positive predictive value, and negative predictive value of the software in detecting amblyopia risk factors were calculated. Results: A total of 157 children were included, with a mean age of 6.0±.5 years (range 5–7). In 94% of the cases, the software was able to analyze the images and release a result, determining whether or not the child presented with amblyopia risk factors. Compared to the ophthalmological examination, the smartphone platform sensitivity in detecting amblyopia risk factors was 84%, the specificity was 74%, the positive predictive value was 86%, and the negative predictive value was 70%. Conclusions: The sensitivity and specificity of the smartphone photoscreening platform to detect amblyopia risk factors were within the range of traditional instrument-based vision screening technology. A smartphone photorefraction platform appears to be a promising cost-effective alternative to assist pediatricians and minimize obstacles to vision screening and amblyopia detection. Future studies are needed to gather additional comparative data.
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Pinhole does not increase screening accuracy of detecting decreased best corrected visual acuity in schoolchildren. BMC Ophthalmol 2021; 21:416. [PMID: 34856946 PMCID: PMC8638540 DOI: 10.1186/s12886-021-02150-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background Decreased best corrected visual acuity among children should be treated early in life, and vision screening in schoolchildren is an efficient and feasible selection for developing countries. Thus, the screening accuracy of different visual acuity tests is the key point for making vision screening strategies. The present study aims to explore the screening accuracy of uncorrected visual acuity (UCVA) and pin-hole corrected visual acuity (PCVA) using different vision chart in the detection of decreased best-corrected visual acuity (BCVA) among schoolchildren. Methods Grade one primary schoolchildren in urban Lhasa with data of UCVA using tumbling E chart (UCVAE), PCVA using tumbling E chart (PCVAE), UCVA using Lea Symbols chart (UCVAL), PCVA using Lea Symbols chart (PCVAL) and BCVA using Lea Symbols chart were reviewed. Decreased BCVA was defined as BCVA≤20/32(≥0.2 logMAR). Difference, reliability, and diagnostic parameters in the detection of decreased BCVA of different visual acuity results were analyzed. Results Overall, 1672 children aged 6.58 ± 0.44 years fulfilling the criteria. The prevalence of decreased BCVA was 6.8%. Although no significant differences were found between UCVAE vs UCVAL (p = .84, paired t-test) as well as PCVAE vs PCVAL (p = .24), the ICC between them was low (0.68 and 0.57, respectively). The average difference between BCVA and UCVAE, UCVAL, PCVAE, PCVAL was logMAR -0.08 (− 0.37, 0.21), − 0.08 (− 0.29, 0.17), − 0.05 (− 0.30, 0.19), − 0.06 (− 0.23, 0.12) using Bland–Altman method. The area under the receiver operating characteristic curve of UCVAE, PCVAE, UCVAL, PCVAL for the detection of decreased BCVA was 0.78 (0.73, 0.84), 0.76 (0.71, 0.82), 0.95 (0.94, 0.96), 0.93 (0.91, 0.95), respectively. Conclusion Pinhole does not increase the screening accuracy of detecting decreased BCVA in grade one primary schoolchildren. Visual acuity test using Lea Symbols is more efficient than Tumbling E in the screening of that age. Trial registration Data were maily from the Lhasa Childhood Eye Study which has finished the clinical registration on (ChiCTR1900026693).
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D'Souza H, Kun A, Martinson S, Bejarano L, McCole S. The positive predictive value of photoscreening devices for amblyogenic conditions. J AAPOS 2021; 25:342.e1-342.e4. [PMID: 34774772 DOI: 10.1016/j.jaapos.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine the positive predictive value (PPV) of four photoscreening devices in detecting amblyogenic risk factors (ARFs). METHODS This is a retrospective cohort study of 1,200 failed vision screenings (FVS) referred to a pediatric eye care practice from general pediatric practices over a 5-year period. Comprehensive eye examinations and cycloplegic refractions were performed. Examination findings and FVS parameters were collected through chart review after completion of visits. Inclusion criteria were age 1-8 years, eye examination within 3 months of initial FVS, and availability of FVS and visit documentation. RESULTS A total of 689 patients met inclusion criteria and were included in final analysis. The PPVs were 64.3% (95% CI, 62.73-65.81) for iScreen (n = 455), 26.8% (95% CI, 26.32-27.25) for Spot (n = 113), 18.9% (95% CI, 17.95-19.92) for Plusoptix (n = 38), and 18.5% (95% CI, 17.86-19.19) for GoCheck Kids (n = 55). For comparison, patients referred for failed Titmus tests were also analyzed. The PPV for Titmus testing was 39.3% (95% CI, 36.65-41.99; n = 28). CONCLUSIONS The only screening device with a PPV >50% was the iScreen. PPV is a useful metric, because it enables referring providers to guide patients on a post-screening plan and to choose devices that minimize over-referral. Device PPV in the general pediatric population can be markedly different from device PPV in already existing pediatric eye care populations due to inherently different prevalence of ARFs. The iScreen also detected conditions such as cataracts, anisocoria, eyelid abnormalities, esotropia, exotropia, hypertropia, and amblyogenic astigmatism.
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Affiliation(s)
| | - Adrian Kun
- Virginia Pediatric Eye Center, Virginia Beach, Virginia.
| | | | - Laura Bejarano
- Virginia Pediatric Eye Center, Virginia Beach, Virginia; Children's Hospital of the King's Daughters, Norfolk, Virginia
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Bosque LE, Yamarino CR, Salcedo N, Schneier AJ, Gold RS, Blumenfeld LC, Hunter DG. Evaluation of the blinq vision scanner for detection of amblyopia and strabismus. J AAPOS 2021; 25:214.e1-214.e7. [PMID: 34246763 DOI: 10.1016/j.jaapos.2021.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/26/2021] [Accepted: 02/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To report the results of a clinical study designed to evaluate the accuracy of the blinq pediatric vision scanner, which detects amblyopia and strabismus directly by means of retinal polarization scanning, unlike other vision screening devices, which infer possible disease based on detection of refractive risk factors. METHODS Subjects 1-20 years of age were prospectively enrolled in this cross-sectional diagnostic accuracy study with planned enrollment of 200. All enrolled subjects were tested by individuals masked to the diagnosis, followed by complete ophthalmologic examination by pediatric ophthalmologists masked to the screening result. Patients previously treated for amblyopia or strabismus were analyzed separately. RESULTS The study cohort comprised 193 subjects, 53 of whom had been previously treated, leaving 140 treatment-naïve subjects, including 65 (46%) with amblyopia or strabismus, 11 (8%) with risk factors/suspected binocular vision deficit without amblyopia/strabismus, and 64 (46%) controls. Sensitivity was 100%, with all 66 patients with referral-warranted ocular disease referred. Five patients with intermittent strabismus receiving pass results were deemed "acceptable pass" when considering patient risk factors and amblyogenic potential. Specificity was 91%, with 7 incorrect referrals. Subanalysis of children aged 2-8 years (n = 92) provided similar results (sensitivity 100%; specificity 89%). CONCLUSIONS In this study cohort, the blinq showed very high sensitivity and specificity for detecting referral-warranted unilateral amblyopia and strabismus. Implementation of the device in vision screening programs could lead to improved rates of disease detection and reduction in false referrals.
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Affiliation(s)
| | | | | | | | - Robert S Gold
- Eye Physicians of Central Florida, Maitland, Florida
| | | | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Rebion Inc, Boston, Massachusetts.
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Van der Ploeg CPB, Grevinga M, Eekhout I, Vlasblom E, Lanting CI, van Minderhout HME, van Dijk-van der Poel J, van den Akker-van Marle ME, Verkerk PH. Costs and effects of conventional vision screening and photoscreening in the Dutch preventive child health care system. Eur J Public Health 2021; 31:7-12. [PMID: 32893298 PMCID: PMC7851894 DOI: 10.1093/eurpub/ckaa098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Little is known about costs and effects of vision screening strategies to detect amblyopia. Aim of this study was to compare costs and effects of conventional (optotype) vision screening, photoscreening or a combination in children aged 3–6 years. Methods Population-based, cross-sectional study in preventive child health care in The Hague. Children aged 3 years (3y), 3 years and 9 months (3y9m) or 5–6 years (5/6y) received the conventional chart vision screening and a test with a photoscreener (Plusoptix S12C). Costs were based on test duration and additional costs for devices and diagnostic work-up. Results Two thousand, one hundred and forty-four children were included. The estimated costs per child screened were €17.44, €20.37 and €6.90 for conventional vision screening at 3y, 3y9m and 5/6y, respectively. For photoscreening, these estimates were €6.61, €7.52 and €9.40 and for photoscreening followed by vision screening if the result was unclear (combination) €9.32 (3y) and €9.33 (3y9m). The number of children detected with amblyopia by age were 9, 14 and 5 (conventional screening), 6, 13 and 3 (photoscreening) and 10 (3y) and 15 (3y9m) (combination), respectively. The estimated costs per child diagnosed with amblyopia were €1500, €1050 and €860 for conventional vision screening, €860, €420 and €1940 for photoscreening and €730 (3y) and €450 (3y9m) for the combination. Conclusions Combining photoscreening with vision screening seems promising to detect amblyopia in children aged 3y/3y9m, whereas conventional screening seems preferable at 5/6y. As the number of study children with amblyopia is small, further research on the effects of these screening alternatives in detecting children with amblyopia is recommended.
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Affiliation(s)
| | - Manon Grevinga
- Department of Child Health, TNO, Leiden, The Netherlands
| | - Iris Eekhout
- Department of Child Health, TNO, Leiden, The Netherlands
| | - Eline Vlasblom
- Department of Child Health, TNO, Leiden, The Netherlands
| | | | | | | | | | - Paul H Verkerk
- Department of Child Health, TNO, Leiden, The Netherlands
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Ekdawi N, Kipp MA, Kipp MP. Mandated Kindergarten Eye Examinations in a US Suburban Clinic: Is It Worth the Cost? Clin Ophthalmol 2021; 15:1331-1337. [PMID: 33824577 PMCID: PMC8018395 DOI: 10.2147/opth.s300725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/08/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The state of Illinois has required an examination by an optometrist or ophthalmologist prior to mandatory kindergarten since 2008. This requirement has allowed us to gather information regarding disease prevalence in a local suburban population. Methods A retrospective chart review was undertaken of kindergarten eye examinations performed at the Wheaton Eye Clinic between September 2008 and February 2017. Inclusion criteria included school eye examination as a reason for the visit, and a cycloplegic refraction was completed. Results Of 3612 patient charts identified, 1085 satisfied the inclusion criteria, of which 48% were female. The average age of the patients was 5.3 years (range, 3.8 to 6.7). Historical characteristics showed 143 (13%) were premature, 28 (3%) patients were autistic and 109 (10%) were developmentally delayed. On examination, 56 (5%) had <20/40 (WHO mild visual impairment) vision in better seeing eye, 34 (3%) had spherical equivalent refractive error in either eye > +3.50 diopters and one < −3.00 diopters. Fifty-eight patients (5%) were diagnosed with amblyopia and 101 patients (9.3%) were given glasses. Abnormal external exam finding was found in 218 (20%) while 16 (1.5%) had an abnormal fundus finding. Thirteen percent (146/1085) had a clinically relevant diagnosis in our examinations, with a cost of $1635/diagnosis. In total, our follow-up rate was 83% (78/94). Conclusion Our rate of treatable ocular conditions discovered via state-mandated kindergarten eye examinations is similar to large-scale screening programs. The cost per condition found with full examinations was substantially higher; however, follow-up was more consistent. ![]()
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Technical Report: A New Device Attached to a Smartphone for Objective Vision Screening. Optom Vis Sci 2021; 98:18-23. [PMID: 33394927 DOI: 10.1097/opx.0000000000001621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE A new device attached to a smartphone was created for objective vision screening of young children including infants and newborns. The device is compact, lightweight, portable, cost-effective, and easy to operate. Therefore, it is suitable for screening large numbers of children in clinical settings, schools, and communities. PURPOSE This article introduces a new device attached to a smartphone for objective vision screening. It can detect and categorize significant refractive errors, anisometropia, strabismus, cloudy ocular media, and ptosis that may cause amblyopia. METHODS The new device applies the same principles as conventional streak retinoscopy but examines both eyes simultaneously and records the results electronically. The device comprises optical elements that produce a precise streak light beam and move it across a child's both eyes. The smartphone's video camera catches and records the motion of retinal reflex inside the child's pupils. By observing the direction of motion of the retinal reflex relative to the light beam motion, as well as its speed, width, and brightness, the examiner is able to assess the individual and comparative refractive status, ocular alignment, and other conditions. RESULTS Vision screening with this device does not require any subjective response from children. The examination can be performed and analyzed by nonprofessionals after a short learning period of time. Because the examination results are electronically recorded by the smartphone, they can be stored in the child's files and sent out for professional consultations. CONCLUSIONS The new device will provide the same functions as conventional streak retinoscopy but examines a child's both eyes simultaneously, so that, in addition to categorizing refractive errors and assessing clarity of refractive media of the eyes, it can also detect anisometropia, strabismus, and anisocoria. In addition to showing the examination results on the smartphone's screen, the device can also store the results electronically.
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Amblyopia Outcomes Through Clinical Trials and Practice Measurement: Room for Improvement: The LXXVII Edward Jackson Memorial Lecture. Am J Ophthalmol 2020; 219:A1-A26. [PMID: 32777377 DOI: 10.1016/j.ajo.2020.07.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe amblyopia prevalence and outcomes using results from randomized studies and a clinical registry. DESIGN Review of published studies, analysis of data in Intelligent Research in Sight (IRIS) Registry from 2013 to 2019, personal perspective. METHODS Literature review, analysis of IRIS Registry data and IRIS-50, a visual acuity quality measure. RESULTS Clinical trials have reduced the treatment burden of amblyopia by reducing hours of patching and frequency of atropine eye drops with clinical success of about 83%. There is no appreciable age effect if treatment is started before 5 years of age, outcomes are stable to at least 15 years of age, and treatment can be somewhat effective until 12 years of age. The IRIS Registry identified 1,760,066 individuals with amblyopia for a prevalence of 2.47%. Refractive error alone accounted for 68.9% of childhood cases. Mean amblyopic eye visual acuity improved 1.8 lines for children 3-6 years of age and 0.8 lines for 7-12 years, but mean residual amblyopia was more than 2 lines. Among 18,841 children aged 3-7 years eligible for IRIS-50, 77.3% were successful. The odds ratios for success were significantly lower for African-American (0.67; 95% confidence interval [CI] = 0.58 to 0.78) and Hispanic or Latino (0.84; 95% CI = 0.75 to 0.94) children compared with white children. CONCLUSIONS Clinical trials provided evidence of a beneficial effect from several treatments, with substantially reduced doses than previously recommended. Registry data from clinical practice found residual visual acuity impairment among all ages and races, especially among minorities.
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Laiginhas R, Ferreira CC, Leitão R, Geraldes R, Chibante-Pedro J, Monteiro M, de Matos C. Prevalence of Amblyopia After Photoscreening. J Pediatr Ophthalmol Strabismus 2020; 57:372-377. [PMID: 33211894 DOI: 10.3928/01913913-20200824-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/27/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the prevalence of amblyopia in a population of adolescents screened for amblyogenic risk factors at preschool age. METHODS Data were retrospectively collected from the preschool screening for amblyogenic risk factors routinely performed in the authors' hospital. A stratified random sampling was used. A school from the region was randomly selected and then two grades were randomly selected. All classes from these grades were evaluated and only children who were previously screened for amblyogenic risk factors were included. Ophthalmological examination included best visual acuity (distance and near, Early Treatment of Diabetic Retinopathy Study scale and Jaeger eye chart) and stereopsis (Randot Stereo Test; Stereo Optical Company, Inc). Sample size was estimated as more than 283 participants. Pertinent data were extracted for analysis. RESULTS A total of 520 children were recruited, and 299 met the inclusion criteria. Fifteen percent of children (n = 46) had results at the screening that prompted a further ophthalmological evaluation and 9% of children (n = 26) had meaningful refractive errors or strabismus. Overall amblyopia prevalence was 1.00%. One of the 3 children who developed amblyopia had microstrabismus, and the remaining 2 children had a previous positive screening result but missed the follow-up evaluations. At the follow-up evaluation, 79.3% (n = 237) of children were not wearing glasses. CONCLUSIONS A structured screening may allow the early detection of amblyogenic factors and prevent further vision deterioration in children, thus improving their long-term quality of life. The prevalence of amblyopia in this study was lower than that recently stated for Europe. [J Pediatr Ophthalmol Strabismus. 2020;57(6):372-377.].
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Ademola-Popoola DS, Olatunji VA, Obajolowo TS, Akande TM, Mokuolu OA. Outcome of vision screening by community health workers at immunization outlets in Nigeria to support access to early visual evaluation in children aged 0-2 years. Taiwan J Ophthalmol 2020; 11:77-85. [PMID: 33767959 PMCID: PMC7971434 DOI: 10.4103/tjo.tjo_39_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/06/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE: Routine eye examination in early life is not the practice in most resource-limited countries. Delay in the presentation for eye problems is typical. Community health officers are often consulted by caregivers for all health problems during routine immunization and well-baby clinics in primary healthcare for children aged 0–2 years. This study evaluated the value and limitation of interview, Bruckner red reflex test, and instrument vision screener by noneye care middle-level staff of rural and urban well-baby immunization clinics, in early detection and referral for childhood eye disorders. MATERIALS AND METHODS: This was a cross-sectional study. Middle-level community health workers (CHWs) working at well-baby/immunization clinics were trained to perform vision screening using interview of caregivers, red reflex eye examination with ophthalmoscope, and instrument vision screener (Welch Allyn SPOT™ Vision Screener) without mydriatic drugs during routine immunization of children aged 0–2 years. IRB approval was obtained. RESULTS: Over a 6-month period in 2017, the CHWs screened 5609 children. Overall, 628 (11.2%) patients were referred to the tertiary child eye care unit. Referred cases included cataract, glaucoma, congenital nasolacrimal duct obstruction, ophthalmia neonatorum, retinoblastoma, and significant refractive errors. Referral from the interview of mothers was enhanced if specific questions to elicit visual function were asked. Bruckner red reflex test was more effective than instrument vision screener in the detection of cataract and life-threatening diseases such as retinoblastoma. Instrument vision screener was preferred by parents and better at detecting amblyopic risk factors. CONCLUSION: Preschool vision screening during routine immunization by primary healthcare workers in resource-limited settings was effective. Whenever instrument vision screener does not give any recommendation during screening, consider vision- or life-threatening pathology and refer.
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Affiliation(s)
- Dupe S Ademola-Popoola
- Department of Ophthalmology, University of Ilorin Teaching Hospital, University of Ilorin, Ilorin, Nigeria
| | - Victoria A Olatunji
- Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Tokunbo S Obajolowo
- Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Tanimola M Akande
- Department Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olugbenga A Mokuolu
- Pediatrics and Child Health, University of Ilorin Teaching Hospital, University of Ilorin, Ilorin, Nigeria
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Kiatos E, Armstrong JJ, Makar I. Successes and shortfalls of community Plusoptix photoscreening: results from the iSee study in Southwestern Ontario. Can J Ophthalmol 2020; 56:49-56. [PMID: 32891567 DOI: 10.1016/j.jcjo.2020.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/12/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this work is to provide the final results from a community-wide photoscreening program in Southwestern Ontario for children aged 18 to 72 months, and to estimate the prevalence of amblyogenic risk factors in this population. STUDY DESIGN Prospective, multisite photoscreening program. PARTICIPANTS 5959 children aged 18-72 months were recruited and screened in Southwestern Ontario at 210 locations over a period of 3 years and 4 months. METHODS Ophthalmic screening examinations were performed with the Plusoptix S12 photoscreener. The threshold for the referral criteria used was the manufacturer's criteria on receiver operating characteristics 4. RESULTS The screening was negative in 5386 children (90.4%), positive in 403 (6.8%), and unreadable in 170 (2.9%); 42% of all screened children were ≤36 months old. The estimated amblyogenic risk factor prevalence of anisometropia was 4.0%, astigmatism was 3.1%, hyperopia was 1.1%, myopia was 0.4%, and strabismus was 0.4%. Of the 403 referred children, 99 (24.5%) completed a formal eye examination based on the responses returned to the study site. CONCLUSIONS This is the first Canadian study that provides data on amblyogenic risk factors based on a volunteer-led photoscreening program. Photoscreening is an effective screening tool, particularly for pre-school-aged children; however, the lack of mandatory follow-up to ensure that children receive proper treatment based on cycloplegic refraction reduces the efficacy of screening.
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Affiliation(s)
| | - James J Armstrong
- Schulich School of Medicine and Dentistry Department of Ophthalmology, London, Ontario; Schulich School of Medicine and Dentistry Department of Pathology and Laboratory Medicine, London, Ontario
| | - Inas Makar
- Ivey Eye Institute, St. Joseph's Healthcare, London, Ontario; Schulich School of Medicine and Dentistry Department of Ophthalmology, London, Ontario.
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Martin SJ, Htoo HE, Hser N, Arnold RW. Performance of Two Photoscreeners Enhanced by Protective Cases. Clin Ophthalmol 2020; 14:1427-1435. [PMID: 32546951 PMCID: PMC7259487 DOI: 10.2147/opth.s251451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/08/2020] [Indexed: 11/29/2022] Open
Abstract
Background Photoscreeners provide valid, cost-effective early detection of amblyopia risk factors; however, they require proper illumination, flash intensity, pupil dilation and patient cooperation. The Kaleidos case for the 2WIN infrared photoscreener fixes focal distance, decreases luminance and provides electric power. GoCheck Kids (GCK) has developed a flash-concentrating case for the Apple iPhone 7 Plus smartphone to reduce exposure time. Methods In remote Burmese and urban Alaskan clinics, Kaleidos and GCK were used before a confirmatory eye examination using 2013 AAPOS uniform guidelines validation, including some older patients. 2WIN refraction was compared to a cycloplegic examination using J0 and J45 vector transformation. Results In total, 48 Burmese patients and 114 Alaskan patients aged 8±6 years were evaluated utilizing 2013 amblyopia risk factor guidelines. Kaleidos, with 13 Burmese inconclusives, had a sensitivity of 84%, specificity of 65% and positive predictive value (PPV) of 63%. GCK, with only six inconclusives, had a sensitivity of 63%, specificity of 83% and PPV of 73%, with sensitivity improving to 74% with central expert interpretation. Kaleidos closely matched cycloplegic refraction, with intraclass correlations of 0.47 for J0 vector and 0.57 for J45 vector. The protective cases provided clearer images and better pupil dilation than similar devices without cases. Conclusion Both devices detected amblyopia risk factors well. GCK gave fewer inconclusive results even with the Asian eyelid configuration, while Kaleidos matched sphere and cylinder refraction. The specialized housing enhanced the performance of the 2WIN and GCK photoscreeners, improving the speed and reliability of amblyopia screening and refraction, even in populous and luminous locations. Clinical Trials Registry NCT04068129. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/8HeHiOiogHg
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Affiliation(s)
| | - Hser Eh Htoo
- Jungle School of Medicine Kawthoolei, Karen State, Burma (Myanmar)
| | - Nay Hser
- Jungle School of Medicine Kawthoolei, Karen State, Burma (Myanmar)
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Liu YL, Lee CJ, Liang JS, Chang SW, Tsai TH. Refinement strategies in photoscreening for the detection of amblyopia risk factors in 12-to-24-month-old children. J Formos Med Assoc 2020; 120:137-144. [PMID: 32223997 DOI: 10.1016/j.jfma.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To establish an appropriate clinical protocol for early photoscreening in 12-to-24-month-old children at pediatric well-baby clinics. METHODS This prospective study included a total of 277 children aged 12-24 months who visited a pediatric well-baby clinic. All participants underwent: 1) inquiry of medical history; 2) photoscreening with PlusoptiX A12; and 3) comprehensive ophthalmologic examinations. The optimal referral cut-off point for PlusoptiX was determined by receiver operating characteristic analyses. A high-risk subgroup was defined as having a birth weight <3000 g or a history of major systemic diseases, based on the results of multivariable risk factor analysis from children's medical history. A strategy of selective photoscreening focusing on the high-risk subgroup was evaluated. The main outcome measures included sensitivity, specificity, and positive and negative predictive values. RESULTS The prevalence of amblyopia risk factors in our study population was 12.3%. A total of 172 children (62.1%) were assigned to the high-risk subgroup. Compared with the nonselective photoscreening of all 277 children, selective photoscreening of the high-risk children yielded a higher positive predictive value (59.6% vs. 46.7%, p = 0.001) while showing no difference in sensitivity (82.3% vs. 85.3%, p = 0.32), specificity (92.2% vs, 86.4%, p = 0.05), and negative predictive value (97.4% vs. 97.6%, p = 0.50). CONCLUSION At pediatric well-baby clinics, selective photoscreening among 12-to-24-month-old children with a birth weight <3000 g or a history of major systemic diseases helped reducing the number of children need to be screened and conserving medical resources yet identifying children at risk for timely eye care.
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Affiliation(s)
- Yao-Lin Liu
- Department of Ophthalmology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan; Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chia-Jung Lee
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jao-Shwann Liang
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shu-Wen Chang
- Department of Ophthalmology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan; Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tzu-Hsun Tsai
- Department of Ophthalmology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
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Sigronde L, Blanc J, Aho S, Pallot C, Bron AM, Creuzot-Garcher C. Evaluation of the Spot Vision Screener in comparison with the orthoptic examination in visual screening in 3-5 year-old schoolchildren. J Fr Ophtalmol 2020; 43:411-416. [PMID: 32143821 DOI: 10.1016/j.jfo.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the Spot Vision Screener (SVS) compared with the orthoptic examination for detection of amblyopia risk factors in preschools. METHODS This prospective study included children with a visual screening organized by the department of "le" (PMI) in Côte d'Or (Burgundy, France), between June 2017 and April 2018. All children were evaluated with the SVS followed by a clinical orthoptic examination. Results with the SVS were compared with those obtained by clinical orthoptic examination. RESULTS A total of 1236 subjects were included in the study from 100 preschools. The mean age of the children was 3.6±0.7 years, and 627 were female (50.7%). The orthoptic examination detected 308 (24.9%) children with subnormal visual acuity for age in one eye or both. In children with a history of prematurity, the orthoptic examination was more frequently abnormal (P=0.002), which was not seen with the SVS (P=0.050). The SVS screened 20 (1.6%) children with strabismus, while 40 (3.2%) were detected by orthoptic examination. At the end of the screening, the SVS detected 182 (14.7%) suspect patients while 311 (25.1%) suspect patients were detected after the orthoptic examination. Comparing SVS with orthoptic examination, agreement was fair (κ=0.4). CONCLUSION The SVS can be a useful device for visual screening, but agreement with the orthoptic examination was only fair. The Spot vision screener should be used in conjunction with a clinical orthoptic examination.
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Affiliation(s)
- L Sigronde
- Department of Ophthalmology, University Hospital, 14, rue Paul-Gaffarel, 21079 Dijon, France.
| | - J Blanc
- Department of Ophthalmology, University Hospital, 14, rue Paul-Gaffarel, 21079 Dijon, France
| | - S Aho
- Department of Epidemiology, University Hospital, Dijon, France
| | - C Pallot
- Department of Ophthalmology, University Hospital, 14, rue Paul-Gaffarel, 21079 Dijon, France
| | - A-M Bron
- Department of Ophthalmology, University Hospital, 14, rue Paul-Gaffarel, 21079 Dijon, France; Centre des Sciences du Goût et de l'Alimentation, CNRS, INRA, University Bourgogne-Franche-Comté, Dijon, France
| | - C Creuzot-Garcher
- Department of Ophthalmology, University Hospital, 14, rue Paul-Gaffarel, 21079 Dijon, France; Centre des Sciences du Goût et de l'Alimentation, CNRS, INRA, University Bourgogne-Franche-Comté, Dijon, France
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Walker M, Duvall A, Daniels M, Doan M, Edmondson LE, Cheeseman EW, Wilson ME, Trivedi RH, Peterseim MMW. Effectiveness of the iPhone GoCheck Kids smartphone vision screener in detecting amblyopia risk factors. J AAPOS 2020; 24:16.e1-16.e5. [PMID: 31904429 DOI: 10.1016/j.jaapos.2019.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The recently released GoCheck Kids iPhone photoscreening app is designed to detect amblyopia risk factors (ARFs) in young children and includes remote review of images captured by smartphone. We aimed to evaluate the system's accuracy in detecting AAPOS guidelines ARFs. METHODS Patients 6 months through 6 years of age at Medical University of South Carolina were recruited for this prospective study. Presence of age-specific ARF was determined based on a complete ophthalmic examination and compared with the GoCheck Kids recommendations. RESULTS A total of 244 children were included (average age, 42 months; 51% male). Sensitivity of the GoCheck Kids iPhone with remote review to detect ARFs was 90.5%; specificity, 68.1%; positive predictive value, 56.8%; negative predictive value, 94.0%. Two of the 7 false negative results had hyperopia of >4 D, 4 had astigmatism, and 1 had anisometropia. Remote review of all images improved sensitivity. CONCLUSIONS The GoCheck Kids app had good sensitivity and adequate specificity in detecting AAPOS ARFs in our enriched cohort of young children.
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Affiliation(s)
- Mollianna Walker
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - Alba Duvall
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - Mackenzie Daniels
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - Mailynh Doan
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - Luke E Edmondson
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - Edward W Cheeseman
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - M Edward Wilson
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
| | - Rupal H Trivedi
- Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina
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