Validation of plusoptiX S04 photoscreener as a vision screening tool in children with intellectual disability

Comparison of Interpupillary Distance, Pupillary Diameter and Corneal Reflex Measured with Plusoptix A09 in Normally Developing Children and Autism

Aim: Autism Spectrum Disorder (ASD) is a developmental disorder that can present with an abnormality of the autonomic nervous system (ANS symptoms).Method: In this study, 38 eyes of 19 ASD were included with 19 healthy children (control group). Participants were analyzed according to their characteristics. Here, used the Plusoptix A09 devices to measure the difference in pupil size, corneal reflex, and interpupillary distance (IPD) between ASD and healthy children.Results: The mean age±standard deviation (SD) for the autism group was 4,6±2,5 years (range 2-11 years). In the group of normally developing children, the mean age was±SD 5,02±2,6 years (range 2-11 years). The size of the right pupil (p=0,006) and left pupil (p=0,007) was found to be significantly different in the control and experimental groups. IPD (p=0,000) was statistically significant between groups unlike the corneal reflex was not (p=0,173). The p-value is less than 0,05 in all statistical results.Conclusion: As a result, pupil diameter and IPD of children with autism were found to be larger than the control group, but there was no significant difference in corneal reflex. Pupillary measurements reveal differences between people with ASD.  

Evaluation of the PlusoptiX photoscreener in the examination of children with intellectual disabilities

PURPOSE:

This study aimed to determine whether the plusoptiX vision screener (PVS) can be used to detect amblyogenic risk factors (ARFs) as defined by the American Association for Paediatric Ophthalmology and Strabismus Vision Screening Committee guidelines (2013) for automated vision screening devices.

METHODS:

In this cross-sectional study, children attending a special needs school underwent screening with the PVS and complete ophthalmologic examinations. Ophthalmologic examinations were used as the gold standard to compute the prevalence, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and testability.

RESULTS:

Forty-four children with special needs (mean age, 8.5 years; range, 4–18 years) were included. The PVS recommended referral of 31 cases (referral rate 70%). Thirty-nine of the 44 children (89%) met the referral-positive threshold for strabismus, reduced vision and/or amblyogenic factors on examination. The plusoptiX had a sensitivity of 40% (confidence interval [CI] 7%–83%), specificity of 78% (CI 55%–85%), PPV of 15% (CI 3%–46%), and NPV of 90.3% (CI 73%–97%). The PVS underestimated refractive errors by 0.67 to 0.71 D in the right (P < 0.001) and left eyes (P = 0.002). Testability was relatively low, with the PVS at 75% compared to the gold standard examination at 100%.

CONCLUSION:

We found that although the plusoptiX photoscreener might be a useful tool in pediatric vision screening, it might not perform as well in children with intellectual disabilities. Utilization of the PVS as a single screening device may fail to identify a considerable proportion of young children with ARFs or amblyopia.

A Comparison of Three Different Photoscreeners in Children

PURPOSE

To compare the results obtained from three non-cycloplegic handheld photorefractometers with cycloplegic autorefractometry (Topcon KR-8100; Topcon Corporation, Tokyo, Japan) measurement in children.

METHODS

The refractive status of 238 eyes in 119 healthy children was assessed. The values acquired using photorefraction with the non-cycloplegic PlusoptiX A12 (Plusoptix GmbH, Nuremberg, Germany), Retinomax K-plus 3 (Righton, Tokyo, Japan), and Spot Vision Screener (Welch Allyn, Skaneateles Falls, NY) devices were compared with those obtained from the cycloplegic Topcon KR-8100. The agreement between the measurements was assessed using the intraclass correlation coefficient.

RESULTS

The mean age was 10.1 ± 3.2 years (range: 6 to 17 years). The mean spherical value for the right eyes was 0.38 diopters (D) (range: -4.50 to 6.25 D) for the Plusoptix A12; 0.45 D (range: -4.50 to 6.25 D) for the Spot Vision Screener; -1.15 D (range: -8.75 to 6.50 D) for the Retinomax K-plus 3; and 0.62 (range: -4.50 to 6.00) for the Topcon KR-8100. The mean spherical equivalent value for the right eyes was 0.41 D (range: -4.50 to 7.90 D) for the Plusoptix A12; 0.18 D (range: -4.75 to 6.13 D) for the Spot Vision Screener; -1.30 D (range: -10.50 to 6.38 D) for the Retinomax K-plus 3; and 0.67 D (range: -4.00 to 6.00 D) for the Topcon KR-8100 (for the right eyes).

CONCLUSIONS

The photorefractometer method was beneficial in the measurement of refractive errors of school-aged children. The PlusoptiX A12 photorefractometer method may eliminate the need for cycloplegia in the detection of refractive errors in children. [J Pediatr Ophthalmol Strabismus. 2018;55(5):306-311.].

A comparison of the Plusoptix S09 with an autorefractometer of noncycloplegics and cycloplegics in children

The aim of the study is to compare outcome measures of refractive error obtained using the Plusoptix S09 photorefractor and an autorefractometer of noncycloplegics and cycloplegics in children.We reviewed the medical records of 40 patients (77 eyes) who were classified using 2 methods. The patients were first assigned to 2 groups consisting of 11 eyes with ≥+3.0 D and 66 eyes with <+3.0 D, and then to 2 groups of 12 and 65 eyes with cycloplegic and noncycloplegic refraction of spherical powers ≥+2.0 D and <+2.0 D, respectively. We compared the outcome measures of refractive error using the Plusoptix S09 photorefractor and an autorefractometer of noncycloplegics and cycloplegics.There was no statistically significant difference between the Plusoptix S09 photorefractor and cycloplegic autorefractometer in the spherical power and spherical equivalent. In contrast, there was a statistically significant difference between the Plusoptix S09 photorefractor and noncycloplegic autorefractometer (P < 0.001). There was a statistically significant difference between the spherical equivalent of the Plusoptix S09 photorefractor and cycloplegic autorefractometer in children with hyperopia ≥+3.0D and with cycloplegic and noncycloplegic refraction of spherical power ≥+2.0 D. We also found a significant difference between the outcomes of the Plusoptix S09 photorefractor and cycloplegic autorefractometer in the spherical power and spherical equivalent for children with hyperopia ≥+3.0 D.The refractive error of the Plusoptix S09 photorefractor was similar to that of the cycloplegic autorefractometer, in contrast to the noncycloplegic autorefractometer. However, the Plusoptix S09 photorefractor is an inaccurate tool to estimate the refractive errors of children with moderate hyperopia.

A Comparison of Refraction Defects in Childhood Measured Using Plusoptix S09, 2WIN Photorefractometer, Benchtop Autorefractometer, and Cycloplegic Retinoscopy

PURPOSE

To compare Plusoptix (Gmbh, Nuremberg, Germany), 2WIN (Adaptica, Padua, Italy), the benchtop refractometer (Auto-Kerato-Refractometer KR-8900; Topcon Co, Tokyo, Japan), and retinoscopy with regard to the consistencies.

MATERIALS AND METHODS

In our prospective study, 200 eyes of 100 patients were included. We analyzed the demographics and characteristics of the patients, the percentage of patients from whom measurements could not be obtained, the measurements from both patients' eyes of pupil diameter, spherical, cylindrical, axis, and spherical equivalence.

RESULTS

The mean age ± SD was 7.8±4.5 years (range, 1-18 years). Pupil diameter measurements were found to be consistent (Cronbach's alpha value >0.8). The sphere and spherical equivalence measurements for both eyes were found to be consistent with each other in all apparatus (Cronbach's alpha value >0.8). However, consistency was found to be lower in cylindrical values and the Jackson cross-cylinder measurements at 0° and 45° axis were found to be inconsistent with each other (Cronbach's alpha value <0.8).

CONCLUSIONS

While consistency was observed in all methods in terms of sphere and spherical equivalence, consistency dropped in cylindrical values and no consistency was observed in axis values. It is important to take this point into consideration, especially in axis measurements.

Comparison between refraction measured by Spot Vision Screening™ and subjective clinical refractometry

OBJECTIVE

The purpose of this study was to evaluate the accuracy of Spot Vision Screening™ as an autorefractor by comparing refraction measurements to subjective clinical refractometry results in children and adult patients.

METHODS

One-hundred and thirty-four eyes of 134 patients were submitted to refractometry by Spot and clinical refractometry under cycloplegia. Patients, students, physicians, staff and children of staff from the Hospital das Clínicas (School of Medicine, University of São Paulo) aged 7-50 years without signs of ocular disease were examined. Only right-eye refraction data were analyzed. The findings were converted in magnitude vectors for analysis.

RESULTS

The difference between Spot Vision Screening™ and subjective clinical refractometry expressed in spherical equivalents was +0.66±0.56 diopters (D), +0.16±0.27 D for the vector projected on the 90 axis and +0.02±0.15 D for the oblique vector.

CONCLUSIONS

Despite the statistical significance of the difference between the two methods, we consider the difference non-relevant in a clinical setting, supporting the use of Spot Vision Screening™ as an ancillary method for estimating refraction.

Photoscreeners in the pediatric eye office: compared testability and refractions on high-risk children

PURPOSE

To compare refractive data and testability of Spot (PediaVision) and Plusoptix A09 (Plusoptix, Inc) photoscreeners and to compare each device with traditional cycloplegic retinoscopy.

DESIGN

Prospective, interventional case series.

METHODS

After informed consent, patients underwent testing with the Spot and Plusoptix photoscreeners before their examination by a pediatric ophthalmologist masked to the results. Data including testability and estimated refractions were entered into a Research Electronic Data Capture database for statistical analysis.

RESULTS

A total of 265 children were enrolled (mean age, 6.0 ± 3.4 years). Both devices produced a computer printout result in 250 (94.3%) of the patients. The Spot photoscreener provided a refractive estimate in all computer printouts, whereas the Plusoptix, used binocularly, provided a refractive estimate in 75.2% (188/250) of the printouts. Compared with cycloplegic retinoscopy, both devices underestimated hyperopia or overestimated myopia (-1.35 diopters [D] and -0.64 D, Spot and Plusoptix, respectively) and overestimated astigmatism (0.36 D and 0.32 D, Spot and Plusoptix, respectively). The intraclass correlation coefficient for spherical equivalents indicated good agreement between cycloplegic retinoscopy and Spot (0.806) and excellent agreement between cycloplegic retinoscopy and Plusoptix (0.898).

CONCLUSIONS

The Spot photoscreener provided refractive data on a greater percentage of children. The photorefractors correlated with cycloplegic retinoscopy refractive findings for sphere and spherical equivalents, but underestimated hyperopia or overestimated myopia and overestimated astigmatism. The binocular refractions of Plusoptix agreed more closely with the refractions of our pediatric ophthalmologists.

Photoscreeners in the pediatric eye office: compared testability and refractions on high-risk children

PURPOSE

To compare refractive data and testability of Spot (PediaVision) and Plusoptix A09 (Plusoptix, Inc) photoscreeners and to compare each device with traditional cycloplegic retinoscopy.

DESIGN

Prospective, interventional case series.

METHODS

After informed consent, patients underwent testing with the Spot and Plusoptix photoscreeners before their examination by a pediatric ophthalmologist masked to the results. Data including testability and estimated refractions were entered into a Research Electronic Data Capture database for statistical analysis.

RESULTS

A total of 265 children were enrolled (mean age, 6.0 ± 3.4 years). Both devices produced a computer printout result in 250 (94.3%) of the patients. The Spot photoscreener provided a refractive estimate in all computer printouts, whereas the Plusoptix, used binocularly, provided a refractive estimate in 75.2% (188/250) of the printouts. Compared with cycloplegic retinoscopy, both devices underestimated hyperopia or overestimated myopia (-1.35 diopters [D] and -0.64 D, Spot and Plusoptix, respectively) and overestimated astigmatism (0.36 D and 0.32 D, Spot and Plusoptix, respectively). The intraclass correlation coefficient for spherical equivalents indicated good agreement between cycloplegic retinoscopy and Spot (0.806) and excellent agreement between cycloplegic retinoscopy and Plusoptix (0.898).

CONCLUSIONS

The Spot photoscreener provided refractive data on a greater percentage of children. The photorefractors correlated with cycloplegic retinoscopy refractive findings for sphere and spherical equivalents, but underestimated hyperopia or overestimated myopia and overestimated astigmatism. The binocular refractions of Plusoptix agreed more closely with the refractions of our pediatric ophthalmologists.

Comparison of photorefraction, autorefractometry and retinoscopy in children

Photorefractive devices have been evaluated for their effectiveness in detecting anisometropia, hyperopia, myopia, and astigmatism. We investigated the reliability of Plusoptix S08, the newest photoscreener, and Topcon autorefractometer by comparing them with cycloplegic retinoscopy. Plusoptix S08, cycloplegic retinoscopy, and cycloplegic autorefractometer measurements for 235 eyes of 118 children (59 female, 59 male) with a mean age of 4.9 ± 2.6 and median age of 5 years (range 1-12) were conducted. The Plusoptix S08 produced the following mean (± SD) results--spherical 0.27 ± 1.64, cylindrical power -0.81 ± 0.71, axis 89.73 ± 61.18, and spherical equivalent -0.05 ± 1.61. The cycloplegic retinoscopy produced the following mean (± SD) results--spherical 0.12 ± 1.35, cylindrical power -0.89 ± 0.71, axis 92.18 ± 68.39, and spherical equivalent -0.15 ± 1.31. The cycloplegic autorefractometer produced the following mean (± SD) results--spherical 0.16 ± 1.44, cylindrical power -0.88 ± 0.72, axis 90.86 ± 68.21, and spherical equivalent -0.12 ± 1.41. This study has shown that cycloplegic autorefractometer and retinoscopy results are similar and Plusoptix S08 is a very safe, easy-to-use and reliable screening method of refraction, especially for ophthalmologists unskilled in retinoscopy. Plusoptix S08 is a useful tool for estimating refraction in patients for whom conventional autorefraction is not an option.

The plusoptiX S08 photoscreener as a vision screening tool for children with autism

PURPOSE

Children with autism and related disorders reportedly have an increased prevalence (40%) of ocular disorders, and comprehensive eye examinations by a pediatric ophthalmologist are recommended. Examinations can be very time consuming, expensive, and stressful for the child. A photoscreener such as the plusoptiX S08 may be a cost-effective, time-saving, and less invasive method for testing patients with autism. The purpose of this study was to determine the efficacy of photoscreening with the plusoptiX S08 in detecting amblyopia risk factors in children with autism.

METHODS

Photoscreening and complete ophthalmologic examinations were performed on 43 children with autism. Prevalence, sensitivity, specificity, positive predictive value, and negative predictive value were calculated using ophthalmologic examination as the gold standard.

RESULTS

The gold standard examination used American Association for Pediatric Ophthalmology and Strabismus Vision Screening Committee guidelines for the definition of amblyopia risk factors. The plusoptiX S08 referred 29 (67%) of 43 children. On examination, 16 patients (37%) had amblyopia risk factors. The plusoptiX S08 had a sensitivity of 94% (95% CI, 0.68-0.99). The specificity was 48% (95% CI, 0.29-0.68), the positive predictive value was 52% (95% CI, 0.33-0.70), and the negative predictive value was 93% (95% CI, 0.64-0.99).

CONCLUSIONS

The plusoptiX S08 is sensitive but less specific at detecting treatable ocular conditions in children with autism. The majority of children with autism and amblyopia risk factors were detected on screening; however, about half of all referrals had no amblyopia risk factors. The plusoptiX S08 reduced the need for a full examination in one-third of the children screened.

The Bruckner test variant (BTV): a promising instrument in detecting vision disorders

BACKGROUND AND PURPOSE

In the Netherlands, children are screened for amblyopia based on the early detection of visual disorders (VOV) protocol by child health care physicians. The positive predictive value (PPV) of the Brückner test variant (BTV) as an alternative method was assessed.

PATIENTS AND METHODS

In this historical prospective analysis, the results of the VOV and BTV methods were compared. Results at the ages of 15 and 27 months of 414 children were compared against diagnosis by the ophthalmologist; follow-up was at 72 months.

RESULTS

Visual disorders were found in 12 of 15 children (14 had an abnormal BTV) who underwent ophthalmological examination. The PPV of the BTV was 86%; 12 of the 14 children with an abnormal BTV had a vision disorder in the preverbal phase.

CONCLUSION

The BTV is superior to the VOV method in the early detection of vision disorders and could be a cost-effective public health intervention.