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Yan Q, Li R, Qian Y, Lin X, Zhu H, Wang Y, Zhao X, Zhang X, Sun Q, Hao Q, Tong H, Zhu Y, Li Z, Zhu Y, Liu H, Huang D. Instrument referral criteria for PlusoptiX and SureSight based on 2021 AAPOS guidelines: A population-based study. Front Public Health 2022; 10:959757. [PMID: 36225773 PMCID: PMC9548965 DOI: 10.3389/fpubh.2022.959757] [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: 06/02/2022] [Accepted: 08/30/2022] [Indexed: 01/24/2023] Open
Abstract
Objective The study aims to assess two refractive instrument-based methods of vision screening (SureSight and PlusoptiX) to detect refractive amblyopia risk factors (ARFs) and significant refractive errors in Chinese preschool children and to develop referral criteria according to the 2021 AAPOS guidelines. Methods Eye examinations were conducted in children aged 61 to 72 months (n = 1,173) using a PlusoptiX photoscreener, SureSight autorefractor, and cycloplegic retinoscopy (CR). The Vision Screening Committee of AAPOS's preschool vision screening guidelines from 2021 were adopted for comparison. Paired t-test analysis and Bland-Altman plots were used to assess the differences and agreement between the PlusoptiX photoscreener, SureSight autorefractor, and CR. In addition, the validity of the cut-off values of the several ARFs measured with the SureSight and PlusoptiX was estimated using receiver operating characteristic (ROC) curves and compared to the age-based 2021 AAPOS examination failure levels. Results A total of 1,173 children were tested with comprehensive eye examinations. When the referral numbers based on the 2013 (43/3.67%) and 2021 (42/3.58%) AAPOS guidelines were compared, significant differences between the values of astigmatism (72.09 vs. 52.38%) and anisometropia (11.63 vs. 38.10%) were found. The 95% limits of agreement (LOA) of the spherical value and the cylindrical value between PlusoptiX and CR were 95.08 and 96.29%. It was 93.87 and 98.10% between SureSight and CR. Considering refractive failure levels, the ROC curves obtained the optimal cut-off points. However, the PlusoptiX and the SureSight showed lower efficiency in hyperopia (Youden index, 0.60 vs. 0.83) and myopia (Youden index, 078 vs. 0.93), respectively. After adjusting the above cut-off points, the optimized NES (Nanjing Eye Study) referral criteria for myopia, hyperopia, astigmatism, and anisometropia were -0.75, 1.25, -1.0, and 0.5 with PlusoptiX and -1.25, 2.75, -1.5, and 0.75 with SureSight. Conclusions SureSight and PlusoptiX showed a good correlation with CR and could effectively detect refractive ARFs and visually significant refractive errors. There were obvious advantages in detecting hyperopia using SureSight and myopia using PlusoptiX. We proposed instrumental referral criteria for age-based preschool children based on AAPOS 2021 guidelines.
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Affiliation(s)
- Qi Yan
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China
| | - Rui Li
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China
| | - YingXiao Qian
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China
| | - Xiao Lin
- College of Optometry, University of Houston, Houston, TX, United States
| | - Hui Zhu
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China
| | - Yue Wang
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China
| | - Xiaoyan Zhao
- Department of Ophthalmology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Xiaohan Zhang
- Department of Ophthalmology, Wuxi Children's Hospital, Wuxi, China
| | - Qigang Sun
- Department of Ophthalmology, Nanjing International Hospital, Nanjing, China
| | - Qingfeng Hao
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China
| | - Haohai Tong
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Eye Center, Hangzhou, China
| | - Yue Zhu
- Fourth School of Clinical Medicine of Nanjing Medical University, Nanjing, China
| | - Zhitong Li
- Fourth School of Clinical Medicine of Nanjing Medical University, Nanjing, China
| | - Yan Zhu
- Fourth School of Clinical Medicine of Nanjing Medical University, Nanjing, China
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China,*Correspondence: Hu Liu
| | - Dan Huang
- Department of Ophthalmology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China,Dan Huang
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Arnold RW. Comparative Validation of PlusoptiX and AI-Optic Photoscreeners in Children with High Amblyopia Risk Factor Prevalence. Clin Ophthalmol 2022; 16:2639-2650. [PMID: 35996434 PMCID: PMC9392476 DOI: 10.2147/opth.s378777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Robert W Arnold
- Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA
- Correspondence: Robert W Arnold, Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, 3500 Latouche Street #280, Anchorage, AK, USA, Tel +19075611917, Fax +19075635373, Email
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