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Joseph M. Miller, Velma Dobson, Erin M. Harvey, Duane L. Sherrill; Comparison of Preschool Vision Screening Methods in a Population with a High Prevalence of Astigmatism. Invest. Ophthalmol. Vis. Sci. 2001;42(5):917-924.
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purpose. To compare the effectiveness of four methods of screening 3- to
5-year-old children for astigmatism high enough to require spectacle
methods. Lea Symbols Visual Acuity Screening (LSVAS), MTI Photoscreening
(MTIPS), Nidek KM-500 Keratometry Screening (KERS), and Retinomax
K-Plus Noncycloplegic Autorefraction Screening (NCARS) were attempted
on 379 preschool children who are members of a Native American tribe
having a high prevalence of astigmatism that is primarily corneal in
origin. The need for spectacle correction was determined by cycloplegic
refraction. Receiver Operating Characteristic (ROC) curves were fit,
confidence intervals were determined, and area under the curves was
results. Astigmatism ≥ 1.00 D was present in the right eye of 47.5% and
in the left eye of 48.0% of children. Spectacles were prescribed for
children < 48 months of age who had cylinder ≥ 2.00 D and
children ≥ 48 months who had cylinder ≥ 1.50 D, with the
result that 33% of subjects required spectacles. Area under the ROC
curve was 0.98 for NCARS, 0.92 for KERS, 0.78 for MTIPS, and 0.70 for
LSVAS, and each of these values differed significantly from the other
three (all P < 0.007). Testability was
significantly higher for NCARS (99.5%) and KERS (99.7%) than for
MTIPS (93.5%) and LSVAS (92.0%).
conclusions. In a population that included many children with astigmatism,
objective, fully automated screening methods (NCARS and KERS) were
superior to both visual acuity screening and photoscreening with
subjective interpretation in identifying children who had astigmatism
requiring spectacle correction.
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