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Hilary Gaiser, Bruce D Moore, Nadine Solaka, Danielle M Ledoux, Josephine Sandoval, Ankoor R Shah, Caitlin Rook, Ran He; Accuracy of the Spot Pediatric Vision Screener for Detection of Hyperopia, Astigmatism and Anisometropia. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2725.
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Detection of significant refractive errors in children is crucial in the prevention of amblyopia. Current vision screening methods consist of three categories of screening techniques; refraction, visual acuity and stereo. The Vision in Preschoolers (VIP) Group, has shown that screening devices, such as Retinomax and SureSight, can be used by licensed, eye-care professionals (LEP), and nurse or lay screeners to detect significant refractive errors. The Spot, a handheld photoscreening device that uses infrared reflections to determine refractive error, is a similar device. The Spot’s ability to detect refractive errors was evaluated by receiver operating characteristic (ROC) analysis in preschool and early elementary aged children.
394 subjects, aged 2 to 7, were screened with the Spot by a lay screener and then presented for a masked Gold Standard Exam (GSE) on a mobile eye clinic van by a LEP. GSE included VA testing with HOTV chart, stereo testing by stereo smile test, NCR, and cycloplegic retinoscopy. Screening results were compared to cycloplegic retinoscopy results for Spot’s ability to pick up refractive error: eye with most hyperopic meridian, eye with most astigmatism and amount of anisometropia in SER. The ability of the Spot to identify these conditions was summarized by the area under the curve (AUC) of the ROC.
Based on a single predictor, eye with most hyperopic meridian and eye with most astigmatism the AUC was 0.71, 95% CI (0.622, 0.796) and 0.84, 95% CI (0.77, 0.91), respectively. For anisometropia, interocular difference in SER, the AUC was 0.66, 95% CI (0.58, 0.75). The aggregate of all three predictors combined AUC was 0.87, 95% CI (0.80, 0.94).
With all three predictors combined, the AUC (0.87) was similar to results of other devices examined by VIP. The results for the most hyperopic meridian and for the eye with the most astigmatism, AUC 0.71 and 0.84, were also similar. Data collection for this study is still ongoing. The AUC for anisometropia, 0.66 was based on SER that may mask hyperopia and was also similar to results reported by the VIP.
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