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Jennifer Dudney Davidson, Mae Millicent Peterseim, Edward W Cheeseman, Rupal Trivedi, Carrie Papa, Courtney Lynn Kraus; Prospective evaluation of autorefraction using the Spot and plusoptiX AO9 vision screeners in children ages 12-30 months for the detection of amblyogenic risk factors. Invest. Ophthalmol. Vis. Sci. 2014;55(13):437. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate two pediatric vision screening devices in a clinical setting for children ages 12-30 months compared to cycloplegic refraction.
After informed consent, children ages 12-30 months underwent screening with the Spot and plusoptiX vision screeners prior to comprehensive examination by a pediatric ophthalmologist masked to the results. Data including refraction, pass/refer, testability (whether the device obtained a refraction), strabismus, and any ocular pathology, were entered into a Redcap database for statistical analysis. All differences in refractions were calculated as Crx minus device refraction for the right eye.
Currently 9 children ages 12-17 months (testability Spot 100%, plusoptiX 44.4%), 13 ages 18-23 months (Spot 64.7%, plusoptiX 23.5%), and 33 age 24-30 months (Spot 82.9%, plusoptiX 48.6%) were included in analysis with a goal of 30 per group. Compared to cycloplegic retinoscopy, the Spot underestimates sphere by 0.89D +/-1.48 (p<0.001) and overestimates cylinder by 0.49D +/-0.89 (p<0.001). The plusoptiX underestimates sphere by 0.53D +/-0.91 (p<0.009) and overestimates cylinder by 0.40 +/-0.56 (p<0.002).
Traditional optotype screening is rarely attainable in this population. A validated and reliable vision screener is useful for the detection of amblyogenic risk factors as defined for children ages 12-30 months that would indicate the need for cycloplegic refraction by a pediatric ophthalmologist. Most children present to the general pediatrician at least twice during this age range for recommended vaccinations. Detection of amblyogenic risk factors is highly dependent on a screeners performance as an autorefractor. Preliminary results suggest that the Spot and the plusioptiX are efficacious autorefractors for young children. The Spot is more effective at obtaining a reading, however is less accurate than the plusoptiX when refraction is obtained. Sensitivity and specificity can also be calcualted for both devices using the recently recommended referral criteria for children ages 12-30 months: astigmatism >2.0 D, hyperopia >4.5 D, and anisometropia >2.5 D, however in a pediatric ophthalmology clinic, prevalence of disease is expected to be higher than that of the general population and should be considered with interpreting sensitivity and specificity.
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