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Irene Campus, Kimberly Gerhart, Jordana M. Smith, Amy Davis, Joseph M Miller, Erin M Harvey; Identification of young children for participation in studies of spectacle correction through pediatric primary care clinics: A pilot study. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2204.
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To determine the true positive rate for children referred for eye examinations based on SPOT (Welch Allyn, Inc) photoscreening in pediatric primary care clinics.
Children were screened at well-child checks with the SPOT photoscreener at one of three pediatric clinics. Screening failures were referred to the University of Arizona Visual Development Laboratory for follow-up eye examinations which included cycloplegic refraction and assessment of ocular alignment. Screening results were considered true positives if examination results met American Academy of Pediatric Ophthalmology and Strabismus (AAPOS) amblyopia risk factor referral criteria for children age 12 months and older.
The final sample included 31 children ranging in age from 12 to 70 months who failed a SPOT screening conducted at their pediatric primary care clinic and completed an eye examination at the Visual Development Lab. Children failed the SPOT screening due to suspected astigmatism (24/31, 77%), anisometropia (5/31, 16%), hyperopia (2/31, 6%), and gaze asymmetry (2/31, 6%) (one child met criteria for astigmatism, hyperopia and anisometropia). Of the 31 children, 16 met AAPOS referral criteria based on eye examination results indicating a true positive rate of 52%. False positive rates were 10/24 (42%) for astigmatism, 1/2 (50%) for hyperopia, 4/5 (80%) for anisometropia, and 2/2 (100%) for gaze asymmetry.
Results indicate that approximately half of the children referred had significant refractive error. True positive referrals may be improved if primary care clinics repeat screenings to verify results before referring children. These preliminary data suggest that this method may be an efficient way to recruit subjects for clinical trials on refractive correction of young children. The primary care recruitment base will produce a study sample of previously untreated children that is more generalizable than samples recruited through ophthalmology/optometry clinics.
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