May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Is Visual Acuity a Reliable Screening Method for Significant Refractive Errors in Adolescents?
Author Affiliations & Notes
  • J. F. Leone
    University of Sydney, Sydney, Australia
    Discipline of Orthoptics,
  • K. A. Rose
    University of Sydney, Sydney, Australia
    Discipline of Orthoptics,
  • A. Kifley
    University of Sydney, Sydney, Australia
    Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute,
  • S. H. Sharbini
    University of Sydney, Sydney, Australia
    Discipline of Orthoptics,
  • P. Mitchell
    University of Sydney, Sydney, Australia
    Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute,
  • Sydney Childhood Eye Study
    University of Sydney, Sydney, Australia
  • Footnotes
    Commercial Relationships  J.F. Leone, None; K.A. Rose, None; A. Kifley, None; S.H. Sharbini, None; P. Mitchell, None.
  • Footnotes
    Support  Australian NHMRC Grant 253732
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 3134. doi:https://doi.org/
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      J. F. Leone, K. A. Rose, A. Kifley, S. H. Sharbini, P. Mitchell, Sydney Childhood Eye Study; Is Visual Acuity a Reliable Screening Method for Significant Refractive Errors in Adolescents?. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3134. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : To examine the sensitivity and specificity of visual acuity (VA) measures to screen for significant refractive error in a population-based random cluster sample of 12-year old school children.

Methods: : The Sydney Myopia Study randomly selected 21 secondary schools, stratified by socio-economic status. Year 7 students were invited to participate. VA was performed monocularly, unaided at 2.44m using a retro-illuminated logMAR chart (CSV1000). Cycloplegic (Cyclopentolate 1%) auto-refraction was conducted. Clinically significant refractive error was defined as spherical equivalent ≤-1.0D for myopia; ≥+2.0D for hyperopia and ≤-1.0D for astigmatism.

Results: : Of the 2353 Year 7 students (mean age 12.7 years), data for both eyes were pooled for a total of 4670 observations, after excluding 18 children with reduced VA from ocular pathology or amblyopia. The sensitivity and specificity for all clinically significant refractive errors at a logMAR VA cut-off level of 6/7.5 were 69% & 96%, respectively. At 6/9, these were 61% & 98%, respectively. Screening sensitivities and specificities were then examined for individual refractive errors. For myopia, sensitivity and specificity were 99% & 93% for 6/7.5 cut-off and with better specificity at 97% & 96% for 6/9 cut-off. For hyperopia, sensitivity and specificity was 37% & 86% using 6/7.5 cut-off and sensitivity reduced to 25% with 90% specificity using 6/9 cut-off. For astigmatism, sensitivity and specificity was 61% & 88% using 6/7.5 cut-off and sensitivity decreased to 45% with 92% specificity using 6/9 cut-off. However, screening sensitivity slightly improved for astigmatism using a 6/6 VA cut-off (69%), but specificity was reduced (84%). Reliability of VA at the 6/12 cut-off was insensitive for hyperopia (17%) and astigmatism (37%), but sensitive for myopia (92%), specificity was sound for all types 98%, 91%, 93% respectively, at this VA level.

Conclusions: : In this adolescent group, sensitivity and specificity values for a VA 6/7.5 cut-off detects myopic refractive error quite reliably. Astigmatism is detected moderately well only when the VA cut-off is 6/6. No VA level adequately screens for clinically significant hyperopia, presumably due to the accommodative ability of young adolescents. Therefore while you can appropriately screen for myopia using a VA cut off of 6/7.5, at present cycloplegic refraction seems to be the only way to reliably screen for hyperopia and astigmatism.

Keywords: visual acuity • refraction • clinical (human) or epidemiologic studies: systems/equipment/techniques 
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