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G.E. Bradford, P.K. Nottingham Chaplin, J.V. Odom, H. Humble; Accuracy of Lea Symbol and Random Dot E Testing by Trained Community Lay Personnel in a Large Preschool Vision Screening Program . Invest. Ophthalmol. Vis. Sci. 2006;47(13):705.
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Random Dot E (RDE) and Leas Symbol (LS) testing are often recommended components of preschool vision screening guidelines to identify children with decreased central visual acuity and/or strabismus. This study seeks to better define the utility of using RDE and LS by trained community lay screeners for identifying preschool–aged children with abnormal vision.
With Institutional Review Board approval, the Vision Initiative for Children (VIC), has, developed a training program incorporating the Maternal Child Health Bureau/National Eye Institute (MCHB/NEI) Interim Recommendations to certify and support community lay preschool vision screeners in the use of the LS and RDE tests. Using HIPAA–compliant documentation, screeners are encouraged to report their results to VIC. Local community optometrists and ophthalmologists are also encouraged to report their examination findings on children who failed their vision screen. All results are entered into the Program’s Access database.
Since 2001, 12,856 screening results have reported on children 36–59 months of age. 2398 (19%) failed the combined RDE + LS, the RDE alone, or the LS alone. Local community optometrists and ophthalmologists have submitted examination results on 227 children who failed their vision screening. 94 (41%) children had significant amblyogenic factors using the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) guidelines. For the combined RDE+LS the positive predictive value (PPV) was 55% and the negative predictive value (NPV) was 66%. There was a PPV of 44% and a NPV of 63% for the RDE alone. There was a PPV of 49% and a NPV of 83% for the LS alone.
If these results from a small sample of completed exams are an accurate reflection of all children screened in general, they suggest the RDE and LS can be used by trained community lay screeners with moderate accuracy in identifying preschool–age children with significant amblyogenic factors. Getting exams on children who fail their screening remains a significant challenge.
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