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P.P. Schmidt, V. Dobson, Vision In Preschoolers (VIP) Study Group; Vision in Preschoolers (VIP) Study: Results of Phase II . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2354.
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Purpose: To compare the performance of nurse screeners and lay screeners in administering 4 vision screening tests to preschool children. Methods: Nurse screeners and lay screeners, experienced in working with young children, completed training and certification procedures for all tests. Subjects were 1,452 3– to 5–year–old children enrolled in Head Start at the 5 VIP Clinical Centers. Approximately 2/3 of the children had failed the routine Head Start vision screening. Screening tests were the Retinomax Autorefractor, SureSight Vision Screener, crowded Linear Lea Symbols visual acuity (VA) test at 3 m, and Stereo Smile II test. Lay screeners also administered the crowded Single Lea Symbols (VA) test at 1.5 m. Screening results were compared to results from a standardized comprehensive eye examination that were used to classify children as having or not having amblyopia, strabismus, significant refractive error and/or unexplained reduced visual acuity. Results: Screening results for each test were obtained on ≥ 98% of children for both nurse screeners and lay screeners. Completion times for each test were similar for both types of screeners. With specificity set at 0.90, sensitivities for detecting children with > 1 targeted condition differed for nurse screeners and lay screeners for the Retinomax (0.68 vs 0.62, p=0.004) and the crowded Linear Lea Symbols VA test (0.49 vs 0.37, p=0.0004), but not for the SureSight (0.64 vs 0.65, p=0.16) or the Stereo Smile II test (0.45 vs 0.40, p=0.06). However, sensitivity was significantly higher for lay screeners using the crowded Single Lea Symbols VA (1.5 m) compared to nurse screeners using the 3.0 m crowded Linear Lea Symbols visual acuity test (0.61 vs 0.49, p=0.0001). At 0.90 specificity, sensitivity for detection of the targeted conditions of greatest severity (e.g. severe anisometropia, constant strabismus, hyperopia > 4.75 D, astigmatism > 2.25 D, myopia > 6 D) did not differ between nurse screeners and lay screeners for any of the 4 tests. Conclusions: Nurse screeners and lay screeners achieved similar sensitivity for detecting preschool children in need of a comprehensive eye examination when specificity is set at 0.90.
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