Abstract
Purpose :
Amblyopia is the most common cause of monocular blindness in adults and children, and disproportionally affects developmentally delayed children; being up to 3 times more common in one study. After the age of 9, amblyopia becomes irreversible, highlighting the importance of early detection. The Welch-Allyn Spot Vision Screener (Spot) is a commonly used device for detecting amblyogenic risk factors. The Spot takes a photograph of the child's eyes and determines approximately their refractive power, eye alignment and if there are any visual obstructions (such as ptosis or cataract). The test typically lasts 6 seconds and is without any known risks. Prior studies have reported good accuracy of Spot in the general population, however its performance in patients with Down Syndrome and special needs is not substantiated. Our study assessed the efficacy of Spot at detecting various amblyogenic risk factors in developmentally delayed children.
Methods :
Children with various disabilities or delays were recruited from the Children’s Hospital of Colorado Eye Clinic, Special Care Clinic and the Sie Center for Down Syndrome. Participants had their photograph taken with Spot pre and post pupillary dilation, and this was then compared to a comprehensive eye exam in the Ophthalmology clinic.
Results :
One hundred children participated in the study. Twelve children were unable to get images with Spot and 5 did not attend for their exam in the eye clinic. The mean age was 5.9 years (standard deviation, SD, 3.4). 64% were male and 58% were non-Hispanic white. The overall sensitivity of Spot was 90% and the positive predictive value was 80% in undilated subjects. The area under the receiver operator curve (AUROC) was 0.68 (95% confidence interval, CI: 0.57-0.79), and this was not significantly different from the AUROC of Spot accuracy after dilation (0.68, 95% CI: 0.54-0.81).
Conclusions :
The Spot Vision Screener performed well in this cohort of special needs children, the children did not need to be dilated in order for the Spot to have good accuracy. Spot could be used by primary care clinics and vision screening programs to better triage which patients need to be referred to Ophthalmology.
This is a 2021 ARVO Annual Meeting abstract.