Agreement between the Welch Allyn Spot Vision Screener and Cycloplegic Retinoscopy in Toddlers

Abstract

Purpose : Photo-screening instruments are commonly utilized in school-aged pediatric populations. This study compared the results of a common photo-screener with cycloplegic retinoscopy in toddlers aged 12 to 36 months.

Methods : Toddlers were screened at a pediatric well-child check using the Welch Allyn Spot Vision Screener and referred for a complete eye exam if they failed the screening. The eye examination included repeating the Spot screening, assessment of ocular alignment, pupils, anterior segment, motility, the fundus, and cycloplegic retinoscopy conducted by an experienced retinoscopist who was masked to the Spot results. We compared the Spot measure to cycloplegic retinoscopy spherical equivalent (M), JO, and astigmatism. We defined a clinically significant difference in sphere to be 0.50D and 1.00D for astigmatism.

Results : One-hundred eighty-seven children were referred and completed a cycloplegic examination. Eight were excluded because the Spot was not able to obtain a reading, leaving a total of 178 subjects for analysis. The average age was 20.2 months (SD=6.7, range: 12.2 to 36.0 months) and the female:male ratio was 49:51. The right and left eye results were similar, so we reported the right eye only. The mean retinoscopy M was 0.76D (SD=1.43D) and the mean Spot M was 0.32D (SD=0.92D) for a difference of 0.44D (SD=1.20D,t-test<0.001). The mean retinoscopy J0 was 0.73D (SD=0.62D) and the mean Spot J0 was 0.71D (SD=0.70D) for a difference of 0.02D (SD=0.54D,t-test=0.004). The mean retinoscopy astigmatism was 1.69D (SD=0.92D) and the mean Spot astigmatism was 1.88D (SD=0.98D) for a difference of 0.19D (SD=0.86D,t-test=0.004). Comparing M, 58% showed a clinically significant difference 0.50D, while for the astigmatism 19% showed 1.00D difference between the two methods. The Spot tended to overestimate cylinder power compared to cycloplegic retinoscopy.

Conclusions : Cycloplegic retinoscopy found more hyperopic/less myopic sphere power. When using the Spot, this could result in under-referral for moderate to severe hyperopia. Cycloplegic retinoscopy showed lower astigmatism results as compared to the Spot. Using the Spot, about one in five subjects showed higher clinically significant cylinder.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.