Abstract
Purpose :
Pediatric vision screening is essential to detecting visual pathologies early to prevent blindness. However, vision screening requires costly equipment and specialized skills that are limited in under-resourced areas. Our prospective, observational clinical study explores whether the Arclight device, a low-cost, solar-powered, easy-to-use combination ophthalmoscope, anterior segment loupe, and otoscope, can be used effectively by non-ophthalmologists to screen for amblyopia and anatomical abnormalities.
Methods :
54 pediatric patients (108 eyes) were examined by five non-ophthalmologist healthcare personnel using the Arclight and by an ophthalmologist using the slit lamp and indirect ophthalmoscope. Both parties were blinded to the other’s exam findings. Tests performed included the optic disc exam, estimation of the cup-to-disc ratio (CDR), corneal light reflex test (CRT), Bruckner’s red reflex test (BRT), and evaluation of refractive error (emmetropia, hyperopia, myopia). Ease of use of the Arclight was also recorded. Statistical analyses were conducted to determine the sensitivity, specificity, positive predictive value, and negative predictive value of the Arclight exam compared to the gold standard exam of the ophthalmologist.
Results :
Using the Arclight device, the optic nerve exam was successfully completed in 65% of patients. CDRs above and below 0.5 could be determined with 66.7% sensitivity and 84.4% specificity. Arclight CRT measurements were significant (p < .00001) predictors of strabismus diagnosed via gold standard, with 80% sensitivity, 95.1% specificity, 80% positive predictive value, and 95.1% negative predictive value. Arclight BRT results were not significant predictors of amblyopia diagnosis, with a 34.6% sensitivity, 85.7% specificity, 69.2% positive predictive value, and 58.5% negative predictive value. Refractive error was estimated with a success rate of 81% for emmetropia, 38% for myopia, and 21% for hyperopia. Ease of use was rated on average as a 4.4 (SD=0.9) on a scale of 1 to 5, with 1 being the hardest and 5 being the easiest.
Conclusions :
Our study demonstrates the Arclight to be a low-cost yet effective and easy-to-use alternative to the traditional ophthalmoscope. Widespread use of the device for the assessment of common pediatric vision disorders offers the opportunity to strengthen eye health services in many low-resourced regions of the world.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.