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Identification of infants with significant refractive error and strabismus in a population screening program using
Shirley Anker1, Janette Atkinson, Oliver Braddick
1Visual Development Unit, Department of Psychology, University College London, London, United Kingdom. s.anker@ucl.ac.uk
Insights
Noncycloplegic videorefraction effectively screens infants for refractive errors and strabismus. This simpler method detects significant ametropia, including hyperopia, a risk factor for amblyopia.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Vision Science
Background:
- Infant vision screening is crucial for early detection of refractive errors and strabismus.
- Standard screening methods often require cycloplegia, which can be challenging in infants.
- Videorefraction offers a potential noncycloplegic alternative for vision screening.
Purpose of the Study:
- To evaluate noncycloplegic videorefraction as a primary screening tool for refractive errors in infants.
- To assess the efficacy of videorefraction in detecting accommodative errors and orthoptic problems.
- To compare videorefraction screening with standard cycloplegic retinoscopy.
Main Methods:
- A prospective screening of 5142 infants using noncycloplegic videorefraction and orthoptic examination.
- Follow-up assessment included cycloplegic retinoscopy for infants identified with potential issues and a control group.
- Data analysis focused on sensitivity and specificity of the screening procedure.
Main Results:
- The screening identified 514 infants with focusing errors or orthoptic problems.
- Sensitivity for detecting refractive or orthoptic conditions was 0.67, with a specificity of 0.96.
- The procedure successfully detected significant ametropia, especially hyperopia.
Conclusions:
- Noncycloplegic videorefraction is a simpler and effective method for infant vision screening.
- This approach can identify a substantial proportion of infants with significant refractive errors.
- Early detection of conditions like hyperopia is vital for preventing amblyopia and strabismus.
Purpose:
The second Cambridge Infant Vision Screening Program examined whether screening for accommodative errors by using videorefraction without cycloplegia could effectively serve as a first stage of screening for refractive errors, measured by standard cycloplegic retinoscopy. The screening also included an orthoptic examination for detection of strabismus.
Methods:
All infants born in the Cambridge (UK) Health District, over a 2-year period, were invited for screening. Of those 5142 (76%) with mean age 8.1 +/- 0.8 months (SD) attended and received noncycloplegic videorefraction and an orthoptic examination. All those with a focusing error or orthoptic problem, as well as a randomly selected sample of visually normal control subjects, were invited to follow-up a month later for cycloplegic retinoscopy, repeat noncycloplegic videorefraction and orthoptic examination.
Results:
Of the 5142 screened, 514 had a focusing error or orthoptic problem (positives). Four hundred thirty-nine of these and 284 visually normal control subjects (negatives) attended follow-up. A refractive or orthoptic condition was confirmed in 59.0% of the positive cases, whereas infants in 96.8% of the negative cases were confirmed normal. Adjusting for the proportions of the population represented by those infants seen at follow-up, sensitivity for the screening procedure was calculated at 0.67 and specificity at 0.96. Detailed results are presented in terms of the different conditions detected at screening (far, near, and anisometropic focus and orthoptic error), distribution of greatest axes at screening, and a comparison of initial videorefraction with repeat videorefraction and cycloplegic retinoscopy.
Conclusions:
A noncycloplegic screening procedure, simpler to perform than cycloplegic screening, succeeded in detecting a large proportion of infants with significant ametropia, particularly those with significant hyperopia, which is considered to be a strabismogenic and amblyogenic risk factor.