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Test characteristics of orthoptic screening examination in 3 year old kindergarten children
1Department of Ophthalmology II, University Eye Hospital Tübingen, Schleichstrasse 12-16, D-72076 Tübingen, Germany. JC.Barry@med.uni-Tuebingen.de
Insights
Orthoptic vision screening effectively identifies amblyopia in 3-year-olds, showing high sensitivity and specificity. Rescreening inconclusive results is recommended for comprehensive early detection of vision problems.
Area of Science:
- Ophthalmology and Vision Science
- Pediatric Healthcare
- Screening and Diagnostic Testing
Background:
- Early detection of amblyopia and amblyogenic risk factors is crucial for effective intervention.
- Kindergarten-based orthoptic screening offers a potential avenue for identifying vision impairments in young children.
- Assessing the diagnostic accuracy of such screening programs is essential for optimizing public health strategies.
Purpose of the Study:
- To evaluate the test characteristics, including sensitivity and specificity, of orthoptic screening for amblyopia or amblyogenic risk factors in 3-year-old children attending kindergarten.
- To determine the effectiveness of a two-stage screening process involving initial screening and re-examination.
- To provide data supporting the implementation or refinement of vision screening programs in early childhood settings.
Main Methods:
- A cohort of 1180 three-year-old children in German kindergartens underwent orthoptic screening, including cover tests, motility and posture assessments, and visual acuity testing.
- A subset of children with positive or inconclusive initial results were re-examined after 3-6 months with a stricter visual acuity threshold.
- Ophthalmological examination served as the gold standard for diagnosing target conditions, with diagnoses confirmed or refuted based on these examinations.
Main Results:
- The gold standard was established in 1114 children, with 2.3% diagnosed with a target condition.
- Initial screening yielded inconclusive results in 10.8% of children, primarily due to collaboration issues.
- Screening demonstrated a sensitivity of 90.9% and a specificity of 93.8% when based on conclusive screening results.
Conclusions:
- Orthoptic vision screening in 3-year-olds within a kindergarten setting is both sensitive and specific for detecting amblyopia and related risk factors.
- A significant proportion of inconclusive screening results highlights the need for strategies to manage non-cooperative children.
- Consideration should be given to rescreening protocols for 3-year-old children who initially present with inconclusive screening results to improve detection rates.
Aim:
To analyse the test characteristics of orthoptic screening for amblyopia or amblyogenic risk factors (target conditions) in kindergarten.
Methods:
1180 three year old children were screened by orthoptists in 121 German kindergartens. Orthoptic screening consisted of cover tests, examination of eye motility and head posture, and monocular visual acuity testing with the Lea single optotype test. Children were re-examined in kindergarten by different orthoptists after 3-6 months using a more demanding pass threshold for visual acuity. All children with at least one positive orthoptic test result or an inconclusive re-examination were referred to an ophthalmologist for diagnosis. The gold standard was set positive if a target condition was diagnosed on ophthalmological examination. It was set negative if no target condition was found upon ophthalmological examination, or if a child who screened negative or inconclusive passed the orthoptic re-examination without any positive test result.
Results:
The gold standard was ascertained in 1114 children. 26 (2.3%) children had a "positive" gold standard. In 10.8% of the children the initial screening was "inconclusive," mostly due to lack of collaboration. Screening test sensitivity (based on conclusive results only) was 90.9% and specificity was 93.8%.
Conclusions:
Orthoptic vision screening of 3 year olds in kindergarten is sensitive and specific. However, owing to a substantial proportion of inconclusive screening results, rescreening of non-cooperative 3 year old children should be considered.
