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Findings from the Vision in Preschoolers (VIP) Study
Insights
The Vision in Preschoolers Study identified effective vision screening tests for children. Best tests for professionals included retinoscopy and autorefractor; nurses and lay screeners found autorefractor and Lea Symbols effective for early detection of vision problems.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Public Health
Background:
- Preschool vision screening is crucial for early detection of visual impairments.
- Amblyopia, strabismus, and refractive errors significantly impact child development.
- Evidence-based guidelines are needed to optimize preschool vision screening protocols.
Purpose of the Study:
- Evaluate the performance of various vision screening tests in preschoolers.
- Identify the most effective screening methods for different personnel (eye care professionals, nurses, lay screeners).
- Provide data to inform national preschool vision screening initiatives.
Main Methods:
- Multicenter, multidisciplinary, two-phase study design.
- Performance evaluation of multiple vision screening tests.
- Assessment of testability and accuracy across different screener types.
Main Results:
- Non-cycloplegic retinoscopy, Retinomax Autorefractor, SureSight, and Lea Symbols (10 ft) were optimal for eye care professionals.
- Retinomax, SureSight, and Lea Symbols (5 ft) were effective for nurses/lay screeners.
- Combining cover test with refraction (professionals) or Stereo Smile II with SureSight (lay screeners) improved strabismus detection. High testability (>98%) was observed for effective tests.
Conclusions:
- Specific screening tests demonstrate high performance for preschool vision screening.
- Children unable to complete screening tests are at higher risk and require further evaluation.
- Further research is needed on the value of correcting refractive errors in preschoolers without amblyopia or strabismus.
Abstract:
The Vision in Preschoolers (VIP) Study Group conducted a multicenter, multidisciplinary, two-phase study to evaluate the performance of vision screening tests for identifying pre-school children with amblyopia, strabismus, significant refractive error, or unexplained reduced visual acuity (VA). The results of the VIP Study provide evidence-based guidelines for preschool vision screening. The best screening tests administered by eye care professionals were non-cycloplegic retinoscopy, Retinomax Autorefractor, SureSight Vision Screener, and linear, crowded Lea Symbols VA at 10 feet. The best screening tests administered by trained nurses and/or lay screeners were Retinomax, SureSight, and VIP single, crowded Lea Symbols VA screening test system at 5 feet. Eye care professionals can improve detection of strabismus by combining unilateral cover test with a refraction test and trained lay screeners can improve detection of strabismus by combining Stereo Smile II with SureSight. The best performing tests had high testability whether performed by trained eye care professionals, nurses, or lay screeners (>or=98%). Although very few children were unable to complete these tests, a child who was "unable" was much more likely to have a vision problem than a child who passed; therefore, children who are unable to complete one of these tests should be referred for further evaluation. When screening using the Retinomax, repeated testing to achieve the manufacturer's suggested confidence number is valuable and improves specificity. Federal initiatives to increase the number of pre-school children receiving vision screening or examination will increase the number of pre-school children identified with amblyopia, strabismus, and/or significant refractive error. Although there is general agreement regarding the importance of early detection of amblyopia, controversy exists regarding the importance of early detection of refractive error. Because of the high prevalence of significant refractive errors and lack of evidenced-based guidelines for correction of refractive error in pre-school children, future research is needed to evaluate the value of correcting refractive errors in preschoolers who do not have amblyopia and/or strabismus.
