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Screening for amblyopia risk factors in pre-verbal children using the Plusoptix photoscreener: a cross-sectional
Ali Akbar Saber Moghaddam1, Abbas Kargozar, Mehran Zarei-Ghanavati
1Eye Research Center of the Mashhad University of Medical Sciences, Khatam-al-Anbia Eye Hospital, Mashhad, Iran.
Insights
The Plusoptix photoscreener shows promise for screening pre-verbal children for amblyopia risk factors, achieving high sensitivity but requiring further refinement for improved specificity in pediatric populations.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Vision Screening Technology
Background:
- Amblyopia, or "lazy eye," is a leading cause of vision impairment in children.
- Early detection and intervention are crucial for effective amblyopia treatment.
- Pre-verbal children present unique challenges for vision screening.
Purpose of the Study:
- To assess the accuracy and practical use of the Plusoptix photoscreener for identifying amblyopia risk factors in very young children.
- To compare Plusoptix measurements with cycloplegic retinoscopy findings.
- To explore modifications to referral criteria to enhance the device's diagnostic performance.
Main Methods:
- A cross-sectional study involving 996 children aged 6-36 months.
- Screening using the Plusoptix photoscreener followed by comprehensive eye examinations, including cycloplegic retinoscopy.
- Analysis of the prevalence of amblyogenic risk factors and comparison of Plusoptix data with retinoscopy results.
Main Results:
- The Plusoptix demonstrated high testability (98.1%) and 100% sensitivity in detecting amblyogenic risk factors.
- Initial referral criteria resulted in low specificity (38.7%).
- Modified criteria (e.g., hyperopia ≥ 2.00 D in infants <12 months) improved specificity to 51.2% while maintaining high sensitivity.
Conclusions:
- The Plusoptix serves as a valuable objective tool for pediatric vision screening.
- Current specificity for detecting amblyopia risk factors in young children needs improvement.
- Further research and optimized referral criteria are necessary to maximize the Plusoptix's clinical utility.
Aims:
To evaluate the accuracy and applicability of Plusoptix photoscreener in screening pre-verbal children at risk of amblyopia.
Methods:
In this cross-sectional population-based study 996 children aged 6-36 months were screened with the Plusoptix. The children underwent complete examinations that included a manual cycloplegic retinoscopy, slit lamp examination, cover test, the Hirschberg test and an assessment of fixation pattern. In addition, the prevalence of amblyogenic risk factors was estimated, the Plusopix measurements were compared with cycloplegic retinoscopy, and the referral criteria were modified to improve the accuracy of the device.
Results:
Amblyogenic hyperopia >+3.50 D, myopia >-3.00 D, astigmatism >1.50 D in the orthogonal meridian or >1.00 D in the oblique meridian, or anisometropia >1.50 D was detected in 4.7%, 0.0%, 12.3% and 0.5% of the samples, respectively. The average difference between retinoscopy and photorefraction for spherical equivalence was -0.16 ± 1.0 D (p<0.05). Testability was 98.1% for the Plusoptix. The Plusoptix vision screener referred 47.8% of these children for sensitivity, specificity, positive predictive value and false-negative rates of 100%, 38.7%, 19% and 100%, respectively. These same measurements with the modified referral criteria (hyperopia ≥ 2.00 D in children under 12 months and astigmatism ≥ 1.25 D) were 93.6%, 51.2%, 21.7% and 98.2%.
Conclusion:
The Plusoptix is a useful objective screening instrument, but still has low specificity for detecting amblyopia risk factors in the paediatric population.
