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Results of a community vision-screening program using the Spot photoscreener
Kristiane M Ransbarger1, Jennifer A Dunbar, So Eun Choi
1Department of Ophthalmology, Loma Linda University , Loma Linda, California.
Insights
The Spot photoscreener identified many vision issues in young children, but a high number of false positives, especially for eye alignment, indicates a need for software improvements.
Area of Science:
- Pediatric Ophthalmology
- Vision Science
- Public Health Screening
Background:
- Community-based vision screenings are crucial for early detection of visual impairments in children.
- The Spot photoscreener is a tool used for non-invasive vision screening in pediatric populations.
- Identifying refractive errors and ocular alignment issues early can prevent long-term vision deficits.
Purpose of the Study:
- To evaluate the effectiveness of the Spot photoscreener in a community setting for vision screening.
- To determine the referral rates and positive predictive value of the Spot photoscreener in low-income preschool children.
- To identify specific vision conditions detected by the photoscreener.
Main Methods:
- Low-income Hispanic children aged 6-72 months were screened using the Spot photoscreener by lay operators.
- Referral criteria followed American Association for Pediatric Ophthalmology and Strabismus guidelines.
- Screening data were analyzed for referral reasons, and records were compared with comprehensive eye exams to calculate positive predictive value.
Main Results:
- Out of 7,814 children screened, 30.6% were referred.
- The most common reasons for referral were astigmatism (23.8%) and ocular misalignment (11.3%).
- The overall positive predictive value was 65.7%, with a high rate of false positives for ocular misalignment.
Conclusions:
- The Spot photoscreener demonstrated a high referral rate in this population.
- While astigmatism was prevalent, the high referral rate for ocular misalignment suggests the need for algorithm refinement in the Spot photoscreener software.
- Further improvements are needed to enhance the accuracy of the Spot photoscreener's referral criteria, particularly for ocular alignment.
Purpose:
To describe the results of vision screenings performed with the Spot photoscreener in the community setting.
Methods:
Low-income, predominantly Hispanic children in day care and preschool settings were screened by lay operators using the Spot photoscreener. Inclusion criteria were age 6-72 months and availability of a complete photoscreening record. Referral criteria were based on Vision Screening Committee of American Association for Pediatric Ophthalmology and Strabismus guidelines. Data were stratified by age group and analyzed for percentage of children referred for hyperopia, myopia, astigmatism, anisometropia, anisocoria, and ocular misalignment. Vision screening records were compared with comprehensive eye examination records from an optometrist or ophthalmologist to determine positive predictive value.
Results:
Vision screening examinations were performed on 8,317 subjects from September 2011 through May 2012. The mean age of the 7,814 subjects (3953 males) meeting inclusion criteria was 44.4 months. The Spot referred 2,393 (30.6%). Of the screened population, the suspected reason for referral was astigmatism in 1,863 (23.8%), ocular misalignment in 879 (11.3%), anisometropia in 90 (1.2%), myopia in 82 (1.1%), hyperopia in 63 (0.8%), and anisocoria in 16 (0.2%). Comprehensive examination reports, including a cycloplegic refraction, were available for 300 referred children (12.5%). The reason for referral was confirmed in 55.7%, with an overall positive predictive value of 65.7%.
Conclusions:
The Spot photoscreener yielded a high overall referral rate. Although a high prevalence of astigmatism may be expected in this population, a high referral rate for suspected ocular misalignment led to a very high proportion of false positive referrals, suggesting that the software for this algorithm is in need of refinement.
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