Efficacy of a vision-screening tool for birth to 3 years early intervention programs

To validate a screening tool used to detect unsuspected visual pathway pathology in preschool children under 3 years of age with developmental disabilities enrolled in an early intervention program using guidelines from the Kansas Department of Health and Environment (KDHE).

The records of 300 consecutive children screened at a birth to 3 early intervention program from 2011 to 2014 were reviewed retrospectively. Inclusion criteria were documented KDHE vision screening examinations performed by trained early interventionist and full ophthalmic evaluations by a general ophthalmologist. The evaluation was only considered a pass if it was recorded on the chart and the child did not have any known risk factors. The visual pathway pathology status was determined after comprehensive ophthalmic examination, with the ophthalmologist masked to the vision screening results.

A total of 216 children met inclusion criteria, of whom 137 were referred. The sensitivity was 95.3% (95% CI, 90.8-99.8); specificity, 57.25% (95% CI, 48.3-65.7); positive predictive value, 59.1% (95% CI, 50.4-67.3); negative predictive value, 94.9% (95% CI, 86.8-98.4); and negative likelihood ratio, 0.082 (95% CI, 0.031-0.22). A Pearson χ² test for fit yielded an approximate P value of <0.0001.

In this study population, good sensitivity and negative predictive value were demonstrated by the inexpensive screening examination coupled with associated risk factors for the 0-3 population of children with developmental disabilities.