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The opportunistic screening of refractive errors in school-going children by pediatrician using enhanced Brückner
Piyush Jain1, Mihir T Kothari2, Vaibhav Gode3
1Department of Pediatric Community Ophthalmology, Pediatric Ophthalmology Brigade of , Jyotirmay Eye Clinic, Ocular Motility Lab and Pediatric Low Vision Center, Thane, Maharashtra, India.
Insights
Pediatricians can effectively screen for childhood refractive errors using the enhanced Brückner test (EBT). Their results closely match those of pediatric ophthalmologists, aiding early detection of ametropia.
Area of Science:
- Ophthalmology
- Pediatrics
- Public Health
Background:
- Refractive errors are a common cause of visual impairment in children.
- Early detection and intervention are crucial for optimal visual development.
- The enhanced Brückner test (EBT) offers a potential method for opportunistic screening.
Purpose of the Study:
- To compare the diagnostic accuracy of the enhanced Brückner test (EBT) when performed by a pediatrician versus a pediatric ophthalmologist.
- To evaluate the feasibility of pediatrician-led EBT for detecting ametropia in school-aged children.
Main Methods:
- A prospective, double-masked cohort study involving 118 children (236 eyes).
- A pediatrician and a pediatric ophthalmologist independently performed the EBT under semi-dark conditions.
- Results were compared using Bayesian analysis and kappa statistics, with ophthalmologist findings as the gold standard.
Main Results:
- The EBT was performed in under 10 seconds per child.
- The pediatrician demonstrated high sensitivity (90.2%) and specificity (97.7%) in detecting ametropia.
- Excellent clinical agreement (kappa = 0.9) was observed between the pediatrician and the pediatric ophthalmologist.
Conclusions:
- Pediatrician-performed EBT yields results comparable to those of experienced pediatric ophthalmologists.
- Opportunistic EBT screening by pediatricians is a valuable strategy for identifying refractive errors in children.
- This approach supports early detection and management of childhood ametropia.
Aim:
The aim of this study was to compare the results of enhanced Brückner test (EBT) performed by a pediatrician and an experienced pediatric ophthalmologist.
Subjects And Methods:
In this prospective double-masked cohort study, a pediatrician and a pediatric ophthalmologist performed the EBT in a classroom of a school in semi-dark lighting condition using a direct ophthalmoscope. The results of the test were compared using 2 × 2 Bayesian table and kappa statistics. The findings of the pediatric ophthalmologists were considered gold standard.
Results:
Two hundred and thirty-six eyes of 118 subjects, mean age 6.8 ± 0.5 years (range, 5.4-7.8 years), were examined. The time taken to complete this test was <10 s per subject. The ophthalmologist identified 59 eyes as ametropic (12 hyperopic and 47 myopic eyes) and 177 as emmetropic compared to 61 eyes as ametropic and 175 emmetropic by pediatrician. The prevalence of the test positive was 25.9%. The sensitivity of the pediatrician was 90.2%, specificity was 97.7%, predictive value of the positive test was 93.2%, and predictive value of the negative test was 96.6%. The clinical agreement (kappa) between the pediatric ophthalmologist and the pediatrician was 0.9.
Conclusion:
The results of the EBT performed by pediatrician were comparable to that of an experienced pediatric ophthalmologist. Opportunistic screening of refractive errors using EBT by a pediatrician can be an important approach in the detection of ametropia in children.
