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Spot Refractive Screening With or Without Maximum Atropine Cycloplegia in Preschool Chinese Children
Insights
The Spot Vision Screener underestimates hyperopia in preschool children without cycloplegia, requiring adjusted screening criteria for accurate refractive error detection. This impacts anisometropia screening in this age group.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Vision Screening Technology
Background:
- Accurate refractive error assessment in preschool children is crucial for early intervention.
- The Spot Vision Screener is a non-contact device used for vision screening.
- Cycloplegia is often used to achieve accurate refractive measurements in children.
Purpose of the Study:
- To evaluate the accuracy of the Spot Vision Screener for refractive screening in preschool Chinese children.
- To compare screening results with and without maximal atropine cycloplegia.
- To assess the device's effectiveness in detecting refractive errors, including anisometropia and hyperopia.
Main Methods:
- 450 preschool children (3-6 years) underwent refractive error measurement using cycloplegic retinoscopy (gold standard).
- The Spot Vision Screener was used for examination before and after cycloplegia.
- Statistical analysis included Wilcoxon test, Bland-Altman plots, and ROC curve analysis.
Main Results:
- Without cycloplegia, the Spot Vision Screener significantly underestimated spherical values (median difference: 1.50 D) and spherical equivalent (median difference: 1.56 D).
- For hyperopia >3.00 D, the underestimation was more pronounced (median difference: 2.63 D).
- Bland-Altman plots indicated substantial differences between methods; optimized criteria improved sensitivity.
Conclusions:
- The Spot Vision Screener is effective for anisometropia detection in Chinese preschoolers.
- The device underestimates hyperopia without cycloplegia, with discrepancies increasing with hyperopic levels.
- Referral criteria require adjustment for clinical practice, necessitating expert guidance.
Purpose:
To evaluate averaged, repeat Spot Vision Screener (Welch Allyn) refractive screening with and without maximal atropine cycloplegia in preschool Chinese children.
Methods:
Refractive errors of 450 preschool children aged 3 to 6 years were measured by cycloplegic retinoscopy as the gold standard. The Spot Vision Screener was used to examine the refractive errors of these children before and after cycloplegia. The differences between the two methods were assessed using the Wilcoxon test and Bland-Altman plot. The accuracy of the Spot Vision Screener in detecting refractive errors was evaluated by receiver operating characteristic curve analysis.
Results:
Before cycloplegia, the Spot Vision Screener provided statistically significantly lower values of sphere (median difference: 1.50 diopters [D], 95% CI: 1.38 to 1.63 D) and spherical equivalent (median difference: 1.56 D, 95% CI: 1.50 to 1.69 D). For hyperopia of greater than 3.00 D spherical value (n = 118), the median difference between the Spot Vision Screener and cycloplegic retinoscopy was 2.63 D (95% CI: 2.50 to 2.88 D). The Bland-Altman plot showed that the difference between the results of the two examination methods was large. The sensitivity of the Spot Vision Screener for detecting refractive errors increased after the screening criteria were optimized.
Conclusions:
The Spot Vision Screener was efficient in detecting anisometropia in Chinese preschool children. The Spot Vision Screener without cycloplegia underestimated the spherical value of hyperopia and the difference was larger when the cycloplegic hyperopia increased. The performance of the Spot Vision Screener without cycloplegia in detecting cycloplegic hyperopia was not complete. The instrument referral criteria of the Spot Vision Screener should be adjusted according to clinical practice, but it is not simple and users should do it with expert assistance. [.
