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Community based vision screening in preschool children; performance of the Spot Vision Screener and optotype testing
Vishal Kapoor1,2, Shaheen P Shah1,3, Timothy Beckman1,3
1Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Australia.
Insights
Comparing vision screening methods for preschool children, this study found that combining the Spot Vision Screener (SVS) and nurse-administered visual acuity screen (NVAS) offers the highest accuracy in detecting vision problems. Relying on a single method risks missing children needing ophthalmic intervention.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Public Health Screening
Background:
- Children's vision screening commonly employs optotype-based visual acuity or instrument-based methods for amblyogenic risk factors (ARFs).
- Early detection of vision issues in children is crucial for preventing long-term visual impairment.
Purpose of the Study:
- To compare the diagnostic performance of the Spot Vision Screener (SVS) and nurse-administered visual acuity screen (NVAS).
- To evaluate the effectiveness of these methods in identifying ARFs and decreased visual acuity in preschool children.
Main Methods:
- A prospective, population-based study involving 2237 preschool children in Australia.
- Children underwent both SVS and NVAS screening.
- Abnormal results from either screen, plus a random sample of normal results, were followed up with a tertiary pediatric ophthalmology assessment.
Main Results:
- 6.4% of children failed SVS and 8.3% failed NVAS, with a 3.8% overlap.
- The positive predictive value (PPV) for SVS was 70.4% and for NVAS was 60.5%.
- A combined 'hybrid' method of SVS and NVAS achieved the highest PPV (91.0%) but risked missing some cases if used alone.
Conclusions:
- This is the first population-based study comparing the diagnostic accuracy of NVAS and SVS in preschoolers.
- Approximately 1 in 10 preschool children failed at least one screening test.
- Utilizing only one screening method may lead to missing children requiring essential ophthalmic intervention.
Background:
Children's vision screening children commonly uses optotype-based visual acuity or instrument-based methods measuring amblyogenic risk factors (ARFs).
Objective:
To compare the performance of the Spot Vision Screener (SVS) (PediaVision, Welch Allyn, NY) and a nurse-administered visual acuity screen (NVAS) in identifying ARFs and decreased visual acuity.
Methods:
A prospective, cross-sectional population-based study of preschool children in South-East Queensland, Australia. Eligible participants had both forms of screening by trained community nurses. All children with an abnormal result by either method as well as a cohort of randomly selected children who passed both assessments were assessed at a tertiary paediatric ophthalmology clinic.
Results:
Over a 10 month period, 2237 children (mean age; 64.4 ± 4.0 months) were screened from 38 schools. 6.4% of children failed SVS and 8.3% failed NVAS (with 3.8% overlap, failing both). The positive predictive value (PPV) in identifying either ARFs and/or reduced VA for the SVS and NVAS was 70.4% (95% Confidence Interval (CI): 61.6%-78.2%) and 60.5% (95% CI: 52.6%-67.9%) respectively. Highest PPV to detect either ARFs and/or reduced VA was achieved by a 'hybrid' method by combining failed NVAS and failed SVS: 91.0% (95% CI: 82.4 to 96.3) but this would risk children with sight impairment being missed in the community.
Conclusion:
To our knowledge, this is the first population-based study providing detailed comparative measures of diagnostic accuracy for NVAS and SVS in preschool children. One in ten preschool children failed one or both screens. A number of children who required ophthalmic intervention were missed if only one screening method was utilized.
