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Pinhole does not increase screening accuracy of detecting decreased best corrected visual acuity in schoolchildren
Weiwei Chen1, Jing Fu2, Ali Sun1
1Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, No.1 Dong Jiao Min Xiang, Beijing, 100730, China.
Insights
Vision screening in schoolchildren is crucial for early detection of decreased visual acuity. The Lea Symbols chart demonstrated higher accuracy than the Tumbling E chart for screening, with pinhole correction not improving results.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Public Health
Background:
- Early detection and treatment of decreased visual acuity in children are vital.
- Vision screening in schoolchildren is an effective strategy, especially in developing nations.
- Evaluating the accuracy of different visual acuity tests is key for effective screening programs.
Purpose of the Study:
- To assess the screening accuracy of uncorrected (UCVA) and pinhole-corrected (PCVA) visual acuity using Tumbling E and Lea Symbols charts.
- To compare the effectiveness of these tests in detecting decreased best-corrected visual acuity (BCVA) in schoolchildren.
Main Methods:
- Retrospective review of data from 1672 first-grade schoolchildren in urban Lhasa.
- Analysis included UCVA and PCVA with Tumbling E and Lea Symbols charts, and BCVA with Lea Symbols.
- Decreased BCVA was defined as BCVA ≤ 20/32 (≥ 0.2 logMAR). Diagnostic parameters were analyzed.
Main Results:
- The prevalence of decreased BCVA was 6.8%.
- Lea Symbols chart demonstrated superior screening accuracy (AUC 0.95 for UCVA, 0.93 for PCVA) compared to Tumbling E chart (AUC 0.78 for UCVA, 0.76 for PCVA).
- Pinhole correction did not significantly improve screening accuracy for either chart.
Conclusions:
- Pinhole correction does not enhance the screening accuracy for decreased BCVA in young schoolchildren.
- The Lea Symbols chart is more effective than the Tumbling E chart for vision screening in this age group.
Background:
Decreased best corrected visual acuity among children should be treated early in life, and vision screening in schoolchildren is an efficient and feasible selection for developing countries. Thus, the screening accuracy of different visual acuity tests is the key point for making vision screening strategies. The present study aims to explore the screening accuracy of uncorrected visual acuity (UCVA) and pin-hole corrected visual acuity (PCVA) using different vision chart in the detection of decreased best-corrected visual acuity (BCVA) among schoolchildren.
Methods:
Grade one primary schoolchildren in urban Lhasa with data of UCVA using tumbling E chart (UCVAE), PCVA using tumbling E chart (PCVAE), UCVA using Lea Symbols chart (UCVAL), PCVA using Lea Symbols chart (PCVAL) and BCVA using Lea Symbols chart were reviewed. Decreased BCVA was defined as BCVA≤20/32(≥0.2 logMAR). Difference, reliability, and diagnostic parameters in the detection of decreased BCVA of different visual acuity results were analyzed.
Results:
Overall, 1672 children aged 6.58 ± 0.44 years fulfilling the criteria. The prevalence of decreased BCVA was 6.8%. Although no significant differences were found between UCVAE vs UCVAL (p = .84, paired t-test) as well as PCVAE vs PCVAL (p = .24), the ICC between them was low (0.68 and 0.57, respectively). The average difference between BCVA and UCVAE, UCVAL, PCVAE, PCVAL was logMAR -0.08 (- 0.37, 0.21), - 0.08 (- 0.29, 0.17), - 0.05 (- 0.30, 0.19), - 0.06 (- 0.23, 0.12) using Bland-Altman method. The area under the receiver operating characteristic curve of UCVAE, PCVAE, UCVAL, PCVAL for the detection of decreased BCVA was 0.78 (0.73, 0.84), 0.76 (0.71, 0.82), 0.95 (0.94, 0.96), 0.93 (0.91, 0.95), respectively.
Conclusion:
Pinhole does not increase the screening accuracy of detecting decreased BCVA in grade one primary schoolchildren. Visual acuity test using Lea Symbols is more efficient than Tumbling E in the screening of that age.
Trial Registration:
Data were maily from the Lhasa Childhood Eye Study which has finished the clinical registration on ( ChiCTR1900026693 ).
