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Detection of Significant Hyperopia in Preschool Children Using Two Automated Vision Screeners
Maureen G Maguire, Gui-Shuang Ying1, Elise B Ciner2
1Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
Automated vision screening devices show varying accuracy in detecting significant hyperopia in preschoolers. The Retinomax Autorefractor demonstrated higher sensitivity than the Power Refractor II, highlighting the need to consider device performance in screening programs.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Vision Science
Background:
- Moderate to high uncorrected hyperopia in preschoolers is linked to amblyopia, strabismus, and reduced literacy.
- Early detection of significant hyperopia is crucial for timely ophthalmic and educational interventions.
Purpose of the Study:
- To compare the sensitivity and specificity of two automated screening devices for identifying moderate to high hyperopia in preschool children.
- Evaluate the effectiveness of the Retinomax Autorefractor and Plusoptix Power Refractor II in preschool vision screening.
Main Methods:
- Children in the Vision in Preschoolers (VIP) study were screened using the Retinomax Autorefractor and Plusoptix Power Refractor II.
- Cycloplegic retinoscopy defined significant hyperopia (>4.00 D for 36-48 months, >3.50 D for >48 months).
- Referral criteria from VIP and a distributor (PediaVision) were applied to device screening results.
Main Results:
- The Retinomax Autorefractor achieved 80.3% sensitivity for significant hyperopia versus 69.7% for the Power Refractor II (VIP criteria).
- Specificities were comparable (89.9% for Retinomax, 89.1% for Power Refractor II).
- Using PediaVision criteria, the Power Refractor II had 84.9% sensitivity but lower specificity (78.3%).
Conclusions:
- Automated devices for preschool vision screening must be carefully evaluated for their potential to miss hyperopia or generate false positives.
- Device selection and referral criteria impact the effectiveness of automated hyperopia screening in young children.
Significance:
Moderate to high uncorrected hyperopia in preschool children is associated with amblyopia, strabismus, reduced visual function, and reduced literacy. Detecting significant hyperopia during screening is important to allow children to be followed for development of amblyopia or strabismus and implementation of any needed ophthalmic or educational interventions.
Purpose:
This study aimed to compare the sensitivity and specificity of two automated screening devices to identify preschool children with moderate to high hyperopia.
Methods:
Children in the Vision in Preschoolers (VIP) study were screened with the Retinomax Autorefractor (Nikon, Inc., Melville, NY) and Plusoptix Power Refractor II (Plusoptix, Nuremberg, Germany) and examined by masked eye care professionals to detect the targeted conditions of amblyopia, strabismus, or significant refractive error, and reduced visual acuity. Significant hyperopia (American Association for Pediatric Ophthalmology and Strabismus definition of hyperopia as an amblyopia risk factor), based on cycloplegic retinoscopy, was >4.00 D for age 36 to 48 months and >3.50 D for age older than 48 months. Referral criteria from VIP for each device and from a distributor (PediaVision) for the Power Refractor II were applied to screening results.
Results:
Among 1430 children, 132 children had significant hyperopia in at least one eye. Using the VIP referral criteria, sensitivities for significant hyperopia were 80.3% for the Retinomax and 69.7% for the Power Refractor II (difference, 10.6%; 95% confidence interval, 7.0 to 20.5%; P = .04); specificities relative to any targeted condition were 89.9 and 89.1%, respectively. Using the PediaVision referral criteria for the Power Refractor, sensitivity for significant hyperopia was 84.9%; however, specificity relative to any targeted condition was 78.3%, 11.6% lower than the specificity for the Retinomax. Analyses using the VIP definition of significant hyperopia yielded results similar to when the American Association for Pediatric Ophthalmology and Strabismus definition was used.
Discussion:
When implementing vision screening programs for preschool children, the potential for automated devices that use eccentric photorefraction to either miss detecting significant hyperopia or increase false-positive referrals must be taken into consideration.
