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Photorefraction with Spot Vision Screener versus Visual Acuity Testing as Community-Based Preschool Vision Screening
Toshihiko Matsuo1,2, Chie Matsuo1, Masami Kayano3
1Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama 700-8558, Japan.
Insights
Photorefraction screening in 3.5-year-old children detected more eye diseases than visual acuity testing alone. Home visual acuity testing remains essential for comprehensive pediatric vision screening.
Area of Science:
- Ophthalmology
- Pediatric Health
- Vision Science
Background:
- Community-based vision screening is crucial for early detection of eye diseases in young children.
- Current Japanese screening involves questionnaires, home visual acuity testing, and health center assessments.
- The efficacy of incorporating photorefraction into existing screening protocols needs evaluation.
Purpose of the Study:
- To assess if photorefraction using a Spot vision screener improves eye disease detection in 3.5-year-old children compared to visual acuity testing.
- To determine if photorefraction could potentially replace traditional visual acuity testing in screening programs.
Main Methods:
- Photorefraction was performed on 813 children aged 3.5 years, alongside standard visual acuity testing.
- Children failing either the Spot vision screener or visual acuity test (0.5 acuity) were referred for tertiary examination.
- Referral criteria included failure in either eye to pass 0.5 visual acuity.
Main Results:
- Photorefraction screening identified additional cases of treatable eye diseases, including amblyopia and accommodative esotropia.
- Children failing both photorefraction and visual acuity tests had the highest rate of detected diseases (66%).
- Photorefraction alone identified more cases (28%) than visual acuity testing alone (18%).
Conclusions:
- Integrating photorefraction with visual acuity testing enhances the detection of critical eye conditions in young children.
- Home-based visual acuity testing should be retained even when photorefraction is introduced.
- Photorefraction offers a valuable adjunct to current pediatric vision screening methods.
Abstract:
Nationwide in Japan, a community-based vision-screening program in 3.5-year-old children is conducted in three steps: questionnaires and home visual acuity testing as the primary screening; visual acuity testing by nurses and pediatricians' inspection in community health centers as the secondary screening; and examinations by ophthalmologists as the tertiary screening. In this study, we introduced photorefraction with a Spot vision screener in addition to visual acuity testing to answer the clinical question of whether photorefraction could better detect eye diseases and potentially replace visual acuity testing. Photorefraction was performed on 813 consecutive 3.5-year-old children in a center. The children were sent to tertiary examinations, which were based on the Spot vision screener standard, in addition to the visual acuity testing standard: failure in either eye to pass 0.5 visual acuity in a center. A notice to visit ophthalmologists was issued for 95 children (11%), and documents with the diagnosis were sent back to the Heath Office for 76 children (80%). The rate of children with anisometropic or ametropic amblyopia or accommodative esotropia as treatment-requiring diseases was highest in cases of no pass at both standards (10/15 = 66%), and higher in cases of no pass only at the Spot vision screener standard (13/45 = 28%), compared with cases of no pass only at the visual acuity testing standard (6/33 = 18%, p = 0.0031). Photorefraction, in addition to visual acuity testing and inspection led to additional eye diseases detection at 3.5 years. Visual acuity testing at home would not be omitted in the introduction of photorefraction.
