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Effectiveness of the Spot Vision Screener using updated 2021 AAPOS guidelines
Mae Millicent W Peterseim1, Rupal H Trivedi1, Savannah Reaves Monahan1
1Medical University of South Carolina, Charleston, South Carolina.
Insights
The Spot Vision Screener shows good overall performance for pediatric vision screening. Adjusting referral criteria for astigmatism and anisometropia can improve sensitivity according to updated guidelines.
Area of Science:
- Ophthalmology
- Pediatric Vision Screening
- Diagnostic Instrument Validation
Background:
- Accurate pediatric vision screening is crucial for early detection of visual impairments.
- The American Academy of Pediatric Ophthalmology and Strabismus (AAPOS) provides updated guidelines for vision screening.
- Instrument-based screeners require validation against current standards.
Purpose of the Study:
- To evaluate the Spot Vision Screener's performance based on the 2021 AAPOS Vision Screening Committee guidelines.
- To assess the device's effectiveness in identifying amblyopia risk factors and refractive errors in children.
Main Methods:
- A prospective study screened 1,090 children using the Spot Vision Screener.
- Screening results were compared to gold standard comprehensive eye examinations.
- Sensitivity, specificity, and receiver operating characteristic (ROC) analysis were performed.
Main Results:
- The Spot Vision Screener achieved 95% successful screening in children.
- Overall sensitivity was 0.88 and specificity was 0.78.
- Performance varied for specific refractive errors, with moderate-to-poor sensitivity for hyperopia, anisometropia, and astigmatism, but excellent specificity.
Conclusions:
- The Spot Vision Screener demonstrates good overall predictive ability for pediatric vision screening.
- Recommendations include adjusting referral criteria for astigmatism (to 2 D) and anisometropia (to 0.75 D) to enhance screening effectiveness.
- Optimizing these criteria aligns the device with updated AAPOS guidelines.
Purpose:
To evaluate the Spot Vision Screener according to updated 2021 AAPOS Vision Screening Committee guidelines for instrument-based pediatric vision screen validation.
Methods:
As part of an IRB-approved ongoing prospective study, children were screened with the Spot prior to a complete examination.
Results:
Spot screening was successful in 1,036 of 1,090 children (95%). Forty-eight percent of participants were referred for further screening using the Spot manufacturer guidelines, and 40% of all children were found to have a 2021 amblyopia risk factor or visually significant refractive error by gold standard examination. The Spot recommendation compared reasonably well to the 2021 criteria, with an overall sensitivity of 0.88 and a specificity of 0.78. Applying updated guidelines to the Spot for hyperopia, anisometropia, and astigmatism yielded moderate-to-poor sensitivity (0.27-0.77) but excellent specificity (>0.9). The area under the curve of the receiver operating characteristic analysis demonstrates overall good prediction performance for the Spot for each diagnosis-myopia, hyperopia, astigmatism, anisometropia (range, 0.87-0.97). Results of our study suggest increasing the instrument referral criterion for astigmatism from 1.5 D (manufacturer thresholds of the screener used in this study) to 2 D in older children. Decreasing the anisometropia cut-off from 1 D to 0.75 D would improve sensitivity from 0.59 to >0.8.
Conclusions:
In our study population, the overall predictive ability of the Spot is good, with a sensitivity of 0.88 and a specificity of 0.78. We recommend specific device refractive referral criteria to maximize screening effectiveness using the updated AAPOS guidelines.
