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Agreement between the Spot Vision Screener and cycloplegic retinoscopy for toddlers with astigmatism
J Daniel Twelker1, Andrew W Arthur2, Rita Bhakta1
1University of Arizona, Tucson, Arizona; Banner University Medical Center, Tucson, Arizona.
Insights
The Spot Vision Screener may under-refer hyperopia and over-refer astigmatism in young children compared to cycloplegic retinoscopy. This screening tool requires careful consideration for accurate pediatric eye care referrals.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Vision Screening Technology
Background:
- Investigated agreement between Spot Vision Screener and cycloplegic retinoscopy in infants/toddlers.
- Focused on accuracy for astigmatism detection.
Purpose of the Study:
- Evaluate the diagnostic accuracy of the Spot Vision Screener.
- Compare Spot Vision Screener results against the gold standard (cycloplegic retinoscopy).
- Assess implications for pediatric eye care referrals.
Main Methods:
- Included 410 children aged 12-35 months.
- Participants failed initial Spot screening and underwent cycloplegic retinoscopy.
- Analyzed spherical equivalent and astigmatism (cylinder) measurements.
Main Results:
- Spot Vision Screener showed significantly less hyperopic spherical equivalent (+0.35 D) vs. retinoscopy (+0.80 D).
- Spot Vision Screener reported significantly higher cylinder (1.84 D) vs. retinoscopy (1.58 D).
- Discrepancies exceeded clinically significant levels (>0.50 D sphere, >1.00 D cylinder) in a substantial proportion of participants.
Conclusions:
- Spot Vision Screener may lead to under-referral for hyperopia.
- Potential for over-referral for astigmatism using 2013 criteria.
- Highlights need for careful interpretation of screening results in young children.
Background:
We investigated the agreement between the Spot Vision Screener (Welch Allyn) and gold standard cycloplegic retinoscopy in infants and toddlers, with special attention to astigmatism.
Methods:
Participants were children 12-35 months of age who failed a routine photoscreening using the Spot conducted at a recent well-child visit and who subsequently received a cycloplegic eye examination through the Spectacle Prescribing in Early Childhood Study (SPECS).
Results:
The final sample included 410 children, with an average age of 20.24 months. The Spot mean spherical equivalent value (M) was significantly less hyperopic than cycloplegic retinoscopy M (+0.35 D vs +0.80 D, t[409] < 0.001), and mean Spot Vision Screener cylinder (CYL) was significantly higher than cycloplegic retinoscopy CYL (1.84 D. vs 1.58 D, t[409] < 0.001).
Conclusions:
Cycloplegic retinoscopy found more hyperopic, or conversely, less myopic sphere power, in 60% of participants at the clinically significant level of >0.50 D. When using the Spot, this could result in under-referral to an eye care professional for moderate to high hyperopia. About 1 in 4 subjects showed higher clinically significant cylinder (>1.00 D) using the Spot compared with cycloplegic retinoscopy, which could result in over-referral for astigmatism when using the 2013 criteria for astigmatism.
