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Dimensional vision screening in preschool children: The Vision study
R Adrar1, A Bourmaud2, D Benni2
1Hôpital universitaire pédiatrique CHU Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Hôpitaux pédiatriques de Nice, Fondation Lenval, 57, avenue de la Californie, 06200 Nice, France.
Insights
The French Association of Strabismology and Pediatric Ophthalmology (AFSOP) vision screening protocol is feasible and shows high sensitivity for detecting amblyopia in preschool children. Further research is needed to improve its specificity and reduce referral rates.
Area of Science:
- Ophthalmology
- Pediatric Health
- Public Health
Background:
- Amblyopia is a significant cause of childhood visual impairment.
- France lacks a national vision screening program for children.
- The French Association of Strabismology and Pediatric Ophthalmology (AFSOP) developed guidelines for preschool vision screening.
Purpose of the Study:
- To assess the feasibility of the AFSOP vision screening protocol.
- To evaluate the performance of the AFSOP protocol compared to the PARIS protocol.
- To determine the sensitivity and specificity of the AFSOP protocol.
Main Methods:
- Prospective, interventional, comparative feasibility study.
- Cluster randomization comparing AFSOP protocol to PARIS school health service protocol.
- Sensitivity measured against ophthalmologic examination with cycloplegia (gold standard).
Main Results:
- Ninety-five preschool children participated (50 AFSOP, 45 PARIS).
- AFSOP protocol demonstrated higher sensitivity (90%) compared to PARIS (62%).
- The AFSOP protocol resulted in a 58% referral rate.
Conclusions:
- The AFSOP 3D visual screening protocol is feasible and highly sensitive.
- Specificity is a limitation, leading to a high referral rate.
- Adjusting visual acuity thresholds may enhance specificity; larger studies are recommended.
Introduction:
Amblyopia can be a cause of visual impairment in children. There is no nationally organized vision screening for children in France. The French Association of Strabismology and Pediatric Ophthalmology (AFSOP) has published guidelines for vision screening in preschool children. Our study aims to evaluate the feasibility and performance of the AFSOP vision screening protocol.
Methods:
This was an interventional prospective feasibility and comparative study with a cluster randomization of the AFSOP vision screening protocol compared to the PARIS school health service protocol for preschool children. The main outcome measure was sensitivity compared to ophthalmologic examination with cycloplegia (gold standard).
Results:
Ninety-five preschool children were included - 50 in the AFSOP protocol and 45 in the PARIS protocol. Sensitivity was higher in the AFSOP protocol (90% vs. 62%). Referral rate was 58% in the AFSOP group protocol.
Conclusion:
AFSOP 3-dimensional visual screening is feasible with a high sensitivity. The main limitation is the specificity, resulting in a high referral rate. Revision of visual acuity thresholds would appear to be a way to improve specificity. Visual acuity screening is encouraged in recent French health policies. Larger studies might assist in refining performance and thresholds.
