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Screening for amblyopia in preverbal children with photoscreening photographs. National Children's Eye Care
P Y Tong1, E Enke-Miyazaki, R E Bassin
1Wilmer Eye Institute and the Department of Molecular Biology and Genetics, Johns Hopkins University, Baltimore, Maryland, USA.
Insights
Healthcare professionals and volunteers showed inconsistent ability to interpret photoscreening images for pediatric vision screening. Improved training and guidelines are needed for the Medical Technology Innovations (MTI) photoscreener to be effective.
Area of Science:
- Ophthalmology
- Pediatric Vision Screening
Background:
- Pediatric vision screening is crucial for early detection of eye conditions.
- Photoscreening offers a potential method for widespread vision screening in young children.
Purpose of the Study:
- To evaluate the ability of healthcare professionals and lay volunteers to interpret photoscreening images.
- To assess the accuracy of photoscreening interpretation for pediatric eye conditions.
Main Methods:
- A cross-sectional study involving 100 children aged 3 years or younger.
- Photos were taken using the Medical Technology Innovations (MTI) photoscreener.
- Eighteen volunteers with varying expertise graded the photographs for vision abnormalities.
Main Results:
- Grader sensitivity ranged from 37% to 88%, and specificity ranged from 40% to 88%.
- No single grader achieved both sensitivity and specificity above 70%.
- Interpretation accuracy was not correlated with the grader's ophthalmologic knowledge.
Conclusions:
- Significant variability in grading suggests issues with interpretation skills or screening guidelines.
- The MTI photoscreener requires enhanced interpretation training to improve its utility.
- Further development is needed for off-axis photoscreening to become a reliable vision-screening tool.
Objective:
This study aimed to determine the ability of healthcare professionals and lay volunteers to grade photoscreening photographs.
Design:
The study design was a cross-sectional study.
Participants And Intervention:
One hundred children 3 years of age or younger received a complete ophthalmologic examination and were photographed using the Medical Technology Innovations (MTI) photoscreener. Twenty-six children had normal examination results, and the remaining 74 children had conditions that are of interest for pediatric screening, including strabismus, refractive error, media opacities, and ptosis. Eighteen volunteers, including pediatric ophthalmologists, pediatricians, ophthalmic technicians, health department nurses, Prevention of Blindness Society personnel, and Lions Club volunteers, graded each of the 100 photoscreening photographs.
Main Outcome Measures:
Sensitivity and specificity of vision screening and of photograph grading were measured.
Results:
Results from various graders yielded sensitivities ranging from 37% to 88% and specificities ranging from 40% to 88%. No single grader achieved sensitivity and specificity both greater than 70%. The grading of the manufacturer's representative had a sensitivity of 43% and a specificity of 85%. Sensitivity decreased to 31% for strabismus and 18% for refractive error when the correct type of strabismus or refractive error was required to be considered true-positives. Results were not positively correlated with the ophthalmologic knowledge of the participant.
Conclusions:
The wide variability in sensitivities and specificities among graders indicates inconsistent photograph interpretation skills or deficient screening guidelines or both. For off-axis photoscreening as implemented by the MTI system to become a useful vision-screening method, additional photograph interpretation skill transfer may be beneficial, although not necessarily sufficient.
