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Ghadimi H, Nikdel M, Suh DW. Comparison of photorefraction by Plusoptix A12 and cycloplegic autorefraction in children. BMC Ophthalmol 2024; 24:179. [PMID: 38641836 PMCID: PMC11027537 DOI: 10.1186/s12886-024-03459-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/17/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Plusoptix photoscreeners are capable of measuring refractive errors of children from 1 meter distance, without cyloplegia. We aimed to compare refractive data obtained from the newest version of Plusoptix (model 12) with cycloplegic autorefraction. METHODS We examined 111 consecutive children aged 3-7 years first by Plusoptix A12C under manifest condition and subsequently for cycloplegic refraction by Topcon KR-1 tabletop autorefractometer. Sphere, spherical equivalent, cylinder and axis of astigmatism measured by the two methods were analyzed to determine correlation, agreement and differences. RESULTS Binocular examination of 111 children aged 4.86±1.27 years revealed good agreement between refractive data obtained by Plusoptix and cycloautorefraction, according to Bland-Altman plots. Significant (p < 0.001) and strong correlation was found between all refractive measurements (Pearson's r value of 0.707 for sphere, 0.756 for pherical equivalent, and 0.863 for cylinder). Plusoptix mean sphere, spherical equivalent and cylinder were 1.22, 0.56, and -1.32 D, respectively. Corresponding values for cycloautorefraction were 1.63, 1.00, and -1.26 D. The difference between axis of cylinder measured by the two methods was < 10° in 144 eyes (64.9%). CONCLUSIONS Considering the significant agreement and correlation between Plusoptix photoscreener and cycloplegic autorefraction, the need for cycloplegic drops in refractive examination of children may be obviated. The mean difference between cylinder measurements are considerably trivial (0.06 D), but sphere is approximately 0.4 D underestimated by Plusoptix compared to cycloautorefraction, on average.
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Affiliation(s)
- Hadi Ghadimi
- Private Ophthalmology Practice, Atieh Medical Center, Rasht, 4144694198, Guilan, Iran
| | - Mojgan Nikdel
- Private Ophthalmology Practice, Atieh Medical Center, Rasht, 4144694198, Guilan, Iran.
| | - Donny W Suh
- Department of Ophthalmology and Visual Science, Gavin Herbert Eye Institute, University of California at Irvine, Irvine, CA, USA
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Guimaraes S, Vieira MJ, Boas JMV. Predicting myopic changes in children wearing glasses using the Plusoptix photoscreener. Int Ophthalmol 2024; 44:84. [PMID: 38363427 PMCID: PMC10873442 DOI: 10.1007/s10792-024-02954-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 12/04/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION With high increase in myopia prevalence, we aimed to assess whether Plusoptix_A09 can be used in myopic children over spectacles to predict visual acuity (VA) and myopic refraction changes. METHODS Myopic children underwent a complete ophthalmological examination. Plusoptix_A09 was performed over spectacles. VA changes, refraction changes and time since previous glasses prescription, were determined. Age, current or past history of amblyopia, presence of strabismus and self-perception of VA changes were registered. RESULTS In total, 199 patients were included. Spherical power (SP) and spherical equivalent (SE) measured by Plusoptix_A09 over spectacles predicted both VA changes (p < 0.001) and refraction changes (p < 0.001). Values of SP < - 0.06D or SE < - 0.22D indicated a VA decrease (AUC > 0.9, p < 0.01) for sensitivity and specificity of 85.1%, 82.1% and 82.6%, 83.3%, respectively. Age and ophthalmological comorbidities did not influence Plusoptix_A09 measurements (p > 0.05). Plusoptix_A09 over spectacles was a stronger predictor of VA changes when compared to children's self-perception, either in 4-9-year-old patients (p < 0.001 versus p = 0.628) and in 10-18-year-old children (OR < = 0.066 versus OR = 0.190). A decrease in SP and SE of - 0.10D in Plusoptix_A09 predicted a myopia progression of - 0.04D and - 0.05D, respectively. CONCLUSION/RELEVANCE This study unveiled new features for the Plusoptix, a worldwide available photoscreener used in amblyopia screening. When Plusoptix is performed in children with their glasses on, it can rapidly predict myopia progression. For each decrease of - 0.10D in Plusoptix, a myopia progression of -0.05D is expected. Moreover, Plusoptix is more reliable than children's self-perception of visual acuity changes, making it a useful tool either in primary care or ophthalmology practice.
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Affiliation(s)
- Sandra Guimaraes
- FP-I3ID (Instituto de Investigação, Inovação e Desenvolvimento da Universidade Fernando Pessoa), Porto, Portugal.
- HE-UFP (Hospital-Escola da Universidade Fernando Pessoa), Av. Fernando Pessoa 150, São Cosme, 4420-096, Portugal.
- FCS-UFP (Faculdade de Ciências da Saúde da da Universidade Fernando Pessoa), Porto, Portugal.
| | - Maria João Vieira
- HE-UFP (Hospital-Escola da Universidade Fernando Pessoa), Av. Fernando Pessoa 150, São Cosme, 4420-096, Portugal
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Alvarez M, Benedi-Garcia C, Concepcion-Grande P, Dotor P, Gonzalez A, Chamorro E, Cleva JM. Early Detection of Refractive Errors by Photorefraction at School Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15880. [PMID: 36497952 PMCID: PMC9739333 DOI: 10.3390/ijerph192315880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Early detection and treatment of refractive defects during school age are essential to avoid irreversible future vision loss and potential school problems. Previously, vision screening of preschool children used methods based on subjective visual acuity; however, technologies such as photorefraction have promoted the detection of refractive errors quickly and easily. In this study, 1347 children from 10 schools in Madrid aged 4 to 12 years participated in a program of early detection of visual problems, which consisted of visual screening composed of anamnesis and photorefraction with a PlusOptix A12R. The prevalence of refractive errors was analyzed in terms of spherical equivalent, cylinder and its orientation, and potential cases of development of high myopia or amblyopia. Hyperopia predominates in the early years, but the number of myopic subjects is higher than that of hyperopic subjects from the age of ten onwards. At all ages, the predominant orientation of astigmatism was with-the-rule. On average, 80% of the myopic subjects were uncorrected. Potential high myopia increased with age, from 4 to 21% of the measured population. Potential amblyopia cases decreased across age groups, from 19 to 13.7%. There is a need to raise awareness of the importance of vision screening at school age to address vision problems.
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Wilson S, Ctori I, Shah R, Suttle C, Conway ML. Systematic review and meta-analysis on the agreement of non-cycloplegic and cycloplegic refraction in children. Ophthalmic Physiol Opt 2022; 42:1276-1288. [PMID: 35913773 PMCID: PMC9804580 DOI: 10.1111/opo.13022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine the diagnostic agreement of non-cycloplegic and cycloplegic refraction in children. METHOD The study methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases were searched for comparative studies exploring refraction performed on children under non-cycloplegic and cycloplegic conditions. There was no restriction on the year of publication; however, only publications in the English language were eligible. Inclusion criteria consisted of children aged ≤12 years, any degree or type of refractive error, either sex and no ocular or binocular co-morbidities. The QUADAS-2 tool was used to evaluate the risk of bias. Meta-analysis was conducted to synthesise data from all included studies. Subgroup and sensitivity analyses were undertaken for those studies with a risk of bias. RESULTS Ten studies consisting of 2724 participants were eligible and included in the meta-analysis. The test for overall effect was not significant when comparing non-cycloplegic Plusoptix and cycloplegic autorefractors (Z = 0.34, p = 0.74). The pooled mean difference (MD) was -0.08 D (95% CI -0.54 D, +0.38 D) with a prediction interval of -1.72 D to +1.56 D. At less than 0.25 D, this indicates marginal overestimation of myopia and underestimation of hyperopia under non-cycloplegic conditions. When comparing non-cycloplegic autorefraction with a Retinomax and Canon autorefractor to cycloplegic refraction, a significant difference was found (Z = 9.79, p < 0.001) and (Z = 4.61, p < 0.001), respectively. DISCUSSION Non-cycloplegic Plusoptix is the most useful autorefractor for estimating refractive error in young children with low to moderate levels of hyperopia. Results also suggest that cycloplegic refraction must remain the test of choice when measuring refractive error ≤12 years of age. There were insufficient data to explore possible reasons for heterogeneity. Further research is needed to investigate the agreement between non-cycloplegic and cycloplegic refraction in relation to the type and level of refractive error at different ages.
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Affiliation(s)
- Salma Wilson
- Division of Optometry and Visual Science, CityUniversity of LondonLondonUK
| | - Irene Ctori
- Division of Optometry and Visual Science, CityUniversity of LondonLondonUK
| | - Rakhee Shah
- Division of Optometry and Visual Science, CityUniversity of LondonLondonUK
| | - Catherine Suttle
- Division of Optometry and Visual Science, CityUniversity of LondonLondonUK
| | - Miriam L. Conway
- Division of Optometry and Visual Science, CityUniversity of LondonLondonUK
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Arnold RW. Comparative Validation of PlusoptiX and AI-Optic Photoscreeners in Children with High Amblyopia Risk Factor Prevalence. Clin Ophthalmol 2022; 16:2639-2650. [PMID: 35996434 PMCID: PMC9392476 DOI: 10.2147/opth.s378777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Robert W Arnold
- Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA
- Correspondence: Robert W Arnold, Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, 3500 Latouche Street #280, Anchorage, AK, USA, Tel +19075611917, Fax +19075635373, Email
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Al-Romhein P, Fröhlich M, Schmickler S, Salchow DJ. [Detections of refractive risk factors for amblyopia with Plusoptix Autorefractor A09]. Ophthalmologe 2022; 119:1035-1040. [PMID: 35507085 DOI: 10.1007/s00347-022-01645-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Amblyopia is the most frequent cause for decreased vision in childhood. Important risk factors for amblyopia (ARF) are refractive errors. The aim of this study was to examine the reliability of the Plusoptix Autorefractor A09 (POA09) to detect refractive ARF. METHOD This prospective non-blinded, one-armed study was conducted between February 2012 and September 2015. Children aged 6 months to 12 years were screened in kindergarten and schools for refractive errors. Thresholds for screening failure were hyperopia ≥ 3.5 diopters (D), myopia ≥ 3.0 D, anisometropia ≥ 1.5 D and astigmatism ≥ 1.5 D (axis 90° or 180° ± 10°) or ≥ 1.0 D (≥ 10° axis deviation of 90° or 180°). Children who failed screening were advised to see an ophthalmologist for a comprehensive eye examination. After the visit, parents were asked for the results of the examination. A reference group of children who did not fail screening also received a comprehensive eye examination. Based on the number of children who failed screening, we calculated the proportion of correctly detected refractive errors. Based on the children of the reference group we calculated the proportion of correctly excluded refractive errors and the false negative rate. RESULTS In this study 3170 children were screened, 715 children (22.3%) failed screening. For 460 of these (64.3%) follow-up was available and for 132 children information on refractive errors in cycloplegia was available. Most frequent refractive errors at screening were astigmatism (90.9%) and anisometropia (11.4%). Most frequent refractive errors in cycloplegia were astigmatism (56.8%) and hyperopia (18.9%). The proportion of correctly detected refractive errors in the screening was highest for astigmatism (60%) and anisometropia (53.3%), followed by hyperopia (33.3%) and myopia (25%). CONCLUSION The reliability of POA09 to detect refractive ARF in children without cycloplegia was limited, highlighting the importance of a systematic amblyopia screening. A screening in cycloplegia can increase the proportion of correctly detected refractive ARF and should be studied.
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Affiliation(s)
| | | | | | - Daniel J Salchow
- Klinik für Augenheilkunde, Sektion Kinderaugenheilkunde
- Strabologie/Orthoptik
- Neuroophthalmologie, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
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Guler Alis M, Alis A. Photoscreener results with and without cycloplegia and their reliability according to biometric parameters. J Fr Ophtalmol 2021; 45:65-73. [PMID: 34924211 DOI: 10.1016/j.jfo.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Our goal in this study is to compare the results of a photoscreener (Plusoptix A12C) with and without cycloplegia and to investigate its reliability as a function of biometric parameters. METHODS In total, 250 eyes of 125 children with a mean age of 6.77±1.59years were included in the study. The results of cycloplegic and noncycloplegic Plusoptix A12C measurements and autorefractometer with cycloplegia (CA) were compared. The spherical equivalent (SE) differences between CA and noncycloplegic Plusoptix A12C measurements (NPO) with CA and cycloplegic Plusoptix A12C measurements (CPO) were compared with axial length (AL), anterior chamber depth (ACD), corneal radius of curvature (CR), mean keratometry (meanK) and axial length/corneal radius of curvature ratio (AL/CR) values. The relationships between these were examined. RESULTS According to amblyopia risk factors (ARFs) based on the criteria in the 2013 AAPOS guidelines, 33 eyes (13%) in the NPO results and 34 eyes (13.6%) in the CPO results were found to be at risk for amblyopia. According to the CA results, the NPO had 67.3% sensitivity and 94.5% specificity, and the CPO 69.4% sensitivity and 89.1% specificity in detecting the values of refractive amblyopia factors determined by the AAPOS. In regard to refraction values determined by the AAPOS for amblyopia, according to CA results, the NPO had 71.4% sensitivity and 88.4% specificity in detecting myopia; 33.3% sensitivity and 93.6% specificity in detecting hyperopia; and 79.4% specificity and 71.2% sensitivity in detecting astigmatism. With regard to refraction values determined by the AAPOS for amblyopia, according to CA results, the CPO had 80.9% sensitivity and 90% specificity in detecting myopia; 13.3% sensitivity and 89.2% specificity in detecting hyperopia; and 44.9% sensitivity and 30.8% specificity in detecting astigmatism. When the SE differences between the CA and NPO values were compared with biometric parameters, a negative correlation was observed with ACD, AL, and especially AL/CR ratio. CONCLUSION Both the NPO and CPO showed moderate sensitivity and high specificity in detecting ARFs based on the criteria in the 2013 AAPOS guidelines. Sensitivity for detecting hyperopic risk factors was lower than for myopia and astigmatism. The CPO has no additional clinical advantage. A negative correlation was found between biometric parameters and NPO results. Thus, the NPO is more reliable in myopic children with higher axial lengths, deeper anterior chambers, and increased AL/CR ratios.
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Affiliation(s)
- M Guler Alis
- Fatih Sultan Mehmet Training and Research Hospital, Atasehir, Istanbul, Turkey.
| | - A Alis
- Fatih Sultan Mehmet Training and Research Hospital, Atasehir, Istanbul, Turkey
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Guimaraes S, Soares A, Freitas C, Barros P, Leite RD, Costa PS, Silva ED. Amblyopia screening effectiveness at 3-4 years old: a cohort study. BMJ Open Ophthalmol 2021; 6:e000599. [PMID: 33437872 PMCID: PMC7783520 DOI: 10.1136/bmjophth-2020-000599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 11/04/2022] Open
Abstract
Objective To study the effectiveness of amblyopia screening at ages 3-4. Methods and Analysis From a population with no previous screening, a cohort of 2300 children with 3-4 years old attending school (91% of children this age attend school in Portugal), were submitted to a complete ophthalmological evaluation. Amblyopia was diagnosed, treated and followed. Amblyopia prevalence, treatment effectiveness, absolute risk reduction (ARR), number needed to screen (NNS) and relative risk reduction (RRR) were estimated. Results Past/present history of amblyopia was higher than 3.1%-4.2%, depending on amblyopia definition normatives. Screening at age 3-4, had estimated ARR=2.09% (95% CI 1.50% to 2.68%) with a reduced risk of amblyopia in adulthood of 87% (RRR). NNS was 47.8 (95% CI 37.3 to 66.7). Treatment effectiveness of new diagnosis was 88% (83% if we include children already followed). 91% of new amblyopia diagnoses were refractive (of which 100% surpassed amblyopia Multi-Ethnic Pediatric Eye Disease Study criteria after treatment), while most strabismic amblyopias were already treated or undertreatment. Only 30% of children with refractive amblyopia risk factors that were not followed by an ophthalmologist, ended up having amblyopia at age 3-4. Eye patch was needed equally in new-diagnosis versus treated-earlier refractive amblyopia. Conclusions Screening amblyopia in a whole-population setting at age 3-4 is highly effective. For each 48 children screened at age 3-4, one amblyopia is estimated to be prevented in the future (NNS). Screening earlier may lead to overdiagnosis and overtreatments: Treating all new diagnosis before age 3-4 would have a maximal difference in ARR of 0.3%, with the possible burden of as much as 70% children being unnecessary treated before age 3-4.Involving primary care, with policies for timely referral of suspicious/high-risk preverbal children, plus whole screening at age 3-4 seems a rational/effective way of controlling amblyopia.
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Affiliation(s)
- Sandra Guimaraes
- Ophthalmology, Hospital-Escola da Universidade Fernando Pessoa, Gondomar, Porto, Portugal.,Ophthalmology, Hospital de Braga, Braga, Portugal
| | - Andreia Soares
- Ophthalmology, Hospital-Escola da Universidade Fernando Pessoa, Gondomar, Porto, Portugal.,Ophthalmology, Hospital de Braga, Braga, Portugal
| | | | - Pedro Barros
- Ophthalmology, Hospital de Braga, Braga, Portugal
| | | | - Patrício Soares Costa
- School Of Medicine - University Of Minho, Universidade do Minho Instituto de Investigacao em Ciencias da Vida e Saude, Braga, Braga, Portugal.,School Of Medicine - University Of Minho, ICVS 3B's Associate Laboratory, Braga, Braga, Portugal
| | - Eduardo D Silva
- Ophthalmology, Centro Cirurgico de Coimbra, Coimbra, Portugal
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Kiatos E, Armstrong JJ, Makar I. Successes and shortfalls of community Plusoptix photoscreening: results from the iSee study in Southwestern Ontario. Can J Ophthalmol 2020; 56:49-56. [PMID: 32891567 DOI: 10.1016/j.jcjo.2020.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/12/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this work is to provide the final results from a community-wide photoscreening program in Southwestern Ontario for children aged 18 to 72 months, and to estimate the prevalence of amblyogenic risk factors in this population. STUDY DESIGN Prospective, multisite photoscreening program. PARTICIPANTS 5959 children aged 18-72 months were recruited and screened in Southwestern Ontario at 210 locations over a period of 3 years and 4 months. METHODS Ophthalmic screening examinations were performed with the Plusoptix S12 photoscreener. The threshold for the referral criteria used was the manufacturer's criteria on receiver operating characteristics 4. RESULTS The screening was negative in 5386 children (90.4%), positive in 403 (6.8%), and unreadable in 170 (2.9%); 42% of all screened children were ≤36 months old. The estimated amblyogenic risk factor prevalence of anisometropia was 4.0%, astigmatism was 3.1%, hyperopia was 1.1%, myopia was 0.4%, and strabismus was 0.4%. Of the 403 referred children, 99 (24.5%) completed a formal eye examination based on the responses returned to the study site. CONCLUSIONS This is the first Canadian study that provides data on amblyogenic risk factors based on a volunteer-led photoscreening program. Photoscreening is an effective screening tool, particularly for pre-school-aged children; however, the lack of mandatory follow-up to ensure that children receive proper treatment based on cycloplegic refraction reduces the efficacy of screening.
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Affiliation(s)
| | - James J Armstrong
- Schulich School of Medicine and Dentistry Department of Ophthalmology, London, Ontario; Schulich School of Medicine and Dentistry Department of Pathology and Laboratory Medicine, London, Ontario
| | - Inas Makar
- Ivey Eye Institute, St. Joseph's Healthcare, London, Ontario; Schulich School of Medicine and Dentistry Department of Ophthalmology, London, Ontario.
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Nishimura M, Wong A, Cohen A, Thorpe K, Maurer D. Choosing appropriate tools and referral criteria for vision screening of children aged 4-5 years in Canada: a quantitative analysis. BMJ Open 2019; 9:e032138. [PMID: 31558460 PMCID: PMC6773298 DOI: 10.1136/bmjopen-2019-032138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To assess the diagnostic accuracy of five vision screening tools used in a school setting using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). DESIGN We compared the results of the five best evidence-based screening tools available in 2014 to the results of a comprehensive eye exam with cycloplegic refraction by a licenced optometrist. Screening included Cambridge Crowded Acuity Cards, Plusoptix S12 and Spot photoscreeners, Preschool Randot Stereoacuity Test and the Pediatric Vision Scanner (PVS). Referral criteria followed AAPOS (2013) guidelines and published norms. SETTING A large school in Toronto, Canada, with 25 split classrooms of junior kindergarten (JK: 4 year olds) and senior kindergarten (SK: 5 year olds) children. PARTICIPANTS Over 2 years, 1132 eligible children were enrolled at the school. After obtaining parental consent, 832 children were screened. Subsequently, 709 children had complete screening and optometry exam data. MAIN OUTCOME MEASURES The presence/absence of a visual problem based on optometrist's assessment: amblyopia, amblyopia risk factors (reduced stereoacuity, strabismus and clinically significant refractive errors) and any other ocular problem (eg, nystagmus). RESULTS Overall, 26.5% of the screened children had a visual problem, including 5.9% with amblyopia. Using all five tools, screening sensitivity=84% (95% CI 78 to 89), specificity=49% (95% CI 44 to 53), PPV=37% (95% CI 33 to 42), and NPV=90% (95% CI 86 to 93). The odds of having a correct screening result in SK (mean age=68.2 months) was 1.5 times those in JK (mean age=55.6 months; 95% CI 1.1 to 2.1), with sensitivity improved to 89% (95% CI 80 to 96) and specificity improved to 57% (95% CI 50 to 64) among SK children. CONCLUSIONS A school-based screening programme correctly identified 84% of those kindergarten children who were found to have a visual problem by a cyclopleged optometry exam. Additional analyses revealed how accuracy varies with different combinations of screening tools and referral criteria.
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Affiliation(s)
- Mayu Nishimura
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Agnes Wong
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Cohen
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Daphne Maurer
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Guimarães S, Soares A, Costa P, Silva E. How Many Plusoptix S04 Measures Yield the Most Sensitive Amblyopia Screening? J Pediatr Ophthalmol Strabismus 2019; 56:305-312. [PMID: 31545864 DOI: 10.3928/01913913-20190702-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/01/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze how the Plusoptix S04 (Plusoptix, Atlanta, GA), a widely used technology for amblyopia screening, predicts amblyopia. METHODS A total of 1,547 children aged 3 to 4 years underwent a non-invasive eye examination in a whole population screening. The Plusoptix was measured binocularly three consecutive times. Seven models were developed: the first (P1), second (P2), and third (P3) measure of Plusoptix, the mean of P1, P2, and P3 (Pmean123), the maximal value of P1, P2, and P3 (Pmax123), the mean of P1 and P2 (Pmean12), and the maximal value of P1 and P2 (Pmax12). RESULTS Internal consistency was excellent for sphere, cylinder (alpha = 0.92 vs 0.97), aniso-sphere, and aniso-cylinder (alpha = 0.87 vs 0.86). All models predicted amblyopia (P < .001); there was 2.3% new diagnosis and 5.1 events per variable. A bootstrap analysis with 1,000 samples confirmed the stability of the model. Astigmatism (P < .001; odds ratio [OR] = 2.1 to 3.6) and aniso-sphere (P < .001; OR = 3.6 to 9.0) predicted amblyopia. Although sphere, when measurable, did not predict amblyopia (P > .19; OR = 1.2 to 1.3), the likelihood of amblyopia presence was 100 times higher when the Plusoptix displayed "hyper." All receiver operating characteristic (ROC) curves were significant (P < .001), with no differences between them (all P > .16). Adjusting the cut-off from ROC curves for the highest sensitivity, Pmax12 referred 31.9% and 16.1% fewer patients than P1 and Pmean12, respectively. A third measure revealed accommodation-related false-negative results; therefore, adding measurements showed no benefit. CONCLUSIONS This was the first study to assess the Plusoptix's prediction of amblyopia. When aiming for maximal sensitivity, the Plusoptix refers many children (> 20% children in all models). The first measure refers more children than two measures. Non-measurable results must be considered abnormal because the chance of amblyopia presence was high. [J Pediatr Ophthalmol Strabismus. 2019;56(5):305-312.].
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Comparison of Autorefraction and Photorefraction with and without Cycloplegia Using 1% Tropicamide in Preschool Children. J Ophthalmol 2019; 2019:1487013. [PMID: 31191991 PMCID: PMC6525892 DOI: 10.1155/2019/1487013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/17/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose We aimed to investigate whether the accuracy of the Plusoptix A09 photorefractor in children with ametropia is enhanced by cycloplegia with 1% tropicamide. Methods A total of 70 eyes (70 children) were retrospectively reviewed. Noncycloplegic photorefraction, cycloplegia with 1% tropicamide, cycloplegic photorefraction, and cycloplegic refraction with a tabletop autorefractometer were performed on all subjects in this order. Measurements were compared statistically. Results The mean age was 45.9 ± 11.4 months. The mean spherical equivalent (0.61 ± 1.03 diopters (D); range, −2.38 to 3.63 D) and mean spherical power (1.16 ± 0.92 D; range, −1.25 to 3.75 D) values that were acquired from the photorefraction without cycloplegia showed statistically significant differences from those of the autorefraction with cycloplegia (mean spherical equivalent = 1.00 ± 1.27 D; range, −1.50 to 4.25 D, mean spherical power = 1.60 ± 1.14; range, −1.25 to 4.50 D). The mean difference for the spherical equivalent was −0.39 ± 0.93 D (P=0.021; 95% limits of agreement (LoA) = −2.22 D to 1.44 D) and for spherical power was −0.44 ± 1.02 D (P=0.016; LoA = −2.44 D to 1.56 D). Without cycloplegia, Plusoptix A09 showed myopic shift, while after cycloplegia, it showed hyperopic shift. Spherical equivalent (mean difference (MD) ± SD = 0.78 ± 1.00 D, P < 0.001; LoA = −1.17 D to 2.72 D) and spherical power (MD ± SD = 0.73 ± 1.04 D, P < 0.001; LoA = −1.31 D to 2.77 D) values were significantly different from those of autorefraction with cycloplegia. Cylindrical power values obtained by photorefraction both with and without cycloplegia were not statistically different from those of autorefraction with cycloplegia (P > 0.05). Conclusion Cycloplegia with 1% tropicamide did not improve the accuracy of photorefraction using Plusoptix A09 in preschool children. The spherical equivalent and spherical power values obtained by photorefraction with cycloplegia were significantly higher from those obtained by autorefraction with cycloplegia.
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Dikkaya F, Erdur SK. Comparison of the PlusOptix S09 and Spot Vision photorefractor to cycloretinoscopy. Int Ophthalmol 2018; 39:1671-1678. [DOI: 10.1007/s10792-018-1026-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 07/04/2018] [Indexed: 11/24/2022]
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Teberik K, Eski MT, Kaya M, Ankarali H. A Comparison of Three Different Photoscreeners in Children. J Pediatr Ophthalmol Strabismus 2018; 55:306-311. [PMID: 29809264 DOI: 10.3928/01913913-20180405-03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 10/19/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To compare the results obtained from three non-cycloplegic handheld photorefractometers with cycloplegic autorefractometry (Topcon KR-8100; Topcon Corporation, Tokyo, Japan) measurement in children. METHODS The refractive status of 238 eyes in 119 healthy children was assessed. The values acquired using photorefraction with the non-cycloplegic PlusoptiX A12 (Plusoptix GmbH, Nuremberg, Germany), Retinomax K-plus 3 (Righton, Tokyo, Japan), and Spot Vision Screener (Welch Allyn, Skaneateles Falls, NY) devices were compared with those obtained from the cycloplegic Topcon KR-8100. The agreement between the measurements was assessed using the intraclass correlation coefficient. RESULTS The mean age was 10.1 ± 3.2 years (range: 6 to 17 years). The mean spherical value for the right eyes was 0.38 diopters (D) (range: -4.50 to 6.25 D) for the Plusoptix A12; 0.45 D (range: -4.50 to 6.25 D) for the Spot Vision Screener; -1.15 D (range: -8.75 to 6.50 D) for the Retinomax K-plus 3; and 0.62 (range: -4.50 to 6.00) for the Topcon KR-8100. The mean spherical equivalent value for the right eyes was 0.41 D (range: -4.50 to 7.90 D) for the Plusoptix A12; 0.18 D (range: -4.75 to 6.13 D) for the Spot Vision Screener; -1.30 D (range: -10.50 to 6.38 D) for the Retinomax K-plus 3; and 0.67 D (range: -4.00 to 6.00 D) for the Topcon KR-8100 (for the right eyes). CONCLUSIONS The photorefractometer method was beneficial in the measurement of refractive errors of school-aged children. The PlusoptiX A12 photorefractometer method may eliminate the need for cycloplegia in the detection of refractive errors in children. [J Pediatr Ophthalmol Strabismus. 2018;55(5):306-311.].
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Guimaraes S, Fernandes T, Costa P, Silva E. Should tumbling E go out of date in amblyopia screening? Evidence from a population-based sample normative in children aged 3-4 years. Br J Ophthalmol 2017; 102:761-766. [PMID: 28988161 PMCID: PMC5969336 DOI: 10.1136/bjophthalmol-2017-310691] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/04/2017] [Accepted: 08/24/2017] [Indexed: 01/27/2023]
Abstract
Aims To determine a normative of tumbling E optotype and its feasibility for visual acuity (VA) assessment in children aged 3-4 years. Methods A cross-sectional study of 1756 children who were invited to participate in a comprehensive non-invasive eye exam. Uncorrected monocular VA with crowded tumbling E with a comprehensive ophthalmological examination were assessed. Testability rates of the whole population and VA of the healthy children for different age subgroups, gender, school type and the order of testing in which the ophthalmological examination was performed were evaluated. Results The overall testability rate was 95% (92% and 98% for children aged 3 and 4 years, respectively). The mean VA of the first-day assessment (first-VA) and best-VA over 2 days’ assessments was 0.14 logMAR (95% CI 0.14 to 0.15) (decimal=0.72, 95% CI 0.71 to 0.73) and 0.13 logMAR (95% CI 0.13 to 0.14) (decimal=0.74, 95% CI 0.73 to 0.74). Analysis with age showed differences between groups in first-VA (F(3,1146)=10.0; p<0.001; η2=0.026) and best-VA (F(3,1155)=8.8; p<0.001; η2=0.022). Our normative was very highly correlated with previous reported HOTV-Amblyopia-Treatment-Study (HOTV-ATS) (first-VA, r=0.97; best-VA, r=0.99), with 0.8 to 0.7 lines consistent overestimation for HOTV-ATS as described in literature. Overall false-positive referral was 1.3%, being specially low regarding anisometropias of ≥2 logMAR lines (0.17%). Interocular difference ≥1 line VA logMAR was not associated with age (p=0.195). Conclusions This is the first normative for European Caucasian children with single crowded tumbling E in healthy eyes and the largest study comparing 3 and 4 years old testability. Testability rates are higher than found in literature with other optotypes, especially in children aged 3 years, where we found 5%–11% better testability rates.
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Affiliation(s)
- Sandra Guimaraes
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal.,School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga, Braga, Portugal
| | - Tiago Fernandes
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal
| | - Patrício Costa
- School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga, Braga, Portugal.,Clinical Academic Center, Braga, Portugal
| | - Eduardo Silva
- Centro Cirúrgico de Coimbra, Coimbra, Portugal.,IBILI, Faculty of Medicine, University of Coimbra, Coimbra, Coimbra, Portugal.,Department of Ophthalmology, CHLN, Lisbon, Portugal
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