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Yum HR, Park YY, Shin SY, Park SH. Diagnostic performance of the Spot vision photoscreener for the detection of exodeviation in preschool-aged children. Ophthalmic Physiol Opt 2023; 43:212-219. [PMID: 36504165 DOI: 10.1111/opo.13080] [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: 07/16/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of the Welch Allyn Spot Vision photoscreener in preschool children for detecting exotropia, the most prevalent type of strabismus among Asian children. METHODS Children aged 3-6 years were screened using the Spot Vision photoscreener and then underwent a complete ophthalmologic examination on the same day. A child with exodeviation ≥8 Δ in the primary position using the cover-uncover test and the alternate prism cover test was confirmed to have exotropia. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the photoscreener in detecting exotropia were calculated. Subgroup analyses were performed according to the angle of deviation (≥25 Δ vs. <25 Δ) and fusional control (good/fair vs. poor). RESULTS Two hundred and ten children were included in this study. Among 80 exotropia-confirmed children, 23 needed referrals for exodeviation (screening-positive) and 57 were proven to be screening-negatives with the photoscreener. The overall sensitivity, specificity, PPV and NPV of the photoscreener for detecting exotropia were 28.8%, 95.4%, 79.3% and 68.5%, respectively. The positive and negative likelihood ratios were 6.26 and 0.75, respectively. Compared with the 57 children with false-negatives (71.3%), those with true-positive results with the photoscreener had significantly larger angles of exodeviation (p = 0.02) and a higher proportion of poor fusional control (p = 0.004). The photoscreener had low sensitivity even in detecting exotropia ≥25 Δ or those with poor fusional control (35.2% and 43.6%, respectively). Approximately 65% (42 out of 64) of the children with a significant exodeviation which needed strabismus surgery were not identified by the Spot Vision Photoscreener. CONCLUSIONS The Spot Vision photoscreener has low sensitivity for detecting exodeviation. It should not be used alone for assessing exotropia in preschool-aged children.
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Affiliation(s)
- Hae Ri Yum
- Department of Ophthalmology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo Yeon Park
- Department of Ophthalmology, College of Medicine, Dankook University, Cheonan, Korea
| | - Sun Young Shin
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Shin Hae Park
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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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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Venkataraman AP, Brautaset R, Domínguez-Vicent A. Effect of six different autorefractor designs on the precision and accuracy of refractive error measurement. PLoS One 2022; 17:e0278269. [PMID: 36441778 PMCID: PMC9704684 DOI: 10.1371/journal.pone.0278269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 11/12/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the precision of objective refraction measurements with six different autorefractors that have different designs and measurement principles and to compare the objective refraction values with the subjective refraction. METHOD Objective refraction of 55 participants was measured using six autorefractors with different designs. The instrument features mainly varied in terms of measurement principles, inbuilt fogging, open or closed view, and handheld or stationary designs. Two repeated measurements of objective refraction were performed with each autorefractor. The objective refractions from the six autorefractors were compared with the standard subjective refraction. The repeatability limit and Bland-Altman were used to describe the precision and accuracy of each autorefractor, respectively. The analysis was done using the spherical component of the refraction and the power-vector components, spherical equivalent (M), and cylindrical vectors. RESULTS The repeatability of all autorefractors was within 1.00 and 0.35D for measuring the M and both cylindrical components, respectively. Inbuilt fogging was the common feature of the instruments that showed better repeatability. Compared to subjective refraction, the mean difference for sphere and M was below +0.50D, and it was close to zero for the cylindrical components. The instruments that had inbuilt fogging showed narrower limit of agreement. When combined with fogging, the open field refractors showed better precision and accuracy. CONCLUSIONS The inbuilt fogging is the most important feature followed by the open view in determining the precision and accuracy of the autorefractor values.
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Affiliation(s)
- Abinaya Priya Venkataraman
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- * E-mail:
| | - Rune Brautaset
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Alberto Domínguez-Vicent
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Guo X, Shakarchi AF, Block SS, Friedman DS, Repka MX, Collins ME. Noncycloplegic Compared with Cycloplegic Refraction in a Chicago School-Aged Population. Ophthalmology 2022; 129:813-820. [PMID: 35245603 DOI: 10.1016/j.ophtha.2022.02.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate differences between autorefraction measurements with and without cycloplegia among school-aged individuals and to explore factors associated with significant differences. DESIGN Cross-sectional, retrospective study. PARTICIPANTS Individuals between 3 and 22 years of age evaluated at the Illinois College of Optometry from September 2016 through June 2019 who underwent same-day noncycloplegic and cycloplegic autorefraction of the right eye. METHODS Demographic information including age, sex, and race or ethnicity were collected during the eye examination. Autorefraction was performed before and after cycloplegia. Myopia, defined as at least -0.50 diopter (D) spherical equivalent (SE), hyperopia, defined as at least +0.50 D SE, and astigmatism of at least 1.00 D cylinder were determined using noncycloplegic and cycloplegic autorefractions. Factors associated with at least 1.00 D more myopic SE or at least 0.75 D cylindrical difference by noncycloplegic autorefraction were assessed using logistic regression models. MAIN OUTCOME MEASURES Differences between noncycloplegic and cycloplegic autorefraction measurements. RESULTS The mean age was 10.8 ± 4.0 years for the 11 119 individuals; 52.4% of participants were female. Noncycloplegic SE measured 0.65 ± 1.04 D more myopic than cycloplegic SE. After adjusting for demographic factors and refractive error, individuals with at least 1.00 D of more myopic SE refraction by noncycloplegic autorefraction (25.9%) were more likely to be younger than 5 years (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.18-1.79) and 5 to younger than 10 years (OR, 1.32; 95% CI, 1.18-1.48) than those 10 to younger than 15 years. This difference of at least 1.00 D of more myopic SE was more likely to be observed in Hispanic people (OR, 1.23; 95% CI, 1.10-1.36) and those with hyperopia (OR range, 4.20-13.31). Individuals with 0.75 D or more of cylindrical difference (5.1%) between refractions were more likely to be younger than 5 years, to be male, and to have mild-moderate-high myopia or moderate-high hyperopia. CONCLUSIONS Three quarters of school-aged individuals had < 1 D of myopic SE difference using noncycloplegic compared with cycloplegic autorefraction. Understanding measurement differences obtained for refractive error and associated factors may provide useful information for future studies or programs involving refraction in school-aged children.
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Affiliation(s)
- Xinxing Guo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ahmed F Shakarchi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - David S Friedman
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Megan E Collins
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Dana Center for Preventive Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland.
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Kumar RS, Moe CA, Kumar D, Rackenchath MV, A. V. SD, Nagaraj S, Wittberg DM, Stamper RL, Keenan JD. Accuracy of autorefraction in an adult Indian population. PLoS One 2021; 16:e0251583. [PMID: 34010350 PMCID: PMC8133404 DOI: 10.1371/journal.pone.0251583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose Autorefractors allow non-specialists to quickly assess refractive error, and thus could be a useful component of large-scale vision screening programs. In order to better characterize the role of autorefraction for public health outreach programs in resource-limited settings, the diagnostic accuracy of two autorefractors was assessed relative to subjective refraction in an adult Indian population. Methods An optometrist refracted a series of patients aged ≥50 years at an eye clinic in Bangalore, India using the Nidek ARK-900 autorefractor first, followed by the 3nethra Royal autorefractor, and then subjective refraction. The diagnostic accuracy of each autorefractor for myopia, hyperopia, and astigmatism was assessed using subjective refraction as the reference standard, and measures of agreement between refractions were calculated. Results A total of 197 eyes in 104 individuals (mean age 63 ± 8 years, 52% female) were evaluated. Both autorefractors produced spherical equivalent estimates that were on average more hyperopic than subjective refraction, with a measurement bias of +0.16 D (95%CI +0.09 to +0.23D) for Nidek and +0.42 D (95%CI +0.28 to +0.54D) for 3nethra. When comparing pairs of measurements from autorefraction and subjective refraction, the limits of agreement were approximately ±1D for the Nidek autorefractor and ±1.75D for the 3Nethra autorefractor. The sensitivity and specificity of detecting ≥1 diopter of myopia were 94.6% (95%CI 86.8–100%) and 92.5% (95%CI 88.9–97.5%) for the Nidek, and 89.2% (95%CI 66.7–97.4) and 77.5% (95%CI 71.2–99.4%) for the 3Nethra. The accuracy of each autorefractor increased at greater levels of refractive error. Conclusions The sensitivity and specificity of the Nidek autorefractor for diagnosing refractive error among adults ≥50 years in an urban Indian clinic was sufficient for screening for visually significant refractive errors, although the relatively wide limits of agreement suggest that subjective refinement of the eyeglasses prescription would still be necessary.
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Affiliation(s)
- Rajesh S. Kumar
- Narayana Nethralaya Eye Hospital, Bangalore, India
- Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Caitlin A. Moe
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States of America
| | - Deepak Kumar
- Narayana Nethralaya Eye Hospital, Bangalore, India
| | | | | | | | - Dionna M. Wittberg
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States of America
| | - Robert L. Stamper
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Jeremy D. Keenan
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States of America
- * E-mail:
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Thomas J, Rajashekar B, Kamath A, Gogate P. Comparison between Plusoptix A09 and gold standard cycloplegic refraction in preschool children and agreement to detect refractive amblyogenic risk factors. Oman J Ophthalmol 2021; 14:14-19. [PMID: 34084029 PMCID: PMC8095298 DOI: 10.4103/ojo.ojo_284_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 09/06/2020] [Accepted: 10/06/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: The preschool children hardly complain about their vision problems. It is of paramount importance to screen them with an objective tool and compare with the gold standard technique. AIM: To compare the values obtained with Plusoptix A09 and cycloplegic refraction in 3–6 years children and agreement to detect refractive amblyogenic risk factors. SUBJECTS AND METHODS: A cross-sectional study was conducted in the Outpatient Department of Ophthalmology in a tertiary care hospital. Informed consent from parents and verbal assent from children were obtained. Each subject had monocular vision assessment with Lea symbol chart, stereo acuity measurement with Frisby, refractive screening with Plusoptix A09, squint assessment, and anterior segment evaluation before administering Homatropine hydrobromide (homide) 2% eye drops. Cycloplegic refraction and posterior segment evaluation were performed for final diagnosis. STATISTICAL ANALYSIS: Descriptive statistics were used to summarize the data. Spearman correlation coefficient and kappa statistics were also employed. RESULTS: In total, data of 94 children were analyzed. The correlation values obtained between plusoptix and cyclorefraction values for spherical, cylindrical, spherical equivalent were 0.508 (P < 0.0001), 0.779 (P < 0.0001), and 0.407 (P < 0.0001), respectively. Refractive errors were seen in 32% and amblyopia in 17% of eyes. Kappa value was κ = 0.974 in detecting refractive amblyogenic risk factors. CONCLUSION: Good correlation was found between the plusoptix and cyclorefraction values. Cylindrical values showed a better correlation. Refractive errors and amblyopia were the major ocular disorders observed. There was significant agreement between the refractive techniques in detecting amblyogenic risk factors.
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Affiliation(s)
- Jyothi Thomas
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - B Rajashekar
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Asha Kamath
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Parikshit Gogate
- Department of Ophthalmology, Dr. D. Y. Patil Medical College Hospital, Pune, Maharashtra, India.,Community Eye Care Foundation, Dr. Gogate's Eye Clinic, Pune, Maharashtra, India
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Wilson LB, Melia M, Kraker RT, VanderVeen DK, Hutchinson AK, Pineles SL, Galvin JA, Lambert SR. Accuracy of Autorefraction in Children: A Report by the American Academy of Ophthalmology. Ophthalmology 2020; 127:1259-1267. [PMID: 32317177 DOI: 10.1016/j.ophtha.2020.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The purpose of this assessment is to evaluate the accuracy of autorefraction compared with cycloplegic retinoscopy in children. METHODS Literature searches were last conducted in October 2019 in the PubMed and the Cochrane Library databases for studies published in English. The combined searches yielded 118 citations, of which 53 were reviewed in full text. Of these, 31 articles were deemed appropriate for inclusion in this assessment and subsequently assigned a level of evidence rating by the panel methodologists. Four articles were rated level I, 11 were rated level II, and 16 were rated level III articles. The 16 level III articles were excluded from this review. RESULTS Thirteen of the 15 studies comparing cycloplegic autorefraction with cycloplegic retinoscopy found a mean difference in spherical equivalent or sphere of less than 0.5 diopters (D); most were less than 0.25 D. Even lower mean differences were found when evaluating the cylindrical component of cycloplegic autorefraction versus cycloplegic retinoscopy. Despite low mean variability, there was significant individual measurement variability; the 95% limits of agreement were wide and included clinically relevant differences. Comparisons of noncycloplegic with cycloplegic autorefractions found that noncyloplegic refraction tends to over minus by 1 to 2 D. CONCLUSIONS Cycloplegic autorefraction is appropriate to use in pediatric population-based studies. Cycloplegic retinoscopy can be valuable in individual clinical cases to confirm the accuracy of cycloplegic autorefraction, particularly when corrected visual acuity is worse than expected or the autorefraction results are not consistent with expected findings.
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Affiliation(s)
- Lorri B Wilson
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | | | | | - Deborah K VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amy K Hutchinson
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Stacy L Pineles
- Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Jennifer A Galvin
- Eye Physicians and Surgeons PC, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
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Agreement and Repeatability of Noncycloplegic and Cycloplegic Wavefront-based Autorefraction in Children. Optom Vis Sci 2020; 96:879-889. [PMID: 31703049 PMCID: PMC6855388 DOI: 10.1097/opx.0000000000001444] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Increasing prevalence of refractive error requires assessment of ametropia as a screening tool in children. If cycloplegia is not an option, knowledge about the increase in uncertainty for wavefront-based autorefraction is needed. The cycloplegic agent as the principal variant presents cross-reference and allows for extraction of the influence of accommodation. PURPOSE The purpose of this study was to determine the repeatability, agreement, and propensity to accommodate of cycloplegic (ARc) and noncycloplegic (ARnc) wavefront-based autorefraction (ZEISS i.Profiler plus; Carl Zeiss Vision, Aalen, Germany) in children aged 2 to 15 years. METHODS In a clinical setting, three consecutive measurements were feasible for 145 eyes (OD) under both conditions. Data are described by spherical equivalent (M), horizontal or vertical astigmatic component (J0), and oblique astigmatic component (J45). In the case of M, the most positive value of the three measurements was chosen, whereas the mean was applied for astigmatic components. RESULTS Regarding agreement, differences for ARc minus ARnc were statistically significant: for M, 0.55 (0.55 D; mean [SD]; P < .001), that is, more hyperopic in cycloplegia; for J0, −0.03 (0.11 D; P = .002); and for J45, −0.03 D (SD, 0.09 D; P < .001). Regarding repeatability, astigmatic components showed excellent repeatability: SD < 0.11 D (ARnc) and SD < 0.09 D (ARc). The repeatability of M was SD = 0.57 D with a 95% interval of 1.49 D (ARnc). Under cycloplegia, this decreased to SD = 0.17 D (ARc) with a 95% interval of 0.50 D. The mean propensity to accommodate was 0.44 D from repeated measurements; in cycloplegia, this was reduced to 0.19 D. CONCLUSIONS Wavefront-based refraction measurement results are highly repeatable and precise for astigmatic components. Noncycloplegic measurements of M show a systematic bias of 0.55 D. Cycloplegia reduces the propensity to accommodate by a factor of 2.4; for noncycloplegic repeated measurements, accommodation is controlled to a total interval of 1.49 D (95%). Without cycloplegia, results improve drastically when measurements are repeated.
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Yang HK, Jung JH. Diagnosis and treatment of childhood strabismus. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2019. [DOI: 10.5124/jkma.2019.62.6.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hee Kyung Yang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Kinori M, Molina I, Hernandez EO, Robbins SL, Granet DB, Coleman AL, Brown SI. The PlusoptiX Photoscreener and the Retinomax Autorefractor as Community-based Screening Devices for Preschool Children. Curr Eye Res 2018; 43:654-658. [PMID: 29424565 DOI: 10.1080/02713683.2018.1437453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the performance of the PlusoptiX S12 mobile photoscreener and the Retinomax K+3 Autorefractor as screening devices in preschool children. METHODS Children ranging from 3 to 5 years of age from 11 San Diego County preschools underwent vision screening in their schools where ambient light could not always be controlled using both the Retinomax and the PlusoptiX. Cycloplegic refraction on the consented children was subsequently performed on the UCSD EyeMobile for children on-site at the school locations. RESULTS A total of 321 children were screened with the PlusoptiX and Retinomax. The PlusoptiX referred 22% of children, of whom 70% of the referrals were read as "unable". The Retinomax referred 13% and there were no "unables". Similar results occurred in the cycloplegic-refracted 182 consented children-64% of the PlusoptiX referrals were read as "unable" . Only one third of these "unables" required glasses. Both devices referred the four children with amblyopia and one case of strabismus. However, PlusoptiX's 3 false negatives had amblyopia risk factors (ARFs) while the one Retinomax's false negative did not have ARFs. The Retinomax screening had 95% sensitivity and 94% specificity. The PlusoptiX screening had 86% sensitivity and 84% specificity. CONCLUSION In this preschool population and environment, the PlusoptiX referred 63% more than the Retinomax in addition to a lower specificity and sensitivity. Adjusting PlusoptiX referral criteria might not substantially improve the specificity of the PlusoptiX due to the high numbers of "unables".
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Affiliation(s)
- Michael Kinori
- a The Goldschleger Eye Institute, Sheba Medical Center, Tel HaShomer, affiliated to the Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Iliana Molina
- b Department of Ophthalmology, Shiley Eye Center, School of Medicine , University of California-San Diego , La Jolla , CA , USA
| | - Eric O Hernandez
- b Department of Ophthalmology, Shiley Eye Center, School of Medicine , University of California-San Diego , La Jolla , CA , USA
| | - Shira L Robbins
- b Department of Ophthalmology, Shiley Eye Center, School of Medicine , University of California-San Diego , La Jolla , CA , USA
| | - David B Granet
- b Department of Ophthalmology, Shiley Eye Center, School of Medicine , University of California-San Diego , La Jolla , CA , USA
| | - Anne L Coleman
- c Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA , University of California, Los Angeles , Los Angeles , CA , USA
| | - Stuart I Brown
- b Department of Ophthalmology, Shiley Eye Center, School of Medicine , University of California-San Diego , La Jolla , CA , USA
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Hull S, Tailor V, Balduzzi S, Rahi J, Schmucker C, Virgili G, Dahlmann‐Noor A. Tests for detecting strabismus in children aged 1 to 6 years in the community. Cochrane Database Syst Rev 2017; 11:CD011221. [PMID: 29105728 PMCID: PMC6486041 DOI: 10.1002/14651858.cd011221.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Strabismus (misalignment of the eyes) is a risk factor for impaired visual development both of visual acuity and of stereopsis. Detection of strabismus in the community by non-expert examiners may be performed using a number of different index tests that include direct measures of misalignment (corneal or fundus reflex tests), or indirect measures such as stereopsis and visual acuity. The reference test to detect strabismus by trained professionals is the cover‒uncover test. OBJECTIVES To assess and compare the accuracy of tests, alone or in combination, for detection of strabismus in children aged 1 to 6 years, in a community setting by non-expert screeners or primary care professionals to inform healthcare commissioners setting up childhood screening programmes.Secondary objectives were to investigate sources of heterogeneity of diagnostic accuracy. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 12) (which contains the Cochrane Eyes and Vision Trials Register) in the Cochrane Library, the Health Technology Assessment Database (HTAD) in the Cochrane Library (2016, Issue 4), MEDLINE Ovid (1946 to 5 January 2017), Embase Ovid (1947 to 5 January 2017), CINAHL (January 1937 to 5 January 2017), Web of Science Conference Proceedings Citation Index-Science (CPCI-S) (January 1990 to 5 January 2017), BIOSIS Previews (January 1969 to 5 January 2017), MEDION (to 18 August 2014), the Aggressive Research Intelligence Facility database (ARIF) (to 5 January 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 5 January 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 5 January 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 5 January 2017. We did not use any date or language restrictions in the electronic searches for trials. In addition, orthoptic journals and conference proceedings without electronic listings were searched. SELECTION CRITERIA All prospective or retrospective population-based test accuracy studies of consecutive participants were included. Studies compared a single or combination of index tests with the reference test. Only those studies with sufficient data for analysis were included specifically to calculate sensitivity and specificity and determine diagnostic accuracy.Participants were aged 1 to 6 years. Studies reporting participants outside this range were included if subgroup data were available.Permitted settings included population-based vision screening programmes or opportunistic screening programmes, such as those performed in schools. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. In brief, two review authors independently assessed titles and abstracts for eligibility and extracted the data, with a third senior author resolving any disagreement. We analysed data primarily for specificity and sensitivity. MAIN RESULTS One study from a total of 1236 papers, abstracts and trials was eligible for inclusion with a total number of participants of 335 of which 271 completed both the screening test and the gold standard test. The screening test using an automated photoscreener had a sensitivity of 0.46 (95% confidence interval (CI) 0.19 to 0.75) and specificity of 0.97 (CI 0.94 to 0.99). The overall number affected by strabismus was low at 13 (4.8%). AUTHORS' CONCLUSIONS There is very limited data in the literature to ascertain the accuracy of tests for detecting strabismus in the community as performed by non-expert screeners. A large prospective study to compare methods would be required to determine which tests have the greatest accuracy.
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Affiliation(s)
- Sarah Hull
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
| | - Vijay Tailor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
| | - Sara Balduzzi
- University of Modena and Reggio EmiliaCochrane Italy, Department of Diagnostic, Clinical and Public Health MedicineVia del Pozzo 71ModenaItaly41124
| | - Jugnoo Rahi
- UCL Institute of Child Health and UCL Institute of OphthalmologyDepartment of EpidemiologyLondonUK
| | - Christine Schmucker
- Medical Center – Univ. of Freiburg, Faculty of Medicine, Univ. of FreiburgCochrane GermanyBreisacher Straße 153FreiburgGermany79110
| | - Gianni Virgili
- University of FlorenceDepartment of Translational Surgery and Medicine, Eye ClinicLargo Brambilla, 3FlorenceItaly50134
| | - Annegret Dahlmann‐Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
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Won JY, Shin HY, Kim SY, Lee YC. A comparison of the Plusoptix S09 with an autorefractometer of noncycloplegics and cycloplegics in children. Medicine (Baltimore) 2016; 95:e4596. [PMID: 27583875 PMCID: PMC5008559 DOI: 10.1097/md.0000000000004596] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study is to compare outcome measures of refractive error obtained using the Plusoptix S09 photorefractor and an autorefractometer of noncycloplegics and cycloplegics in children.We reviewed the medical records of 40 patients (77 eyes) who were classified using 2 methods. The patients were first assigned to 2 groups consisting of 11 eyes with ≥+3.0 D and 66 eyes with <+3.0 D, and then to 2 groups of 12 and 65 eyes with cycloplegic and noncycloplegic refraction of spherical powers ≥+2.0 D and <+2.0 D, respectively. We compared the outcome measures of refractive error using the Plusoptix S09 photorefractor and an autorefractometer of noncycloplegics and cycloplegics.There was no statistically significant difference between the Plusoptix S09 photorefractor and cycloplegic autorefractometer in the spherical power and spherical equivalent. In contrast, there was a statistically significant difference between the Plusoptix S09 photorefractor and noncycloplegic autorefractometer (P < 0.001). There was a statistically significant difference between the spherical equivalent of the Plusoptix S09 photorefractor and cycloplegic autorefractometer in children with hyperopia ≥+3.0D and with cycloplegic and noncycloplegic refraction of spherical power ≥+2.0 D. We also found a significant difference between the outcomes of the Plusoptix S09 photorefractor and cycloplegic autorefractometer in the spherical power and spherical equivalent for children with hyperopia ≥+3.0 D.The refractive error of the Plusoptix S09 photorefractor was similar to that of the cycloplegic autorefractometer, in contrast to the noncycloplegic autorefractometer. However, the Plusoptix S09 photorefractor is an inaccurate tool to estimate the refractive errors of children with moderate hyperopia.
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Affiliation(s)
- Jae Yon Won
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital
| | - Hye Young Shin
- Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Su Young Kim
- Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Chun Lee
- Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Correspondence: Young Chun Lee, Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Cheonbo-Ro, Uijeongbu-si, Gyeonggi-do, Republic of Korea (e-mail: )
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Payerols A, Eliaou C, Trezeguet V, Villain M, Daien V. Accuracy of PlusOptix A09 distance refraction in pediatric myopia and hyperopia. BMC Ophthalmol 2016; 16:72. [PMID: 27246869 PMCID: PMC4888737 DOI: 10.1186/s12886-016-0247-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 05/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background The PlusOptix photoscreeners (PlusOptix GmbH, Nuremberg, Germany) is used in many vision screening programs. The purpose of the present study was to further explore the accuracy of the PlusOptix A09 photoscreener in children with ametropia (myopia or hyperopia). Methods A total of 70 eyes (35 children) were prospectively included. Before administration with the cycloplegia treatment 1 % cyclopentolate hydrochloride, children underwent refraction measurement with the PlusOptix A09. A refraction was then performed after cycloplegia with either Retinomax hand-held or Nidek autorefractor before and after 3 years old, respectively. Results The median (interquartile range) age was 58 (18 to 86) months. The mean (SD) spherical equivalent differed between PlusOptix A09 and cycloplegic autorefraction (+0.54 [1.82] D vs +1.06 [2.04] D, p = 0.04). PlusOptix A09 refraction was positively correlated with cycloplegic autorefraction (r = 0.81, p < 0.001) with higher coefficient in myopic than in hyperopic children (r = 0.91, p = 0.0002 and r = 0.52, p = 0.01, respectively). The mean (SD) difference between PlusOptix A09 and cycloplegic autorefraction was higher with hyperopia than myopia (0.73 [1.34] vs 0.05 [0.66], p = 0.01). The proportion of children with < 1-D difference between cycloplegic and PlusOptix A09 refraction was 68.8 %, higher with myopia than hyperopia (90 % vs 54.5 %, p = 0.01). Conclusion The spherical equivalent value with non-cycloplegic PlusOptix A09 refraction is closer to that with cycloplegic autorefraction than non-cycloplegic autorefraction. The PlusOptix A09 photoscreener underestimated the hyperopia of 0.73 D and slightly overestimated myopia of 0.05 D. The PlusOptix A09 could be used for screening with higher accuracy in myopic than hyperopic children.
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Affiliation(s)
- Arnaud Payerols
- Department of Ophthalmology, Gui De Chauliac Hospital, CHU de Montpellier, 80, avenue Augustin Fliche, 34295 cedex 5, Montpellier, F-34000, France
| | - Claudie Eliaou
- Department of Ophthalmology, Gui De Chauliac Hospital, CHU de Montpellier, 80, avenue Augustin Fliche, 34295 cedex 5, Montpellier, F-34000, France
| | - Véronique Trezeguet
- Department of Ophthalmology, Gui De Chauliac Hospital, CHU de Montpellier, 80, avenue Augustin Fliche, 34295 cedex 5, Montpellier, F-34000, France
| | - Max Villain
- Department of Ophthalmology, Gui De Chauliac Hospital, CHU de Montpellier, 80, avenue Augustin Fliche, 34295 cedex 5, Montpellier, F-34000, France.,Univ Montpellier 1, Montpellier, F-34000, France
| | - Vincent Daien
- Department of Ophthalmology, Gui De Chauliac Hospital, CHU de Montpellier, 80, avenue Augustin Fliche, 34295 cedex 5, Montpellier, F-34000, France. .,Univ Montpellier 1, Montpellier, F-34000, France. .,Inserm, U1061, Montpellier, F-34093, France.
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Yan XR, Jiao WZ, Li ZW, Xu WW, Li FJ, Wang LH. Performance of the Plusoptix A09 photoscreener in detecting amblyopia risk factors in Chinese children attending an eye clinic. PLoS One 2015; 10:e0126052. [PMID: 26030210 PMCID: PMC4452218 DOI: 10.1371/journal.pone.0126052] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/28/2015] [Indexed: 12/03/2022] Open
Abstract
Purpose To assess the accuracy of the Plusoptix A09 photoscreener in detecting amblyopia risk factors in children and determine referral criteria when using Plusoptix A09 for a large-scale vision screening. Methods Pediatric patients attending our eye clinic underwent a comprehensive ophthalmic examination that included photorefraction, orthoptic examination, anterior segment assessment, fundus examination and cycloplegic retinoscopy. The measurements were collected for statistical analyses. Results One hundred and seventy-eight children (mean age ± SD: 6.2±2.4 years, range: 2.2 to 14.1 years) were included in the study. The mean spherical equivalent (SE) obtained using Plusoptix A09 (PSE) was 0.57 D lower than that obtained from cycloplegic retinoscopy (CRSE) (P = 0.00). However, there was no statistically significant difference of Jackson cross cylinder J0 and J45 between Plusoptix A09 (PJ) and cycloplegic retinoscopy (CRJ) (P = 0.14, P = 0.26). The relationship of SE obtained from Plusoptix A09 and SE obtained from cycloplegic retinoscopy was presented as the equation: CRSE = 0.358 + 0.776 PSE + 0.064 PSE2 + 0.011 PSE3. Based on the Receiver Operating Characteristic (ROC) curve, the Plusoptix A09 had an overall sensitivity of 94.9% and specificity of 67.5% for detecting refractive amblyopia risk factors. The sensitivity and specificity of the Plusoptix A09 for detection of strabismus were 40.7% and 98.3%, respectively; detection of amblyopia and/or strabismus was 84.7% and 63.2%, respectively. Conclusions The Plusoptix A09 photoscreener underestimated hyperopia and overestimated myopia according to SE when compared with cycloplegic retinoscopy. The accuracy of the Plusoptix A09 in detecting amblyopia risk factors in children could be improved by the regression equation and optimized criteria for refractive amblyopia risk factors developed in the present study. Moreover, the Plusoptix A09 photoscreener is not suitable for a large-scale strabismus screening when it is applied solely.
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Affiliation(s)
- Xiao-Ran Yan
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Wan-Zhen Jiao
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Zhi-Wei Li
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Wen-Wen Xu
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Feng-Jiao Li
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Li-Hua Wang
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
- * E-mail:
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Objective vision screening in 3-year-old children at a multispecialty practice. J AAPOS 2015; 19:16-20. [PMID: 25727580 DOI: 10.1016/j.jaapos.2014.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 09/11/2014] [Accepted: 09/25/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Vision screening is rarely effectively accomplished for 3-year-olds as part of pediatric well-child examinations. We investigate changes in screening rates and positive predictive values of referrals for 3-year-olds after introducing a photoscreener to a multispecialty group practice. METHODS The vision screening results of 3-year-old children undergoing routine well-child examinations between 2007 and 2013 were retrospectively reviewed. From 2007 to 2009, the only method available for vision screening was the Kindergarten Eye Test Chart. From 2010 to 2013 a PlusOptix photoscreener was also available. Rates of vision screening before and after PlusOptix adoption were compared. All children who failed screening were referred to a single pediatric ophthalmologist. Referral rates, follow-up rates, and positive predictive values were determined for PlusOptix photoscreening. Cases were defined by cycloplegic retinoscopy using the 2013 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) vision screening recommendations for amblyopia risk factors. RESULTS Of 593 children seen for their 3-year well-child examination between 2007-2009, before introduction of a photoscreener, 59 (10%) received vision screening. The screening rate increased to 766 of 958 (80%) between 2010 and 2013, after introduction of the PlusOptix (P < 0.001). Only 49% of children had a reliable first screening with PlusOptix, and the average number of screenings to obtain a reliable result was 2.39. The positive predictive value of PlusOptix referrals was 51% for amblyopia risk factors and 41% for potential amblyopia. CONCLUSIONS Availability of a photoscreener can increase the rate of vision screening for 3-year-old children in a multispecialty practice.
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Durr NJ, Dave SR, Lage E, Marcos S, Thorn F, Lim D. From Unseen to Seen: Tackling the Global Burden of Uncorrected Refractive Errors. Annu Rev Biomed Eng 2014; 16:131-53. [DOI: 10.1146/annurev-bioeng-071813-105216] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nicholas J. Durr
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139;
| | - Shivang R. Dave
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139;
| | - Eduardo Lage
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139;
| | - Susana Marcos
- Instituto de Óptica “Daza de Valdés,” Consejo Superior de Investigaciones Científicas, 28006 Madrid, Spain
| | - Frank Thorn
- New England College of Optometry, Boston, Massachusetts 02115
| | - Daryl Lim
- Madrid-MIT M+Visión Consortium, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139;
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Saber Moghadam A, Alizadeh R, Zarei-Ghanavati M. Plusoptix S08 sensitivity in detecting strabismus as amblyogenic risk factor. Strabismus 2013; 21:230-4. [PMID: 24299331 DOI: 10.3109/09273972.2013.851259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the sensitivity of photoscreener Plusoptix S08 in screening strabismus. METHODS Eighty-three consecutive patients were examined by a single expert to determine the type and amount of the deviation. Then photoscreening was done for all the patients via Plusoptix S08 photoscreener (Plusoptix GmbH, Nuremberg, Germany) on the same day, using the default software for referring the patients. RESULTS The age range was between 6 months and 40 years. The overall sensitivity of the device to detect strabismus is 70%; it was 25% for exophoria, 67% for esotropia, 73% for exotropia, and 89% in patients who had mixed strabismus. Regarding degree of deviation, sensitivity was 46% in deviations less than 30 prism diopters (PD) and rises while the degree of deviation increases. CONCLUSIONS Our research shows that Plusoptix should not be used solely in evaluating strabismus because its sensitivity decreases significantly specially in esotropic patients with less than 30 PD deviations.
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Affiliation(s)
- AliAkbar Saber Moghadam
- Khatam Eye Research Center and Hospital, Mashhad University of Medical Sciences (MUMS) , Mashhad , Islamic Republic of Iran
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Mirzajani A, Heirani M, Jafarzadehpur E, Haghani H. A comparison of the Plusoptix S08 photorefractor to retinoscopy and cycloretinoscopy. Clin Exp Optom 2013; 96:394-9. [PMID: 23679982 DOI: 10.1111/cxo.12063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 11/22/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim was to compare outcome measures of refractive error by the Plusoptix S08 photorefractor with measures obtained by retinoscopy and cycloretinoscopy in children. METHOD The refractive error of the right eye of 144 non-strabismic children, aged 2.5 to 5.5 years, was determined by Plusoptix S08 photorefraction, retinoscopy and cycloretinoscopy. Agreement between outcome measures of refractive error (spherical error, cylindrical error and spherical equivalent) by the three techniques were tested by Bland-Altman limits of agreement. RESULTS The mean difference for spherical equivalent results of photorefraction (P(se)) minus those of retinoscopy (R(se)) and photorefraction minus those of cycloretinoscopy (CR(se)) were +0.53 ± 0.62 D and -0.22 ± 0.75 D, respectively. The 95 per cent limits of agreement for spherical photorefraction with retinoscopy and cycloretinoscopy were ±1.22 D (range -0.69 to +1.75) and ±1.47 D (range -1.69 to +1.25), respectively. The mean difference for cylindrical results of photorefraction (P(c)) minus those of retinoscopy (R(c)) and Pc minus those of cycloretinoscopy (CR(c)) were +0.11 ± 0.39 D and +0.13 ± 0.44 D, respectively. The 95 per cent limits of agreement for P(c) with R(c) and CR(c) were ±0.76 D (range -0.65 to +0.87) and ±0.86 D (range -0.73 to +0.99), respectively. The mean and standard deviation of weighted axes difference, comparing Plusoptix S08 and retinoscopy was 0.25 ± 0.36 and comparing Plusoptix S08 and cycloretinoscopy was 0.29 ± 0.51. Eighty-two per cent of the spherical equivalent findings in photorefraction and cycloretinoscopy show a difference of within 1.00 D. Regarding cylindrical power, this percentage is 96.6 per cent. CONCLUSION As the findings demonstrate a fairly good consistency between the results of the Plusoptix S08 Photorefractor without using cycloplegic agents and those of cycloretinoscopy, the Plusoptix S08 is a fairly accurate tool to estimate refractive errors of children in the limited working range of the instrument.
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Affiliation(s)
- Ali Mirzajani
- Optometry Department, Tehran University of Medical Sciences, Tehran, Iran.
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Oral Y, Gunaydin N, Ozgur O, Arsan AK, Oskan S. A comparison of different autorefractors with retinoscopy in children. J Pediatr Ophthalmol Strabismus 2012; 49:370-7. [PMID: 22938517 DOI: 10.3928/01913913-20120821-04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 07/06/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the results of different refractive error measurement devices including table-mounted and hand-held autorefractors and videoretinoscopy with cycloplegic retinoscopy (CR) in children to evaluate the usability and reliability of these devices in measuring refractive errors. METHODS Two hundred eyes of 100 children underwent autorefraction using table-mounted autorefractor with and without cycloplegia and videoretinoscopy after cycloplegia. All results were compared statistically. RESULTS The mean spheric values (SV) and spherical equivalent values (SEV) of the non-cycloplegic table-mounted autorefractor were found to be significantly lower and those of the cycloplegic table-mounted autorefractor were found to be significantly higher than CR results. There was no statistically significant difference in terms of mean SV and SEV between the hand-held autorefractor and CR. Although the mean SV using videoretinoscopy were 0.15 diopters lower than CR, this difference was not significant. Comparing CR with the other refraction methods, all devices correlated with each other. Sensitivity in diagnosing myopia was low for all methods but sensitivity in diagnosing hyperopia and astigmatism was high for table-mounted and hand-held autorefractors. The other reliability parameters were found to be similar for all devices. CONCLUSIONS Both videoretinoscopy and hand-held autorefractor can be used in both screening and examination for children as an alternative to CR and table-mounted autorefractor.
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Kemper AR, Wallace DK, Patel N, Crews JE. Preschool vision testing by health providers in the United States: findings from the 2006-2007 Medical Expenditure Panel Survey. J AAPOS 2011; 15:480-3. [PMID: 22108361 DOI: 10.1016/j.jaapos.2011.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 06/01/2011] [Accepted: 07/13/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few data are available regarding the rate of preschool vision screening. The purpose of this study is to estimate the current rate of vision testing among children ages 3 through 6 years by any health care provider and to the characterize the children reported to have been tested. METHODS We conducted a cross-sectional analysis of the 4,237 children aged 3 through 6 years included in either the 2006 or 2007 Medical Expenditure Panel Survey. Household respondents were asked whether selected children ever had vision testing by a doctor or other health provider. Data were weighted to make estimates representative of the civilian noninstitutionalized population. RESULTS Overall, 64.9% (95% CI, 62.9%-66.9%) of children 3 through 6 years of age were reported to have ever had vision testing. The likelihood of previous reported testing increased with age, from 42.9% among 3-year-olds to 79.4% among 6-year-olds (P < 0.001). After adjusting for age, family income, insurance status, whether the child had a regular health care provider, and whether the child had special health care needs, we found that lower odds of testing were reported among non-Hispanic white children (odds ratio [OR], 0.73; 95% CI, 0.55-0.97) and among Hispanic children (OR, 0.62; 95% CI, 0.47-0.82) compared with non-Hispanic black children (OR, 1). CONCLUSIONS These findings highlight the gaps in the delivery of preschool vision screening. Improved population-level surveillance of children's vision and methods to track use of vision-related health services are needed to inform policy makers to develop new strategies to improve care.
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Affiliation(s)
- Alex R Kemper
- Department of Pediatrics, Duke University, Durham, NC, USA.
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Chou R, Dana T, Bougatsos C. Screening for visual impairment in children ages 1-5 years: update for the USPSTF. Pediatrics 2011; 127:e442-79. [PMID: 21282269 DOI: 10.1542/peds.2010-0462] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Screening could identify preschool-aged children with vision problems at a critical period of visual development and lead to treatments that could improve vision. OBJECTIVE To determine the effectiveness of screening preschool-aged children for impaired visual acuity on health outcomes. METHODS We searched Medline from 1950 to July 2009 and the Cochrane Library through the third quarter of 2009, reviewed reference lists, and consulted experts. We selected randomized trials and controlled observational studies on preschool vision screening and treatments, and studies of diagnostic accuracy of screening tests. One investigator abstracted relevant data, and a second investigator checked data abstraction and quality assessments. RESULTS Direct evidence on the effectiveness of preschool vision screening for improving visual acuity or other clinical outcomes remains limited and does not adequately address whether screening is more effective than no screening. Regarding indirect evidence, a number of screening tests have utility for identification of preschool-aged children with vision problems. Diagnostic accuracy did not clearly differ for children stratified according to age, although testability rates were generally lower in children 1 to 3 years of age. Treatments for amblyopia or unilateral refractive error were associated with mild improvements in visual acuity compared with no treatment. No study has evaluated school performance or other functional outcomes. CONCLUSIONS Although treatments for amblyopia or unilateral refractive error can improve vision in preschool-aged children and screening tests have utility for identifying vision problems, additional studies are needed to better understand the effects of screening compared with no screening.
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Affiliation(s)
- Roger Chou
- Oregon Evidence-Based Practice Center and Department of Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA.
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Screening for refractive errors in children: the plusoptiX S08 and the Retinomax K-plus2 performed by a lay screener compared to cycloplegic retinoscopy. J AAPOS 2010; 14:478-83. [PMID: 21168070 DOI: 10.1016/j.jaapos.2010.09.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 09/15/2010] [Accepted: 09/26/2010] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate the performance of the autorefractor Retinomax K-plus2 and the photoscreener plusoptiX S08 in measuring refractive errors by comparing them with cycloplegic retinoscopy (CR) and to assess limitations associated with their use. METHODS Cross-sectional study to compare data from CR, performed by an orthoptist, to data from Retinomax K-plus2 and plusoptiX S08 performed by a lay screener. Sensitivity and specificity for the detection of significant refractive errors were determined according to American Academy of Pediatric Ophthalmology and Strabismus criteria. RESULTS Two hundred children were included, with a mean age of 5.2 ± 2.6 years (3 months to 11 years). Compared to CR, the plusoptiX S08 showed a mean difference of -1.13 ± 1.25 D (95% limits of agreement [LOA], -3.59 to +1.32) for spherical equivalent (SE) and -0.23 ± 0.53 D (LOA, -1.28 to +0.81) for the cylinder. Mean difference for the Retinomax K-plus2 before cycloplegia was -0.08 ± 0.58 D (LOA, -1.23 to +1.06) for SE and 0.03 ± 0.38 D (LOA, -0.72 to +0.78) for the cylinder; after cycloplegia -2.11 ± 1.64 D (LOA, -5.33 to +1.10) for SE and -0.06 ± 0.47 D (LOA, -0.98 to +0.86) for the cylinder. Sensitivity for detecting hyperopia >3.5 D with the plusoptiX S08 was 33.3%, the Retinomax before cycloplegia 31.0% and after cycloplegia 84.6% and high for detecting myopia, astigmatism, and anisometropia. CONCLUSIONS Retinomax K-plus2 and plusoptiX S08 have high sensitivity for the detection of myopia, astigmatism, and anisometropia compared to cycloplegic retinoscopy; however, when used without cycloplegia, hyperopia is underestimated.
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Abstract
PURPOSE Accommodation can mask hyperopia and reduce the accuracy of non-cycloplegic refraction. It is, therefore, important to minimize accommodation to obtain a measure of hyperopia as accurate as possible. To characterize the parameters required to measure the maximally hyperopic error using photorefraction, we used different target types and distances to determine which target was most likely to maximally relax accommodation and thus more accurately detect hyperopia in an individual. METHODS A PlusoptiX SO4 infra-red photorefractor was mounted in a remote haploscope which presented the targets. All participants were tested with targets at four fixation distances between 0.3 and 2 m containing all combinations of blur, disparity, and proximity/looming cues. Thirty-eight infants (6 to 44 weeks) were studied longitudinally, and 104 children [4 to 15 years (mean 6.4)] and 85 adults, with a range of refractive errors and binocular vision status, were tested once. Cycloplegic refraction data were available for a sub-set of 59 participants spread across the age range. RESULTS The maximally hyperopic refraction (MHR) found at any time in the session was most frequently found when fixating the most distant targets and those containing disparity and dynamic proximity/looming cues. Presence or absence of blur was less significant, and targets in which only single cues to depth were present were also less likely to produce MHR. MHR correlated closely with cycloplegic refraction (r = 0.93, mean difference 0.07 D, p = n.s., 95% confidence interval +/-<0.25 D) after correction by a calibration factor. CONCLUSIONS Maximum relaxation of accommodation occurred for binocular targets receding into the distance. Proximal and disparity cues aid relaxation of accommodation to a greater extent than blur, and thus non-cycloplegic refraction targets should incorporate these cues. This is especially important in screening contexts with a brief opportunity to test for significant hyperopia. MHR in our laboratory was found to be a reliable estimation of cycloplegic refraction.
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