A Comparison of Three Different Photoscreeners in Children

Test-Retest of the Spot Vision Screener among Children with Ophthalmological Diseases including Strabismus

Background

The spot vision screener (SVS) has been widely used for eye health examinations of infants and young children. The purpose of this study was to evaluate the reproducibility of two SVS measurements in children with ophthalmological diseases.

Methods

29 patients aged 15 years or younger who visited our hospital for refraction examinations with SVS before and at least 60 minutes after administration of 2 drops of 1% cyclopentolate ophthalmic solution (before and after cycloplegia) were included in this study. Two SVS measurements were made before and after cycloplegia, respectively. Intraclass correlation coefficients (ICCs) and Bland-Altman analysis for spherical, spherical equivalent (SE), cylindrical, J0, and J45 values before and after cycloplegia were analyzed.

Results

The mean age ± standard deviation (SD) of the 29 patients was 7.6 ± 2.4 years. There were 11 males and 18 females. The mean spherical values based on the SVS before and after cycloplegia were 0.42 ± 1.67 diopter (D), and 1.47 ± 2.23 D for the first measurement and 0.60 ± 1.74 D, and 1.42 ± 2.27 D for the second measurement, respectively. The mean cylindrical values based on SVS before and after cycloplegia were -1.45 ± 0.96 D and -1.65 ± 0.89 D for the first measurement and -1.58 ± 1.13 D and -1.66 ± 0.91 D for the second measurement, respectively. The ICCs for the first and second spherical, SE, cylindrical, J0, and J45 values before cycloplegia were 0.95, 0.98, 0.83, 0.86, and 0.86, respectively. The ICCs for the first and second spherical, SE, cylindrical, J0, and J45 values after cycloplegia were 0.99, 0.99, 0,87, 0.73, and 0.80, respectively. The Bland-Altman analysis of the first and second spherical and SE values before cycloplegia showed fan-shaped variation as hyperopia increased.

Conclusions

Two consecutive SVS refraction measurements have a high degree of reproducibility for spherical and SE values but a low degree for cylindrical, J0, and J45 values. From these results, multiple measurements are required to obtain reliable results for cylindrical values.

Comparison of photorefraction by Plusoptix A12 and cycloplegic autorefraction in children

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.

Comparison of the new self-contained darkroom refractive screener versus table-top autorefractor and cycloplegia retinoscopy in detecting refractive error

PURPOSE

By comparing the results of the new self-contained darkroom refractive screener (YD-SX-A) versus table-top autorefractor and cycloplegic retinoscopy, to evaluate the performance of the YD-SX-A in detecting refractive error in children and adolescents and then judge whether it can be used in refractive screening.

METHODS

Cross-sectional study. 1000 participants between the ages of 6 and 18 who visited the Optometry Center of the People's Hospital of Guangxi Zhuang Autonomous Region from June to December 2022 were selected. First, participants were instructed to measure their diopter with a table-top autorefractor (Topcon KR8800) and YD-SX-A in a noncycloplegic setting. After cycloplegia, they were retinoscopy by a professional optometrist. The results measured by three methods were collected respectively. To avoid deviation, only the right eye (1000 eyes) data were used in the statistical analysis. The Bland-Altman plots were used to evaluate the agreement of diopters measured by the three methods. The receiver operating characteristic (ROC) curves was used to analysis effectiveness of detecting refractive error of YD-SX-A.

RESULTS

The average age of participants was 10.77 ± 3.00 years, including 504 boys (50.4%) and 496 girls (49.6%). When YD-SX-A and cycloplegia retinoscopy (CR) were compared in the myopia group, there was no statistical difference in spherical equivalent (SE) (P > 0.05), but there was a statistical difference in diopter spherical (DS) and diopter cylinder (DC) (P < 0.05). Comparing the diopter results of Topcon KR8800 and CR, the difference between each test value in the myopia group was statistically significant (P < 0.05). In the hyperopia group, the comparison between YD-SX-A and CR showed no statistically significant differences in the DC (P > 0.05), but there were significant differences in the SE and DS (P < 0.05). In the astigmatism group, the SE, DS, and DC were statistically different, and the DC of YD-SX-A was lower than that of CR and Topcon KR8800. Bland-Altman plots indicated that YD-SX-A has a moderate agreement with CR and Topcon KR8800. The sensitivity and specificity of YD-SX-A for detecting myopia, hyperopia and astigmatism were 90.17% and 90.32%, 97.78% and 87.88%, 84.08% and 74.26%, respectively.

CONCLUSION

This study has identified that YD-SX-A has shown good performance in both agreement and effectiveness in detecting refractive error when compared with Topcon KR8800 and CR. YD-SX-A could be a useful tool for large-scale population refractive screening.

Measurement Accuracy When Using Spot Vision Screener With or Without Cycloplegia in Young Adults

Purpose

There are many unclear points about the accuracy of measurement of cycloplegic refraction using the Spot Vision Screener (SVS). This study aimed to investigate the accuracy of SVS measurements with cycloplegia for myopia.

Materials and Methods

Forty-nine healthy subjects were included, and refraction was measured. Objective refractions were measured by SVS, table-mounted autorefractometer (RT7000), and handheld autorefractometer (Retinomax Screeen) at noncycloplegic and cycloplegic conditions by 1% cyclopentolate. Subjective noncycloplegic refraction was obtained by a visual acuity and refraction test performed by certified orthoptists using a cross-cylinder. One-way repeated-measures analysis of variance was used to examine whether the measured refractions fluctuate due to different reflection tests.

Results

In the noncycloplegic condition, the mean (±standard deviation) spherical equivalent (SE) measured by subjective method, SVS, RT7000, and Retinomax Screeen were -2.56 ± 3.00, -2.62 ± 2.38, -3.05 ± 2.84, and -3.26 ± 2.97, respectively. The subjective SE and objective SE measured by SVS had significantly less myopic value than the objective SE measured by two autorefractometers (p < 0.001). In the cycloplegic condition, the mean (± standard deviation) SE measured by SVS, RT7000, and Retinomax Screeen were -2.07 ± 2.66, -2.62 ± 2.98, and -2.66 ± 3.02, respectively. The objective SE measured by SVS had significantly less myopic value than SEs measured using other methods (p < 0.001). In the cycloplegic condition, SVS showed a fixed error wherein the SE was more hyperopic than that with the subjective method and SVS had a proportional error.

Conclusion

In the measurement under cycloplegic conditions, use of an autorefractometer rather than a photorefractometer such as SVS was preferable.

The change of myopic prevalence in children and adolescents before and after COVID-19 pandemic in Suqian, China

Purpose

The aim of this study was to investigate the change of myopic prevalence in students with different demographic characteristics before and after the COVID-19 pandemic in Suqian, China.

Methods

A retrospective, cross-sectional study was conducted. Student data from 52 schools in 2019 and 2020 were collected from the electronic medical records database through cluster sampling. Ophthalmic examinations were conducted on students from September to December in 2019 and 2020. Measurements of uncorrected visual acuity (UCVA) and noncycloplegic autorefraction were included to obtain the spherical equivalent refraction (SER) and prevalence of myopia. The difference in the rate of myopia and SER of students ages 6 to 18 with various demographic characteristics was compared between the two years.

Results

Records from 118,479 students in 2019 and the 121,881 students in 2020 were obtained. In 2019 and 2020, the prevalence of overall myopia increased from 43.1% to 48.9% (5.8 percentage point), and a substantial shift in myopic rate occurred in grades 4 to 6 (6.9 percentage point). The change in the prevalence of myopia in girls (5.9 percentage point) was approximately equal to that in boys (5.8 percentage point) and it was more common in rural students (5.9 percentage point) than in urban students (5.1 percentage point). The prevalence of low myopia increased more in children, and the prevalence of moderate myopia increased more in adolescents. The mean spherical equivalent refraction (SER) (-1.34±2.03 D) was lower in 2020 than in 2019 (-1.16±1.92 D), while SER decreased mainly at ages 7 to 15. The SER presented myopic status at the age of 9 (-0.55±1.26 D in 2019, -0.71±1.42 D in 2020), and attained moderate myopia at the age of 15 (-3.06±2.41 D in 2019, -3.22±2.40 D in 2020).

Conclusions

After the COVID-19 pandemic, myopia increased in this population with variable rates of increase in different demographic groups. The change of myopia in children was comparatively greater than that in adolescents. Therefore, we should take measures to prevent and control the development of myopia after the COVID-19 pandemic, especially for younger students.

Performance of a photoscreener in detecting accommodation spasm

CLINICAL RELEVANCE

For a correct spectacle prescription, accommodation spasm should not be overlooked in the measurements made using an autorefractometer. Although this can be easily understood with cycloplegia, it is not practical. Therefore, investigating practical methods that can predict excess accommodation will be useful in clinical practice.

BACKGROUND

To evaluate the performance of a photoscreener in detecting pseudo-myopia due to accommodation spasm and whether it eliminates the need for cycloplegia.

METHODS

Study was conducted in Van Training and Research Hospital. The manifest refraction of the patients was measured using an by an autorefractometer followed by a photoscreener before cycloplegia. Cycloplegic refraction errors were detected using an autorefractometer. Patients with pseudo-myopia due to accommodation spasm were diagnosed by observing a significant hyperopic shift in cycloplegic autorefractometer values compared to the non-cycloplegic values and were included in study. Cycloplegic autorefractometer and non-cycloplegic photoscreener measurements were compared.

RESULTS

The mean non-cycloplegic autorefractometer values were as follows: --6.34 ± 1.29D, -0.42 ± 0.58D, and -6.55 ± 1.36D for spherical, cylindrical, and spherical equivalents, respectively. These values were 0.23 ± 0.63D, -0.21 ± 0.41D, and 0.11 ± 0.73D for cycloplegic autorefractometer measurements, respectively. Cycloplegic autorefractometer values showed a significant hyperopic shift of 6.57 ± 1.26D and 6.67 ± 1.34D for spherical and spherical equivalents, respectively, compared to non-cycloplegic values (p < 0.001 for both). There was no significant difference between non-cycloplegic photoscreener and cycloplegic autorefractometer measurements for spherical, cylindrical, and spherical equivalents (p = 0.126, p = 0.078, and p = 0.053, respectively). . There was agreement between the measurements in the Bland-Altman graph.

CONCLUSION

There was consistency between non-cycloplegic photoscreener and cycloplegic autorefractometer measurements in patients with pseudomyopia due to accommodation spasm. Therefore, photoscreener measurements can be a fast, practical, cost-effective examination method for screening these patients without the need for cycloplegia.

Comparison between two autorefractor performances in large scale vision screening in Chinese school age children

AIM

To evaluate the effectiveness of Grand Seiko Ref/Keratometer WAM-5500 compared to Topcon KR800 autorefractor in detecting refractive error in large scale vision screening for Chinese school age children with the WHO criteria.

METHODS

A total of 886 participants were enrolled with mean age of 9.49±1.88y from Tianjin, China. Spherical equivalent (SE) was obtained from un-cycloplegic autorefraction and cycloplegic autorefraction. Topcon KR 800 (Topcon) and Grand Seiko WAM-5500 (WAM) autorefractors were used. Bland-Altman Plot and regression were generated to compare their performance. The overall effectiveness of detecting early stage refractive error was analyzed with receiver operating characteristic (ROC) curves.

RESULTS

The mean SE was -0.98±1.81 diopter (D) and the prevalence of myopia was 48.9% defined by WHO criteria according to the result of cycloplegic autorefraction. The mean SE of un-cycloplegic autorefraction with Topcon and WAM were -1.21±1.65 and -1.20±1.68 D respectively. There was a strong linear agreement between result obtained from WAM and cycloplegic autorefraction with an R² of 0.8318. Bland-Altman plot indicated a moderate agreement of cylinder values between the two methods. The sensitivity and specificity for detecting hyperopia were 90.52% and 83.51%; for detecting myopia were 95.60% and 90.24%; for detecting astigmatism were 79.40% and 90.21%; for detecting high myopia were 98.16% and 98.91% respectively.

CONCLUSION

These findings suggest that both Grand Seiko and Topcon autorefractor can be used in large-scale vision screening for detecting refractive error in Chinese population. Grand Seiko gives relatively better performance in detecting myopia, hyperopia, and high myopia for school age children.

Comparison of refractive value and pupil size under monocular and binocular conditions between the Spot Vision Screener and binocular open-field autorefractor

We determined the repeatability-reproducibility of refraction values and pupil size measured using the Spot Vision Screener and compare the obtained values with those measured using the binocular open-field autorefractor Grand Seiko WAM 5500 in healthy adults. This cross-sectional study included 22 eyes of 22 healthy adults with emmetropia to myopia. For each participant, spherical equivalent value, cylindrical value, and pupil size were measured in the right eye using the Spot Vision Screener and Grand Seiko autorefractor devices by two different orthoptists under two conditions: monocular and binocular (three consecutive refraction measurements). Repeatability-reproducibility of values measured using both devices were evaluated using intra-class correlation coefficients (ICCs). The mean spherical equivalent value measured using the Spot Vision Screener was -2.79D in the monocular condition and -2.69D in binocular condition, which showed a small significant difference to those measured using the Grand Seiko autorefractor (-2.98D and -2.93D, respectively). The mean cylindrical value measured using the Spot Vision Screener was -0.59D in the monocular condition and -0.52D in the binocular condition, which showed a small significant difference compared with those measured using the Grand Seiko autorefractor in the binocular condition (-0.70D and -0.75D, respectively). Correlation coefficients of the spherical equivalent values, cylindrical values, and pupil sizes measured using both devices were R=0.959 (P<0.001), R=0.243 (P=0.260) and R=0.917 (P<0.001), respectively, in the monocular condition and R=0.962 (P<0.001), R=0.444 (P=0.040), and R=0.832 (P<0.001), respectively, in the binocular condition. ICC values of spherical equivalent value in intra-rater or inter-rater were more than 0.99 in both devices and conditions. ICC values of cylindrical values under the binocular condition in the Spot Vision Screener were 0.636 in intra-rater and 0.574 in inter-rater, which were lower than those of the Grand Seiko autorefractor (0.874 and 0.839, respectively). ICC values of pupil sizes under the binocular condition in the Spot Vision Screener were 0.871 in intra-rater and 0.760 in inter-rater, which were lower than those of the Grand Seiko autorefractor (0.967 and 0.943, respectively). The refractive value and pupil size obtained using the Spot Vision Screener showed high repeatability and reproducibility and were similar to the values obtained using the Grand Seiko autorefractor. Thus, the Spot Vision Screener, an automated vision screener, is a reliable portable refractor and pupillometry device for measuring refractive errors in clinical settings.

School-based epidemiology study of myopia in Tianjin, China

PURPOSE

To study the epidemiology of myopia in school-aged children in Tianjin and the relationship between visual acuity-based screening and refraction-based screening.

METHOD

This school-based prospective cohort study was performed on children from 42 elementary schools and 17 middle schools in Tianjin, China. Totally 14,551 children, ages ranging from 5 to 16 years, were included in this study. Uncorrected visual acuity (UCVA) was determined by logarithmic tumbling E chart. Non-cycloplegic photorefraction was examined by the Spot (v2.1.4) photoscreener. The relationship between the UCVA and refractive error was investigated for different age groups.

RESULTS

The overall prevalence of myopia at this school based screen is 78.2%, ranged from 10% at age of 5 to 95% at age of 16. The most dramatic increase in prevalence is from age of 6 (14.8%) to age of 7 (38.5%). The overall prevalence of high myopia is 2.5%. UCVA is found corresponding to spherical equivalent refraction (SER) in a manner of normal distribution and is significantly affected by age. When using UCVA to estimate the prevalence of myopia, the overall sensitivity and specificity are 0.824 and 0.820, respectively. Age-dependent optimal cutoff points and 95% confident intervals of such estimation are reported.

CONCLUSIONS

Myopia is heavily affecting school-aged children in Tianjin, China. The refraction screening is preferable for myopia screening, whereas the UCVA screening results need to be interpreted in an age-dependent manner for myopia estimation.

Clinical Performance of the Spot Vision Photo Screener before and after Induction of Cycloplegia in Children

Aim

To compare the clinical performance of the Spot Vision Screener used to detect amblyopia risk factors (ARFs) in children before and after induction of cycloplegia; the children were referred because they met the screening criteria of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS).

Methods

The Spot Vision Screener and a standard autorefractometer were used to examine 200 eyes of 100 children aged 3–10 years, before and after cycloplegia induction, in terms of ARFs. Sensitivity, specificity, and positive and negative predictive values for the detection of significant refractive errors were measured using the AAPOS referral criteria. It was explored that Spot Screener data were affected by cycloplegia. The extent of agreement between cycloplegic/noncycloplegic photoscreening data and cycloplegic autorefraction measurements was assessed using Wilcoxon and Spearman correlation analyses.

Results

The Spot's sensitivity was improved from 60.9% to 85.3% and specificity from 94.9% to 87.4% with cycloplegia compared to cycloplegic standard autorefractometer results. The positive predictive value of Spot was 75.7%, and the negative predictive value was 90.4% without cycloplegia. With cycloplegia, the positive predictive value of Spot was 63.6% and the negative predictive value was 95.8%.

Conclusions

The Spot Screener afforded moderate sensitivity and high specificity prior to cycloplegia. The sensitivity and negative predictive value improved after induction of cycloplegia. Examiners should be aware of the effects of cycloplegia on their findings.