“…The 2021 AAPOS Uniform Guidelines for vision screen validation provide not only age-based refractive cut-offs but also strabismus and visual acuity amblyopia risk factor levels. 17 David Hunter, the co-developer of the blinq has recognized the deficiencies of purely refractive amblyopia risk factors. 18 He helped develop a 24-point rubric for determination of “Referral Warranted” pediatric eye disease targeting actual amblyopia and strabismus.…”
Section: Discussionmentioning
confidence: 99%
“…2021. Epub (12) Yes 1 line nl Not Strabismus <20/40 ou age 48–72 months Yes nl ARF nl Strabismus <20/50 ou age <48 months Yes nl ARF Not Strabismus Hyperopia ≥4D Yes nl nl nl Strabismus Myopia ≤6D Yes nl nl Not Strabismus cyl ≥2.5D Notes : On the left regions, columns represent the 2021 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Uniform guidelines, 17 then the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS) 11 and then the ‘referral-warranted’ eye disease proposed by Bosque and Hunter. 12 The Middle region clarifies the ‘referral Warranted’ 24-point rubric.…”
Section: Methodsmentioning
confidence: 99%
“… Notes : On the left regions, columns represent the 2021 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Uniform guidelines, 17 then the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS) 11 and then the ‘referral-warranted’ eye disease proposed by Bosque and Hunter. 12 The Middle region clarifies the ‘referral Warranted’ 24-point rubric.…”
Background
The purpose of this paper is to validate three recent non-refractive devices that target sensory and/or strabismus risk factors for amblyopia. EyeSwift® with eye tracking and PDI Check on autostereoscopic Nintendo 3DS are video games that estimate acuity, binocularity and color. The Rebion blinq assesses foveation by birefringence.
Methods
Students were consented to be screened by each device as if by a school nurse before confirmatory examination with optimized, refined refraction. Results were compared with correlation and Bland Altman plots while screening ability was compared with 2021 AAPOS Guidelines and the strabismus-amblyopia rubric proposed by David Hunter.
Results
A total of 77 ethnically diverse students, aged 11±4 (4–19) years had a 77% prevalence of 2021 risk factors. Near visual acuity, inter-eye difference and stereopsis correlated significantly (p<0.01) for the EyeSwift® (r
2
0.14, 0.06 and 0.45) and PDI Check (r
2
0.23, 0.22 and 0.32). The sensitivity/specificity to target 2021-AAPOS: Hunter-rubric for EyeSwift® was 82%/56%: 74%/62%, for PDI Check was 75/64%: 69%/69% and for blinq 75/48%: 82%/39%. Sensitivity/specificity for the seven color-deficient students was 86%/84% for EyeSwift® and 100%/81% for PDI Check. Screening time was 96±19 s for PDI Check and 375±102 s for EyeSwift but less than 25 s for blinq.
Conclusion
Reliable near visual acuity, stereo and color testing were obtained from the two binocular and touch screen devices often with minimal coaching of the student. The blinq rapidly gives an estimate of whether both eyes are steadily fixing, and the ProVersion predicted 100% which eye is deviated or amblyopic. Non-refractive validation metrics were beneficial.
“…The 2021 AAPOS Uniform Guidelines for vision screen validation provide not only age-based refractive cut-offs but also strabismus and visual acuity amblyopia risk factor levels. 17 David Hunter, the co-developer of the blinq has recognized the deficiencies of purely refractive amblyopia risk factors. 18 He helped develop a 24-point rubric for determination of “Referral Warranted” pediatric eye disease targeting actual amblyopia and strabismus.…”
Section: Discussionmentioning
confidence: 99%
“…2021. Epub (12) Yes 1 line nl Not Strabismus <20/40 ou age 48–72 months Yes nl ARF nl Strabismus <20/50 ou age <48 months Yes nl ARF Not Strabismus Hyperopia ≥4D Yes nl nl nl Strabismus Myopia ≤6D Yes nl nl Not Strabismus cyl ≥2.5D Notes : On the left regions, columns represent the 2021 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Uniform guidelines, 17 then the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS) 11 and then the ‘referral-warranted’ eye disease proposed by Bosque and Hunter. 12 The Middle region clarifies the ‘referral Warranted’ 24-point rubric.…”
Section: Methodsmentioning
confidence: 99%
“… Notes : On the left regions, columns represent the 2021 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Uniform guidelines, 17 then the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS) 11 and then the ‘referral-warranted’ eye disease proposed by Bosque and Hunter. 12 The Middle region clarifies the ‘referral Warranted’ 24-point rubric.…”
Background
The purpose of this paper is to validate three recent non-refractive devices that target sensory and/or strabismus risk factors for amblyopia. EyeSwift® with eye tracking and PDI Check on autostereoscopic Nintendo 3DS are video games that estimate acuity, binocularity and color. The Rebion blinq assesses foveation by birefringence.
Methods
Students were consented to be screened by each device as if by a school nurse before confirmatory examination with optimized, refined refraction. Results were compared with correlation and Bland Altman plots while screening ability was compared with 2021 AAPOS Guidelines and the strabismus-amblyopia rubric proposed by David Hunter.
Results
A total of 77 ethnically diverse students, aged 11±4 (4–19) years had a 77% prevalence of 2021 risk factors. Near visual acuity, inter-eye difference and stereopsis correlated significantly (p<0.01) for the EyeSwift® (r
2
0.14, 0.06 and 0.45) and PDI Check (r
2
0.23, 0.22 and 0.32). The sensitivity/specificity to target 2021-AAPOS: Hunter-rubric for EyeSwift® was 82%/56%: 74%/62%, for PDI Check was 75/64%: 69%/69% and for blinq 75/48%: 82%/39%. Sensitivity/specificity for the seven color-deficient students was 86%/84% for EyeSwift® and 100%/81% for PDI Check. Screening time was 96±19 s for PDI Check and 375±102 s for EyeSwift but less than 25 s for blinq.
Conclusion
Reliable near visual acuity, stereo and color testing were obtained from the two binocular and touch screen devices often with minimal coaching of the student. The blinq rapidly gives an estimate of whether both eyes are steadily fixing, and the ProVersion predicted 100% which eye is deviated or amblyopic. Non-refractive validation metrics were beneficial.
“…As a result, combining knowledge of community ARF prevalence and information on relative amblyopiagenic potential of ARFs ( Figure 1 ), and emphasizing school-performance levels of moderate symmetric myopia and astigmatism, an update from 2003 and 2013 in the AAPOS uniform Amblyopia Risk Factor and Visually Significant Refractive Error guidelines was presented in 2021. 9 Figure 1 Refractive Amblyopia Risk Factors (ARFs) “diamond graph” AAPOS diopter cut-offs with prevalence scale under each orange axis with thickness approximating each ARF’s severity. Upper graph: 2003 AAPOS preschool guidelines indicated by red diamond.…”
Background:The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) issued a 2021 update of Uniform Validation Guidelines for instrument-based pediatric vision screeners. With each update it is important for each manufacturer to update the Instrument Referral Criteria (IRC) programed into their devices in order to optimize sensitivity and specificity to detect AAPOS criteria. Methods: De-identified data comparing photoscreening with simultaneous confirmatory examinations constituted separate cohorts for the development of IRC via receiver operating characteristic (ROC) curves. The refractions of the devices were also compared. Results: This study defines three sets of refractive IRC (Sensitive, Medium, and Specific) for three leading infrared photoscreening devices, PlusoptiX A12, Welch-Allyn SPOT, and Adaptica 2WIN for children < 4 and ≥ 4 years in order to better target the 2021 AAPOS guidelines. The cohorts were similar but the SPOT group (n=755, mean age 9) was older with more astigmatism and the 2WIN (n=1362, mean age 7) was younger with more hyperopia and anisometropia compared to the cohort for PlusoptiX A12 (n=616, mean age 8). The age-based, medium magnitude IRC for anisometropia, hyperopia, astigmatism and myopia for SPOT were: <4y: 1
“…The Vision Screening Committee of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) has published confirmatory exam failure levels for amblyopia risk factors starting in 2003 3 and updated with three age ranges in 2013 4 with even further refinement in 2021. 5 …”
Purpose
In 2022, an inexpensive multi-radial infrared photoscreener, the AI Optic was released in a similar format as the 2012 PlusoptiX a-12 but utilizing artificial intelligence (AI) for online, central image interpretation. We studied them because no prior comparative validation concerning amblyopia risk factors and particularly refractive error has been done.
Patients and Methods
Children from a pediatric ophthalmology practice had AI Optic and PlusoptiX-a12 photoscreen concomitantly during comprehensive examination with precisely measured strabismus and refraction. Validation to AAPOS 2021 and 2013 guidelines was evaluated with receiver operating characteristic (ROC) curves while refractive estimates were compared by the ABCD ellipsoid univariable technique.
Results
In 200 ethnically diverse children aged 1–18, 148 were 4 years or older, 35% had developmental delays, and 2/3 had amblyopia risk factors (ARF). Area under the ROC curve (AUC) targeting AAPOS 2021 refractive plus strabismus for age ≥4 years was 0.58 for AI Optic and 0.74 for PlusoptiX while for children <4 years, AUC was 0.53 for AI Optic and 0.72 for PlusoptiX. For 134 comparable sphero-cylinder refractions, the ABCD Ellipsoid median (interquartile ranges) for AI Optic right eye 2.53 (1.54, 4.01) and left eye 3.05 (1.83, 5.00) did not approximate actual refraction as well as by PlusoptiX right eye 1.88 (1.12, 2.86) and left eye 2.10 (1.26, 3.04) Mann Whitney z=3.7 right and 4.2 left, p<0.001 each. AI Optic via central “AI” reading gave sphero-cylinder and referral estimates in all but 16 of 200 high risk children whereas Plusoptix had 25 inconclusives. On the other hand, with inconclusives scored as a refer, Plusoptix outperformed AI Optic in terms of ARF validation and refractive estimate.
Conclusion
Plusoptix provided more valid amblyopia and refractive screening than the cheaper AI Optic. Clinics must weigh cost versus performance, and central data sharing before selecting one of these vision-saving devices.
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