Comparative Validation of PlusoptiX and AI-Optic Photoscreeners in Children with High Amblyopia Risk Factor Prevalence

Abstract

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.

Global research of artificial intelligence in strabismus: a bibliometric analysis

“…Meanwhile, USA had the closest international cooperation, while other countries such as South Korea and Brazil sustained high scientific productions with poor international collaboration. Publications from USA in recent years inclined to study new screening devices which were able to detect amblyopia risk factors or directly detect strabismus ( 48 , 49 ). Publications from China brought more focus on deep learning-based image analysis.…”