High specificity of the pediatric vision scanner in a private pediatric primary care setting

Abstract

Purpose-To determine the specificity of the Pediatric Vision Scanner, a binocular retinal birefringence scanner, in its intended setting, a pediatric primary care office.Methods-A total of 102 preschool children (age 2-6 years) were screened during a well-child pediatric visit using the Pediatric Vision Scanner and the SureSight Autorefractor and completed a masked comprehensive pediatric ophthalmic examination (gold standard examination).Results-Based on the gold standard examination, one child had anisometropic amblyopia, and the remaining 101 had no amblyopia or strabismus. Specificity of the Pediatric Vision Scanner was 90% (95% CI, 82%-95%) while specificity of the SureSight was 87% (95%CI, 79-93%). Combining these results with the sensitivity of the devices determined in our previous study conducted in a pediatric ophthalmology office setting, the positive likelihood ratio for the Pediatric Vision Scanner was 10.2; for the SureSight, 5.0. The negative likelihood ratio for the Pediatric Vision Scanner was 0.03; for the SureSight, 0.42, a significant difference. Conclusions-ThePediatric Vision Scanner had high specificity (90%) in screening for amblyopia and strabismus as part of a pediatric well-child visit. Likelihood ratio analysis suggests that affected children have a high probability of being correctly identified by the Pediatric Vision Scanner. The high level of confidence conferred by Pediatric Vision Scanner screening may remove an important barrier to vision screening in pediatric primary care.Correspondence: Reed M. Jost, MS, Retina Foundation of the Southwest, 9600 North Central Expressway, Suite 200, Dallas, TX 75231 (reedjost@retinafoundation.org). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The authors have no financial interest in any screening device. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptAmblyopia is the most common cause of monocular visual impairment, affecting 2%-4% of children age 6 years and younger. 1,2 Delayed detection and treatment can lead to permanent vision loss. [3][4][5][6] Young children are unlikely to be aware of decreased vision in one eye; thus, the primary aim of preschool vision screening is the detection of amblyopia. Strabismus is the most common amblyogenic risk factor. 7,8 Even in the absence of amblyopia, strabismus can disrupt the development of normal binocular vision, detrimentally affect fine motor skills, and have psychosocial consequences. 9-13 Preschool vision screening could help identify children with the targeted conditions of amblyopia or strabismus wh...

Vision Screening in Children Aged 6 Months to 5 Years

“…Sixteen fair-quality studie s (16 7 12 obser vations) evaluated autorefractors (eTables 6-17 in the Supplement). 49,51,55,57,58,65,66,70,[72][73][74]77,78,84,88,91 Overall, most studies found moderate positive LRs and small negative LRs, although some found large positive and negative LRs.…”

“…70,91 About one-third of the studies included participants younger than 3 years. 48,56,65,66,71,72,[75][76][77]80,81,85,88,91 The included studies reported accuracy of tests for a variety of target conditions, ranging from very specific (eg, astigmatism) to broad (eg, amblyopia risk factors). The prevalence of target conditions was generally much higher in samples from ophthalmology clinics 53,56,57,62,66,68,69,72,75,77,80,81,85,88 than in those from primary care, community, Head Start, or school settings.…”

Recent Advances in Screening and Treatment for Amblyopia

“…1). In a pair of studies, 400 preschool children were screened using a prototype retinal birefringence scanner that collected five scans in 2.5 s from children aged 2-6 years old at two pediatric ophthalmology private practices and at one pediatric primary care practice [18,19]. Screening results were compared with findings at a gold standard comprehensive examination by a pediatric ophthalmologist who was masked to screening results.…”

Early diagnosis of amblyopia

“…Testing can be completed in 10 s in children as young as 2 years of age. Thus far, the ability of the PVS to detect amblyopia and strabismus has been promising (Loudon et al, 2011; Jost et al, 2014; Jost et al, 2015). While the device was originally designed to assess strabismus, it has been hypothesized that the PVS also detects amblyopia because, similar to strabismic patients, amblyopic patients also have inaccurate and/or unstable fixation (Loudon et al, 2011; Gonzalez et al, 2012; Jost et al, 2015).…”