Instrument Referral Criteria for PlusoptiX, SPOT and 2WIN Targeting 2021 AAPOS Guidelines

Abstract

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

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

“…We employed IRC rating number 4 out of five options for specificity 12 (anisometropia 1.25, hyperopia 2.00, cylinder 1.50 and myopia 1.50) when this device was employed hand-held in a dim exam room. A range of instrument referral criteria previously reported for PlusoptiX 21 are employed and new regular, sensitive and specific and extra-specific alternatives are generated from adjusted ARF component contributions to preliminary AUC, particularly for the recently released AI Optics device are given in Table 1 .…”

“…SAMPLE SIZE CALCULATION: Prior experience with infrared photoscreener refraction comparison demonstrated the ABCD ellipsoid mean about 2.0 with standard deviation 2.0. 21 Therefore, to detect a difference of 0.5, with beta 0.8 and alpha 0.05, a sample size of 126 would be needed. If 2/3 of the patients were predicted older than 4 years, then about 180 patients should be recruited expecting some to be inconclusive or out-of-range.…”

“… 39 Evidence-based instrument referral guidelines with sensitive and specific alternatives for the three leading infrared photoscreeners PlusoptiX, SPOT (Welch-Allyn, Schenectady, New York) and the Adaptica 2WIN (Padova, Italy) targeting the 2021 revision in AAPOS guidelines 5 have been published. 21 …”

“…The Plusoptix family of photoscreeners (S04, s08, s09, s-12, s-16) has had extensive validation compared with eye chart visual acuity, 6,7 digital flash cameras, [7][8][9] the MTI photoscreener, 9,10 the iScreen, 9,[11][12][13] Suresight, 9,14-16 compared with SPOT, 12,13,[17][18][19][20][21] 2WIN, 17,[21][22][23][24][25][26] GoCheck Kids, 13 blinq, 25,26 with Retinomax 9,23,24,27,28 and table-top autorefractors, 22,29 community screening 30,31 and examination. 28,[32][33][34][35][36][37][38][39][40][41][42][43][44] The refractive accuracy has been compared.…”

Pediatric Non-Refractive Vision Screening with EyeSwift, PDI Check and Blinq: Non-Refractive Vision Screening with Two Binocular Video Games and Birefringent Scanning

“…Validation targets: Confirmatory examinations were classified as to amblyopia risk factors using the 2021 AAPOS Guidelines for the ages 4 years and older. 16 The refractive components were analyzed separately and then refractive ± strabismic ± visual acuity were also analyzed. The 24-point rubric based on MEPEDS 12 was also analyzed and compared to AAPOS 2021 guideline amblyopia ± strabismus ( Table 1 ).…”