Preschool Vision Screening in Primary Care Pediatric Practice

Hered, Robert W.; Wood, David L.

doi:10.1177/003335491312800309

Cited by 22 publications

(18 citation statements)

References 29 publications

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“…Using HOTV optotypes, overall sensitivity found by the VIP group was 54%, 18 with which the JVAS again compares favorably. In a study of visual acuity screening using a Lea symbol chart, 19 the PPV was found to be 66.7%, similar to our PPV result of 66% to 79% (Table 3). Although JVAS sensitivity appears higher than sensitivities found for visual acuity tests in the VIP studies, it is difficult to compare directly results when there are differences between studies regarding primary care versus enriched populations, ages of subjects, screening pass/fail thresholds, and the gold standard criteria used.…”

Section: Discussionsupporting

confidence: 87%

A new computer-based pediatric vision-screening test

Yamada

Hatt

Moke

et al. 2015

Journal of American Association for Pediatric Ophthalmology and

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Background We developed and validated the Jaeb Visual Acuity Screener (JVAS), a computerized visual acuity-based screening program for children that employs a rapid, age-specific, standardized algorithm for vision screening in the medical home that is available for download at no cost. Methods A total of 175 children aged 3 to <8 (median, 6) years were screened with the JVAS before undergoing a complete eye examination (gold standard). The JVAS presented 2 large single surround optotypes (20/100 and 20/80) and then 5 optotypes at a predetermined, age-specific normal threshold. Failure on the gold standard examination was determined using recently published referral criteria and published visual acuity norms for age. We evaluated the sensitivity and specificity of the JVAS for detecting reduced visual acuity, amblyopia, and amblyopia risk factors. JVAS pass/fail paradigms evaluated were inability to identify 3 of 4, 3 of 5, and 4 of 5 age-appropriate optotype presentations. Results Screening testability for the JVAS was high, at 100%. Sensitivity of the JVAS ranged from 88% to 91%, and specificity from 73% to 86%, with positive predictive value ranging from 66% to 79% and negative predictive value from 92% to 93% (ranges reflect different pass/fail paradigms). Conclusions The new JVAS provides an effective and practical method for screening 3- to 7-year-olds using any Windows-based computer. Providing the JVAS free-of-charge to pediatricians and school systems would standardize currently fragmented visual acuity-based screening practices.

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Section: Discussionsupporting

confidence: 87%

A new computer-based pediatric vision-screening test

Yamada

Hatt

Moke

et al. 2015

Journal of American Association for Pediatric Ophthalmology and

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show abstract

Section: Discussionsupporting

confidence: 87%

A new computer-based pediatric vision-screening test

Hatt¹,

Yamada²,

Moke³

et al. 2015

Journal of American Association for Pediatric Ophthalmology and

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“…Even if the GSE is free, parents must take time off work to appear for the appointment, and they may not be aware-even in the case of a failed screening-of the importance of early detection and treatment of amblyopia and strabismus. Overall, our completed GSE rate was comparable with that in other published studies, 17,[21][22][23] and there was no reason to assume that any systematic errors could have led to bias in the patients who did receive GSE. Although we cannot know whether the children who did not attend the GSE had amblyopia or strabismus, our finding of 1 of 102 children (1%) who completed the GSE affected with amblyopia is consistent with the published prevalence of 2.5%.…”

Section: Discussionsupporting

confidence: 85%

“…22 Considering the expected low attendance at the GSE, and further considering that most families in the present study would not have the imperative of a screening failure referral to motivate them to take the time to schedule the GSE, it was anticipated that only 20%-40% of patients would obtain the GSE and that screening of up to 300 patients would be required to achieve the desired sample size of 100 children with completed GSEs.…”

Section: Author Manuscript Author Manuscript Author Manuscriptmentioning

confidence: 99%

“…The protocol was therefore designed to continue until 100 children had participated in screening and completed the GSE. Prior studies have reported that only 38%-48% of children who fail a vision screening will report for a comprehensive eye examination, [21][22][23] even when the pediatric ophthalmologist is a member of the same multispecialty practice as the pediatricians who perform the vision screening. 22 Considering the expected low attendance at the GSE, and further considering that most families in the present study would not have the imperative of a screening failure referral to motivate them to take the time to schedule the GSE, it was anticipated that only 20%-40% of patients would obtain the GSE and that screening of up to 300 patients would be required to achieve the desired sample size of 100 children with completed GSEs.…”

Section: Sample Sizementioning

confidence: 99%

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

Jost¹,

Dao²,

Katz³

et al. 2015

Journal of American Association for Pediatric Ophthalmology and

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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...

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Preschool Vision Screening in Primary Care Pediatric Practice

Cited by 22 publications

References 29 publications

A new computer-based pediatric vision-screening test

A new computer-based pediatric vision-screening test

A new computer-based pediatric vision-screening test

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

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