Accuracy of noncycloplegic photorefraction using Spot photoscreener in detecting amblyopia risk factors in preschool children in an Indian eye clinic

Purpose: To evaluate the accuracy of Spot photoscreener (PS) as a noncycloplegic photorefractor in detecting amblyopia risk factors (ARFs) in preschool children in an Indian eye clinic setting. Also, to derive appropriate cutoff values for screening to obtain maximum sensitivity and specificity of the device in detecting ARF. Methods: This was a cross-sectional study conducted in the outpatient pediatric eye clinic at a tertiary eye care institute. A Spot PS was used to screen all the children between the ages of 6 months and 5 years that presented to the eye clinic from August 2018 to October 2018. This screening was followed by a complete eye examination, including cycloplegic refraction by a masked examiner. The 2013 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines were considered the standard cutoff values for clinically significant refractive error in children younger than 5 years of age. Results: The study comprised of 219 children. The Spot PS diagnosed 135 (61.64%) children with ARF as compared with 124 (56.62%) children detected by clinic examination. For ARF detection, the Spot photoscreeneer had 85.48% sensitivity, 69.47% specificity, 78.52% positive predictive value and 78.57% negative predictive value. The sensitivity for detection of strabismus and hypermetropia was very low (42% and 36%, respectively). The 95% limits of agreement ranged from ?5.48 to +5.59 diopters (D) with a bias of 0.06 D for spherical equivalent between noncycloplegic photorefraction and cycloplegic refraction. Conclusion: The Spot PS may be used as a screening tool to detect ARF in children younger than 5 years of age keeping its limitations in consideration. However, the performance can be improved by modifying the cutoff values for the referral.

Comparison of Plusoptix S12R photoscreener with cycloplegic retinoscopy and autorefraction in pediatric age group

Purpose: To compare refractive measurements of noncycloplegic photoscreener Plusoptix S12R with cycloplegic retinoscopy, noncycloplegic autorefractor, and cycloplegic autorefractor in children. Methods: The study population (200 eyes of 100 children) was divided into two groups: Group 1 (age 3–7 years) and Group 2 (age 8–15 years). In Group 1, Plusoptix was compared with cycloplegic retinoscopy. In Group 2, Plusoptix was compared with cycloplegic retinoscopy and autorefraction. The second group was made because the younger group was found to be uncooperative for autorefraction. Paired t-test and Pearson's correlation were used for statistical analysis. Results: The mean difference in sphere (DS), spherical equivalent (DSE), and cylinder (DC) between cycloplegic retinoscopy and Plusoptix in Group 1 was 0.68 ± 0.55 (P < 0.001), 0.77 ± 0.61 (P < 0.001), and 0.18 ± 0.28 (P < 0.001), respectively. In Group 2, DS, DSE, and DC between cycloplegic retinoscopy and Plusoptix were 0.86 ± 0.49 (P < 0.001), 0.97 ± 0.51 (P < 0.001), and 0.23 ± 0.28 (P < 0.001); between cycloplegic autorefractor and Plusoptix were 0.69 ± 0.47 (P < 0.001), 0.74 ± 0.49 (P < 0.001), and 0.10 ± 0.31 (P = 0.002); and between noncycloplegic autorefractor and Plusoptix were ? 0.25 ± 0.39 (P < 0.001), ?0.19 ± 0.41 (P < 0.001), and 0.11 ± 0.31 (P < 0.001), respectively. Pearson's correlation coefficients of S, SE, and C between Plusoptix and cycloplegic retinoscopy were 0.948, 0.938, and 0.924 in Group 1 and 0.972, 0.972, and 0.946 in Group 2, and these values were statistically significant. Bland–Altman plots showed good agreement between cycloplegic retinoscopy and Plusoptix in both groups. Plusoptix gave axis values within 10° of cycloplegic retinoscopy in 81.56% of eyes in Group 1 and in 71.44% of eyes in Group 2. Conclusion: Plusoptix photoscreener can be used for prescription of axis of cylinder in children; however, other refractive measurements must be refined by cycloplegic retinoscopy.

Comparision between Manifest vs. Cycloplegic Photore fraction with MTI Photoscreener in Prematurity

Amblyopia and strabismus are common in eyes of prematurity and the need for early detection of amblyopia and amblyogenic factors is widely recognized. So, we performed refraction in premature infants at the 6 months of age to evaluate the incidence and degree of myopia and the changes of refractive errors according to the development, disease course and photocoagulation therapy of retinopathy of prematurity[ROP]. It is the purpose of this study to evaluate the effectiveness of MTI[medical Technology, Inc]photoscreener by comparing the sensitivity and specificity between refractive errors determined by manifest photorefraction and cycloplegic photorefraction in 6-month-old premature infants in Sung-Ae General Hospital. Pass or fail screening data from photograph of 32 non-dilated and dilated premature infant were calculated by two masked observers, compared with the results of cycloplegic retinoscopy, and the statical analysis was carried out. In the cases of cycloplegic photorefraction, Ten eyes of myopia, 4 eyes of emetropia, and 50 eyes of hyperopia were found, and 21 eyes of astigmatism above 1.5D were also detected. Overall statistical analysis of sensitivity and specificity rate were 71.7% and 69.5%in manifest photorefraction, 87.5% and of 75%in cycloplegic photorefraction, respectively. In non-cycloplegic photorefraction, sensitivity of myopia and hyperopia were 92.8%, 65%, but in cycloplegic photorefraction, sensitivity of myopia and hyperopia were 75%, 100%, respectively. The outcomes of our study suggest that MTI photoscreener in cycloplegic photorefraction was more reliable than non-cycloplegic photorefraction. Myopia under 1D turned to hyperopia in cycloplegic photorefraction, so the sensitivity of that was not to be reliable, but the sensitivity of hyperopia was high. Thus, the authors can readily recommand this cycloplegic photorefraction in uncooperable infants to evalute the refractive error conveniently.

The Effectiveness of Photorefraction for the Screening of Amblyogenic Factors

It is the purpose of this study to evaluate the effectiveness of MTI photoscreener(using the eccentric photorefraction principle) by comparing the sensitivity and specificity between the refractive errors determined by MTI photoscreener and cycloplegic refraction in 5 to 6 year-old children in the kindergartens. Pass/fail screening data was determined by the two masked observers, and compared with the results of cycloplegic refraction. And, the statistical analysis was done. There was some differences in the sensitivity rate between the two examiners. Two cases of anisometropia and one media opacity were found by the two observers, respectively. The sensitivity rate was 70%, specificity rate 90%, overall correlation rate 87%, positive predictive value 52% and negative predictive value 95% in the combined results by the observer A and B. The results of our study suggest that MTI photoscreener may be a reliable mass-screening method of detecting amblyogenic factors(refractive error, etc) in the preschool children although the sensitivity rate is slightly variable.

Polaroid Photoscreening for Amblyogenic Factors

We investigate the effect of a new photoscreening camera designed to detect amblyogenic factors including strabismus, asymmetric and abnormal refractive errors and media opacities. The photoscreener uses eccentric photorefraction principles and provides two meridian photographs of the retinal reflex. Pass/fail screening data from photograph of 58 nondilated children, determined by two masked observers, were compared with data from complete ophthalmologic examinations. Photoscreener had a sensitivity rate of 92.0%, a specificity rate of 72.2%, a positive predictive value of 94.8%, a negative predictive value of 61.9% and overall agreement rate of 90.5%. The new two-flash photoscreenig camera, which uses high-speed polaroid film, is an accurate and reliable method of detecting amblyogenic factors in undilated children, and the camera promise as a useful mass screening tool.