Comparison of refractometric measurements obtained with a portable autorefractor and conventional methods of refraction in schoolchildren / Comparação de medidas refratométricas obtidas com autorrefrator portátil e métodos convencionais de refração em escolares

ABSTRACT Objective: To assess the performance of a portable autorefractor as refractor and screening tool for refractive errors in schoolchildren. Methods: Cross-sectional observational study. Refractometric measurements of children between 5 and 10 years old were obtained through four methods: 2WIN under non-cycloplegic conditions, and 2WIN, conventional autorefractor, and retinoscopy, under cycloplegic conditions. Correlations and agreement between the methods and accuracy of the portable autorefractor to define whether to prescribe glasses were assessed. Results: The mean age ± standard deviation was 6.87 ± 1.42 years. The portable autorefractor without cycloplegia showed a high correlation with retinoscopy (0.77) but tended to underestimate hyperopia and overestimate high astigmatism. Regarding screening for prescription of glasses in comparison with the reference method "retinoscopy," the sensitivity of the portable autorefractor without cycloplegia was calculated to be 100,00% and the specificity, 34.3%. Conclusion: The portable autorefractor should be used as a screening tool and, when prescribing glasses, the tendency of underestimating hyperopia and overestimating high astigmatism should be kept in mind.

RESUMO Objetivo: Avaliar o desempenho de um autorrefrator portátil como refrator e ferramenta de triagem para erros de refração em crianças em idade escolar. Métodos: Estudo observacional transversal. As medidas refratométricas de crianças de 5 a 10 anos foram obtidas por meio de quatro métodos: 2WIN em condições não cicloplégicas e 2WIN, autorrefrator convencional e retinoscopia, em condições cicloplégicas. Foram avaliadas as correlações e a concordância entre os métodos e a acurácia do autorrefrator portátil para definir a prescrição de óculos. Resultados: A média de idade ± desvio-padrão foi de 6,87 ± 1,42 anos. O autorrefrator portátil sem cicloplegia apresentou alta correlação com a retinoscopia (0,77), mas tendeu a subestimar a hipermetropia e a superestimar o alto astigmatismo. Em relação à triagem para prescrição de óculos em comparação com o método de referência retinoscópio, a sensibilidade do autorrefrator portátil sem cicloplegia foi calculada em 100,00% e a especificidade, em 34,3%. Conclusão: O autorrefrator portátil deve ser usado como ferramenta de triagem e, ao se prescreverem óculos, deve-se ter em mente a tendência de subestimar a hipermetropia e superestimar o alto astigmatismo.

Can photoscreening effectively detect amblyogenic risk factors in children with neurodevelopmental disability?

Purpose: To analyze whether photoscreening can effectively detect amblyogenic risk factors in children with neurodevelopmental disability. Methods: A prospective study of 52 children attending a special school for children with neurodevelopmental disability from December 2017 to May 2018. All were initially tested with a photoscreening device: Welch Allyn® Spot® Vision Screener: model VS100 (Spot®) and further evaluated at a later date by a pediatric ophthalmologist, with a complete ocular evaluation including squint assessment, cycloplegic retinoscopy, and dilated fundus examination. The key parameters studied were demographic features, type of neurodevelopmental disability, refraction, ocular alignment, media clarity, any other ocular morbidity, and time taken for examination. The presence of amblyogenic risk factors (ARF) was analyzed as per the 2013 guidelines of the American Association for Pediatric Ophthalmology and Strabismus. Results: The mean age was 10.5 years (range: 1–17.5 years). Males (73.1%) outnumbered females (26.9%). The most common neurodevelopmental disability was cerebral palsy. Simple myopic astigmatism was the most common type of refractive error. Presence of ARF in our study was 73.1%. The sensitivity and specificity of photoscreening in detecting ARF were 96.5% and 63.61%, respectively, with a positive predictive value of 80% and negative predictive value of 92.31%. The predictive ability of photoscreening was 79.9% as per the area under curve. The average time taken for photoscreening was less than 60 s. Conclusion: Photoscreening can detect ARF with high sensitivity and reasonable specificity and is a handy, useful, and time?saving tool in screening children with neurodevelopmental disability.

Beyond photography: Evaluation of the consumer digital camera to identify strabismus and anisometropia by analyzing the Bruckner's reflex.

Amblyopia screening is often either costly or laborious. We evaluated the Canon Powershot TX1 (CPTX1) digital camera as an efficient screener for amblyogenic risk factors (ARF). We included 138 subjects: 84‑amblyopes and 54‑normal. With the red‑eye‑reduction feature off, we obtained Bruckner reflex photographs of different sized crescents which suggested anisometropia, while asymmetrical brightness indicated strabismus; symmetry implied normalcy. Eight sets of randomly arranged 138 photographs were made. After training, 8 personnel, marked each as normal or abnormal. Of the 84 amblyopes, 42 were strabismus alone (SA), 36 had anisometropia alone (AA) while six were mixed amblyopes (MA). Overall mean sensitivity for amblyopes was 0.86 (95% CI: 0.83‑0.89) and specificity 0.85 (95% CI: 0.77‑0.93). Sub‑group analyses on SA, AA and MA returned sensitivities of 0.86, 0.89 and 0.69, while specificities were 0.85 for all three. Overall Cohen’s Kappa was 0.66 (95% CI: 0.62‑0.71). The CPTX1 appears to be a feasible option to screen for ARF, although results need to be validated on appropriate age groups.

Comparison of computer-photoscreening with non-cycloplegic retinoscopy for amblyopiogenic risk factors in children / 眼科新进展

Objective　To determine the sensitivity and specificity of using the computer-photoscreener and non-cycloplegic retinoscopy in the detection of amblyopiogenic factors in nine to fifty months old infants.Methods　Three hundred children whose ages range from nine to fifty months were screened with the computer-photoscreener and non-cycloplegic retinoscopy. With a masked standardized clinical assessment as the standard, an overall comparison of the results obtained with the two techniques revealed a sensitivity and specificity. Photoscreen images on the computer monitor screen were reviewed and analyzed immediately by two independent observers for indicators of amblyopiogenic risk factors. Simultaneously, the results were compared to the findings of a full ophthalmologic examination.Results　The computer-photoscreener revealed a sensitivity of 94.2% and specificity of 90.1%, and the non-cycloplegic retinocopy revealed a sensitivity of 85.7% and specificity of 81.1% for the detection of amblyopiogenic risk factors, including hyperopia (+2.75 D or more), myopia (-1.50 D or more), astigmatism (2.00 D or more),anisometropia (2.00 D or more), ocular misalignment (5 degrees or more), and media opacity (1.5mm or more). Conclusion　The computer-photoscreener offers an opportunity to identify problems that limit vision, and could provide a feasible and sufficiently reliable screening technique in infants and preschool children who can be screened successfully for amblyopiogenic risk factors.

Effectiveness of Polaroid Photoscreening for Amblyogenic Fctors in Infants & Young Children

PURPOSE: Amblyopia is the commonest cause of defective vision in childhood. It develops during the sensitive period of visual maturation which continues until about 7-8 years of age. The authors investigated the effect of a polaroid photoscreening camera designed to detect amblyogenic factors, including asymmetric and abnormal refractive errors, strabismus, ptosis and media opacities. METHODS: Fifty-four children aged 3-24 months were evaluated for amblyogenic factors using the polaroid photoscreening carnera from March 1998 to March 1999 in Chungnam National University Children's Hospital. Then each child underwent medical examination by an ophthamologist. Results The mean age was 9.0+/-4.5 months. The results of photoscreening were normal findings of 74.1%, abnormal findings of 25.9%, and slight eccentric fixation in 18 cases, normal findings in 9 cases, peripheral crescents in 13 cases, strabismus in 4 cases, myopia in 5 cases, hyperopia in 2 cases, anisometropia in 2 cases, ptosis in 1 case and reexam in 14 cases. The photoscreener had a sensitivity rate of 81.8%, a specificity rate of 88.4%, a positive predictive value of 64.3% and a negative predictive value of 95.0%. CONCLUSION: Polaroid photoscreening method is an easy, noninvasive and reliable mass screening method of detecting amblyogenic factors in undilated children.

Effectiveness of Polaroid Photoscreening for Amblyogenic Fctors in Infants & Young Children

PURPOSE: Amblyopia is the commonest cause of defective vision in childhood. It develops during the sensitive period of visual maturation which continues until about 7-8 years of age. The authors investigated the effect of a polaroid photoscreening camera designed to detect amblyogenic factors, including asymmetric and abnormal refractive errors, strabismus, ptosis and media opacities. METHODS: Fifty-four children aged 3-24 months were evaluated for amblyogenic factors using the polaroid photoscreening carnera from March 1998 to March 1999 in Chungnam National University Children's Hospital. Then each child underwent medical examination by an ophthamologist. Results The mean age was 9.0+/-4.5 months. The results of photoscreening were normal findings of 74.1%, abnormal findings of 25.9%, and slight eccentric fixation in 18 cases, normal findings in 9 cases, peripheral crescents in 13 cases, strabismus in 4 cases, myopia in 5 cases, hyperopia in 2 cases, anisometropia in 2 cases, ptosis in 1 case and reexam in 14 cases. The photoscreener had a sensitivity rate of 81.8%, a specificity rate of 88.4%, a positive predictive value of 64.3% and a negative predictive value of 95.0%. CONCLUSION: Polaroid photoscreening method is an easy, noninvasive and reliable mass screening method of detecting amblyogenic factors in undilated children.