ABSTRACT
PURPOSE: To describe program planning and effectiveness of multistage school eye screening and assess accuracy of teachers in vision screening and detection of other ocular anomalies in Rayagada District School Sight Program, Odisha, India. METHODS: This multistage screening of students included as follows: stage I: screening for vision and other ocular anomalies by school teachers in the school; stage II: photorefraction, subjective correction and other ocular anomaly confirmation by optometrists in the school; stage III: comprehensive ophthalmologist examination in secondary eye center; and stage IV: pediatric ophthalmologist examination in tertiary eye center. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of teachers for vision screening and other ocular anomaly detection were calculated vis-à-vis optometrist (gold standard). RESULTS: In the study, 216 teachers examined 153,107 (95.7% of enrolled) students aged 5-15 years. Teachers referred 8,363 (5.4% of examined) students and 5,990 (71.6% of referred) were examined in stage II. After prescribing spectacles to 443, optometrists referred 883 students to stage III. The sensitivity (80.51%) and PPV (93.05%) of teachers for vision screening were high, but specificity (53.29%) and NPV (26.02%) were low. The specificity and NPV, in general, were higher in ocular anomaly detection but varied from disease to disease. CONCLUSION: Multistage school screening is rapid and comprehensive in a resource-limited community. Regular training and periodic reinforcement of teachers for vision assessment and other ocular anomaly identification are required for further success of the strategy.
ABSTRACT
PURPOSE: To evaluate effectiveness of Welch Allyn Spot Vision Screener in detecting refractive error in all age groups and amblyopia risk factors in children in a tribal district of India. METHODS: All participants received dry retinoscopy and photorefraction; children also received cycloplegic retinoscopy. Statistical analysis included Bland-Altman and coefficient of determination (R2). RESULTS: Photoscreener could not elicit a response in 113 adults and 5 children of 580 recruited participants. In Bland-Altman analysis mean difference of Spot screener spherical equivalent (SSSE) and dry retinoscopy spherical equivalent (DRSE) was 0.32 diopters (D) in adults and 0.18 D in children; this was an overestimation of hyperopia and underestimation of myopia. In Bland-Altman analysis of SSSE and cycloplegic retinoscopy spherical equivalent (CRSE) the mean difference was -0.30 D in children; this was an overestimation of myopia and underestimation of hyperopia. In regression analysis the relationship between SSSE and DRSE was poor in adults (R2 = 0.50) and good in children (R2 = 0.92). Cubic regression model for Spot versus cycloretinoscopy in children was: CRSE = 0.34 + 0.85 SSSE - 0.01 SSSE2 + 0.006 SSSE3. It was 87% accurate. Sensitivity and specificity of Spot in detecting amblyopia risk factors (2013 American Association for Pediatric Ophthalmology and Strabismus [AAPOS] criteria) was 93.3% and 96.9% respectively. Sensitivity of Spot screener in detection of amblyopia was 72%. CONCLUSIONS: Photoscreener has 87% accuracy in refraction in children. Its value could be used for subjective correction tests. TRANSLATIONAL RELEVANCE: Photoscreening could complement traditional retinoscopy to address refractive error in children in a resource-limited facility region.
