A smartphone ocular alignment measurement app in school screening for strabismus.

BACKGROUND: Strabismus is the leading risk factor for amblyopia, which should be early detected for minimized visual impairment. However, traditional school screening for strabismus can be challenged due to several factors, most notably training, mobility and cost. The purpose of our study is to evaluate the feasibility of using a smartphone application in school vision screening for detection of strabismus. METHODS: The beta smartphone application, EyeTurn, can measure ocular misalignment by computerized Hirschberg test. The application was used by a school nurse in a routine vision screening for 133 elementary school children. All app measurements were reviewed by an ophthalmologist to assess the rate of successful measurement and were flagged for in-person verification with prism alternating cover test (PACT) using a 2.4Δ threshold (root mean squared error of the app). A receiver operating characteristic (ROC) curve was used to determine the best sensitivity and specificity for an 8Δ threshold (recommended by AAPOS) with the PACT measurement as ground truth. RESULTS: The nurse obtained at least one successful app measurement for 93% of children (125/133). 40 were flagged for PACT, of which 6 were confirmed to have strabismus, including 4 exotropia (10△, 10△, 14△ and 18△), 1 constant esotropia (25△) and 1 accommodative esotropia (14△). Based on the ROC curve, the optimum threshold for the app to detect strabismus was determined to be 3.0△, with the best sensitivity (83.0%), specificity (76.5%). With this threshold the app would have missed one child with accommodative esotriopia, whereas conventional screening missed 3 cases of intermittent extropia. CONCLUSIONS: Results support feasibility of use of the app by personnel without professional training in routine school screenings to improve detection of strabismus.

Expanding the pathway to postsecondary success: how recuperative back-on-track schools are making a difference.

Districts and states that have begun to get traction in improving their graduation rates are pursuing a reform agenda that includes both the redesign of failing high schools and the development of multiple alternative pathways that help young people get back on track to graduation and to postsecondary education. Unlike traditional alternative education, new back-on-track models assume that challenge, not remediation, will make the most difference, especially for youth who are over age for grade and far behind in accumulating the credits they need. The goal is for students to make up for lost time by accelerating their learning so that they can complete high school and move successfully to postsecondary education and careers. Although these small schools do not in themselves constitute a replacement or transformation strategy for large low-performing high schools, they are a necessary part of a comprehensive approach to turning such schools around.

Multiple pathways to adulthood: expanding the learning options for urban youth.

Some learning environments show particular promise of creating pathways to postsecondary education, careers, and engaged citizenship for urban young adults from ages fifteen to twenty-four.