Flip chart Visual Acuity Screening for Amblyopia Risk Factors Compared to the PlusoptiX A09 Photoscreener,Tests Performed by a Lay Screener.

Abstract

Importance: The gold standard of vision screening is considered acuity testing, this article will compare the gold standard against new technology to provide more choices for pediatric vision screening programs.

Objective: To determine the reliability of recognition visual acuity screening performed by a lay screener compared to the plusoptiX A09 photoscreener for the detection of amblyopia risk factors.

Design: One lay screener received basic training in how to test monocular visual acuity using the 10 foot Patti Pics single crowded chart and the plusoptiX A09 photoscreener. All children underwent a complete pediatric ophthalmology examination and cycloplegic refraction after screening and this examination was the standard against which the screening method was compared. Each patient received a pass or refer grade after either screening. For the Patti Pics screening, children were referred if they failed to reach threshold visual acuity of twenty forty in either eye; the plusoptiX determines if the child is a pass or refer based on pre-set referral criteria.

Setting: Pediatric ophthalmology clinic.

Participants: Screening was performed on children ages 3 to 10 years.

Results: Seventy-one children were screened. Flip chart-screening was found to have a sensitivity of 83%, specificity of 44%, false positive rate of 56% and false negative rate of 17%. Those same metrics for the plusoptiX A09 were 94%, 89%, 11% and 6%, respectively.

Conclusion: The plusoptiX photoscreener was more sensitive and specific in making appropriate referrals for further care than flip chart-screening in this cohort of children age 3-10. The plusoptiX A09 photoscreener operated by a lay screener is a reliable method to screen for amblyopia risk factors. These finding have important implications for community based vision screening, and screening in the medical home.