Impact of Confidence Number on Accuracy of the SureSight Vision Screener

Abstract

To assess the relation between the confidence number provided by the Welch Allyn SureSight Vision Screener and screening accuracy, and to determine whether repeated testing to achieve a higher confidence number improves screening accuracy in pre-school children. Lay and nurse screeners screened 1452 children enrolled in the Vision in Preschoolers (VIP) Phase II Study. All children also underwent a comprehensive eye examination. By using statistical comparison of proportions, we examined sensitivity and specificity for detecting any ocular condition targeted for detection in the VIP study and conditions grouped by severity and by type (amblyopia, strabismus, significant refractive error, and unexplained decreased visual acuity) among children who had confidence numbers < or =4 (retest necessary), 5 (retest if possible), > or =6 (acceptable). Among the 687 (47.3%) children who had repeated testing by either lay or nurse screeners because of a low confidence number (<6) for one or both eyes in the initial testing, the same analyses were also conducted to compare results between the initial reading and repeated test reading with the highest confidence number in the same child. These analyses were based on the failure criteria associated with 90% specificity for detecting any VIP condition in VIP Phase II. A lower confidence number category were associated with higher sensitivity (0.71, 0.65, and 0.59 for < or =4, 5, and > or =6, respectively, p = 0.04) but no statistical difference in specificity (0.85, 0.85, and 0.91, p = 0.07) of detecting any VIP-targeted condition. Children with any VIP-targeted condition were as likely to be detected using the initial confidence number reading as using the higher confidence number reading from repeated testing. A higher confidence number obtained during screening with the SureSight Vision Screener is not associated with better screening accuracy. Repeated testing to reach the manufacturer's recommended minimum value is not helpful in pre-school vision screening.