ROC Analysis of the Accuracy of Noncycloplegic Retinoscopy, Retinomax Autorefractor, and SureSight Vision Screener for Preschool Vision Screening

Abstract

To evaluate, by receiver operating characteristic (ROC) analysis, the accuracy of three instruments of refractive error in detecting eye conditions among 3- to 5-year-old Head Start preschoolers and to evaluate differences in accuracy between instruments and screeners and by age of the child. Children participating in the Vision In Preschoolers (VIP) Study (n = 4040), had screening tests administered by pediatric eye care providers (phase I) or by both nurse and lay screeners (phase II). Noncycloplegic retinoscopy (NCR), the Retinomax Autorefractor (Nikon, Tokyo, Japan), and the SureSight Vision Screener (SureSight, Alpharetta, GA) were used in phase I, and Retinomax and SureSight were used in phase II. Pediatric eye care providers performed a standardized eye examination to identify amblyopia, strabismus, significant refractive error, and reduced visual acuity. The accuracy of the screening tests was summarized by the area under the ROC curve (AUC) and compared between instruments and screeners and by age group. The three screening tests had a high AUC for all categories of screening personnel. The AUC for detecting any VIP-targeted condition was 0.83 for NCR, 0.83 (phase I) to 0.88 (phase II) for Retinomax, and 0.86 (phase I) to 0.87 (phase II) for SureSight. The AUC was 0.93 to 0.95 for detecting group 1 (most severe) conditions and did not differ between instruments or screeners or by age of the child. NCR, Retinomax, and SureSight had similar and high accuracy in detecting vision disorders in preschoolers across all types of screeners and age of child, consistent with previously reported results at specificity levels of 90% and 94%.