Traditional and instrument-based vision screening in third-grade students

Abstract

The American Association for Pediatric Ophthalmology and Strabismus recommends optotype-based vision screening for children >5years of age. Instrument-based screening for 3- to 4-year-old children is more time efficient and has a higher positive predictive value than traditional optotype screening. The purpose of this study was to directly compare instrument-based vision screening and traditional screening of third graders in a school-based setting. Third graders from 16 schools in Chesterfield County, Virginia, were screened by traditional methods (optotypes and stereoacuity) and using a photoscreener (Plusoptix S12). Children referred from either method were offered a comprehensive eye examination with cycloplegic refraction. Time to screen was recorded. Screening was performed on 1,593 children, of whom 516 (32.4%) were referred for a complete eye examination by either screening method. Traditional screening and photoscreening referred 287 and 398 children, respectively; 169 were referred by both methods. Cycloplegic examinations were completed on 247 children (47.9%). There was no statistical difference between the two methods for detecting visual acuity of <20/30 or the number of children requiring intervention. The average time to screen a child using the photoscreener and the traditional screening method was 30seconds and 120seconds, respectively. The positive predictive value for detecting a need for glasses in third-graders is not statistically significant between traditional and instrument-based screening. Instrument-based vision screening takes less time than traditional screening.