Vision in Preschoolers Study

Abstract

I have anxiously awaited the initial publication from the Vision in Preschoolers Study (VIPS). I was not disappointed by the recent excellent report,1Vision in Preschoolers Study GroupComparison of preschool vision screening tests as administered by licensed eye care professionals in the Vision in Preschoolers Study.Ophthalmology. 2004; 111: 637-650Abstract Full Text Full Text PDF PubMed Scopus (233) Google Scholar though many details probably have been trimmed in the interest of journal space limitations. We have used similar combinations of sensory and objective tests in the Alaska Blind Child Discovery Project. The proportion of young children not testable and with inconclusive interpretations varies greatly with the level of experience of the screening personnel. Over half of Alaskan children live in urban environments similar to the VIPS communities; however, many others live in remote villages, and for them, confirmatory examinations can be very expensive ($1000). For this reason, we have attempted to reduce false-positive overreferrals with highly specific photoscreen interpretation.2Arnold R.W. Highly specific photoscreening at the Alaska State Fair: valid Alaska Blind Child Discovery photography and interpretation.Alaska Med. 2003; 45: 34-40PubMed Google Scholar (In rural and remote screening, the cost benefit increases with more specific tests.) One of the occult disorders most likely to cause amblyopia is hyperopic anisometropia, a condition that is represented by two thirds of the patients recruited into the amblyopia treatment studies.3Pediatric Eye Disease Investigator GroupThe clinical profile of moderate amblyopia in children younger than 7 years.Arch Ophthalmol. 2002; 120: 281-287Crossref PubMed Scopus (140) Google Scholar From Table 3 in the VIPS, severe anisometropia was reported as a mixture of hyperopia, astigmatism, and myopia, or 1.7% of children tested. Group 2 anisometropic patients were defined as not severe, did not have type or magnitude of refractive error listed, but occupied 2.5% of children. Consistent with published reporting guidelines,4Donahue S. Arnold R. Ruben J.B. AAPOS Vision Screening CommitteePreschool vision screening: what should we be detecting and how should we report it? Uniform guidelines for reporting results from studies.J AAPOS. 2003; 7: 314-316Abstract Full Text Full Text PDF PubMed Scopus (194) Google Scholar I would like to know the sensitivities to detect threshold hyperopic anisometropia ≥1.50 diopters from the various VIPS modalities at the comparable specificity level of 94%. I applaud the authors on this first phase of an important study. Comparison of preschool vision screening tests as administered by licensed eye care professionals in the vision in preschoolers studyOphthalmologyVol. 111Issue 4PreviewTo compare 11 preschool vision screening tests administered by licensed eye care professionals (LEPs; optometrists and pediatric ophthalmologists). Full-Text PDF Vision in Preschoolers Study: Author replyOphthalmologyVol. 111Issue 12PreviewWe thank Dr Arnold for his favorable comments on our article summarizing phase I of the Vision in Preschoolers (VIP) Study. Because of the high cost of overreferrals in his screening program, Dr Arnold is interested in the sensitivity of the screening tests when specificity is relatively high, at 0.94. Among a number of established amblyogenic conditions,1 he has selected hyperopic anisometropia of ≥1.5 diopters (D) for special consideration. Inspection of the VIP data shows that the 4 tests that were best at detecting children with any targeted condition and children with a group I (very important to detect and treat early) condition were also the best at detecting hyperopic anisometropia of ≥1.5 D. Full-Text PDF