Amblyopia Risk Factors Research Articles

Outcome of vision screening by community health workers at immunization outlets in Nigeria to support access to early visual evaluation in children aged 0–2 years

PURPOSE:Routine eye examination in early life is not the practice in most resource-limited countries. Delay in the presentation for eye problems is typical. Community health officers are often consulted by caregivers for all health problems during routine immunization and well-baby clinics in primary healthcare for children aged 0–2 years. This study evaluated the value and limitation of interview, Bruckner red reflex test, and instrument vision screener by noneye care middle-level staff of rural and urban well-baby immunization clinics, in early detection and referral for childhood eye disorders.MATERIALS AND METHODS:This was a cross-sectional study. Middle-level community health workers (CHWs) working at well-baby/immunization clinics were trained to perform vision screening using interview of caregivers, red reflex eye examination with ophthalmoscope, and instrument vision screener (Welch Allyn SPOT™ Vision Screener) without mydriatic drugs during routine immunization of children aged 0–2 years. IRB approval was obtained.RESULTS:Over a 6-month period in 2017, the CHWs screened 5609 children. Overall, 628 (11.2%) patients were referred to the tertiary child eye care unit. Referred cases included cataract, glaucoma, congenital nasolacrimal duct obstruction, ophthalmia neonatorum, retinoblastoma, and significant refractive errors. Referral from the interview of mothers was enhanced if specific questions to elicit visual function were asked. Bruckner red reflex test was more effective than instrument vision screener in the detection of cataract and life-threatening diseases such as retinoblastoma. Instrument vision screener was preferred by parents and better at detecting amblyopic risk factors.CONCLUSION:Preschool vision screening during routine immunization by primary healthcare workers in resource-limited settings was effective. Whenever instrument vision screener does not give any recommendation during screening, consider vision- or life-threatening pathology and refer.

Increased Incidence of Ophthalmologic Findings in Children With Concurrent Isolated Nonsyndromic Metopic Suture Abnormalities and Deformational Cranial Vault Asymmetry.

The purpose of this project was to study the incidence of ophthalmologic findings which are known to be risk factors for amblyopia in children who have coexisting metopic suture abnormalities and deformational plagiocephaly (DP) and brachycephaly (DB). Institutional Review Board-approved retrospective study reviewing records of a consecutive cohort of children under 2 years of age with metopic suture abnormalities and cranial vault asymmetries seen in both the plastic surgery and ophthalmology clinics from 2007 to 2017. Institutional tertiary care center with all care in plastic surgery under the senior author and the standard of care accepted in pediatric ophthalmology under one of two ophthalmologists. After application of exclusion criteria, 76 children diagnosed with metopic suture abnormalities and DP/DB were included in the study. Patients with severe trigonocephaly, other suture involvement, syndromic diagnoses, and primary ocular disorders were excluded. Describe the incidences of refractive errors (astigmatism, hyperopia, and myopia), anisometropia, strabismus, and amblyopia within the study population. In our patient population, the rates of amblyopia (17.1%) and strabismus (15.8%) are higher than the general pediatric population rates of 1.5% to 1.8% and 2.4% to 3.6%, respectively. Overall, 47.4% had significant refractive error: 28.9% with astigmatism, 15.8% with hyperopia, 5.3% with myopia, and 10.5% with anisometropia. In our patient population, children with coexisting metopic suture abnormalities and DP or DB had significant risk for amblyopia, strabismus, and refractive errors.

Performance of Glow Fixation GoCheck Kids and 2WIN Photoscreeners and Retinomax to Uncover Hyperopia.

BackgroundA low-detail, glowing fixation device was added to GoCheck Kids (GCK) photoscreener in the hope of unmasking hyperopia and amblyopia risk factors (ARF).MethodsPediatric eye patients were screened by GCK and 2WIN photoscreeners, and Retinomax autorefractor before being compared to AAPOS ARFs.ResultsScreening was attempted by 131 children who then had school bus accommodation-relaxing skiascopy (SBA-RS) before cycloplegic examination. By 2013 AAPOS uniform guidelines, sensitivity/specificity for GCK was 87%/68%, for 2WIN 87%/71% and for Retinomax 79%/68%. Detection of amblyopia had sensitivity/specificity by GCK of 78%/63%, for 2WIN 79%/65% and for Retinomax 77%/68%. Inconclusive screens were seven for GCK, six for 2WIN and 13 for Retinomax. Mean hyperopia for GCK (+2.49±0.74 D) was similar to cycloplegic refraction (+2.93±0.72 D) and SBA-RS (+2.80±0.82 D) while GCK was slightly more than Retinomax (+1.59±0.93 D, p=0.13) but significantly more than 2WIN (+1.02±0.49 D, p<0.01).ConclusionGCK, 2WIN and Retinomax had similar validity detecting uniform amblyopia risk factors and amblyopia itself. The nondetailed glow fixation device allowed GCK to uncover substantial hyperopia while the detailed flashing fixation devices on 2WIN and Retinomax seemed to stimulate accommodation in some hyperopic children.Clinical Trials RegistryNCT04297969. Data Access: http://www.abcd-vision.org/references/GCK%20glow%202WIN%20deidentify.pdf.PrécisA glow fixation device on a smart phone photoscreener allowed robust detection of hyperopia.

A One-Step, Streamlined Children's Vision Screening Solution Based on Smartphone Imaging for Resource-Limited Areas: Design and Preliminary Field Evaluation.

BackgroundYoung children’s vision screening, as part of a preventative health care service, produces great value for developing regions. Besides yielding a high return on investment from forestalling surgeries using a low-cost intervention at a young age, it improves school performance and thus boosts future labor force quality. Leveraging low-skilled health care workers with smartphones and automated diagnosis to offer such programs can be a scalable model in resource-limited areas.ObjectiveThis study aimed to develop and evaluate an effective, efficient, and comprehensive vision screening solution for school children in resource-limited areas. First, such an exam would need to cover the major risk factors of amblyopia and myopia, 2 major sources of vision impairment effectively preventable at a young age. Second, the solution must be integrated with digital patient record-keeping for long-term monitoring and popular statistical analysis. Last, it should utilize low-skilled technicians and only low-cost tools that are available in a typical school in developing regions, without compromising quality or efficiency.MethodsA workflow for the screening program was designed and a smartphone app was developed to implement it. In the standardized screening procedure, a young child went through the smartphone-based photoscreening in a dark room. The child held a smartphone in front of their forehead, displaying pre-entered personal information as a quick response code that duplexed as a reference of scale. In one 10-second procedure, the child’s personal information and interpupillary distance, relative visual axis alignment, and refractive error ranges were measured and analyzed automatically using image processing and artificial intelligence algorithms. The child’s risk for strabismus, myopia, and anisometropia was then derived and consultation given.ResultsA preliminary evaluation of the solution was conducted alongside yearly physical exams in Luoyang, Henan, People’s Republic of China. It covered 20 students with suspected strabismus and 80 randomly selected students, aged evenly between 8 and 10. Each examinee took about 1 minute, and a streamlined workflow allowed 3 exams to run in parallel. The 1-shot and 2-shot measurement success rates were 87% and 100%, respectively. The sensitivity and specificity of strabismus detection were 0.80 and 0.98, respectively. The sensitivity and specificity of myopia detection were 0.83 and 1.00, respectively. The sensitivity and specificity of anisometropia detection were 0.80 and 1.00, respectively.ConclusionsThe proposed vision screening program is effective, efficient, and scalable. Compared with previously published studies on utilizing a smartphone for an automated Hirschberg test and photorefraction screening, this comprehensive solution is optimized for practicality and robustness, and is thus better ready-to-deploy. Our evaluation validated the achievement of the program’s design specifications.

Performance of Two Photoscreeners Enhanced by Protective Cases.

BackgroundPhotoscreeners provide valid, cost-effective early detection of amblyopia risk factors; however, they require proper illumination, flash intensity, pupil dilation and patient cooperation. The Kaleidos case for the 2WIN infrared photoscreener fixes focal distance, decreases luminance and provides electric power. GoCheck Kids (GCK) has developed a flash-concentrating case for the Apple iPhone 7 Plus smartphone to reduce exposure time.MethodsIn remote Burmese and urban Alaskan clinics, Kaleidos and GCK were used before a confirmatory eye examination using 2013 AAPOS uniform guidelines validation, including some older patients. 2WIN refraction was compared to a cycloplegic examination using J0 and J45 vector transformation.ResultsIn total, 48 Burmese patients and 114 Alaskan patients aged 8±6 years were evaluated utilizing 2013 amblyopia risk factor guidelines. Kaleidos, with 13 Burmese inconclusives, had a sensitivity of 84%, specificity of 65% and positive predictive value (PPV) of 63%. GCK, with only six inconclusives, had a sensitivity of 63%, specificity of 83% and PPV of 73%, with sensitivity improving to 74% with central expert interpretation. Kaleidos closely matched cycloplegic refraction, with intraclass correlations of 0.47 for J0 vector and 0.57 for J45 vector. The protective cases provided clearer images and better pupil dilation than similar devices without cases.ConclusionBoth devices detected amblyopia risk factors well. GCK gave fewer inconclusive results even with the Asian eyelid configuration, while Kaleidos matched sphere and cylinder refraction. The specialized housing enhanced the performance of the 2WIN and GCK photoscreeners, improving the speed and reliability of amblyopia screening and refraction, even in populous and luminous locations.Clinical Trials RegistryNCT04068129.

Evaluation of the Spot Vision Screener in School-Aged Children.

To determine the accuracy of the Spot Vision Screener (Welch Allyn, Skaneateles Falls, NY) in children 6 years and older and recommend device thresholds to improve its accuracy for the detection of refractive error. The Spot Vision Screener results were compared with three gold standard conditions of increasingly narrow refractive error criterion. The sensitivity, specificity, positive predictive value, and negative predictive value of the Spot Vision Screener in detecting each gold standard criterion were calculated. The most accurate threshold setting for each parameter was identified by calculating the area under the curve receiver operating characteristic. The Spot Vision Screener was able to successfully evaluate 313 of 330 children (95%). The sensitivity of the Spot Vision Screener to detect American Association for Pediatric Ophthalmology and Strabismus guidelines for amblyopia risk factors was 89.5% and the specificity was 76.7%. The sensitivity decreased to 80% and the specificity increased to 75.3% with narrower refractive criteria. The sensitivity in detecting refractive criteria improved with the proposed optimized device thresholds. Estimates for the general population indicate that the positive predictive value is reasonable at 52.3% to 61.8%, depending on the stringency of the criteria, with excellent negative predictive values. In school-aged children, the primary screening focus shifts from preventing amblyopia to detecting visual disturbances, including refractive error, that may interfere with academic performance. In this age group, the Spot Vision Screener was an acceptable method of detecting significant refractive error with improved sensitivity with threshold optimization. [J Pediatr Ophthalmol Strabismus. 2020;57(3):146-153.].

Refinement strategies in photoscreening for the detection of amblyopia risk factors in 12-to-24-month-old children

To establish an appropriate clinical protocol for early photoscreening in 12-to-24-month-old children at pediatric well-baby clinics. This prospective study included a total of 277 children aged 12-24 months who visited a pediatric well-baby clinic. All participants underwent: 1) inquiry of medical history; 2) photoscreening with PlusoptiX A12; and 3) comprehensive ophthalmologic examinations. The optimal referral cut-off point for PlusoptiX was determined by receiver operating characteristic analyses. A high-risk subgroup was defined as having a birth weight <3000g or a history of major systemic diseases, based on the results of multivariable risk factor analysis from children's medical history. A strategy of selective photoscreening focusing on the high-risk subgroup was evaluated. The main outcome measures included sensitivity, specificity, and positive and negative predictive values. The prevalence of amblyopia risk factors in our study population was 12.3%. A total of 172 children (62.1%) were assigned to the high-risk subgroup. Compared with the nonselective photoscreening of all 277 children, selective photoscreening of the high-risk children yielded a higher positive predictive value (59.6% vs. 46.7%, p=0.001) while showing no difference in sensitivity (82.3% vs. 85.3%, p=0.32), specificity (92.2% vs, 86.4%, p=0.05), and negative predictive value (97.4% vs. 97.6%, p=0.50). At pediatric well-baby clinics, selective photoscreening among 12-to-24-month-old children with a birth weight <3000g or a history of major systemic diseases helped reducing the number of children need to be screened and conserving medical resources yet identifying children at risk for timely eye care.

The performance of visual photoscreening for Chinese preschool children aged 4 to 5 years

Objective: To assess the accuracy of photoscreening for detecting refractive amblyopia risk factors (ARFs) in Chinese preschool children aged 4 to 5 years. Methods: A cross-sectional study. Comprehensive ocular examinations were conducted for preschool children in Nanjing, China from September to December, 2016. Photoscreening (Plusoptix A12C) was applied for refractive screening without cycloplegia. Voluntary children and children suspected of eyes abnormalities received cycloplegic retinoscopy (CR). Results of photoscreening and CR were compared using Wilcoxon signed rank test, and Bland-Altman plot were used to assess the agreement between the photoscreener and CR. According to the updated preschool vision screening guidelines from American Association for Pediatric Ophthalmology and Strabismus (AAPOS) in 2013, CR was adopted for identifying children with ARFs, which was considered as a golden standard. Based on the golden standard, the accuracy of 5 sets of referral criteria (including sensitivity standard, Matta/Silbert standard, AAPOS2013 standard, Alaska Blind Child Discovery standard, specificity standard) for photoscreener were tested. Receiver operating characteristics curves were constructed applied to evaluate the quality of the photoscreener in refractive ARFs detection and to find probably the best cut-off points. Results: In total, 1 986 children [mean age, (4.57±0.29) years] received comprehensive examinations, including 1 084 boys and 902 girls. The test ability of photoscreening was 99.04% (1 967/1 986) in the preschool children, and 96.56%(1 827/1 892) of the children got a reliable result within three screening attempts. In 538 children who had data of CR, refractive error of one child exceeded the upper limit of the photoscreener value setting, which was directly categorized as hyperopia, so in the end, 537 children were included to analyze the comparison between the two tests. The measurement values of photoscreening were lower than those of CR in sphere, cylinder and spherical equivalent [(0.75 (0.50, 1.25) D vs. 1.25 (1.00, 1.75) D, Z=-10.36, P<0.01; -0.50 (-0.75, -0.25) D vs. -0.25 (-0.75, 0.00) D, Z=-11.10, P<0.01; 0.63 (0.38, 0.88) D vs. 1.00 (0.75, 1.50) D, Z=-13.33, P<0.01]. The 95% limit of agreement cover rates between the photoscreening and CR in sphere, cylinder and spherical equivalent was 96.28% (517/537), 95.34% (512/537) and 96.65% (519/537), respectively. Based on the golden standard, 47 (8.74%) children had refractive ARFs, and the range of sensitivity, specificity, Youden index, positive predictive values and negative predictive values for detecting refractive ARFs of the 5 common used referral criteria was from 63.83% to 97.87%, from 53.36% to 97.56%, from 0.51 to 0.80, from 16.73% to 74.51% and from 96.57% to 99.62%, respectively. Considering particular refractive ARFs on the basis of the receiver operating characteristic curves, the optimal cut-off point for astigmatism was set at 1.38 D. Conclusion: Photoscreening could be an applicable tool to detect refractive ARFs in preschool children. (Chin J Ophthalmol, 2020, 56: 189-196).

Evaluation of the Spot Vision Screener in comparison with the orthoptic examination in visual screening in 3–5 year-old schoolchildren

To evaluate the Spot Vision Screener (SVS) compared with the orthoptic examination for detection of amblyopia risk factors in preschools. This prospective study included children with a visual screening organized by the department of "le" (PMI) in Côte d'Or (Burgundy, France), between June 2017 and April 2018. All children were evaluated with the SVS followed by a clinical orthoptic examination. Results with the SVS were compared with those obtained by clinical orthoptic examination. A total of 1236 subjects were included in the study from 100 preschools. The mean age of the children was 3.6±0.7 years, and 627 were female (50.7%). The orthoptic examination detected 308 (24.9%) children with subnormal visual acuity for age in one eye or both. In children with a history of prematurity, the orthoptic examination was more frequently abnormal (P=0.002), which was not seen with the SVS (P=0.050). The SVS screened 20 (1.6%) children with strabismus, while 40 (3.2%) were detected by orthoptic examination. At the end of the screening, the SVS detected 182 (14.7%) suspect patients while 311 (25.1%) suspect patients were detected after the orthoptic examination. Comparing SVS with orthoptic examination, agreement was fair (κ=0.4). The SVS can be a useful device for visual screening, but agreement with the orthoptic examination was only fair. The Spot vision screener should be used in conjunction with a clinical orthoptic examination.

Positive predictive value and screening performance of GoCheck Kids in a primary care university clinic

To determine the positive predictive value (PPV) of GoCheck Kids, a smartphone-based photoscreener, to detect refractive amblyopia risk factors (ARFs) in children 3-48months of age. The medical records of all children ≤48months of age who failed GoCheck Kids photoscreening at a University of California, San Francisco, pediatric clinic between February 2017 and August 2018 and subsequently examined at the pediatric ophthalmology clinic were reviewed retrospectively. The PPV of GoCheck Kids was determined, where a true positive represents an abnormal cycloplegic refractive error according to the 2013 American Association of Pediatric Ophthalmology and Strabismus Vision Screening Committee criteria. For patients ≤12months of age, refractive error thresholds were based on the 2017 American Academy of Ophthalmology Preferred Practice Patterns Pediatric Eye Evaluation guidelines. A total of 2,963 children were screened with GoCheck Kids. Of these, 172 (5.8%) failed the screening, of whom 115 (67%) were evaluated in the pediatric ophthalmology clinic. The mean age was 24.9±11.1months (range, 3-48). Fifty-seven patients met ARF criteria yielding a PPV of 50% (95% CI, 41%-60%). The PPV was higher in patients of Latino/hispanic ethnicity (75%; 95% CI, 57%-100%; P<0.01) and changed significantly with increasing age (P=0.03). Patients who were screened between age 3-12months had the lowest PPV at 26% (95% CI, 14%-47%). Modifying refractive error thresholds based on patient age and prevalence of ARFs in a population may improve the PPV of GoCheck Kids in a community-based screening program.

Comparison of photoscreening and autorefractive screening for the detection of amblyopia risk factors in children under 3 years of age

To evaluate the effectiveness of photoscreening and autorefractive screening for the detection of amblyopia risk factors (ARFs) in a cohort of preterm and term-born children <3years of age. In this cross-sectional study, the Spot Vision photoscreener and the SureSight autorefractor were used to screen participants. The diagnostic and predictive values of the devices in detecting ARF based on American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2013 referral criteria was calculated using manufacturer criteria, the VIP 90 (90% specificity) and VIP 94 (94% specificity) criteria from the Vision in Preschool (VIP) study, and criteria recommended by Rowatt and colleagues. Results were evaluated using receiver operating characteristic (ROC) curves. A total of 368 patients (mean age, 14.4±10.4months) were included. The ARF rate was 25% according to the 2013 AAPOS criteria. The highest specificity and positive predictive values (PPV) were obtained with Spot Vision manufacturer criteria (specificity, 0.91; PPV, 0.69). SureSight manufacturer criteria showed very low specificity and PPV values (specificity, 0.43; PPV, 0.35) and a high false positive rate (57%). The highest specificity and PPV values for SureSight were obtained with the Rowatt criteria (specificity, 0.86; PPV, 0.62). In our study cohort, photoscreening with the Spot Vision manufacturer criteria seemed sufficient for vision screening in the 0-3years age group, with high specificity values.The Rowatt criteria may increase performance of the SureSight in this age group.

Effectiveness of the iPhone GoCheck Kids smartphone vision screener in detecting amblyopia risk factors

The recently released GoCheck Kids iPhone photoscreening app is designed to detect amblyopia risk factors (ARFs) in young children and includes remote review of images captured by smartphone. We aimed to evaluate the system's accuracy in detecting AAPOS guidelines ARFs. Patients 6months through 6years of age at Medical University of South Carolina were recruited for this prospective study. Presence of age-specific ARF was determined based on a complete ophthalmic examination and compared with the GoCheck Kids recommendations. A total of 244 children were included (average age, 42months; 51% male). Sensitivity of the GoCheck Kids iPhone with remote review to detect ARFs was 90.5%; specificity, 68.1%; positive predictive value, 56.8%; negative predictive value, 94.0%. Two of the 7 false negative results had hyperopia of >4 D, 4 had astigmatism, and 1 had anisometropia. Remote review of all images improved sensitivity. The GoCheck Kids app had good sensitivity and adequate specificity in detecting AAPOS ARFs in our enriched cohort of young children.

Application of deep learning and image processing analysis of photographs for amblyopia screening.

Purpose:Photo screeners and autorefractors have been used to screen children for amblyopia risk factors (ARF) but are limited by cost and efficacy. We looked for a deep learning and image processing analysis-based system to screen for ARF.Methods:An android smartphone was used to capture images using a specially coded application that modified the camera setting. An algorithm was developed to process images taken in different light conditions in an automated manner to predict the presence of ARF. Deep learning and image processing models were used to segment images of the face. Light settings and distances were tested to obtain the necessary features. Deep learning was thereafter used to formulate normalized risks using sigmoidal models for each ARF creating a risk dashboard. The model was tested on 54 young adults and results statistically analyzed.Results:A combination of low-light and ambient-light images was needed for screening for exclusive ARF. The algorithm had an F-Score of 73.2% with an accuracy of 79.6%, a sensitivity of 88.2%, and a specificity of 75.6% in detecting the ARF.Conclusion:Deep-learning and image-processing analysis of photographs acquired from a smartphone are useful in screening for ARF in children and young adults for a referral to doctors for further diagnosis and treatment.

Accuracy of noncycloplegic photorefraction using Spot photoscreener in detecting amblyopia risk factors in preschool children in an Indian eye clinic.

Purpose:To evaluate the accuracy of Spot photoscreener (PS) as a noncycloplegic photorefractor in detecting amblyopia risk factors (ARFs) in preschool children in an Indian eye clinic setting. Also, to derive appropriate cutoff values for screening to obtain maximum sensitivity and specificity of the device in detecting ARF.Methods:This was a cross-sectional study conducted in the outpatient pediatric eye clinic at a tertiary eye care institute. A Spot PS was used to screen all the children between the ages of 6 months and 5 years that presented to the eye clinic from August 2018 to October 2018. This screening was followed by a complete eye examination, including cycloplegic refraction by a masked examiner. The 2013 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines were considered the standard cutoff values for clinically significant refractive error in children younger than 5 years of age.Results:The study comprised of 219 children. The Spot PS diagnosed 135 (61.64%) children with ARF as compared with 124 (56.62%) children detected by clinic examination. For ARF detection, the Spot photoscreeneer had 85.48% sensitivity, 69.47% specificity, 78.52% positive predictive value and 78.57% negative predictive value. The sensitivity for detection of strabismus and hypermetropia was very low (42% and 36%, respectively). The 95% limits of agreement ranged from −5.48 to +5.59 diopters (D) with a bias of 0.06 D for spherical equivalent between noncycloplegic photorefraction and cycloplegic refraction.Conclusion:The Spot PS may be used as a screening tool to detect ARF in children younger than 5 years of age keeping its limitations in consideration. However, the performance can be improved by modifying the cutoff values for the referral.

Doğumsal Tek Taraflı Gözyaşı Kanal Tıkanıklığı Olan Olgularda Refraktif Durum

Objective: To investigate the refractive status and frequency of amblyopia risk factors in children who underwent probing for unilateral nasolacrimal duct obstruction (NLDO). Material and Methods: This descriptive cross-sectional study included 65 consecutive children with unilateral congenital NLDO who were still symptomatic at one year examination and necessiated nasolacrimal duct probing. A complete ophthalmic evaluation including cycloplegic refraction was performed. The spherical, cylindrical and spherical equivalent retinoscopy measurements of both eyes were noted. The risk factors for amblyopia and differences between refractive values of both eyes were evaluated. Results: The mean age at presentation was 20.4±9.2 months (range, 12 to 48 months). The left eye was involved in 30 (46.2 %) patients. Thirty-five subjects (54 %) were female. Nine children had amblyopia risk factors (13.8%). There was no statistically significant difference regarding cylindrical refractive error, spherical refractive error and spherical equivalent (p=0.9, p=0.9 and p=0.5 respectively) between two eyes. Conclusion: In the current study, no statistically significant difference was found between refractive values of both eyes. One tenth of children in our study group were found to be under risk of amblyopia mostly due to high astigmatism. Further studies about the effect of blurred vision on visual development of both eyes and binocular vision may provide more information about the refractive status in this group of patients.

Comparative AAPOS Validation of the Birefringent Amblyopia Screener with Isolated Small-Angle Strabismus.

BackgroundThe Rebion blinq binocular birefringent ocular alignment screener was recently commercially released, but it did not yet have validation by American Association for Pediatric Ophthalmology and Strabismus (AAPOS) uniform guidelines.MethodsChildren and adults from a high-risk eye practice had screening by blinq with validation by AAPOS 2003 guidelines. Then, the blinq was compared to the Adaptica 2WIN with CR corneal reflex strabismus estimation by AAPOS 2003 guidelines plus additional efforts to identify patients with diminished binocularity.ResultsBlinq in 100 patients compared to 2003 AAPOS amblyopia risk factors (ARF) had sensitivity 67%, specificity 75% and PPV of 82%. Both blinq and 2WIN were completed by 87 patients median age 6.5 years. Sensitivity, specificity and positive predictive value (PPV) for blinq were 75%, 68% and 81% whereas 2WIN had 91%, 68% and 84%. The blinq referred two young patients with isolated, small-angle strabismic amblyopia that 2WIN refractive function passed.ConclusionDespite its non-refractive design to identify binocular foveation, blinq performed well with refractive and strabismic uniform risk factors and a PPV greater than 80%.Clinical Trials RegistryNCT04195711.

Anterior chamber depth and axial length affect clinical performance of Spot Vision Screener.

The aim of this study was to evaluate the effect of anterior chamber depth and axial length on clinical performance of the Spot Vision Screener in detecting amblyopia risk factors in children aged 3-10 years. A total of 300 eyes from 150 patients aged 3-10 years were prospectively tested with Spot Vision Screener (firmware version 3.0.02.32, software version 3.0.04.06) and a standard autorefractometer (Nidek ARK-1). The anterior chamber depth and axial length were measured with an optical biometer (Nidek AL-Scan). The sensitivity and specificity values for detecting significant refractive errors using the referral criteria of the American Association for Pediatric Ophthalmology and Strabismus were determined. Pearson's correlation analysis was employed to evaluate the relationship between the Spot Vision results and the anterior chamber depth and axial length. Compared with the standard autorefractometer results, the Spot Vision Screener's sensitivity and specificity was 59% and 94%, respectively. The differences between the cycloplegic autorefractometer and the Spot Vision Screener spherical equivalents were negatively correlated with anterior chamber depth (r=-0.48; p<0.001) and axial length (r=-0.45; p<0.001). The Spot Vision Screener has moderate sensitivity and high specificity, using the criteria of the American Association for Pediatric Ophthalmology and Strabismus. The anterior chamber depth and axial length affect the Spot Vision results.

Evidence-based clinical practice guidelines for the periodic eye examination in children aged 0–5 years in Canada

BackgroundAs eye disease before age 5 years is common, some form of vision screening should be performed on children before attending primary school. However, the lack of consistent national recommendations creates confusion for patients, eye care professionals, and governments alike. MethodsThe objective of this document is to provide guidance on the recommended timing, intervals, and types of ocular assessments for healthy children aged 0–5 years. A literature search yielded 403 articles. A multidisciplinary expert committee (comprising 2 optometrists, a comprehensive ophthalmologist, a pediatric ophthalmologist, a family physician, and a pediatrician) independently determined those articles deemed to be key to the clinical question. Articles that were gradable (n = 16) were then submitted for independent critical appraisal by an external review group, which provided a Grading of Recommendations Assessment, Development and Evaluation profile of the reviewed articles to use for assigning a grade of evidence. RecommendationsIn addition to routine screening by a primary health care professional, a comprehensive eye examination by an individual with the expertise to detect risk factors for amblyopia—such as an ophthalmologist or optometrist—is required in early childhood. The findings support the importance of early detection of amblyopia before 36 months and no later than 48 months of age via screening with at least 1 comprehensive eye examination before age 5 years. ConclusionsVision screening performed by primary health care providers during routine well-baby/child visits and scheduled vaccinations is an essential part of the detection of ocular disease. However, this early detection potential is limited, and a full oculovisual assessment is also recommended before the child entering the school system. If amblyopia, strabismus, or other eye pathology is detected or suspected that is beyond the scope of the eye care professional examining the patient, a referral to the appropriate specialist can be made, allowing treatment to be initiated in a timely fashion.

Ophthalmologic disorders and risk factors in children with autism spectrum disorder

To report the results of our review of all children with autism spectrum disorder (ASD) who underwent complete pediatric ophthalmologic examination at our institution over a 10-year period. The medical records of all children (0-17years of age) with a diagnosis of ASD seen at University of California, Davis, over a 10-year period were reviewed retrospectively. Demographic data, birth history, genetic testing results, neuropsychiatric comorbidities, and ophthalmologic findings were extracted from the record. Multiple logistic regression was used to identify risk factors for ophthalmologic disorders. A total of 2,555 children with ASD were seen at the university over the study period, of whom 380 (15%) were evaluated in the ophthalmology clinic. Eye examination revealed an ophthalmic diagnosis in 71% of children, of which the most common were significant refractive error (42%), strabismus (32%), and amblyopia (19%). Optic neuropathy occurred in 14 children (4%). Cerebral palsy was a significant risk factor for refractive error (OR=3.22; P=0.016), strabismus (OR=3.59; P=0.012), amblyopia (OR=3.49; P=0.0097), and optic neuropathy (OR=14.0; P=0.0009). Ophthalmic disorders were found in 71% of children with ASD evaluated at our university-based ophthalmology clinic. The rates of significant refractive error, strabismus, amblyopia, and optic neuropathy exceeded those of the general pediatric population. ASD and cerebral palsy may have additive risk for these disorders.

School bus accommodation-relaxing skiascopy.

ObjectiveAccurate estimation of hyperopia and astigmatism is challenging in delayed children. Conventional skiascopy holds rows of increasing power ± lenses vertically in front of one eye. The school bus accommodation-relaxing skiascopy (SBA-RS) design holds child-friendly, lenses +1 to +10D horizontally so that a higher power fogs the nontested eye-relaxing accommodation without cycloplegia.MethodsDesign: Evaluation of diagnostic test. Subjects: Patients undergoing comprehensive eye examination in a pediatric ophthalmology practice. Cycloplegic (cyclopentolate 1%) retinoscopy was compared to dry SBA-RS and Retinomax (Righton, Japan) during pediatric eye examinations. Outcome measures: correlations, Chi-square and receiver operating characteristic (ROC) curve.ResultsOf 470 patients with a median age 6 years, 238 were under the age of 60 months and 110 had developmental delays. For those with cycloplegic spherical equivalent hyperopia over 0.7 D, median (90% CI) value for retinoscopy was +2.63 D (+0.75, +6.88), for SBA-RS was +2.50 D (+0.50, +6.75) and less for 184 with Retinomax +1.88 D (−1.56, +6.13) but similar despite delays. Astigmatic cylinder SBA-RS +1.50 D (+0.25, +4.00) lagged retinoscopy +1.75 D (+0.75,+4.50) but Retinomax was greater +2.00 D (+0.25, +4.64). Cycloplegic refractive components such as spherical equivalent, cylinder, and J0 and J45 power vectors correlated highly and were near unity with SBA-RS and Retinomax with the latter deviating greater. SBA-RS screened for amblyopia risk factors up to 92% sensitive and 94% specific.ConclusionAccommodation-relaxing horizontal skiascopy very precisely estimates astigmatism power and axis and only lags cycloplegic refraction by about 0.15D in hyperopic patients fairly independent of neurodevelopmental delay. This technique can quickly estimate refraction even in delayed patients potentially reducing some need for cycloplegia.Clinical Trials RegistryNCT03668067.