Detecting Amblyopia Risk Factors Research Articles

Evaluation of cycloplegic and noncycloplegic performance of spot vision screener in detection of amblyopia risk factors using 2021 AAPOS guidelines

PurposeThis research evaluates the effectiveness of the Spot Vision Screener (SVS) before and after cycloplegia to detect amblyogenic refractive errors in children. MethodsChildren ages 3 to 10 years old were screened by the SVS before and after cycloplegia. Sensitivity, specificity, positive and negative predictive value, paired t-test, Bland-Altman plot and receiver operating characteristic area under the curve were evaluated by comparing the results of the SVS (v3.0.05) measurements with the results of the cycloplegic Topcon autorefractometer according to the 2021 guidelines of the American Association for Pediatric Ophthalmology and Strabismus. ResultsBoth eyes of 211 patients aged 3 to 10 years old were included. Regarding the amblyopia risk factors, the noncycloplegic SVS had 65.7 % sensitivity, 94.9 % specificity, 81.2 % positive predictive value and 89.3 % negative predictive value. The SVS's sensitivity increased from 65.7 % to 81.9 % with cycloplegia compared to noncycloplegic SVS results. The sensitivity detection of hyperopia was improved from 4.2 % to 100 % after cycloplegia. Areas under the receiver operator characteristic curve for noncycloplegic SVS and cycloplegic SVS were 0.506 (95 % CI, 0.395 to 0.646, p = 0737) and 0.905 (95 % CI, 0.915 to 0.971, p < 0.001) for hyperopia, respectively. Using the +1.64 D revised cutoff criteria for hyperopia increased sensitivity from 4.2 % to 78 %. ConclusionNoncycloplegic SVS measurements showed relatively high specificity in detecting amblyopia risk factors. The fact that noncycloplegic measurements have a very low sensitivity for hyperopia is an important weakness of the SVS, especially because hyperopia is the most frequently encountered refractive error in very young children. It should be noted that amblyogenic hyperopia may be overlooked by an SVS without cycloplegia.

Performance of the Spot Vision Screener in children with Down syndrome and other special needs

Amblyopia is a common cause of monocular vision impairment and disproportionally affects developmentally delayed children. Photoscreeners have been suggested as a method to detect amblyopia risk factors (ARFs) in children with developmental disabilities who may not be amenable to traditional vision screening methods. The Spot Vision Screener is a commonly used photoscreener for detecting ARF and has shown excellent sensitivity and accuracy in the general pediatric population. The purpose of this study was to evaluate its accuracy in children with Down syndrome and other special needs. Children with various disabilities or delays were recruited from outpatient clinics at the Children's Hospital of Colorado. Participants had their photograph taken with Spot before and after pupil dilation and cycloplegia. Images were compared to results of a comprehensive clinical eye examination. A total of 100 children participated in the study. Images could not be obtained in 12 children; 5 children did not attend their clinical examination. The overall sensitivity of Spot was 90%, with a positive predictive value of 80% in undilated subjects. The area under the receiver operator curve (AUROC) was 0.68 (95% CI, 0.57-0.79), which did not differ significantly from the AUROC after dilation/cycloplegia (0.68; 95% CI, 0.54-0.81). The Spot Vision Screener could be used by primary care clinics and vision screening programs with a high sensitivity to determine which patients with Down syndrome and special needs should be referred for clinical examination.

Effectiveness of the vision screener using updated uniform 2021 AAPOS guidelines

In 2021 the AAPOS Vision Screening Committee updated the Uniform Guidelines for Instrument-Based Pediatric Vision Screen Validation. We evaluate the Spot Vision Screener in detecting amblyopia risk factors and visually significant refractive errors according to these new guidelines.

Vision screening using a smartphone platform.

ABSTRACTObjective:The main aim of this study was to evaluate the performance of a platform designed for pediatricians to screen amblyopia using a smartphone.Methods:The medical records of consecutive children who received visual screening using a smartphone platform were retrospectively reviewed. The smartphone was used with a flash concentrator case and a software for capturing images of both eyes simultaneously by a photorefraction mechanism. The platform performance was compared to the comprehensive ophthalmological examination, which is considered the gold standard for detecting amblyopia. Sensitivity, specificity, positive predictive value, and negative predictive value of the software in detecting amblyopia risk factors were calculated. Results:A total of 157 children were included, with a mean age of 6.0±.5 years (range 5–7). In 94% of the cases, the software was able to analyze the images and release a result, determining whether or not the child presented with amblyopia risk factors. Compared to the ophthalmological examination, the smartphone platform sensitivity in detecting amblyopia risk factors was 84%, the specificity was 74%, the positive predictive value was 86%, and the negative predictive value was 70%.Conclusions:The sensitivity and specificity of the smartphone photoscreening platform to detect amblyopia risk factors were within the range of traditional instrument-based vision screening technology. A smartphone photorefraction platform appears to be a promising cost-effective alternative to assist pediatricians and minimize obstacles to vision screening and amblyopia detection. Future studies are needed to gather additional comparative data.

Age Does Not Influence the Positive Predictive Value of Vision Screening to Detect Amblyopia Risk Factors

Among 3114 children seen at Vanderbilt Eye Institute from 11/1/2017-3/1/2020, the positive predictive value of vision screening to detect Amblyopia Risk Factors was similar for children <3 and for those aged 3-5 years.

Age does not influence the positive predictive value of vision screening to detect amblyopia risk factors

Abstract Among 3114 children seen at Vanderbilt Eye Institute from 11/1/2017-3/1/2020, the positive predictive value of vision screening to detect Amblyopia Risk Factors was similar for children

Comparison of Two Photoscreeners in a Population of Syrian Refugee Children.

To evaluate children in the Za'atari refugee camp in Jordan to better understand the prevalence of ocular pathology and to compare two photoscreening devices to evaluate their utility. Families at the Syrian American Medical Society Clinic were offered vision screening for children aged 1 to 18 years. Participants were offered visual acuity measurement and photoscreening with two devices approved for use in the United States. If visual acuity in either eye was worse than 20/40 or either photoscreening device indicated possible pathology, a complete eye examination was performed with cycloplegic refraction and dilated examination. Ninety-one participants completed the screening protocol. The average age of participants who completed the study was 7.8 years (range: 1 to 16 years). Twenty-eight participants (30.8%) failed at least one screening component. In this population, the following pathology was identified: astigmatism (12.1%), esotropia (9.9%), amblyopia (9.9%), hyperopia (7.7%), exotropia (3.3%), and myopia (1.1%). The Plusoptix vision screener (Plusoptix) had a sensitivity of 100% for the identification of amblyopia and 85% specificity. The GoCheck Kids application (Gobiquity) had a sensitivity of 66.67% for the identification of amblyopia and 94% specificity. The positive predictive value for the Plusoptix vision screener and the GoCheck Kids application for the detection of amblyopia risk factors was 77% for both. The high rate of ophthalmic pathology identified in this study reinforces the urgent need for proper vision screening and intervention in this population. [J Pediatr Ophthalmol Strabismus. 2021;58(6):396-400.].

Instrument-based screening for amblyopia risk factors in a primary care setting in children aged 18 to 30months.

Amblyopia is the leading cause of vision impairment in children, and its early detection can avoid irreversible consequences for a child's visual ability. In this prospective study, to detect amblyopia risk factors, we examined patients aged 18 to 30months in primary care settings. Patients were referred to an ophthalmologist for confirmation. The main aims were to detect amblyogenic risk factors and to assess the usefulness of a photoscreener in such settings. Out of 453 patients, 42 (9.3%) presented visual alterations according to the photoscreener, with astigmatism being the most common. The instrument had good sensitivity (89%) and specificity (91%), with a positive predictive value of 76% and a negative predictive value of 96%. Overall, 38% of the patients required follow-up, and 47% needed glasses. The automated screening device allowed these children to be diagnosed at an early stage.Conclusions: The use of a photoscreener to screen 2-year-old children in primary care settings was helpful and accurate. What is Known: • Early detection of amblyopic risk factors is important to avoid vision defects. However, it is very difficult to measure visual acuity using visual charts in children younger than 4years old. What is New: • Instrument-based screening in children aged 18 to 30months allows excellent detection of early amblyopia risk factors in primary care settings.

Effectiveness of Kanna photoscreener in detecting amblyopia risk factors.

Purpose:Amblyopia is a significant public health problem. Photoscreeners have been shown to have significant potential for screening; however, most are limited by cost and display low accuracy. The purpose of this study was validate a novel artificial intelligence (AI) and machine learning–based facial photoscreener “Kanna,” and to determine its effectiveness in detecting amblyopia risk factors.Methods:A prospective study that included 654 patients aged below 18 years was conducted in our outpatient clinic. Using an android smartphone, three images of each the participants’ face were captured by trained optometrists in dark and ambient light conditions and uploaded onto Kanna. Deep learning was used to create an amblyopia risk score based on our previous study. The algorithm generates a risk dashboard consisting of six values: five normalized risk scores for ptosis, strabismus, hyperopia, myopia and media opacities; and one binary value denoting if a child is “at-risk” or “not at-risk.” The presence of amblyopia risk factors (ARF) as determined on the ophthalmic examination was compared with the Kanna photoscreener.Results:Correlated patient data for 654 participants were analyzed. The mean age of the study population was 7.87 years. The algorithm had an F-score, 85.9%; accuracy, 90.8%; sensitivity, 83.6%; specificity, 94.5%; positive predictive value, 88.4%; and negative predictive value, 91.9% in identifying amblyopia risk factors. The P value for the amblyopia risk calculation was 8.5 × 10−142 implying strong statistical significance.Conclusion:The Kanna photo-based screener that uses deep learning to analyze photographs is an effective alternative for screening children for amblyopia risk factors.

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.

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.

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.

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.

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.

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.

Comparison of 2Win and plusoptiX A12R refractometers with Retinomax handheld autorefractor keratometer

To test the accuracy and validity of the 2Win and the plusoptiX A12R refractometers in detecting amblyopia risk factors. Children were screened using both devices, using two sets of referral criteria each, and underwent complete ophthalmic examination, including cycloplegic refraction. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Median values for the pairs of refractometers were compared using the Wilcoxon signed-rank sum test for sphere, cylinder, and power vectors J0 and J45 for axis (both eyes). A total of 284 eyes of 142 children (mean age, 37.9±19.8months) were included. Comparison of mean cycloplegic and manifest refractometer measurements provided statistically significant differences in both eyes. For sphere, the means were lower and for cylinder, higher for both devices, and both correlated well with the gold standard for astigmatic power vectors J0 and J45. Using referral criteria 1, the sensitivity, specificity, PPV and NPV, and inconclusive results were 67.4%, 83.7%, 87.9%, 59.4%, and 4.9%, respectively, for the 2Win, with sensitivity of 13% in the hyperopia group; 73.1%, 95.9%, 96.6%, 69.1%, and 10.6%, respectively, for the plusoptiX A12R, with a sensitivity of 33.3% in the hyperopia group. Using criteria 2, the values were 98.8%, 38.8%, 73.9%, and 95.0% (2Win) and 94.9%, 65.3%, 81.3%, and 88.9% (plusoptiX A12R). In manifest conditions, the accuracy of the 2Win and plusoptiX A12R refractometers is low in hyperopia and astigmatism, but the devices are well correlated with each other, and both have high specificity; sensitivity is low in hyperopia, resulting in the underestimation of hyperopic refractive error. The optional Plusoptix sensitive referral criteria seems to be appropriate for the A12R. The 2Win provided fewer inconclusive results and was preferred for use with younger and developmentally delayed children.

Diagnostic test accuracy of Spot and Plusoptix photoscreeners in detecting amblyogenic risk factors in children: a systemic review and meta-analysis.

Amblyopia is a permanent visual impairment developed in early childhood. Recently, instrument-based photoscreeners have been widely used for vision screening to detect amblyopia risk factors, which is key for the prevention and treatment of amblyopia. This meta-analysis aims to evaluate the diagnostic test accuracy of Spot and Plusoptix photoscreeners in detecting risk factors for amblyopia in children. An electronic literature search was performed in October 2018 using the MEDLINE, Embase, and Web of Science databases. Twenty-one publications with a total of 5022 subjects were included. Subjects given a comprehensive examination were considered to have amblyopia or amblyogenic risk factors based on the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) referral criteria guidelines. The overall sensitivity for Spot and Plusoptix was 87.7% and 89.4%, respectively (p=0.38); the specificity was 78.0% and 89.9%, respectively (p=0.90). For subjects under 7years old (preschool children), the overall sensitivity for Spot and Plusoptix was 91.7% and 90.2%, respectively (p=0.81); the specificity was 82.6% and 93.0%, respectively (p=0.46). Both Spot and Plusoptix photoscreeners demonstrated good sensitivity and specificity in detecting amblyopia risk factors in children, especially at preschool ages. There was no significant difference in diagnostic test accuracy between them.

Clinical Performance of the Spot Vision Photo Screener before and after Induction of Cycloplegia in Children.

Aim To compare the clinical performance of the Spot Vision Screener used to detect amblyopia risk factors (ARFs) in children before and after induction of cycloplegia; the children were referred because they met the screening criteria of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Methods The Spot Vision Screener and a standard autorefractometer were used to examine 200 eyes of 100 children aged 3–10 years, before and after cycloplegia induction, in terms of ARFs. Sensitivity, specificity, and positive and negative predictive values for the detection of significant refractive errors were measured using the AAPOS referral criteria. It was explored that Spot Screener data were affected by cycloplegia. The extent of agreement between cycloplegic/noncycloplegic photoscreening data and cycloplegic autorefraction measurements was assessed using Wilcoxon and Spearman correlation analyses. Results The Spot's sensitivity was improved from 60.9% to 85.3% and specificity from 94.9% to 87.4% with cycloplegia compared to cycloplegic standard autorefractometer results. The positive predictive value of Spot was 75.7%, and the negative predictive value was 90.4% without cycloplegia. With cycloplegia, the positive predictive value of Spot was 63.6% and the negative predictive value was 95.8%. Conclusions The Spot Screener afforded moderate sensitivity and high specificity prior to cycloplegia. The sensitivity and negative predictive value improved after induction of cycloplegia. Examiners should be aware of the effects of cycloplegia on their findings.

Objective vision screening using PlusoptiX for children aged 3\u201311 years in rural Turkey

BackgroundThis population based cross sectional study was conducted to detect amblyopia risk factors and myopia in a rural district of Northwestern Turkey by using PlusoptiX S12R (Photoscreener PlusoptiX Inc., Nuremberg, Germany).MethodsChildren from 38 rural schools in Caycuma district of Zonguldak Turkey underwent vision screening in their school using PlusoptiX S12 photoscreener. Data were analyzed using the factory default level 5 referral criteria targeting 80% sensitivity and 95% specificity. Referral, unable readings, and positive predictive value (PPV) were reported.ResultsData from 2846 children were analyzed. Mean age was 7.9 years (±0.8) (range 36 months to 11 years). Three hundred ten (11%) were referred of whom 32% were read as ‘unable’. 150 children (48% of the referred) received a gold standard examination. Positive predictive value of PlusoptiX was 69%. PPV was 83% when unable readings were excluded. 93 children with amblyopia risk factors were identified. Only 26% (n = 25) had received glasses priorly. 49 children had amblyopia of whom 33 were newly diagnosed.ConclusionsPlusoptiX showed a reasonable level of positive predictive value in community setting and the device could be a useful tool for vision screening in preschoolers and schoolers. We found most of the amblyogenic refractive errors were underdiagnosed in rural school children leading to a call for action on vision screening.