Plusoptix Photoscreener Research Articles

Comparing the SureSight autorefractor and the plusoptiX photoscreener for pediatric vision screening

Purpose: Both the plusoptiX photoscreener photoscreener and the SureSight autorefractor can be used to objectively screen for amblyogenic risk factors in children. We compare the plusoptiX and the SureSight to a pediatric ophthalmology examination on a single cohort of children.Methods: We performed a retrospective medical records review of 90 children. Each patient was screened with both the PlusoptiX A09 and SureSight devices on the same day as part of a comprehensive pediatric ophthalmic examination. The ages of the patients ranged from <1 to 17 years. All patients had a cycloplegic refraction on the day of their exam, or within the previous 6 months.Results: Of the children reviewed, 71% had amblyopia risk factors. The plusoptiX demonstrated a sensitivity of 98% and a specificity of 88%. The SureSight demonstrated a sensitivity of 95% and a specificity of 65% utilizing the manufacturer’s criteria.Conclusion: The SureSight and plusoptiX were both found to be reliable objective vision screening devices, though the plusoptiX did have a higher sensitivity and specificity than the SureSight using the manufacturer’s referral criteria. Using the Vision In Preschoolers Study (VIPS) referral criteria, the specificity of the SureSight improved but the sensitivity was reduced.

The Accuracy of the PlusoptiX for Measuring Pupillary Distance

Introduction: The plusoptiX photoscreener provides a number of measurements, including an estimate of inter-pupillary distance. We compare the plusoptiX photoscreening measurements of pupillary distance to that of an experienced optician in order to measure the accuracy of this reading.Methods: A retrospective chart review was done on 731 patients ranging in age from 1 to 16 years. Of these, 256 patients had both a plusoptiX photoscreening and a pupillary distance measurement by one of our office opticians.Results: Of the 236 patients evaluated, 142 were orthophoric, 97 were esotropic, and 17 were exotropic. The mean absolute difference for the entire group between the two measurements was 0.3 mm. For the orthophoric patients, this metric was 0.3 mm, while for the esotropic patients it was 0.8 mm. There were too few exotropic patients to obtain reliable statistics.Conclusions: Although the average difference between the optician’s measurements and those provided by the plusoptiX was within 0.5 mm for orthophoric patients, the variability of the measurements provided by the plusoptiX was too great to permit us to recommend the device as an alternative to the optician for routinely dispensing spectacles.

Comparison of SureSight autorefractor and plusoptiX A09 photoscreener for vision screening in rural Honduras

To evaluate the SureSight autorefractor and compare it to the plusoptiX A09 photoscreener in the detection of amblyopia risk factors in a cohort of Honduran children examined during medical mission work and to assess the utility of both devices in the rural setting. The medical records of patients who had undergone SureSight autorefractor screening, plusoptiX photoscreening, and a gold standard pediatric ophthalmology examination, including cycloplegic refraction, during a recent medical mission trip to Honduras were retrospectively reviewed. A total of 216 children were examined. Of these, 9 (4%) were found to have amblyopia risk factors based on the current referral criteria of the American Association for Pediatric Ophthalmology and Strabismus on ophthalmological examination. The plusoptiX was found to have 89% sensitivity and 80% specificity; the SureSight, using manufacturer's referral criteria, was found to have sensitivity of 89% and specificity of 71%. Both devices were found to be reliable vision screening devices when used on the general population of remote villages in Honduras, although the specificity of the plusoptiX A09 was higher.

Pupil size and anisocoria in children measured by the plusoptiX photoscreener

To investigate pupil size and the incidence of anisocoria in children at a single community-based practice using the plusoptiX A04 and A09 photoscreeners (plusoptiX GmbH, Nuremberg, Germany). The medical records of consecutive patients <1 to 17 years of age who had received a comprehensive ophthalmological examination that included photoscreening with the plusoptiX were retrospectively reviewed. Data collected included sizes of both pupils, age, sex, laterality, and magnitude of anisocoria. A total of 1,306 patient records were reviewed. Of these, 1,057 (80.9%) had 0-0.4 mm of anisocoria; 219 (16.8%), 0.5-0.9 mm; 20 (1.5%), 1.0-1.4 mm; and 10 (0.8%), ≥1.5 mm. Magnitude of anisocoria appears to increase with age (P = 0.0073). Pupil size and age were positively correlated (P < 0.0001), that is, older children had larger pupils. Average pupil size of children <1 year of age was 5.0 mm; of children ≥16 years of age, 6.1 mm. When sorted into age buckets of 0-3, 4-7, 8-11, 12-15, and 16-17, this increase becomes apparent. There is no significant relationship between pupil size and sex (P = 0.14). Our study of 1,306 children shows that pupil size increases through childhood, andthat19.1% of children in a clinical population have anisocoria >0.4 mm.

A Comparison of Referral Criteria used by the PlusoptiX Photoscreener

Purpose: To evaluate the sensitivity, specificity, and predictive value of 7 different referral criteria used for the plusoptiX photoscreener on the same cohort of children.Methods: Retrospective chart review of patients presenting to a pediatric ophthalmology clinic who underwent plusoptiX photoscreening as part of a comprehensive examination. We applied multiple referral criteria from previously published studies as well as the manufacturer’s criteria in order to calculate specificity, sensitivity, and predictive value differences between the various referral criteria. We compared all criteria to the results of a pediatric ophthalmology examination based upon the 2003 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) criteria, as well as the newly accepted revision of the AAPOS referral criteria.Results: 109 children were examined with a thorough pediatric ophthalmic exam and with the plusoptiX photoscreener. Of these, 58 (53%) were confirmed to demonstrate amblyopia risk factors, according to 2003 AAPOS criteria. The plusoptiX referral criteria were adjusted to match 7 different published plusoptiX referral paradigms so that the differing referral paradigms could be analyzed for sensitivity and specificity. When comparing the differing plusoptiX referral paradigms to 2003 AAPOS criteria, the sensitivity/specificity of the 7 different paradigms were respectively: Matta/Silbert 98%/80%, Arthur (2) 67%/96%, Arnold 81%/96%, Arthur 81%/92%, PediaVision 80%/94%, plusoptiX 98%/41%, AAPOS 74%/86%. When comparing the 7 differing referral paradigms to the newly approved (2013) AAPOS criteria, the sensitivity/specificity were respectively: Matta/Silbert 98%/68%, Arthur (2) 73%/92%, Arnold 92%/90%, Arthur 86%/85%, PediaVision 90%/92%, plusoptiX 98%/35%, AAPOS 87%/87%.Conclusion: There are multiple referral criteria available for the plusoptiX photoscreener. Screening programs need to evaluate their own requirements with respect to desired sensitivity and specificity and decide on the most appropriate referral criteria for their program. The “Arnold” criteria is the best at maximizing sensitivity and specificity utilizing the 2003 “AAPOS” criteria and the “Arnold” and “PediaVision” were best at maximizing sensitivity and specificity for the newly accepted AAPOS referral criteria. Screening programs will need to decide the level of sensitivity and specificity that they wish to obtain, but for most screening programs the “Arnold” criteria may be preferred.

Evaluation of plusoptiX Photoscreening During Examinations of Children with Autism

Purpose: We evaluated the reliability of the the plusoptiX photoscreener compared to a standard pediatric eye exam offered to children with autism.Methods: This is a retrospective chart review of children diagnosed with autism seen at one pediatric ophthalmology practice.Results: Twenty-five children were evaluated. The plusoptiX was found to have a sensitivity of 88% and a specificity of 87% in identifying amblyopia risk factors based on the current American Association for Pediatric Ophthalmology and Strabismus referral criteria.Conclusion: Pediatric vision screening can be especially challenging in children with autism. Minimizing the need for examinations in these children is important. While the plusoptiX does not perform as well when applied to children with autism as it does when offered to children in the general population, it is still a useful tool.

Plusoptix photoscreening may replace cycloplegic examination in select pediatric ophthalmology patients

To determine whether children presenting to a pediatric ophthalmologist and found to have a normal Plusoptix photoscreener (PlusoptiX GmbH, Nuremberg, Germany) result, normal visual acuity (children age 3+), and normal alignment/motility receive additional benefit from a dilated fundus examination. The medical records of all children seen at one pediatric ophthalmology practice between 2007 and 2010 who were coded as having had a photoscreening were retrospectively reviewed. Of the total number of records identified, one-half were selected randomly for review. Patients who underwent plusoptiX screening on the first visit were included. Patients with abnormal alignment and/or abnormal vision as well as those referred for examination as determined by a medical or ophthalmic condition that required a dilated fundus examination were excluded. Of 1,377 patients identified, 697 were selected randomly for record review. Of these, 451 had had an initial plusoptiX screening. A total of 222 had a normal result. Of the 190 patients analyzed, cycloplegic examination provided additional diagnostic information for only 4 children: 1 with nonvisually significant congenital cataract, 1 with refractive amblyopia from moderate astigmatism, 1 with moderate hyperopia who later was found to have accommodative esotropia, and 1 with increased cupping but normal IOP. A normal plusoptiX result, combined with normal alignment/motility evaluation and visual acuity was found to have a 98% negative predictive value for ophthalmic pathology, including significant refractive error. The plusoptiX and an abbreviated eye examination may obviate the need for dilation in select children.

Normative data on pupil size and anisocoria in children

IntroductionThe plusoptiX photoscreener is able to measure noncycloplegic refraction as well as pupil size and deviation. Both pupils are measured simultaneously, making it an ideal instrument to measure the magnitude of anisocoria in children.MethodsRetrospective chart review was performed on 516 children aged <1 to 17 years who had a plusoptiX performed as part of a pediatric ophthalmology examination. plusoptiX was performed by an orthoptist or ophthalmic technician in dim illumination. Data collected included size of left and right pupils by age and laterality and magnitude of anisocoria.Results88% of children had less than 0.5mm of anisocoria, 9% had 0.5-0.9mm of anisocoria, 1% had 1.0-1.4 mm of anisocoria, and 1% had 1.5+ mm of anisocoria. Pupil size increased with age from an average 5.2 mm for age less than 1, to 6.5 mm for age 16-17, ANOVA test (P < 0.0001). There is not a statistical difference in laterality of anisocoria (P = 0.56).DiscussionAlthough pupil size decreases in adults with increasing age, there has been little reported on normative data for pupil size or anisocoria in children. Our data shows that pupil size increases throughout childhood through age 17. Also of interest, nearly 11% of children had anisocoria of 0.5mm or greater, an asymmetry visible to parents and casual observers.ConclusionsOur study provides normative data useful to the clinician when discussing anisocoria and pupil size with patients and families. IntroductionThe plusoptiX photoscreener is able to measure noncycloplegic refraction as well as pupil size and deviation. Both pupils are measured simultaneously, making it an ideal instrument to measure the magnitude of anisocoria in children. The plusoptiX photoscreener is able to measure noncycloplegic refraction as well as pupil size and deviation. Both pupils are measured simultaneously, making it an ideal instrument to measure the magnitude of anisocoria in children. MethodsRetrospective chart review was performed on 516 children aged <1 to 17 years who had a plusoptiX performed as part of a pediatric ophthalmology examination. plusoptiX was performed by an orthoptist or ophthalmic technician in dim illumination. Data collected included size of left and right pupils by age and laterality and magnitude of anisocoria. Retrospective chart review was performed on 516 children aged <1 to 17 years who had a plusoptiX performed as part of a pediatric ophthalmology examination. plusoptiX was performed by an orthoptist or ophthalmic technician in dim illumination. Data collected included size of left and right pupils by age and laterality and magnitude of anisocoria. Results88% of children had less than 0.5mm of anisocoria, 9% had 0.5-0.9mm of anisocoria, 1% had 1.0-1.4 mm of anisocoria, and 1% had 1.5+ mm of anisocoria. Pupil size increased with age from an average 5.2 mm for age less than 1, to 6.5 mm for age 16-17, ANOVA test (P < 0.0001). There is not a statistical difference in laterality of anisocoria (P = 0.56). 88% of children had less than 0.5mm of anisocoria, 9% had 0.5-0.9mm of anisocoria, 1% had 1.0-1.4 mm of anisocoria, and 1% had 1.5+ mm of anisocoria. Pupil size increased with age from an average 5.2 mm for age less than 1, to 6.5 mm for age 16-17, ANOVA test (P < 0.0001). There is not a statistical difference in laterality of anisocoria (P = 0.56). DiscussionAlthough pupil size decreases in adults with increasing age, there has been little reported on normative data for pupil size or anisocoria in children. Our data shows that pupil size increases throughout childhood through age 17. Also of interest, nearly 11% of children had anisocoria of 0.5mm or greater, an asymmetry visible to parents and casual observers. Although pupil size decreases in adults with increasing age, there has been little reported on normative data for pupil size or anisocoria in children. Our data shows that pupil size increases throughout childhood through age 17. Also of interest, nearly 11% of children had anisocoria of 0.5mm or greater, an asymmetry visible to parents and casual observers. ConclusionsOur study provides normative data useful to the clinician when discussing anisocoria and pupil size with patients and families. Our study provides normative data useful to the clinician when discussing anisocoria and pupil size with patients and families.

Does adding stereo testing to Plusoptix photoscreening improve sensitivity?

Does adding stereo testing to Plusoptix photoscreening improve sensitivity?

The use of the plusoptiX photoscreener for vision screening

The BIOJ is the official journal of the British and Irish Orthoptic Society. The BIOS was founded in 1937. BIOS is a professional and educational body for the UK and Republic of Ireland representing orthoptists. Orthoptics is a world-wide profession, and the BIOS is recognised as being a leader in both education and clinical practice. The BIOJ invites submissions relating to original research, review articles, case reports and scientific letters to the editor in areas related to clinical ocular motility, visual function, amblyopia, binocular vision and strabismus. The journal will accept submissions from a wide variety of disciplines, including orthoptists, optometrists, ophthalmologists, and vision technicians, among others.

Can the plusoptiX replace the need for a cycloplegic examination in select pediatric ophthalmology patients?

To determine if children presenting to a pediatric ophthalmologist and found to have a normal plusoptiX photoscreening, normal acuity (if 3 or older), and normal alignment/motility, receive any additional benefit from having a dilated examination.

Screening for amblyopia risk factors in pre-verbal children using the Plusoptix photoscreener: a cross-sectional population-based study

AimsTo evaluate the accuracy and applicability of Plusoptix photoscreener in screening pre-verbal children at risk of amblyopia.MethodsIn this cross-sectional population-based study 996 children aged 6–36 months were screened with the...

Screening for Amblyogenic Risk Factors Using the PlusoptiX S04 Photoscreener on the Indigent Population of Honduras

To evaluate the PlusoptiX S04 photoscreener (PlusoptiX GmbH, Nürnberg, Germany) compared with a gold standard pediatric ophthalmology examination for children seen during a medical missionary trip. Retrospective chart review. One hundred five children were examined during a medical mission trip to Honduras. Patients included in the study were infants and children up to 17 years of age who sought treatment at the clinic for an eye examination. Each patient was screened with the PlusoptiX S04 photoscreener on the same day as part of a comprehensive pediatric ophthalmology examination. Comparison of photoscreening results with those of comprehensive pediatric ophthalmology examination. Fourteen percent of the patients were found to have amblyopia or amblyopia risk factors during the pediatric ophthalmology examination. Using these results as the standard, the PlusoptiX photoscreener was calculated to have a sensitivity of 94%, specificity of 98%, false-positive rate of 2.2%, false-negative rate of 6.2%, and positive predictive value of 88%. These findings were similar to the results achieved in a previous study with older children. When evaluating children in the age group who are most likely to require automated photoscreening technology and who will benefit from mass screenings, the PlusoptiX S04 photoscreener is a very useful tool. It is a noninvasive, quick, objective, user-friendly, and portable device that provides the added benefit of software able to interpret the results immediately. It also seems to be a useful tool for medical mission work. Vision screening programs likely will find this a useful option when examining children.

Pediatrician experience with the Plusoptix vision screener: An observational clinical trial

Introduction: To determine the usefulness of the Plusoptix photoscreener in the pediatric office.

Comparison Between the plusoptiX and MTI Photoscreeners

Both the Medical Technology and Innovations (MTI) and plusoptiX photoscreeners are used to objectively screen for amblyogenic risk factors in children. The MTI has been extensively studied, but the limited availability of film may render it obsolete. We compared the MTI with the plusoptiX, a newer digital photoscreener, for the ability to detect amblyogenic factors when compared with a comprehensive pediatric ophthalmic examination. We believe our results will help to guide community-based vision screening programs. One hundred fifty-one children were examined consecutively in our office. Each patient was screened with the MTI and plusoptiX devices on the same day as part of a comprehensive pediatric ophthalmic examination. Results via MTI were evaluated by an expert masked examiner (R.W.A.), and the plusoptiX results were interpreted by the incorporated software. Sixty-five percent of patients were found to have amblyopia or amblyogenic risk factors during the pediatric ophthalmic examination conducted via the American Association of Pediatric Ophthalmology and Strabismus referral criteria. We found the MTI photoscreener to have a sensitivity of 83.6%, specificity of 90.5%, false- positive rate of 9.4%, false-negative rate of 16.3%, and positive predictive value of 94.2%. The plusoptiX demonstrated a sensitivity of 98.9%, specificity of 96.1%, false- positive rate of 3.7%, false-negative rate of 1.0%, and positive predictive value of 97.9%. The MTI and plusoptiX photoscreeners proved to be effective when compared with a comprehensive cycloplegic pediatric ophthalmic examination. The plusoptiX, however, was found to have a higher sensitivity and specificity than the MTI.