The Vision in Preschoolers Study Group, The Ohio State University, College of Optometry, Columbus 43218-2342, USA.
Optom Vis Sci. 2007 Mar;84(3):181-8. doi: 10.1097/OPX.0b013e3180339f5a.
To assess the impact of Retinomax reading confidence number on screening accuracy and to determine whether repeated testing to achieve a higher confidence number improves screening accuracy in preschool children.
Lay and nurse screeners trained in the use of the Retinomax Autorefractor screened 1452 children enrolled in the Vision in Preschoolers (VIP) Phase II Study. All children also received a comprehensive eye examination. Using statistical comparison of correlated proportions, we compared sensitivity and specificity for detecting any VIP-targeted condition and conditions grouped by severity and by type (amblyopia, strabismus, significant refractive error, and unexplained decreased visual acuity) among three groups of children who had confidence numbers below, at or above the manufacturer's suggested confidence number of 8. The reading with the highest confidence number for each eye was used in the analysis. Each child's confidence number group was defined based on the lower confidence number of the pair of readings for the two eyes. Among the 771 (53.1%) children who had repeated testing either by lay or nurse screeners because of a low confidence number (<8) for one or both eyes in the initial testing, the same analyses were also conducted to compare results between the initial reading with confidence number<8 and repeated test reading with the highest confidence number in the same child. These analyses were based on the failure criteria associated with 90% specificity for detecting any VIP condition in VIP Phase II. We also examined the association between ocular conditions and confidence number. Hochberg procedure was used to adjust the p value for multiple comparisons.
A lower confidence number category was associated with higher sensitivity (0.78, 0.65, and 0.61 for<8, 8, >8, respectively, p=0.04) but much lower specificity (0.64, 0.89, and 0.93, p<0.0001) of detecting any VIP-targeted condition. Through repeated testing, 87% of readings that initially had a confidence number below 8 reached 8 or above, and the increased confidence number that resulted from repeated testing was associated with significantly higher specificity (0.81 vs. 0.86, p=0.002) and a nonsignificant change (by -0.04 to 0.03) in sensitivities. Children with any VIP-targeted condition, significant refractive error, hyperopia, astigmatism, or myopia were more likely to have a low confidence number.
A higher confidence number obtained during Retinomax Autorefractor screening is associated with better screening accuracy. Repeated testing to reach the manufacturer's recommended minimum value is worthwhile in preschool vision screening with the Retinomax. Failure to achieve manufacturer's recommended minimum value through repeated testing should be a factor considered in referring children for a comprehensive eye examination.
评估Retinomax读数置信度数值对筛查准确性的影响，并确定为获得更高的置信度数值而进行重复测试是否能提高学龄前儿童的筛查准确性。
接受过Retinomax自动验光仪使用培训的外行人及护士筛查人员对1452名参加学龄前儿童视力（VIP）二期研究的儿童进行了筛查。所有儿童还接受了全面的眼科检查。通过相关比例的统计比较，我们比较了三组置信度数值低于、等于或高于制造商建议的8的儿童在检测任何VIP目标疾病以及按严重程度和类型（弱视、斜视、显著屈光不正和不明原因的视力下降）分组的疾病时的敏感性和特异性。分析中使用每只眼睛置信度数值最高的读数。每个儿童的置信度数值组根据双眼读数中较低的置信度数值来定义。在771名（53.1%）因初次测试时一只或两只眼睛的置信度数值低（<8）而由外行人或护士筛查人员进行重复测试的儿童中，也进行了相同的分析，以比较同一儿童初次读数置信度数值<8与重复测试读数中置信度数值最高的结果。这些分析基于VIP二期中检测任何VIP疾病时90%特异性相关的失败标准。我们还研究了眼部疾病与置信度数值之间的关联。采用霍奇伯格程序调整多重比较的p值。
较低的置信度数值类别与检测任何VIP目标疾病的较高敏感性相关（<8、8、>8时分别为0.78、0.65和0.61，p = 0.04），但特异性低得多（分别为0.64、0.89和0.93，p<0.0001）。通过重复测试，最初置信度数值低于8的读数中有87%达到了8或更高，重复测试导致的置信度数值增加与显著更高的特异性相关（0.81对0.86，p = 0.002），敏感性有不显著变化（下降0.04至上升至0.03）。患有任何VIP目标疾病、显著屈光不正、远视、散光或近视的儿童更有可能置信度数值低。
Retinomax自动验光仪筛查期间获得的较高置信度数值与更好的筛查准确性相关。在使用Retinomax进行学龄前视力筛查时，为达到制造商推荐的最小值而进行重复测试是值得的。通过重复测试未能达到制造商推荐的最小值应作为将儿童转诊进行全面眼科检查时考虑的一个因素。
