Yanovitch Tammy, Wallace David K, Freedman Sharon F, Enyedi Laura B, Kishnani Priya, Worley Gordon, Crissman Blythe, Burner Erica, Young Terri L
Duke University Eye Center, Durham, North Carolina 27710, USA.
J AAPOS. 2010 Dec;14(6):472-7. doi: 10.1016/j.jaapos.2010.09.016.
Children with Down syndrome (DS) have an increased prevalence of ocular disorders, including amblyopia, strabismus, and refractive error. Health maintenance guidelines from the Down Syndrome Medical Interest Group recommend ophthalmologic examinations every 1 to 2 years for these children. Photoscreening may be a cost-effective option for subsequent screening evaluations after an initial complete examination, but no study has evaluated the accuracy of photoscreening in children with DS. The purpose of this study is to determine the sensitivity, specificity, and positive and negative predictive values of photoscreening in detecting treatable ocular conditions in children with DS.
Photoscreening and complete ophthalmologic evaluations were performed in 50 consecutive 3- to 10-year-old children with DS. Sensitivity, specificity, and positive and negative predictive values were calculated with the use of ophthalmologic examination findings as the reference standard.
Most children were able to complete photoscreening (94% with Medical Technology and Innovations [MTI] and 90% with Visiscreen OSS-C [VR]). Many children had an identified diagnosis on ophthalmologic examination (n = 46, 92%). Of these, approximately one-half (n = 27, 54%) had one or more condition(s) requiring treatment. Both the MTI and VR photoscreening devices had a sensitivity of 93% (95% confidence interval 0.76-0.99) for detecting treatable ocular conditions. The specificities for the MTI and VR photoscreening were 0.35 (0.18-0.57) and 0.55 (0.34-0.74), respectively.
Photoscreening is sensitive but less specific at detecting treatable ocular conditions in children with DS. In specific instances, the use of photoscreening in the DS population has the potential to save time and expense related to routine eye examinations, particularly in children with a normal baseline comprehensive examination.
唐氏综合征（DS）患儿眼部疾病的患病率较高，包括弱视、斜视和屈光不正。唐氏综合征医学兴趣小组的健康维护指南建议对这些患儿每1至2年进行一次眼科检查。在首次全面检查之后，照片筛查可能是后续筛查评估的一种经济有效的选择，但尚无研究评估照片筛查在DS患儿中的准确性。本研究的目的是确定照片筛查在检测DS患儿可治疗眼部疾病方面的敏感性、特异性、阳性预测值和阴性预测值。
对50名连续的3至10岁DS患儿进行了照片筛查和全面的眼科评估。以眼科检查结果作为参考标准，计算敏感性、特异性、阳性预测值和阴性预测值。
大多数患儿能够完成照片筛查（使用Medical Technology and Innovations [MTI]设备的完成率为94%，使用Visiscreen OSS-C [VR]设备的完成率为90%）。许多患儿在眼科检查中得到了明确诊断（n = 46，92%）。其中，约一半（n = 27，54%）有一项或多项需要治疗的疾病。MTI和VR照片筛查设备在检测可治疗眼部疾病方面的敏感性均为93%（95%置信区间0.76 - 0.99）。MTI和VR照片筛查的特异性分别为0.35（0.18 - 0.57）和0.55（0.34 - 0.74）。
照片筛查在检测DS患儿可治疗眼部疾病方面具有敏感性，但特异性较低。在特定情况下，在DS人群中使用照片筛查有可能节省与常规眼部检查相关的时间和费用，特别是对于基线综合检查正常的患儿。
