de Venecia Bryce, Bradfield Yasmin, Trane Ralph Møller, Bareiro Alicia, Scalamogna Miguel
Department of Ophthalmology and Visual Sciences, University of Wisconsin Madison, Madison 53792, Wisconsin, USA.
Fundación Visión, Calle Ingavi y Coronel Cazal Departamento, San Lorenzo 2300, Central, Paraguay.
Int J Ophthalmol. 2018 Aug 18;11(8):1384-1389. doi: 10.18240/ijo.2018.08.21. eCollection 2018.
To validate the Peek Acuity mobile phone application in pediatric populations and compare its utility, both economic and diagnostic, against conventional screening methods using a pediatric ophthalmologist examination as the gold standard.
A cohort of 393 subjects from Fernando de la Mora, Paraguay (ages 6-16y) were enrolled in the study. Subjects were randomly assigned a starting screening modality among: Peek Acuity, a single line of tumbling E optotypes set at 20/40, and Spot Vision Screener. Once completing the first screening modality, the subjects completed the two remaining techniques. Referral criteria were established based on the most current American Association of Pediatric Ophthalmology and Strabismus (AAPOS) recommendations: 20/40 for Peek Acuity and the tumbling E, and refractive error detection for the Spot Vision Screener. Subjects that failed to achieve the cut-off for any of the three screening techniques or subjects that passed the screening but were randomly selected to perform a comprehensive eye exam to determine the false negative rate, were evaluated by a pediatric ophthalmologist. This evaluation was considered the gold standard, and included vision assessment by a Snellen chart, strabismus evaluation, and cycloplegic refraction with dilated fundoscopy.
We obtained 48% sensitivity, 83% specificity, 43% positive predictive value, and 86% negative predictive value for Peek Acuity's ability to refer compared to evaluation by a pediatric ophthalmologist, failing to achieve a desired sensitivity for implementation. Peek Acuity trended to overestimate the subject's visual acuity, providing a higher visual acuity that would not indicate referral for a comprehensive eye examination. However, its high specificity accurately predicted a significant number of children who did not need further evaluation. When comparing the three screening methods, no single screening modality outperformed the others. Peek Acuity represented a technology that was economically feasible compared to other screening modalities in low income settings, due to the prevalence of cell phone use.
Peek Acuity represents an efficient tool that has potential for implementation in school screenings with different strategies aimed at pediatric populations due to its low cost and high specificity. An increase in sensitivity would improve detection of children with refractive errors.
验证Peek视力手机应用程序在儿科人群中的有效性，并将其在经济和诊断方面的效用与以儿科眼科医生检查为金标准的传统筛查方法进行比较。
来自巴拉圭费尔南多·德拉莫拉的393名受试者（年龄6 - 16岁）参与了该研究。受试者被随机分配到以下起始筛查方式之一：Peek视力、设置为20/40的单行翻转E视力表以及Spot视力筛查仪。完成第一种筛查方式后，受试者再完成其余两种技术。根据美国儿科眼科与斜视协会（AAPOS）的最新建议确定转诊标准：Peek视力和翻转E视力表为20/40，Spot视力筛查仪为屈光不正检测。任何一种筛查技术未达到临界值的受试者，或通过筛查但被随机选中进行全面眼科检查以确定假阴性率的受试者，均由儿科眼科医生进行评估。该评估被视为金标准，包括使用斯内伦视力表进行视力评估、斜视评估以及散瞳眼底检查下的睫状肌麻痹验光。
与儿科眼科医生的评估相比，Peek视力转诊能力的灵敏度为48%，特异度为83%，阳性预测值为43%，阴性预测值为86%，未达到实施所需的灵敏度。Peek视力往往高估受试者的视力，提供的视力高于表明无需进行全面眼科检查的水平。然而，其高特异度准确预测了大量无需进一步评估的儿童。比较三种筛查方法时，没有一种筛查方式优于其他方式。由于手机的普及，在低收入环境中，与其他筛查方式相比，Peek视力是一种经济上可行的技术。
Peek视力是一种高效工具，因其低成本和高特异度，有潜力通过不同策略应用于针对儿科人群的学校筛查。提高灵敏度将改善对屈光不正儿童的检测。
