Eye Department, Zealand University Hospital, Roskilde, Denmark.
University of Copenhagen, Copenhagen, Denmark.
Acta Ophthalmol. 2019 Aug;97(5):473-477. doi: 10.1111/aos.13922. Epub 2018 Sep 14.
To analyse the current vision screening programme for children attending school with respect to identifying children with significant refractive errors.
A total of 950 children from the municipality of Roskilde, Denmark, were invited to participate in a cross-sectional study of vision screening. 447 children aged 4.5-7 years participated in the study. The children completed a vision screening and a full eye examination. The vision screening consisted of visual acuity at distance (VA), visual acuity at distance with +2.0 glasses (VA+2), visual acuity at near (VAnear) and Lang II stereotest. A LogMAR-based picture chart was used for the vision testing. Significant refractive errors were defined as hyperopia ≥+3.5 D, myopia >1.0 D, astigmatism ≥1.25 D and anisometropia >1.0 D.
Using receiver operating characteristic (ROC) curves, we could compare the efficiency of VA, VA+2, VAnear, VA in combination with VA+2 and VA in combination with VAnear. Area under the curve (AUC) for VA, VA combined with VA+2 and VA combined with VAnear was 0.841, 0.857 and 0.857, respectively, that is all classified as 'very good' screening tools, whereas VA+2 and VAnear as single screening tools were classified as 'good' with AUC of 0.704 and 0.775, respectively. Using the optimal cut-off limit from the ROC curves, VA above 0.05 LogMAR as cut-off limit showed a sensitivity of 85.2% with a specificity of 74.9%. A slightly higher sensitivity could be found when combining screening tests, but with declining specificities.
Visual acuity at distance with the use of LogMAR-based charts is the optimal screening tool of choice; only minor improvements can be obtained combining with other tests.
分析丹麦罗斯基勒市儿童在校视力筛查计划，以发现有明显屈光不正的儿童。
共邀请丹麦罗斯基勒市 950 名儿童参加一项视力筛查的横断面研究。447 名 4.5-7 岁的儿童参加了研究。儿童完成视力筛查和全面眼科检查。视力筛查包括远视力（VA）、远视力加+2.0 镜（VA+2）、近视力（VAnear）和 Lang II 立体视。LogMAR 图片图表用于视力测试。远视≥+3.5D、近视>1.0D、散光≥1.25D 和屈光参差>1.0D 定义为显著屈光不正。
使用受试者工作特征（ROC）曲线，我们可以比较 VA、VA+2、VAnear、VA+2 与 VA 结合以及 VAnear 与 VA 结合的效率。VA、VA+2 与 VA 结合以及 VAnear 与 VA 结合的曲线下面积（AUC）分别为 0.841、0.857 和 0.857，均归类为“非常好”的筛查工具，而 VA+2 和 VAnear 作为单一筛查工具的 AUC 分别为 0.704 和 0.775，归类为“良好”。使用 ROC 曲线的最佳截断值，VA 高于 0.05 LogMAR 作为截断值，灵敏度为 85.2%，特异性为 74.9%。当结合使用筛查测试时，可以发现灵敏度略有提高，但特异性降低。
使用 LogMAR 图表的远视力是最佳的筛查工具；与其他测试结合使用只能略有改善。
