Department of Pediatric Ophthalmology and Strabismus, Dr Shroff's Charity Eye Hospital, New Delhi, India.
Department of Community Outreach Services, Dr Shroff's Charity Eye Hospital, New Delhi, India.
Indian J Ophthalmol. 2020 Mar;68(3):504-509. doi: 10.4103/ijo.IJO_701_19.
To evaluate the accuracy of Spot photoscreener (PS) as a noncycloplegic photorefractor in detecting amblyopia risk factors (ARFs) in preschool children in an Indian eye clinic setting. Also, to derive appropriate cutoff values for screening to obtain maximum sensitivity and specificity of the device in detecting ARF.
This was a cross-sectional study conducted in the outpatient pediatric eye clinic at a tertiary eye care institute. A Spot PS was used to screen all the children between the ages of 6 months and 5 years that presented to the eye clinic from August 2018 to October 2018. This screening was followed by a complete eye examination, including cycloplegic refraction by a masked examiner. The 2013 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines were considered the standard cutoff values for clinically significant refractive error in children younger than 5 years of age.
The study comprised of 219 children. The Spot PS diagnosed 135 (61.64%) children with ARF as compared with 124 (56.62%) children detected by clinic examination. For ARF detection, the Spot photoscreeneer had 85.48% sensitivity, 69.47% specificity, 78.52% positive predictive value and 78.57% negative predictive value. The sensitivity for detection of strabismus and hypermetropia was very low (42% and 36%, respectively). The 95% limits of agreement ranged from -5.48 to +5.59 diopters (D) with a bias of 0.06 D for spherical equivalent between noncycloplegic photorefraction and cycloplegic refraction.
The Spot PS may be used as a screening tool to detect ARF in children younger than 5 years of age keeping its limitations in consideration. However, the performance can be improved by modifying the cutoff values for the referral.
评估 Spot 视力筛查仪（PS）作为一种非睫状肌麻痹检影镜在印度眼科诊所环境下检测学龄前儿童弱视危险因素（ARF）的准确性。此外，还得出了适当的筛查截断值，以获得该设备检测 ARF 的最大灵敏度和特异性。
这是一项在一家三级眼科护理机构的门诊儿科眼科诊所进行的横断面研究。使用 Spot PS 筛查 2018 年 8 月至 2018 年 10 月期间到眼科诊所就诊的 6 个月至 5 岁儿童。在进行此筛查后，对所有儿童进行全面眼科检查，包括由一名掩蔽检查者进行睫状肌麻痹验光。2013 年美国儿科学会眼科和斜视分会（AAPOS）指南被认为是 5 岁以下儿童临床显著屈光不正的标准截断值。
该研究共纳入 219 名儿童。与通过临床检查发现的 124 名（56.62%）儿童相比，Spot PS 诊断出 135 名（61.64%）患有 ARF 的儿童。对于 ARF 的检测，Spot 视力筛查仪的灵敏度为 85.48%，特异性为 69.47%，阳性预测值为 78.52%，阴性预测值为 78.57%。斜视和远视的检测灵敏度均较低（分别为 42%和 36%）。非睫状肌麻痹检影和睫状肌麻痹验光之间的 95%一致性界限范围为-5.48 至+5.59 屈光度（D），偏差为 0.06 D 的等效球镜。
Spot PS 可作为一种筛查工具，用于检测 5 岁以下儿童的 ARF，但需考虑其局限性。然而，通过修改转诊的截断值，可以提高其性能。
