Primary Care Department, New England College of Optometry, Boston, Massachusetts.
360 Eye Care, Toronto, Ontario, Canada.
Optom Vis Sci. 2020 May;97(5):324-331. doi: 10.1097/OPX.0000000000001505.
Vision screenings are conducted to detect significant refractive errors, amblyopia, and ocular diseases. Vision screening devices are desired to have high testability, sensitivity, and specificity. Spot has demonstrated high testability, but previous reports suggest that the Spot has low sensitivity for detecting amblyogenic hyperopia and moderate sensitivity for amblyogenic astigmatism.
This study assessed the concurrent validity of detecting amblyogenic refractive errors by the Spot (v.1.1.50; Welch Allyn Inc., Skaneateles Falls, NY) compared with cycloplegic retinoscopy.
A total of 475 subjects (24 to 96 months) were screened by Spot and then received a masked comprehensive examination. Sensitivity and specificity, Bland-Altman plot, receiver operating characteristic area under the curve, and paired t test were evaluated by comparing the results of the Spot (v1.1.50) using the manufacturer referral criteria with the results of the comprehensive examination using the 2013 American Association for Pediatric Ophthalmology and Strabismus criteria.
The Spot (v.1.1.50) referred 107 subjects (22.53%) for the following: 18.73% (89/475) astigmatism, 4.63% (22/475) myopia, 0.42% (2/475) hyperopia, and 2.11% (10/475) anisometropia. The sensitivity and specificity of the Spot vision screener for detecting amblyogenic risk factors were 86.08% (95% confidence interval [CI], 76.45 to 92.84%) and 90.15% (95% CI, 86.78 to 92.90%). Areas under the curve were 0.906 (95% CI, 0.836 to 0.976) for hyperopia, 0.887 (95% CI, 0.803 to 0.972) for spherical equivalent, and 0.914 (95% CI, 0.866 to 0.962) for astigmatism. A modified hyperopia criteria cutoff of greater than +1.06 D improved the sensitivity from 25 to 80% with 90% specificity. The current cutoff criterion, greater than -1.75 D, for astigmatism seemed optimal.
This study shows that the Spot vision screener accurately detects low spherical refractive errors and astigmatism. Lowering the hyperopia cutoff criteria from the current Spot screener referral criteria improves the sensitivity with desired (high) specificity.
视力筛查旨在检测显著的屈光不正、弱视和眼部疾病。视力筛查设备需要具有高可测试性、敏感性和特异性。Spot 已被证明具有高可测试性，但之前的报告表明，Spot 对检测致弱视远视的敏感性较低，对致弱视散光的敏感性中等。
本研究评估了 Spot（v.1.1.50；Welch Allyn Inc.，Skaneateles Falls，NY）检测致弱视屈光不正的与睫状肌麻痹视网膜镜检查的一致性。
共有 475 名（24 至 96 个月）儿童接受了 Spot 筛查，然后接受了一项隐蔽的全面检查。通过比较使用制造商推荐标准的 Spot（v1.1.50）的结果与使用 2013 年美国小儿眼科学会和斜视学会标准的综合检查的结果，评估敏感性和特异性、Bland-Altman 图、受试者工作特征曲线下面积和配对 t 检验。
Spot（v.1.1.50）转诊了 107 名（22.53%）儿童，原因如下：18.73%（89/475）散光、4.63%（22/475）近视、0.42%（2/475）远视和 2.11%（10/475）屈光参差。Spot 视力筛查仪检测致弱视危险因素的敏感性和特异性分别为 86.08%（95%置信区间[CI]，76.45 至 92.84%）和 90.15%（95% CI，86.78 至 92.90%）。远视的曲线下面积为 0.906（95% CI，0.836 至 0.976），等效球镜为 0.887（95% CI，0.803 至 0.972），散光为 0.914（95% CI，0.866 至 0.962）。修改后的远视标准界值大于+1.06 D 可将敏感性从 25%提高到 80%，特异性为 90%。目前的散光标准界值为-1.75 D 似乎是最佳的。
本研究表明 Spot 视力筛查仪能准确检测低球镜屈光不正和散光。降低当前 Spot 筛查仪转诊标准的远视界值可提高敏感性，同时保持（高）特异性。
