Gore Rujuta, Wang Jenny N, Yang Christopher D, An Miranda, Hunter Stephen C, Shahraki Kourosh, Blaikie Andrew, Suh Donny W
Department of Pediatrics, University of Illinois College of Medicine Peoria, Peoria, IL, US.
Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, US.
Indian J Ophthalmol. 2025 Jan 1;73(1):41-44. doi: 10.4103/IJO.IJO_3027_23. Epub 2024 Jul 11.
To explore whether a low-cost ophthalmoscope (Arclight) can be used by naive nonophthalmic examiners to effectively screen for pediatric eye disease.
Fifty-four children (108 eyes) were examined by five medical students using an Arclight. Gold standard examination was performed by an ophthalmologist using a slit lamp and indirect ophthalmoscope. Examinations performed included ophthalmoscopy of the optic disc, estimation of the cup-to-disc ratio (CDR), corneal light reflex test (CRT), Bruckner's reflex test (BRT), and evaluation of refractive error. We determined the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the nonophthalmologist's Arclight exam compared to the gold standard findings of comprehensive evaluation by pediatric ophthalmologists.
Using the Arclight, the optic nerve exam was successfully completed in 65% of patients. CDRs above and below 0.5 could be determined with 66.7% sensitivity and 84.4% specificity. Arclight CRT measurements were significant ( P < .00001) predictors of strabismus, with 80% sensitivity, 95.1%, specificity, 80% PPV, and 95.1% NPV. BRT was not a significant predictor of amblyopia, with a 34.6% sensitivity, 85.7% specificity, 69.2% PPV, and 58.5% NPV. Refractive error was estimated with a success rate of 81% for emmetropia, 38% for myopia, and 21% for hyperopia. The Arclight ease-of-use was rated on average as 4.4 (SD = 0.9) on a scale of 1 to 5, with 1 being the hardest and 5 being the easiest.
Our study shows the Arclight as an affordable and effective alternative to the traditional ophthalmoscope for assessing eye disease in children. This device can improve eye health services in under-resourced regions.
探讨未经培训的非眼科检查人员能否使用低成本检眼镜（弧光检眼镜）有效筛查小儿眼病。
5名医学生使用弧光检眼镜对54名儿童（108只眼）进行检查。由眼科医生使用裂隙灯和间接检眼镜进行金标准检查。检查项目包括视盘检眼镜检查、杯盘比（CDR）评估、角膜光反射试验（CRT）、布吕克纳反射试验（BRT）以及屈光不正评估。我们将非眼科医生使用弧光检眼镜检查的结果与小儿眼科医生综合评估的金标准结果进行比较，确定其敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
使用弧光检眼镜时，65%的患者成功完成了视神经检查。CDR高于和低于0.5时，其敏感性为66.7 %，特异性为84.4 %。弧光检眼镜CRT测量结果是斜视的显著预测指标（P <.００００１），敏感性为80% , 特异性为95.1% , PPV为80%，NPV为95.1%。BRT不是弱视的显著预测指标，敏感性为34.6%，特异性为85.7%，PPV为69.2%，NPV为58.5%。屈光不正的估计成功率为：正视眼81%，近视38%，远视21%。弧光检眼镜的易用性在1至5分的评分中平均得分为4.4（标准差 = 0.9），1分表示最难，5分表示最容易。
我们的研究表明，弧光检眼镜是评估儿童眼病的一种经济有效的传统检眼镜替代品。该设备可以改善资源匮乏地区的眼部健康服务。
