| Purpose The risk factors for amblyopia include ametropia, strabismus, and optical deprivation.Amblyopia can be successfully prevented and cured if these risk factors can be detected and treated within the critical visual development stage. However, once missed the critical period of visual development, poor eyesight will cause irreversible visual impairment. Therefore, both strabismus and pediatric ophthalmology society in China and abroad, such as the American academy of ophthalmology gave some advice and guidelines for the screening of amblyopia risk factors for preschool children. Common method for the inspection of amblyopia risk factors includes retinoscopy, cover test for the eye position and visual acuity examination and so on.Considering these examinations are strongly professional, time-consuming and children’s cooperation dependent, there are some limitations of its application in children’s eye disease screening. Spot is a newly developed portable hand-held infrared photo screener(Welch Allyn, Skaneateles Falls, NY).It appeared on the market in 2001 in United States and has been rarely used in China. Therefore, the purpose of the present study was to evaluate the effectiveness of Spot in detecting amblyopia risk factors in Chinese pre-school and to determine how it could be improved by optimizing the criteria guidelines for detecting amblyopia risk factors based on ROC analysis, besides, to explore the feasibility of kindergarten screening.Methods There were 155 subjects(310 eyes) were recruited in this study. All of them were for the first time coming to Tianjin Medical University Eye Hospital Strabismus and Pediatric Eye Disease Center. The ages were between 4 to 7 years(5.74±1.2 years).The agreement of the results obtained with the photo screening and retinoscopy was evaluated by linear regression and Bland-Altman plots. The sensitivity and specificity of detecting amblyopia risk factors were calculated based on the American Association of Pediatric Ophthalmology and Strabismus(AAPOS) 2013 guidelines.The overall effectiveness of detecting amblyopia risk factors were analyzed with Receiver Operating Characteristic(ROC) curves.Results1 The mean refractive errors measured with the Spot were: spherical equivalent(SE)= 0.70 ± 1.99 D, J0 = 0.87 ± 1.01 D, J45= 0.09 ± 0.60 D. The mean results from retinoscopy were: SE=1.19 ± 2.22 D, J0 = 0.77 ± 1.00 D, J45 =-0.02 ± 0.45 D.2 There was a strong linear agreement between results obtained from those two methods(SEspot=-0.30 + 0.84 x SEcr,R2=0.88,P<0.01).Bland–Altman plot indicated a good agreement of cylinder values between the two methods.3 Based on the criteria specified by the AAPOS 2013 guidelines, the sensitivity was81%, the specificity was 85%, the Youden index was 0,82, the positive likelihood ratio was 27.51, negative likelihood ratio was 0.12,the coincidence rate was0.84,Kappa value was 0.66, positive predictive value was 0.83, negative predictive value was 0.80.4 The AUC of Spot in detecting amblyopia risk factors were:hyperopia 0.995、myopia0.890、astigmatism 0.901、anisometropia 0.917 and strabismus 0.863.5 Optimized criteria of detecting amblyopia risk factors based on ROC analysis were:hyperopia > 1.25 D, myopia >-2.00 D, astigmatism >1.25 D, anisometropia > 1.125 D,strabismus > 12 PD. The sensitivity and specificity( in respective order) for hyperopia、myopia、astigmatism、anisometropia and strabismus were 98.31% and97.14%, 78.50% and 88.64%, 90.91% and 80.37%, 93.10% and 85.25%, 77.55%and 88.18%.Conclusions1 There was a high accuracy of Spot in detecting amblyopia risk factors, and Spot photoscreener can be a reliable method for large-scale vision screening.2 The refractive values measured from Spot photoscreener showed a very good liner correlation with the results from cycloplegic retinoscopy refraction, however there is an overall myopic shift of-0.49 D.3 The performance in detecting individual amblyopia risk factors was satisfactory, but could be further improved by optimizing criteria based on ROC curves. |
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