Performance of the Spot vision screener for the detection of amblyopia risk factors in children

doi:10.1016/j.jaapos.2013.11.019

Journal of American Association for Pediatric Ophthalmology and Strabismus

Volume 18, Issue 2, April 2014, Pages 169-172

https://doi.org/10.1016/j.jaapos.2013.11.019 Get rights and content

Purpose

To compare the accuracy of the Spot photoscreener (Pediavision Holdings LLC Lake Mary, FL) in detecting amblyopia risk factors in children to the 2003 and 2013 referral criteria of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS).

Methods

The medical records of children 1-6 years of age who underwent vision screening at a single clinic from February 2012 through May 2012 were retrospectively reviewed. Participants were screened with the Spot photoscreener on the same day as a pediatric ophthalmology examination. Visual acuity examination, ocular alignment testing, and cycloplegic refraction were performed that day or within the preceding 6 months for all included subjects by one pediatric ophthalmologist. Sensitivity and specificity of the Spot photoscreening results were compared to the 2003 and to the recently revised 2013 AAPOS referral criteria.

Results

A total of 151 children were included. The Spot had a sensitivity of 80% and specificity of 74%. With the revised 2013 AAPOS referral criteria, the sensitivity was 87% and specificity was 74%.

Conclusions

The Spot is a fully portable, automated tool for the detection of amblyopia risk factors in children. In this study cohort it was found to reliably detect amblyopia risk in children when compared to the 2003 and 2013 AAPOS referral criteria.

Section snippets

Subjects and Methods

This study received approval from the Lancaster General Hospital Institutional Review Board and was granted a waiver of consent because of the low risk of this research; appropriate guidelines of the Health Insurance Portability and Accountability Act of 1996 were followed.

Referral data from noncycloplegic images from the Spot photoscreener was compared with data obtained from a comprehensive examination performed by one pediatric ophthalmologist (DS). All children examined with the Spot had a

Results

A total of 151 patients between the ages of <1-6 years old were examined. The clinic patients studied were a population enriched for pathology, with 106 (70%) of the patients found to have amblyopia or amblyopia risk factors based on the 2003 AAPOS referral criteria¹⁰: anisometropia (spherical or cylindrical) 1.5 D, any manifest strabismus, hyperopia 3.50 D in any meridian, myopia magnitude 3.00 D in any meridian, any media opacity 1 mm in size, astigmatism 1.5 D at 90° or 180° or 1.0 D in

Discussion

Detection and treatment of amblyopia has been shown to be cost effective. The cost of detecting and treating amblyopia is quite reasonable with a ratio of cost to quality-adjusted life years for amblyopia screening estimated at $6,000.¹² This is significantly less than the estimated $231,000 for annual screening for diabetic retinopathy in adults.¹² Well-constructed photoscreening programs can have referral rates less than 10% with high sensitivity and specificity for detecting amblyopia and

References (15)

K. Simons
Amblyopia characterization, treatment, and prophylaxis
Surv Ophthalmol
(2005)
K. Attebo et al.
Prevalence and causes of amblyopia in an adult population
Ophthalmology
(1998)
N.S. Matta et al.
Performance of the plusoptiX vision screener for the detection of amblyopia risk factors in children
J AAPOS
(2008)
N.S. Matta et al.
Screening for amblyogenic risk factors using the plusoptiX S04 photoscreener on the indigent population of Honduras
Ophthalmology
(2010)
S.P. Donahue et al.
Preschool vision screening: what should we be detecting and how should we report it? Uniform guidelines for reporting results of preschool vision screening studies
J AAPOS
(2003)
S.P. Donahue et al.
Guidelines for automated preschool vision screening: A 10-year, evidence-based update
J AAPOS
(2013)
S.Q. Longmuir et al.
Nine-year results of a volunteer lay network photoscreening program of 147 809 children using a photoscreener in Iowa
Ophthalmology
(2010)

There are more references available in the full text version of this article.

Cited by (58)

Performance of the Spot Vision Screener in children with Down syndrome and other special needs
2023, Journal of AAPOS
Amblyopia is a common cause of monocular vision impairment and disproportionally affects developmentally delayed children. Photoscreeners have been suggested as a method to detect amblyopia risk factors (ARFs) in children with developmental disabilities who may not be amenable to traditional vision screening methods. The Spot Vision Screener is a commonly used photoscreener for detecting ARF and has shown excellent sensitivity and accuracy in the general pediatric population. The purpose of this study was to evaluate its accuracy in children with Down syndrome and other special needs.
Children with various disabilities or delays were recruited from outpatient clinics at the Children’s Hospital of Colorado. Participants had their photograph taken with Spot before and after pupil dilation and cycloplegia. Images were compared to results of a comprehensive clinical eye examination.
A total of 100 children participated in the study. Images could not be obtained in 12 children; 5 children did not attend their clinical examination. The overall sensitivity of Spot was 90%, with a positive predictive value of 80% in undilated subjects. The area under the receiver operator curve (AUROC) was 0.68 (95% CI, 0.57-0.79), which did not differ significantly from the AUROC after dilation/cycloplegia (0.68; 95% CI, 0.54-0.81).
The Spot Vision Screener could be used by primary care clinics and vision screening programs with a high sensitivity to determine which patients with Down syndrome and special needs should be referred for clinical examination.
Effectiveness of the Spot Vision Screener using updated 2021 AAPOS guidelines
2023, Journal of AAPOS
To evaluate the Spot Vision Screener according to updated 2021 AAPOS Vision Screening Committee guidelines for instrument-based pediatric vision screen validation.
As part of an IRB-approved ongoing prospective study, children were screened with the Spot prior to a complete examination.
Spot screening was successful in 1,036 of 1,090 children (95%). Forty-eight percent of participants were referred for further screening using the Spot manufacturer guidelines, and 40% of all children were found to have a 2021 amblyopia risk factor or visually significant refractive error by gold standard examination. The Spot recommendation compared reasonably well to the 2021 criteria, with an overall sensitivity of 0.88 and a specificity of 0.78. Applying updated guidelines to the Spot for hyperopia, anisometropia, and astigmatism yielded moderate-to-poor sensitivity (0.27-0.77) but excellent specificity (>0.9). The area under the curve of the receiver operating characteristic analysis demonstrates overall good prediction performance for the Spot for each diagnosis—myopia, hyperopia, astigmatism, anisometropia (range, 0.87-0.97). Results of our study suggest increasing the instrument referral criterion for astigmatism from 1.5 D (manufacturer thresholds of the screener used in this study) to 2 D in older children. Decreasing the anisometropia cut-off from 1 D to 0.75 D would improve sensitivity from 0.59 to >0.8.
In our study population, the overall predictive ability of the Spot is good, with a sensitivity of 0.88 and a specificity of 0.78. We recommend specific device refractive referral criteria to maximize screening effectiveness using the updated AAPOS guidelines.
Photoscreener results with and without cycloplegia and their reliability according to biometric parameters
2022, Journal Francais d'Ophtalmologie
Our goal in this study is to compare the results of a photoscreener (Plusoptix A12C) with and without cycloplegia and to investigate its reliability as a function of biometric parameters.
In total, 250 eyes of 125 children with a mean age of 6.77 ± 1.59 years were included in the study. The results of cycloplegic and noncycloplegic Plusoptix A12C measurements and autorefractometer with cycloplegia (CA) were compared. The spherical equivalent (SE) differences between CA and noncycloplegic Plusoptix A12C measurements (NPO) with CA and cycloplegic Plusoptix A12C measurements (CPO) were compared with axial length (AL), anterior chamber depth (ACD), corneal radius of curvature (CR), mean keratometry (meanK) and axial length/corneal radius of curvature ratio (AL/CR) values. The relationships between these were examined.
According to amblyopia risk factors (ARFs) based on the criteria in the 2013 AAPOS guidelines, 33 eyes (13%) in the NPO results and 34 eyes (13.6%) in the CPO results were found to be at risk for amblyopia. According to the CA results, the NPO had 67.3% sensitivity and 94.5% specificity, and the CPO 69.4% sensitivity and 89.1% specificity in detecting the values of refractive amblyopia factors determined by the AAPOS. In regard to refraction values determined by the AAPOS for amblyopia, according to CA results, the NPO had 71.4% sensitivity and 88.4% specificity in detecting myopia; 33.3% sensitivity and 93.6% specificity in detecting hyperopia; and 79.4% specificity and 71.2% sensitivity in detecting astigmatism. With regard to refraction values determined by the AAPOS for amblyopia, according to CA results, the CPO had 80.9% sensitivity and 90% specificity in detecting myopia; 13.3% sensitivity and 89.2% specificity in detecting hyperopia; and 44.9% sensitivity and 30.8% specificity in detecting astigmatism. When the SE differences between the CA and NPO values were compared with biometric parameters, a negative correlation was observed with ACD, AL, and especially AL/CR ratio.
Both the NPO and CPO showed moderate sensitivity and high specificity in detecting ARFs based on the criteria in the 2013 AAPOS guidelines. Sensitivity for detecting hyperopic risk factors was lower than for myopia and astigmatism. The CPO has no additional clinical advantage. A negative correlation was found between biometric parameters and NPO results. Thus, the NPO is more reliable in myopic children with higher axial lengths, deeper anterior chambers, and increased AL/CR ratios.
Notre objectif dans cette étude est de comparer les résultats d’un photoscreener (Plusoptix A12C) avec et sans cycloplégie et d’étudier sa fiabilité selon des paramètres biométriques.
Au total, 250 yeux de 125 enfants d’un âge moyen de 6,77 ± 1,59 ans ont été inclus dans l’étude. Les résultats des mesures cycloplégiques et non cycloplégiques du Plusoptix A12C et de l’autoréfractomètre avec cycloplégie (CA) ont été comparés. Les différences d’équivalent sphérique (SE) entre les mesures CA et non cycloplégiques Plusoptix A12C (NPO) avec CA et cycloplégiques Plusoptix A12C (CPO) ont été comparées avec la longueur axiale (AL), la profondeur de la chambre antérieure (ACD), le rayon de courbure cornéen (CR), la kératométrie moyenne (meanK) et les valeurs du rapport longueur axiale/rayon de courbure cornéenne (AL/CR). Les relations entre celles-ci ont été examinées.
Selon les facteurs de risque d’amblyopie (FRA) basés sur les critères des lignes directrices de l’AAPOS 2013, 33 yeux (13 %) dans les résultats NPO et 34 yeux (13,6 %) dans les résultats CPO étaient à risque d’amblyopie. Selon les résultats de l’AC, le NPO avait une sensibilité de 67,3 % et une spécificité de 94,5 %, et le CPO une sensibilité de 69,4 % et une spécificité de 89,1 % dans la détection des valeurs des facteurs d’amblyopie réfractive déterminés par l’AAPOS. En ce qui concerne les valeurs de réfraction déterminées par l’AAPOS pour l’amblyopie, selon les résultats de l’AC, le NPO avait une sensibilité de 71,4 % et une spécificité de 88,4 % dans la détection de la myopie ; 33,3 % de sensibilité et 93,6 % de spécificité dans la détection de l’hypermétropie ; et 79,4 % de spécificité et 71,2 % de sensibilité dans la détection de l’astigmatisme. En ce qui concerne les valeurs de réfraction déterminées par l’AAPOS pour l’amblyopie, selon les résultats de l’AC, le CPO avait une sensibilité de 80,9 % et une spécificité de 90 % dans la détection de la myopie ; 13,3 % de sensibilité et 89,2 % de spécificité dans la détection de l’hypermétropie ; et une sensibilité de 44,9 % et une spécificité de 30,8 % dans la détection de l’astigmatisme. Lorsque les différences de SE entre les valeurs CA et NPO ont été comparées aux paramètres biométriques, une corrélation négative a été observée avec l’ACD, l’AL et surtout le rapport AL/CR.
Le NPO et le CPO ont tous deux montré une sensibilité modérée et une spécificité élevée dans la détection des FRA sur la base des critères des lignes directrices de l’AAPOS 2013. La sensibilité pour la détection des facteurs de risque d’hypermétropie était plus faible que pour la myopie et l’astigmatisme. Le CPO n’a pas d’avantage clinique supplémentaire. Une corrélation négative a été trouvée entre les paramètres biométriques et les résultats NPO. Ainsi, le NPO est plus fiable chez les enfants myopes avec de longues longueurs axiales, des chambres antérieures profondes et des rapports AL/CR accrus.
Implementation of Photoscreening to Improve the Preschool Vision Screening Process
2021, Journal for Nurse Practitioners
Citation Excerpt :
The incidence of amblyopia risk factors (ARFs), which include astigmatism, strabismus, near sightedness, farsightedness, unequal pupil size, and unequal refractive power,1 is even greater, affecting nearly 1 in 5 children.4 Failure to identify and treat amblyopia by early primary school can lead to permanent and untreatable vision loss into adulthood1,5 and negatively affect a child’s self-esteem and school performance.6 Therefore, the ability to detect amblyopia and ARFs is an essential component of the preschool vision screening process,4,7 because children in this age-group have been shown to respond more favorably to treatment.8
Amblyopia is the most common cause of preventable visual impairment in childhood. A quality improvement project was conducted at a pediatric primary care clinic located in North Carolina over a 3-month period with the intent of improving the preschool vision screening process. Vision screening rates and time to complete a screening were compared between a Plusoptix S12C photoscreener (Plusoptix Inc.) and a traditional eye chart. Successful vision screening rates were significantly higher and time to perform a vision screening was significantly lower using the photoscreener compared with screening with an eye chart. A significant increase in knowledge among clinic staff after an in-person educational presentation on amblyopia was also noted.
Evaluation of the Spot Vision Screener in comparison with the orthoptic examination in visual screening in 3–5 year-old schoolchildren
2020, Journal Francais d'Ophtalmologie
To evaluate the Spot Vision Screener (SVS) compared with the orthoptic examination for detection of amblyopia risk factors in preschools.
This prospective study included children with a visual screening organized by the department of “le” (PMI) in Côte d’Or (Burgundy, France), between June 2017 and April 2018. All children were evaluated with the SVS followed by a clinical orthoptic examination. Results with the SVS were compared with those obtained by clinical orthoptic examination.
A total of 1236 subjects were included in the study from 100 preschools. The mean age of the children was 3.6 ± 0.7 years, and 627 were female (50.7%). The orthoptic examination detected 308 (24.9%) children with subnormal visual acuity for age in one eye or both. In children with a history of prematurity, the orthoptic examination was more frequently abnormal (P = 0.002), which was not seen with the SVS (P = 0.050). The SVS screened 20 (1.6%) children with strabismus, while 40 (3.2%) were detected by orthoptic examination. At the end of the screening, the SVS detected 182 (14.7%) suspect patients while 311 (25.1%) suspect patients were detected after the orthoptic examination. Comparing SVS with orthoptic examination, agreement was fair (κ = 0.4).
The SVS can be a useful device for visual screening, but agreement with the orthoptic examination was only fair. The Spot vision screener should be used in conjunction with a clinical orthoptic examination.
Évaluer les capacités de dépistage des facteurs de risque d’amblyopie du Spot Vision Screener (SVS) en le comparant au bilan orthoptique chez les enfants en école maternelle.
Étude prospective incluant des enfants ayant bénéficié d’un dépistage visuel organisé par la « protection maternelle et infantile » (PMI) de Côte d’Or (Bourgogne, France) entre juin 2017 et avril 2018. Les enfants ont bénéficié d’une mesure de la réfraction sans cycloplégie via le SVS puis d’un bilan orthoptique. Les résultats du bilan orthoptique ont été comparés aux résultats du SVS.
Mille deux cent trente-six enfants d’âge moyen 3,6 ± 0,7 ans, dont 627 de sexe féminin (50,7 %) ont bénéficié du dépistage dans 100 écoles maternelles. Le bilan orthoptique a détecté 308 (24,9 %) enfants présentant une acuité visuelle trop faible pour l’âge. Le bilan orthoptique était plus fréquemment anormal (p = 0,002) chez les enfants avec des antécédents de prématurité mais pas le SVS (p = 0,050). Le SVS a dépisté 20 (1,6 %) enfants présentant un strabisme alors que 40 (3,2 %) ont été dépistés après un bilan orthoptique. À l’issue du dépistage, le SVS a détecté 182 (14,7 %) enfants considérés à risque d’amblyopie contre 311 (25,1 %) bilans orthoptiques anormaux. En comparant les résultats du SVS avec ceux du bilan orthoptique, la concordance était modérée (κ = 0,4).
Le SVS semble être un dispositif utile dans le dépistage visuel, mais avec une concordance modérée en le comparant au bilan orthoptique. Sa place est probablement complémentaire du bilan orthoptique.
Comparison of photoscreening and autorefractive screening for the detection of amblyopia risk factors in children under 3 years of age
2020, Journal of AAPOS
To evaluate the effectiveness of photoscreening and autorefractive screening for the detection of amblyopia risk factors (ARFs) in a cohort of preterm and term-born children <3 years of age.
In this cross-sectional study, the Spot Vision photoscreener and the SureSight autorefractor were used to screen participants. The diagnostic and predictive values of the devices in detecting ARF based on American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2013 referral criteria was calculated using manufacturer criteria, the VIP 90 (90% specificity) and VIP 94 (94% specificity) criteria from the Vision in Preschool (VIP) study, and criteria recommended by Rowatt and colleagues. Results were evaluated using receiver operating characteristic (ROC) curves.
A total of 368 patients (mean age, 14.4 ± 10.4 months) were included. The ARF rate was 25% according to the 2013 AAPOS criteria. The highest specificity and positive predictive values (PPV) were obtained with Spot Vision manufacturer criteria (specificity, 0.91; PPV, 0.69). SureSight manufacturer criteria showed very low specificity and PPV values (specificity, 0.43; PPV, 0.35) and a high false positive rate (57%). The highest specificity and PPV values for SureSight were obtained with the Rowatt criteria (specificity, 0.86; PPV, 0.62).
In our study cohort, photoscreening with the Spot Vision manufacturer criteria seemed sufficient for vision screening in the 0-3 years age group, with high specificity values. The Rowatt criteria may increase performance of the SureSight in this age group.

View all citing articles on Scopus

View full text

Major ArticlePerformance of the Spot vision screener for the detection of amblyopia risk factors in children

Purpose

Methods

Results

Conclusions

Section snippets

Subjects and Methods

Results

Discussion

Surv Ophthalmol

Ophthalmology

J AAPOS

Ophthalmology

J AAPOS

J AAPOS

Ophthalmology

Major Article
Performance of the Spot vision screener for the detection of amblyopia risk factors in children