Major Article
The effectiveness of the Spot Vision Screener in detecting amblyopia risk factors

https://doi.org/10.1016/j.jaapos.2014.07.176Get rights and content

Purpose

To evaluate the updated Spot Vision Screener (PediaVision, Welch Allyn, Skaneateles Falls, NY) in detecting amblyopia risk factors using 2013 guidelines of American Association for Pediatric Ophthalmology and Strabismus (AAPOS).

Methods

In this prospective study, patients seen from June 2012 to November 2013 were tested with the Spot prior to examination by a pediatric ophthalmologist who was masked to test results. The following data were analyzed: age, subject testability, examination findings, and systemic and ocular pathology. Children were divided into three age groups to determine gold standard results according to the AAPOS guidelines.

Results

A total of 444 children (average age, 72 months) were included. Compared to the ophthalmologist's examination, the Spot sensitivity was 87.7% and the specificity was 75.9% in detecting amblyopia risk factors. Sensitivity did not differ significantly between age groups, although the positive predictive value improved in the older age groups.

Conclusions

In our study cohort, the Spot provided good specificity and sensitivity in detecting amblyopia risk factors according 2013 AAPOS criteria, with minor improvements with updated versions.

Section snippets

Methods

This prospective study was approved by the Medical University of South Carolina Institutional Review Board and adhered to the US Health Insurance Portability and Accountability Act of 1996. Written informed consent was obtained from parents or guardians. Patients 1-16 years of age presenting for complete pediatric ophthalmological examination to the Storm Eye Institute of the Medical University of South Carolina between June 2012 and November 2013, with appropriate personnel and guardianship

Results

A total of 444 children (226 males [51%]) were included: 54% white, 35% African American/black, and 9% Hispanic. Average age was 72 months (range, 11-221 months). The prevalence of 2013 AAPOS amblyopia risk factors was found to be 55%. Of those children found to have amblyopia risk factors, 93 (38%) were referred for strabismus and 127 (52%) for refractive error.

With version 1.151, the Spot referred 61% (272/444) of the patients. When compared with the ophthalmologist's examination, the

Discussion

This study compared the updated version of the Spot Vision Screener to ophthalmological examination in children seen at a pediatric ophthalmology practice. Using the manufacturer's referral criteria, we found reasonably good sensitivity and specificity with both recent software updates, as did Silbert and Matta9 using the original software and higher than did Arnold and colleagues.6 While a specificity in the low 70% range may be not be adequate for some screening situations, adjustments in

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Supported in part by an unrestricted grant to MUSC-SEI from Research to Prevent Blindness, Inc, New York, NY, and by the South Carolina Clinical and Translational Research Institute, with a home at Medical University of South Carolina, through NIH/NCRR Grant Number UL1RR029882.

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