Vision Screening Performance Data: A Resource

1. Schwartz RH, Schuman J, Wei LL. Instrument-based vision screening: Update and review. Contemporary Pediatrics Online publish date: Feb 01, 2014. http://contemporarypediatrics.modernmedicine.com/contemporary-pediatrics/content/tags/amblyopia/instrument-based-vision-screening-update-and-review?page=full.
2. Schuman, AJ. Vision Screening in Children. The role of automated vision screening technology. Contemporary Pediatrics. V2.0 Jan. 2013, 41-44.
3. EyeWiki. Photoscreening. http://eyewiki.aao.org/Photoscreening.
4. Alley CL. Preschool vision screening: update on guidelines and techniques. Curr Opin Ophthalmol. 2013;24(5):415-20. doi: 10.1097/ICU.0b013e3283641c56.
5. Singman E, Matta N, Tian J, Silbert D. A comparison of referral criteria used by the PlusoptiX photoscreener. Strabismus. 2013;21(3):190-4. doi: 10.3109/09273972.2013.811606.
6. Birch EE. Amblyopia and binocular vision. Prog Retin Eye Res. 2013;33:67-84. doi: 10.1016/j.preteyeres.2012.11.001. Epub 2012 Nov 29.
7. Pascual M, Huang J, Maguire MG, Kulp MT, et al. Vision In Preschoolers (VIP) Study Group. Risk factors for amblyopia in the Vision in Preschoolers study. Ophthalmology. 2014; 121(3): 622-629. 2013 Oct 18. pii: S0161-6420(13)00800-2. doi: 10.1016/j.ophtha.2013.08.040. [Epub ahead of print]
8. Rein DB, Wittenborn JS, Zhang X, Song M, Saaddine JB; Vision Cost-effectiveness Study Group. The potential cost-effectiveness of amblyopia screening programs. J Pediatr Ophthalmol Strabismus. 2012; 49(3):146–156. Published online 2011 August 30. doi: 10.3928/01913913-20110823-02.
9. Choosing Wisely: Vision care for children When they need it—and when they don’t. http://www.choosingwisely.org/societies/american-association-for-pediatric-ophthalmology-and-strabismus/.
10. Matta, NS. Pediatric Vision Screening - Photoscreening (ppt). http://www.authorstream.com/Presentation/noellematta-1990915-matta-photoscreening-talk.
11. Moon JH, Lee MY, Moon NJ Association between video display terminal use and dry eye disease in school children. J Pediatr Ophthalmol Strabismus. 2014; 51(2):87-92.

* Results produced by instrument no longer in production. However, as indicated in studies below, one of these, the MTI has been used for large and long-term studies.

iScreen

• http://www.iscreenvision.com/
• PubMed reference: http://www.ncbi.nlm.nih.gov/pubmed/?term=iScreen
• See also (not listed in PubMed for this unit):: Kemper AR, Margolis PA, Downs SM, Bordley WC. A systematic review of vision screening tests for the detection of amblyopia. Pediatrics. 1999 Nov;104(5 Pt 2):1220-2.

MTI* PS-100 Photoscreener

MTI has been used for large and long-term studies. However, the company appears to be out of business (e.g. its website, http://www.photoscreener.com/ now forwards to iScreen).

There are many MTI units still in service. Consequently, as a convenience to the reader, MTI study results are still included in this listing.

• PubMed reference: http://www.ncbi.nlm.nih.gov/pubmed/?term=mti+photoscreener

PlusOptix Auto-Refractor/Photoscreener

There have been several versions of this instrument over the course of its development. It is not clear to what extent performance of earlier models may reflect performance of current models. Their website is: http://www.plusoptix.com/

PubMed references:

• http://www.ncbi.nlm.nih.gov/pubmed/?term=plus+optix
• http://www.ncbi.nlm.nih.gov/pubmed/?term=plusoptix
• http://www.ncbi.nlm.nih.gov/pubmed/?term=power+refractor
• http://www.ncbi.nlm.nih.gov/pubmed/?term=powerrefractor

Right Medical (originally Nikon) Retinomax Autorefractor

PubMed reference:

• http://www.ncbi.nlm.nih.gov/pubmed/?term=retinomax

Visiscreen 100 (or Visiscreen OSS-C) (used by Vision Research, Inc. Photoscreening Service)

PubMed reference:

• http://www.ncbi.nlm.nih.gov/pubmed/?term=visiscreen

GoCheck/Gobiquity

• http://gobiquity.com/product.html

PubMed reference:

• http://www.ncbi.nlm.nih.gov/pubmed/?term=GoCheck%2FGobiquity

SPOT photoscreener

• https://www.welchallyn.com/en/products/categories/physical-exam/eye-exam/vision-screeners/spot-vision-screener.html

PubMed reference:

• http://www.ncbi.nlm.nih.gov/pubmed/?term=SPOT+photoscreener

Marco AR-30

• http://www.marco.com/ark-30.html

PubMed reference:

• http://www.ncbi.nlm.nih.gov/pubmed/?term=Palm-AR
• http://www.ncbi.nlm.nih.gov/pubmed/?term=Retinomax

Grand Seiko WAM-5500

• http://www.grandseiko.com/english/WAM-5500e.htm

PubMed reference:

• http://www.ncbi.nlm.nih.gov/pubmed/?term=Grand+Seiko

GoCheckKids /Gobiquity

• http://www.gocheckkids.com/
• http://gobiquity.com/

PubMed reference:

• http://www.ncbi.nlm.nih.gov/pubmed/?term=Gobiquity
• http://www.ncbi.nlm.nih.gov/pubmed/?term=GoCheckKids

Canon Powershot TX1 (CPTX1)

• http://www.amazon.com/Canon-PowerShot-Digital-Optical-Stabilized/dp/B000NK6DZI

Adaptica 2WIN Binocular Mobile Refractometer and Vision Analyser

• http://www.mercoframes.net/p/autorefractor/2win 

Note: Some of the following studies measured refraction under cycloplegia. Screening is virtually always done under non-cycloplegic conditions.

MTI* and SureSight

Most recent article date: 2008

• Rogers DL, Neely DE, Chapman JB, et al. Comparison of the MTI Photoscreener and the Welch-Allyn SureSight autorefractor in a tertiary care center. J AAPOS. 2008; 12(1):77-82.

Retinomax and SureSight

Most recent article date: 2014 

• Miller JM, Dobson V, Harvey EM, Sherrill DL. Comparison of preschool vision screening methods in a population with a high prevalence of astigmatism. Invest Ophthalmol Vis Sci. 2001; 42(5):917-924.
• Cordonnier M, De Maertelaer V. Comparison between two hand-held autorefractors: the Sure-Sight and the Retinomax. Strabismus. 2004; 12(4):261-274.
• Ying GS, Maguire M, Quinn G, Kulp MT, Cyert L; Vision In Preschoolers (VIP) Study Group. ROC analysis of the accuracy of Noncycloplegic retinoscopy, Retinomax Autorefractor, and SureSight Vision Screener for preschool vision screening. Invest Ophthalmol Vis Sci. 2011; 52(13):9658-9664. Print 2011 Dec.
• Kulp MT, Ying GS, Huang J, Maguire M, Quinn G, Ciner EB, Cyert LA, Orel-Bixler DA, Moore BD. Accuracy of noncycloplegic retinoscopy, retinomax autorefractor, and SureSight vision screener for detecting significant refractive errors. Invest Ophthalmol Vis Sci. 2014; 55(3):1378-1385. 

Retinomax, SureSight, Power Refractor II*, iScreen, MTI* and non-cycloplegic retinoscopy

Most recent article date: 2010 

• The Vision in Preschoolers Study Group. Preschool vision screening tests administered by nurse screeners compared with lay screeners in the vision in preschoolers study. Invest Ophthalmol Vis Sci. 2005; 46(8):2639-2648.
• Schmidt P, Maguire M, Dobson V, et al; Vision in Preschoolers Study Group. Comparison of preschool vision screening tests as administered by licensed eye care professionals in the Vision In Preschoolers Study. Ophthalmology. 2004; 111(4):637-650.
• Ying GS, Kulp MT, Maguire M, Ciner E, Cyert L, Schmidt P; Vision in Preschoolers Study Group. Sensitivity of screening tests for detecting vision in preschoolers-targeted vision disorders when specificity is 94%. Optom Vis Sci. 2005; 82(5):432-438.
• Schmidt P, Baumritter A, Ciner E, et al. Predictive value of photoscreening and traditional screening of preschool children. J AAPOS. 2006;10(4):377-378; author reply 378-379.
• Ying GS, Kulp MT, Maguire M, Ciner E, Cyert L, Schmidt P; Vision in Preschoolers Study Group. Sensitivity of screening tests for detecting vision in preschoolers-targeted vision disorders when specificity is 94%. Optom Vis Sci. 2005; 82(5):432-438.
• Vision in Preschoolers Study Group. Does assessing eye alignment along with refractive error or visual acuity increase sensitivity for detection of strabismus in preschool vision screening? Invest Ophthalmol Vis Sci. 2007; 48(7):3115-3125.
• Vision in Preschoolers Study Group. Validity of noncycloplegic retinoscopy, Retinomax Autorefractor and SureSight vision screener for detecting VIP-targeted eye conditions. ARVO, 2010 Annual Meeting, Monday, May 03, 2010, Poster # 1704. 

MTI* and comprehensive examination

Most recent article date: 2005

• Salcido AA, Bradley J, Donahue SP. Predictive value of photoscreening and traditional screening of preschool children. J AAPOS. 2005; 9(2):114-120.

MTI* and Visiscreen 100

Most recent article date: 2010

• Kemper AR, Margolis PA, Downs SM, Bordley WC. A systematic review of vision screening tests for the detection of amblyopia. Pediatrics. 1999; 104(5 Pt 2):1220-1222.
• Schworm HD, Kau C, Reindl B, Horstmann S, Dollinger B, Boergen KP. [Photoscreening for early detection of amblyogenic eye changes] Klin Monatsbl Augenheilkd. 1997; 210(3):158-164.
• Yanovitch T, Wallace DK, Freedman SF, et al. The accuracy of photoscreening at detecting treatable ocular conditions in children with Down syndrome. J AAPOS. 2010;14(6):472-7.

SureSight and comprehensive examination

Most recent article date: 2010

• Kemper AR, Keating LM, Jackson JL, Levin EM. Comparison of monocular autorefraction to comprehensive eye examinations in preschool-aged and younger children. Arch Pediatr Adolesc Med. 2005; 159(5):435-439.
• Rowatt AJ, Donahue SP, Crosby C, Hudson AC, Simon S, Emmons K. Field evaluation of the Welch Allyn SureSight vision screener: incorporating the vision in preschoolers study recommendations. J AAPOS. 2007;11(3):243-8. Epub 2006 Nov 30.
• Iuorno JD, Grant WD, Noël LP. Clinical comparison of the Welch Allyn SureSight handheld autorefractor versus cycloplegic autorefraction and retinoscopic refraction. J AAPOS. 2004; 8(2):123-127.
• Vision in Preschoolers (VIP) Study Group. Impact of confidence number on accuracy of the SureSight Vision Screener. Optom Vis Sci. 2010; 87(2):96-103.
• Harvey EM, Dobson V, Miller JM, et al. Accuracy of the Welch Allyn SureSight for measurement of magnitude of astigmatism in 3- to 7-year-old children. J AAPOS. 2009; 13(5):466-471.

PlusOptix and comprehensive examination

Most recent article date: 2013

• Matta NS, Singman EL, Silbert DI. Performance of the PlusOptix vision screener for the detection of amblyopia risk factors in children. J AAPOS. 2008 Jun 4. [Epub ahead of print]
  (Note: AAPOS standard pass/fail criteria, listed below in section 6, were used in this study.)
• Dahlmann-Noor AH, Vrotsou K, Kostakis V, et al. Vision screening in children by Plusoptix Vision ScreenerTM compared with gold standard orthoptic assessment. Br J Ophthalmol. 2009; 93(3):342-345.
• Gabriel GM, Mutti DO. Evaluation of infant accommodation using retinoscopy and photoretinoscopy. Optom Vis Sci. 2009; 86(3):208-215.
• Matta NS, Singman EL, Silbert DI. Performance of the plusoptiX S04 photoscreener for the detection of amblyopia risk factors in children aged 3 to 5. J AAPOS. 2010; 14(2):147-149.
• Matta NS, Singman EL, McCarus C, Matta E, Silbert DI. Screening for amblyogenic risk factors using the PlusoptiX S04 Photoscreener on the indigent population of Honduras. Ophthalmology. 2010;117(9):1848-1850. Epub 2010 May 15.
• Strauss RW, Ehrt O. [Detection of amlyogenic risk factors with the vision screener S 04].Klin Monbl Augenheilkd. 2010; 227(10):798-803. Epub 2010 Oct 20. [abstract only; Full article, in German]
• Nathan NR, Donahue SP. Modification of Plusoptix referral criteria to enhance sensitivity and specificity during pediatric vision screening. J AAPOS. 2011; 15(6):551-555.
• Ugurbas SC, Alpay A, Tutar H, Sagdik HM, Ugurbas SH. Validation of plusoptiX S04 photoscreener as a vision screening tool in children with intellectual disability. J AAPOS. 2011; 15(5):476-479.
• Singman E, Matta N, Fairward A, Silbert D. Evaluation of PlusoptiX photoscreening during examinations of children with autism. Strabismus. 2013; 21(2):103-105. doi: 10.3109/09273972.2013.786736.
• Bogdanici T, Tone S, Miron M, Boboc M, Bogdanici C. [Use of Plusoptix as a screening method for refractive ambliopia]. [Article in Romanian] Oftalmologia. 2012;56(2):49-55.

MTI* and comprehensive examination

Most recent article date: 2005

• Tong PY, Enke-Miyazaki E, Bassin RE, et al. Screening for amblyopia in preverbal children with photoscreening photographs. National Children's Eye Care Foundation Vision Screening Study Group. Ophthalmology. 1998; 105(5):856-863.
• Tong PY, Bassin RE, Enke-Miyazaki E, et al. Screening for amblyopia in preverbal children with photoscreening photographs: II. Sensitivity and specificity of the MTI photoscreener. Ophthalmology. 2000;107(9):1623-1629.
• Tong PY, Macke JP, Bassin RE, et al. Screening for amblyopia in preverbal children with photoscreening photographs. III. improved grading criteria for hyperopia. Ophthalmology. 2000; 107(9):1630-6.
• Kim AH, Chen J, Ottar-Pfeifer W, et al. Screening for amblyopia in preverbal children with photoscreening photographs: IV. Interobserver variability in photograph grading: origin and method of reduction. Binocul Vis Strabismus Q. 2005;20(2):71-80.
• Simons BD, Siatkowski RM, Schiffman JC, Berry BE, Flynn JT. Pediatric photoscreening for strabismus and refractive errors in a high-risk population. Ophthalmology. 1999;106(6):1073-1080.

PowerRefractor*, Retinomax, SureSight and retinoscopy

Most recent article date: 2003

• Suryakumar R, Bobier WR. The manifestation of noncycloplegic refractive state in pre-school children is dependent on autorefractor design. Optom Vis Sci. 2003; 80(8):578-586.

PowerRefractor* and retinoscopy

Most recent article date: 2006

• Abrahamsson M, Ohlsson J, Björndahl M, Abrahamsson H. Clinical evaluation of an eccentric infrared photorefractor: the PowerRefractor. Acta Ophthalmol Scand. 2003; 81(6):605-610.
• Blade PJ, Candy TR. Validation of the PowerRefractor for measuring human infant refraction. Optom Vis Sci. 2006; 83(6):346-353.
• Schimitzek T, Haase W. Efficiency of a video-autorefractometer used as a screening device for amblyogenic factors. Graefes Arch Clin Exp Ophthalmol. 2002; 240(9):710-716. Epub 2002 Aug 27.
• Schimitzek T, Lagrèze WA. Accuracy of a new photo-refractometer in young and adult patients. Graefes Arch Clin Exp Ophthalmol. 2005;243(7):637-645. Epub 2005 Jan 14.
• Hunt OA, Wolffsohn JS, Gilmartin B. Evaluation of the measurement of refractive error by the PowerRefractor: a remote, continuous and binocular measurement system of oculomotor function. Br J Ophthalmol. 2003; 87(12):1504-1508.

iScreen and comprehensive examination

Most recent article date: 2011

• Kennedy RA, Thomas DE. Evaluation of the iScreen digital screening system for amblyogenic factors. Can J Ophthalmol. 2000;35(5):258-262.
• Kerr NC, Somes G, Enzenauer RW. The effect of developmentally-at-risk status on the reliability of the iScreen® photorefractive device in young children. Am Orthopt J. 2011;61:117-123.

iScreen and MTI*

Most recent article date: 2013

• Silbert DI, Arnold RW, Matta NS. Comparison of the iScreen and the MTI photoscreeners for the detection of amblyopia risk factors in children. J AAPOS. 2013; 17(1):34-37. doi: 10.1016/j.jaapos.2012.09.015.

SureSight and retinoscopy

Most recent article date: 2002

• Schimitzek T, Wesemann W. Clinical evaluation of refraction using a handheld wavefront autorefractor in young and adult patients. J Cataract Refract Surg. 2002; 28(9):1655-1666.

Retinomax and SureSight

Most recent article date: 2004

• Steele G, Ireland D, Block S. Cycloplegic autorefraction results in pre-school children using the Nikon Retinomax Plus and the Welch Allyn SureSight. Optom Vis Sci. 2003 Aug;80(8):573-577.
• Cordonnier M, De Maertelaer V. Comparison between two hand-held autorefractors: the Sure-Sight and the Retinomax. Strabismus. 2004; 12(4):261-274.

Retinomax and retinoscopy

Most recent article date: 2003

• Gole GA, Schluter PJ, Hall J, Colville D. Comparison of the Retinomax autorefractor with hand-held retinoscopy in 1-year-old infants. Clin Experiment Ophthalmol. 2003; 31(4):341-347.
• Cordonnier M, Kallay O. Non-cycloplegic screening for refractive errors in children with the hand-held autorefractor Retinomax: final results and comparison with non-cycloplegic photoscreening. Strabismus. 2001; 9(2):59-70.

MTI*, Nidek K-500/560 Keratometer and Retinomax

Most recent article date: 2014

• Miller JM, Dobson V, Harvey EM, Sherrill DL. Comparison of preschool vision screening methods in a population with a high prevalence of astigmatism. Invest Ophthalmol Vis Sci. 2001;42(5):917-924.
• Kirschen D, Isenberg SJ. The effectiveness of an autorefractor with eye-tracking capability in pediatric patients. J AAPOS. 2014;18(3):217-21. doi: 10.1016/j.jaapos.2013.12.019.

PlusOptix

Most recent article date: 2014

• Matta NS, Arnold RW, Singman EL, Silbert DI. Can a photoscreener help us remotely evaluate and manage amblyopia? Am Orthopt J. 2011;61:124-127.
• PlusOptix S12 Latest version of PlusOptix. No reports as yet. Instrument Manual.

PowerRefractor* and Autorefractor

Most recent article date: 2007

• Virgili G, Angi M, Heede S, Rodriguez D, Bottega E, Molinari A. PowerRefractor versus Canon R-50 Autorefraction to assess refractive error in children: a community-based study in Ecuador. Optom Vis Sci. 2007; 84(2):144-148.
• Choi M, Weiss S, Schaeffel F, Seidemann A, Howland HC, Wilhelm B, Wilhelm H. Laboratory, clinical, and kindergarten test of a new eccentric infrared photorefractor (PowerRefractor). Optom Vis Sci. 2000;77(10):537-548.

PlusOptix and retinoscopy

Most recent article date: 2012

• Erdurmus M, Yagci R, Karadag R, Durmus M. A comparison of photorefraction and retinoscopy in children. J AAPOS. 2007;11(6):606-11. Epub 2007 Jun 25. (See comment and reply) .
• Gabriel GM, Mutti DO. Evaluation of infant accommodation using retinoscopy and photoretinoscopy. Optom Vis Sci. 2009; 86(3):208-215.
• Ehrt O, Weber A, Boergen KP. Screening for refractive errors in preschool children with the vision screener. Strabismus. 2007; 15(1):13-19.
• J.M. Vaughan, D. Wheeler, A. Summers. Lay vision screening: Can the Plusoptix vision screener replace the LEA symbol chart and Random Dot Stereotest? ARVO, 2010 Annual Meeting, Monday, May 03, 2010, Poster # 2341.
• Silbert D, Matta N. ROC Analysis to Improve Sensitivity and Specificity of the PlusoptiX Photoscreener. J Ophthalmic Vis Res. 2012; 7(1):2.

PlusOptix and MTI*

Most recent article date: 2009

• Matta NS, Arnold RW, Singman EL, Silbert DI. Comparison between the Plusoptix and MTI photoscreeners. Arch Ophthalmol. 2009;127(12):1591-1595.

PlusOptix and Retinomax and retinoscopy

Most recent article date: 2012

• Paff T, Oudesluys-Murphy AM, Wolterbeek R, et al. Screening for refractive errors in children: The plusoptiX S08 and the Retinomax K-plus2 performed by a lay screener compared to cycloplegic retinoscopy. J AAPOS. 2010;14(6):478-483.
• Rajavi Z, Parsafar H, Ramezani A, Yaseri M. Is noncycloplegic photorefraction applicable for screening refractive amblyopia risk factors? J Ophthalmic Vis Res. 2012;7(1):3-9.

Comment on above:

• Silbert D, Matta N. ROC Analysis to Improve Sensitivity and Specificity of the PlusoptiX Photoscreener. J Ophthalmic Vis Res. 2012 January; 7(1): 2.

PlusOptix 04 and visual acuity

Most recent article date: 2007

• Clausen MM, Arnold RW. Pediatric eye/vision screening. Referral criteria for the Pediavision Plus Optix s 04 photoscreener compared to visual acuity and digital photoscreening. Kindergarten computer photoscreening. Binocul Vis Strabismus Q. 2007;22(2):83-89.

PlusOptix, iscreen, SPOT, ICheckKids

Most recent article date: 2014

• Arnold RW, Arnold AW, Armitage MD, Shen JM, Hepler TE, Woodard TL. Pediatric photoscreeners in high risk patients 2012: a comparison study of Plusoptix, iScreen and SPOT. Binocul Vis Strabolog Q Simms Romano. 2013;28(1):20-28.
• Arnold RW, Armitage, M. iCheckKids, SPOT, iScreen, and Plusoptix performance in a high-risk, young pediatric eye practice. JAAPOS Abstract 006: February 2013.
• Wang JG, Suh DW. Comparison between the PlusoptiX and IScreen Photoscreeners in Detecting Amblyopic Risk Factors in Children. Open Journal of Ophthalmology. 2013; 3(1):7-12.
• Arnold, R. Practical Validation Of Plusoptix, Iscreen, SPOT, Icheckkids. Photoscreeners In Young and Developmentally Delayed Pediatric Patients Practical Validation Of Plusoptix, Iscreen, SPOT and Icheckkids Photoscreeners In Young and Developmentally Delayed Pediatric Patients. American Academy of Pediatrics National Conference & Exhibition, October 28, 2013 # 7.
• Vaughan, J., Dale, T, Huang, D Photoscreening for Refractive Error and Strabismus With a Smartphone App. American Academy of Pediatrics National Conference & Exhibition, October 28, 2013 # 2.
• Arnold RW, Armitage MD. Performance of Four New Photoscreeners on Pediatric Patients With High Risk Amblyopia. J Pediatr Ophthalmol Strabismus. 2014; 51(1)46-52. doi: 10.3928/01913913-20131223-02. [Epub ahead of print] .
• Jennifer, DD, Peterseim, MM, Cheeseman, EW, Trivedi R, Papa, C, Kraus, CL. Prospective evaluation of autorefraction using the Spot and plusoptiX AO9 vision screeners in children ages 12-30 months for the detection of amblyogenic risk factors. ARVO meeting abstract 2014 (Go to Link and scroll down) .
• Peterseim MM, Papa CE, Wilson ME, et al. Photoscreeners in the pediatric eye office: compared testability and refractions on high risk children. Am J Ophthalmol. 2014; 158(5):932-938. Aug 1. pii: S0002-9394(14)00477-2. doi: 10.1016/j.ajo.2014.07.041. [Epub ahead of print].

Grand Seiko WAM-5500, Accuref K9001 and retinoscopy

Most recent article date: 2013

• Matta NS, Singman EL, Brubaker C, Silbert DI. Auto-objective accommodative measurements as a valid and reliable new method of pediatric, strabismus and amblyopia, vision screening. Binocul Vis Strabolog Q Simms Romano. 2011; 26(3):140-145.
• Singman E, Matta N, Tian J, Silbert D. Association between accommodative amplitudes and amblyopia. Strabismus. 2013; 21(2):137-139. doi: 10.3109/09273972.2013.786737.
• Wan XH, Lin Z, Cai XG, et al. [Comparison between binocular, open-field auto ref/keratometer and conventional autorefractor]. Zhonghua Yan Ke Za Zhi. 2012; 48(6):519-523.

PlusOptix S04, A09

Most recent article date: 2013 

• Singman E, Matta N, Tian J, Brubaker A, Silbert D. A Comparison of the PlusoptiX S04 and A09 Photoscreeners. Strabismus. 2013; 21(2):85-87. doi: 10.3109/09273972.2013.786735. Autorefraction and vision screening instruments, brand not reported, and retinoscopy Most recent article date: 2014.
• Matsuo T, Matsuo C, Kio K, Ichiba N, Matsuoka H. Is refraction with a hand-held autorefractometer useful in addition to visual acuity testing and questionnaires in preschool vision screening at 3.5 years in Japan? Acta Med Okayama. 2009; 63(4):195-220.
• Rein DB, Wittenborn JS, Zhang X, Song M, Saaddine JB; Vision Cost-effectiveness Study Group. The potential cost-cffectiveness of amblyopia screening programs. J Pediatr Ophthalmol Strabismus. 2011;1-10. doi: 10.3928/01913913-20110823-02. [Epub ahead of print] .
• Lai YH, Tseng HY, Hsu HT, Chang SJ, Wang HZ. Uncorrected visual acuity and noncycloplegic autorefraction predict significant refractive errors in Taiwanese preschool children. Ophthalmology. 2013; 120(2):271-276. 2012 Nov 22. pii: S0161-6420(12)00764-6. doi: 10.1016/j.ophtha.2012.08.009. [Epub ahead of print] .
• Arnold RW, Davis B, Arnold LE, Rowe KS, Davis JM. Calibration and Validation of Nine Objective Vision Screeners With Contact Lens-Induced Anisometropia. J Pediatr Ophthalmol Strabismus. 2013; 50(3):184-190. 2013 Apr 9:1-7. doi: 10.3928/01913913-20130402-02. [Epub ahead of print] .
• Lai YH, Tseng HY, Hsu HT, Chang SJ, Wang HZ. Uncorrected visual acuity and noncycloplegic autorefraction predict significant refractive errors in Taiwanese preschool children. Ophthalmology. 2013; 120(2): 271-276. 2013 Feb;120(2):271-6. doi: 10.1016/j.ophtha.2012.08.009. Epub 2012 Nov 22.
• Halegoua J, Schwartz RH.Vision Photoscreening of Infants and Young Children in a Primary Care Pediatric Office: Can It Identify Asymptomatic Treatable Amblyopic Risk Factors? Clin Pediatr (Phila). 2015; 54(1):33-39. 2014 Jul 8. pii: 0009922814541805. [Epub ahead of print].

Canon Powershot TX1 and comprehensive exam

Most recent article date: 2013

• Bani SA, Amitava AK, Sharma R, Danish A. Beyond photography: Evaluation of the consumer digital camera to identify strabismus and anisometropia by analyzing the Bruckner's reflex. Indian J Ophthalmol. 2013; 61(10):608-611. doi: 10.4103/0301-4738.121092.

SureSight and PlusOptix

Most recent article date: 2014

• Silbert D, Matta N, Tian J, Singman E. Comparing the SureSight autorefractor and the PlusoptiX photoscreener for pediatric vision screening. Strabismus. 2014; 22(2): 64-67. 2014 Apr 17. [Epub ahead of print] .

Moderate- to Large-Scale Screening Studies With No Cycloplegia

** Unit was Included in Vision in Preschoolers screening studies.

iScreen**

Most recent article date: 2011

• Kennedy RA, Thomas DE. Evaluation of the iScreen digital screening system for amblyogenic factors. Can J Ophthalmol. 2000; 35(5):258-262.
• Kerr NC, Somes G, Enzenauer RW. The effect of developmentally-at-risk status on the reliability of the iScreen® photorefractive device in young children. Am Orthopt J. 2011; 61:117-123.

MTI**

Most recent article date: 2013

• Donahue SP, Baker JD, Scott WE, et al. Lions Clubs International Foundation Core Four Photoscreening: results from 17 programs and 400,000 preschool children. J AAPOS. 2006; 10(1):44-48.
• Donahue SP, Johnson TM, Leonard-Martin TC. Screening for amblyogenic factors using a volunteer lay network and the MTI photoscreener. Initial results from 15,000 preschool children in a statewide effort. Ophthalmology. 2000; 107(9):1637-1644; discussion 1645-1646.
• Kirk VG, Clausen MM, Armitage MD, Arnold RW. Preverbal photoscreening for amblyogenic factors and outcomes in amblyopia treatment: early objective screening and visual acuities. Arch Ophthalmol. 2008; 126(4):489-492.
• See Tong et al. studies under "MTI and comprehensive examination" in section 3, above.
• Miller JM, Schwiegerling J, Leising-Hall H, Surachatkumtonekul T. Detection of improper fixation in MTI photoscreening images. J AAPOS. 2001; 5(1):35-43.
• Salcido AA, Bradley J, Donahue SP. Predictive value of photoscreening and traditional screening of preschool children. J AAPOS. 2005; 9(2):114-120.
• Donahue SP, Johnson TM. Age-based refinement of referral criteria for photoscreening. Ophthalmology. 2001; 108(12):2309-2314; discussion 2314-2315.
• Donahue SP, Johnson TM, Ottar W, Scott WE. Sensitivity of photoscreening to detect high-magnitude amblyogenic factors. JAAPOS. 2002; 6(2):86-91.
• Arnold RW, Donahue SP. The yield and challenges of charitable state-wide photoscreening. Binocul Vis Strabismus Q. 2006; 21(2):93-100.
• Simons BD, Siatkowski RM, Schiffman JC, Berry BE, Flynn JT. Pediatric photoscreening for strabismus and refractive errors in a high-risk population. Ophthalmology. 1999; 106(6):1073-1080.
• Weinand F, Gräf M, Demming K. Sensitivity of the MTI photoscreener for amblyogenic factors in infancy and early childhood. Graefes Arch Clin Exp Ophthalmol. 1998; 236(11):801-805.
• Donahue SP, Lorenz S, Johnson T. Screening around the world: Lions Club International Foundation experience. Semin Ophthalmol. 2008; 23(5):294-297.
• Teed RG, Bui CM, Morrison DG, Estes RL, Donahue SP. Amblyopia therapy in children identified by photoscreening. Ophthalmology. 2010; 117(1): 159-162. 2009 Nov 4. [Epub ahead of print].
• Arnold RW, Armitage MD, Gionet EG, et al. The cost and yield of photoscreening: impact of photoscreening on overall pediatric ophthalmic costs. J Pediatr Ophthalmol Strabismus. 2005; 42(2):103-111.
• Colburn JD, Morrison DG, Estes RL, Li C, Lu P, Donahue SP. Longitudinal follow-up of hypermetropic children identified during preschool vision screening. J AAPOS. 2010; 14(3):211-215.
• Longmuir SQ, Pfeifer W, Leon A, Olson RJ, Short L, Scott WE. Nine-year results of a volunteer lay network photoscreening program of 147,809 children using the MTI PhotoScreener in Iowa. Ophthalmology. 2010; 117(1):18691875. 2010 Jul 23. [Epub ahead of print] .
• Longmuir SQ, Boese EA, Pfeifer W, Zimmerman B, Short L, Scott WE. Practical Community Photoscreening in Very Young Children. Pediatrics. 2013; 131(3): e764-769. 2013 Feb 11. [Epub ahead of print] .

PowerRefractor**

Most recent article date: 2007

• Schaeffel F, Mathis U, Brüggemann G. Noncycloplegic photorefractive screening in pre-school children with the "PowerRefractor" in a pediatric practice. Optom Vis Sci. 2007; 84(7):630-639.
• Virgili G, Angi M, Heede S, Rodriguez D, Bottega E, Molinari A. PowerRefractor versus Canon R-50 Autorefraction to assess refractive error in children: a community-based study in Ecuador. Optom Vis Sci. 2007; 84(2):144-148.

PlusOptix

Most recent article date: 2013

• Arthur BW, Riyaz R, Rodriguez S, Wong J. Field testing of the PlusoptiX S04 photoscreener. J AAPOS. 2009; 13(1): 51-57. 2008 Dec 31. [Epub ahead of print] .
• Vaughan, J.M. Wheeler, D. A. Summers. A. Lay Vision Screening: Can the Plusoptix Vision Screener Replace the LEA Symbol Chart and Random Dot Stereotest? ARVO 2010 Abstract, #2341.
• Moghaddam AA, Kargozar A, Zarei-Ghanavati M, Najjaran M, Nozari V, Shakeri MT. Screening for amblyopia risk factors in pre-verbal children using the Plusoptix photoscreener: a cross-sectional population-based study. Br J Ophthalmol. 2012; 96(1):83-86. 2011 Apr 21. [Epub ahead of print] 
• Nathan NR, Donahue SP. Modification of Plusoptix referral criteria to enhance sensitivity and specificity during pediatric vision screening. J AAPOS. 2011; 15(6):551-555.
• Matta NS, Arnold RW, Singman EL, Silbert DI. Can a photoscreener help us remotely evaluate and manage amblyopia? Am Orthopt J. 2011; 61:124-127.
• Arnold RW, Tulip D, McArthur E, et al. Predictive value from pediatrician Plusoptix screening: impact of refraction and binocular alignment. Binocul Vis Strabolog Q Simms Romano. 2012; 27(4):227-232.
• Silbert DI, Matta NS, Andersen K. Plusoptix photoscreening may replace cycloplegic examination in select pediatric ophthalmology patients. JAAPOS. 2013; 17(2):163-165. 2013 Mar 20. pii: S1091-8531(13)00058-X. doi: 10.1016/j.jaapos.2012.11.008. [Epub ahead of print] .
• Bloomberg JD, Suh DW. The accuracy of the plusoptiX A08 photoscreener in detecting risk factors for amblyopia in central Iowa. J AAPOS. 2013; 17(3):301-304. doi: 10.1016/j.jaapos.2013.03.014.
• Silbert J, Matta N, Tian J, Singman E, Silbert DI. Pupil size and anisocoria in children measured by the plusoptiX photoscreener. J AAPOS. 2013; 17(6):609-611. 2013 Nov 8. doi:pii: S1091-8531(13)00328-5. 10.1016/j.jaapos.2013.09.003. [Epub ahead of print].
• Saber Moghadam A, Alizadeh R, Zarei-Ghanavati M. Plusoptix S08 sensitivity in detecting strabismus as amblyogenic risk factor. Strabismus. 2013; 21(4):230-234. doi: 10.3109/09273972.2013.851259.
• Couser NL. The W.H.E.E.L.S. Preschool Vision Screening Program’s Initial Outcomes for 12,402 Children Screened Using the Plusoptix Photoscreener. International Scholarly Research Notices. Volume 2014 (2014), Article ID 793546, 4 pages.

Retinomax**

Most recent article date: 2014

• Barry JC, König HH. Non-cycloplegic screening for amblyopia via refractive findings with the Nikon Retinomax hand held autorefractor in 3 year old kindergarten children. Br J Ophthalmol. 2001; 85(10):1179-1182.
• Cordonnier M, Dramaix M. Screening for abnormal levels of hyperopia in children: a non-cycloplegic method with a hand held refractor. Br J Ophthalmol. 1998; 82(11):1260-1264.
• Cordonnier M, Dramaix M. Screening for refractive errors in children: accuracy of the hand held refractor Retinomax to screen for astigmatism. Br J Ophthalmol. 1999 Feb;83(2):157-61.
• Cordonnier M, Kallay O. Non-cycloplegic screening for refractive errors in children with the hand-held autorefractor Retinomax: final results and comparison with non-cycloplegic photoscreening. Strabismus. 2001; 9(2):59-70.
• Vision in Preschoolers Study Group. Impact of confidence number on the screening accuracy of the Retinomax autorefractor. Optom Vis Sci. 2007; 84(3):181-188.
• Lowry EA, Lui R, Enanoria W, Keenan J, de Alba Campomanes AG. Repeat Retinomax screening changes positive predictive value. J AAPOS. 2014; 18(1):45-49. doi: 10.1016/j.jaapos.2013.11.004.

SureSight**

Most recent article date: 2010

• Clarke N, Shacks J, Kerr AR, Bottrell CL, Poulsen MK, Yin L.Use of a noncycloplegic autorefractor to perform vision screening in preschools. J Sch Nurs. 2008; 24(3):158-163.
• Büchner TF, Schnorbus U, Grenzebach UH, Busse H. Examination of preschool children for ametropia: first experiences using a new hand-held autorefractor. Strabismus. 2004; 12(2):111-117.
• Silverstein E, Lorenz S, Emmons K, Donahue SP. Limits on improving the positive predictive value of the Welch Allyn SureSight for preschool vision screening. J AAPOS. 2009; 13(1):45-50. 2008 Oct 29.
• Vision in Preschoolers (VIP) Study Group. Impact of Confidence Number on Accuracy of the SureSight Vision Screener. Optom Vis Sci. 2010; 87(2):96-103. 2010 Jan 7. [Epub ahead of print].

Visi-Screen 100/OSS-C

Most recent article date: 1997

• Schworm HD, Kau C, Reindl B, Horstmann S, Dollinger B, Boergen KP. [Photoscreening for early detection of amblyogenic eye changes] Klin Monatsbl Augenheilkd. 1997; 210(3):158-164.
• Morgan KS, Kennemer JC. Off-axis photorefractive eye screening in children. J Cataract Refract Surg. 1997; 23(3):423-428.

Retinomax and Palm-AR Auto-Refractor

Most recent article date: 2011

• Vision in Preschoolers (VIP) Study Group, Ciner E, Carter A, Ying GS, Maguire M, Kulp MT. Comparison of the Retinomax and Palm-AR Auto-Refractors: a pilot study. Optom Vis Sci. 2011; 88(7):830-836.

SPOT Photoscreener

Most recent article date: 2014

• Kristiane M. Ransbarger, Michaela L. Gruzensky, Julie P. Chun, Julia Rittenhouse, Rebecca S. Leenheer, Jennifer A. Dunbar, Leila M. Khazaeni. Results of Vision Screening Using the SPOT Photoscreener in Children ≤ 6 Years. ARVO Abstract 1767, May 7, 2012 Ophthalmology, Loma Linda University, Loma Linda, CA.
• Ransbarger KM, Dunbar JA, Choi SE, Khazaeni LM. Results of a community vision-screening program using the SPOT photoscreener. J AAPOS. 2013; 17(5):516-520. doi: 10.1016/j.jaapos.2013.06.013.
• Silbert D, Matta NS Performance of the Spot vision screener for the detection of amblyopia risk factors in children. J AAPOS. 2014 Apr;18(2):169-72. doi: 10.1016/j.jaapos.2013.11.019.
• Silbert DI, Matta NS. Performance of the Spot vision screener for the detection of amblyopia risk factors in children. J AAPOS. 2014; 18(2):169-172.
• Garry GA, Donahue SP. Validation of SPOT screening device for amblyopia risk factors. J AAPOS. 2014; 18(5):476-480. 2014 Sep 27. pii: S1091-8531(14)00419-4. doi: 10.1016/j.jaapos.2014.07.156. [Epub ahead of print].

Retinomax vs. Canon Autorfractor vs. sensory measures (acuity, stereopsis)

Most recent article date: 2012

• Pai AS, Rose KA, Samarawickrama C, et al. Testability of refraction, stereopsis, and other ocular measures in preschool children: the Sydney Paediatric Eye Disease Study. J AAPOS. 2012; 16(2):185-192. doi: 10.1016/j.jaapos.2011.09.017.

Unspecified Autorfractor vs. sensory measures (acuity, stereopsis)

Most recent article date: 2013

• Lai YH, Tseng HY, Hsu HT, Chang SJ, Wang HZ. Uncorrected visual acuity and noncycloplegic autorefraction predict significant refractive errors in Taiwanese preschool children. Ophthalmology. 2013; 120(2):271-276. doi: 10.1016/j.ophtha.2012.08.009. Epub 2012 Nov 22.

Retinblastoma and screening

Most recent article date: 2011

• Estopinal CB, Donahue SP, Gitschlag GN. Retinoblastoma in a child after normal autorefraction and traditional vision screening. Pediatrics. 2011;128(5):e1285-1288. doi: 10.1542/peds.2011-0325. Epub 2011 Oct 3.

Flip Chart Acuity Screening vs. PlusOptix S09

Most recent article date: 2013

• Silbert, D, Noelle S. Matta, N Brubaker BS. Flip Chart Visual Acuity Screening Compared to the plusOptix S09 Photoscreener Performed by a Lay Screener.Poster presentation at the Association for Research in Vision and Opthhalmology meeting May 8, 2012, Ft. Lauderdale, Florida USA.
• Silbert DI, Matta NS, Brubaker A. Flip chart Visual Acuity Screening for Amblyopia Risk Factors Compared to the PlusoptiX A09 Photoscreener,Tests Performed by a Lay Screener. Binocul Vis Strabolog Q Simms Romano. 2013;28(4):222-228.

SureSight vs. PlusOptix A09

Most recent article date: 2014

• Silbert DI, Matta NS, Ely AL. Comparison of SureSight autorefractor and plusoptiX A09 photoscreener for vision screening in rural Honduras. J AAPOS. 2014; 18(1):42-44. doi: 10.1016/j.JAAOPOSIS.2013.09.006.

Adaptica 2WIN vs. PlusOptix 12

Most recent article date: 2014

• Kirk S, Armitage MD, Dunn S, Arnold RW. Calibration and validation of the 2WIN photoscreener compared to the PlusoptiX S12 and the SPOT. J Pediatr Ophthalmol Strabismus. 2014; 8:1-4. doi: 10.3928/01913913-20140701-01. [Epub ahead of print] .

Clarity Ret-Cam Shuttle

• http://www.claritymsi.com/international/retcam_shuttle.html

Most recent article date: 2014

• Quinn GE, Ying GS, Daniel E, et al; e-ROP Cooperative Group. Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity. JAMA Ophthalmol. 2014 Jun 26. doi: 10.1001.

 See also:

• Johns Hopkins Children’s Center. July 02, 2014. Remote Photo Screening Effective in Detecting Eye Damage in Premature Babies.

Smartphone

Most recent article date: 2014

• Vaughan J, Dale T, Huang D. Photoscreening for Refractive Error and Strabismus With a Smartphone App American Academy of Pediatrics National Conference & Exhibtion, October 28, 2013 # 2.
• Gobiquity Mobile Health. First Smartphone App Developed for Pediatric Photoscreening Medical Design Technology Thu, 06/19/2014 - 3:05pm.

Vison Screening review articles (list)

• Definitions and History (brief descriptions of photoscreener and autorefractor)
• Instruments by manufacturer, the websites of the manufacturers, and reviews of the instruments
• Comparisons of photoscreeners, etc.
• Screening studies with no cycloplegia
• Pediatric Vision Scanner under development
• Notes on Photoscreeners and Autorefractors (already a table)
• AAPOS standard vision screening criteria
• Editorials
• Tests

Photoscreening policy

• Comparisons of photoscreeners (already a table)
• Visual acuity (explanation and articles)

• Jost RM, Yanni SE, Beauchamp CL, Stager DR Sr, Stager D Jr, Dao L, Birch EE. Beyond screening for risk factors: objective detection of strabismus and amblyopia. JAMA Ophthalmol. 2014; 132(7):814-820. doi: 10.1001/jamaophthalmol.2014.424.
• Holmes JM [Invited Commentary] Screening, confirming, and treating amblyopia based on binocularity. JAMA Ophthalmol. 2014;132(7):820-822. doi:10.1001/jamaophthalmol.2014.2455.
• Irsch K, Gramatikov BI, Wu YK, Guyton DL. New pediatric vision screener employing polarization-modulated, retinal-birefringence-scanning-based strabismus detection and bull's eye focus detection with an improved target system: opto-mechanical design and operation. J Biomed Opt. 2014; 19(6):67004. doi: 10.1117/1.JBO.19.6.067004.
• Loudon SE, Rook CA, Nassif DS, Piskun NV, Hunter DG. Rapid, high-accuracy detection of strabismus and amblyopia using the pediatric vision scanner. Invest Ophthalmol Vis Sci. 2011; 52(8):5043-8. Print 2011 Jul. (See also video and reanalysis).

From ARVO 2014 Abstracts

Program Number: 438 Poster Board Number: D0057

Presentation Time: 8:30 AM–10:15 AM

High Specificity and Accuracy of the Pediatric Vision Scanner in a Pediatric Primary Care Setting

Reed Jost, David Stager, Jr, Lori Dao, Scott Katz, Russ McDonald, Eileen Birch, Retina Foundation of the Southwest, Dallas, TX; Pediatric Ophthalmology & Adult Strabismus, Plano, TX; Plano Pediatrics, PA, Plano, TX; Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX.

Purpose: The Pediatric Vision Scanner (PVS) directly detects strabismus and amblyopia by analyzing binocular scans for the presence or absence of birefringence that, due to the organization of the radially arranged Henle fibers, is characteristic of steady, bifoveal fixation. In an initial study of patients tested in a pediatric ophthalmology office setting, the PVS had 98% sensitivity and 87% specificity for detection of strabismus and amblyopia. (Jost et al., AAPOS 2013) Here we report an intermediate evaluation of PVS sensitivity, specificity, and accuracy for a preliminary cohort of children screened in a pediatric primary care setting.

Methods: 60 children (2-6y) were enrolled. In addition to screening with the PVS, children were screened with the SureSight™ Autorefractor. Each test yielded a recommendation of “pass” or “refer.” All children received a gold-standard comprehensive ophthalmic exam by a pediatric ophthalmologist who was masked to the screening results.

Results: At the gold-standard exam, 4 children were identified as having strabismus and/or amblyopia; 56 had normal exams. Three children were uncooperative for testing with the PVS and 7 could not be tested with SureSight™. Both the PVS and SureSight™ referred all 4 children with strabismus and/or amblyopia. Overall accuracy of the PVS was 90%. The PVS passed 47 of 53 children with no strabismus or amblyopia (89% specificity; 95%CI: 78-99%). In comparison, overall accuracy of the SureSight™ was 74%. The SureSight™ referred 14 of 49 children with no strabismus or amblyopia; i.e., the SureSight™ had significantly more false positives than the PVS (z=2.19; p=0.029; 71% specificity; 95%CI: 55-88%).

Conclusions: In this ongoing study of the PVS in a pediatric primary care setting, results were comparable to the 87% specificity reported previously for a large cohort (n=250) tested in an ophthalmology practice with high prevalence of strabismus and amblyopia. In a pediatric primary care setting, the PVS had higher specificity and accuracy than the SureSight™, resulting in fewer over-referrals of children with no strabismus or amblyopia. Preschool vision screening may be more efficient with a device that directly detects strabismus and/or amblyopia.

Commercial Relationships: Reed Jost, None; David Stager, Jr, None; Lori Dao, None; Scott Katz, None; Russ McDonald, None; Eileen Birch, None

Support: Thrasher Research Fund Grant 9491, National Eye Institute

Grant EY022313

http://www.arvo.org/webs/am2014/abstract/sessions/114.pdf

Program Number: 813

Presentation Time: 3:45 PM–4:00 PM

Kristina Irsch, Robert B. Geary, Jing Tian, David L. Guyton, Boris I. Gramatikov, Howard S. Ying.

Purpose: To investigate whether detection of interocular fixation instability may serve as a single sensitive test for amblyopia.

Methods: Binocular eye movements were recorded at 500 Hz using the EyeLink 1000 eye tracker (SR Research Ltd., Ontario, Canada) and analyzed using EyeLink software and Matlab (Mathworks, Natick, MS). Eight subjects (three non-amblyopic and five amblyopic including one successfully-treated amblyope; age: 7-44 years) were asked to fixate on a cross subtending 0.5° at a distance of 57cm. Interocular fixation stability was quantified by calculating the minimum-area bivariate contour ellipse (BCEA) encompassing 68% of the difference between right and left eye fixation points during a 20-second binocular viewing epoch. For statistical analysis, BCEA values were normalized by a common logarithm transformation.

Results: The amblyopic subjects with persistent vision loss (one anisometropic, two strabismic, and one deprivation; uncorrected visual acuity range 20/60-20/300) showed significantly higher interocular fixation instability (larger 68% BCEAs) than the nonamblyopic subjects (uncorrected visual acuity range 20/20-20/800), and the successfully-treated strabismic amblyope (to the 20/20 level of visual acuity); p < 0.01.

Conclusions: Based on our results, interocular fixation instability differentiates amblyopic from non-amblyopic subjects and improves after successful treatment. Interocular fixation instability may therefore prove to be a single sensitive test for the presence of amblyopia. As a difference measure, it is less susceptible to head motion and calibration error, as well as to conjugate eye motion, and as such is expected to be somewhat immune to latent nystagmus. Interocular fixation instability may also be used to guide treatment, especially in preverbal children and to assess the efficacy of novel treatments. Further research is required to establish optimal interocular fixation instability thresholds and to determine how specific this measure is to amblyopia.

Commercial Relationships: Kristina Irsch, pending (P); Robert B. Geary, pending (P); Jing Tian, pending (P); David L. Guyton, pending (P); Boris I. Gramatikov, pending (P); Howard S. Ying, pending (P)

Support: RPB Disney Award (H.S. Ying)

http://www.arvo.org/webs/am2014/abstract/sessions/144.pdf

From ARVO 2012 Abstracts

Detecting amblyopia and strabismus in children with the Pediatric Vision Scanner (PVS)

Jessica Kane OC (C); Sina Salehi Omran MS2; Sean P Donahue MD, PhD Vanderbilt University Medical Center, Nashville, TN

Purpose: Most photoscreening technology identifies patients having amblyopia riskfactors; however, not all patients with risk factors develop amblyopia or strabismus. PVS identifies lack of central foveal fixation as a direct indicator of amblyopia or strabismus. We sought to validate this technology.

Methods: A prospective study identified and screened 77 clinic patients between ages three and eight. All patients had complete eye exams with cycloplegic retinoscopy and were classified as at risk for amblyopia if any of the AAPOS VSC amblyopia risk factors were present. Strabismus was further defined as constant or intermittent. All patients were screened using PVS, and the device’s pass/refer recommendation was used to calculate sensitivity and specificity.

Results: Of the 77 patients, 16 were normal (no amblyopia risk factors) and 61 were amblyopic or had risk factors. 14 had anisometropic amblyopia; 21 had constant strabismus (11 amblyopic); 17 had intermittent strabismus (11 amblyopic, typically partially or fully accommodative esotropia with monofixation syndrome or post-operative from strabismus surgery); and 9 had non-strabismus non-anisometropic risk factors for amblyopia (1 amblyopic). Sensitivity to amblyopia was 95% (35/37, including one referral misidentifying the amblyopic eye). Sensitivity to constant strabismus without amblyopia was 60%. Sensitivity to intermittent strabismus without amblyopia was 50%. With respect to AAPOS amblyopia risk factors, overall sensitivity was 84% (51/61) and specificity was 75% (12/16).

Discussion: PVS is very effective at detecting amblyopia and is sensitive to amblyopia risk factors in children who do not present with amblyopia.

Conclusion: PVS shows potential to screen children aged 3-8 for present amblyopia and strabismus.

http://www.jaapos.org/issues?issue_key=S1091-8531%2811%29X0008-3#

Vision screening instruments and services should be able to detect the following amblyopiagenic conditions with a high degree of sensitivity and specificity:

• 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° >1.0 in oblique axis (>10° eccentric to 90° or 180°);
• ptosis ≤1 mm margin reflex distance;

(from Donahue SP, Arnold RW, Ruben JB; AAPOS Vision Screening Committee. 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;7[5]:314-316)

Few extant studies use all of these criteria, however. In evaluation of a study's results, then, consideration should be given to which of these criteria, if any, are used or at least what approximation to them are used.

Updated Criteria

Donahue SP, Arthur B, Neely DE, Arnold RW, Silbert D, Ruben JB; POS Vision Screening Committee. Guidelines for automated preschool vision screening: A 10-year, evidence-based update. J AAPOS. 2013; 17(1):4-8. doi: 10.1016/j.jaapos.2012.09.012. Epub 2013 Jan 27.

• http://www.sciencedirect.com/science/article/pii/S0161642000002979
• http://www.sciencedirect.com/science/article/pii/S0161642010005567

1. Freiburg Tests

• Bach M. The Freiburg Visual Acuity test--automatic measurement of visual acuity. Optom Vis Sci. 1996; 73(1):49-53.
• http://www.ncbi.nlm.nih.gov/pubmed/8867682
• http://ridgevue.com
• http://michaelbach.de/fract/index.html

2. iPad based

• Zhang ZT, Zhang SC, Huang XG, Liang LY. A pilot trial of the iPad tablet computer as a portable device for visual acuity testing. J Telemed Telecare. 2013; 19(1):55-59. http://www.ncbi.nlm.nih.gov/pubmed/23434538.
• Black JM, Jacobs RJ, Phillips G, et al. An assessment of the iPad as a testing platform for distance visual acuity in adults. BMJ Open. 2013; 3(6). http://bmjopen.bmj.com/content/3/6/e002730.full.pdf+html.
• Dorr MI, Lesmes LA, Lu ZL, Bex PJ. Rapid and reliable assessment of the contrast sensitivity function on an iPad. Invest Ophthalmol Vis Sci. 2013; 54(12):7266-7273. http://www.ncbi.nlm.nih.gov/pubmed/?term=dorr+ipad.
• Kollbaum PS, Jansen ME, Kollbaum EJ, Bullimore MA.Validation of an iPad Test of Letter Contrast Sensitivity. Optom Vis Sci. 2014; 91(3):291-296. http://www.ncbi.nlm.nih.gov/pubmed/?term=kollbaum+ipad.
• Ruamviboonsuk P1, Sudsakorn N, Somkijrungroj T, Engkagul C, Tiensuwan M. Reliability of visual acuity measurements taken with a notebook and a tablet computer in participants who were illiterate to Roman characters. J Med Assoc Thai. 2012; 95 Suppl 3:S109-116. http://www.ncbi.nlm.nih.gov/pubmed/22619896.

ARVO Annual Meeting 2014

508 Digital and Handheld Vision Tests

Program Number: 5599 Poster Board Number: A0238

• Evaluation of Tablet Computers in the Assessment of Visual Acuity: Can iPads™ Replace the Snellen Chart?
• Conor P. Malone1, 2, Colm McCourt1, Nawal T. Al Daqqaq3, 1, Conor Murphy1, 2. 1Ophthalmology, Royal College of Surgeons in Ireland, Dublin.

2A. iPad 3 (Apple Inc.) Google Nexus 10 (Google Inc.) and Galaxy Tab 2 10.1 (Samsung Electronics) based

• Tahir HJ, Ian J. Murray, Neil R. A. Parry, Tariq M. Aslam, Optimisation and Assessment of Three Modern Touch Screen Tablet Computers for Clinical Vision Testing PLOSone Published: April 23, 2014 •DOI

3. iPod based

• Arora KS, Chang DS, Supakontanasan W, Lakkur M, Friedman DS. Assessment of a rapid method to determine approximate visual acuity in large surveys and other such settings. Am J Ophthalmol. 2014; 157(6):1315-1321. 2014 Feb 15. pii: S0002-9394(14)00095-6. doi: 10.1016/j.ajo.2014.02.031. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/?term=arora+ipod

4. Pediatric Video Game

• Ma, DJ, Yang HK, Hwang JM. Reliability and validity of an automated computerized visual acuity and stereoacuity test in children using an interactive video game. Am J Ophthalmol. 2013;156(1):195-201.e1. http://www.ncbi.nlm.nih.gov/pubmed/?term=ma+validity+stereoacity
• Arora KS, Chang DS, Supakontanasan W, Lakkur M, Friedman DS. Assessment of a rapid method to determine approximate visual acuity in large surveys and other such settings. Am J Ophthalmol. 2014; 157(6): 1315-1321. 2014 Feb 15. pii: S0002-9394(14)00095-6. doi: 10.1016/j.ajo.2014.02.031. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/?term=arora+lakkur

5. Automated pediatric acuity test from Amblyopia Treatment Study and Vision in Preschool Study

• Holmes JM, Beck RW, Repka MX, et al. The amblyopia treatment study visual acuity testing protocol. Arch Ophthalmol. 2001; 19:1345-1353. http://www.ncbi.nlm.nih.gov/pubmed/11545641
• Vision in Preschoolers Study Group. Preschool vision screening tests administered by nurse screeners compared with lay screeners in the vision in preschoolers study. Invest Ophthalmol Vis Sci. 2005; 46(8):2639-2648. http://www.ncbi.nlm.nih.gov/pubmed/16043831
• Kulp MT, Dobson V, Peskin E, Quinn G, Schmidt P; Vision in Preschoolers Study Group. The electronic visual acuity tester: testability in preschool children. Optom Vis Sci. 2004; 81(4):238-44. http://www.ncbi.nlm.nih.gov/pubmed/15097765

6. Miscellaneous

• Schlenker MB1, Christakis TJ, Braga-Mele RM.
• Comparing a traditional single optotype visual acuity test with a computer-based visual acuity test for childhood amblyopia vision screening: a pilot study. Can J Ophthalmol. 2010; 45(4):368-74. doi: 10.3129/i10-034. http://www.ncbi.nlm.nih.gov/pubmed/?term=schlenker+single+optotype

7. Online Test Administration

• Vision for Kids: http://www.visionforkids.org/index.htm

8. Commercially Available Sensory Tests

• Isight (see Video Preview) http://isighttest.com/
• Test-Eye. Includes stereo and contrast sensitivity tests http://www.test-eye.com/
• EyeSpy 20/20 Animated cartoon-based, apparently free (Visionquest) source and commercially (Good-Lite) http://www.visionquest2020.org/thesolution.asp
• https://www.good-lite.com/Details.cfm?ProdID=799
• Kybervision. Click on "iOSapps" tab for acuity and contrast: http://www.kybervision.com/index.html
• Precision Vision IVA and PVVAT. http://precision-vision.com/product-category/computerized-visual-acuity-testing/
• M&S Technologies (with pediatric section) http://www.mstech-eyes.com/
• Accommodata Corporation http://www.accommodata.com/index.html
• Diopsys Infant Test System. http://www.diopsys.com/wp-content/uploads/2012/07/Enfant-Patient-Brochure-Eye-Care.pdf http://www.diopsys.com/patients/vep-testing
• Canela Software http://canelasoftware.com/help-files/2020_vision_brochure.pdf

PlusOptix

• Photoscreener PlusOptix 12 Oregon Elks primer on vision screening and Plusoptix S12 instructions
• Plus Optix S 12

iScreen

• iScreen Vision Photoscreening Video.mp4
• iScreen #2
• PR piece and demo

Pediatric Vision Scanner (PVS)

(See section #5, above)

SPOT

• http://www.spotvisionscreening.com/2013/

Multiple Photoscreeners

• PlusOptix, iScreen, Suresight, etc.

iCheckKids

• http://vimeo.com/62983911

Adaptica

• 2Win Photoscreener https://www.youtube.com/watch?v=atBnyAVeE1o

American Academy of Pediatrics Section on Ophthalmology and; Committee on Practice and Ambulatory Medicine; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus, American Association of Certified Orthoptists. Instrument-Based Pediatric Vision Screening Policy Statement. Pediatrics. 2012 Oct 29. [Epub ahead of print]

Compiled in April, 2014 by Jeffrey D. Colburn, MD for AAPOS.

• Note that AAPOS does not endorse any particular product, but rather seeks to educate and inform regarding available options.
• For validation studies and more information, see Kurt Simons PhD's website, above.

Visual acuity is routinely referred to as a gold standard of vision screening (eg, Silbert et al. 2014 http://www.ncbi.nlm.nih.gov/pubmed/24372416). However there are a variety of visual acuity tests available, some not adequately validated or with other problems. The following list reviews current acuity tests.

While electronic versions of visual acuity tests are widely used (see Section 9. Automated and Semi-Automated Sensory Tests), the cost-effectiveness of acuity based on card or plastic stock. is significant for many settings.

1. Sonksen logMAR Test

Salt AT, Wade AM, Proffitt R, Heavens S, Sonksen PM. The Sonksen logMAR Test of Visual Acuity: I. Testability and reliability. J AAPOS. 2007; 11(6):589-596. Epub 2007 Jul 27. http://www.ncbi.nlm.nih.gov/pubmed/17681815

2. Sonksen logMAR Test

Sonksen PM, Wade AM, Proffitt R, Heavens S, Salt AT. The Sonksen logMAR test of visual acuity: II. Age norms from 2 years 9 months to 8 years. J AAPOS. 2008; 12(1):18-22. Epub 2007 Jul 24. http://www.ncbi.nlm.nih.gov/pubmed/17651997

3. logMAR Crowded test, Sonksen logMAR test, Crowded Kay Picture test

Norgett Y, Siderov J. Crowding in children's visual acuity tests--effect of test design and age. Optom Vis Sci. 2011 Aug;88(8):920-927. doi:10.1097/OPX.0b013e31821bd2d3. http://www.ncbi.nlm.nih.gov/pubmed/21532515

4. Keeler LogMAR crowded test, Crowded Kay Picture test

Little JA, Molloy J, Saunders KJ.The differing impact of induced astigmatic blur on crowded and uncrowded paediatric visual acuity chart results. Ophthalmic Physiol Opt. 2012; 32(6):492-500. doi: 10.1111/j.1475-1313.2012.00939.x. Epub 2012 Sep 26. http://www.ncbi.nlm.nih.gov/pubmed/23009274

5. Keeler LogMAR crowded test, Crowded Kay Picture test

Little JA, Molloy J, Saunders KJ. The differing impact of induced astigmatic blur on crowded and uncrowded paediatric visual acuity chart results. Ophthalmic Physiol Opt. 2012; 32(6):492-500. doi: 10.1111/j.1475-1313.2012.00939.x. Epub 2012 Sep 26. http://www.ncbi.nlm.nih.gov/pubmed/23009274

6. Crowded Kay Picture Test

Shah N, Laidlaw DA, Rashid S, Hysi P. Validation of printed and computerised crowded Kay picture logMAR tests against gold standard ETDRS acuity test chart measurements in adult and amblyopic paediatric subjects. Eye (Lond). 2012; 26(4):593-600. doi: 10.1038/eye.2011.333. Epub 2011 Dec 23. http://www.ncbi.nlm.nih.gov/pubmed/22193878

7. logMAR Kay picture test, logMAR acuity test

Elliott MC, Firth AY. The logMAR Kay picture test and the logMAR acuity test: a comparative study. Eye (Lond). 2009; 23(1):85-88. Epub 2007 Sep 28.

8. Kay Picture Test, logMAR Crowded Test

Jones D, Westall C, Averbeck K, Abdolell M. Visual acuity assessment: a comparison of two tests for measuring children's vision. Ophthalmic Physiol Opt. 2003 Nov;23(6):541-6. http://www.ncbi.nlm.nih.gov/pubmed/14622358

9. HOTV, Lea

Ruttum MS, Dahlgren M. Comparison of the HOTV and Lea symbols visual acuity tests in patients with amblyopia. J Pediatr Ophthalmol Strabismus. 2006 May-Jun;43(3):157-160. http://www.ncbi.nlm.nih.gov/pubmed/16761636

10. HOTV, Lea

Cyert L, Schmidt P, Maguire M, Moore B, Dobson V, Quinn G; Vision in Preschoolers (VIP) Study Group. Threshold visual acuity testing of preschool children using the crowded HOTV and Lea Symbols acuity tests. J AAPOS. 2003; 7(6):396-399. 

11. HOTV, Lea

Vision in Preschoolers Study Group. Preschool visual acuity screening with HOTV and Lea symbols: testability and between-test agreement. Optom Vis Sci. 2004; 81(9):678-683. http://www.ncbi.nlm.nih.gov/pubmed/15365387

12. Patti Pics

Silbert DI, Matta NS, Brubaker A. Flip chart Visual Acuity Screening for Amblyopia Risk Factors Compared to the PlusoptiX A09 Photoscreener,Tests Performed by a Lay screener. Binocul Vis Strabolog Q Simms Romano. 2013;28(4):222-228. http://www.ncbi.nlm.nih.gov/pubmed/24372416

13. Patti Pics, Lea

Mercer ME, Drover JR, Penney KJ, Courage ML, Adams RJ. Comparison of Patti Pics and Lea Symbols optotypes in children and adults. Optom Vis Sci. 2013; 90(3):236-241. doi: 0.1097/OPX.0b013e3182825eb7. http://www.ncbi.nlm.nih.gov/pubmed/?term=patti+pics

14. No crowding specified except “A line of figures is preferred over single figures”

Committee on Practice and Ambulatory Medicine Section on Ophthalmology; American Association of Certified Orthoptists; American Association for Pediatric Ophthalmology and Strabismus; American Academy of Ophthalmology. Eye examination in infants, children, and young adults by pediatricians: organizational principles to guide and define the child health care system and/or improve the health of all children. Ophthalmology. 2003; 110(4):860-865. http://www.ncbi.nlm.nih.gov/pubmed/12689914

15. LeaLinear, HOTV

Ying GS, Kulp MT, Maguire M, Ciner E, Cyert L, Schmidt P; Vision in Preschoolers Study Group. Sensitivity of screening tests for detecting vision in preschoolers-targeted vision disorders when specificity is 94%. Optom Vis Sci. 2005; 82(5):432-438. http://www.ncbi.nlm.nih.gov/pubmed/15894920

16. Lea linear, HOTV

Schmidt P, Maguire M, Dobson V, Quinn G, Ciner E, Cyert L, Kulp MT, Moore B, Orel-Bixler D, Redford M, Ying GS; Vision in Preschoolers Study Group. Comparison of preschool vision screening tests as administered by licensed eye care professionals in the Vision In Preschoolers Study. Ophthalmology. 2004 ;111(4):637-650. http://www.ncbi.nlm.nih.gov/pubmed/15051194

17. Lea Single

Vision in Preschoolers Study Group. Preschool vision screening tests administered by nurse screeners compared with lay screeners in the vision in preschoolers study. Invest Ophthalmol Vis Sci. 2005; 46(8):2639-2648. http://www.ncbi.nlm.nih.gov/pubmed/16043831

18. Not Specified

AAPOS Vision Screening Recommendations http://www.aapos.org/terms/conditions/13

19. Not Specified

Joint Policy Statement. Vision Screening for Infants and Children. A joint statement of the American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Ophthalmology.

20. Linear Lea, Single Lea

Maguire MG; Vision in Preschoolers Study Group. Children unable to perform screening tests in vision in preschoolers study: proportion with ocular conditions and impact on measures of test accuracy. Invest Ophthalmol Vis Sci. 2007; 48(1):83-87. http://www.ncbi.nlm.nih.gov/pubmed/17197520

21. Linear HOTV, Linear Lea

Vision in Preschoolers Study Group. Preschool visual acuity screening with HOTV and Lea symbols: testability and between-test agreement. Optom Vis Sci. 2004 ; 81(9):678-683. http://www.ncbi.nlm.nih.gov/pubmed/15365387

22. Linear HOTV, Linear Lea

Vision in Preschoolers (VIP) Study Group. Effect of age using Lea Symbols or HOTV for preschool vision screening. Optom Vis Sci. 2010; 87(2):87-95. doi: 10.1097/OPX.0b013e3181c750b1. http://www.ncbi.nlm.nih.gov/pubmed/19996814

23. Bailey-Lovie E chart, Lea chart

Sanker N, Dhirani S, Bhakat P. Comparison of visual acuity results in preschool children with Lea symbols and Bailey-Lovie E chart. Middle East Afr J Ophthalmol. 2013; 20(4):345-348. doi: 10.4103/0974-9233.120020. http://www.ncbi.nlm.nih.gov/pubmed/24339687

24. HOTV Linear, Lea linear

Vision in Preschoolers Study Group. Preschool visual acuity screening with HOTV and Lea symbols: testability and between-test agreement. Optom Vis Sci. 2004; 81(9):678-683. http://www.ncbi.nlm.nih.gov/pubmed/15365387

25. Lea Chart, Bailey-Lovie Chart

Dobson V, Maguire M, Orel-Bixler D, Quinn G, Ying GS; Vision in Preschoolers (VIP) Study Group.Visual acuity results in school-aged children and adults: Lea Symbols chart versus Bailey-Lovie chart. Optom Vis Sci. 2003; 80(9):650-654. http://www.ncbi.nlm.nih.gov/pubmed/14502046

26. Kay pictures, LogMAR

Elliott MC, Firth AY. The logMAR Kay picture test and the logMAR acuity test: a comparative study. Eye (Lond). 2009; 23(1):85-88. Epub 2007 Sep 28. http://www.ncbi.nlm.nih.gov/pubmed/17901881

27. Glasgow Acuity Cards (= LogMar Acuity Test )

Simmers AJ, Gray LS, Spowart K. Screening for amblyopia: a comparison of paediatric letter tests. Br J Ophthalmol. 1997; 81(6):465-469. http://bjo.bmj.com/content/81/6/465.full.pdf+html

28. Glasgow Acuity Cards (= LogMar Acuity Test)

McGraw PV, Winn B, Gray LS, Elliott DB. Improving the reliability of visual acuity measures in young children. Ophthalmic Physiol Opt. 2000; 20(3):173-184. http://www.ncbi.nlm.nih.gov/pubmed/10897339

29. Crowded linear Kay Pictures, crowded linear Lea Symbols, crowded linear Keeler logMAR and multiple line HOTV

Nicola Anstice, Samantha Watkins, Melissa Thomson, Benjamin Thompson, Robert J. Jacobs, Andrew Collins.
Comparison of visual acuity across pediatric tests
From: ARVO Meeting 2014
Program Number: 439 Poster Board Number: D0058
Presentation Time: 8:30 AM–10:15 AM
Go to following and scroll down: http://www.arvo.org/webs/am2014/abstract/sessions/114.pdf.

30. Acuity test design

Song S, Levi DM, Pelli DG. A double dissociation of the acuity and crowding limits to letter identification, and the promise of improved visual screening. J Vis. 2014; 14(5). pii: 3. doi: 10.1167/14.5.3. http://www.ncbi.nlm.nih.gov/pubmed/24799622.

31. Crowded Lea Chartt

Chen SI, Chandna A, Norcia AM, Pettet M, Stone D. The repeatability of best corrected acuity in normal and amblyopic children 4 to 12 years of age. Invest Ophthalmol Vis Sci. 2006;47(2):614-619. http://www.ncbi.nlm.nih.gov/pubmed/16431958.