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  • Written By: Jeffrey N. Bloom, MD
    Pediatric Ophth/Strabismus

    This study compared the performance of the PhotoScreener (PhotoScreener, Inc., Lancaster, PA) and the SureSight Vision Screener autorefractor (Welch Allyn, Skaneateles Falls, NY) for amblyopia screening in 100 children between ages one and six who were seen at a tertiary referral center. Although the PhotoScreener has been demonstrated to have high levels of sensitivity and specificity and to be operated relatively easily by laypeople, its use is expensive and there is a significant lag time between the actual exam and the subsequent interpretation of its photographic results. As a result of these problems, the SureSight, which provides immediate exam outcomes, was tested alongside the PhotoScreener.

    The patients were screened with each of the devices and received comprehensive eye examinations. Using the manufacturer's referral criteria, the SureSight's sensitivity was found to be the same as the PhotoScreener's (96.6% versus 94.8%). However, the SureSight had a low specificity (38.1%), which would be expected to produce a higher overreferral rate, whereas the PhotoScreener had a specificity of 88.1%. When the specificity levels of the SureSight were increased, a substantial number of children with risk factors for amblyopia were not properly identified. The trained layperson who performed all of the screenings was able to obtain data for 76% of the subjects with the SureSight and 96% with the PhotoScreener.

    The authors note that since the alternative to a vision screening program is to provide all children with comprehensive eye examinations, the SureSight is still useful, even if it may produce an increased overreferral rate.