Vision Screening of Disadvantaged Children

Journal Highlights

Journal of AAPOS
Published online April 24, 2019

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Barugel et al. compared the specific­ity and sensitivity of the Spot Vision Screener, a handheld automatic photo­screener, with gold standard cyclople­gic measurements in a population of underprivileged children and teenagers with limited access to medical care. They found that although the handheld screener detected most refractive errors, it fell short in accurately identifying cases of hyperopia.

For this study, 41 children 4 years and older with poor access to medical care were recruited by social workers and referred to a single hospital in Paris for refractive error screening during a full-day dedicated session. The children had a mean age of 126 months (range, 48-246 months).

The same orthoptist performed noncycloplegic refraction measurements using the Spot Vision Screener in all patients. In the absence of contrain­dications, cycloplegic autorefraction using the Retinomax K-Plus 3 autore­fractometer (Righton) was performed and independently evaluated by an ophthalmologist. Slit-lamp and fundus examinations were performed in all cases. Glasses were prescribed as nec­essary.

The sensitivity of the Spot Vision Screener to detect myopia was high (>80%), at 84.61%. However, its sen­sitivity for the detection of hyperopia, astigmatism, and anisometropia was lower (<80%), at 27.27%, 78.57%, and 66.67%, respectively. The specificity for hyperopia, myopia, astigmatism, and anisometropia was high, at 100%, 98.55%, 89.71%, and 94.29%, respec­tively. The referral rate was 39.02%.

The Spot Vision Screener’s low sen­sitivity with regard to hyperopia seems to remain a limitation of the device, the researchers said, and they recommend­ed cycloplegic refraction be considered in public health initiatives. Even with this limitation, they noted that the study offered a real-world example of a dedicated day of screening in disadvan­taged children.

The original article can be found here.