Comparison of preschool vision screening tests as administered by licensed eye care professionals in the vision in preschoolers study

• Published in: Ophthalmology (Rochester, Minn.) Vol. 111; no. 4; pp. 637 - 650
• Main Authors: Schmidt, Paulette, Maguire, Maureen, Dobson, Velma, Quinn, Graham, Ciner, Elise, Cyert, Lynn, Kulp, Marjean Taylor, Moore, Bruce, Orel-Bixler, Deborah, Redford, Maryann, Ying, Gui-shuang
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2004; Elsevier
• Subjects: Amblyopia - diagnosis; Biological and medical sciences; Child, Preschool; Cross-Sectional Studies; Female; Humans; Investigative techniques of ocular function and vision; Investigative techniques, diagnostic techniques (general aspects); Licensure, Medical; Male; Medical sciences; Ophthalmology; Optometry; Refractive Errors - diagnosis; Reproducibility of Results; Sensitivity and Specificity; Strabismus - diagnosis; Vision Disorders - diagnosis; Vision Screening; Vision Tests - instrumentation; Visual Acuity; Human; Eye; Vision; Comparison test; Ophthalmology; Screening test; Care
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2004.01.022

To compare 11 preschool vision screening tests administered by licensed eye care professionals (LEPs; optometrists and pediatric ophthalmologists). Multicenter, cross-sectional study. A sample (N = 2588) of 3- to 5-year-old children enrolled in Head Start was selected to over-represent children with vision problems. Certified LEPs administered 11 commonly used or commercially available screening tests. Results from a standardized comprehensive eye examination were used to classify children with respect to 4 targeted conditions: amblyopia, strabismus, significant refractive error, and unexplained reduced visual acuity (VA). Sensitivity for detecting children with ≥1 targeted conditions at selected levels of specificity was the primary outcome measure. Sensitivity also was calculated for detecting conditions grouped into 3 levels of importance. At 90% specificity, sensitivities of noncycloplegic retinoscopy (NCR) (64%), the Retinomax Autorefractor (63%), SureSight Vision Screener (63%), and Lea Symbols test (61%) were similar. Sensitivities of the Power Refractor II (54%) and HOTV VA test (54%) were similar to each other. Sensitivities of the Random Dot E stereoacuity (42%) and Stereo Smile II (44%) tests were similar to each other and lower ( P<0.0001) than the sensitivities of NCR, the 2 autorefractors, and the Lea Symbols test. The cover–uncover test had very low sensitivity (16%) but very high specificity (98%). Sensitivity for conditions considered the most important to detect was 80% to 90% for the 2 autorefractors and NCR. Central interpretations for the MTI and iScreen photoscreeners each yielded 94% specificity and 37% sensitivity. At 94% specificity, the sensitivities were significantly better for NCR, the 2 autorefractors, and the Lea Symbols VA test than for the 2 photoscreeners for detecting ≥1 targeted conditions and for detecting the most important conditions. Screening tests administered by LEPs vary widely in performance. With 90% specificity, the best tests detected only two thirds of children having ≥1 targeted conditions, but nearly 90% of children with the most important conditions. The 2 tests that use static photorefractive technology were less accurate than 3 tests that assess refractive error in other ways. These results have important implications for screening preschool-aged children.