A Comparison of Referral Criteria used by the PlusoptiX Photoscreener

Abstract

Purpose: To evaluate the sensitivity, specificity, and predictive value of 7 different referral criteria used for the plusoptiX photoscreener on the same cohort of children.

Methods: Retrospective chart review of patients presenting to a pediatric ophthalmology clinic who underwent plusoptiX photoscreening as part of a comprehensive examination. We applied multiple referral criteria from previously published studies as well as the manufacturer’s criteria in order to calculate specificity, sensitivity, and predictive value differences between the various referral criteria. We compared all criteria to the results of a pediatric ophthalmology examination based upon the 2003 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) criteria, as well as the newly accepted revision of the AAPOS referral criteria.

Results: 109 children were examined with a thorough pediatric ophthalmic exam and with the plusoptiX photoscreener. Of these, 58 (53%) were confirmed to demonstrate amblyopia risk factors, according to 2003 AAPOS criteria. The plusoptiX referral criteria were adjusted to match 7 different published plusoptiX referral paradigms so that the differing referral paradigms could be analyzed for sensitivity and specificity. When comparing the differing plusoptiX referral paradigms to 2003 AAPOS criteria, the sensitivity/specificity of the 7 different paradigms were respectively: Matta/Silbert 98%/80%, Arthur (2) 67%/96%, Arnold 81%/96%, Arthur 81%/92%, PediaVision 80%/94%, plusoptiX 98%/41%, AAPOS 74%/86%. When comparing the 7 differing referral paradigms to the newly approved (2013) AAPOS criteria, the sensitivity/specificity were respectively: Matta/Silbert 98%/68%, Arthur (2) 73%/92%, Arnold 92%/90%, Arthur 86%/85%, PediaVision 90%/92%, plusoptiX 98%/35%, AAPOS 87%/87%.

Conclusion: There are multiple referral criteria available for the plusoptiX photoscreener. Screening programs need to evaluate their own requirements with respect to desired sensitivity and specificity and decide on the most appropriate referral criteria for their program. The “Arnold” criteria is the best at maximizing sensitivity and specificity utilizing the 2003 “AAPOS” criteria and the “Arnold” and “PediaVision” were best at maximizing sensitivity and specificity for the newly accepted AAPOS referral criteria. Screening programs will need to decide the level of sensitivity and specificity that they wish to obtain, but for most screening programs the “Arnold” criteria may be preferred.     

A Vision Screening Report of a Teacher-selected Primary School Population

ABSTRACT Ninety-six children, teacher-selected as below their expected achievement levels and displaying behaviour indicative of visual anomalies, were screened using a form of Modified Clinical Technique. Eleven tests of visual function were measured. Eighty-seven per cent of children failed one or more tests, and fifty-eight percent required referral based on the clinical intuition of the author. Unconventionally, tests of accommodation, vergences and visual motor skills were attempted within the context of a screening.     

Outcomes of a Vision Screening Program for Underserved Populations in the United States

ABSTRACT

Purpose: To evaluate which components of a vision screening process are most effective in identifying individuals who need eye care services.

Methods: Subjects visiting a free health clinic were screened using visual acuity and a questionnaire. Persons who failed screening were referred for a professional eye examination.

Results: A total of 1380 of 3004 screened persons (46%) screened positive on question(s) or distance visual acuity; 81% of screened positives were referred for an eye exam, <50% of the positives attended the examination, and one-third had ≥1 problem requiring intervention or monitoring. The most common problem was distance refractive error that, once corrected, improved vision by two or more lines, followed by glaucoma or glaucoma suspect (8.9%), visually significant cataract (7.2%), and diabetic retinopathy (2.5%). Ninety-four subjects who screened negative (“normal”) were examined; nearly half of these had 2+ lines of visual acuity improvement with refraction (from 20/40 or 20/32 to 20/20). Sensitivity for detecting specific eye conditions varied substantially, ranging from 0–83% for individual screening questions. Time since last exam and distance acuity <20/50 were the most sensitive questions for visually significant cataract; however, their specificity was low. No combination of questions and acuity testing had both high sensitivity and specificity.

Conclusions: Vision problems requiring intervention were common among this relatively young population, but no combination of screening questions and vision testing proved effective for screening. More than half of those who screened positive never showed for an examination, indicating that on-site eye exams might be more effective.     

Screening for amblyopia in preschool children: Results of a population-based,randomised controlled trial

INTRODUCTION The rationale for preschool vision screening programmes has recently been questioned. Evidence about the effects of early treatment is needed, but it is not known how early the target conditions can reliably be detected. In this study, an intensive programme comprising several different screening methods, used at different ages up to 37 months, was compared with the usual practice of visual surveillance and ad hoc referrals.

METHODS Two groups were randomly selected from children in a population birth cohort study. The control group (n = 1461) received visual surveillance only. The intervention group (n = 2029) was offered in addition a programme of regular visual assessments by orthoptists testing visual acuity, ocular alignment, stereopsis and non-cycloplegic photorefraction.

RESULTS The intervention group programme yielded more children with amblyopia (1.6% vs. 0.5%, p < 0.01), and was more specific (95% vs. 92%, p < 0.01), than the control programme. The individual components of the intervention programme were compared. The cover test and visual acuity tests were poorly sensitive until the children were 37 months, but were always >99% specific. Photorefraction was more sensitive than acuity testing at all ages below 37 months, with specificity >95% at 31 and 37 months.

CONCLUSIONS Photorefraction would have detected more children less than 37 months of age with straight-eyed amblyopia than did visual acuity testing, but with more false positives. At 37 months, photore-fraction plus a cover test would have been comparable in effectiveness to visual acuity testing plus a cover test.     

The Handan Eye Study: Comparison of Screening Methods for Primary Angle Closure Suspects in a Rural Chinese Population

Objective: To evaluate the van Herick test, anterior segment optical coherence tomography (AS-OCT), Pentacam and scanning peripheral anterior chamber depth analyzer (SPAC) for detecting primary angle-closure suspect (PACS) in a rural Chinese population.

Methods: Eligible subjects aged ≥40 years were examined at the 5-year follow-up of the Handan Eye Study. PACS was defined as non-visibility of the posterior pigmented trabecular meshwork for ≥180° of the angle. Sensitivity, specificity, predictive values and receiver operating characteristic curves were used to assess the tests.

Results: A total of 425 right eyes of 431 eligible subjects were analyzed. The area under the curve (AUC) for the van Herick test and AS-OCT were 0.711 and 0.799, respectively. The AUC for Pentacam anterior chamber depth was 0.834, while anterior chamber angle and anterior chamber volume had AUCs of 0.680 and 0.800, respectively. The AUC for SPAC was 0.779. AS-OCT had a specificity of 87% with a sensitivity of 73%. The best specificity of 92% (sensitivity 19%) was achieved by the van Herrick test at the 15% cut-off.

Conclusions: None of the tests evaluated achieved the combination of specificity and sensitivity needed for population-based screening and their current capability does not realize the objective of case detection in the setting of an ophthalmology clinic.     

A Randomised Controlled Trial of Treatment for Post-Stroke Homonymous Hemianopia: Screening and Recruitment

The authors report the screening process and recruitment figures for the VISION (Visual Impairment in Stroke; Intervention Or Not) trial. This is a prospective, randomised, single-blinded, three-arm controlled trial in 14 UK acute hospital stroke units. Stroke teams identified stroke survivors suspected as having homonymous hemianopia. Interventions included Fresnel prisms versus visual search training versus standard care (information only). Primary outcome was change in visual field assessment from baseline to 26 weeks. Secondary measures included change in quality-of-life questionnaires. Recruitment opened in May 2011. A total of 1171 patients were screened by the local principal investigators. Of 1171 patients, 178 (15.2%) were eligible for recruitment: 87 patients (7.4%) provided consent and were recruited; 91 patients (7.8%) did not provide consent, and 993 of 1171 patients (84.8%) failed to meet the eligibility criteria. Almost half were excluded due to complete/partial recovery of hemianopia (43.6%; n = 511). The most common ineligibility reason was recovery of hemianopia. When designing future trials in this area, changes in eligibility criteria/outcome selection to allow more patients to be recruited should be considered, e.g., less stringent levels of visual acuity/refractive error. Alternative outcomes measurable in the home environment, rather than requiring hospital attendance for follow-up, could facilitate increased recruitment.     

Barriers for Poor Cataract Surgery Uptake among Patients with Operable Cataract in a Program of Outreach Screening and Low-cost Surgery in Rural China

Aims: To identify the reasons for poor uptake of cataract surgery in a program of outreach screening and low-cost surgery in Pucheng County, a rural area in northwestern China.

Methods: Detailed interviews with a semi-structured questionnaire were conducted by telephone or face-to-face for participants who had been advised to attend a low-cost cataract surgery program but did not schedule the surgery within 3 months after the initial screening.

Results: Among 432 eligible subjects, 355 (82.2%) were interviewed (mean age 70.6?±?6.6 years, 73.8% female). A total of 138 subjects (38.9%) were interviewed by phone and 217 (61.1%) were interviewed face-to-face. Lack of family support (n?=?106, 29.9%) and failure to understand the need for surgery (n?=?96, 27.0%) were the two main reasons for not undergoing cataract surgery. Other factors included fear of surgery (n?=?62, 17.5%), lack of faith in doctors (n?=?36, 10.1%), financial constraints (n?=?25, 7.0%) and lack of transportation (n?=?4, 1.1%).

Conclusion: The principal barriers to low-cost cataract surgery uptake in rural China included lack of family support and failure to understand the need for surgery. Education targeting entire families to eliminate these barriers and development of community support systems at the family level are required to achieve greater uptake of low-cost cataract surgery programs in rural China.     

首选青光眼引流装置植入术与小梁切除术治疗青光眼疗效及术后并发症差异的荟萃分析

目的 评价首选青光眼引流装置（GDD）植入术与小梁切除术治疗青光眼的疗效及术后并发症的差异.设计系统综述.研究对象国内外于1966年至2009年发表与未发表的以青光眼患者作为研究对象,治疗方案采用GDD植入术与小梁切除术相比较的所有临床对照研究.方法 采用Cochrane系统评价方法,检索Medline（1966～2009）、Embase（1966～2009）、Cochrane图书馆（2009）及中国生物医学文献数据库CBM（1979～2009）,按照纳入和排除标准收集所有相关临床对照研究,通过Jadad评分量表进行文献质量评估后,使用Cochrare协作网提供的RevMan4.2统计软件进行Meta分析,以获得GDD植入术与小梁切除术治疗青光眼患者的疗效及术后并发症是否存在差异的相关证据.主要指标不同研究中眼压降低、最佳矫正视力和术后并发症发生的组间差异.结果 共纳入GDD植入术与小梁切除术治疗青光眼的临床对照研究8项,共计877眼.Meta分析结果显示,GDD植入术治疗青光眼在降低眼压、维持最佳矫正视力方面,与联合抗代谢药物的小梁切除术治疗组间的差异没有统计学意义（P〉0.05）.各研究中随访期间两组间并发症和不良事件的发生分别为20.2%（GDD植入术组）和22.1%（小梁切除术组）,两组间差异无统计学意义（P〉0.05）.结论 首选GDD植入术治疗青光眼与小梁切除术相比疗效相仿、术后并发症发生率近似,两术式间在疗效和安全性方面未见明显差异.